Associations between subjective social status and physical and mental health functioning among patients with hypertension

We examine the cross-sectional association between subjective social status and self-rated physical and mental health functioning in 518 Black and White patients enrolled in a community-based hypertension control research study. We found that (1) subjective social status, measured using both a proximal and distal referent group, was positively associated with physical and mental health functioning scores independent of educational level, household income, or both; (2) the effect of subjective social status on physical and mental health functioning differed significantly by race when using the distal, not the proximal, referent group. When the associations differed, they were stronger for Whites than Blacks

Practice level costs of office-based hypertension performance improvement: The Heart Healthy Lenoir study

Primary care practice leaderswho consider engaging in quality improvement (QI) need to understand the practice level costs incurred when asking staff to take on new tasks. The HeartHealthy Lenoir study is a prospective cohort trial in whichQImethods were used to enhance hypertension (HTN) care and reduce racial disparities in blood pressure control in small rural primary care practices inNorth Carolina. As part of this effort, we performed an activity-based costing analysis to describe the costs incurred to develop, implement, and maintain key tasks. We interviewed 20 practice stakeholders and phone-based health coaches during 2012-2014. We calculated the time invested by individuals to perform each task within each study phase and applied national hourly wages to generate cost estimates. Our descriptive analyses focus on four of themost widely used practices. Activities included time to abstract HTN control data, participate in project meetings, identify patients with uncontrolled HTN, create standardized work, and provide additional health coaching for patients with uncontrolled HTN. Despite practice and staffing differences, the developmental phase costs were similar, ranging from $879 to$1, 417. Implementation costs varied more widely as practices took different approaches to identifying patients with uncontrolled HTN. Practice-specific phone health coaching costs ranged from $19, 508 to more than$38, 000. This study adds to the growing literature regarding practice level costs of engaging in systems change. Understanding these costs and balancing them against practice incentives may be helpful as stakeholders make decisions regarding HTN QI

Perceived Social Standing, Medication Nonadherence, and Systolic Blood Pressure in the Rural South

Purpose: Little is known about how perceived social standing versus traditional socioeconomic characteristics influence medication adherence and blood pressure (BP) among African American and white patients with hypertension in the rural southeastern United States. Methods: Perceived social standing, socioeconomic characteristics, self-reported antihypertensive medication adherence, and BP were measured at baseline in a cohort of rural African American and white patients (n = 495) with uncontrolled hypertension attending primary care practices. Multivariate models examined the relationship of perceived social standing and socioeconomic indicators with medication adherence and systolic BP. Findings: Medication nonadherence was reported by 40% of patients. Younger age [β = 0.20; P = .001], African American race [β = -0.30; P = .03], and lower perceived social standing [β = 0.08; P = .002] but not sex or traditional socioeconomic characteristics including education and household income, were significantly associated with lower medication adherence. Race-specific analyses revealed that this pattern was limited to African Americans and not observed in whites. In stepwise modeling, older age [β = 0.57, P = .001], African American race [β = 4.4; P = .03], and lower medication adherence [β = -1.7, P = .01] but not gender, education, or household income, were significantly associated with higher systolic BP. Conclusions: Lower perceived social standing and age, but not traditional socioeconomic characteristics, were significantly associated with lower medication adherence in African Americans. Lower medication adherence was associated with higher systolic BP. These findings suggest the need for tailored, culturally relevant medication adherence interventions in rural communities

Race-Specific Patterns of Treatment Intensification Among Hypertensive Patients Using Home Blood Pressure Monitoring: Analysis Using Defined Daily Doses in the Heart Healthy Lenoir Study

