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Sample records for 24-hour ambulatory systolic

  1. Activity-adjusted 24-hour ambulatory blood pressure and cardiac remodeling in children with sleep disordered breathing.

    PubMed

    Amin, Raouf; Somers, Virend K; McConnell, Keith; Willging, Paul; Myer, Charles; Sherman, Marc; McPhail, Gary; Morgenthal, Ashley; Fenchel, Matthew; Bean, Judy; Kimball, Thomas; Daniels, Stephen

    2008-01-01

    Questions remain as to whether pediatric sleep disordered breathing increases the risk for elevated blood pressure and blood pressure-dependent cardiac remodeling. We tested the hypothesis that activity-adjusted morning blood pressure surge, blood pressure load, and diurnal and nocturnal blood pressure are significantly higher in children with sleep disordered breathing than in healthy controls and that these blood pressure parameters relate to left ventricular remodeling. 24-hour ambulatory blood pressure parameters were compared between groups. The associations between blood pressure and left ventricular relative wall thickness and mass were measured. 140 children met the inclusion criteria. In children with apnea hypopnea index <5 per hour, a significant difference from controls was the morning blood surge. Significant increases in blood pressure surge, blood pressure load, and in 24-hour ambulatory blood pressure were evident in those whom the apnea hypopnea index exceeded 5 per hour. Sleep disordered breathing and body mass index had similar effect on blood pressure parameters except for nocturnal diastolic blood pressure, where sleep disordered breathing had a significantly greater effect than body mass index. Diurnal and nocturnal systolic blood pressure, diastolic blood pressure, and mean arterial blood pressure predicted the changes in left ventricular relative wall thickness. Therefore, sleep disordered breathing in children who are otherwise healthy is independently associated with an increase in morning blood pressure surge, blood pressure load, and 24-hour ambulatory blood pressure. The association between left ventricular remodeling and 24-hour blood pressure highlights the role of sleep disordered breathing in increasing cardiovascular morbidity.

  2. Depressive Symptoms and 24-Hour Ambulatory Blood Pressure in Africans: The SABPA Study

    PubMed Central

    Hamer, Mark; Frasure-Smith, Nancy; Lespérance, François; Harvey, Brian H.; Malan, Nico T.; Malan, Leoné

    2012-01-01

    Disturbances in circadian rhythm might play a central role in the neurobiology of depression. We examined the association between depressive symptoms and 24-hour ambulatory BP in a sample of 405 (197 black and 208 Caucasian) urbanized African teachers aged 25 to 60 yrs (mean 44.6 ± 9.6 yrs). Depressive symptoms were assessed using the self-administered 9-item Patient Health Questionnaire (PHQ-9). After adjusting for age, sex, and ethnicity, participants with severe depressive symptoms (PHQ-9 ≥ 15) had higher odds of hypertension defined from ambulatory BP and/or use of antihypertensive medication (odds ratio = 2.19, 95% CI, 1.00–4.90) in comparison to participants with no symptoms. Compared to Caucasians with no depressive symptoms, those with severe symptoms had blunted nocturnal systolic BP drop of 4.7 mmHg (95% CI, −0.5 to 10.0, P = 0.07). In summary, depressive symptoms were associated with the circadian BP profile in black and Caucasian Africans. PMID:22028954

  3. Cardiovascular Outcomes in Patients with Normal and Abnormal 24-Hour Ambulatory Blood Pressure Monitoring

    PubMed Central

    Iqbal, P.; Stevenson, Louise

    2011-01-01

    Introduction. 24-hour ambulatory blood pressure monitoring (ABPM) plays an important role in assessing cardiovascular prognosis, through presence or absence of ABPM-related prognostic features. Objectives. To study relationship between 24-hour ABPM and cardiovascular outcomes in patients from Chesterfield Royal Hospital. Material and Methods. Over 12 months from the 1st of August 2002, 1187 individuals had 24-hour ABPM performed. Cardiovascular outcomes were studied in a subset (297) of the original cohort, made up by every 4th consecutive subject. The following ABPM-related prognostic features were studied—high day time systolic and diastolic BP (≥135, ≥85 mmHg), high night time systolic and diastolic BP (≥120 mmHg, ≥75 mmHg), absence of nocturnal dip (≤10% fall in night time SBP), high early morning SBP (≥140 mmHg), and morning surge (≥20/15 mmHg). The cardiovascular outcomes studied in the fourth table included fatal and nonfatal MI, new diagnosis of angina, acute coronary syndrome, sudden cardiac death, cardiac arrhythmias, acute LVF, cerbrovascular events, peripheral vascular disease, abdominal aortic aneurysm, and CKD stage 3 or above. Results. Over a followup period of 2015 ± 116 days (1720–2305 days) 82 cardiovascular events occurred in 61 subjects. Cardiac arrhythmias were the most common CV outcome (34 events) followed by cerebrovascular events (15). Statistically significant associations found were between cerebrovascular events and absent nocturnal dip ≤ 10% (P = .05) and high day time DBP (P = .029), peripheral vascular disease and morning surge ≥ 20/15 mmHg (P = .014), cardiac arrhythmias and high day time and night time DBP (P = .009 and .033, resp.). Conclusion. Significant associations were found between cerebrovascular events and absent nocturnal dip ≤ 10% and high day time DBP, peripheral vascular disease and morning surge ≥ 20/15 mmHg, cardiac arrhythmias and high day time and night time DBP. PMID

  4. Association of target organ damage with 24-hour systolic and diastolic blood pressure levels and hypertension subtypes in untreated Chinese.

    PubMed

    Wei, Fang-Fei; Li, Yan; Zhang, Lu; Xu, Ting-Yan; Ding, Feng-Hua; Staessen, Jan A; Wang, Ji-Guang

    2014-02-01

    The association of target organ damage with 24-hour systolic and diastolic blood pressure levels and ambulatory hypertension subtypes has not yet been examined in untreated Chinese patients. We measured left ventricular mass index by echocardiography (n=619), the urinary albumin:creatinine ratio (n=1047), and aortic pulse wave velocity by tonometry (n=1013) in 1047 untreated subjects (mean age, 50.6 years; 48.9% women). Normotension was a 24-hour systolic/diastolic blood pressure <130/<80 mm Hg. Hypertension subtypes were isolated diastolic hypertension and mixed systolic plus diastolic hypertension. We assessed associations of interest by multivariable-adjusted linear models. Using normotension as reference, mixed hypertension was associated with higher (P≤0.003) left ventricular mass index (+4.31 g/m(2)), urinary albumin:creatinine ratio (+1.63 mg/mmol), and pulse wave velocity (+0.76 m/s); and isolated diastolic hypertension was associated with similar left ventricular mass index and pulse wave velocity (P≥0.39), but higher urinary albumin:creatinine ratio (+1.24 mg/mmol; P=0.002). In younger participants (<55 years), the mutually independent effect sizes associated with 1 SD increases in 24-hour systolic/diastolic blood pressure were +3.31/-0.36 g/m(2) (P=0.009/0.79) for left ventricular mass index, +1.15/+1.14 mg/mmol (P=0.02/0.04) for the urinary albumin:creatinine ratio, and +0.54/-0.05 m/s (P<0.001/0.54) for pulse wave velocity. In older participants, these estimates were +3.58/+0.30 g/m(2) (P=0.045/0.88), +1.23/+1.05 mg/mmol (P=0.002/0.54), and +0.76/-0.49 m/s (P<0.001/<0.001), respectively. In conclusion, 24-hour systolic blood pressure and mixed hypertension are major determinants of target organ damage irrespective of age and target organ, whereas 24-hour diastolic blood pressure and isolated diastolic hypertension only relate to the urinary albumin:creatinine ratio below middle age.

  5. Pharmacist-physician co-management of hypertension reduces 24-hour ambulatory blood pressures

    PubMed Central

    Weber, Cynthia A.; Ernst, Michael E.; Sezate, Genesis S.; Zheng, Shimin; Carter, Barry L.

    2010-01-01

    Background Pharmacist-physician co-management of hypertension has been shown to improve office blood pressures (BP). We sought to describe the effect of such a model on 24-hour ambulatory BPs. Methods We performed a prospective, cluster-randomised controlled clinical trial in 179 patients with uncontrolled hypertension from five primary care clinics in Iowa City, Iowa. Patients were randomized by clinic to receive pharmacist-physician collaborative management of hypertension (intervention) or usual care (control) for a 9-month period. In the intervention group, pharmacists helped patients identify barriers to BP control, counselled on lifestyle and dietary modifications, and adjusted antihypertensive therapy in collaboration with the patient’s primary care provider. Patients were seen by pharmacists a minimum every 2 months. Ambulatory BP was obtained at baseline and study end. Results Baseline and end of study ambulatory BP profiles were evaluated for 175 patients. Ambulatory BPs were reduced to a greater extent in the intervention compared to control group (daytime ΔSBP [SD] 15.2[11.5] vs 5.5[13.5], p<0.001; nighttime ΔSBP [SD] 12.2[14.8] vs 3.4[13.3], p<0.001; 24-hour ΔSBP [SD] 14.1[11.3] vs 5.5[12.5], p<0.001). More patients in the intervention group had BP controlled at the end of the study (75% vs 50.7%, p<0.001) as defined by overall 24-hour ambulatory BP monitoring. Conclusions Pharmacist-physician collaborative management of hypertension achieved consistent and significantly greater reduction in 24-hour BP and a high rate of BP control. PMID:20937921

  6. Experience with noninvasive ambulatory 24-hour blood pressure recording in a community hospital.

    PubMed

    van de Weijgert, E J; Braun, J J

    1992-04-01

    In 40 subjects (23 treated with antihypertensive medication), 24-h ambulatory blood pressure was measured with an oscillometric blood pressure monitor (Spacelabs model 90202). We studied applicability in the out-patient department with regard to patient tolerance, correlation with mercury manometer measurements, 24-h blood pressure variability and the use in detecting "white-coat" hypertension. The measurements were tolerated quite well except for complaints of sleep disturbance and local irritation from the cuff. The average percentage of missed measuring points was 9.2%. Correlation between blood pressure with the mercury manometer and the Spacelabs monitor (averages of three consecutive readings) was: systolic 0.87 and diastolic 0.73 (P less than 0.001). No evidence for systematic error between the two methods was found. Diurnal blood pressure variation was significant with an average night-time drop of 12 +/- 15 mmHg systolic and 12 +/- 11 mmHg diastolic. "Office" blood pressure measured with the Spacelabs monitor was in the hypertensive range for 28 patients (systolic greater than or equal to 160 and/or diastolic greater than or equal to 95 mmHg). Only 15 of these subjects still met the hypertension criteria on the basis of mean daytime ambulatory blood pressure values. When ambulatory blood pressures during arbitrary 3-h periods of the daytime were studied, the number of patients with established hypertension did not change. The patients with this "office" or "white-coat" hypertensive response could not be distinguished on the basis of variability in daytime blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

  7. Ambulatory 24-hour cardiac oxygen consumption and blood pressure-heart rate variability: effects of nebivolol and valsartan alone and in combination.

    PubMed

    Izzo, Joseph L; Khan, Safi U; Saleem, Osman; Osmond, Peter J

    2015-07-01

    We compared an angiotensin receptor blocker (valsartan; VAL), a beta-blocker (nebivolol; NEB) and the combination of NEB/VAL with respect to 24-hour myocardial oxygen consumption (determined by 24-hour ambulatory heart rate-central systolic pressure product [ACRPP]) and its components. Subjects with hypertension (systolic blood pressure >140 or diastolic blood pressure >90; n = 26) were studied in a double-blinded, double-dummy, forced-titration, crossover design with 3 random-order experimental periods: VAL 320 mg, NEB 40 mg, and NEB/VAL 320/40 mg daily. After 4 weeks of each drug, ambulatory pulse wave analysis (MobilOGraph) was performed every 20 minutes for 24 hours. All three treatments resulted in nearly identical brachial and central systolic blood pressures. NEB alone or in combination with VAL resulted in lower ACRPP (by 11%-14%; P < .001 each) and heart rate (by 18%-20%; P < .001 each) compared with VAL, but stroke work (ACRPP per beat) was lower with VAL. Relative and adjusted variability (standard deviation and coefficient of variation) of heart rate were also lower with NEB and NEB/VAL than VAL. Results in African Americans, the majority subpopulation, were similar to those of the entire treatment group. We conclude that the rate-slowing effects of NEB cause ambulatory cardiac myocardial oxygen consumption to be lower with NEB monotherapy or NEB/VAL combination therapy than with VAL monotherapy. NEB/VAL is not superior to NEB alone in controlling heart rate, blood pressure, or ACRPP. Heart rate variability but not ACRPP variability is reduced by NEB or the combination NEB/VAL. There is no attenuation of beta-blocker-induced rate-slowing effects of in African Americans.

  8. Disproportional decrease in office blood pressure compared with 24-hour ambulatory blood pressure with antihypertensive treatment: dependency on pretreatment blood pressure levels.

    PubMed

    Schmieder, Roland E; Schmidt, Stephanie T; Riemer, Thomas; Dechend, Ralf; Hagedorn, Ina; Senges, Jochen; Messerli, Franz H; Zeymer, Uwe

    2014-11-01

    The long-term relationship between 24-hour ambulatory blood pressure (ABP) and office BP in patients on therapy is not well documented. From a registry we included all patients in whom antihypertensive therapy needed to be uptitrated. Drug treatment included the direct renin inhibitor aliskiren or an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker or drugs not blocking the renin-angiotensin system, alone or on top of an existing drug regimen. In all patients, office BP and 24-hour ABP were obtained at baseline and after 1 year with validated devices. In the study population of 2722 patients, there was a good correlation between the change in office BP and 24-hour ABP (systolic: r=0.39; P<0.001; diastolic: r=0.34; P<0.001). However, the numeric decrease in office BP did not correspond to the decrease in ABP in a 1:1 fashion, for example, a decrease of 10, 20, and 30 mm Hg corresponded to a decrease of ≈7.2, 10.5, and 13.9 mm Hg in systolic ABP, respectively. The disproportionally greater decrease in systolic office BP compared with ABP was dependent on the level of the pretreatment BP, which was consistently higher for office BP than ABP. The white coat effect (difference between office BP and ABP) was on average 10/5 mm Hg lower 1 year after intensifying treatment and the magnitude of that was also dependent on pretreatment BP. There was a disproportionally greater decrease in systolic office BP than in ABP, which for both office BP and ABP seemed to depend on the pretreatment BP level.

