Benefits of once-daily therapies in the treatment of hypertension

In patients with hypertension, 24-hour blood pressure control is the major therapeutic goal. The number of daily doses is one characteristic of an antihypertensive agent that may affect the adequacy of 24-hour control. One measure of therapeutic coverage is the 24-hour trough-to-peak ratio, which determines the suitability of an agent for once-daily administration. The closer an agent is to a 100% trough-to-peak ratio, the more uniform the 24-hour coverage and therefore blood pressure control. High trough-to-peak ratio, long-acting antihypertensive medications lower blood pressure more gradually, which reduces the likelihood of adverse events attributable to abrupt drug action that occurs with shorter-acting agents. In hypertension, the natural diurnal variation of blood pressure may be altered, including elevated nighttime pressures. An optimal once-daily hypertension therapy would not only lower blood pressure but also normalize any blunted circadian variations in blood pressure. The benefits of once-daily agents with sustained therapeutic coverage may also be explained, in part, by increased patient adherence to simpler regimens as well as lower loss of blood pressure control during virtually inevitable intermittent noncompliance. Studies have demonstrated that once-daily antihypertensive agents have the highest adherence compared with twice-daily or multiple daily doses, including greater adherence to the prescribed timing of doses

Religiöse Erziehung in der Schule (anglikanische Sicht)

Ovaj tekst je panoramski pregled školskoga vjeronauka u zemljama s pravoslavnom većinom u Istočnoj Europi, jer polazi od pravnoga stanja, a bavi se čak i didaktičkim praktičnim pitanjima u pravom smislu riječi. Prostor pravoslavne duhovnosti nudi heterogenost situacija i iskustava s obzirom na poučavanje religije u školi. Zajedničko obilježje predstavlja tranzicija, eksperimentiranje, prijelaz od empirijskih formula, eseja i pogrešaka na koherentne, racionalne i usavršene strategije. Očit je malen, ali izrazit napredak od amaterizma do profesionalizma.Der Autor schildert den Zustand des Schulwesens und Präsenz der Anglikanischen und Katholischen Kirche in den Schulen der ersten und zweiten Stufe im Vereinigten Königtum. Im Hinblick auf die juristische und pädagogisch-theologische Gründung des schulischen Religionsunterrichts macht der Autor auf die Rolle des schulischen Religionsunterrichts aufmerksam: den Schülern zu helfen, sich mit den Fragen und Werten der christlichen Religion zu konfrontieren. Ausserdem, in den Schulen der zweiten Stufe begegnen die Schüler auch den fünf grossen Weltreligionen. Um den schulischen Religionsunterricht als Fach populär zu machen, ist es notwendig das Dialog zu fördern und konkrete Situationen der heutigen Welt zu studieren. Heute ist das Gespräch nicht mehr genügend, sondern auch Wirken, Praktizieren der eigenen Prinzipien in der realen Welt des Leidens, der Krankheiten und des Hungers

The Authors Reply, “as‐needed intravenous antihypertensive therapy and blood pressure control”

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/122423/1/jhm2565_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/122423/2/jhm2565.pd

Achirality in the low temperature structure and lattice modes of tris(acetylacetonate)iron(iii)

Tris(acetylacteonate) iron(III) is a relatively ubiquitous mononuclear inorganic coordination complex. The bidentate nature of the three acetylacteonate ligands coordinating around a single centre inevitably leads to structural isomeric forms, however whether or not this relates to chirality in the solid state has been questioned in the literature. Variable temperature neutron diffraction data down to T = 3 K, highlights the dynamic nature of the ligand environment, including the motions of the hydrogen atoms. The Fourier transform of the molecular dynamics simulation based on the experimentally determined structure was shown to closely reproduce the low temperature vibrational density of states obtained using inelastic neutron scattering

Municipal water use in Northern Colorado: development of efficiency-of-use criterion

Includes bibliographical references.OWRT project no. A-042-COLO

Achieving urban water conservation: a handbook

September 1977.Bibliography: pages 159-167.OWRT project no. A-030-COLO; supported by U.S. Dept. of the Interior, Office of Water Research and Technology, under Grant Agreement nos. 14-34-0001-6006, 14-34-0001-7011, 14-34-0001-7012

2-Ferrocenyl-N-(6-methyl-2-pyrid­yl)benzamide

The title compound, [Fe(C5H5)(C18H15N2O)], a product of the reaction of 2-ferrocenylbenzoic acid and 2-amino-6-methyl­pyridine, crystallizes with two dissimilar mol­ecules in the asymmetric unit. In one mol­ecule, the picoline amide group is directed away from the 2-ferrocenylbenzene moiety (anti) whereas in the other, these are proximate (syn). In the crystal structure, mol­ecules aggregate into dimers via cyclic, asymmetric N—H⋯N inter­actions with graph set R 2 2(8), and are further augmented via intra­molecular C—H⋯O=C and inter­dimer C—H⋯π(arene) inter­actions. Dimers are linked into chains along the [102] direction via weak C—H⋯O hydrogen bonds

