Adherence to pharmacologic management of hypertension

Adherence to pharmacologic therapy of hypertension is low (in the range of 50-70%) and has important implications both for blood pressure control and cardiovascular complications. Based on a review of the literature using the levels of evidence grading technique, determinants of adherence to the pharmacologic therapy of hypertension have been assessed. Additionally, interventions to improve compliance were evaluated. Patient-centred, health care provider-centred and drug-specific factors have all been shown to affect adherence rates. We conclude that the extent of adherence to pharmacologic therapy is modifiable. Measurable improvements in adherence can be obtained from simplified medication regimens and a combination of behaviour strategies, including the tailoring of pill-taking to patients' daily habits and rituals, the advocacy of self-monitoring of pills and blood pressure, and the institution of reward systems.     

Gastric mucosal biopsy via a nasogastric tube: a nonendoscopic method for diagnosing fundic and antral mucosal gastritis and Helicobacter pylori infection in man

Synthesis of poly(gamma-glutamate) metabolites of natural folates and antifolates is a critical process. Folypolyglutamates are essential for cell proliferation. Polyglutamates of glutamate (Glu)-containing antifolates are often critical for their cytotoxic action and are relevant to antifolate resistance. However, the role of polyglutamate synthesis in selectivity is less clear. We have undertaken a research program to further define the significance of polyglutamate metabolism and to devise ways to exploit this metabolism to achieve greater therapeutic selectivity in cancer chemotherapy. This article briefly reviews several approaches tested thus far. Inhibition of folypolyglutamate synthesis should lead to cell death. Current ornithine (Orn)-containing folate-based inhibitors of the enzyme responsible for their synthesis, folypolyglutamate synthetase (FPGS), are poorly transported, apparently because of interference by the protonated delta-amine. Replacement of Orn with 4, 4-difluoroOrn, the delta-amine of which has a much lower pKa and is thus less protonated at physiological pH, was explored. Since it is unclear how polyglutamylation contributes to selectivity, we explored generic means either to eliminate or to enhance polyglutamylation. The data indicate that substitution for Glu in an antifolate by some Glu analogs in which the gamma-COOH is either altered or replaced (e.g., gamma-tetrazole-Glu) leads to loss of both FPGS substrate activity and binding; antifolate target specificity is unchanged, while uptake is actually enhanced. Substitution of 3,3-difluoroGlu for Glu leads to enhanced polyglutamylation (although probably only to the diglutamate), retention of target specificity, and at least equal uptake. Comparative studies of the same antifolate containing different replacements for Glu, such as gamma-tetrazole-Glu (no polyglutamylation) or 3,3-difluoroGlu (enhanced polyglutamylation), will be useful in exploring the role and significance of polyglutamylation.     

Hidden-Action in Network Routing

In communication networks, such as the Internet or mobile ad-hoc networks, the actions taken by intermediate nodes or links are typically hidden from the communicating endpoints; all the endpoints can observe is whether or not the end-to-end transmission was successful. Therefore, in the absence of incentives to the contrary, rational (i.e., selfish) intermediaries may choose to forward messages at a low priority or simply not forward messages at all. Using a principal-agent model, we show how the hidden-action problem can be overcome through appropriate design of contracts in both the direct (the endpoints contract with each individual router directly) and the recursive (each router contracts with the next downstream router) cases. We further show that, depending on the network topology, per-hop or per-path monitoring may not necessarily improve the utility of the principal or the social welfare of the system.     

Flux Jumps and H-T Diagram of Instability for MgB2

We present a study of magneto-thermal instabilities in polycrystalline MgB₂ superconductor, by magnetic hysteresis loop measurements and by investigations of magnetic flux dynamics with a miniature Hall probe. Temperature and magnetic field ranges where the flux jumps may be observed have been determined. On the basis of measurements of the magnetic flux dynamics, an average magnetic diffusivity describing the process of the flux jump is estimated. This parameter is compared with the thermal and magnetic diffusivities calculated on the basis of available data for thermal conductivity, heat capacity and resistivity. It is shown that the estimated value of the field of the first flux jump is influenced significantly by the field dependence of specific heat. In order to explain the observed phenomenon, the temperature reached by the sample during the flux jump at different magnetic fields is calculated.     

Full scale thermal testing of latent heat storage in wallboard

Full scale thermal storage tests were conducted in a room lined with PCM wallboard having latent heat storage capacity. The results were compared with those obtained from tests conducted in a similar room lined with ordinary wallboard. The research showed that PCM wallboard can function efficiently as a thermal storage medium which can be applied to peak load shifting, improved use of waste and solar heat as well as more efficient operation of heating and cooling equipment.     

Differential effects of aging on directional and absolute errors in visuospatial memory.

Studied memory for visuospatial arrays in 28 male and 34 female healthy dextral adults (aged 20–90 yrs). 10 abstract figures were presented in each hemispace over a series of learning trials, and then delayed free recall of figure placement was obtained. Figures were misplaced significantly downward and leftward in both hemispaces. Both vertical and horizontal absolute error increased significanty with age, but no age effects on directional errors were observed. The increase in absolute error over age is consistent with decreased anterograde memory and visuospatial skills in the elderly. The directional errors are believed to result from an attentional shift toward proximal peripersonal space, in combination with attentional shifts from differential left vs right cerebral activation. Gender effects were also observed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A population study of the natural history of Wolff-Parkinson-White syndrome in Olmsted County, Minnesota, 1953-1989

BACKGROUND: Virtually all natural history studies of Wolff-Parkinson-White (WPW) syndrome have been case series and, as such, have been constrained by referral biases, skewed age and sex distributions, or brief follow-up periods. The purpose of our study was to examine the natural history, the development of arrhythmias, and the incidence of sudden death in an entire cohort of pediatric and adult WPW patients from a community-based local population. METHODS AND RESULTS: We identified 113 residents of Olmsted County, Minnesota, during the period 1953-1989 using the centralized records-linkage system provided by the Mayo Clinic and the Rochester Epidemiology Program Project. Medical records and ECGs were reviewed to confirm the diagnosis and to establish pathway location by ECG criteria. Follow-up, via record review and telephone interview, was complete in 95% of subjects through 1990. The incidence of newly diagnosed cases was approximately four per 100,000 per year. Preexcitation was not present on the initial ECG of 22% of the cohort. Approximately 50% of the population was asymptomatic at diagnosis, with 30% subsequently having symptoms related to arrhythmia at follow-up. Two sudden cardiac deaths (SCD) occurred over 1,338 patient-years of follow-up, yielding an overall SCD rate of 0.0015 (95% confidence interval, 0.0002-0.0054) per patient-year. No SCD occurred in patients asymptomatic at diagnosis. CONCLUSIONS: The incidence of sudden death in a local community-based population is low and suggests that electrophysiological testing should not be performed routinely in asymptomatic patients with WPW syndrome. Nevertheless, young, asymptomatic patients, particularly those < 40 years old, should return for medical follow-up should symptoms develop.