  9. Reductions in Mean 24-Hour Ambulatory Blood Pressure After 6-Week Treatment With Canagliflozin in Patients With Type 2 Diabetes Mellitus and Hypertension.

    PubMed

    Townsend, Raymond R; Machin, Israel; Ren, Jimmy; Trujillo, Angelina; Kawaguchi, Masato; Vijapurkar, Ujjwala; Damaraju, Chandrasekharrao V; Pfeifer, Michael

    2016-01-01

    This randomized, double-blind, placebo-controlled study evaluated the early effects of canagliflozin on blood pressure (BP) in patients with type 2 diabetes mellitus (T2DM) and hypertension. Patients were randomized to canagliflozin 300 mg, canagliflozin 100 mg, or placebo for 6 weeks and underwent 24-hour ambulatory BP monitoring before randomization, on day 1 of treatment, and after 6 weeks. The primary endpoint was change in mean 24-hour systolic BP (SBP) from baseline to week 6. Overall, 169 patients were included (mean age, 58.6 years; glycated hemoglobin, 8.1%; seated BP 138.5/82.7 mm Hg). At week 6, canagliflozin 300 mg provided greater reductions in mean 24-hour SBP than placebo (least squares mean -6.2 vs -1.2 mm Hg, respectively; P=.006). Numerical reductions in SBP were observed with canagliflozin 100 mg. Canagliflozin was generally well tolerated, with side effects similar to those reported in previous studies. These results suggest that canagliflozin rapidly reduces BP in patients with T2DM and hypertension.

  10. Effect of Intensive Versus Standard Clinic-Based Hypertension Management on Ambulatory Blood Pressure: Results From the SPRINT (Systolic Blood Pressure Intervention Trial) Ambulatory Blood Pressure Study.

    PubMed

    Drawz, Paul E; Pajewski, Nicholas M; Bates, Jeffrey T; Bello, Natalie A; Cushman, William C; Dwyer, Jamie P; Fine, Lawrence J; Goff, David C; Haley, William E; Krousel-Wood, Marie; McWilliams, Andrew; Rifkin, Dena E; Slinin, Yelena; Taylor, Addison; Townsend, Raymond; Wall, Barry; Wright, Jackson T; Rahman, Mahboob

    2017-01-01

    The effect of clinic-based intensive hypertension treatment on ambulatory blood pressure (BP) is unknown. The goal of the SPRINT (Systolic Blood Pressure Intervention Trial) ambulatory BP ancillary study was to evaluate the effect of intensive versus standard clinic-based BP targets on ambulatory BP. Ambulatory BP was obtained within 3 weeks of the 27-month study visit in 897 SPRINT participants. Intensive treatment resulted in lower clinic systolic BP (mean difference between groups=16.0 mm Hg; 95% confidence interval, 14.1-17.8 mm Hg), nighttime systolic BP (mean difference=9.6 mm Hg; 95% confidence interval, 7.7-11.5 mm Hg), daytime systolic BP (mean difference=12.3 mm Hg; 95% confidence interval, 10.6-13.9 mm Hg), and 24-hour systolic BP (mean difference=11.2 mm Hg; 95% confidence interval, 9.7-12.8 mm Hg). The night/day systolic BP ratio was similar between the intensive (0.92±0.09) and standard-treatment groups (0.91±0.09). There was considerable lack of agreement within participants between clinic systolic BP and daytime ambulatory systolic BP with wide limits of agreement on Bland-Altman plots. In conclusion, targeting a systolic BP of <120 mm Hg, when compared with <140 mm Hg, resulted in lower nighttime, daytime, and 24-hour systolic BP, but did not change the night/day systolic BP ratio. Ambulatory BP monitoring may be required to assess the effect of targeted hypertension therapy on out of office BP. Further studies are needed to assess whether targeting hypertension therapy based on ambulatory BP improves clinical outcomes.

  11. Effect of an L- and T-Type Calcium Channel Blocker on 24-Hour Systolic Blood Pressure and Heart Rate in Hypertensive Patients

    PubMed Central

    Tsutsumi, Takeshi; Ebado, Mio; Takeyama, Youichi

    2012-01-01

    Background and Objectives The aim of this study was to evaluate the effects of an L- and T-type calcium channel blocker (CCB) on 24-hour systolic blood pressure (24-hour SBP) and heart rate (24-hour HR) profiles in essential hypertensive patients. Subjects and Methods Thirty-seven consecutive patients were enrolled in this study. The 24-hour SBP and HR were recorded before and after treatment with efonidipine (L- and T-type CCB, 40 mg), after waking. Changes in 24-hour SBP and HR and the diurnal to nocturnal SBP ratio were measured. The best-fit curves of changes in SBP and HR were depicted using a periodic function. Results The mean 24-hour SBP and HR decreased significantly after treatment. The diurnal to nocturnal SBP ratio in dipper-type hypertension cases decreased from 16.7±6.1% to 8.3±9.8% (p<0.05), whereas in non-dipper hypertension cases, it increased from 2.3±2.9% to 7.7±5.1% (p<0.01). The antihypertensive effect was minimal at 5.0 hours after drug administration and it slowly recovered at a constant rate (2.1 mm Hg/h) over 12 hours in dipper cases. The median 24-hour changes in HR in the dipper and non-dipper cases were -2.3/min and -5.4/min, respectively. A continuous reduction in the change in HR was seen from 3.5 to 23 hours after drug administration. Conclusion The antihypertensive action of efonidipine was characterized by a slow recovery of the SBP decrease at a constant rate (2.1 mm Hg/h) and a non-administration time dependent reduction in 24-hour HR. PMID:22563335

  12. Prevalence of Masked Hypertension: a Population-Based Survey in a Large City by Using 24-Hour Ambulatory Blood Pressure Monitoring

    PubMed Central

    Kim, Sun-Woong; Choi, Eun-Hee; Kim, Ji-Hyun; Nah, Deuk-Young; Shin, Sung-Joon; Gu, Namyi

    2016-01-01

    Background and Objectives We estimated the prevalence of hypertension and hypertension subtypes in a large semi-urban city in Korea, using 24-hour ambulatory blood pressure monitoring (ABPM) in a randomly selected sample population. Subjects and Methods A random sample (aged 20-65 years) from a city with an adult population of approximately 600000 was selected by using a list-assisted random digit dialing method. The 24-hour ABPM and conventional blood pressure measurement (CBPM) of these individuals were obtained. Results Among the 496 participants, valid 24-hour ABPM and CBPM were obtained from 462 (93%) individuals. The estimated prevalence of hypertension in Goyang was 17.54% by CBPM and 32.70% by 24-hour ABPM (p<0.01). In the age stratified analysis, both CBPM and 24-hour ABPM showed increased prevalence of hypertension with age. The estimated prevalence of masked hypertension was 16.22% and that of white-coat hypertension was 1.08%. Men had a higher prevalence of masked hypertension than women (20.79% vs. 11.86%, p=0.0295). The estimated prevalence of masked hypertension was 17.5%, 20.58%, 24.34%, and 13.29% in the age categories of 30s, 40s, 50s, and 60s, respectively. The estimated prevalence of masked uncontrolled hypertension was 26.79% in patients with hypertension who were taking antihypertensive medications. Conclusion The estimated prevalence of hypertension by 24-hour ABPM was higher than that by CBPM, revealing high prevalence of masked hypertension. The high prevalence of masked hypertension supports the adoption of ABPM in the national population survey and clinical practice to improve public health and reduce health care costs. PMID:27721860

  13. Relative prognostic value of rest thallium-201 imaging, radionuclide ventriculography and 24 hour ambulatory electrocardiographic monitoring after acute myocardial infarction

    SciTech Connect

    Hakki, A.H.; Nestico, P.F.; Heo, J.; Unwala, A.A.; Iskandrian, A.S.

    1987-07-01

    Rest thallium-201 scintigraphy, radionuclide ventriculography and 24 hour Holter monitoring are acceptable methods to assess myocardial necrosis, performance and electrical instability. This study examined the relative value of the three tests, when obtained a mean of 7 days after acute myocardial infarction, in predicting 1 year mortality in 93 patients. Planar thallium-201 images were obtained in three projections and were scored on a scale of 0 to 4 in 15 segments (normal score = 60). Patients were classified as having high risk test results as follows: thallium score less than or equal to 45 (33 patients), left ventricular ejection fraction less than or equal to 40% (51 patients) and complex ventricular arrhythmias on Holter monitoring (36 patients). During the follow-up of 6.4 +/- 3.4 months (mean +/- SD), 15 patients died of cardiac causes. All three tests were important predictors of survival by univariate Cox survival analysis; the thallium score, however, was the only important predictor by multivariate analysis. The predictive power of the thallium score was comparable with that of combined ejection fraction and Holter monitoring (chi-square = 21 versus chi-square = 22). Thus, rest thallium-201 imaging performed before hospital discharge provides important prognostic information in survivors of acute myocardial infarction which is comparable with that provided by left ventricular ejection fraction and Holter monitoring. Patients with a lower thallium score (large perfusion defects) are at high risk of cardiac death during the first year after infarction.

  14. Effects of verapamil SR and atenolol on 24-hour blood pressure and heart rate in hypertension patients with coronary artery disease: an international verapamil SR-trandolapril ambulatory monitoring substudy.

    PubMed

    Denardo, Scott J; Gong, Yan; Cooper-DeHoff, Rhonda M; Farsang, Csaba; Keltai, Matyas; Szirmai, László; Messerli, Franz H; Bavry, Anthony A; Handberg, Eileen M; Mancia, Giuseppe; Pepine, Carl J

    2015-01-01

    Elevated nighttime blood pressure (BP) and heart rate (HR), increased BP and HR variability, and altered diurnal variations of BP and HR (nighttime dipping and morning surge) in patients with systemic hypertension are each associated with increased adverse cardiovascular events. However, there are no reports on the effect of hypertension treatment on these important hemodynamic parameters in the growing population of hypertensive patients with atherosclerotic coronary artery disease (CAD). This was a pre-specified subgroup analysis of the INternational VErapamil SR-Trandolapril STudy (INVEST), which involved 22,576 clinically stable patients aged ≥ 50 years with hypertension and CAD randomized to either verapamil SR- or atenolol-based hypertension treatment strategies. The subgroup consisted of 117 patients undergoing 24-hour ambulatory monitoring at baseline and after 1 year of treatment. Hourly systolic and diastolic BP (SBP and DBP) decreased after 1 year for both verapamil SR- and atenolol-based treatment strategies compared with baseline (P<0.0001). Atenolol also decreased hourly HR (P<0.0001). Both treatment strategies decreased SBP variability (weighted standard deviation: P = 0.012 and 0.021, respectively). Compared with verapamil SR, atenolol also increased the prevalence of BP and HR nighttime dipping among prior non-dippers (BP: OR = 3.37; 95% CI: 1.26-8.97 P = 0.015; HR: OR = 4.06; 95% CI: 1.35-12.17; P = 0.012) and blunted HR morning surge (+2.8 vs. +4.5 beats/min/hr; P = 0.019). Both verapamil SR- and especially atenolol-based strategies resulted in favorable changes in ambulatory monitoring parameters that have been previously associated with increased adverse cardiovascular events.

  15. Derivation of a measure of systolic blood pressure mutability: a novel information theory-based metric from ambulatory blood pressure tests.

    PubMed

    Contreras, Danitza J; Vogel, Eugenio E; Saravia, Gonzalo; Stockins, Benjamin

    2016-03-01

    We provide ambulatory blood pressure (BP) exams with tools based on information theory to quantify fluctuations thus increasing the capture of dynamic test components. Data from 515 ambulatory 24-hour BP exams were considered. Average age was 54 years, 54% were women, and 53% were under BP treatment. The average systolic pressure (SP) was 127 ± 8 mm Hg. A data compressor (wlzip) designed to recognize meaningful information is invoked to measure mutability which is a form of dynamical variability. For patients with the same average SP, different mutability values are obtained which reflects the differences in dynamical variability. In unadjusted linear regression models, mutability had low association with the mean systolic BP (R(2) = 0.056; P < .000001) but larger association with the SP deviation (R(2) = 0.761; P < .001). Wlzip allows detecting levels of variability in SP that could be hazardous. This new indicator can be easily added to the 24-hour BP monitors improving information toward diagnosis.

  16. Ambulatory blood pressure monitoring: importance of sampling rate and duration--48 versus 24 hours--on the accurate assessment of cardiovascular risk.

    PubMed

    Hermida, Ramón C; Ayala, Diana E; Fontao, María J; Mojón, Artemio; Fernández, José R

    2013-03-01

    Independent prospective studies have found that ambulatory blood pressure (BP) monitoring (ABPM) is more closely correlated with target organ damage and cardiovascular disease (CVD) risk than clinic BP measurement. This is based on studies in which BP was sampled every 15-30 min for ≤24 h, without taking into account that reproducibility of any estimated parameter from a time series to be potentially used for CVD risk assessment might depend more on monitoring duration than on sampling rate. Herein, we evaluated the influence of duration (48 vs. 24 h) and sampling rate of BP measurements (form every 20-30 min up to every 2 h) on the prognostic value of ABPM-derived parameters. We prospectively studied 3344 subjects (1718 men/1626 women), 52.6 ± 14.5 yrs of age, during a median follow-up of 5.6 yrs. Those with hypertension at baseline were randomized to ingest all their prescribed hypertension medications upon awakening or ≥1 of them at bedtime. At baseline, BP was measured at 20-min intervals from 07:00 to 23:00 h and at 30-min intervals at night for 48 h, and physical activity was simultaneously monitored every min by wrist actigraphy to accurately derive the awake and asleep BP means. Identical assessment was scheduled annually and more frequently (quarterly) if treatment adjustment was required. ABPM profiles were modified to generate time series of identical 48-h duration but with data sampled at 1- or 2-h intervals, or shorter, i.e., first 24 h, time series with data sampled at the original rate (daytime 20-min intervals/nighttime 30-min intervals). Bland-Altman plots indicated that the range of individual differences in the estimated awake and asleep systolic (SBP) and diastolic BP (DBP) means between the original and modified ABPM profiles was up to 3-fold smaller for data sampled every 1 h for 48 h than for data sampled every 20-30 min for the first 24 h. Reduction of ABPM duration to just 24 h resulted in error of the

  17. Utility of ambulatory 24-hour esophageal pH and motility monitoring in noncardiac chest pain: report of 90 patients and review of the literature.

