The implementation of a translational study involving a primary care based behavioral program to improve blood pressure control: The HTN-IMPROVE study protocol (01295)

<p>Abstract</p> <p>Background</p> <p>Despite the impact of hypertension and widely accepted target values for blood pressure (BP), interventions to improve BP control have had limited success.</p> <p>Objectives</p> <p>We describe the design of a 'translational' study that examines the implementation, impact, sustainability, and cost of an evidence-based nurse-delivered tailored behavioral self-management intervention to improve BP control as it moves from a research context to healthcare delivery. The study addresses four specific aims: assess the implementation of an evidence-based behavioral self-management intervention to improve BP levels; evaluate the clinical impact of the intervention as it is implemented; assess organizational factors associated with the sustainability of the intervention; and assess the cost of implementing and sustaining the intervention.</p> <p>Methods</p> <p>The project involves three geographically diverse VA intervention facilities and nine control sites. We first conduct an evaluation of barriers and facilitators for implementing the intervention at intervention sites. We examine the impact of the intervention by comparing 12-month pre/post changes in BP control between patients in intervention sites versus patients in the matched control sites. Next, we examine the sustainability of the intervention and organizational factors facilitating or hindering the sustained implementation. Finally, we examine the costs of intervention implementation. Key outcomes are acceptability and costs of the program, as well as changes in BP. Outcomes will be assessed using mixed methods (<it>e.g</it>., qualitative analyses--pattern matching; quantitative methods--linear mixed models).</p> <p>Discussion</p> <p>The study results will provide information about the challenges and costs to implement and sustain the intervention, and what clinical impact can be expected.</p

The heart healthy lenoir project-an intervention to reduce disparities in hypertension control: study protocol

Background Racial disparities in blood pressure control are well established; however the impact of low health literacy (LHL) on blood pressure has garnered less attention. Office based interventions that are created with iterative patient, practice and community stakeholder input and are rolled out incrementally, may help address these disparities in hypertension control. This paper describes our study protocol. Methods/design Using a community based participatory research (CBPR) approach, we designed and implemented a cohort study that includes both a practice level and patient level intervention to enhance the care and support of patients with hypertension in primary care practices in a rural region of eastern North Carolina. The study is divided into a formative phase and an ongoing 2.5 year implementation phase. Our main care enhancement activities include the integration of a community health coach, using home blood pressure monitoring in clinical decision making, standardizing care delivery processes, and working to improve medication adherence. Main outcomes include overall blood pressure change, the differential change in blood pressure by race (African American vs. White) and health literacy level (low vs. higher health literacy). Discussion Using a community based participatory approach in primary care practice settings has helped to engage patients and practice staff and providers in the research effort and in making practice changes to support hypertension care. Practices have engaged at varying levels, but progress has been made in implementing and iteratively improving upon the interventions to date

An empirical analysis of patents flows and R&D flows around the world

In this article, we empirically investigate the effect of Research and Development (R&amp;D) flows on patent flows around the world. We do this using an unbalanced panel consisting primarily of Organization for Economic Co-operation and Development (OECD) countries that have both patent and R&amp;D expenditure information broken down by domestic and foreign sources. Our analysis shows that even among a fairly homogeneous group of countries, the sources of patents and R&amp;D differ substantially. Using a dynamic panel framework, we find that domestic R&amp;D per capita increases domestic patents per capita only for the European Patent Convention (EPC) countries that already have a decentralized approach to innovation. Foreign R&amp;D per capita increases foreign patents per capita in all countries even though foreign R&amp;D constitutes a very small fraction of total R&amp;D. We find that some of these differences can be attributed to the locations of the patent applications, including those to the European Patent Office (EPO), United States Patent and Trademark Office (USPTO) and triadic patent applications to the EPO, USPTO and Japan Patent Office (JPO) simultaneously

Development and Flight Testing of a Neural Network Based Flight Control System on the NF-15B Aircraft

The Intelligent Flight Control System (IFCS) project at the NASA Dryden Flight Research Center, Edwards AFB, CA, has been investigating the use of neural network based adaptive control on a unique NF-15B test aircraft. The IFCS neural network is a software processor that stores measured aircraft response information to dynamically alter flight control gains. In 2006, the neural network was engaged and allowed to learn in real time to dynamically alter the aircraft handling qualities characteristics in the presence of actual aerodynamic failure conditions injected into the aircraft through the flight control system. The use of neural network and similar adaptive technologies in the design of highly fault and damage tolerant flight control systems shows promise in making future aircraft far more survivable than current technology allows. This paper will present the results of the IFCS flight test program conducted at the NASA Dryden Flight Research Center in 2006, with emphasis on challenges encountered and lessons learned

Built Environment and Its Influences on Walking among Older Women: Use of Standardized Geographic Units to Define Urban Forms