Background: Racial disparities in blood pressure (BP) control persist, but whether differences by race in antihypertensive medication intensification (AMI) contribute is unknown. Objective: To compare AMI by race for patients with elevated home BP readings. Methods: This prospective cohort study followed adult patients from 6 rural primary care practices who used home BP monitoring (HBPM) and recorded/reported values. For providers, AMI was encouraged when mean HBPM systolic blood pressure (SBP) values were ⩾135 mm Hg; patients received phone-based coaching on HBPM technique and sharing HBPM findings. AMI was assessed between baseline and 12 months using defined daily dose (DDD) and summed to create a total antihypertensive DDD value. Results: A total of 217 patients (mean age = 61.4 ± 10.2 years; 66% female; 57% black) provided usable HBPM data. Among 90 (41%) intensification-eligible hypertensive patients (ie, mean HBPM SBP values for 6-months ⩾135 mm Hg), mean total antihypertensive DDD was increased in 61% at 12 months. Blacks had significantly higher mean DDD at baseline and 12 months, but intensification (+0.72 vs +0.65; P = 0.83) was similar by race. However, intensification was greater in males than females (+1.1 vs +0.39; P = 0.031). Reduction in mean SBP following intensification was greater in white versus black patients (−8.2 vs −3.9 mm Hg; P = 0.14). Conclusion/Relevance: Treatment intensification in HBPM users was similar by race, differed significantly by gender, and may produce a greater response in white patients. Differential AMI in HBPM users does not appear to contribute to persistent racial disparities in BP control

Explosive volcanic activity on Venus: The roles of volatile contribution, degassing, and external environment

We investigate the conditions that will promote explosive volcanic activity on Venus. Conduit processes were simulated using a steady-state, isothermal, homogeneous flow model in tandem with a degassing model. The response of exit pressure, exit velocity, and degree of volatile exsolution was explored over a range of volatile concentrations (H2O and CO2), magma temperatures, vent altitudes, and conduit geometries relevant to the Venusian environment. We find that the addition of CO2 to an H2O-driven eruption increases the final pressure, velocity, and volume fraction gas. Increasing vent elevation leads to a greater degree of magma fragmentation, due to the decrease in the final pressure at the vent, resulting in a greater likelihood of explosive activity. Increasing the magmatic temperature generates higher final pressures, greater velocities, and lower final volume fraction gas values with a correspondingly lower chance of explosive volcanism. Cross-sectionally smaller, and/or deeper, conduits were more conducive to explosive activity. Model runs show that for an explosive eruption to occur at Scathach Fluctus, at Venus’ mean planetary radius (MPR), 4.5% H2O or 3% H2O with 3% CO2 (from a 25 m radius conduit) would be required to initiate fragmentation; at Ma’at Mons (~9 km above MPR) only ~2% H2O is required. A buoyant plume model was used to investigate plume behaviour. It was found that it was not possible to achieve a buoyant column from a 25 m radius conduit at Scathach Fluctus, but a buoyant column reaching up to ~20 km above the vent could be generated at Ma’at Mons with an H2O concentration of 4.7% (at 1300 K) or a mixed volatile concentration of 3% H2O with 3% CO2 (at 1200 K). We also estimate the flux of volcanic gases to the lower atmosphere of Venus, should explosive volcanism occur. Model results suggest explosive activity at Scathach Fluctus would result in an H2O flux of ~107 kg s-1. Were Scathach Fluctus emplaced in a single event, our model suggests that it may have been emplaced in a period of ~15 days, supplying 1-2 x 104 Mt H2O to the atmosphere locally. An eruption of this scale might increase local atmospheric H2O abundance by several ppm over an area large enough to be detectable by near-infrared nightside sounding using the 1.18 µm spectral window such as that carried out by the Venus Express/VIRTIS spectrometer. Further interrogation of the VIRTIS dataset is recommended to search for ongoing volcanism on Venus

Lessons learned from implementing health coaching in the heart healthy lenoir hypertension study

Background: Health coaching is increasingly important in patient-centered medical homes. Objectives: Describe formative evaluation results and lessons learned from implementing health coaching to improve hypertension self-management in rural primary care. Methods: A hypertension collaborative was formed consisting of six primary care sites. Twelve monthly health coaching phone calls were attempted for 487 participants with hypertension. Lessons Learned: Participant engagement was challenging; 58% remained engaged, missing fewer than three consecutive calls. Multivariate analyses revealed that older age (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01–1.05), African American race (O,R 1.73; 95% CI, 1.15–2.60), greater number of comorbidities (OR, 1.17; 95% CI, 1.05–1.30) and receiving coaching closer to enrollment (OR, 5.03; 95% CI, 2.53–9.99) were correlated independently with engagement. Participants reported the coaching valuable; 96% would recommend health coaching to others. Conclusions: Health coaching in hypertension care can be successful strategy for engaging more vulnerable groups. A more tailored approach may improve engagement with counseling