    PubMed

    Lacima, Gloria; Grande, Luis; Pera, Manuel; Francino, Antonio; Ros, Emilio

    2003-05-01

    It is unclear whether prolonged motility monitoring improves the diagnostic yield of standard esophageal tests in patients with noncardiac chest pain. Our aim was to assess the diagnostic value of ambulatory 24-hr pH and pressure monitoring in patients with noncardiac chest pain. Stationary manometry, edrophonium testing, and ambulatory pH and motility studies were performed in 90 consecutive patients with recurrent chest pain and normal coronary angiograms. Normality limits of ambulatory 24-hr motility were established in 30 healthy controls. The diagnoses of specific esophageal motility disorders (nutcracker esophagus and diffuse esophageal spasm) by stationary and ambulatory manometry were discordant in 48% of the patients. Edrophonium testing was positive in 9 patients, but correlated poorly with esophageal diagnoses. During ambulatory studies, 144 chest pain events occurred in 42 patients, and 72 (50%) were related to esophageal dysfunction. Strict temporal associations of events with esophageal dysfunction in relation to ambulatory 24-hr pH/motility scores permitted four patient categorizations: true positives (event-related and abnormal tests), N = 15; true negatives (event-unrelated and abnormal tests), N = 10; reduced esophageal pain threshold (event-related and normal tests), N = 4; and indeterminate origin (event-unrelated and normal tests), N = 13. Overall, 19 patients (21%) had a probable esophageal cause for chest pain (14 esophageal motility disorder, 4 acid reflux, 1 both). In conclusion, ambulatory manometry increases the diagnostic yield of standard esophageal testing in noncardiac chest pain, but the gain is small. Causes of chest pain other than high esophageal pressures and acid reflux must still be sought in most patients with chest pain of unknown origin after a negative cardiac work-up.

  18. Impact of Stress Reduction Interventions on Hostility and Ambulatory Systolic Blood Pressure in African American Adolescents

    ERIC Educational Resources Information Center

    Wright, Lynda Brown; Gregoski, Mathew J.; Tingen, Martha S.; Barnes, Vernon A.; Treiber, Frank A.

    2011-01-01

    This study examined the impact of breathing awareness meditation (BAM), life skills (LS) training, and health education (HE) interventions on self-reported hostility and 24-hour ambulatory blood pressure (ABP) in 121 African American (AA) ninth graders at increased risk for development of essential hypertension. They were randomly assigned to BAM,…

  19. Preliminary report: the effect of a 6-month dietary glycemic index manipulation in addition to healthy eating advice and weight loss on arterial compliance and 24-hour ambulatory blood pressure in men: a pilot study.

    PubMed

    Philippou, Elena; Bovill-Taylor, Candace; Rajkumar, Chakravarthi; Vampa, Maria Luisa; Ntatsaki, Eleana; Brynes, Audrey E; Hickson, Mary; Frost, Gary S

    2009-12-01

    We aimed to determine whether altering dietary glycemic index (GI) in addition to healthy eating and weight loss advice affects arterial compliance and 24-hour blood pressure (BP), both coronary heart disease (CHD) risk factors. Middle-aged men with at least 1 CHD risk were randomized to a 6-month low-GI (LGI) or high-GI (HGI) diet. All were advised on healthy eating and weight loss. They were seen monthly to assess dietary compliance and anthropometrics. Carotid-femoral pulse wave velocity (PWV), fasting blood lipid profile, and glucose and insulin concentrations were measured at baseline and at months 3 and 6. Six-hour postprandial glucose and insulin responses and 24-hour ambulatory BP were also assessed at baseline and month 6. Thirty-eight subjects (HGI group, n = 16; LGI group, n = 22) completed the study. At month 6, groups differed in dietary GI, glycemic load, and carbohydrate intake (P < .001). Fasting insulin concentration and insulin resistance (calculated by homeostatic model assessment) were lower in the LGI than the HGI group (P < .01). The reduction in total cholesterol and 24-hour BP was bigger in the LGI than the HGI group (P < .05); and only the LGI group had significant reductions (P < .05) in PWV, low-density lipoprotein cholesterol, and triacylglycerol concentration. There were no differences in postprandial glucose or insulin responses between the groups. The results suggest that an LGI diet may be more beneficial in reducing CHD risk, including PWV and 24-hour BP, even in the setting of healthy eating and weight loss; and thus, further study is warranted.

  20. Effect of nasal continuous positive airway pressure during sleep on 24-hour blood pressure in obstructive sleep apnea.

    PubMed

    Wilcox, I; Grunstein, R R; Hedner, J A; Doyle, J; Collins, F L; Fletcher, P J; Kelly, D T; Sullivan, C E

    1993-09-01

    Ambulatory blood pressure (BP) was measured noninvasively (Oxford Medilog ABP) at 15-minute intervals for 24 hours before and after 8 weeks of treatment with nasal continuous positive airway pressure (nCPAP) in 19 men with obstructive sleep apnea (OSA). We included both normotensive and hypertensive patients, but hypertensives were studied after withdrawal of antihypertensive drugs. Ambulatory BP before and after treatment was compared using patients as their own controls. Treatment with nCPAP was successfully established in 14 of the 19 patients (74%). Blood pressure fell significantly in patients who were successfully treated: 24-hour mean BP (systolic/diastolic) decreased from 141 +/- 18/89 +/- 11 mm Hg to 134 +/- 19/85 +/- 13 mm Hg (p < 0.05). The reduction in 24-hour mean systolic BP occurred during both day and night, but a significant fall in mean diastolic BP was only observed during the day. The mean blood pressure fell in both normotensive and hypertensive patients. Patients who were inadequately treated with nCPAP had no reduction in mean 24-hour BP. Effective treatment of sleep apnea with nCPAP was associated with a significant fall in both systolic and diastolic BP independent of changes in body weight or alcohol consumption, suggesting that sleep apnea was an independent factor contributing to elevated nighttime and daytime BP in these patients.

  1. Physician-pharmacist co-management and 24-hour blood pressure control.

    PubMed

    Chen, Ziqian; Ernst, Michael E; Ardery, Gail; Xu, Yinghui; Carter, Barry L

    2013-05-01

    The objectives of this study were to compare indices of 24-hour blood pressure (BP) following a physician-pharmacist collaborative intervention and to describe the associated changes in antihypertensive medications. This was a secondary analysis of a prospective, cluster-randomized clinical trial conducted in 6 family medicine clinics randomized to co-managed (n=3 clinics, 176 patients) or control (n=3 clinics, 198 patients) groups. Mean ambulatory systolic BP (SBP) was significantly lower in the co-managed vs the control group: daytime BP 122.8 mm Hg vs 134.4 mm Hg (P<.001); nighttime SBP 114.8 mm Hg vs 123.7 mm Hg (P<.001); and 24-hour SBP 120.4 mm Hg vs 131.8 mm Hg (P<.001), respectively. Significantly more drug changes were made in the co-managed than in the control group (2.7 vs 1.1 changes per patient, P<.001), and there was greater diuretic use in co-managed patients (79.6% vs 62.6%, P<.001). Ambulatory BPs were significantly lower for the patients who had a diuretic added during the first month compared with those who never had a diuretic added (P<.01). Physician-pharmacist co-management significantly improved ambulatory BP compared with the control group. Antihypertensive drug therapy was intensified much more for patients in the co-managed group.

  2. Echocardiographic Assessment of Pulmonary Artery Systolic Pressure and Outcomes in Ambulatory Heart Failure Patients

    PubMed Central

    Kalogeropoulos, Andreas P.; Siwamogsatham, Sarawut; Hayek, Salim; Li, Song; Deka, Anjan; Marti, Catherine N.; Georgiopoulou, Vasiliki V.; Butler, Javed

    2014-01-01

    Background Pulmonary hypertension (PH) in patients with heart failure (HF) is associated with worse outcomes and is rapidly being recognized as a therapeutic target. To facilitate pragmatic research efforts, data regarding the prognostic importance of noninvasively assessed pulmonary artery systolic pressure (PASP) in stable ambulatory patients with HF are needed. Methods and Results We examined the association between echocardiographic PASP and outcomes in 417 outpatients with HF (age, 54±13 years; 60.7% men; 50.4% whites; 24.9% with preserved ejection fraction). Median PASP was 36 mm Hg (interquartile range [IQR]: 29, 46). After a median follow‐up of 2.6 years (IQR: 1.7, 3.9) there were 72 major events (57 deaths; 9 urgent heart transplants; and 6 ventricular assist device implantations) and 431 hospitalizations for HF. In models adjusting for clinical risk factors and therapy, a 10‐mm Hg higher PASP was associated with 37% higher risk (95% CI: 18, 59; P<0.001) for major events, and 11% higher risk (95% CI: 1, 23; P=0.039) for major events or HF hospitalization. The threshold that maximized the likelihood ratio for both endpoints was 48 mm Hg; those with PASP ≥48 mm Hg (N=84; 20.1%) had an adjusted hazard ratio of 3.33 (95% CI: 1.96, 5.65; P<0.001) for major events and 1.47 (95% CI: 1.02, 2.11; P=0.037) for major events or HF hospitalization. Reduced right ventricular systolic function had independent prognostic utility over PASP for adverse outcomes. Right atrial pressure and transtricuspid gradient both contributed to risk. Conclusions Elevated PASP, determined by echocardiography, identifies ambulatory patients with HF at increased risk for adverse events. PMID:24492947

  3. 24-h ambulatory recording of aortic pulse wave velocity and central systolic augmentation: a feasibility study.

    PubMed

    Luzardo, Leonella; Lujambio, Inés; Sottolano, Mariana; da Rosa, Alicia; Thijs, Lutgarde; Noboa, Oscar; Staessen, Jan A; Boggia, José

    2012-10-01

    We assessed the feasibility of ambulatory pulse wave analysis by comparing this approach with an established tonometric technique. We investigated 35 volunteers (45.6 years; 51.0% women) exclusively at rest (R study) and 83 volunteers (49.9 years; 61.4% women) at rest and during daytime (1000-2000 h) ambulatory monitoring (R+A study). We recorded central systolic (cSP), diastolic (cDP) and pulse (cPP) pressures, augmentation index (cAI) and pulse wave velocity (PWV) by brachial oscillometry (Mobil-O-Graph 24h PWA Monitor) and radial tonometry (SphygmoCor). We applied the Bland and Altman's statistics. In the R study, tonometric and oscillometric estimates of cSP (105.6 vs. 106.9 mm Hg), cDP (74.6 vs. 74.7 mm Hg), cPP (31.0 vs. 32.1 mm Hg), cAI (21.1 vs. 20.6%) and PWV (7.3 vs. 7.0 m s(-1)) were similar (P0.11). In the R+A study, tonometric vs. oscillometric assessment yielded similar values for cSP (115.4 vs. 113.9 mm Hg; P=0.19) and cAI (26.5 vs. 25.3%; P=0.54), but lower cDP (77.8 vs. 81.9 mm Hg; P<0.0001), so that cPP was higher (37.6 vs. 32.1 mm Hg; P<0.0001). PWV (7.9 vs. 7.4 m s(-1)) was higher (P=0.0002) on tonometric assessment. The differences between tonometric and oscillometric estimates increased (P0.004) with cSP (r=0.37), cAI (r=0.39) and PWV (r=0.39), but not (P0.17) with cDP (r=0.15) or cPP (r=0.13). Irrespective of measurement conditions, brachial oscillometry compared with an established tonometric method provided similar estimates for cSP and systolic augmentation, but slightly underestimated PWV. Pending further validation, ambulatory assessment of central hemodynamic variables is feasible.

  4. 24-Hour Relativistic Bit Commitment

    NASA Astrophysics Data System (ADS)

    Verbanis, Ephanielle; Martin, Anthony; Houlmann, Raphaël; Boso, Gianluca; Bussières, Félix; Zbinden, Hugo

    2016-09-01

    Bit commitment is a fundamental cryptographic primitive in which a party wishes to commit a secret bit to another party. Perfect security between mistrustful parties is unfortunately impossible to achieve through the asynchronous exchange of classical and quantum messages. Perfect security can nonetheless be achieved if each party splits into two agents exchanging classical information at times and locations satisfying strict relativistic constraints. A relativistic multiround protocol to achieve this was previously proposed and used to implement a 2-millisecond commitment time. Much longer durations were initially thought to be insecure, but recent theoretical progress showed that this is not so. In this Letter, we report on the implementation of a 24-hour bit commitment solely based on timed high-speed optical communication and fast data processing, with all agents located within the city of Geneva. This duration is more than 6 orders of magnitude longer than before, and we argue that it could be extended to one year and allow much more flexibility on the locations of the agents. Our implementation offers a practical and viable solution for use in applications such as digital signatures, secure voting and honesty-preserving auctions.

  5. The 24-hour pulse wave velocity, aortic augmentation index, and central blood pressure in normotensive volunteers.

    PubMed

    Kuznetsova, Tatyana Y; Korneva, Viktoria A; Bryantseva, Evgeniya N; Barkan, Vitaliy S; Orlov, Artemy V; Posokhov, Igor N; Rogoza, Anatoly N

    2014-01-01

    The purpose of this study was to examine the pulse wave velocity, aortic augmentation index corrected for heart rate 75 (AIx@75), and central systolic and diastolic blood pressure during 24-hour monitoring in normotensive volunteers. Overall, 467 subjects (206 men and 261 women) were recruited in this study. Participants were excluded from the study if they were less than 19 years of age, had blood test abnormalities, had a body mass index greater than 2 7.5 kg/m(2), had impaired glucose tolerance, or had hypotension or hypertension. Ambulatory blood pressure monitoring (ABPM) with the BPLab(®) device was performed in each subject. ABPM waveforms were analyzed using the special automatic Vasotens(®) algorithm, which allows the calculation of pulse wave velocity, AIx@75, central systolic and diastolic blood pressure for "24-hour", "awake", and "asleep" periods. Circadian rhythms and sex differences in these indexes were identified. Pending further validation in prospective outcome-based studies, our data may be used as preliminary diagnostic values for the BPLab ABPM additional index in adult subjects.