Consensus is lacking on specific and policy-relevant measures of neighborhood attributes that may affect health outcomes. To address this limitation, we created small standardized geographic units measuring the transit, commercial, and park area access, intersection, and population density for the Portland, Oregon metropolitan area. Cluster analysis was used to identify six unique urban forms: central city, city periphery, suburb, urban fringe with poor commercial access, urban fringe with pool park access, and satellite city. The urban form information was linkable to the detailed physical activity, health, and socio-demographic data of 2,005 older women without the use of administrative boundaries. Evaluation of the relationship between urban forms and walking behavior indicates that older women residing in city center were more likely to walk than those living in city periphery, suburb communities, and urban fringe with poor commercial access; however, these women were not significantly more likely to walk compared to those residing in urban fringe with poor park access or satellite city. Utility of small standardized geographic units and clusters to measure and define built environment support research investigating the impact of built environment and health. The findings may inform environmental/policy interventions that shape communities and promote active living

PRIVATE SAVINGS IN TRANSITION ECONOMIES: ARE THERE TERMS OF TRADE SHOCKS?

The paper examines the impact of terms of trade shocks on private savings in the transition economies after accounting for the effect of other determinants. Economic agents in the transition economies are subject to tight credit constraints which are more pronounced during bad state of nature. Thus, adverse shocks to commodity prices in the world market can force them to reduce savings by a larger amount than they would otherwise have. Empirical analysis using a dynamic panel model and data from twenty one transition economies confirm that most of the determinants of savings identified in the literature also apply to the transition economies. Favorable movements in both the permanent and transitory components of the terms of trade have a significant positive impact on private savings with transitory movements having a larger impact than the permanent component. This reflects the lack of access to foreign borrowing that many of the transition economies have faced during the last decade. Although the impact of terms of trade shocks are found to be asymmetric, the magnitude of the impact appears to be small. The results are robust for alternative estimators, determinants, and country groupings.http://deepblue.lib.umich.edu/bitstream/2027.42/39958/3/wp572.pd

A comparison of host gene expression signatures associated with infection in vitro by the Makona and Ecran (Mayinga) variants of Ebola virus

The Ebola virus (EBOV) variant Makona (which emerged in 2013) was the causative agent of the largest outbreak of Ebola Virus Disease recorded. Differences in virus-host interactions between viral variants have potential consequences for transmission, disease severity and mortality. A detailed profile of the cellular changes induced by the Makona variant compared with other Ebola virus variants was lacking. In this study, A549 cells, a human cell line with a robust innate response, were infected with the Makona variant or with the Ecran variant originating from the 1976 outbreak in Central Africa. The abundance of viral and cellular mRNA transcripts was profiled using RNASeq and differential gene expression analysis performed. Differences in effects of each virus on the expression of interferon-stimulated genes were also investigated in A549 NPro cells where the type 1 interferon response had been attenuated. Cellular transcriptomic changes were compared with those induced by human respiratory syncytial virus (HRSV), a virus with a similar genome organisation and replication strategy to EBOV. Pathway and gene ontology analysis revealed differential expression of functionally important genes; including genes involved in the inflammatory response, cell proliferation, leukocyte extravasation and cholesterol biosynthesis. Whilst there was overlap with HRSV, there was unique commonality to the EBOV variants

Unsettling Appearances: Diane Arbus, Erving Goffman and the Sociological Eye

Both the photographer Diane Arbus and sociologist Erving Goffman were fascinated by the way we present ourselves to others and this paper sets out how each understood the drama of human interaction. It begins by exploring how their work parallels some developments in the sociology of deviance, and notes how Goffman was one of the earliest critics of this field, before briefly sketching out Arbus’s controversial career and then turning to a more detailed look at three of her images. It concentrates on how the gap between intention and effect, or what Goffman terms the difference between the impressions we ‘give’ and those we actually ‘give off’, are at the core of her work and this sociological insight animates her compositions. The paper then describes how their work unsettles ‘normal appearances’ and provides rich resources for understanding human conduct

Policy as a Crime Scene

This paper explores how policy constructs the objects it seeks to regulate, taking as its case the setting of penal policy in contemporary Scotland. It employs two distinctive theoretical frames to develop the analysis: Science and Technology Studies (STS) and ‘scene theory’ a body of work in cultural studies. These offer distinctive lenses that bring into focus how the technologies of policy – statistical reports, independent Commissions, research advice – help produce populations that require intervention. The penal policy setting in question, we argue, can be understood in the same way as a crime scene, where investigators must re-construct forensically a narrative that will be legally validated. In line with the theme of this book, it offers a reflexive account of how researchers themselves are drawn into and participate as key witnesses in the scene, testifying to ‘facts’ about a crime that may have never taken place. The article aims to make the case for the potential of STS and scene theory in producing insights about our understanding of policy, particularly criminal justice policy. In doing this, it also offers a critique of the formation of the criminological discipline in a way that has side-lined policy as an ‘administrative’ rather than critical intellectual issue