Community based trial of home blood pressure monitoring with nurse-led telephone support in patients with stroke or transient ischaemic attack recently discharged from hospital.

BACKGROUND: High blood pressure in patients with stroke increases the risk of recurrence but management in the community is often inadequate. Home blood pressure monitoring may increase patients' involvement in their care, increase compliance, and reduce the need for patients to attend their General Practitioner if blood pressure is adequately controlled. However the value of home monitoring to improve blood pressure control is unclear. In particular its use has not been evaluated in stroke patients in whom neurological and cognitive ability may present unique challenges. DESIGN: Community based randomised trial with follow up after 12 months. PARTICIPANTS: 360 patients admitted to three South London Stroke units with stroke or transient ischaemic attack within the past 9 months will be recruited from the wards or outpatients and randomly allocated into two groups. All patients will be visited by the specialist nurse at home at baseline when she will measure their blood pressure and administer a questionnaire. These procedures will be repeated at 12 months follow up by another researcher blind as to whether the patient is in intervention or control group. INTERVENTION: INTERVENTION patients will be given a validated home blood pressure monitor and support from the specialist nurse. Control patients will continue with usual care (blood pressure monitoring by their practice). Main outcome measures in both groups after 12 months: 1. Change in systolic blood pressure.2. Cost effectiveness: Incremental cost of the intervention to the National Health Service and incremental cost per quality adjusted life year gained

Synthesis and Characterization of some new perovskite type mixed oxide materials

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How Firms Respond to Mandatory Information Disclosure

Mandatory information disclosure regulations seek to create institutional pressure to spur performance improvement. By examining how organizational characteristics moderate establishments' responses to a prominent environmental information disclosure program, we provide among the first empirical evidence characterizing heterogeneous responses by those mandated to disclose information. We find particularly rapid improvement among establishments located close to their headquarters and among establishments with proximate siblings, especially when the proximate siblings are in the same industry. Large establishments improve more slowly than small establishments in sparse regions, but both groups improve similarly in dense regions, suggesting that density mitigates the power of large establishments to resist institutional pressures. Finally, privately held firms' establishments outperform those owned by public firms. We highlight implications for institutional theory, managers, and policymakers.information disclosure, institutional theory, environmental strategy, mandatory disclosure, environmental performance.

Hydrous Titanium Oxide as a Concentrator for Trace Nuclides in Seawater

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A proposed increase in retinal field-of-view may lead to spatial shifts in images

Visual information determines majority of our spatial behavior. The eye projects a 2-D image of the world on the retina. We demonstrate that when a monocular-like imaging system operates entirely with optically dense fluids, an increase in field-of-view (FOV) is observed compared to an experimental condition, where the ocular medium is optically neutral. Resulting spatial shifts in the retinal image towards the fovea complement the photoreceptor distribution pattern, incidentally revealing a new role for ocular fluids in the image space. Possible effects on the perceived egocentric object location are discussed.Comment: 13 pages, 2 figures, 1 tabl

How the Supply of Fake News Affected Consumer Behavior during the 2016 US Election

We characterize the effect of fake news on online browsing during the 2016 US presidential election. We estimate that weekday increases of 10 fake news articles — that were confirmed to be false by third-party services — increased the incidence of fake news site visits by 3.0%. To address endogeneity, we employ two approaches that attempt to isolate exogenous variation in fake news supply. We also estimate that weekday 10-article increases in fake news increase the odds of visiting one or more fake news sites by 3.7%. Overall, this evidence demonstrates the effectiveness of fake news production in reaching a diverse set of consumers

Study, Survey and Analysis for Media Selection

This paper is a literature review on practical techniques and rules using PowerPoint, animation, and video effectively for instruction. Instruction may be teaching, training, coaching, tutoring, schooling etc. This paper must be of awareness to mentors and instructional technology staff who support faculty members in the development of instructional media. Main objective of this paper is to identify and select the proper technologies for enhancing a particular pedagogy or learning goal. Choose media that support instructor's activity

PHYTOCHEMICAL SCREENING OF SAPTAPARNA (ALSTONIA SCHOLARIS R. Br.) BARK

The Ayurvedic Pharmaceutical Industries use barks of many herbal drugs like Neema, Vata, Udumbara, Parisha, Saptaparna, Plaksha, Baboola etc. for the manufacturing of different herbal medicines. The stem bark of Alstonia scholaris R. Br. commonly known as Saptaparna in Ayurved, is in demand, due to its antipyretic, galactogogue, cardiotonic, anticancer, anti-helminthic etc. activities. But, the identification and separation of these barks drugs from each other is very difficult. Hence, a preliminary study has been done to ensure the basic phytochemical profile of A. scholaris R. Br. stem bark for identification of herbal drug. Physicochemical parameters, preliminary phytochemical screening, quantitative estimation of alkaloid and Thin Layer Chromatography (TLC) were carried out in the present study. Physicochemical data revealed, there is more amount of water soluble extractive value (27.10% w/w) than alcohol soluble extractive value (7.40% w/w). Facts of phytochemical screening showed presents of alkaloid, carbohydrate, tannin, saponin, flavanoids and cardiotonic glycosides in the sample. Result of TLC identification showed 7, 8, and 6 spots under short UV, long UV and after spray reagent respectively. The present study on phytochemical investigation of A. scholaris R. Br. bark will be helpful in developing standards for quality, purity and sample identification of this plant

Effect of Intravenous Phenobarbital on Left Ventricular Myocardial Contractility Determined by Echocardiography in Children

Introduction. Animal studies and rare human studies have suggesteda negative effect of barbiturates on cardiac function. Althoughintravenous (IV) phenobarbital is used routinely in children in theclinical setting, studies in children are lacking. We performed a studyto evaluate effect of IV phenobarbital loading on myocardial systolicfunction of children.Methods.xIn a prospective pilot study in children without congenitalheart defects, the effect of IV phenobarbital was evaluated on theleft ventricular systolic function measured by ejection fraction (EF)by Simpson’s method via an echocardiogram. Any child less than 18years of age who received IV loading dose of at least 20 mg/kg ofphenobarbital given as an infusion over 20 - 30 minutes for variousmedical indications was eligible to take part in the study. Three measurementsof EF by an echocardiogram were made: before loadingdose, 30 minutes after completion of the loading dose, and prior tothe first maintenance dose. Relevant clinical data were recorded,including vital signs, immediately prior to each echocardiogram.Change of function as measured by EF over time was analyzed usinglinear mixed modeling methods. For this study, significant change inblood pressure was defined as a drop of at least 20 mmHg in systolicblood pressure.Results. Ten children (70% female, age range two days to 8.2 years)were enrolled. Three had hypotension with a drop of systolic bloodpressure greater than 20 mmHg from baseline. On examining thetrajectory of EF on each individual graphically, the left ventricularEF tended to fall immediately following phenobarbital therapy andreturn to baseline on re-evaluation. These trajectories were statisticallysignificant for EF.Conclusions. Phenobarbital had a direct and transient depressanteffect on systolic function of the myocardium in one third of the cases.The depression in EF appeared to be transient with return to baseline in less than 24 hours. We recommend close monitoring with anticipationof decreased function in children when using IV phenobarbital.Kans J Med 2019;12(2):40-44