Clinical inertia in poorly controlled elderly hypertensive patients: a cross-sectional study in Spanish physicians to ascertain reasons for not intensifying treatment

Background Clinical inertia, the failure of physicians to initiate or intensify therapy when indicated, is a major problem in the management of hypertension and may be more prevalent in elderly patients. Overcoming clinical inertia requires understanding its causes and evaluating certain factors, particularly those related to physicians. Objective The objective of our study was to determine the rate of clinical inertia and the physician-reported rea- sons for it. Conclusion Physicians provided reasons for not intensi- fying treatment in poorly controlled patients in only 30 % of instances. Main reasons for not intensifying treatment were borderline BP values, co-morbidity, suspected white coat effect, or perceived difficulty achieving target. nJCI was associated with high borderline BP values and car- diovascular diseas

Wild-type and mutant SOD1 share an aberrant conformation and a common pathogenic pathway in ALS.

Many mutations confer one or more toxic function(s) on copper/zinc superoxide dismutase 1 (SOD1) that impair motor neuron viability and cause familial amyotrophic lateral sclerosis (FALS). Using a conformation-specific antibody that detects misfolded SOD1 (C4F6), we found that oxidized wild-type SOD1 and mutant SOD1 share a conformational epitope that is not present in normal wild-type SOD1. In a subset of human sporadic ALS (SALS) cases, motor neurons in the lumbosacral spinal cord were markedly C4F6 immunoreactive, indicating that an aberrant wild-type SOD1 species was present. Recombinant, oxidized wild-type SOD1 and wild-type SOD1 immunopurified from SALS tissues inhibited kinesin-based fast axonal transport in a manner similar to that of FALS-linked mutant SOD1. Our findings suggest that wild-type SOD1 can be pathogenic in SALS and identify an SOD1-dependent pathogenic mechanism common to FALS and SALS

State of the California current 2009-2010: Regional variation persists through transition from la Niña to el Niño (and back?)

This report summarizes observations of the California Current System (CCS) from Baja California, Mexico to Oregon for the period from spring 2009 through spring 2010. During this period, changes in the state of the CCS reflected a transition from cool La Niña conditions into and through a short-lived, relatively weak El Niño event. Weaker than normal upwelling and several extended relaxation events contributed to warming over much of the CCS during summer 2009, especially in the north. Moderation of La Niña conditions in the CCS coincided with the development of El Niño conditions in the equatorial Pacific, yet manifested well in advance of any evidence for direct effects of El Niño on the CCS. Responses to El Niño in fall 2009 and winter 2009-2010 appear to have varied substantially with latitude: conditions off southern California returned to near climatological values with the decline of La Niña, and did not indicate any subsequent response to El Niño, yet the northern CCS warmed subtantially following the decline of La Niña and was strongly affected by intense downwelling during winter 2009-2010. The 2009-2010 El Niño diminished rapidly in early 2010, and upwelling off central and southern California resumed unusually early and strongly for a spring following an El Niño, but recovery from El Niño in early 2010 appears to be less robust in the northern CCS. Thus, despite dynamic changes in the overall state of the California Current, 2009-2010 continued the recent pattern of strong regional variability across the CCS

Land Subsidence

Kluwer Academic Publ., Dordrech