Management of Hypertension in High-Risk Ethnic Minority with Heart Failure

Hypertension (HTN) is the most common co-morbidity in the world, and its sequelae, heart failure (HF) is one of most common causes of mortality and morbidity in the world. Current understanding of pathophysiology and management of HTN in HF is mainly based on studies, which have mainly included whites. Among racial groups, African-American adults have the highest rates (44%) of hypertension in the world and are more resistant to treatment. There is an emerging consensus on the significance of racial disparities in the pathophysiology and treatment options of hypertension and heart failure. However, African Americans had been underrepresented in all the trials until the initiation of the A-HEFT trial. Since the recognition of obstructive sleep apnea (OSA) as an important medical condition, large clinical trials have shown benefits of OSA treatment among patients with HTN and HF. This paper focuses on the pathophysiology, causes of secondary hypertension, and treatment of hypertension among African-American patients with heart failure. There is increasing need for randomized clinical trials testing innovative treatment options for African-American patients

An inquiry-based learning approach to teaching information retrieval

The study of information retrieval (IR) has increased in interest and importance with the explosive growth of online information in recent years. Learning about IR within formal courses of study enables users of search engines to use them more knowledgeably and effectively, while providing the starting point for the explorations of new researchers into novel search technologies. Although IR can be taught in a traditional manner of formal classroom instruction with students being led through the details of the subject and expected to reproduce this in assessment, the nature of IR as a topic makes it an ideal subject for inquiry-based learning approaches to teaching. In an inquiry-based learning approach students are introduced to the principles of a subject and then encouraged to develop their understanding by solving structured or open problems. Working through solutions in subsequent class discussions enables students to appreciate the availability of alternative solutions as proposed by their classmates. Following this approach students not only learn the details of IR techniques, but significantly, naturally learn to apply them in solution of problems. In doing this they not only gain an appreciation of alternative solutions to a problem, but also how to assess their relative strengths and weaknesses. Developing confidence and skills in problem solving enables student assessment to be structured around solution of problems. Thus students can be assessed on the basis of their understanding and ability to apply techniques, rather simply their skill at reciting facts. This has the additional benefit of encouraging general problem solving skills which can be of benefit in other subjects. This approach to teaching IR was successfully implemented in an undergraduate module where students were assessed in a written examination exploring their knowledge and understanding of the principles of IR and their ability to apply them to solving problems, and a written assignment based on developing an individual research proposal

Resistant Hypertension and Obstructive Sleep Apnea in the Primary-Care Setting

We ascertained the prevalence of resistant hypertension (RH) among blacks and determined whether RH patients are at greater risk for obstructive sleep apnea (OSA) than hypertensives. Method. Data emanated from Metabolic Syndrome Outcome Study (MetSO), a study investigating metabolic syndrome among blacks in the primary-care setting. Sample of 200 patients (mean age = 63 ± 13 years; female = 61%) with a diagnosis of hypertension provided subjective and clinical data. RH was defined using the JNC 7and European Society guidelines. We assessed OSA risk using the Apnea Risk Evaluation System ARES), defining high risk as a total ARES score ≥6. Results. Overall, 26% met criteria for RH and 40% were at high OSA risk. Logistic regression analysis, adjusting for effects of age, gender, and medical co morbidities, showed that patients with RH were nearly 2.5 times more likely to be at high OSA risk, relative to those with hypertension (OR = 2.46, 95% CI: 1.03–5.88, P < .05). Conclusion. Our findings show that the prevalence of RH among blacks fell within the range of RH for the general hypertensive population (3–29%). However, patients with RH were at significantly greater risk of OSA compared to patients with hypertension

Doppler-Free Spectroscopy of Weak Transitions: An Analytical Model Applied to Formaldehyde

Experimental observation of Doppler-free signals for weak transitions can be greatly facilitated by an estimate for their expected amplitudes. We derive an analytical model which allows the Doppler-free amplitude to be estimated for small Doppler-free signals. Application of this model to formaldehyde allows the amplitude of experimentally observed Doppler-free signals to be reproduced to within the experimental error.Comment: 7 pages, 7 figures, 1 table, v2: many small improvements + corrected line assignmen

