Suboptimal blood pressure control in chronic kidney disease stage 3: baseline data from a cohort study in primary care

Background: poorly controlled hypertension is independently associated with mortality, cardiovascular risk and disease progression in chronic kidney disease (CKD). In the UK, CKD stage 3 is principally managed in primary care, including blood pressure (BP) management. Controlling BP is key to improving outcomes in CKD. This study aimed to investigate associations of BP control in people with CKD stage 3.Methods: 1,741 patients with CKD 3 recruited from 32 general practices for the Renal Risk in Derby Study underwent medical history, clinical assessment and biochemistry testing. BP control was assessed by three standards: National Institute for Health and Clinical Excellence (NICE), National Kidney Foundation Kidney Disease Outcome Quality Initiative (KDOQI) and Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Descriptive statistics were used to compare characteristics of people achieving and not achieving BP control. Univariate and multivariate logistic regression was used to identify factors associated with BP control.Results: the prevalence of hypertension was 88%. Among people with hypertension, 829/1426 (58.1%) achieved NICE BP targets, 512/1426 (35.9%) KDOQI targets and 859/1426 (60.2%) KDIGO targets. Smaller proportions of people with diabetes and/or albuminuria achieved hypertension targets. 615/1426 (43.1%) were only taking one antihypertensive agent. On multivariable analysis, BP control (NICE and KDIGO) was negatively associated with age (NICE odds ratio (OR) 0.27; 95% confidence interval (95% CI) 0.17-0.43) 70–79 compared to &lt;60), diabetes (OR 0.32; 95% CI 0.25-0.43)), and albuminuria (OR 0.56; 95% CI 0.42-0.74)). For the KDOQI target, there was also association with males (OR 0.76; 95% CI 0.60-0.96)) but not diabetes (target not diabetes specific). Older people were less likely to achieve systolic targets (NICE target OR 0.17 (95% CI 0.09,0.32) p?&lt;?0.001) and more likely to achieve diastolic targets (OR 2.35 (95% CI 1.11,4.96) p?&lt;?0.001) for people &gt;80 compared to?&lt;?60).Conclusions: suboptimal BP control was common in CKD patients with hypertension in this study, particularly those at highest risk of adverse outcomes due to diabetes and or albuminuria. This study suggests there is scope for improving BP control in people with CKD by using more antihypertensive agents in combination while considering issues of adherence and potential side effects.<br/

A Knob for Changing Light Propagation from Subluminal to Superluminal

We show how the application of a coupling field connecting the two lower metastable states of a lambda-system can produce a variety of new results on the propagation of a weak electromagnetic pulse. In principle the light propagation can be changed from subluminal to superluminal. The negative group index results from the regions of anomalous dispersion and gain in susceptibility.Comment: 6 pages,5 figures, typed in RevTeX, accepted in Phys. Rev.

Abundance and phenology of two pest species, Cacoecimorpha pronubana and Epiphyas postvittana (Lepidoptera: Tortricidae)

Cacoecimorpha pronubana (Hübner, [1799]) and Epiphyas postvittana (Walker, 1863) are economically important polyphagous pest species. The larvae of these moths affect a wide range of horticultural crops. We evaluated the seasonal abundance and population dynamics of these two species, hypothesising that both species of moth exhibit similar patterns in their seasonal abundance and respond to abiotic factors. The study was carried out on a wide range of protected ornamental crops grown on a total area of one hectare at a commercial nursery. The study was completed over 5 consecutive years from 2015 to 2019, where both populations were monitored weekly during the months of moth activity, from April to November, using sex pheromone traps to trap the males of both species. The timing and abundance of catches were analysed in relation to local meteorological data. The mean yearly abundance of adult males was 604 ± 23.89 (mean ± SE; C. pronubana) and 1706 ± 167.18 (E. postvittana) also differing significantly between years for both species. There was no influence of any weather measures on the abundance of E. postvittana, but sunshine duration (4.84 ± 0.26 h) and temperature (13.04 ± 0.57°C) affected the mean seasonal abundance of C. pronubana. There was an overall difference in the seasonal pattern of abundance between the species studied. While we demonstrate a seasonal abundance difference between years for C. pronubana, we found no significant seasonal differences for E. postvittana. Improved understanding of seasonal abundance, phenological patterns and inter‐seasonal variations in population dynamics of these two species may be useful in developing forecasting models that can be used in improving integrated pest management strategies for these two pests