  6. 24-Hour Academic Libraries: Adjusting to Change

    ERIC Educational Resources Information Center

    Bowman, Adam C.

    2013-01-01

    The purpose of this study was to explore the adaptive measures that academic libraries perform when implementing and operating a 24-hour schedule. Five in-depth interviews were conducted with current managerial-level librarians at 24-hour academic libraries. The exploratory interviews revealed similar measures for security, budgeting, employee…

  7. The 24-Hour Mathematical Modeling Challenge

    ERIC Educational Resources Information Center

    Galluzzo, Benjamin J.; Wendt, Theodore J.

    2015-01-01

    Across the mathematics curriculum there is a renewed emphasis on applications of mathematics and on mathematical modeling. Providing students with modeling experiences beyond the ordinary classroom setting remains a challenge, however. In this article, we describe the 24-hour Mathematical Modeling Challenge, an extracurricular event that exposes…

  8. Low correlation between visit-to-visit variability and 24-hour variability of blood pressure

    PubMed Central

    Muntner, Paul; Shimbo, Daichi; Diaz, Keith M.; Newman, Jonathan; Sloan, Richard P.; Schwartz, Joseph E.

    2013-01-01

    Visit-to-visit variability (VVV) of clinic systolic blood pressure (SBP) has been associated with cardiovascular disease risk. Given the need for obtaining blood pressure (BP) at multiple visits to calculate VVV, substituting BP variability from ambulatory blood pressure monitoring (ABPM) may be a practical alternative. We assessed the correlation between VVV of BP and BP variability from ABPM using data from 146 untreated, mostly normotensive participants (mean age 47.9 years) in a substudy of the ongoing Masked Hypertension Study. VVV of SBP and diastolic blood pressure (DBP) was estimated by the standard deviation (SDvvv) and average real variability (ARVvvv) from 6 study visits over a median of 216 days. ABPM data were used to calculate the day-night SD (SDdn) and the ARV of SBP and DBP over 24 hours (ARV24). For SBP, the mean SDvvv and SDdn were 6.3 (SD=2.5) and 8.8 (SD=1.8) mmHg, respectively, and mean ARVvvv and ARV24 were 7.2 (SD=3.2) and 8.4 (SD=2.1) mmHg, respectively. The Spearman correlation coefficient between SDvvv and SDdn of SBP was rs=0.25 and between ARVvvv and ARV24 was rs=0.17. Participants in the highest quartile of SDdn of SBP were 1.66 (95% CI: 0.93 – 2.75) times more likely to be in the highest quartile of SDvvv of SBP. The observed-to-expected ratio between the highest quartiles of ARVvvv and ARV24 of SBP was 0.89 (95% CI: 0.41 – 1.69). The correlations for SDvvv and SDdn and ARVvvv and ARV24 of DBP were minimal. These data suggest VVV and 24-hour variability are weakly correlated and not interchangeable. PMID:23784506

  9. Aldosterone-to-Renin Ratio Is Associated With Reduced 24-Hour Heart Rate Variability and QTc Prolongation in Hypertensive Patients.

    PubMed

    Grübler, Martin R; Kienreich, Katharina; Gaksch, Martin; Verheyen, Nicolas; Hartaigh, Bríain Ó; Fahrleitner-Pammer, Astrid; März, Winfried; Schmid, Johannes; Oberreither, Eva-Maria; Wetzel, Julia; Catena, Cristiana; Sechi, Leonardo A; Pieske, Burkert; Tomaschitz, Andreas; Pilz, Stefan

    2016-02-01

    Aldosterone is considered to exert direct effects on the myocardium and the sympathetic nervous system. Both QT time and heart rate (HR) variability (HRV) are considered to be markers of arrhythmic risk and autonomous dysregulation. In this study, we investigated the associations between aldosterone, QT time, and HRV in patients with arterial hypertension.We recruited 477 hypertensive patients (age: 60.2 ± 10.2 years; 52.3% females) with a mean systolic/diastolic 24-hour ambulatory blood pressure monitoring (ABPM) value of 128 ± 12.8/77.1 ± 9.2 mmHg and with a median of 2 (IQR: 1-3) antihypertensive agents. Patients were recruited from the outpatient clinic at the Department of Internal Medicine of the Medical University of Graz, Austria. Blood samples, 24-hour HRV derived from 24-hour blood pressure monitoring (ABPM) and ECG's were obtained. Plasma aldosterone and plasma renin concentrations were measured by means of a radioimmunoassay. Twenty-four-hour urine specimens were collected in parallel with ABPM.Mean QTc was 423.3 ± 42.0 milliseconds for males and 434.7 ± 38.3 milliseconds for females. Mean 24H-HR and 24H-HRV was 71.9 ± 9.8 and 10.0 ± 3.6 bpm, respectively. In linear regression analyses adjusted for age, sex, body mass index, ABPM, and current medication, aldosterone to active renin ratio (AARR) was significantly associated with the QTc interval, a marker for cardiac repolarization abnormalities (mean = 426 ± 42.4 milliseconds; β-coefficient = 0.121; P = 0.03) as well as with the 24-hour heart rate variability a surrogate for autonomic dysfunction (median = 9.67 [IQR = 7.38-12.22 bpm]; β-coefficient = -0.133; P = 0.01).In hypertensive patients, AARR is significantly related to QTc prolongation as well as HRV. Further studies investigating the effects of mineralocorticoid receptor blocker and aldosterone synthase inhibitors on QTc and HRV are warranted.

  10. Acute and chronic effects of a hypocaloric diet on 24-hour blood pressure, heart rate and heart-rate variability in mildly-to-moderately obese patients with essential hypertension.

    PubMed

    Minami, J; Kawano, Y; Ishimitsu, T; Matsuoka, H; Takishita, S

    1999-11-01

    We examined the acute and chronic effects of a nutritionally balanced, moderately hypocaloric diet on 24-hour ambulatory blood pressure, heart rate and heart-rate variability in mildly-to-moderately obese patients with essential hypertension. We enrolled 16 obese patients with essential hypertension [age: 51-76 years, body mass index (BMI): 26-32 kg/m2]. For the initial week, a standard diet of 2,000 kcal/day was given, followed by a 3-week of a hypocaloric diet of 850 kcal/day. In the last period of the standard diet and in the first and the last periods of the hypocaloric diet, each subject's 24-hour ambulatory blood pressure, heart rate and R-R intervals of the electrocardiogram were recorded, and electrolytes and catecholamines in 24-hour urine samples were also measured. A power spectral analysis of the heart-rate variability was performed over a 24-hour period based on the autoregressive method. The subjects lost 3.7+/-0.3 kg (mean +/- s.e.m.) of body weight during the 3-week hypocaloric diet period. The 24-hour blood pressure did not differ between the last period of the standard diet and the first period of the hypocaloric diet; however, it showed a significant reduction after 3 weeks of the hypocaloric diet. The decrease in the 24-hour blood pressure during the study period was 10.5+/-1.5 mm Hg systole and 4.3+/-1.8 mm Hg diastole. In contrast, the 24-hour heart rate was significantly reduced in the first period of the hypocaloric diet, although the body weight and blood pressure did not change, and the rate was maintained even in the last period of the hypocaloric diet. The decrease in the 24-hour heart rate during the study period was 2.8+/-0.9 beats per minute. The hypocaloric diet did not change any autonomic indices obtained from a power spectral analysis of the heart-rate variability. In conclusion, different responses to a hypocaloric diet were observed between the blood pressure and the heart rate in obese hypertensive patients. The changes in

  11. Human prolactin - 24-hour pattern with increased release during sleep.

    NASA Technical Reports Server (NTRS)

    Sassin, J. F.; Weitzman, E. D.; Kapen, S.; Frantz, A. G.

    1972-01-01

    Human prolactin was measured in plasma by radioimmunoassay at 20-minute intervals for a 24-hour period in each of six normal adults, whose sleep-wake cycles were monitored polygraphically. A marked diurnal variation in plasma concentrations was demonstrated, with highest values during sleep. Periods of episodic release occurred throughout the 24 hours.

  12. Correlation of 24-Hour Blood Pressure and Heart Rate Variability to Renal Function Parameters in Hypertensive Patients. The Effect of Smoking.

    PubMed

    Liakos, Charalampos I; Karpanou, Eva A; Markou, Maria I; Grassos, Charalampos A; Vyssoulis, Gregory P

    2015-12-01

    Intrarenal hemodynamics depend on blood pressure (BP), heart rate (HR), and smoking. Although BP levels have been associated with kidney function, the effect of HR levels, BP, and HR variability on renal function are less well clarified. This cross-sectional study sought to determine the association of 24-hour BP and HR variability with kidney function in hypertensive patients, stratified by smoking. The study comprised 9600 nondiabetic, never-treated hypertensive individuals without evident renal impairment examined from 1985 to 2014 (aged 53.3±13.4 years, 55.3% males). The 24-hour systolic BP (SBP) and HR variability were estimated via their coefficient of variation (CV =standard deviation×100/mean value) derived from ambulatory recording. The CV SBP-to-CV HR ratio (CV R) was used as a marker of the interplay between 24-hour SBP and HR variability. Renal function was estimated via 24-hour urine creatinine clearance (CrCl), estimated glomerular filtration rate (eGFR), albumin-to-creatinine ratio (ACR), and 24-hour urine α1 -microglobulin. After adjustment for age, sex, and smoking, CV SBP was found to be weakly correlated to eGFR (r=-0.017, P=.1) and somewhat more strongly to CrCl, ACR, and α1 -microglobulin (r=-0.032, 0.072, and 0.065; P=.002, <.001 and <.001, respectively). CV HR was much better related to renal function, with stronger adjusted correlations to CrCl, eGFR, ACR, and α1 -microglobulin (r=0.185, 0.134, -0.306, -0.247; all P<.001, respectively). CV R also showed equally good adjusted correlations (r=-0.175, -0.125, 0.336, 0.262; all P<.001, respectively). Most adjusted correlations for CV HR and CV R were even better in smokers (r=0.213, 0.158, -0.332, -0.272 and -0.183, -0.118, 0.351, 0.275, respectively; all P<.001). CV HR and CV R emerge as better related to kidney function than CV SBP, especially in smokers. The correlation of CV HR and CV SBP to renal function is inverse to each other. ACR and α1 -microglobulin are better related to

  13. 29 CFR 785.21 - Less than 24-hour duty.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Sleeping Time and Certain Other Activities § 785.21 Less than 24-hour duty. An employee who is required to... difference that she is furnished facilities for sleeping. Her time is given to her employer. She is...

  14. 29 CFR 785.21 - Less than 24-hour duty.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Sleeping Time and Certain Other Activities § 785.21 Less than 24-hour duty. An employee who is required to... difference that she is furnished facilities for sleeping. Her time is given to her employer. She is...

  15. 29 CFR 785.21 - Less than 24-hour duty.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Sleeping Time and Certain Other Activities § 785.21 Less than 24-hour duty. An employee who is required to... difference that she is furnished facilities for sleeping. Her time is given to her employer. She is...

  16. 29 CFR 785.21 - Less than 24-hour duty.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Sleeping Time and Certain Other Activities § 785.21 Less than 24-hour duty. An employee who is required to... difference that she is furnished facilities for sleeping. Her time is given to her employer. She is...

  17. 29 CFR 785.21 - Less than 24-hour duty.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Sleeping Time and Certain Other Activities § 785.21 Less than 24-hour duty. An employee who is required to... difference that she is furnished facilities for sleeping. Her time is given to her employer. She is...

