Is it better to take that antihypertensive at night?

A large RCT in a primary care setting comparing bedtime to upon-waking administration of antihypertensives answers the question. PRACTICE CHANGER: Advise patients to take blood pressure (BP) medication at bedtime rather than upon waking because it results in a decrease in major cardiovascular disease events. STRENGTH OF RECOMMENDATION: B: Based on a single, good-quality, multi-center trial

Modelling the delivery of low carbon energy service in residential buildings

The UK is facing a retrofit challenge due to its legacy of old homes which are poorly suited to modern expectations of indoor thermal comfort. The housing stock accounts for almost a third of total energy use and is responsible for significant CO2 emissions. There is global recognition that the current rate of greenhouse gas emissions is causing long term damage and that changes are required in all sectors in order to limit the impacts of our generation on the global climate. The energy service concept offers an alternative perspective on the energy system. It reframes our demand for energy as a desire for the service which it can provide, such as comfortable homes, illuminated spaces, warm meals and security. This thesis is an investigation of how energy efficiency technologies and measures can deliver energy services with a lower energy input and uses building modelling software as a tool to do so. Four approaches to improving energy service efficiency are compared, and these are high efficiency conversion device, improved passive system, more accurate service control and a reduced service level. These energy efficiency measures are compared based on energy savings attainable and the efficacy of energy service delivery, using the example service of heating thermal comfort. In recognition of the large influence that household occupants have on energy consumption, household behaviours are included in the analysis. Household occupancy pattern is used to define the service demanded and thus energy efficiency measures are compared for a working family, working couple and daytime-present couple occupancy pattern. The suitability of measures for different households is addressed according to elements of motivation for energy efficiency improvement and technical skills of the occupants. The results of this work show that improved passive system performed best in both energy savings and heating thermal comfort delivery for all occupancy patterns. However, combinations of lower cost measures of control and service level demonstrate an ability to deliver comparable energy savings for occupancy patterns of working couple and daytime-present couple. The findings of this thesis confirm the importance of improving the thermal performance of the housing stock, but also that increased adoption of heating controls and a readdressing of expectations of service level can deliver significant energy savings. The modelling of the delivery of thermal comfort requires an enhanced modelling approach, but offers the ability for energy efficiency recommendations to be made based on suitability for the household, which will lead to greater energy savings within the domestic sector

Automated office BP measurement : the new standard in HTN screening

Automated office BP measurement: The new standard in HTN screening. Obtain greater accuracy in blood pressure measurement with an automated office device. PRACTICE CHANGER: Measure patients' blood pressure (BP) using an oscillometric, fully automated office BP device, with the patient sitting alone in a quiet exam room, to accurately diagnose hypertension and eliminate the "white-coat" effect. STRENGTH OF RECOMMENDATION: B: Based on a systematic review and meta-analysis of randomized controlled trials and cohort studies.Samuel Miguel Tiglao, DO, FAAP; Erica S. Meisenheimer, MD; Robert C. Marshall, MD, MPH, MISM, FAAFP, FAMIA (Madigan Family Medicine Residency, Joint Base , Lewis-McChord, WA)Includes bibliographical reference

What are we measuring? : A review of metrics used to describe biodiversity in offsets exchanges

Peer reviewe

Can early introduction of gluten reduce risk of celiac disease?

This UK study revealed the benefits of introducing gluten at age 4 months.Ashley U. Hall, (MD, FACOG); Erica S. Meisenheimer, (MD, MBA, FAAFP); Robert C. Marshall, (MD, MPH, MISM, FAAFP, FAMIA Madigan Army Medical Center, Joint Base Lewis-McChord, WA). Deputy Editor: Rebecca Mullen, (MD, MPH University of Colorado Department of Family Medicine, Denver)Includes bibliographical reference

The Effects of Machine-Weight and Free-Weight Resistance Exercise on Hemodynamics and Vascular Function

International Journal of Exercise Science 13(2): 526-538, 2020. The purpose of this study was to examine hemodynamic and vascular responses between machine-weight and free-weight exercise. Resistance-trained individuals were assigned to a machine-weight (n= 13) or free-weight (n= 15) group. Groups completed two visits consisting of their assigned exercise condition and a control (CON). A 2 x 2 x 3 repeated measures ANOVA was used to test the effects of group across condition and time on the hemodynamic parameters [cardiac output (CO), heart rate (HR), total peripheral resistance (TPR), mean arterial pressure (MAP), and stroke volume (SV)]. A 2 x 2 x 2 repeated measures ANOVA was used to test the effects of group across condition and time on the hemodynamic variable, forearm vascular conductance (FVC), as well as on vascular measures [forearm blood flow (FBF), blood flow peak, and total reactive hyperemia (RH)]. Main effects were analyzed using pairwise comparisons. The results of the present study demonstrate that both machine-weight and free-weight exerciseproduce similar (p \u3e 0.05)alterations in hemodynamics and vascular function. Specifically, during recovery both groups demonstrated significant (p ≤ 0.05) increases in measures of hemodynamics such as CO, HR and FVC, as well as significant (p ≤ 0.05) decreases in TPR, MAP, and SV. Measures of vascular function such as FBF, blood flow peak, and total RH were also significantly (p ≤ 0.05) increased during recovery.Therefore, this study suggests that either machine weight or free-weight exercise may induce acute hemodynamic and vascular benefits, which may reduce the risk of cardiovascular disease (CVD) and CVD events

Hemodynamic response and pulse wave analysis after upper- and lower-body resistance exercise with and without blood flow restriction

Resistance exercise (RE) has been shown to elevate hemodynamics and pulse wave reflection. However, the effects of acute RE with blood flow restriction (BFR) on hemodynamics and pulse wave reflection are unclear. The purpose of this study was to evaluate the differences between upper- and lower-body RE with and without BFR on hemodynamics and pulse wave reflection. Twenty-three young resistance-trained individuals volunteered for the study. Hemodynamics and pulse wave reflection were assessed at rest, 10, 25, 40, and 55 minutes after either upper- or lower-body with or without BFR. The upper-body RE (URE) consisted of the latissimus dorsi pulldown and chest press; the lower-body RE (LRE) consisted of knee extension and knee flexion. The BFR condition consisted of four sets of 30, 15, 15, and 15 repetitions at 30% 1-repetition maximum (1RM) while the without BFR condition consisted of four sets of 8 repetitions at 70% 1RM. Heart rate, rate pressure product, and subendocardial viability ratio significantly (p\u3c0.05) increased after all exercises. Brachial and aortic systolic blood pressure (BP) significantly (p\u3c0.05) elevated after LRE while brachial and aortic diastolic BP significantly (p\u3c0.05) reduced after URE. Augmentation pressure, augmentation index (AIx), AIx normalized at 75 bpm, and wasted left ventricular pressure energy significantly (p\u3c0.05) increased after URE while transit time of reflected wave significantly (p\u3c0.05) decreased after LRE. URE places greater stress on pulse wave reflection while LRE results in greater responses in BP. Regardless of URE or LRE, the cardiovascular responses between BFR and without BFR are similar