Physiological Phenotyping for Personalized Therapy of Uncontrolled Hypertension in Africa

OBJECTIVES African and African American hypertensives tend to retain salt and water, with lower levels of plasma renin and more resistant hypertension. We tested the hypothesis that physiological phenotyping with plasma renin and aldosterone would improve blood pressure control in uncontrolled hypertensives in Africa. METHODS Patients at hypertension clinics in Nigeria, Kenya, and South Africa with a systolic blood pressure \u3e140 mm Hg or diastolic pressure \u3e 90 mm Hg despite treatment were allocated to usual care (UC) vs. physiologically individualized care (PhysRx). Plasma renin activity and aldosterone were measured using ELISA kits. Patients were followed for 1 year; the primary outcome was the percentage of patients achieving blood pressure \u3c140 mm Hg and diastolic \u3c90 mm Hg. RESULTS Results are presented for the 94/105 participants who completed the study (42 UC, 52 PhysRx). Control of both systolic and diastolic pressures was obtained in 11.1% of UC vs. 50.0% of PhysRx (P = 0.0001). Systolic control was achieved in 13.9% of UC vs. 60.3% of PhysRx (P = 0.0001); diastolic control in 36.1% of UC vs. 67.2% of PhysRx, vs. (P = 0.003). Number of visits and total number of medications were not significantly different between treatment groups, but there were differences across the sites. There were important differences in prescription of amiloride as specified in the PhysRx algorithm. CONCLUSIONS Physiologically individualized therapy based on renin/aldosterone phenotyping significantly improved blood pressure control in a sample of African patients with uncontrolled hypertension. This approach should be tested in African American and other patients with resistant hypertension. Registered as ISRCTN6944003

Cardioprotective role of heat shock proteins in atrial fibrillation: From mechanism of action to therapeutic and diagnostic t

Atrial fibrillation (AF) is the most common age-related cardiac arrhythmia worldwide and is associated with ischemic stroke, heart failure, and substantial morbidity and mortality. Unfortunately, current AF therapy is only moderately effective and does not prevent AF progression from recurrent intermittent episodes (paroxysmal) to persistent and finally permanent AF. It has been recognized that AF persistence is related to the presence of electropathology. Electropathology is defined as structural damage, including degradation of sarcomere structures, in the atrial tissue which, in turn, impairs electrical conduction and subsequently the contractile function of atrial cardiomyocytes. Recent research findings indicate that derailed proteostasis underlies structural damage and, consequently, electrical conduction impairment. A healthy proteostasis is of vital importance for proper function of cells, including cardiomyocytes. Cells respond to a loss of proteostatic control by inducing a heat shock response (HSR), which results in heat shock protein (HSP) expression. Emerging clinical evidence indicates that AF-induced proteostasis derailment is rooted in exhaustion of HSPs. Cardiomyocytes lose defense against structural damage-inducing pathways, which drives progression of AF and induction of HSP expression. In particular, small HSPB1 conserves sarcomere structures by preventing their degradation by proteases, and overexpression of HSPB1 accelerates recovery from structural damage in experimental AF model systems. In this review, we provide an overview of the mechanisms of action of HSPs in preventing AF and discuss the therapeutic potential of HSP-inducing compounds in clinical AF, as well as the potential of HSPs as biomarkers to discriminate between the various stages of AF and recurrence of AF after treatment

The Intentional Use of Service Recovery Strategies to Influence Consumer Emotion, Cognition and Behaviour

Service recovery strategies have been identified as a critical factor in the success of. service organizations. This study develops a conceptual frame work to investigate how specific service recovery strategies influence the emotional, cognitive and negative behavioural responses of . consumers., as well as how emotion and cognition influence negative behavior. Understanding the impact of specific service recovery strategies will allow service providers' to more deliberately and intentionally engage in strategies that result in positive organizational outcomes. This study was conducted using a 2 x 2 between-subjects quasi-experimental design. The results suggest that service recovery has a significant impact on emotion, cognition and negative behavior. Similarly, satisfaction, negative emotion and positive emotion all influence negative behavior but distributive justice has no effect

On the energy-momentum tensor for a scalar field on manifolds with boundaries

We argue that already at classical level the energy-momentum tensor for a scalar field on manifolds with boundaries in addition to the bulk part contains a contribution located on the boundary. Using the standard variational procedure for the action with the boundary term, the expression for the surface energy-momentum tensor is derived for arbitrary bulk and boundary geometries. Integral conservation laws are investigated. The corresponding conserved charges are constructed and their relation to the proper densities is discussed. Further we study the vacuum expectation value of the energy-momentum tensor in the corresponding quantum field theory. It is shown that the surface term in the energy-momentum tensor is essential to obtain the equality between the vacuum energy, evaluated as the sum of the zero-point energies for each normal mode of frequency, and the energy derived by the integration of the corresponding vacuum energy density. As an application, by using the zeta function technique, we evaluate the surface energy for a quantum scalar field confined inside a spherical shell.Comment: 25 pages, 2 figures, section and appendix on the surface energy for a spherical shell are added, references added, accepted for publication in Phys. Rev.