  18. High serum lactate level may predict death within 24 hours

    PubMed Central

    Zoubi, Abd Almajid; Kuria, Shiran; Blum, Nava

    2015-01-01

    Background Unexpected death within 24 hours of admission is a real challenge for the clinician in the emergency room. How to diagnose these patients and the right approach to prevent sudden death with 24 hours is still an enigma. The aims of our study were to find the independent factors that may affect the clinical outcome in the first 24 hours of admission to the hospital. Methods We performed a retrospective study defining unexpected death within 24 hours of admission in our Department of Medicine in the last 6 years. We found 43 patients who died within 24 hours of admission, and compared their clinical and biochemical characteristics to 6055 consecutive patients who were admitted in that period of time and did not die within the first 24 hours of admission. The parameters that were used include gender, age, temperature, clinical and laboratory criteria for SIRS, arterial blood lactate, and arterial blood pH. Results Most of the patients who died within 24 hours had sepsis with SIRS. These patients were older (78.6±14.7 vs. 65.2±20.2 years [p<.0001]), had higher lactate levels (8.0±4.8 vs. 2.1±1.8mmol/L [p<.0001]), and lower pH (7.2±0.2 vs. 7.4±0.1 [p<.0001]). Logistic regression analysis found that lactate was the strongest independent parameter to predict death within 24 hours of admission (OR 1.366 [95% CI 1.235–1.512]), followed by old age (OR 1.048 [95% CI 1.048–1.075] and low arterial blood pH (OR 0.007 [CI <0.001–0.147]). When gender was analyzed, pH was not an independent variable in females (only in males). Conclusions The significant independent variable that predicted death within 24 hours of admission was arterial blood lactate level on admission. Older age was also an independent variable; low pH affected only males, but was a less dominant variable. We suggest use of arterial blood lactate level on admission as a bio-marker in patients with suspected sepsis admitted to the hospital for risk assessment and prediction of death within 24

  19. Impact of Different Normality Thresholds for 24-hour ABPM at the Primary Health Care Level

    PubMed Central

    Grezzana, Guilherme Brasil; Moraes, David William; Stein, Airton Tetelbon; Pellanda, Lucia Campos

    2017-01-01

    Background Hypertension is an important risk factor for cardiovascular outcomes. Primary health care (PHC) physicians should be prepared to act appropriately in the prevention of cardiovascular risk factors. However, the rates of patients with control of blood pressure (BP) remain low. The impact of the reclassification of high BP by 24-hour ambulatory BP monitoring (ABPM) can lead to different medical decisions in PHC. Objective To evaluate the agreement between the BP measured by a conventional method by PHC physicians and by 24-hour ABPM, considering different BP normal thresholds for the 24-hour ABPM according to the V Brazilian ABPM Guidelines and the European Society of Hypertension Guidelines. Methods A cross-sectional study including 569 hypertensive patients. The BP was initially measured by the PHC physicians and, later, by 24-hour ABPM. The BP measurements were obtained independently between the two methods. The therapeutic targets for the conventional BP followed the guidelines by the Eighth Joint National Committee (JNC 8), the V ABPM Brazilian Guidelines, and the 2013 European Hypertension Guidelines. Results There was an accuracy of 54.8% (95% confidence interval [95%CI] 0.51 - 0.58%) for the BP measured with the conventional method when compared with the 24-hour ABPM, with a sensitivity of 85% (95%CI 80.8 - 88.6%), specificity of 31.9% (95%CI 28.7 - 34.7%), and kappa value of 0.155, when considering the European Hypertension Guidelines. When using more stringent thresholds to characterize the BP as "normal" by ABPM, the accuracy was 45% (95%CI 0.41 - 0.47%) for conventional measurement when compared with 24-hour ABPM, with a sensitivity of 86.7% (95%CI 0.81 - 0.91%), specificity of 29% (95%CI 0.26 - 0.30%), and kappa value of 0.103. Conclusion The BP measurements obtained by PHC physicians showed low accuracy when compared with those obtained by 24-hour ABPM, regardless of the threshold set by the different guidelines. PMID:28099585

  20. Cognitive Function in Ambulatory Patients with Systolic Heart Failure: Insights from the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) Trial

    PubMed Central

    Graham, Susan; Ye, Siqin; Qian, Min; Sanford, Alexandra R.; Di Tullio, Marco R.; Sacco, Ralph L.; Mann, Douglas L.; Levin, Bruce; Pullicino, Patrick M.; Freudenberger, Ronald S.; Teerlink, John R.; Mohr, J. P.; Labovitz, Arthur J.; Lip, Gregory Y. H.; Estol, Conrado J.; Lok, Dirk J.; Ponikowski, Piotr; Anker, Stefan D.; Thompson, John L. P.; Homma, Shunichi

    2014-01-01

    We sought to determine whether cognitive function in stable outpatients with heart failure (HF) is affected by HF severity. A retrospective, cross-sectional analysis was performed using data from 2, 043 outpatients with systolic HF and without prior stroke enrolled in the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) Trial. Multivariable regression analysis was used to assess the relationship between cognitive function measured using the Mini-Mental Status Exam (MMSE) and markers of HF severity (left ventricular ejection fraction [LVEF], New York Heart Association [NYHA] functional class, and 6-minute walk distance). The mean (SD) for the MMSE was 28.6 (2.0), with 64 (3.1%) of the 2,043 patients meeting the cut-off of MMSE <24 that indicates need for further evaluation of cognitive impairment. After adjustment for demographic and clinical covariates, 6-minute walk distance (β-coefficient 0.002, p<0.0001), but not LVEF or NYHA functional class, was independently associated with the MMSE as a continuous measure. Age, education, smoking status, body mass index, and hemoglobin level were also independently associated with the MMSE. In conclusion, six-minute walk distance, but not LVEF or NYHA functional class, was an important predictor of cognitive function in ambulatory patients with systolic heart failure. PMID:25426862

  1. Ambulatory arterial stiffness index is not associated with magnetic resonance imaging markers of cerebral small vessel disease in lacunar stroke patients.

    PubMed

    Klarenbeek, Pim; van Oostenbrugge, Robert J; Staals, Julie

    2015-05-01

    Ambulatory arterial stiffness index (AASI) is associated with microvascular damage in other organs, but the association with microvascular brain damage is unknown. The association of AASI with magnetic resonance imaging (MRI) markers of cerebral small vessel disease in 143 patients with lacunar stroke was investigated. We performed 24-hour ambulatory blood pressure monitoring and scored the presence of lacunes, white matter hyperintensities, perivascular spaces, and cerebral microbleeds on brain MRI. In logistic regression analyses, AASI was associated with white matter hyperintensities, but, after adjustment for age and sex, this association lost significance. AASI was not associated with lacunes, microbleeds, or perivascular spaces. Systolic and diastolic 24-hour blood pressure values were associated with lacunes, perivascular spaces, and microbleeds independent of age and sex. Despite its significance and growing interest as a possible prognostic and therapeutic target in (micro)vascular diseases, AASI seems to have no added value over standard 24-hour blood pressure in cerebral small vessel disease.

  2. The 24 Hours before Hospitalization: Factors Related to Suicide Attempting.

    ERIC Educational Resources Information Center

    Chiles, John A.; And Others

    1986-01-01

    Psychiatric inpatients (N=59) were interviewd concerning psychological and environmental events that occurred in the 24 hours prior to their hospitalization. Suicide attempters were more likely to have used alcohol or marijuana and less likely to have contacted a health care professional than suicide ideators, even when past history of suicide…

  3. 24-hour rhythmicity of seizures in refractory focal epilepsy.

    PubMed

    Nzwalo, Hipólito; Menezes Cordeiro, Inês; Santos, Ana Catarina; Peralta, Rita; Paiva, Teresa; Bentes, Carla

    2016-02-01

    The occurrence of seizures in specific types of epilepsies can follow a 24-hour nonuniform or nonrandom pattern. We described the 24-hour pattern of clinical seizures in patients with focal refractory epilepsy who underwent video-electroencephalography monitoring. Only patients who were candidates for epilepsy surgery with an unequivocal seizure focus were included in the study. A total of 544 seizures from 123 consecutive patients were analyzed. Specific time of seizures were distributed along 3- or 4-hour time blocks or bins throughout the 24-hour period. The mean age of the subjects was 37.7 years, with standard deviation of 11.5 years, median of 37. The majority were females (70/56%). The majority of patients had a seizure focus located in the mesial temporal lobe (102/83%) and in the neocortical temporal lobe (13/11%). The remaining patients had a seizure focus located in the extratemporal lobe (8/6%). The most common etiology was mesial temporal sclerosis (86/69.9%). Nonuniform seizure distribution was observed in seizures arising from the temporal lobe (mesial temporal lobe and neocortical temporal lobe), with two peaks found in both 3- and 4-hour bins: 10:00-13:00/16:00-19:00 and 08:00-12:00/16:00-20:00 respectively (p=0.004). No specific 24-hour pattern was identified in seizures from extratemporal location. The 24-hour rhythmicity of seizure distribution is recognized in certain types of epilepsy, but studies on the topic are scarce. Their replication and validation is therefore needed. Our study confirms the bimodal pattern of temporal lobe epilepsy independently of the nature of the lesion. However, peak times differ between different studies, suggesting that the ambient, rhythmic exogenous factors or environmental/social zeitgebers, may modulate the 24-hour rhythmicity of seizures. Characterization of these 24-hour patterns of seizure occurrence can influence diagnosis and treatment in selected types of epilepsy, such as the case of temporal lobe

  4. Seasonal changes of 24-hour intraocular pressure rhythm in healthy Shanghai population

    PubMed Central

    Cheng, Jingyi; Xiao, Ming; Xu, Huan; Fang, Shaobin; Chen, Xu; Kong, Xiangmei; Sun, Xinghuai

    2016-01-01

    Abstract The aim of the present study was to investigate and compare the 24-hour intraocular pressure (IOP) rhythms in winter and summer in the healthy population of Shanghai, China. This is a cross-sectional study in which 24-hour IOP measurements were taken for all eligible healthy volunteers in winter and summer, respectively, and the temperature, hours of sunlight (sunlight time), and circulatory parameters, including heart rate, systolic blood pressure, and diastolic blood pressure, were also recorded. The 24-hour IOP curves and IOP parameters (mean, peak, trough, and fluctuation of IOP together with the diurnal-to-nocturnal IOP change) in winter and summer were obtained and compared. The magnitude of IOP changes from summer to winter was also calculated. A total of 29 participants (58 eyes), 14 (48.28%) male and 15 (51.72%) female, aged 43.66 ± 12.20 (19–61) years, were considered eligible for this study. Generally, IOP decreased progressively before noon, increased notably in the nocturnal period, and peaked at 12:00 am in winter and at 2:00 am in summer. The pattern of 24-hour IOP in winter and summer was significantly different (P = 0.002). The average IOPs from 4:00 pm to 8:00 am, except for 6:00 am, were significantly higher in winter (P < 0.05). However, no significant differences were shown after adjusting for temperature and/or sunlight time. From summer to winter, the extent of IOP increase was mostly around 0 to 3 mm Hg, and the IOPs increased more significantly in the nocturnal period than in the diurnal period (P = 0.05). The 24-hour IOP rhythms were different in winter and summer, with higher IOP level in winter. Temperature and sunlight time, which are independent of heart rate and blood pressure, affected the 24-hour IOP rhythms in healthy people in Shanghai, China. Further investigations are expected for the rhythm of some endogenous substance secretion and the inner mechanism of regulation of IOP. PMID:27495076

  5. Associations of ambulatory blood pressure with urinary caffeine and caffeine metabolite excretions.

    PubMed

    Guessous, Idris; Pruijm, Menno; Ponte, Belén; Ackermann, Daniel; Ehret, Georg; Ansermot, Nicolas; Vuistiner, Philippe; Staessen, Jan; Gu, Yumei; Paccaud, Fred; Mohaupt, Markus; Vogt, Bruno; Pechère-Bertschi, Antoinette; Pechère-Berstchi, Antoinette; Martin, Pierre-Yves; Burnier, Michel; Eap, Chin B; Bochud, Murielle

    2015-03-01

    Intake of caffeinated beverages might be associated with reduced cardiovascular mortality possibly via the lowering of blood pressure. We estimated the association of ambulatory blood pressure with urinary caffeine and caffeine metabolites in a population-based sample. Families were randomly selected from the general population of Swiss cities. Ambulatory blood pressure monitoring was conducted using validated devices. Urinary caffeine, paraxanthine, theophylline, and theobromine excretions were measured in 24 hours urine using ultrahigh performance liquid chromatography tandem mass spectrometry. We used mixed models to explore the associations of urinary excretions with blood pressure although adjusting for major confounders. The 836 participants (48.9% men) included in this analysis had mean age of 47.8 and mean 24-hour systolic and diastolic blood pressure of 120.1 and 78.0 mm Hg. For each doubling of caffeine excretion, 24-hour and night-time systolic blood pressure decreased by 0.642 and 1.107 mm Hg (both P values <0.040). Similar inverse associations were observed for paraxanthine and theophylline. Adjusted night-time systolic blood pressure in the first (lowest), second, third, and fourth (highest) quartile of paraxanthine urinary excretions were 110.3, 107.3, 107.3, and 105.1 mm Hg, respectively (P trend <0.05). No associations of urinary excretions with diastolic blood pressure were generally found, and theobromine excretion was not associated with blood pressure. Anti-hypertensive therapy, diabetes mellitus, and alcohol consumption modify the association of caffeine urinary excretion with systolic blood pressure. Ambulatory systolic blood pressure was inversely associated with urinary excretions of caffeine and other caffeine metabolites. Our results are compatible with a potential protective effect of caffeine on blood pressure.

  6. Is 24-hour Intraocular Pressure Monitoring Necessary in Glaucoma?

    PubMed Central

    Mansouri, Kaweh; Weinreb, Robert N.; Medeiros, Felipe A.

    2013-01-01

    Although intraocular pressure (IOP) is the only treatable risk factor for glaucoma, its 24-hour behavior is poorly understood. Conflicting information is available in the literature with regard to the importance and predictive value of IOP peaks and fluctuations on the risk of glaucoma development and progression. This may be secondary to lack of prospective studies designed to address this issue. This article critically reviews the current evidence for the importance of 24-h IOP measurements in glaucoma and discusses shortcomings of current methods to assess 24-h IOP data, drawing attention to new developments in this field. PMID:23697618

  7. The effects of calcium supplementation on ambulatory blood pressure in African-American adolescents.

    PubMed Central

    Davis, I. J.; Grim, C.; Dwyer, K.; Nicholson, L.; Dwyer, J.

    1996-01-01

    This longitudinal trial investigated the effects of calcium supplementation on the mean 24-hour blood pressure in African-American adolescents. Subjects were self-identified African-American adolescents from a high school in a suburb of Los Angeles, California. The subjects were randomly placed in a placebo or treatment group (placebo versus 1.5 g of calcium/day x 4 weeks). Follow-up mean 24-hour ambulatory blood pressure (ABP) for both the treatment and control groups was lower than the baseline mean 24-hour ABP. In the treatment group, there was a decrease of 2.2 mm Hg in the mean systolic blood pressure and 0.7 mm Hg in the diastolic blood pressure. Relative to the placebo group, the net change in ABP was -1.7 mm Hg for systolic blood pressure and -0.5 mm Hg for the diastolic blood pressure. There was no statistically significant effect of calcium supplementation on the 24-hour mean ABP. The net effect of supplementation on ABP during waking and sleeping hours also was not significant. PMID:8990802

  8. Crossover comparison of atenolol, enalapril, hydrochlorothiazide and isradipine for isolated systolic systemic hypertension.

