Targets and self monitoring in hypertension: randomised controlled trial and cost effectiveness analysis

Objectives: To assess whether blood pressure control in primary care could be improved with the use of patient held targets and self monitoring in a practice setting, and to assess the impact of these on health behaviours, anxiety, prescribed antihypertensive drugs, patients’ preferences, and costs. \ud Design: Randomised controlled trial. \ud Setting: Eight general practices in south Birmingham. \ud Participants: 441 people receiving treatment in primary care for hypertension but not controlled below the target of < 140/85 mm Hg. \ud Interventions: Patients in the intervention group received treatment targets along with facilities to measure their own blood pressure at their general practice; they were also asked to visit their general practitioner or practice nurse if their blood pressure was repeatedly above the target level. Patients in the control group received usual care (blood pressure monitoring by their practice). \ud Main outcome measures: Primary outcome: change in systolic blood pressure at six months and one year in both intervention and control groups. Secondary outcomes: change in health behaviours, anxiety, prescribed antihypertensive drugs, patients’ preferences of method of blood pressure monitoring, and costs. \ud Results: 400 (91%) patients attended follow up at one year. Systolic blood pressure in the intervention group had significantly reduced after six months (mean difference 4.3 mm Hg (95% confidence interval 0.8 mm Hg to 7.9 mm Hg)) but not after one year (mean difference 2.7 mm Hg (-1.2 mm Hg to 6.6 mm Hg)). No overall difference was found in diastolic blood pressure, anxiety, health behaviours, or number of prescribed drugs. Patients who self monitored lost more weight than controls (as evidenced by a drop in body mass index), rated self monitoring above monitoring by a doctor or nurse, and consulted less often. Overall, self monitoring did not cost significantly more than usual care (£251 ($437; 364 euros) (95% confidence interval £233 to £275) versus £240 (£217 to £263). \ud Conclusions: Practice based self monitoring resulted in small but significant improvements of blood pressure at six months, which were not sustained after a year. Self monitoring was well received by patients, anxiety did not increase, and there was no appreciable additional cost. Practice based self monitoring is feasible and results in blood pressure control that is similar to that in usual care. \u

Evaluating Effects of H2O and overhead O3 on Global Mean Tropospheric OH Concentration

The oxidizing capacity of the troposphere is controlled, to a large extent, by the abundance of hydroxyl radical (OH). The global mean concentration of OH, [OH]GLOBAL, inferred from measurements of methyl chloroform, has remained relatively constant during the past several decades, despite rising levels of CH4 that should have led to a steady decline. Here we examine other factors that may have affected [OH]GLOBAL, such as the overhead burden of stratospheric O3 and tropospheric H2O, using global OH fields from the GEOS-CHEM Chemistry-Climate Model. Our analysis suggests these factors may have contributed a positive trend to [OH]GLOBAL large enough to counter the decrease due to CH4

Effective T-odd P-even hadronic interactions from quark models

Tests of time reversal symmetry at low and medium energies may be analyzed in the framework of effective hadronic interactions. Here, we consider the quark structure of hadrons to make a connection to the more fundamental degrees of freedom. It turns out that for P-even T-odd interactions hadronic matrix elements evaluated in terms of quark models give rise to factors of 2 to 5. Also, it is possible to relate the strength of the anomalous part of the effective rho-type T-odd P-even tensor coupling to quark structure effects.Comment: 6 pages, 1 figure, RevTe

Model Analysis of Time Reversal Symmetry Test in the Caltech Fe-57 Gamma-Transition Experiment

The CALTECH gamma-transition experiment testing time reversal symmetry via the E2/M1 mulipole mixing ratio of the 122 keV gamma-line in Fe-57 has already been performed in 1977. Extending an earlier analysis in terms of an effective one-body potential, this experiment is now analyzed in terms of effective one boson exchange T-odd P-even nucleon nucleon potentials. Within the model space considered for the Fe-57 nucleus no contribution from isovector rho-type exchange is possible. The bound on the coupling strength phi_A from effective short range axial-vector type exchange induced by the experimental bound on sin(eta) leads to phi_A < 10^{-2}.Comment: 5 pages, RevTex 3.

