Virtual Nurse-Led Hypertension Management

Background: Hypertension (HTN) affects about 75 million adults in the United States. HTN significantly contributes to morbidity, mortality, and healthcare costs. In the U.S., only 50% of over 10 million young adults with HTN have optimal blood pressure (BP) control. According to the University of California (UC) Health Hypertension dashboard, the overall average for blood pressure control in 2024 was 71.5% for UC Los Angeles (UCLA) compared to the UC average of 72.5%. The management of HTN can reduce future healthcare costs, morbidity, and mortality. Evidence from several randomized controlled trials demonstrated that lowering bloodpressure can reduce cardiovascular disease risks. Purpose: The project aimed to assess the impact of virtual nurse-led HTN management incorporating home blood pressure (BP) monitoring and lifestyle modification education on BP control and self-care behavior over two months. Methods: The Doctor of Nursing Practice (DNP) student collaborated with the UCLA Department of Medicine (DOM) quality team and a primary care physician to co-lead a virtual nurse-led HTN management pilot study. The intervention included biweekly virtual/phone visits, lifestyle modification counseling, and home BP monitoring based on the American Heart Association (AHA) and American College of Cardiology (ACC) guidelines, utilizing motivational interviewing techniques. Ten adult primary care patients with a primary hypertension diagnosis were recruited through MyChart messaging and three outreach phone calls. Participants measured their BP at home and reported the readings every two weeks. The DNP student provided tailored feedback and counseling based on blood pressure readings and self-care behaviors. Participants completed a hypertension self-care profile survey during the initial and final virtual visits. Results: The baseline sample included 10 individuals with primary hypertension, who self-reported race as: African American (6), Black (2), and African (2). The mean age was 57.1 years, 80% of the participants were female, and 50% were married. Paired-samples t-tests were performed to evaluate the effectiveness of the virtual nurse-led hypertension management intervention in reducing blood pressure. Six paired comparisons were performed between pre- and post-intervention blood pressure measurements. The following statistically significant differences were identified: Pre and post morning (AM) and evening before supper (PM) systolic blood pressure (SBP): M difference = 9.63, t (8) = 2.47, p = .039, d = 0.824. Pre and post PM SBP M difference = 7.20, t (8) = 2.68, p = .028, d = 0.892. Pre and post average SBP: M difference = 8.47, t (8) = 3.10, p = .015, d = 1.033. These results demonstrate statistically significant reductions in systolic blood pressure post-intervention, with effect sizes ranging from medium to large. For diastolic measures, results were more mixed: Pre and post AM diastolic blood pressure (DBP): M difference = 6.04, t (8) = 2.00, p = .080, d = 0.743. Pre and post PM DBP: M difference = 2.99, t (8) = 1.77, p = .115, d = 0.590. Pre and post average DBP: M difference = 4.52, t (8) = 2.24, p = .055, d = 0.746. While none of the diastolic comparisons reached conventional significance (p < .05), the average diastolic reduction approached significance and showed a moderate effect size, further confirming the clinical significance of the intervention. The pre- and post-intervention self-care behavior was compared. Notable results include question one, self-care motivation to check blood pressure at home daily, which improved significantly (Wilcoxon, p = .006). Question four, reading nutrition facts labels for sodium content, showed a significant improvement (Wilcoxon p = .01). Question five, participating in regular exercise, and question eight, engaging in activities to lower stress, also demonstrated significant post-intervention improvements (p = .011 and p = .025, respectively). The post-intervention total self-care score increased significantly (p = .011). Questions Q2 (taking BP medication regularly), Q3 (Eating fruits & vegetables daily), Q6 (avoiding drinking), and Q7 you can(practicing non-smoking) did not reach statistical significance, although positive trends were observed. Participants also completed an end-of-intervention satisfaction survey with eight questions rated on a scale from -2 (Strongly Disagree) to 2 (Strongly Agree). The average score across all questions ranged from 1.7 to 2.0. Conclusions and Implications: This virtual nurse-led hypertension management pilot project, which integrated home blood pressure (BP) monitoring and lifestyle modification education counseling (awareness of sodium content, regular physical activity, stress management), enhanced BP and self-care behaviors, The intervention produced statistically significant reductions in systolic blood pressure and significant improvements in diastolic pressure among the participants. Effect sizes ranged from medium to large. For diastolic measures, results were more mixed: Pre and post AM diastolic blood pressure (DBP): M difference = 6.04, t (8) = 2.00, p = .080, d = 0.743. Pre and post PM DBP: M difference = 2.99, t (8) = 1.77, p = .115, d = 0.590. Pre and post average DBP: M difference = 4.52, t (8) = 2.24, p = .055, d = 0.746. While none of the diastolic comparisons reached conventional significance (p < .05), the average diastolic reduction approached significance and showed a moderate effect size, further confirming the clinical significance of the intervention. The pre- and post-intervention self-care behavior was compared. Notable results include question one, where self-care motivation to check blood pressure at home daily improved significantly (Wilcoxon, p = .006). Question four, reading nutrition facts labels for sodium content, showed a significant improvement (Wilcoxon p = .01). Question five, participating in regular exercise, and question eight, engaging in activities to lower stress, also demonstrated significant post-intervention improvements (p = .011 and p = .025, respectively). The post-intervention total self-care score increased significantly (p = .011). Questions Q2 (taking BP medication regularly), Q3 (Eating fruits & vegetables daily), Q6 (avoiding drinking), and Q7 you can(practicing non-smoking) did not reach statistical significance, although positive trends were observed. Participants also completed an end-of-intervention satisfaction survey with eight questions rated on a scale from -2 (Strongly Disagree) to 2 (Strongly Agree). The average score across all questions ranged from 1.7 to 2.0. Conclusions and Implications: This virtual nurse-led hypertension management pilot project, which integrated home blood pressure (BP) monitoring and lifestyle modification education counseling (awareness of sodium content, regular physical activity, stress management), enhanced BP and self-care behaviors, The intervention produced statistically significant reductions in systolic blood pressure and significant improvements in diastolic pressure among the participants. Effect sizes ranged from medium to large for changes in systolic blood pressure, and moderate for diastolic blood pressure, suggesting a meaningful clinical impact. These findings support the continued application and evaluation of similar interventions in broader populations to reduce cardiovascular risk through improved BP control. The pilot project presented a scalable and effective model for managing hypertension in primary care settings, examining its impact on both practice and research