    PubMed

    Silagy, C A; McNeil, J J; McGrath, B P

    1992-11-15

    The benefit of antihypertensive therapy in reducing cardiovascular morbidity and mortality associated with isolated systolic hypertension has now been established by the Systolic Hypertension in the Elderly Program. However, there is little information about the relative effectiveness of different drug regimens in this condition. This study compared the efficacy and tolerability of 50 mg of atenolol, 10 mg of enalapril, 25 mg of hydrochlorothiazide and 2.5 mg of isradipine in the treatment of isolated systolic hypertension. After a 3-week placebo run-in phase, 24 subjects were randomized into a 4-period double-blind crossover study by use of an orthogonal latin square design. Treatment periods were of 6 weeks' duration with titration to a higher dose after 4 weeks in those not reaching goal blood pressure (BP). Each active treatment was followed by a 3-week placebo washout. Casual clinic and 24-hour ambulatory BP (Accutracker II) were measured at the end of each treatment phase. Routine biochemistry was also performed after the placebo run-in, at the end of each active treatment phase, and after the placebo run-out. Of the 24 subjects entered (mean age 72.3 years, 38% men) 20 completed the whole study. Mean +/- standard deviation of supine clinic and daytime ambulatory BP on entry were 181/79 +/- 21/9 mm Hg and 165/82 +/- 23/15 mm Hg, respectively. All drugs reduced mean casual and ambulatory BP significantly relative to placebo but only hydrochlorothiazide and enalapril produced a consistent hypotensive effect throughout the entire 24-hour period. Isradipine and enalapril exhibited a relatively greater effect on reducing systolic BP than either hydrochlorothiazide or atenolol.(ABSTRACT TRUNCATED AT 250 WORDS)

  9. Managing sleep and wakefulness in a 24-hour world.

    PubMed

    Coveney, Catherine M

    2014-01-01

    This article contributes to literature on the sociology of sleep by exploring the sleeping practices and subjective sleep experiences of two social groups: shift workers and students. It draws on data, collected in the UK from 25 semi-structured interviews, to discuss the complex ways in which working patterns and social activities impact upon experiences and expectations of sleep in our wired awake world. The data show that, typically, sleep is valued and considered to be important for health, general wellbeing, appearance and physical and cognitive functioning. However, sleep time is often cut back on in favour of work demands and social activities. While shift workers described their efforts to fit in an adequate amount of sleep per 24-hour period, for students, the adoption of a flexible sleep routine was thought to be favourable for maintaining a work-social life balance. Collectively, respondents reported using a wide range of strategies, techniques, technologies and practices to encourage, overcome or delay sleep(iness) and boost, promote or enhance wakefulness/alertness at socially desirable times. The analysis demonstrates how social context impacts not only on how we come to think about sleep and understand it, but also how we manage or self-regulate our sleeping patterns.

  10. Managing sleep and wakefulness in a 24-hour world

    PubMed Central

    Coveney, Catherine M

    2014-01-01

    This article contributes to literature on the sociology of sleep by exploring the sleeping practices and subjective sleep experiences of two social groups: shift workers and students. It draws on data, collected in the UK from 25 semi-structured interviews, to discuss the complex ways in which working patterns and social activities impact upon experiences and expectations of sleep in our wired awake world. The data show that, typically, sleep is valued and considered to be important for health, general wellbeing, appearance and physical and cognitive functioning. However, sleep time is often cut back on in favour of work demands and social activities. While shift workers described their efforts to fit in an adequate amount of sleep per 24-hour period, for students, the adoption of a flexible sleep routine was thought to be favourable for maintaining a work–social life balance. Collectively, respondents reported using a wide range of strategies, techniques, technologies and practices to encourage, overcome or delay sleep(iness) and boost, promote or enhance wakefulness/alertness at socially desirable times. The analysis demonstrates how social context impacts not only on how we come to think about sleep and understand it, but also how we manage or self-regulate our sleeping patterns. PMID:23957268

  11. Cognitive Performance during a 24-Hour Cold Exposure Survival Simulation

    PubMed Central

    Hartley, Geoffrey L.; Zaharieva, Dessi; Basset, Fabien A.; Hynes, Zach

    2016-01-01

    Survivor of a ship ground in polar regions may have to wait more than five days before being rescued. Therefore, the purpose of this study was to explore cognitive performance during prolonged cold exposure. Core temperature (Tc) and cognitive test battery (CTB) performance data were collected from eight participants during 24 hours of cold exposure (7.5°C ambient air temperature). Participants (recruited from those who have regular occupational exposure to cold) were instructed that they could freely engage in minimal exercise that was perceived to maintaining a tolerable level of thermal comfort. Despite the active engagement, test conditions were sufficient to significantly decrease Tc after exposure and to eliminate the typical 0.5–1.0°C circadian rise and drop in core temperature throughout a 24 h cycle. Results showed minimal changes in CTB performance regardless of exposure time. Based on the results, it is recommended that survivors who are waiting for rescue should be encouraged to engage in mild physical activity, which could have the benefit of maintaining metabolic heat production, improve motivation, and act as a distractor from cold discomfort. This recommendation should be taken into consideration during future research and when considering guidelines for mandatory survival equipment regarding cognitive performance. PMID:27478839

  12. Reduced effect of percutaneous renal denervation on blood pressure in patients with isolated systolic hypertension.

    PubMed

    Ewen, Sebastian; Ukena, Christian; Linz, Dominik; Kindermann, Ingrid; Cremers, Bodo; Laufs, Ulrich; Wagenpfeil, Stefan; Schmieder, Roland E; Böhm, Michael; Mahfoud, Felix

    2015-01-01

    Renal denervation can reduce blood pressure in certain patients with resistant hypertension. The effect in patients with isolated systolic hypertension (ISH, ≥140/<90 mm Hg) is unknown. This study investigated the effects of renal denervation in 126 patients divided into 63 patients with ISH and 63 patients with combined hypertension (CH, ≥140/≥90 mm Hg) defined as baseline office systolic blood pressure (SBP) ≥140 mm Hg despite treatment with ≥3 antihypertensive agents. Renal denervation significantly reduced office SBP and diastolic blood pressure (DBP) at 3, 6, and 12 months by 17/18/17 and 5/4/4 mm Hg in ISH and by 28/27/30 and 13/16/18 mm Hg in CH, respectively. The reduction in SBP and DBP in ISH was lower compared with patients with CH at all observed time points (P<0.05 for SBP/DBP intergroup comparison). The nonresponder rate (change in office SBP <10 mm Hg) after 6 months was 37% in ISH and 21% in CH (P<0.001). Mean 24-hour ambulatory SBP and DBP after 3, 6, and 12 months were significantly reduced by 10/13/15 and 6/6/9 mm Hg in CH, respectively. In patients with ISH the reduction in systolic ambulatory blood pressure was 4/8/7 mm Hg (P=0.032/P<0.001/P=0.009) and 3/4/2 mm Hg (P=0.08/P<0.001/P=0.130) in diastolic ambulatory blood pressure after 3, 6, and 12 months, respectively. The ambulatory blood pressure reduction was significantly lower after 3 and 12 months in SBP and after 12 months in ambulatory DBP, respectively. In conclusion, renal denervation reduces office and ambulatory blood pressure in patients with ISH. However, this reduction is less pronounced compared with patients with CH.

  13. Kidney volume and ambulatory blood pressure in children.

    PubMed

    Gurusinghe, Shari; Palvanov, Arkadiy; Bittman, Mark E; Singer, Pamela; Frank, Rachel; Chorny, Nataliya; Infante, Lulette; Sethna, Christine B

    2016-12-16

    Low nephron number has been shown to be a risk factor for hypertension (HTN) in adulthood. Kidney volume may serve as a surrogate marker for nephron mass. The relationship between kidney volume and ambulatory blood pressure (BP) in the pediatric population is not known. A retrospective chart review of children younger than 21 years who were evaluated for HTN was performed. Twenty-four-hour BP and ultrasonography data were obtained. Multiple regression was used to examine associations between BP and kidney volume. Of 84 children (mean age 13.87 years, 72.6% males), 54 had HTN. Systolic BP index during the awake, sleep, and 24-hour periods (all P≤.05) was found to be positively correlated with total kidney volume. Greater total kidney volume was found to be a positive predictor of 24-hour and sleep systolic index (P≤.05). It failed to serve as a predictor of HTN, pre-HTN, or white-coat HTN. Contrary to expectation, total kidney volume was positively associated with systolic BP indices.

  14. Beetroot supplementation lowers daily systolic blood pressure in older, overweight subjects.

    PubMed

    Jajja, A; Sutyarjoko, A; Lara, J; Rennie, K; Brandt, K; Qadir, O; Siervo, M

    2014-10-01

    Although inorganic nitrate and beetroot juice supplementation are associated with decreased systolic blood pressure (BP), these results have primarily been obtained from short-term trials that focused on healthy young adults. Therefore, we hypothesized that oral supplementation of beetroot juice concentrate would decrease systolic BP in overweight older participants but that the decline in BP would not be sustained after a 1-week interruption of the beetroot juice supplementation. For 3 weeks, 24 participants were randomized to either the beetroot juice concentrate or blackcurrant juice group, with a 1-week postsupplementation phase (week 4). Changes in systolic and diastolic BP were assessed during the supplementation and postsupplementation phases. Blood pressure was measured using 3 different methods: (1) resting clinic BP, (2) 24-hour ambulatory BP monitoring, and (3) home monitoring of daily resting BP. The first 2 methods were applied at baseline and after weeks 3 and 4. Daily measurements were conducted throughout the study, with 21 subjects completing the study (beetroot/blackcurrant = 10/11; male/female = 12/9; age = 62.0 ± 1.4 years; body mass index = 30.1 ± 1.2 kg/m(2)). After 3 weeks, beetroot juice supplementation was not associated with significant changes in resting clinic BP or 24-hour ABPM. Conversely, beetroot juice concentrate reduced daily systolic BP after 3 weeks (-7.3 ± 5.9 mm Hg, P = .02); however, the effect was not maintained after the interruption of the supplementation (week 4, 2.8 ± 6.1 mm Hg, P = .09). In overweight older subjects, beetroot juice concentrate supplementation was associated with beneficial effects on daily systolic BP, although the effects were not significant when measured by 24-hour ABPM or resting clinic BP.

  15. Preparation and results of a 24-hour orbital flight.

    PubMed

    Titov, G S

    1963-01-01

    The space age presents man with unprecedented opportunities for discovery and for cooperative endeavors to benefit all mankind. My flight of August 6-7, 1961 was conducted for the purpose of determining whether man can stay and work effectively and whether all systems of the spaceship can operate successfully during a period of 24 hours in space. The flight of Vostok II represents an experimental step in a logical sequence which included the first earth orbiting flight of USSR citizen Yuri A. Gagarin. Preparation for the flight included the study of theoretical and applied subjects, testing in various kinds of apparatus which provide acceleration, heat and isolation experience, brief airborne weightless flights and parachute landings, in addition to extensive training in a real spacecraft having simulators for normal and emergency contingencies of space flight. The actual flight was therefore carried out with a sense of confidence and familiarity and with continuous close radio contact with ground centers from whom my fellow cosmonauts served as spokesmen. Sequential boosters totaling 600 000 kg thrust placed the 4731 kg spaceship into a perfect orbit varying in altitude from 178-246 km in a plane 64 degrees 58' inclined to the equator. The spaceship made 17 orbits around the earth landing 25 hours, 18 minutes after take-off. The cabin had full atmospheric pressure and a comfortable habitability which could be extended for 10 days. I was able to maneuver the spaceship and perform many other control functions, make observations and take pictures of the earth and its cloud cover, eat meals and sleep all with good efficiency. I experienced mild symptoms suggestive of seasickness which were aggravated by head turning, ameliorated by sleep and entirely relieved by resumption of g-loading during descent. Altogether analyses of the physical and structural performance of the spaceship and the continuously monitored physiological responses of the pilot indicate that all

  16. Prognostic Effect of the Nocturnal Blood Pressure Fall in Hypertensive Patients: The Ambulatory Blood Pressure Collaboration in Patients With Hypertension (ABC-H) Meta-Analysis.

    PubMed

    Salles, Gil F; Reboldi, Gianpaolo; Fagard, Robert H; Cardoso, Claudia R L; Pierdomenico, Sante D; Verdecchia, Paolo; Eguchi, Kazuo; Kario, Kazuomi; Hoshide, Satoshi; Polonia, Jorge; de la Sierra, Alejandro; Hermida, Ramon C; Dolan, Eamon; O'Brien, Eoin; Roush, George C

    2016-04-01

    The prognostic importance of the nocturnal systolic blood pressure (SBP) fall, adjusted for average 24-hour SBP levels, is unclear. The Ambulatory Blood Pressure Collaboration in Patients With Hypertension (ABC-H) examined this issue in a meta-analysis of 17 312 hypertensives from 3 continents. Risks were computed for the systolic night-to-day ratio and for different dipping patterns (extreme, reduced, and reverse dippers) relative to normal dippers. ABC-H investigators provided multivariate adjusted hazard ratios (HRs), with and without adjustment for 24-hour SBP, for total cardiovascular events (CVEs), coronary events, strokes, cardiovascular mortality, and total mortality. Average 24-hour SBP varied from 131 to 140 mm Hg and systolic night-to-day ratio from 0.88 to 0.93. There were 1769 total CVEs, 916 coronary events, 698 strokes, 450 cardiovascular deaths, and 903 total deaths. After adjustment for 24-hour SBP, the systolic night-to-day ratio predicted all outcomes: from a 1-SD increase, summary HRs were 1.12 to 1.23. Reverse dipping also predicted all end points: HRs were 1.57 to 1.89. Reduced dippers, relative to normal dippers, had a significant 27% higher risk for total CVEs. Risks for extreme dippers were significantly influenced by antihypertensive treatment (P<0.001): untreated patients had increased risk of total CVEs (HR, 1.92), whereas treated patients had borderline lower risk (HR, 0.72) than normal dippers. For CVEs, heterogeneity was low for systolic night-to-day ratio and reverse/reduced dipping and moderate for extreme dippers. Quality of included studies was moderate to high, and publication bias was undetectable. In conclusion, in this largest meta-analysis of hypertensive patients, the nocturnal BP fall provided substantial prognostic information, independent of 24-hour SBP levels.

  17. Ambulatory blood pressure reduction following high-intensity interval exercise performed in water or dryland condition.

