Lifestyle Interventions for the Management of Hypertension in Adults: A Review of Reviews

Introduction: Hypertension is the most pervasive health concern in the U.S. with an estimated prevalence of 29.1–32.6%. Guidelines advise comprehensive treatment of hypertension that should include lifestyle changes. The objective of this review of reviews was to synthesize evidence on lifestyle interventions to reduce blood pressure in adults with essential hypertension and identify how race plays a role in determining which interventions are most effective. Methods: A systematic review of reviews was conducted in PubMed and CINAHL from January 2008 to October 2014 with the following search criteria: (1) major subject heading relating to the disease hypertension, (2) terms related to lifestyle and behavior modification interventions, and (3) systematic review or meta-analysis. Results: The literature search identified 652 citations, of which 10 met the selection criteria. These 10 reviews summarized evidence on 13 interventions that employed the following strategies: self-monitoring, professional support, education, diet, clinic reminders, problem solving, self-management, family involvement, or proactive delivery. The results demonstrated that although some individual strategies were successful in reducing blood pressure, combinations of strategies were the most successful. Discussion: Combinations of intervention strategies to reduce blood pressure are more successful than single strategies. No conclusions could be made about the differential effectiveness of based on race. Future studies need to evaluate which combinations of interventions are most successful to reduce blood pressure.Bachelor of Scienc

A Hybrid Implementation-Effectiveness Study of a Community Health Worker-Delivered Intervention to Reduce Cardiovascular Disease Risk in a Rural, Underserved Non-Hispanic Black Population: The CHANGE Study

Purpose To evaluate the implementation and effectiveness of the Carolina Heart Alliance Networking for Greater Equity (CHANGE) Program, an adapted evidence-based cardiovascular disease risk reduction intervention delivered by Community Health Workers (CHW) to rural adults. Design Hybrid implementation-effectiveness study with a pre–post design. Setting North Carolina Federally Qualified Health Center and local health department in a rural, medically underserved area. Sample Participants (n = 255) included 87% Non-Hispanic Black with a mean age of 57 years; 84% had diagnosed hypertension, 55% had diabetes, and 65% had hypercholesterolemia. Intervention A CHW-delivered, low-intensity, 4-month behavioral lifestyle intervention promoting a southern-style Mediterranean dietary pattern and physical activity. Measures We measured number and representativeness of participants reached and retained, intervention delivery fidelity, weight, blood pressure, and self-reported dietary and physical activity behaviors. Analysis Pre–post changes at 4 months were analyzed using paired t-tests. Results Study participants completed 90% of planned intervention contacts; 87% were retained. Intervention delivery fidelity measures showed participants receiving a mean of 3.5 counseling visits, 2.7 booster calls, and on average completing 1.7 modules, setting 1.8 goals, and receiving 1.3 referrals per visit. There were significant mean reductions in systolic (−2.5 mmHg, P < .05) and diastolic blood pressure (−2.1 mmHg, P < .01); the proportion of participants with systolic blood pressure <130 increased by 7 % points (P = .05), and diastolic pressure <80 by 9 percentage points (P < .01). Dietary behaviors improved significantly with average weekly servings of nuts increased by .5 serving (P < .0001), and fruits and vegetables by .8 daily serving (P < .0001). Physical activity also increased on average by 45 min./week (P < .001). Weight did not change significantly. Conclusions The CHANGE program showed both implementation and program effectiveness and adds to the evidence supporting CHW-delivered lifestyle interventions to reduce CVD risk among rural, Non-Hispanic Black, and medically underserved populations

Development of Modeling Approaches for Nuclear Thermal Propulsion Test Facilities