Integrated transcriptome and proteome analyses reveal organ-specific proteome deterioration in old rats

Aging is associated with the decline of protein, cell, and organ function. Here, we use an integrated approach to characterize gene expression, bulk translation, and cell biology in the brains and livers of young and old rats. We identify 468 differences in protein abundance between young and old animals. The majority are a consequence of altered translation output, that is, the combined effect of changes in transcript abundance and translation efficiency. In addition, we identify 130 proteins whose overall abundance remains unchanged but whose sub-cellular localization, phosphorylation state, or splice-form varies. While some protein-level differences appear to be a generic property of the rats’ chronological age, the majority are specific to one organ. These may be a consequence of the organ’s physiology or the chronological age of the cells within the tissue. Taken together, our study provides an initial view of the proteome at the molecular, sub-cellular, and organ level in young and old rats

Evolution of the melt source during protracted crustal anatexis: An example from the Bhutan Himalaya

The chemical compositions of magmatic zircon growth zones provide powerful insight into evolving magma compositions due to their ability to record both time and the local chemical environment. In situ U-Pb and Hf isotope analyses of zircon rims from Oligocene–Miocene leucogranites of the Bhutan Himalaya reveal, for the first time, an evolution in melt composition between 32 and 12 Ma. The data indicate a uniform melt source from 32 Ma to 17 Ma, and the progressive addition of an older source component to the melt from at least ca. 17 Ma. Age-corrected εHf ratios decrease from between –10 and –15 down to values as low as –23 by 12 Ma. Complementary whole-rock Nd isotope data corroborate the Hf data, with a progressive decrease in εNd(t) from ca. 18 to 12 Ma. Published zircon and whole-rock Nd data from different lithotectonic units in the Himalaya suggest a chemical distinction between the younger Greater Himalayan Series (GHS) and the older Lesser Himalayan Series (LHS). The time-dependent isotopic evolution shown in the leucogranites demonstrates a progressive increase in melt contribution from older lithologies, suggestive of increasing LHS involvement in Himalayan melting over time. The time-resolved data are consistent with LHS material being progressively accreted to the base of the GHS from ca. 17 Ma, facilitated by deformation along the Main Central thrust. From 17 Ma, decompression, which had triggered anatexis in the GHS since the Paleogene, enabled melting in older sources from the accreted LHS, now forming the lowermost hanging wall of the thrust

Accessing elite nurses for research: reflections on the theoretical and practical issues of telephone interviewing

Elite groups are interesting as they frequently are powerful (in terms of position, knowledge and influence) and enjoy considerable authority. It is important, therefore, to involve them in research concerned with understanding social contexts and processes. This is particularly pertinent in healthcare, where considerable strategic development and change are features of everyday practice that may be guided or perceived as being guided, by elites. This paper evolved from a study investigating the availability and role of nurses whose remit involved leading nursing research and development within acute NHS Trusts in two health regions in Southern England. The study design included telephone interviews with Directors of Nursing Services during which time the researchers engaged in a reflective analysis of their experiences of conducting research with an `elite' group. Important issues identified were the role of gatekeepers, engagement with elites and the use of the telephone interview method in this context. The paper examines these issues and makes a case for involving executive nurses in further research. The paper also offers strategies to help researchers design and implement telephone interview studies successfully to maximise access to the views and experiences of `hard to reach groups', such as elites, while minimising the associated disruption