    PubMed

    Sosner, Philippe; Gayda, Mathieu; Dupuy, Olivier; Garzon, Mauricio; Lemasson, Christopher; Gremeaux, Vincent; Lalongé, Julie; Gonzales, Mariel; Hayami, Douglas; Juneau, Martin; Nigam, Anil; Bosquet, Laurent

    2016-05-01

    We aimed to compare blood pressure (BP) responses following moderate-intensity continuous exercise (MICE), high-intensity interval exercise (HIIE) in dry land or HIIE in immersed condition, using 24-hour ambulatory BP monitoring. Forty-two individuals (65 ± 7 years, 52% men) with a baseline BP ≥ 130/85 mm Hg (systolic/diastolic blood pressures [SBP/DBP]) were randomly assigned to perform one of the three following exercises on a stationary cycle: MICE (24 minutes at 50% peak power output) or HIIE in dry land (two sets of 10 minutes with phases of 15 seconds 100% peak power output interspersed by 15 seconds of passive recovery) or HIIE in up-to-the-chest immersed condition. While MICE modified none of the 24-hour average hemodynamic variables, dryland HIIE induced a 24-hour BP decrease (SBP: -3.6 ± 5.7/DBP: -2.8 ± 3.0 mm Hg, P < .05) and, to a much greater extent, immersed HIIE (SBP: -6.8 ± 9.5/DBP: -3.0 ± 4.5 mm Hg, P < .05). The one condition that modified 24-hour pulse-wave velocity was immersed HIIE (-0.21 ± 0.30 m/s, P < .05).

  18. [A validation of the data obtained with the simultaneous recording of blood pressure and the 24-hour electrocardiogram].

    PubMed

    Germanò, G; Caparra, A; Valentino, S; Coia, F; Federico, L; Santucci, A

    1993-06-01

    Aim of this study was to evaluate the blood pressure (BP) measurement reliability of a light weight ambulatory BP and ECG recorder. Micro AM is a new 300 g portable apparatus that combines in one device both the ambulatory BP and solid state ECG recording. The dimensions of the Micro AM are 75 x 140 x 29 mm. The monitor measures BP using Korotkoff phase 1 for systolic and phase 5 for diastolic BP, and concurrently measures oscillometric BP, one method validating the other. In addition, the manual and programmed BP measurement modes can be supplemented by an "intelligent" mode in which the ECG triggers an ambulatory BP reading during an abnormal ST segment change. A standard mercury manometer was connected with the cuff of the Micro AM with a Y-shaped part, and 12 BP measurements were simultaneously taken at 5 min intervals by the automatic device in auscultatory mode and by a trained technician in 86 normotensive volunteers (aged from 18 to 44 years, 37 males and 49 females). The algebraic differences, the frequency distribution and the difference distribution of systolic and diastolic data between the 2 methods were calculated. The results show that the automatic method gives values for systolic BP that are lower than conventional ones (average differences -0.643 mmHg), whereas for diastolic BP, the values are higher (average differences +0.229 mmHg). Then, Student's paired t-test was used to evaluate statistically significant differences. The test relative to systolic BP was significant to the critical level of 0.1%, but the differences being 3 times smaller than the instrumental tolerance. On the contrary, diastolic BP differences were non significant. In conclusion, we found a good agreement between BP recorded automatically and by sphygmomanometer.

  19. Effects of the once-weekly glucagon-like peptide-1 receptor agonist dulaglutide on ambulatory blood pressure and heart rate in patients with type 2 diabetes mellitus.

    PubMed

    Ferdinand, Keith C; White, William B; Calhoun, David A; Lonn, Eva M; Sager, Philip T; Brunelle, Rocco; Jiang, Honghua H; Threlkeld, Rebecca J; Robertson, Kenneth E; Geiger, Mary Jane

    2014-10-01

    Glucagon-like peptide-1 receptor agonists, used to treat type 2 diabetes mellitus, are associated with small reductions in systolic blood pressure (SBP) and increases in heart rate. However, findings based on clinic measurements do not adequately assess a drug's 24-hour pharmacodynamic profile. The effects of dulaglutide, a once-weekly glucagon-like peptide-1 receptor agonist, on BP and heart rate were investigated using ambulatory BP monitoring. Patients (n=755; 56±10 years; 81% white; 48% women), with type 2 diabetes mellitus, taking ≥1 oral antihyperglycemic medication, with a clinic BP between 90/60 and 140/90 mm Hg were randomized to dulaglutide (1.5 or 0.75 mg) or placebo subcutaneously for 26 weeks. Ambulatory BP monitoring was performed at baseline and at 4, 16, and 26 weeks. The primary end point was change from baseline to week 16 in mean 24-hour SBP, a tree gatekeeping strategy compared the effects of dulaglutide to placebo. Both doses of dulaglutide were noninferior to placebo for changes in 24-hour SBP and diastolic blood pressure, and dulaglutide 1.5 mg significantly reduced SBP (least squares mean difference [95% confidence interval]), -2.8 mm Hg [-4.6, -1.0]; P≤0.001). Dulaglutide 0.75 mg was noninferior to placebo (1.6 bpm; [0.3, 2.9]; P≤0.02) for 24-hour heart rate (least squares mean difference [95% confidence interval]), but dulaglutide 1.5 mg was not (2.8 bpm [1.5, 4.2]). Dulaglutide 1.5 mg was associated with a reduction in 24-hour SBP and an increase in 24-hour heart rate. The mechanisms responsible for the observed effects remain to be clarified.

  20. Effects of continuous positive airway pressure treatment on clinic and ambulatory blood pressures in patients with obstructive sleep apnea and resistant hypertension: a randomized controlled trial.

    PubMed

    Muxfeldt, Elizabeth S; Margallo, Victor; Costa, Leonardo M S; Guimarães, Gleison; Cavalcante, Aline H; Azevedo, João C M; de Souza, Fabio; Cardoso, Claudia R L; Salles, Gil F

    2015-04-01

    The effect of continuous positive airway pressure (CPAP) on blood pressures (BPs) in patients with resistant hypertension and obstructive sleep apnea is not established. We aimed to evaluate it in a randomized controlled clinical trial, with blinded assessment of outcomes. Four hundred thirty-four resistant hypertensive patients were screened and 117 patients with moderate/severe obstructive sleep apnea, defined by an apnea-hypopnea index ≥15 per hour, were randomized to 6-month CPAP treatment (57 patients) or no therapy (60 patients), while maintaining antihypertensive treatment. Clinic and 24-hour ambulatory BPs were obtained before and after 6-month treatment. Primary outcomes were changes in clinic and ambulatory BPs and in nocturnal BP fall patterns. Intention-to-treat and per-protocol (limited to those with uncontrolled ambulatory BPs) analyses were performed. Patients had mean (SD) 24-hour BP of 129(16)/75(12) mm Hg, and 59% had uncontrolled ambulatory BPs. Mean apnea-hypopnea index was 41 per hour and 58.5% had severe obstructive sleep apnea. On intention-to-treat analysis, there was no significant difference in any BP change, neither in nocturnal BP fall, between CPAP and control groups. The best effect of CPAP was on night-time systolic blood pressure in per-protocol analysis, with greater reduction of 4.7 mm Hg (95% confidence interval, -11.3 to +3.1 mm Hg; P=0.24) and an increase in nocturnal BP fall of 2.2% (95% confidence interval, -1.6% to +5.8%; P=0.25), in comparison with control group. In conclusion, CPAP treatment had no significant effect on clinic and ambulatory BPs in patients with resistant hypertension and moderate/severe obstructive sleep apnea, although a beneficial effect on night-time systolic blood pressure and on nocturnal BP fall might exist in patients with uncontrolled ambulatory BP levels.

  1. A comparison of overnight and 24 hour collection to measure urinary catecholamines.

    PubMed

    White, I R; Brunner, E J; Barron, J L

    1995-02-01

    The period of urine collection used to measure excretion of catecholamines varies in epidemiological practice. We set out to compare overnight with 24 hour collection. Twenty-four subjects each collected urine for 24 hours, with the overnight urine being separately collected. The correlation of overnight and 24 hour catecholamines was highest when both measures were standardised for creatinine excretion and when creatinine excretion was adjusted for urine flow rate. The observed correlations were 0.74 for dopamine, 0.81 for noradrenaline and 0.54 for adrenaline. The use of overnight collections may therefore require a sample size up to 1.5 times as large (for noradrenaline) or 3.4 times as large (for adrenaline) to achieve the same power as with 24 hour collections. However, the figures given exaggerate the advantage of 24 hour collections if these incorporate measurement errors that are not present in overnight collections.

  2. Effects of Sacubitril/Valsartan Versus Olmesartan on Central Hemodynamics in the Elderly With Systolic Hypertension: The PARAMETER Study.

    PubMed

    Williams, Bryan; Cockcroft, John R; Kario, Kazuomi; Zappe, Dion H; Brunel, Patrick C; Wang, Qian; Guo, Weinong

    2017-03-01

    Effective treatment of systolic hypertension in elderly patients remains a major therapeutic challenge. A multicenter, double-blind, randomized controlled trial with sacubitril/valsartan (LCZ696), a first-in-class angiotensin receptor neprilysin inhibitor, was conducted to determine its effects versus olmesartan (angiotensin receptor blocker) on central aortic pressures, in elderly patients (aged ≥60 years) with systolic hypertension and pulse pressure >60 mm Hg, indicative of arterial stiffness. Patients (n=454; mean age, 67.7 years; mean seated systolic blood pressure, 158.6 mm Hg; mean seated pulse pressure, 69.7 mm Hg) were randomized to receive once-daily sacubitril/valsartan 200 mg or olmesartan 20 mg, force titrated to double the initial doses after 4 weeks, before primary assessment at 12 weeks. The study extended double-blind treatment for 12 to 52 weeks, during which amlodipine (2.5-5 mg) and subsequently hydrochlorothiazide (6.25-25 mg) were added-on for patients not achieving blood pressure target (<140/90). At week 12, sacubitril/valsartan reduced central aortic systolic pressure (primary assessment) greater than olmesartan by -3.7 mm Hg (P=0.010), further corroborated by secondary assessments at week 12 (central aortic pulse pressure, -2.4 mm Hg, P<0.012; mean 24-hour ambulatory brachial systolic blood pressure and central aortic systolic pressure, -4.1 mm Hg and -3.6 mm Hg, respectively, both P<0.001). Differences in 24-hour ambulatory pressures were pronounced during sleep. After 52 weeks, blood pressure parameters were similar between treatments (P<0.002); however, more patients required add-on antihypertensive therapy with olmesartan (47%) versus sacubitril/valsartan (32%; P<0.002). Both treatments were equally well tolerated. The PARAMETER study (Prospective Comparison of Angiotensin Receptor Neprilysin Inhibitor With Angiotensin Receptor Blocker Measuring Arterial Stiffness in the Elderly), for the first time, demonstrated

  3. Enhanced carotid-cardiac baroreflex response and elimination of orthostatic hypotension 24 hours after acute exercise in paraplegics

    NASA Technical Reports Server (NTRS)

    Engelke, K. A.; Shea, J. D.; Doerr, D. F.; Convertino, V. A.

    1992-01-01

    To test the hypothesis that an acute bout of maximal exercise can ameliorate orthostatic hypotension consequent to prolonged wheelchair confinement, we evaluated heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure responses during 15 minutes of 70 degrees head-up tilt (HUT) in 10 paraplegic subjects 24 hours after arm crank exercise designed to elicit maximal effort, and during a control (no exercise) conditions. Additionally, the carotid baroreceptor stimulus-cardiac response relationship was determined by measurement of R-R interval during external application of graded pressures to the carotid sinuses. One week separated the treatment conditions. The maximum slope of the carotid-cardiac baroreflex response was increased (p = 0.049) by exercise (6.2 +/- 1.7 msec/mmHg) compared to control (3.3 +/- 0.6). During control HUT, HR increased from 61 +/- 1 to 90 +/- 7 bpm (p = 0.001) while SBP decreased from 118 +/- 5 to 106 +/- 9 mmHg (p = 0.025). During HUT 24 hours after exercise, HR increased from 60 +/- 2 to 90 +/- 4 bpm (p = 0.001), but the reduction in SBP was essentially eliminated (116 +/- 5 to 113 +/- 5 mmHg).

  4. Ambulatory monitoring detects sorafenib-induced blood pressure elevations on the first day of treatment

    PubMed Central

    Maitland, Michael L.; Kasza, Kristen E.; Karrison, Theodore; Moshier, Kristin; Sit, Laura; Black, Henry R.; Undevia, Samir D.; Stadler, Walter M.; Elliott, William J.; Ratain, Mark J.

