Nurse led interventions to improve control of blood pressure in people with hypertension: systematic review and meta-analysis

This is a freely-available open access publication. Please cite the published version which is available via the DOI link in this record.OBJECTIVE: To review trials of nurse led interventions for hypertension in primary care to clarify the evidence base, establish whether nurse prescribing is an important intervention, and identify areas requiring further study. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Ovid Medline, Cochrane Central Register of Controlled Trials, British Nursing Index, Cinahl, Embase, Database of Abstracts of Reviews of Effects, and the NHS Economic Evaluation Database. STUDY SELECTION: Randomised controlled trials of nursing interventions for hypertension compared with usual care in adults. DATA EXTRACTION: Systolic and diastolic blood pressure, percentages reaching target blood pressure, and percentages taking antihypertensive drugs. Intervention effects were calculated as relative risks or weighted mean differences, as appropriate, and sensitivity analysis by study quality was undertaken. DATA SYNTHESIS: Compared with usual care, interventions that included a stepped treatment algorithm showed greater reductions in systolic blood pressure (weighted mean difference -8.2 mm Hg, 95% confidence interval -11.5 to -4.9), nurse prescribing showed greater reductions in blood pressure (systolic -8.9 mm Hg, -12.5 to -5.3 and diastolic -4.0 mm Hg, -5.3 to -2.7), telephone monitoring showed higher achievement of blood pressure targets (relative risk 1.24, 95% confidence interval 1.08 to 1.43), and community monitoring showed greater reductions in blood pressure (weighted mean difference, systolic -4.8 mm Hg, 95% confidence interval -7.0 to -2.7 and diastolic -3.5 mm Hg, -4.5 to -2.5). CONCLUSIONS: Nurse led interventions for hypertension require an algorithm to structure care. Evidence was found of improved outcomes with nurse prescribers from non-UK healthcare settings. Good quality evidence from UK primary health care is insufficient to support widespread employment of nurses in the management of hypertension within such healthcare systems.Scientific Foundation Board of the Royal College of General PractitionersSouth West GP Trus

UAS Literary & Arts Journal

Proof copy provided by Tidal Echoes.Featuring the work of students, faculty, and staff of the University of Alaska Southeast and members of the community.A Note from Emily Wall -- Editor’s Note -- Mask -- Image of Nora, Rendering Seal Oil -- Based of course on hearsay -- Bowl with Spoon -- Gathering Indigo -- Shed -- Decay -- At the Core -- After Summer Time -- Sitka Fishing Boat -- Pericles at the Beach -- Funny Face Fido (detail) -- The Answer Dog -- Direction of the Wind -- Eagle -- An Interview with Nathan Jackson -- Water Becoming Land -- An Interview with John Straley -- Halibut Point View -- Night Monsters -- Sea Lion -- Trophy -- Humpback Flukes -- Homecoming -- Spinning Tires -- Hiking the Salt Chuck Trail -- Sitka Rose -- Columbine -- Chocolate Lily -- Bleeding Hearts -- Salmon Egg Puller—$2.15 an hour -- Granddaughters Dancing -- Sitka Sentinel -- Kootznoowoo -- Ode to Wildlife -- Dinner Party -- Floating Islands (detail) -- To My Departed Kishka -- Wisteria -- Untitled -- Fairweather Laundry -- Struggling with My Language -- “Culture” in the Juneau Museum -- Thane -- Juneau Goldbelt & 9th -- Pink Blue Leaves -- Slow Fall -- Tango -- Pacific Coast Mask with Copper Luster -- Against Confessional -- Sunday Afternoon 3:30 to 3:31 -- Downtown -- Tony, Six Flags Great Adventure, Jackson, New Jersey -- Land and Water Series -- On the Day They Buried Gus Hall -- Solju Sapnu -- Nattie -- The First Half of the Last Century -- A Church Remains -- Mexican Wall -- Eagle Reflections -- The Saving Son -- Axh Leelk’w -- Sinister Place -- Blue Halibuts -- Fishing Again -- The Masai -- Wanting to Know Water -- For Women Like Me -- Mountain Bleu -- Untitled -- Single Word Title -- Charms (detail) -- e.e isn’t Cummings back -- Mocha Gal -- Poppies -- Ideal Woman Blues -- Near the End -- Poet at Work -- Stills -- Serenity -- Lupine Bugs -- Spring Fiddleheads -- What a Piece of Work! -- Biographie