Net Charge on a Noble Gas Atom Adsorbed on a Metallic Surface

Adsorbed noble gas atoms donate (on the average) a fraction of an electronic charge to the substrate metal. The effect has been experimentally observed as an adsorptive change in the electronic work function. The connection between the effective net atomic charge and the binding energy of the atom to the metal is theoretically explored.Comment: ReVvTeX 3.1 format, Two Figures, Three Table

Effectiveness of surgery for lumbar spinal stenosis

Background: The management of spinal stenosis by surgery has increased rapidly in the past two decades, however, there is still controversy regarding the efficacy of surgery for this condition. Our aim was to investigate the efficacy and comparative effectiveness of surgery in the management of patients with lumbar spinal stenosis. Methods: Electronic searches were performed on MEDLINE, EMBASE, AMED, CINAHL, Web of Science, LILACS and Cochrane Library from inception to November 2014. Hand searches were conducted on included articles and relevant reviews. We included randomised controlled trials evaluating surgery compared to no treatment, placebo/sham, or to another surgical technique in patients with lumbar spinal stenosis. Primary outcome measures were pain, disability, recovery and quality of life. The PEDro scale was used for risk of bias assessment. Data were pooled with a random-effects model, and the GRADE approach was used to summarise conclusions. Results: Nineteen published reports (17 trials) were included. No trials were identified comparing surgery to no treatment or placebo/sham. Pooling revealed that decompression plus fusion is not superior to decompression alone for pain (mean difference -3.7, 95% confidence interval -15.6 to 8.1), disability (mean difference 9.8, 95% confidence interval -9.4 to 28.9), or walking ability (risk ratio 0.9, 95% confidence interval 0.4 to 1.9). Interspinous process spacer devices are slightly more effective than decompression plus fusion for disability (mean difference 5.7, 95% confidence interval 1.3 to 10.0), but they resulted in significantly higher reoperation rates when compared to decompression alone (28% v 7%, P < 0.001). There are no differences in the effectiveness between other surgical techniques for our main outcomes. Conclusions: The relative efficacy of various surgical options for treatment of spinal stenosis remains uncertain. Decompression plus fusion is not more effective than decompression alone. Interspinous process spacer devices result in higher reoperation rates than bony decompression

An Effective-Medium Tight-Binding Model for Silicon

A new method for calculating the total energy of Si systems is presented. The method is based on the effective-medium theory concept of a reference system. Instead of calculating the energy of an atom in the system of interest a reference system is introduced where the local surroundings are similar. The energy of the reference system can be calculated selfconsistently once and for all while the energy difference to the reference system can be obtained approximately. We propose to calculate it using the tight-binding LMTO scheme with the Atomic-Sphere Approximation(ASA) for the potential, and by using the ASA with charge-conserving spheres we are able to treat open system without introducing empty spheres. All steps in the calculational method is {\em ab initio} in the sense that all quantities entering are calculated from first principles without any fitting to experiment. A complete and detailed description of the method is given together with test calculations of the energies of phonons, elastic constants, different structures, surfaces and surface reconstructions. We compare the results to calculations using an empirical tight-binding scheme.Comment: 26 pages (11 uuencoded Postscript figures appended), LaTeX, CAMP-090594-

Thin-Film Metamaterials called Sculptured Thin Films

Morphology and performance are conjointed attributes of metamaterials, of which sculptured thin films (STFs) are examples. STFs are assemblies of nanowires that can be fabricated from many different materials, typically via physical vapor deposition onto rotating substrates. The curvilinear--nanowire morphology of STFs is determined by the substrate motions during fabrication. The optical properties, especially, can be tailored by varying the morphology of STFs. In many cases prototype devices have been fabricated for various optical, thermal, chemical, and biological applications.Comment: to be published in Proc. ICTP School on Metamaterials (Augsut 2009, Sibiu, Romania