Observing the First Stars and Black Holes

The high sensitivity of JWST will open a new window on the end of the cosmological dark ages. Small stellar clusters, with a stellar mass of several 10^6 M_sun, and low-mass black holes (BHs), with a mass of several 10^5 M_sun should be directly detectable out to redshift z=10, and individual supernovae (SNe) and gamma ray burst (GRB) afterglows are bright enough to be visible beyond this redshift. Dense primordial gas, in the process of collapsing from large scales to form protogalaxies, may also be possible to image through diffuse recombination line emission, possibly even before stars or BHs are formed. In this article, I discuss the key physical processes that are expected to have determined the sizes of the first star-clusters and black holes, and the prospect of studying these objects by direct detections with JWST and with other instruments. The direct light emitted by the very first stellar clusters and intermediate-mass black holes at z>10 will likely fall below JWST's detection threshold. However, JWST could reveal a decline at the faint-end of the high-redshift luminosity function, and thereby shed light on radiative and other feedback effects that operate at these early epochs. JWST will also have the sensitivity to detect individual SNe from beyond z=10. In a dedicated survey lasting for several weeks, thousands of SNe could be detected at z>6, with a redshift distribution extending to the formation of the very first stars at z>15. Using these SNe as tracers may be the only method to map out the earliest stages of the cosmic star-formation history. Finally, we point out that studying the earliest objects at high redshift will also offer a new window on the primordial power spectrum, on 100 times smaller scales than probed by current large-scale structure data.Comment: Invited contribution to "Astrophysics in the Next Decade: JWST and Concurrent Facilities", Astrophysics & Space Science Library, Eds. H. Thronson, A. Tielens, M. Stiavelli, Springer: Dordrecht (2008

Baryons: What, When and Where?

We review the current state of empirical knowledge of the total budget of baryonic matter in the Universe as observed since the epoch of reionization. Our summary examines on three milestone redshifts since the reionization of H in the IGM, z = 3, 1, and 0, with emphasis on the endpoints. We review the observational techniques used to discover and characterize the phases of baryons. In the spirit of the meeting, the level is aimed at a diverse and non-expert audience and additional attention is given to describe how space missions expected to launch within the next decade will impact this scientific field.Comment: Proceedings Review for "Astrophysics in the Next Decade: JWST and Concurrent Facilities", ed. X. Tielens, 38 pages, 10 color figures. Revised to address comments from the communit

The MeerKAT Fornax Survey. I. Survey description and first evidence of ram pressure in the Fornax galaxy cluster

The MeerKAT Fornax Survey maps the distribution and kinematics of atomic neutral hydrogen gas (HI) in the nearby Fornax galaxy cluster using the MeerKAT telescope. The 12 deg^2 survey footprint covers the central region of the cluster out to ~ Rvir and stretches out to ~ 2 Rvir towards south west to include the NGC 1316 galaxy group. The HI column density sensitivity (3 sigma over 25 km/s) ranges from 5e+19/cm^2 at a resolution of ~ 10" (~ 1 kpc at the 20 Mpc distance of Fornax) down to ~ 1e+18/cm^2 at ~ 1' (~ 6 kpc), and slightly below this level at the lowest resolution of ~ 100" (~ 10 kpc). The HI mass sensitivity (3 sigma over 50 km/s) is 6e+5 Msun. The HI velocity resolution is 1.4 km/s. In this paper we describe the survey design and HI data processing, and we present a sample of six galaxies with long, one-sided, star-less HI tails (of which only one was previously known) radially oriented within the cluster and with measurable internal velocity gradients. We argue that the joint properties of the HI tails represent the first unambiguous evidence of ram pressure shaping the distribution of HI in the Fornax cluster. The disturbed optical morphology of all host galaxies supports the idea that the tails consist of HI initially pulled out of the galaxies' stellar body by tidal forces. Ram pressure was then able to further displace the weakly bound HI and give the tails their present direction, length and velocity gradient.Comment: Astronomy & Astrophysics, accepted. Data available at the MeerKAT Fornax Survey website https://sites.google.com/inaf.it/meerkatfornaxsurve