Untimely Initiation of Whole Cow Milk, Stunting, and Related Factors in South Gondar, Ethiopia

Hiwot Yisak,1 Dejen Gedamu,2 Amien Ewunetei3 1Department of Nutrition, Debre Tabor University, Debre Tabor, Ethiopia; 2Department of Statistics, Debre Tabor University, Debre Tabor, Ethiopia; 3Department of Pharmacy, Debre Tabor University, Debre Tabor, EthiopiaCorrespondence: Hiwot Yisak, Email [email protected]: Despite being an excellent source of essential nutrients, whole cow’s milk poses risks for young children. This is mainly due to its association with adverse effects, including growth inhibition, delayed brain and motor development, and increased morbidity and mortality. The current study aimed to evaluate the occurrence of untimely introduction of whole cow milk, stunting and related factors among children below the age of 5 years.Methods: A community-centered survey was implemented on 806 mother–child matches. Expressive statistics such as frequency, magnitude, mean and standard deviation were computed. Multivariable logistic regression was done to discover independent determinants of the dependent variables. A p-value of < 0.05 was used to affirm significant association.Results: From the survey participant children 311 (39.2%) of them were stunted. About 453 (57.1%) of children were fed whole cow milk earlier than the age of one year. Mothers who are able to read and write were 49% less likely to initiate cow milk earlier than the age of one year with AOR = 0.51, 95% CI 0.33– 0.78. Not attending the growth monitoring and promotion service is a risk for untimely introduction of whole cow milk (AOR = 3.47, 95% CI 2.43– 4.94). Children who did not start consuming whole cow milk earlier than the age of one year were 54% less likely to be stunted than those who started consuming whole cow milk before the age of one year (AOR = 0.46, 95% CI 0.33– 0.65).Conclusion: More than half of the study participant children started consuming whole cow milk before the age of one year. Children who did not start consuming whole cow milk early were less likely to be stunted.Keywords: untimely initiation, whole cow milk, stunting, Ethiopi

Nanomechanics of individual aerographite tetrapods

R.A., O.L. and K.S. would like to thank the German Research Foundation (DFG) for the financial support under schemes AD 183/17-1 and SFB 986-TP-B1, respectively, and the Graphene FET Flagship. R.M. and D.E. would like to thank for financial support from Latvian Council of Science, no. 549/2012. N.M.P. is supported by the European Research Council (ERC PoC 2015 SILKENE no. 693670) and by the European Commission H2020 under the Graphene Flagship (WP14 ‘Polymer Composites’, no. 696656) and under the FET Proactive (‘Neurofibres’ no. 732344). S.S. acknowledges support from SILKENE

