Impact of hypertension guideline implementation on blood pressure control and drug use in primary care clinics

BACKGROUND: A worsening of blood pressure control has occurred in the 1990s despite the availability of sophisticated technologic, pharmacologic, and educational advances applicable to hypertension care. Clinical guidelines that are intended to improve hypertension care by making specific recommendations on drug use, frequency of follow-up care, and target levels of blood pressure have been developed. METHODS: The Institute for Clinical Systems Integration's (ICSI's; Minneapolis) Hypertension Treatment Guideline was developed in 1994 and is updated annually. This study employed a quasi-experimental, before-and-after design at two medical groups to assess changes in the care provided to patients 18 years of age and older with identified hypertension (International Classification of Diseases-9 codes 401.0, 401.1, or 401.9). RESULTS: Among adults with hypertension, the proportion meeting the blood pressure goal of < 140/90 mm Hg increased from 36.8% (of 685 patients) preguideline to 50.3% (of 928 patients) postguideline (chi-square = 29.4, p < 0.001); the mean arterial pressure decreased from 102.7 mm Hg to 99.4 mm Hg (t = 5.45, p < 0.001). Cohort analysis of patients enrolled at both points in time confirmed these findings and showed an increase in the number of office visits from 5.4 to 6.7 visits per patient per year after guideline implementation (F = 10.9, p = 0.001). The use of a guideline-recommended medication for treatment of blood pressure was 35.9% preguideline and 36.2% postguideline. CONCLUSIONS: Implementation of a hypertension treatment guideline in primary care clinics was related to significantly improved hypertension control. Identification, tracking, and active outreach to patients with hypertension were used by all clinics.     

Neutron imaging studies of metal-hydride storage beds

Neutron radiography and tomography were used to study the transient and steady-state distributions, respectively, of hydrogen within a prototypical, LaNi_4.78Sn_0.22-based hydrogen-storage bed during and after various absorption and desorption steps. It was shown that using deuterium instead of hydrogen enabled the imaging of thicker beds. These measurements serve to demonstrate the unique utility of neutron imaging as an important diagnostic tool for in situ, real-time characterization of hydrogen-concentration profiles in practical hydrogen-storage systems.     

Cocaine improves inhibitory control in a human model of response conflict.

The present study was designed to test the acute effects of cocaine on behavioral control in the presence and absence of motivational conflict. Adults (N=14) with a history of stimulant use received oral cocaine hydrogen chloride (0, 100, 200, and 300 mg) and performed a cue-dependent go/no-go task to measure inhibitory and activational mechanisms of behavioral control either with or without motivated conflict between the inhibition and the activation of responses. Cocaine improved response inhibition in both conflict conditions, as evident by a decrease in inhibitory failures following active doses. The current study provides a useful model to investigate the effects of other drugs reported to have performance-enhancing effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adrenergic receptors in premenstrual dysphoric disorder: I. Platelet alpha 2 receptors: Gi protein coupling, phase of menstrual cycle, and prediction of luteal phase symptom severity

BACKGROUND: Abnormal alpha 2-adrenergic receptor (AR) function is implicated in anxiety and depressive disorders. Premenstrual dysphoric disorder (PMDD) is characterized by anxiety and depressive symptoms, which may be associated with changes in alpha 2AR function. Previous studies on alpha 2AR function during phases of the menstrual cycle in controls and PMDD patients are inconsistent. METHODS: alpha 2AR function was examined in 16 PMDD patients and 15 controls during the follicular phase, and in 10 PMDD patients during late luteal phase. Antagonist-measured maximum binding capacity, agonist-measured receptor density in high- and low-conformational states, and agonist affinity to both states were measured. Coupling efficiency to Gi protein was estimated. RESULTS: There were no significant differences in coupling efficiency. PMDD patients had significantly low antagonist affinity; there were no differences in other binding parameters. There were no changes in alpha 2AR binding parameters between phases of menstrual cycle in PMDD women. alpha 2AR density and symptom severity were inversely related during the follicular phase in controls and patients. During luteal phase, alpha 2AR density correlated positively with symptom severity in patients. High follicular alpha 2AR density predicted more severe luteal symptoms in PMDD patients. CONCLUSIONS: These findings are discussed in view of the molecular biology of alpha 2AR, and their role in PMDD, anxiety, and depressive disorders.     

