Wisdom of the crowd: insights gained from comparing predicted and observed effects of blood pressure lowering strategies

In a first of its kind assessment in cardiovascular research, we assessed whether pooled cardiovascular expertise could accurately predict efficacy and tolerability for both a novel and an established treatment option. A survey was administered prior to the publication of the QUARTET (A Quadruple UltrA-low-dose tReatment for hypErTension) trial. QUARTET was a multicentre, double-blind, parallel-group, trial that randomised participants to initial treatment with either monotherapy or an ultra-low dose quadruple single pill combination for 12 weeks. Survey participants were asked to predict blood pressure (BP) at 12 weeks and 52 weeks for both groups

An overview of historical and contemporary concrete shells, their construction and factors in their general disappearance

Only through understanding why concrete shells’ loss in popularity over the course of modern history can designers be equipped with the skills to create and apply this type of construction. Through modifications to design processes, construction stages, material understanding and relevant formwork improvements will architects and designers be able to meet the demands of the 21st century and beyond. To understand why concrete shells are no longer commonly built is to understand its construction process. An amorphous material, the fundamental relationship between formwork and the resultant concrete shell needs to be raised, appreciated, understood and analyzed for a holistic understanding of concrete shells. Through understanding this, issues and factors affecting concrete shells can be tackled and designed out in reviving this type of structures because they can be efficient in structural performance, economical in cost and provide high aesthetic value. This paper discusses concrete shells as an architectural solution by asking the question to what constituted their popularity and factors that led to their demise in the modern age of technological advancement, construction process and environmental concerns. This paper presents a cultural perspective and an overview of seminal, historical and contemporary concrete shells so as to bring about a renaissance of such structures in our built environment once again because of all the benefits it can offer.</p

Regional and seasonal flight speeds of soaring migrants and the role of weather conditions at hourly and daily scales

Given that soaring birds travel faster with supportive winds or in good thermal soaring conditions, we expect weather conditions en route of migration to explain commonly observed regional and seasonal patterns in the performance of soaring migrants. We used GPS-loggers to track 13 honey buzzards and four Montagu's harriers for two to six migrations each. We determined how tailwinds, crosswinds, boundary layer height (a proxy for thermal convection) and precipitation affected hourly speeds, daily distances and daily mean speeds with linear regression models. Honey buzzards mostly travel by soaring while Montagu's harriers supplement soaring with flapping. Therefore, we expect that performance of harriers will be less affected by weather than for buzzards. Weather conditions explained between 30 and 50% of variation in migration performance of both species. Tailwind had the largest effect on hourly speeds, daily mean speeds and daily travel distances. Honey buzzards travelled significantly faster and farther, and Montagu's harriers non-significantly faster, under better convective conditions. Honey buzzards travelled at slower speeds and shorter distances in crosswinds, whereas harriers maintained high speeds in crosswinds. Weather conditions varied between regions and seasons, and this variation accounted for nearly all regional and seasonal variation in flight performance. Hourly performance was higher than predicted at times when we suspect birds had switched to intermittent or continuous flapping flight, for example during sea-crossings. The daily travel distance of Montagu's harriers was determined to a significant extent by their daily travel time, which differed between regions, possibly also due to weather conditions. We conclude with the implications of our work for studies on migration phenology and we suggest an important role for high-resolution telemetry in understanding migratory behavior across entire migratory journeys

Sympatho-renal axis in chronic disease

Essential hypertension, insulin resistance, heart failure, congestion, diuretic resistance, and functional renal disease are all characterized by excessive central sympathetic drive. The contribution of the kidney’s somatic afferent nerves, as an underlying cause of elevated central sympathetic drive, and the consequences of excessive efferent sympathetic signals to the kidney itself, as well as other organs, identify the renal sympathetic nerves as a uniquely logical therapeutic target for diseases linked by excessive central sympathetic drive. Clinical studies of renal denervation in patients with resistant hypertension using an endovascular radiofrequency ablation methodology have exposed the sympathetic link between these conditions. Renal denervation could be expected to simultaneously affect blood pressure, insulin resistance, sleep disorders, congestion in heart failure, cardiorenal syndrome and diuretic resistance. The striking epidemiologic evidence for coexistence of these disorders suggests common causal pathways. Chronic activation of the sympathetic nervous system has been associated with components of the metabolic syndrome, such as blood pressure elevation, obesity, dyslipidemia, and impaired fasting glucose with hyperinsulinemia. Over 50% of patients with essential hypertension are hyperinsulinemic, regardless of whether they are untreated or in a stable program of treatment. Insulin resistance is related to sympathetic drive via a bidirectional mechanism. In this manuscript, we review the data that suggests that selective impairment of renal somatic afferent and sympathetic efferent nerves in patients with resistant hypertension both reduces markers of central sympathetic drive and favorably impacts diseases linked through central sympathetics—insulin resistance, heart failure, congestion, diuretic resistance, and cardiorenal disorders