The difference in blood pressure readings between arms and survival: primary care cohort study

addresses: Primary Care Research Group, Institute of Health Services Research, Peninsula College of Medicine and Dentistry, University of Exeter, Devon EX1 2LU, UK. [email protected]: PMCID: PMC3309155To determine whether a difference in systolic blood pressure readings between arms can predict a reduced event free survival after 10 years

The difference in blood pressure readings between arms and survival: primary care cohort study

Objective To determine whether a difference in systolic blood pressure readings between arms can predict a reduced event free survival after 10 years

Nurse led interventions to improve control of blood pressure in people with hypertension: systematic review and meta-analysis

Objective To review trials of nurse led interventions for hypertension in primary care to clarify the evidence base, establish whether nurse prescribing is an important intervention, and identify areas requiring further study

UAS Literary & Arts Journal

Proof copy provided by Tidal Echoes.The 2016 edition of Tidal Echoes presents an annual showcase of writers and artists who share one thing in common: a life surrounded by the rainforests and waterways of Southeast Alaska.a heart is a heavy burden -- Editor’s Note -- Acknowledgements -- Always a Pause -- Untitled -- Mishima Teabowls -- Mint Tea and Red Wine -- The Dry Winter Scent of Prairies -- Northern Sunrise -- Musical Theory in a Falling Tree -- Jumbo Lookout -- The Shape of an Echo -- Wonderwall -- It’s Difficult [excerpt from the poem “Marissa”] -- Yéil x’us.eetí Raven Footprints -- táakw winter -- King Fisher -- Bear -- A Dandelion by its own Name -- Migrations -- Untitled -- They Named Her Driftwood -- Kissing in the Rain -- Waltz of the Flowers: Anna and Company -- Sun Catcher -- Porcelain Curtains -- The River -- Kathleen Lake -- A Living Tapestry -- Red Cedar Tlingit Haida Weave -- Skinned -- Survivor -- Auke Lake Lights -- Aurora Chasers -- Emma Afloat -- I Can’t Sleep -- The Ghost I’m Left With -- Framed Memories -- Tequila, Sweat, and Prayers -- The Alchemical Marriage -- A New New Hope -- each dream practice -- Clouds -- Seasons Change and the Waters Run On -- John Muir -- Salmon Speaks -- A Place That Holds Names -- Untitled -- Salmon Spirit Chest, Connected (box) -- The Language of Weaving: Featured Artist Dr. Teri Rofkar -- Nome, Alaska -- Drained -- I’m From -- Srevlla—The state of things where the spring snow is so soft that one sinks into it. -- Reflections -- Txamsem -- Post-Glacial Rebound -- Dressed in Garlands -- Learning the Dance -- Shamrocks -- When You See Me -- Water Spirit -- To Speak for Restraint, for Wildness, for Beauty: Featured Writer Aleria Jensen -- Young Eagle -- Untitled (detail) -- Baula -- Airport Dike Trail Evening -- Ninja Meatballs -- Untitled -- In the Wild Without Child: One Mother’s Invitation to Self -- Whale Tail Vista -- Questions for Anemones -- Yellow Cedarbark Wool on Starfish Pot -- Gleaming Orange and Pissed -- Through the Sky She Comes -- Love for the Honeybee -- The Last Speaker -- Juneau Fireweed -- Judy Plays the Tuba -- Illuminated Juneau -- Airport Dike Trail Moonlight -- Escape -- A Wooden Mother -- Black and Whites -- an excuse for staying indoors (a working title for a work in progress) -- Insecurities -- Lake Farm -- Yew Bear -- Rupture -- Mendenhall Glacier -- The Rookery -- Transient -- Laminaria -- Untitled -- Querencia -- Hoard -- Untitled -- Small Birds Sign -- Selfie at Two -- Entropy -- Goodbye -- Sitka Bridge -- My Remedy -- S1 -- Delta Symbols Static -- Falling -- Breathe Deeply -- Drum, drum away -- Eaglefest Dancer -- Wasichana -- Writer & Artist Biographie

Onset of Impaired Sleep and Cardiovascular Disease Risk Factors: A Longitudinal Study