A review of studies of adherence with antihypertensive drugs using prescription databases

Poor adherence with antihypertensive therapies is a major factor in the low rates of blood pressure control among people with hypertension. Patient adherence is influenced by a large number of interacting factors but their exact impact is not well understood, partly because it is difficult to measure adherence. Longitudinal prescription data can be used as a measure of drug supply and are particularly useful to identify interruptions and changes of treatment. Obtaining a medicine does not ensure its use; however, it has been established that continuous collection of prescription medications is a useful marker of adherence. We found 20 studies published in the last 10 years that used large prescription databases to investigate adherence with antihypertensive therapies. These were assessed in terms of patient selection, the definition of the adherence outcome(s), and statistical modeling. There was large variation between studies, limiting their comparability. Particular methodological problems included: the failure to identify an inception cohort, which ensures baseline comparability, in four studies; the exclusion of patients who could not be followed up, which results in a selection bias, in 17 studies; failure to validate outcome definitions; and failure to model the discrete-time structure of the data in all the studies we examined. Although the data give repeated measurements on patients, none of the studies attempted to model patient-level variability. Studies of such observational data have inherent limitations, but their potential has not been fully realized in the modeling of adherence with antihypertensive drugs. Many of the studies we reviewed found high rates of nonadherence to antihypertensive therapies despite differences in populations and methods used. Adherence rates from one database ranged from 34% to 78% at 1 year. Some studies found women had better adherence than men, while others found the reverse. Novel approaches to analyzing data from such databases are required to use the information available appropriately and avoid the problems of bias

Symmetrical viewpoint representations in face-selective regions convey an advantage in the perception and recognition of faces

Learning new identities is crucial for effective social interaction. A critical aspect of this process is the integration of different images from the same face into a view-invariant representation that can be used for recognition. The representation of symmetrical viewpoints has been proposed to be a key computational step in achieving view-invariance. The aim of this study was to determine whether the representation of symmetrical viewpoints in face-selective regions is directly linked to the perception and recognition of face identity. In Experiment 1, we measured fMRI responses while male and female human participants viewed images of real faces from different viewpoints (-90⁰, -45⁰, 0⁰, 45⁰, 90⁰ from full-face view). Within the face regions, patterns of neural response to symmetrical views (-45⁰ & 45⁰ or -90⁰ & 90⁰) were more similar than responses to non-symmetrical views in the FFA and STS, but not in the OFA. In Experiment 2, participants made perceptual similarity judgements to pairs of face images. Images with symmetrical viewpoints were reported as being more similar than non-symmetric views. In Experiment 3, we asked whether symmetrical views also convey an advantage when learning new faces. We found that recognition was best when participants were tested with novel face images that were symmetrical to the learning viewpoint. Critically, the pattern of perceptual similarity and recognition across different viewpoints predicted the pattern of neural response in face-selective regions. Together, our results provide support for the functional value of symmetry as an intermediate step in generating view-invariant representations

Effect of Long-Term Exposure to Lower Low-Density Lipoprotein Cholesterol Beginning Early in Life on the Risk of Coronary Heart Disease A Mendelian Randomization Analysis

ObjectivesThe purpose of this study was to estimate the effect of long-term exposure to lower plasma low-density lipoprotein cholesterol (LDL-C) on the risk of coronary heart disease (CHD).BackgroundLDL-C is causally related to the risk of CHD. However, the association between long-term exposure to lower LDL-C beginning early in life and the risk of CHD has not been reliably quantified.MethodsWe conducted a series of meta-analyses to estimate the effect of long-term exposure to lower LDL-C on the risk of CHD mediated by 9 polymorphisms in 6 different genes. We then combined these Mendelian randomization studies in a meta-analysis to obtain a more precise estimate of the effect of long-term exposure to lower LDL-C and compared it with the clinical benefit associated with the same magnitude of LDL-C reduction during treatment with a statin.ResultsAll 9 polymorphisms were associated with a highly consistent reduction in the risk of CHD per unit lower LDL-C, with no evidence of heterogeneity of effect (I2 = 0.0%). In a meta-analysis combining nonoverlapping data from 312,321 participants, naturally random allocation to long-term exposure to lower LDL-C was associated with a 54.5% (95% confidence interval: 48.8% to 59.5%) reduction in the risk of CHD for each mmol/l (38.7 mg/dl) lower LDL-C. This represents a 3-fold greater reduction in the risk of CHD per unit lower LDL-C than that observed during treatment with a statin started later in life (p = 8.43 × 10−19).ConclusionsProlonged exposure to lower LDL-C beginning early in life is associated with a substantially greater reduction in the risk of CHD than the current practice of lowering LDL-C beginning later in life