Hypertension treatment intensification among stroke survivors with uncontrolled blood pressure

Objective The study objective was to evaluate a pharmacist hypertension care management program within the patient-centered medical home. Methods This was a retrospective case-control study. Cases included all patients with hypertension who were referred to the care management program, and controls included patients with hypertension who were not referred to the program during the same 1-year period. Each case was matched to a maximum of 3 controls on the basis of primary care physician, age ±5 years, gender, diagnoses of diabetes and kidney disease, baseline systolic blood pressure ±10 mm Hg, and number of unique antihypertensive medications. Pharmacists provided a hypertension care management program under an approved scope of practice that allowed pharmacists to meet individually with patients, adjust medications, and provide patient education. Primary outcomes were systolic blood pressure and diastolic blood pressure at 6 and 12 months. Multivariate regression models compared each blood pressure end point between cases and controls adjusting for age, comorbidities, baseline blood pressure, and baseline number of blood pressure medications. Results A total of 573 patients were referred to the hypertension program; 86% (465/543) had at least 1 matched control and were included as cases in the analyses; 3:1 matching was achieved in 90% (418/465) of cases. At baseline, cases and controls did not differ with respect to age, gender, race, or comorbidity; baseline blood pressure was higher (139.9/80.0 mm Hg vs 136.7/78.2 mm Hg, P ≤ .0002) in the cases compared with controls. Multivariate regression modeling identified significantly lower systolic blood pressure for the cases compared with controls at both 6 and 12 months (6-month risk ratio [RR], 9.7; 95% confidence interval [CI], 2.7-35.3; 12-month RR, 20.3; 95% CI, 4.1-99.2; P < .01 for both comparisons). Diastolic blood pressure was significantly lower at 12 months (RR, 2.9; 95% CI, 1.2-7.1; P < .01) but not at 6 months (RR, 1.0; 95% CI, 0.31-3.4; P = .9) for the cases compared with controls. Conclusions Patients who were referred to the pharmacist hypertension care management program had a significant improvement in most blood pressure outcomes. This program may be an effective method of improving blood pressure control among patients in a medical home model of primary care

Coiled-coil domain containing 42 (Ccdc42) is necessary for proper sperm development and male fertility in the mouse

Spermiogenesis is the differentiation of spermatids into motile sperm consisting of a head and a tail. The head harbors a condensed elongated nucleus partially covered by the acrosome-acroplaxome complex. Defects in the acrosome-acroplaxome complex are associated with abnormalities in sperm head shaping. The head-tail coupling apparatus (HTCA), a complex structure consisting of two cylindrical microtubule-based centrioles and associated components, connects the tail or flagellum to the sperm head. Defects in the development of the HTCA cause sperm decapitation and disrupt sperm motility, two major contributors to male infertility. Here, we provide data indicating that mutations in the gene Coiled-coil domain containing 42 (Ccdc42) is associated with malformation of the mouse sperm flagella. In contrast to many other flagella and motile cilia genes, Ccdc42 expression is only observed in the brain and developing sperm. Male mice homozygous for a loss-of-function Ccdc42 allele (Ccdc42(KO)) display defects in the number and location of the HTCA, lack flagellated sperm, and are sterile. The testes enriched expression of Ccdc42 and lack of other phenotypes in mutant mice make it an ideal candidate for screening cases of azoospermia in humans

Oecusse's Special Economic Zone and Local Governance

This In Brief provides an update on the initiative’s progress and examines how ZEESM is affecting local governance as of December 2015. Data for this paper were gathered in Oecusse, November–December 2015, via attendance at public events, interviews and document review.AusAI

Yielded to Christ or conformed to this world? Postwar Mennonite responses to labour activism

This is the accepted version of the manuscript.The urbanization of North American Mennonites after the Second World War necessitated a reconsideration of Mennonite religious beliefs. Post-war concerns for social justice led to a greater emphasis on non-violence and agape at the expense of Gelassenheit. The tenor of Mennonite church conference resolutions regarding labour union membership changed; while skepticism remained regarding the wisdom of union involvement, the door was left open for participation in unions. The labour militancy of the 1970s led Manitoba Mennonites to re-examine their engagement with the labour movement, a process that has continued to the present day. Without further research on Mennonite workplaces, it cannot be known exactly how the change in religious emphases has affected Mennonite identity.https://journals.sagepub.com/doi/abs/10.1177/00084298070360020

Political ecologies of wood and wax: sandalwood and beeswax as symbols and shapers of customary authority in the Oecusse enclave, Timor