Skin color-specific and spectrally-selective naked-eye dosimetry of UVA, B and C radiations

Spectrally–selective monitoring of ultraviolet radiations (UVR) is of paramount importance across diverse fields, including effective monitoring of excessive solar exposure. Current UV sensors cannot differentiate between UVA, B, and C, each of which has a remarkably different impact on human health. Here we show spectrally selective colorimetric monitoring of UVR by developing a photoelectrochromic ink that consists of a multi-redox polyoxometalate and an e− donor. We combine this ink with simple components such as filter paper and transparency sheets to fabricate low-cost sensors that provide naked-eye monitoring of UVR, even at low doses typically encountered during solar exposure. Importantly, the diverse UV tolerance of different skin colors demands personalized sensors. In this spirit, we demonstrate the customized design of robust real-time solar UV dosimeters to meet the specific need of different skin phototypes. These spectrally–selective UV sensors offer remarkable potential in managing the impact of UVR in our day-to-day life

Risk factors for pressure injury development in critically ill patients in the intensive care unit: a systematic review protocol

BACKGROUND: Pressure injuries (PIs) create a significant burden in the health care system. Up to 49% of critically ill patients develop PIs. Identifying and understanding potential risk factors is essential to the provision of effective targeted prevention strategies to mitigate risk. The objectives of this review are to identify patient-centred clinical factors that may be associated with PI development in the adult intensive care environment and to determine the effect size of the relationship between identified factors and PI development in this unique population. METHOD/DESIGN: The review will follow the PRISMA reporting guidelines for systematic reviews. Electronic databases (Cochrane; PubMed/MEDLINE; CINAHL (EBSCOhost); Embase; Scopus; PsycINFO; Proquest; Networked Digital Library of Theses and Dissertations; Australian Digital Theses Program, Grey literature, Google scholar, and Clinical Trial Registries) will be systematically searched. A suite of search terms will identify articles that have examined the patient-centred risk factors for PI development in adult intensive care units. The search strategy will be designed to retrieve studies published since inception to 2016 in English language. Quality of the studies will be assessed by using an assessment framework designed to appraise quality in prognostic studies and methodological considerations in the analysis and publication of observational studies. Screening, study selection process, and data extraction will be undertaken by two independent reviewers. Disagreement will be resolved by discussion and, if required, a third independent reviewer. Clinical and methodological heterogeneity across studies will be assessed and, if possible, meta-analyses will be performed. DISCUSSION: The evidence synthesis arising from this review will identify person-centred risk factors that are associated with PI development among critically ill patients in intensive care. Findings from this review will demonstrate potential patient risk factors that may influence practice and research priorities to prevent PI development and improve the quality of care provided. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016037690 ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13643-017-0451-5) contains supplementary material, which is available to authorized users

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions

Iron Superoxide Dismutases Targeted to the Glycosomes of Leishmania chagasi Are Important for Survival

Kinetoplastid glycosomes contain a variety of metabolic activities, such as glycolysis, β-oxidation of fatty acids, lipid biosynthesis, and purine salvage. One advantage of sequestering metabolic activities is the avoidance of cellular oxidative damage by reactive oxygen species produced as a by-product of metabolism. Little is known about how glycosomes themselves withstand these toxic metabolites. We previously isolated an iron superoxide dismutase from Leishmania chagasi that is expressed at low levels in the early logarithmic promastigote stage and increases toward the stationary promastigote and amastigote stages. We have since identified a second highly homologous Lcfesodb gene that is expressed at high levels in the early logarithmic promastigote stage and decreases toward the stationary promastigote and amastigote stages. Localization studies using green fluorescent protein fusions have revealed that LcFeSODB1 and LcFeSODB2 are localized within the glycosomes by the last three amino acids of their carboxyl termini. To better understand the specific role that FeSODB plays in parasite growth and survival, a single-allele knockout of the Lcfesodb1 gene was generated. The parasites with these genes exhibited a significant reduction in growth when endogenous superoxide levels were increased with paraquat in culture. Furthermore, the FeSODB1-deficient parasites exhibited a significant reduction in survival within human macrophages. Our results suggest that LcFeSODB plays an important role in parasite growth and survival by protecting glycosomes from superoxide toxicity