Interaction of Low - Energy Induced Gravity with Quantized Matter and Phase Transition Induced by Curvature

At high energy scale the only quantum effect of any asymptotic free and asymptotically conformal invariant GUT is the trace anomaly of the energy-momentum tensor. Anomaly generates the new degree of freedom, that is propagating conformal factor. At lower energies conformal factor starts to interact with scalar field because of the violation of conformal invariance. We estimate the effect of such an interaction and find the running of the nonminimal coupling from conformal value $\frac{1}{6}$ to $0$. Then we discuss the possibility of the first order phase transition induced by curvature in a region close to the stable fixed point and calculate the induced values of Newtonian and cosmological constants.Comment: 11 pages, LaTex, KEK-TH-397-KEK Preprint 94-3

Two-loop representations of low-energy pion form factors and pi-pi scattering phases in the presence of isospin breaking

Dispersive representations of the pi-pi scattering amplitudes and pion form factors, valid at two-loop accuracy in the low-energy expansion, are constructed in the presence of isospin-breaking effects induced by the difference between the charged and neutral pion masses. Analytical expressions for the corresponding phases of the scalar and vector pion form factors are computed. It is shown that each of these phases consists of the sum of a "universal" part and a form-factor dependent contribution. The first one is entirely determined in terms of the pi-pi scattering amplitudes alone, and reduces to the phase satisfying Watson's theorem in the isospin limit. The second one can be sizeable, although it vanishes in the same limit. The dependence of these isospin corrections with respect to the parameters of the subthreshold expansion of the pi-pi amplitude is studied, and an equivalent representation in terms of the S-wave scattering lengths is also briefly presented and discussed. In addition, partially analytical expressions for the two-loop form factors and pi-pi scattering amplitudes in the presence of isospin breaking are provided.Comment: 57 pages, 12 figure

Measurement of the partial widths of the Z into up- and down-type quarks

Using the entire OPAL LEP1 on-peak Z hadronic decay sample, Z -> qbarq gamma decays were selected by tagging hadronic final states with isolated photon candidates in the electromagnetic calorimeter. Combining the measured rates of Z -> qbarq gamma decays with the total rate of hadronic Z decays permits the simultaneous determination of the widths of the Z into up- and down-type quarks. The values obtained, with total errors, were Gamma u = 300 ^{+19}_{-18} MeV and Gamma d = 381 ^{+12}_{-12} MeV. The results are in good agreement with the Standard Model expectation.Comment: 22 pages, 5 figures, Submitted to Phys. Letts.

Search for R-Parity Violating Decays of Scalar Fermions at LEP

A search for pair-produced scalar fermions under the assumption that R-parity is not conserved has been performed using data collected with the OPAL detector at LEP. The data samples analysed correspond to an integrated luminosity of about 610 pb-1 collected at centre-of-mass energies of sqrt(s) 189-209 GeV. An important consequence of R-parity violation is that the lightest supersymmetric particle is expected to be unstable. Searches of R-parity violating decays of charged sleptons, sneutrinos and squarks have been performed under the assumptions that the lightest supersymmetric particle decays promptly and that only one of the R-parity violating couplings is dominant for each of the decay modes considered. Such processes would yield final states consisting of leptons, jets, or both with or without missing energy. No significant single-like excess of events has been observed with respect to the Standard Model expectations. Limits on the production cross- section of scalar fermions in R-parity violating scenarios are obtained. Constraints on the supersymmetric particle masses are also presented in an R-parity violating framework analogous to the Constrained Minimal Supersymmetric Standard Model.Comment: 51 pages, 24 figures, Submitted to Eur. Phys. J.

Measurement of the Strong Coupling alpha s from Four-Jet Observables in e+e- Annihilation

Data from e+e- annihilation into hadrons at centre-of-mass energies between 91 GeV and 209 GeV collected with the OPAL detector at LEP, are used to study the four-jet rate as a function of the Durham algorithm resolution parameter ycut. The four-jet rate is compared to next-to-leading order calculations that include the resummation of large logarithms. The strong coupling measured from the four-jet rate is alphas(Mz0)= 0.1182+-0.0003(stat.)+-0.0015(exp.)+-0.0011(had.)+-0.0012(scale)+-0.0013(mass) in agreement with the world average. Next-to-leading order fits to the D-parameter and thrust minor event-shape observables are also performed for the first time. We find consistent results, but with significantly larger theoretical uncertainties.Comment: 25 pages, 15 figures, Submitted to Euro. Phys. J.

Measurement of the Hadronic Photon Structure Function F_2^gamma at LEP2

The hadronic structure function of the photon F_2^gamma is measured as a function of Bjorken x and of the factorisation scale Q^2 using data taken by the OPAL detector at LEP. Previous OPAL measurements of the x dependence of F_2^gamma are extended to an average Q^2 of 767 GeV^2. The Q^2 evolution of F_2^gamma is studied for average Q^2 between 11.9 and 1051 GeV^2. As predicted by QCD, the data show positive scaling violations in F_2^gamma. Several parameterisations of F_2^gamma are in agreement with the measurements whereas the quark-parton model prediction fails to describe the data.Comment: 4 pages, 2 figures, to appear in the proceedings of Photon 2001, Ascona, Switzerlan