The enclave of Oecusse-Ambeno, Timor Leste, was formed in part through struggles over controlling trade in sandalwood and beeswax, two forest products that continue to influence political and ritual allegiances, and the political history of Oecusse. These products are interwoven with the region's contacts with outsiders, influencing local political hierarchies and roles of kings, village heads, and ritual authorities. While wood and wax are recognized to be of Timorese origin, local myths posit that their use and value was unrecognized before the arrival of Chinese traders and Portuguese missionaries. Several narratives of the origins of trade in sandalwood, and the kings' annual beeswax candle tributes, illustrate the enduring connections among local authorities, forest resource control, religious symbolism, and ritual obligations surrounding harvests of sandalwood and beeswax. Customary practices contribute to forest conservation through local protection of beeswax-producing forests, and by circumscribing the harvest. While both beehives and sandalwood impede intensive agricultural land uses, farmers welcome beeswax as a profitable product that supports ritual. But they resent sandalwood's growth in their fields since it involves more regulation and increased labor requirements. The two products' different ecologies of disturbance and incidence contributed over time to distinct ownership norms and forms of control by customary authorities. This is the "political ecology of wood and wax" in Oecusse. Key words: Oecusse, Timor Leste/East Timor, sandalwood, beeswax, customary authority, colonialism

The development eraser: fantastical schemes, aspirational distractions and high modern mega-events in the Oecusse enclave, Timor-Leste

The array of challenges to durably improving rural peoples' lives in remote regions is so daunting that it can be tempting to erase what is there, and to seek a blank slate. This tension is being played out in the OecusseAmbeno enclave of Timor-Leste, a region long familiar with geographic and political isolation. Residents now encounter a new iteration of their unique status: rapid declaration of their region as a special economic zone (ZEESM), with a new regional governance structure and an appointed leadership. The advent of this new zone is meant to catapult Oecusse from its current state of chronic infrastructure and basic development challenges to a booming economic center and a fount of national income in short order. Early emphasis is placed on rapid, major coastal infrastructure construction deemed necessary for the November 2015 commemoration of the 500th anniversary of Portuguese arrival, with the hallmarks associated with high modernism and mega-event preparation worldwide: spatial re-ordering and regulation; a strong orientation to external inputs, resources, and services; and centralized control of rapid infrastructure change. This article investigates the ideological underpinnings of these plans, and explores the irony of how the proposals and their governance arrangement are a disjuncture with Oecusse as a historically important place. It concludes with observations on this project's place in the national development context, and the likely costs and impacts of development for the Oecusse population. Risks include further political and economic marginalization of the mountain-dwelling and rural population, local residents' loss of productive agricultural land and access to water, reduced protection through administrative exclusion from national political structures, and the opportunity costs of misdevelopment's aspirational distractions. Key words: Special Economic Zone; high modernism; mega-event; Timor-Leste; Oecusse Ambeno; economic developmen

Introduction: The political dynamics and social effects of megaproject development

This special issue examines the political context and social impacts of plans for two statesponsored megaprojects in Timor-Leste: the Special Zone of Social Market Economy (ZEESM) in the Oecusse enclave, and the Tasi Mane Project stretching along the south coast. Tracing debates about national development models in Timor-Leste back to the Indonesian occupation and transition period to independence, this Introduction situates these projects within contemporary debates about development. We pay special attention to two key aspects: how megaprojects transform people’s relations with the land, a vital source of livelihoods and cultural meaning; and how different ethnolinguistic groups in Timor-Leste are adapting local practice to accommodate change. We conclude by highlighting how megaprojects reflect and affect aspects of life beyond economic development: governance practice, assertion of sovereignty, sensory losses and identity, ritual adaptations and aspirations for the future

Beneficial Aerodynamic Effect of Wing Scales on the Climbing Flight of Butterflies

It is hypothesized that butterfly wing scale geometry and surface patterning may function to improve aerodynamic efficiency. In order to investigate this hypothesis, a method to measure butterfly flapping kinematics optically over long uninhibited flapping sequences was developed. Statistical results for the climbing flight flapping kinematics of 11 butterflies, based on a total of 236 individual flights, both with and without their wing scales, are presented. Results show, that for each of the 11 butterflies, the mean climbing efficiency decreased after scales were removed. Data was reduced to a single set of differences of climbing efficiency using are paired t-test. Results show a mean decrease in climbing efficiency of 32.2% occurred with a 95% confidence interval of 45.6%–18.8%. Similar analysis showed that the flapping amplitude decreased by 7% while the flapping frequency did not show a significant difference. Results provide strong evidence that butterfly wing scale geometry and surface patterning improve butterfly climbing efficiency. The authors hypothesize that the wing scale\u27s effect in measured climbing efficiency may be due to an improved aerodynamic efficiency of the butterfly and could similarly be used on flapping wing micro air vehicles to potentially achieve similar gains in efficiency