Reducing risk with e-based support for adherence to lifestyle change in hypertension (REACH): Protocol for a multicentred randomised controlled trial

Introduction: Web-based lifestyle counselling designed to improve adherence to self-management behaviours for diet, exercise and medication has been shown to reduce blood pressure (BP). However, the long-term clinical outcome of these interventions is not established. Our aim was to establish whether an e-counselling program is independently associated with improved clinical outcomes over a 12-month period, as defined by the following criteria: (1) reduction of systolic BP, diastolic BP, pulse pressure and associated risk factors for cardiovascular events; and (2) adherence to self-management behaviour (diet, exercise, smoke-free living and prescribed medication). Methods and analysis: Reducing risk with e-based support for adherence to lifestyle change in hypertension is a two-parallel group, double-blind randomised controlled trial that will utilise a two (Groups: e-counselling vs control) by three (assessment intervals: baseline, 4-month and 12-month outcome) design. BP, lipoprotein cholesterol, physical activity and dietary behaviours and psychological distress will be measured at each assessment. We plan to recruit 528 participants (35-74 years of age) diagnosed with stage 1 or 2 hypertension (systolic BP, 140-180 mm Hg; diastolic BP 90-110 mm Hg) from three major cities (Toronto, London, Vancouver) and one rural area (Grey Bruce region) across Canada between February 2012 and July 2015. Controls will receive general educational e-messages on heart healthy living and the e-counselling group will receive tailored e-messages that are matched to their stage of readiness for change. For both groups, e-messages will be sent proactively on a weekly basis during months 1-4, then bi-weekly during months 5-8 and then monthly during months 9-12. Ethics and dissemination: Ethical approval has been obtained from all recruitment sites. This will be one of the first studies to evaluate the long-term efficacy of preventive e-counselling strategies for cardiovascular disease prevention in patients with hypertension. Findings from this study will be used to guide the ongoing development of e-counselling services

Influence of the calcium concentration in the presence of organic phosphorus on the physicochemical compatibility and stability of all-in-one admixtures for neonatal use

<p>Abstract</p> <p>Background</p> <p>Preterm infants need high amounts of calcium and phosphorus for bone mineralization, which is difficult to obtain with parenteral feeding due to the low solubility of these salts. The objective of this study was to evaluate the physicochemical compatibility of high concentrations of calcium associated with organic phosphate and its influence on the stability of AIO admixtures for neonatal use.</p> <p>Methods</p> <p>Three TPN admixture formulas were prepared in multilayered bags. The calcium content of the admixtures was adjusted to 0, 46.5 or 93 mg/100 ml in the presence of a fixed organic phosphate concentration as well as lipids, amino acids, inorganic salts, glucose, vitamins and oligoelements at pH 5.5. Each admixture was stored at 4°C, 25°C or 37°C and evaluated over a period of 7 days. The physicochemical stability parameters evaluated were visual aspect, pH, sterility, osmolality, peroxide formation, precipitation, and the size of lipid globules.</p> <p>Results</p> <p>Color alterations occurred from the first day on, and reversible lipid film formation from the third day of study for the admixtures stored at 25°C and 37°C. According to the parameters evaluated, the admixtures were stable at 4°C; and none of them presented precipitated particles due to calcium/phosphate incompatibility or lipid globules larger than 5 μm, which is the main parameter currently used to evaluate lipid emulsion stability. The admixtures maintained low peroxide levels and osmolarity was appropriate for parenteral administration.</p> <p>Conclusion</p> <p>The total calcium and calcium/phosphorus ratios studied appeared not to influence the physicochemical compatibility and stability of AIO admixtures.</p

Transient Cholestasis in Newborn Infants with Perinatal Asphyxia

In asphyxiated newborn infants, cholestasis often leads to extensive investigations and a cause can rarely be found

The Pre-Alpine Basement of the Briançonnais (Wallis, Switzerland)