Application of Plasticity Theory to Reinforced Concrete Deep Beams

yesThis paper reviews the application of the plasticity theory to reinforced concrete deep beams. Both the truss analogy and mechanism approach were employed to predict the capacity of reinforced concrete deep beams. In addition, most current codes of practice, for example Eurocode 1992 and ACI 318-05, recommend the strut-and-tie model for designing reinforced concrete deep beams. Compared with methods based on empirical or semi-empirical equations, the strut-and-tie model and mechanism analyses are more rational, adequately accurate and sufficiently simple for estimating the load capacity of reinforced concrete deep beams. However, there is a problem of selecting the effectiveness factor of concrete as reflected in the wide range of values reported in the literature for deep beams

Plasma lipocalin-2/NGAL is stable over 12 weeks and is not modulated by exercise or dieting

Amongst other immune cells, neutrophils play a key role in systemic inflammation leading to cardiovascular disease and can release inflammatory factors, including lipocalin-2 (LCN2). LCN2 drives cardiac hypertrophy and plays a role in maladaptive remodelling of the heart and has been associated with renal injury. While lifestyle factors such as diet and exercise are known to attenuate low-grade inflammation, their ability to modulate plasma LCN2 levels is unknown. Forty-eight endurance athletes and 52 controls (18–55 years) underwent measurement for various cardiovascular health indicators, along with plasma LCN2 concentration. No significant difference in LCN2 concentration was seen between the two groups. LCN2 was a very weak predictor or absent from models describing blood pressures or predicting athlete status. In another cohort, 57 non-diabetic overweight or obese men and post-menopausal women who fulfilled Adult Treatment Panel III metabolic syndrome criteria were randomly allocated into either a control, modified Dietary Approaches to Stop Hypertension (DASH) diet, or DASH and exercise group. Pre- and post-intervention demographic, cardiovascular health indicators, and plasma LCN2 expression were measured in each individual. While BMI fell in intervention groups, LCN2 levels remained unchanged within and between all groups, as illustrated by strong correlations between LCN2 concentrations pre- and 12 weeks post-intervention (r = 0.743, P < 0.0001). This suggests that circulating LCN2 expression are stable over a period of at least 12 weeks and is not modifiable by diet and exercise

Age-related hyperkyphosis, independent of spinal osteoporosis, is associated with impaired mobility in older community-dwelling women

While many assume hyperkyphosis reflects underlying spinal osteoporosis and vertebral fractures, our results suggest hyperkyphosis is independently associated with decreased mobility. Hyperyphosis is associated with slower Timed Up and Go performance times and may be a useful clinical marker signaling the need for evaluation of vertebral fracture and falling risk. While multiple studies have demonstrated negative effects of hyperkyphosis on physical function, none have disentangled the relationship between hyperkyphosis, impaired function, and underlying spinal osteoporosis. The purpose of this study is to determine whether kyphosis, independent of spinal osteoporosis, is associated with mobility on the Timed Up and Go, and to quantify effects of other factors contributing to impaired mobility. We used data for 3,108 community-dwelling women aged 55-80 years in the Fracture Intervention Trial. All participants had measurements of kyphosis, mobility time on the Timed Up and Go test, height, weight, total hip bone mineral density (BMD), grip strength, and vertebral fractures at baseline visits in 1993. Demographic characteristics included age and smoking status. We calculated mean Timed Up and Go time by quartile of kyphosis. Using multivariate linear regression, we estimated the independent association of kyphosis with mobility time, and quantified effects of other covariates on mobility. Mean mobility time increased from 9.3 s in the lowest to 10.1 s in the highest quartile of kyphosis. In a multivariate-adjusted model, mobility time increased 0.11 s (p = 0.02) for each standard deviation (11.9°) increase in kyphosis. Longer performance times were significantly associated with increasing age, decreasing grip strength, vertebral fractures, body mass index ≥25, and total hip BMD in the osteoporotic range. Kyphosis angle is independently associated with decreased mobility on the Timed Up and Go, which is in turn correlated with increased fall risk. Hyperkyphosis may be a useful clinical marker signaling the need for evaluation of vertebral fracture and falling risk

Increased fracture rate in women with breast cancer: a review of the hidden risk

Women with breast cancer, particularly individuals diagnosed at a relatively early age, have an increased incidence of fractures. Fractures can have serious clinical consequences including the need for major surgery, increased morbidity and mortality, increased cost of disease management, and reduced quality of life for patients. The primary cause of the increased fracture risk appears to be an accelerated decrease in bone mineral density (BMD) resulting from the loss of estrogenic signaling that occurs with most treatments for breast cancer, including aromatase inhibitors. However, factors other than BMD levels alone may influence treatment decisions to reduce fracture risk in this setting. Our purpose is to review current evidence for BMD loss and fracture risk during treatment for breast cancer and discuss pharmacologic means to reduce this risk.Journal ArticleResearch Support, Non-U.S. Gov'tReviewSCOPUS: re.jinfo:eu-repo/semantics/publishe

Comparative Proteomics Analysis of the Root Apoplasts of Rice Seedlings in Response to Hydrogen Peroxide

-responsive proteins in the apoplast of rice seedling roots. stress. response