No abstract availabl

Mammography: EUSOBI recommendations for women’s information

This paper summarises the basic information to be offered to women who undergo mammography. After a delineation of the general aim of early diagnosis of breast cancer, the main difference between screening mammography and diagnostic mammography is explained. The best time for scheduling mammography in fertile women is defined. The need to bring images and reports from the previous mammogram (and from other recent breast imaging examinations) is highlighted. The technique and procedure of mammography are briefly described with particular attention to discomfort and pain experienced by a fraction of women who undergo the test. Information is given on the recall during a screening program and on the request for further work-up after a diagnostic mammography. The logic of the diagnostic mammography report and of classification systems such as BI-RADS and R1-R5 is illustrated, and brief but clear information is given about the diagnostic performance of the test, with particular reference to interval cancers. Moreover, the breast cancer risk due to radiation exposure from mammography is compared to the reduction in mortality obtained with the test, and the concept of overdiagnosis is presented. Finally, five frequently asked questions are answered

A Counterpart to the Radial Orbit Instability in Triaxial Stellar Systems

Self-consistent solutions for triaxial mass models are highly non-unique. In general, some of these solutions might be dynamically unstable, making them inappropriate as descriptions of steady-state galaxies. Here we demonstrate for the first time the existence in triaxial galaxy models of an instability similar to the radial-orbit instability of spherical models. The instability manifests itself when the number of box orbits, with predominantly radially motions, is sufficiently large. N-body simulations verify that the evolution is due neither to chaotic orbits nor to departures of the model from self-consistency, but rather to a collective mode. The instability transforms the triaxial model into a more prolate, but still triaxial, configuration. Stable triaxial models are obtained when the mass contribution of radial orbits is reduced. The implications of our results for the shapes of dark-matter halos are discussed.Comment: 14 pages, 16 figure

Quantifying the heart of darkness with GHALO - a multi-billion particle simulation of our galactic halo

We perform a series of simulations of a Galactic mass dark matter halo at different resolutions, our largest uses over three billion particles and has a mass resolution of 1000 M_sun. We quantify the structural properties of the inner dark matter distribution and study how they depend on numerical resolution. We can measure the density profile to a distance of 120 pc (0.05% of R_vir) where the logarithmic slope is -0.8 and -1.4 at (0.5% of R_vir). We propose a new two parameter fitting function that has a linearly varying logarithmic density gradient which fits the GHALO and VL2 density profiles extremely well. Convergence in the density profile and the halo shape scales as N^(-1/3), but the shape converges at a radius three times larger at which point the halo becomes more spherical due to numerical resolution. The six dimensional phase-space profile is dominated by the presence of the substructures and does not follow a power law, except in the smooth under-resolved inner few kpc.Comment: 6 pages, 4 figures, submitted to MNRAS Letters, for full sized images, see http://www.itp.uzh.ch/news.htm

Serving East African Bioethics information and education needs

Objective: To identify the challenges of supporting the information needs of students and researchers participating in an international research ethics education practicum and exchange between universities in Kenya and the United States. Methods: One component of a grant-funded international research ethics training partnership supports a six-week intensive practicum exchange program. Master's level students from Moi University, Eldoret, Kenya, travel to the Indiana University (IU) School of Medicine-Indianapolis. While at the IU School of Medicine, the Kenyan students use library services to prepare for a mentored research project. As an outcome of the project, students are expected to conduct an extensive literature search that will be used as a foundational component for a thesis that is completed in Kenya. An informationist is embedded in this program to support the information needs of faculty mentors and practicum students. This paper uses narrative reports and program evaluation data to identify the challenges of (1) providing information literacy education, (2) confronting resource inequities, and (3) supporting information needs across cultures and universities in two countries. Results: Two cohorts of Kenyan students completed this practicum. The program leaders and librarians continue to adapt the information skills sessions to meet student interests and needs. Teaching has been a challenge because students demonstrate a wide range of technical sophistication. Some have extensive computing experience, but others struggle with Internet navigation, account authentication, and common technology skills. In the second cohort, the students worked well in pairs to find relevant research ethics materials while using the university's information portals and subscription resources. In both cohorts, students expressed a desire for a slower instruction pace and for additional sessions. Students were frequent customers for reference support. Librarians observed a preference for print monographs. While confirming a need for both print and electronic resources, practicum students have initiated a small and growing library of print materials for bioethics research at Moi University. Conclusion: Teaching information skills to a small group of adult students with a wide range of educational experiences is a challenge when students are working in a new (information rich) environment. Student evaluations have expressed an appreciation for instruction customized to their interests and needs, a slow delivery style, and opportunities for one-to-one instruction