A multicomponent quality improvement intervention to improve blood pressure and reduce racial disparities in rural primary care practices

The Southeastern United States has the highest prevalence of hypertension and African Americans have disproportionately worse blood pressure control. The authors sought to evaluate the effect of a multicomponent practice-based quality improvement intervention on lowering mean systolic blood pressure (SBP) at 12 and 24 months compared with baseline among 525 patients, and to assess for a differential effect of the intervention by race (African Americans vs white). At 12 months, both African Americans (−5.0 mm Hg) and whites (−7.8 mm Hg) had a significant decrease in mean SBP compared with baseline, with no significant between-group difference. Similarly, at 24 months, mean SBP decreased in both African Americans (−6.0 mm Hg) and whites (−7.2 mm Hg), with no significant difference between groups. Notably, no significant racial disparity in mean SBP at baseline was shown. The intervention was effective in lowering mean SBP in both African Americans and whites but there was no differential effect of the intervention by race

Applicability of precision medicine approaches to managing hypertension in rural populations

As part of the Heart Healthy Lenoir Project, we developed a practice level intervention to improve blood pressure control. The goal of this study was: (i) to determine if single nucleotide polymorphisms (SNPs) that associate with blood pressure variation, identified in large studies, are applicable to blood pressure control in subjects from a rural population; (ii) to measure the association of these SNPs with subjects’ responsiveness to the hypertension intervention; and (iii) to identify other SNPs that may help understand patient-specific responses to an intervention. We used a combination of candidate SNPs and genome-wide analyses to test associations with either baseline systolic blood pressure (SBP) or change in systolic blood pressure one year after the intervention in two genetically defined ancestral groups: African Americans (AA) and Caucasian Americans (CAU). Of the 48 candidate SNPs, 13 SNPs associated with baseline SBP in our study; however, one candidate SNP, rs592582, also associated with a change in SBP after one year. Using our study data, we identified 4 and 15 additional loci that associated with a change in SBP in the AA and CAU groups, respectively. Our analysis of gene-age interactions identified genotypes associated with SBP improvement within different age groups of our populations. Moreover, our integrative analysis identified AQP4-AS1 and PADI2 as genes whose expression levels may contribute to the pleiotropy of complex traits involved in cardiovascular health and blood pressure regulation in response to an intervention targeting hypertension. In conclusion, the identification of SNPs associated with the success of a hypertension treatment intervention suggests that genetic factors in combination with age may contribute to an individual’s success in lowering SBP. If these findings prove to be applicable to other populations, the use of this genetic variation in making patient-specific interventions may help providers with making decisions to improve patient outcomes. Further investigation is required to determine the role of this genetic variance with respect to the management of hypertension such that more precise treatment recommendations may be made in the future as part of personalized medicine

The pipeline project: Pre-publication independent replications of a single laboratory's research pipeline

This crowdsourced project introduces a collaborative approach to improving the reproducibility of scientific research, in which findings are replicated in qualified independent laboratories before (rather than after) they are published. Our goal is to establish a non-adversarial replication process with highly informative final results. To illustrate the Pre-Publication Independent Replication (PPIR) approach, 25 research groups conducted replications of all ten moral judgment effects which the last author and his collaborators had “in the pipeline” as of August 2014. Six findings replicated according to all replication criteria, one finding replicated but with a significantly smaller effect size than the original, one finding replicated consistently in the original culture but not outside of it, and two findings failed to find support. In total, 40% of the original findings failed at least one major replication criterion. Potential ways to implement and incentivize pre-publication independent replication on a large scale are discussed