STUDY OBJECTIVES: Impaired sleep has been linked to increased risk of cardiovascular disease (CVD), but the underlying mechanisms are still unsettled. We sought to determine how onset of impaired sleep affects the risk of established physiological CVD risk factors (i.e., hypertension, diabetes, and dyslipidemia). METHODS: In a longitudinal cohort study with 3 survey waves (2000, 2004, 2008) from the Finnish Public Sector study we used repeated information on sleep duration and disturbances to determine onset of impaired sleep. Information on development of CVD risk factors, as indicated by initiation of medication for hypertension, diabetes, and dyslipidemia was derived from electronic medical records within 8 years of follow-up. Data on 45,647 participants was structured as two data-cycles to examine the effect of change in sleep (between two waves) on incident CVD events. We applied strict inclusion and exclusion criteria to determine temporality between changes in sleep and the outcomes. RESULTS: While we did not find consistent effects of onset of short or long sleep, we found onset of disturbed sleep to predict subsequent risk of hypertension (hazard ratio = 1.22, 95% CI: 1.04–1.44) and dyslipidemia (HR = 1.17, 95% CI: 1.07–1.29) in fully adjusted analyses. CONCLUSIONS: Results suggest that onset of sleep disturbances rather than short or long sleep mark an increase in physiological risk factors, which may partly explain the higher risk of CVD observed among impaired sleepers

Effect of Fuel Properties on Emissions from Euro 4 and Euro 5 Diesel Passenger Cars

Abstract The EN 590 specification allows up to 7% v/v FAME to be blended into conventional diesel fuel which can then be used in most light-duty diesel vehicles. It is anticipated that higher FAME levels may be needed in order to meet the 10% renewable energy target mandated by the Renewable Energy Directive (2009/EC/28). Certain diesel fuel specification properties are considered to be environmental parameters according to the European Fuels Quality Directive (FQD, 2009/EC/30) and previous regulations. These limits included in the EN 590 specification were derived from the European Programme on Emissions, Fuels and Engine Technologies (EPEFE) which was carried out in the 1990's on diesel vehicles meeting up to Euro 3 emissions standards. These limits could potentially constrain FAME blending levels higher than 7% v/v. No significant work has been conducted to investigate whether relaxing these limits would give rise to efficiency or emissions debits or benefits. For this reason, Concawe was interested in studying the impact of these parameters in Euro 4+ vehicle technology. A test programme has been conducted to evaluate the impact of specific diesel properties on emissions on a Euro 5 light-duty diesel vehicle. Tests were also carried out in a Euro 4 vehicle to provide comparison with previous work. Properties studied were Poly-Aromatic Hydrocarbon (PAH) content, density, and cetane number. The Fatty Acid Methyl Ester (FAME) content was an additional variable in the study. Results of emissions testing will be presented and discussed including effects of the above fuel properties on particulates, NOx, CO2 and fuel consumption

FFRE Powered Spacecraft

Describes concept of the Fission Fragment Rocket Engine (FFRE)

Informal caregiving and diurnal patterns of salivary cortisol : Results from the Whitehall II cohort study

The objective was to investigate the relationship between various aspects of informal caregiving and diurnal patterns of salivary cortisol, with special attention to the moderating effect of sex and work status. The study population was composed of 3727 men and women from the British Whitehall II study. Salivary cortisol was measured six times during a weekday. Aspects of caregiving included the relationship of caregiver to recipient, weekly hours of caregiving, and length of caregiving. Diurnal cortisol profiles were assessed using the cortisol awakening response (CAR) and diurnal cortisol slopes. Results showed that men, but not women, providing informal care had a blunted CAR compared with non-caregivers (P-Interaction = 0.03). Furthermore, we found a dose-response relationship showing that more weekly hours of informal care was associated with a more blunted CAR for men (P-trend = 0.03). Also, the blunted CAR for men was especially pronounced in short-term caregivers and those in paid work. In women, the steepest cortisol slope was seen among those in paid work who provided informal care (P-Interaction = 0.01). To conclude, we found different cortisol profiles in male and female informal caregivers. Male caregivers had a blunted CAR, which has previously been associated with chronic stress and burnout. Future research should investigate whether results are generalizable beyond UK citizens with a working history in the civil service.Peer reviewe