A multicentre integration of a computer-led follow-up of prostate cancer is valid and safe

Background Prostate cancer (CaP) has a rising number of patients requiring routine follow up. In this study, we aimed to test a computer led follow up service for prostate cancer in two UK hospitals. The testing aimed to validate the computer Expert system in making clinical decisions according to the individual patient’s clinical need. The valid model should accurately identify patients with disease recurrence or treatment failure based on their blood test and clinical picture. Methods A clinical decision support system (CDSS) was developed from European (EAU) and national (NICE) guidelines along with knowledge acquired from Urologists. This model was then applied in two UK hospitals to review patients post CaP treatment. These patients’ data (n= 200) were then reviewed by two independent Urology consultants (blinded from the CDSS and other consultant’s rating) and the agreement was calculated by kappa statistics for validation. The second objective aimed to verify the system by estimating the system reliability. Results The two individual urology consultants identified 12 % & 15% of the patients to have potential disease progression and recommended their referral to the Urology care. The kappa coefficient for the agreement between the CDSS and the 2 consultants was 0.81 (p < 0.001) and 0.84 (p < 0.001). The agreement among both specialist was also high with k = 0.83 (p < 0.001). The system reliability was estimated on all cases and this demonstrated 100% repeatability of the decisions. Conclusion The computer led follow up is a valid model for providing safe follow up for prostate cancer

Miniaturized data loggers and computer programming improve seabird risk and damage assessments for marine oil spills in Atlantic Canada

Obtaining useful information on marine birds that can aid in oil spill (and other hydrocarbon release) risk and damage assessments in offshore environments is challenging. Technological innovations in miniaturization have allowed archival data loggers to be deployed successfully on marine birds vulnerable to hydrocarbons on water. A number of species, including murres (both Common, Uria aalge, and Thick-billed, U. lomvia) have been tracked using geolocation devices in eastern Canada, increasing our knowledge of the seasonality and colony-specific nature of their susceptibility to oil on water in offshore hydrocarbon production areas and major shipping lanes. Archival data tags are starting to resolve questions around behaviour of vulnerable seabirds at small spatial scales relevant to oil spill impact modelling, specifically to determine the duration and frequency at which birds fly at sea. Advances in data capture methods using voice activated software have eased the burden on seabird observers who are collecting increasingly more detailed information on seabirds during ship-board and aerial transects. Computer programs that integrate seabird density and bird behaviour have been constructed, all with a goal of creating more credible seabird oil spill risk and damage assessments. In this paper, we discuss how each of these technological and computing innovations can help define critical inputs into seabird risk and damage assessments, and when combined, can provide a more realistic understanding of the impacts to seabirds from any hydrocarbon release

The association of histological and radiological indicators of breast cancer risk.

Previous work has shown that extensive mammographic dysplasia in women aged less than 50 was strongly associated with breast cancer but that the radiological appearance of ductal prominence was not associated with risk. In the present paper we examine the association between these mammographic signs in the breast and histological patterns in the terminal ductal lobular unit (TDLU), the region of the breast where breast cancer is believed to originate. Surgical biopsies from a consecutive series of women aged less than 50 were reviewed and classified according to the histopathology of the epithelium in the TDLU. Mammograms from the same subjects were independently classified according to the extent of the radiological signs of dysplasia and ductal prominence. Degree of histopathology and the extent of mammographic dysplasia were associated and atypia of the ductal type was found more frequently in patients with extensive dysplasia. However, the strength and statistical significance of the association varied according to the radiologist who classified the mammograms. No association was found between degree of histopathology and ductal prominence. These results add to the evidence that extensive mammographic dysplasia in women aged less than 50 is a risk factor for breast cancer. They do not indicate that the radiological signs of dysplasia are caused by histological changes in the TDLU

Investigation of diode-pumped 2.8-µm laser performance in Er:BaY2F8

Laser operation at 2.8 mm in BaY2F8 with erbium concentrations of 7.5% and 20% is investigated under laser-diode pumping at 967 nm. Output powers as high as 250 mW and slope efficiencies as high as 24% are obtained. Results are comparable with those of Er3+:LiYF4 under the same pump conditions. Slope efficiencies above 30% are predicted for optimized erbium concentrations