Astronomical X-Ray Optics Using Mono-Crystalline Silicon: High Resolution, Light Weight, and Low Cost

X-ray astronomy critically depends on X-ray optics. The capability of an X-ray telescope is largelydetermined by the point-spread function (PSF) and the photon-collection area of its mirrors, the same astelescopes in other wavelength bands. Since an X-ray telescope must be operated above the atmosphere inspace and that X-rays reflect only at grazing incidence, X-ray mirrors must be both lightweight and thin, bothof which add significant technical and engineering challenge to making an X-ray telescope. In this paper wereport our effort at NASA Goddard Space Flight Center (GSFC) of developing an approach to making an Xraymirror assembly that can be significantly better than the mirror assembly currently flying on the ChandraX-ray Observatory in each of the three aspects: PSF, effective area per unit mass, and production cost per uniteffective area. Our approach is based on the precision polishing of mono-crystalline silicon to fabricate thinand lightweight X-ray mirrors of the highest figure quality and micro-roughness, therefore, having thepotential of achieving diffraction-limited X-ray optics. When successfully developed, this approach will makeimplementable in the 2020s and 2030s many X-ray astronomical missions that are currently on the drawingboard, including sounding rocket flights such as OGRE, Explorer class missions such as STAR-X andFORCE, Probe class missions such as AXIS, TAP, and HEX-P, as well as large missions such as Lynx

Kinematic Alignment and Bonding of Silicon Mirrors for High-Resolution Astronomical X-Ray Optics

Optics for the next generation's high-resolution, high throughput x-ray telescope requires fabrication of well-formed lightweight mirror segments and their integration at arc-second precision. Recent advances in the fabrication of silicon mirrors developed at NASA/Goddard prompted us to develop a new method of mirror alignment and integration. In this method, stiff silicon mirrors are aligned quasi-kinematically and are bonded in an interlocking fashion to produce a "meta-shell" with large collective area. We address issues of aligning and bonding mirrors with this method and show a recent result of 4 seconds-of-arc for a single pair of mirrors tested at soft x-rays

Constraints on the shapes of galaxy dark matter haloes from weak gravitational lensing

We study the shapes of galaxy dark matter haloes by measuring the anisotropy of the weak gravitational lensing signal around galaxies in the second Red-sequence Cluster Survey (RCS2). We determine the average shear anisotropy within the virial radius for three lens samples: all galaxies with 19<m_r'<21.5, and the `red' and `blue' samples, whose lensing signals are dominated by massive low-redshift early-type and late-type galaxies, respectively. To study the environmental dependence of the lensing signal, we separate each lens sample into an isolated and clustered part and analyse them separately. We also measure the azimuthal dependence of the distribution of physically associated galaxies around the lens samples. We find that these satellites preferentially reside near the major axis of the lenses, and constrain the angle between the major axis of the lens and the average location of the satellites to =43.7 deg +/- 0.3 deg for the `all' lenses, =41.7 deg +/- 0.5 deg for the `red' lenses and =42.0 deg +/- 1.4 deg for the `blue' lenses. For the `all' sample, we find that the anisotropy of the galaxy-mass cross-correlation function =0.23 +/- 0.12, providing weak support for the view that the average galaxy is embedded in, and preferentially aligned with, a triaxial dark matter halo. Assuming an elliptical Navarro-Frenk-White (NFW) profile, we find that the ratio of the dark matter halo ellipticity and the galaxy ellipticity f_h=e_h/e_g=1.50+1.03-1.01, which for a mean lens ellipticity of 0.25 corresponds to a projected halo ellipticity of e_h=0.38+0.26-0.25 if the halo and the lens are perfectly aligned. For isolated galaxies of the `all' sample, the average shear anisotropy increases to =0.51+0.26-0.25 and f_h=4.73+2.17-2.05, whilst for clustered galaxies the signal is consistent with zero. (abridged)Comment: 28 pages, 23 figues, accepted for publication in A&