Cytologic evaluation of bronchoalveolar lavage fluid from horses with recurrent airway obstruction after aerosol and parenteral administration of beclomethasone dipropionate and dexamethasone, respectively

OBJECTIVE: To determine cytologic changes in horses with recurrent airway obstruction (heaves) after administration of aerosolized beclomethasone dipropionate and dexamethasone parenterally. ANIMALS: 6 horses with inducible and reversible heaves. PROCEDURE: Episodes of heaves were induced by exposure to moldy hay and straw for 7 days. Horses were assigned to treatment groups (aerosolized beclomethasone, parenterally administered dexamethasone, aerosolized propellant), and pulmonary inflammation was evaluated by serial cytologic examination of bronchoalveolar lavage (BAL) fluid samples obtained on days 0, 7, 10, 14, and 21. Total and differential cell counting and phenotypic analysis of lymphocyte subpopulations in BAL fluid were performed. RESULTS: 7 days of natural challenge induced neutrophilic inflammation. Neutrophil counts in BAL fluid were reduced in beclomethasone- and dexamethasone-treated horses on days 10 and 14 but rebounded to pretreatment values on day 21. The proportion of proinflammatory lymphocyte subpopulations (CD4+ and B+) and MHC class-II antigen expression were increased on days 14 and 21 in propellant-treated horses, compared with beclomethasone- and dexamethasone-treated horses. CONCLUSIONS: Aerosolized beclomethasone attenuated neutrophilic pulmonary inflammation and prevented alteration in lymphocyte subpopulations in horses with heaves. Results were similar to the response associated with parenterally administered dexamethasone. Short-term administration of aerosolized beclomethasone without minimizing environmental allergen exposure is not expected to provide prolonged anti-inflammatory benefit for horses with heaves.     

Ring‐opening polymerization of epoxy end‐terminated poly(ethylene oxide) as a route to highly crosslinked materials with exceptional swelling behavior (II)

Highly swellable poly(ethylene oxide) (PEO) gels were prepared by anionic ring‐opening polymerization of diepoxy end‐capped PEO (3400 g mol^?1) and PEO (8000 g mol^?1) using dianionic glycerol and glycolic acid initiators at scales of up to 50 g diepoxide. The glycerol‐derived materials swell to almost 20 times their mass in water. The driving force for rapid swelling appears to arise during ‘crystallization’, as segments between crosslinks are forced to pack under conditions that create high‐energy domains within the material. Solvation and therefore swelling are driven by the release of the resulting packing energy. These observations may offer insight into methods for designing other highly swellable materials. When the polyfunctional initiators have groups with different reactivities (e.g. alkoxide versus carboxylate), as might be expected, the more nucleophilic functional group appears to dominate the ring‐opening polymerization process. Copyright © 2007 Society of Chemical Industry     

应急照明的分类及设计实践中的问题分析

文章就应急照明的电源、控制、应用场所等谈谈看法,并针对一些设计中存在的问题结合实际进行探讨。     

Immune therapy in respiratory disease

Pharmacologic manipulation of pulmonary immunity plays an important role in primary and adjunct therapy for equine respiratory disease. Frequent exposure to respiratory viral pathogens, strenuous exercise, long distance transport, and inhalation of harmful substances destroy various aspects of the pulmonary defense system and predispose performance horses to development of infectious and noninfectious respiratory disease. Pulmonary immunity may be bolstered by nonspecific immunostimulants to combat primary or secondary immunodeficiency. State of the art technology improves active and passive-specific immunity for prevention of common infectious respiratory diseases in horses. Immuno-suppressive therapy can attenuate hyperreactive pulmonary immune responses in horses with allergic airway disease.     

Nutritional alterations and the effect of fish oil supplementation in dogs with heart failure

Alterations in body composition and nutritional status are common in humans with heart failure and are related, in part, to increases in cytokine concentrations. Cytokines have not been studied previously in dogs with naturally occurring cardiac disease nor has fish oil administration been used in this population to decrease cytokine production. The purposes of this study were to characterize nutritional and cytokine alterations in dogs with heart failure and to test the ability of fish oil to reduce cytokines and improve clinical outcome. Body composition, insulinlike growth factor-1, fatty acids, and cytokines were measured in 28 dogs with heart failure and in 5 healthy controls. Dogs with heart failure then were randomized to receive either fish oil or placebo for 8 weeks. All parameters were measured again at the end of the study period. At baseline, 54% of dogs with heart failure were cachectic and the severity of cachexia correlated with circulating tumor necrosis factor-alpha concentrations (P = .05). Cytokine concentrations at baseline, however, were not significantly increased in dogs with heart failure compared to controls. Baseline plasma arachidonic acid (P = .02), eicosapentaenoic acid (P = .03), and docosahexaenoic acid (P = .004) concentrations were lower in dogs with heart failure than in controls. Fish oil supplementation decreased interleukin-1 beta (IL-1) concentrations (P = .02) and improved cachexia (P = .01) compared to the placebo group. The mean caloric intake of the heart failure dogs as a group was below the maintenance energy requirement (P < .001), but no difference was found in food intake between the fish oil and placebo groups. Insulinlike growth factor-1 concentrations (P = .01) and reductions in circulating IL-1 concentrations over the study period (P = .02) correlated with survival. These data demonstrate that canine heart failure is associated with cachexia, alterations in fatty acids, and reduced caloric intake. Fish oil supplementation decreased IL-1 concentrations and improved cachexia. In addition, reductions in IL-1 predicted survival, suggesting that anticytokine strategies may benefit patients with heart failure.