The basement lithostratigraphy within the Middle Penninic domain in Wallis, Switzerland (formerly the Grand St. Bernard nappe), is described in order to try to produce reconstruction of the pre-Alpine history. The combined effect of pervasive Alpine deformation and metamorphism (mainly Tertiary greenschist facies overprint) as well as the lack of biostratigraphic and radiometric data make this attempt difficult. Polymetamorphic basements, affected successively by pre-Alpine metamorphism(s) and by Alpine metamorphism, are distinguished from monometamorphic basements, that apparently were only subject to this latter disturbance. The Pontis and Siviez- Mischabel nappes comprise both poly- and mono-metamorphic units while the rocks of the "Zone Houillère" and the Mont Fort nappe do not seem to have suffered Pre-Alpine metamorphism. Upper Proterozoic to lower Palaeozoic(?) siliciclastic meta-sediments of the polymetamorphic basement form a thick coarse-grained series overlaid by a dominantly pelitic series. Carbonate rocks (skarns, marbles) do not exist. A wide variety of magmatites (calc-alkaline granitoids, pyroxenites, felsic and mafic volcanites) are presumed to have been generated in different geodynamic environments from upper Proterozoic to lower Palaeozoic time. Two metamorphic preserved windows allow a partial reconstitution of the pre-Alpine metamorphic history: (1) outcrops of eclogites and retroeclogites (Siviez-Mischabel nappe), usually associated with banded amphibolites, show HP mineral assemblages (pyrope-rich almandine and omphacite) which are overprinted by an amphibolite-facies event (syn- Variscan?); (2) the most internal part of the Ruitor zone (Pontis nappe) is essentially composed of garnet- staurolite micaschists and aluminum silicatebearing schists (andalusite-sillimanite). Textures and mineral chemistry support a possible evolution in staurolite-almandine subfacies and P-T estimates lead to a polyphase metamorphic trajectory, retrograde in pressure (10→2.5 kb) and thermally prograde (470→580 °C). Correlation with Variscan climax is likely, even if radiometric data is still lacking. Post-metamorphic late Carboniferous to Early Triassic fluviatil deposits form a thick sequence within the "Zone Houillère" and other parallel grabens(?). The most southern pull-apart(?) basin that is filled up with a thick volcano-sedimentary series (Carboniferous(?) Early Triassic) is largely incorporated into the Mont Fort nappe. Permian gabbros and subalkaline granitoids form sills and laccoliths intruding both poly- and mono-metamorphic basements. The major uncertainties still concern: (1) the precise age of all rocks and series, except those belonging to the "Zone Houillère"; (2) the initial nature of the polymetamorphic magmatites and the geodynamic context during their ascent; (3) the age and the geodynamic meaning of the different pre-Alpine metamorphic events (HP, HT), especially the age of Variscan(?) paroxysm (amphibolite-facies)

U-Pb isotopic ages of zircons from Precambrian rocks of South Greenland

Results of age determinations on zircons from samples of gneiss, granite, syenite and diorite from the Ketilidian mobile belt of South Greenland are presented. The lead isotopes were determined by a direct ionisation method. As three of the four zircon concentrates gave more or less discordant results, their interpretation is difficult. However, the data agree with the view that late Ketilidian granite emplacement took place roughly 1800 m.y. ago and not around 1600 m.y. age as the previously available K/Ar dates on pre-Gardar rocks seemed to indicate

Estimating Neonatal Oxygen Consumption from Heart Rate

ABSTRACT The relationship between heart rate (HR) and oxygen consumption (V̇o2) has been investigated in a sample of 20 low‐risk, term neonates aged 14–48 hrs. Repeated, simultaneous measurements of HR and V̇o2 were performed on each neonate during each of three epochs ordered by increasing level of activity. A robust linear relationship was found between HR and V̇o2, with an average correlation of.90. Substantial variation was observed across individuals in the slope of the HR‐V̇o2 regression line. This variation was curvilinearly related to ponderal index (PI), with low PI neonates having the shallowest and steepest slopes. These findings suggest that HR may provide a flexible, non‐restrictive means of estimating neonatal V̇o2 but that the impact of prenatal growth history and postnatal growth performance on the estimation of V̇o2 from HR merits further investigation