Diving into the vertical dimension of elasmobranch movement ecology

Knowledge of the three-dimensional movement patterns of elasmobranchs is vital to understand their ecological roles and exposure to anthropogenic pressures. To date, comparative studies among species at global scales have mostly focused on horizontal movements. Our study addresses the knowledge gap of vertical movements by compiling the first global synthesis of vertical habitat use by elasmobranchs from data obtained by deployment of 989 biotelemetry tags on 38 elasmobranch species. Elasmobranchs displayed high intra- and interspecific variability in vertical movement patterns. Substantial vertical overlap was observed for many epipelagic elasmobranchs, indicating an increased likelihood to display spatial overlap, biologically interact, and share similar risk to anthropogenic threats that vary on a vertical gradient. We highlight the critical next steps toward incorporating vertical movement into global management and monitoring strategies for elasmobranchs, emphasizing the need to address geographic and taxonomic biases in deployments and to concurrently consider both horizontal and vertical movements

Modeling Host Genetic Regulation of Influenza Pathogenesis in the Collaborative Cross

Genetic variation contributes to host responses and outcomes following infection by influenza A virus or other viral infections. Yet narrow windows of disease symptoms and confounding environmental factors have made it difficult to identify polymorphic genes that contribute to differential disease outcomes in human populations. Therefore, to control for these confounding environmental variables in a system that models the levels of genetic diversity found in outbred populations such as humans, we used incipient lines of the highly genetically diverse Collaborative Cross (CC) recombinant inbred (RI) panel (the pre-CC population) to study how genetic variation impacts influenza associated disease across a genetically diverse population. A wide range of variation in influenza disease related phenotypes including virus replication, virus-induced inflammation, and weight loss was observed. Many of the disease associated phenotypes were correlated, with viral replication and virus-induced inflammation being predictors of virus-induced weight loss. Despite these correlations, pre-CC mice with unique and novel disease phenotype combinations were observed. We also identified sets of transcripts (modules) that were correlated with aspects of disease. In order to identify how host genetic polymorphisms contribute to the observed variation in disease, we conducted quantitative trait loci (QTL) mapping. We identified several QTL contributing to specific aspects of the host response including virus-induced weight loss, titer, pulmonary edema, neutrophil recruitment to the airways, and transcriptional expression. Existing whole-genome sequence data was applied to identify high priority candidate genes within QTL regions. A key host response QTL was located at the site of the known anti-influenza Mx1 gene. We sequenced the coding regions of Mx1 in the eight CC founder strains, and identified a novel Mx1 allele that showed reduced ability to inhibit viral replication, while maintaining protection from weight loss

Age at first birth in women is genetically associated with increased risk of schizophrenia

Prof. Paunio on PGC:n jäsenPrevious studies have shown an increased risk for mental health problems in children born to both younger and older parents compared to children of average-aged parents. We previously used a novel design to reveal a latent mechanism of genetic association between schizophrenia and age at first birth in women (AFB). Here, we use independent data from the UK Biobank (N = 38,892) to replicate the finding of an association between predicted genetic risk of schizophrenia and AFB in women, and to estimate the genetic correlation between schizophrenia and AFB in women stratified into younger and older groups. We find evidence for an association between predicted genetic risk of schizophrenia and AFB in women (P-value = 1.12E-05), and we show genetic heterogeneity between younger and older AFB groups (P-value = 3.45E-03). The genetic correlation between schizophrenia and AFB in the younger AFB group is -0.16 (SE = 0.04) while that between schizophrenia and AFB in the older AFB group is 0.14 (SE = 0.08). Our results suggest that early, and perhaps also late, age at first birth in women is associated with increased genetic risk for schizophrenia in the UK Biobank sample. These findings contribute new insights into factors contributing to the complex bio-social risk architecture underpinning the association between parental age and offspring mental health.Peer reviewe