    2009-01-01

    Purpose Hypertension is a mechanism-based toxicity of sorafenib and other cancer therapeutics that inhibit the vascular endothelial growth factor (VEGF) signaling pathway (VSP). This prospective, single center, cohort study characterized ambulatory blood pressure (BP) monitoring (ABPM) as an early pharmacodynamic biomarker of VSP inhibition by sorafenib. Experimental Design Fifty-four normotensive advanced cancer patients underwent 24-hour ABPM prior to and between days 6 and 10 of sorafenib therapy. After BP changes were detected among the first cohort within 10 days, ABPM was performed during the first 24 hours of treatment for the second cohort. Results For the entire patient population the BP increase (mean systolic +10.8 mmHg [95% CI, 8.6 to 13.0], range −5.2 to +28.7 mmHg; mean diastolic +8.0 mmHg [95% CI, 6.3 to 9.7], range −4.4 to +27.1mmHg) was detected between days 6 and 10 (P <0.0001 for both) and plateaued thereafter. Variability in BP change did not associate with: age, body size, sex, self-reported race, baseline BP, or steady state sorafenib plasma concentrations. In the second cohort the BP elevation was detected during the first 24 hours (mean systolic +8.2 mmHg [95% CI, 5.0 to 11.3]; mean diastolic +6.5 mmHg [95% CI, 4.7 to 8.3] P <0.0001 for both). Conclusions ABPM detects the BP response to VSP inhibition by sorafenib during the first 24 hours of treatment. The magnitude of BP elevation is highly variable and unpredictable, but could be important in optimizing the therapeutic index of VSP inhibitor therapy. PMID:19773379

  5. Optimal dose of oral omeprazole for maximal 24 hour decrease of intragastric acidity.

    PubMed Central

    Sharma, B K; Walt, R P; Pounder, R E; Gomes, M D; Wood, E C; Logan, L H

    1984-01-01

    In a series of 59 experiments in nine duodenal ulcer patients, 24 hour intragastric acidity was measured before, during, and after treatment with daily oral omeprazole. Omeprazole 10, 20, and 30 mg/day for one week caused a 37, 90, and 97% decrease of 24 hour intragastric acidity, respectively. No further decrease of acidity was observed when the dose of omeprazole was doubled to 60 mg/day, or after a second week of treatment with 30 mg/day. One week after stopping treatment with omeprazole (14 doses) there was a significant 26% decrease of 24 hour intragastric acidity, with full recovery seven weeks later. Fasting plasma gastrin concentration was significantly raised during treatment with all doses of omeprazole. Omeprazole 30 mg/day is the optimal dose for a maximal decrease of 24 hour intragastric acidity in duodenal ulcer patients. PMID:6469081

  6. Comparison of anthropometric and training characteristics between recreational male marathoners and 24-hour ultramarathoners

    PubMed Central

    Rüst, Christoph Alexander; Knechtle, Beat; Knechtle, Patrizia; Rosemann, Thomas

    2012-01-01

    Background Of the anthropometry and training variables used to predict race performance in a 24-hour ultrarun, the personal best marathon time is the strongest predictor in recreational male 24-hour ultramarathoners. This finding raises the question of whether similarities exist between male recreational 24-hour ultramarathoners and male recreational marathoners. Methods The association between age, anthropometric variables (ie, body mass, body height, body mass index, percent body fat, skeletal muscle mass, limb circumference, and skinfold thickness at the pectoral, mid axillary, triceps, subscapular, abdominal, suprailiac, front thigh, and medial calf sites), previous experience and training characteristics (ie, volume, speed, and personal best time), and race time for 79 male recreational 24-hour ultramarathoners and 126 male recreational marathoners was investigated using bivariate and multivariate analysis. Results The 24-hour ultramarathoners were older (P < 0.05), had a lower circumference at both the upper arm (P < 0.05) and thigh (P < 0.01), and a lower skinfold thickness at the pectoral, axillary, and suprailiac sites (P < 0.05) compared with the marathoners. During training, the 24-hour ultramarathoners were running for more hours per week (P < 0.001) and completed more kilometers (P < 0.001), but were running slower (P < 0.01) compared with the marathoners. In the 24-hour ultramarathoners, neither anthropometric nor training variables were associated with kilometers completed in the race (P > 0.05). In the marathoners, percent body fat (P < 0.001) and running speed during training (P < 0.0001) were related to marathon race times. Conclusion In summary, differences in anthropometric and training predictor variables do exist between male recreational 24-hour ultramarathoners and male recreational marathoners for race performance. PMID:24198595

  7. Effects of Baroreflex Activation Therapy on Ambulatory Blood Pressure in Patients With Resistant Hypertension.

    PubMed

    Wallbach, Manuel; Lehnig, Luca-Yves; Schroer, Charlotte; Lüders, Stephan; Böhning, Enrico; Müller, Gerhard A; Wachter, Rolf; Koziolek, Michael J

    2016-04-01

    Baroreflex activation therapy (BAT) has been demonstrated to decrease office blood pressure (BP) in the randomized, double-blind Rheos trial. There are limited data on 24-hour BP changes measured by ambulatory BP measurements (ABPMs) using the first generation rheos BAT system suggesting a significant reduction but there are no information about the effect of the currently used, unilateral BAT neo device on ABPM. Patients treated with the BAT neo device for uncontrolled resistant hypertension were prospectively included into this study. ABPM was performed before BAT implantation and 6 months after initiation of BAT. A total of 51 patients were included into this study, 7 dropped out from analysis because of missing or insufficient follow-up. After 6 months, 24-hour ambulatory systolic (from 148 ± 17 mm Hg to 140 ± 23 mm Hg, P<0.01), diastolic (from 82 ± 13 mm Hg to 77 ± 15 mm Hg, P<0.01), day- and night-time systolic and diastolic BP (all P ≤ 0.01) significantly decreased while the number of prescribed antihypertensive classes could be reduced from 6.5 ± 1.5 to 6.0 ± 1.8 (P=0.03). Heart rate and pulse pressure remained unchanged. BAT was equally effective in reducing ambulatory BP in all subgroups of patients. This is the first study demonstrating a significant BP reduction in ABPM in patients undergoing chronically stimulation of the carotid sinus using the BAT neo device. About that BAT-reduced office BP and improved relevant aspects of ABPM, BAT might be considered as a new therapeutic option to reduce cardiovascular risk in patients with resistant hypertension. Randomized controlled trials are needed to evaluate BAT effects on ABPM in patients with resistant hypertension accurately.

  8. Mean 24-hours sympathetic nervous system activity decreases during head-down tilted bed rest but not during microgravity

    NASA Astrophysics Data System (ADS)

    Christensen, Nj; Heer, M.; Ivanova, K.; Norsk, P.

    Sympathetic nervous system activity is closely related to gravitational stress in ground based experiments. Thus a high activity is present in the standing-up position and a very low activity is observed during acute head-out water immersion. Adjustments in sympathetic activity are necessary to maintain a constant blood pressure during variations in venous return. Head-down tilted bed rest is applied as a model to simulate changes observed during microgravity. The aim of the present study was to test the hypothesis that mean 24-hours sympathetic activity was low and similar during space flight and in ground based observation obtained during long-term head-down tilted bed rest. Forearm venous plasma noradrenaline was measured by a radioenzymatic technique as an index of muscle sympathetic activity and thrombocyte noradrenaline and adrenaline were measured as indices of mean 24-hours sympathoadrenal activity. Previous results have indicated that thrombocyte noradrenaline level has a half-time of 2 days. Thus to reflect sympathetic activity during a specific experiment the study period must last for at least 6 days and a sample must be obtained within 12 hours after the experiment has ended. Ten normal healthy subjects were studied before and during a 14 days head-down tilted bed rest as well as during an ambulatory study period of a similar length. The whole experiment was repeated while the subjects were on a low calorie diet. Thrombocyte noradrenaline levels were studied in 4 cosmonauts before and within 12 hours after landing after more than 7 days in flight. Thrombocyte noradrenaline decreased markedly during the head-down tilted bed rest (p<0.001), whereas there were no significant changes in the ambulatory study. Plasma noradrenaline decreased in the adaptation period but not during the intervention. During microgravity thrombocyte noradrenaline increased in four cosmonauts and the percentage changes were significantly different in cosmonauts and in subjects

  9. Insights about serum sodium behavior after 24 hours of continuous renal replacement therapy

    PubMed Central

    Romano, Thiago Gomes; Martins, Cassia Pimenta Barufi; Mendes, Pedro Vitale; Besen, Bruno Adler Maccagnan Pinheiro; Zampieri, Fernando Godinho; Park, Marcelo

    2016-01-01

    Objective The aim of this study was to investigate the clinical and laboratorial factors associated with serum sodium variation during continuous renal replacement therapy and to assess whether the perfect admixture formula could predict 24-hour sodium variation. Methods Thirty-six continuous renal replacement therapy sessions of 33 patients, in which the affluent prescription was unchanged during the first 24 hours, were retrieved from a prospective collected database and then analyzed. A mixed linear model was performed to investigate the factors associated with large serum sodium variations (≥ 8mEq/L), and a Bland-Altman plot was generated to assess the agreement between the predicted and observed variations. Results In continuous renal replacement therapy 24-hour sessions, SAPS 3 (p = 0.022) and baseline hypernatremia (p = 0.023) were statistically significant predictors of serum sodium variations ≥ 8mEq/L in univariate analysis, but only hypernatremia demonstrated an independent association (β = 0.429, p < 0.001). The perfect admixture formula for sodium prediction at 24 hours demonstrated poor agreement with the observed values. Conclusions Hypernatremia at the time of continuous renal replacement therapy initiation is an important factor associated with clinically significant serum sodium variation. The use of 4% citrate or acid citrate dextrose - formula A 2.2% as anticoagulants was not associated with higher serum sodium variations. A mathematical prediction for the serum sodium concentration after 24 hours was not feasible. PMID:27410407

  10. [THE INFLUENCE OF CYTOFLAVIN AND CARDIOXIPIN ON THE PARAMETERS OF 24-HOUR ARTERIAL PRESSURE MONITORING IN PATIENTS WITH CHRONIC CEREBRAL CIRCULATION INSUFFICIENCY, ARTERIAL HYPERTENSION AND HYPERCHOLESTEROLEMIA].

    PubMed

    Vodop'ianova, O A; Moiseeva, I Ia; Rodina, O P; Kustikova, I N; Antropova, N V

    2015-01-01

    This comparative study of the influence of cytoflavin and cardioxipin on the parameters of 24-hour arterial pressure monitoring in 56 patients with chronic cerebral circulation insufficiency, arterial hypertension and hypercholesterolemia included 32 women and 24 men aged 42-72 years divided into 3 groups matchedfor the stage of diseases, age, sex, severity of AH, total cholesterol level, and antihypertensive therapy. Patients of group 1 were treated without cytoflavin and cardioxipin. Those in group 2 received daily i/v droplet infusion of 10 mg/kg cardioxipin (20-30 droplets/min). Patients of group 3 were given daily i/v droplet infusion of 10 ml cytoflavin in 200 ml 0.9% sodium chloride solution for 10 days. 24-hour arterial pressure monitoring was used to estimate the influence of the two drugs on systolic and diastolic pressure, its daily rhythm, AP variability and frequency of elevation. The study showed that both therapeutic modalities improved daily AP rhythm as manifested in a significant increase of the number of patients with the dipper rhythm and a decrease in the number of systolic/diastolic non-dipper patients. Moreover cytoflavin significantly decreased the number of systolic over-dippers compared with control group.

  11. Agreement between 24-hour salt ingestion and sodium excretion in a controlled environment.

    PubMed

    Lerchl, Kathrin; Rakova, Natalia; Dahlmann, Anke; Rauh, Manfred; Goller, Ulrike; Basner, Mathias; Dinges, David F; Beck, Luis; Agureev, Alexander; Larina, Irina; Baranov, Victor; Morukov, Boris; Eckardt, Kai-Uwe; Vassilieva, Galina; Wabel, Peter; Vienken, Jörg; Kirsch, Karl; Johannes, Bernd; Krannich, Alexander; Luft, Friedrich C; Titze, Jens

    2015-10-01

    Accurately collected 24-hour urine collections are presumed to be valid for estimating salt intake in individuals. We performed 2 independent ultralong-term salt balance studies lasting 105 (4 men) and 205 (6 men) days in 10 men simulating a flight to Mars. We controlled dietary intake of all constituents for months at salt intakes of 12, 9, and 6 g/d and collected all urine. The subjects' daily menus consisted of 27 279 individual servings, of which 83.0% were completely consumed, 16.5% completely rejected, and 0.5% incompletely consumed. Urinary recovery of dietary salt was 92% of recorded intake, indicating long-term steady-state sodium balance in both studies. Even at fixed salt intake, 24-hour urine collection for sodium excretion (UNaV) showed infradian rhythmicity. We defined a ±25 mmol deviation from the average difference between recorded sodium intake and UNaV as the prediction interval to accurately classify a 3-g difference in salt intake. Because of the biological variability in UNaV, only every other daily urine sample correctly classified a 3-g difference in salt intake (49%). By increasing the observations to 3 consecutive 24-hour collections and sodium intakes, classification accuracy improved to 75%. Collecting seven 24-hour urines and sodium intake samples improved classification accuracy to 92%. We conclude that single 24-hour urine collections at intakes ranging from 6 to 12 g salt per day were not suitable to detect a 3-g difference in individual salt intake. Repeated measurements of 24-hour UNaV improve precision. This knowledge could be relevant to patient care and the conduct of intervention trials.

  12. Asymptomatic rhythm and conduction abnormalities in children with acute rheumatic fever: 24-hour electrocardiography study.

    PubMed

    Karacan, Mehmet; Işıkay, Sedat; Olgun, Haşim; Ceviz, Naci

    2010-12-01

    Some rhythm and conduction abnormalities can occur in children with acute rheumatic fever. These abnormalities have been defined based on standard electrocardiography; however, the real prevalence of these abnormalities has not been investigated previously by the evaluation of long-term electrocardiographic recordings. In this study, we evaluated the asymptomatic rhythm and conduction abnormalities in children with acute rheumatic fever by evaluating the 24-hour electrocardiography. We evaluated the standard electrocardiography and the 24-hour electrocardiography of 64 children with acute rheumatic fever. On standard electrocardiography, the frequency of the first-degree atrioventricular block was found to be 21.9%. Electrocardiography at 24 hours detected three additional and separate patients with a long PR interval. Mobitz type I block and atypical Wenckebach periodicity were determined in one patient (1.56%) on 24-hour electrocardiography. While accelerated junctional rhythm was detected in three patients on standard electrocardiography, it was present in nine patients according to 24-hour electrocardiography. Premature contractions were present in 1.7% of standard electrocardiography, but in 29.7% of 24-hour electrocardiography. Absence of carditis was found to be related to the presence of accelerated junctional rhythm (p > 0.05), and the presence of carditis was found to be related to the presence of premature contractions (p = 0.000). In conclusion, our results suggest that in children with acute rheumatic fever, the prevalence of rhythm and conduction abnormalities may be much higher than determined on standard electrocardiography. Further studies are needed to clarify whether or not these abnormalities are specific to acute rheumatic fever.

  13. Continual 24-hour observations of thermospheric winds made with the SOFDI instrument from Huancayo, Peru

    NASA Astrophysics Data System (ADS)

    Gerrard, Andrew; Meriwether, John W.

    The Second generation Optimized Fabry-Perot Doppler Imager (SOFDI), a state-of-the-art triple-etalon Fabry-Perot interferometer, has been sucessfully relocated to Huancayo, Peru and is making continual 24-hour observations. The 630-nm data, originating from layer-integrated OI emission with centroid heights of 250 km at night and 220 km during the day, are analyzed so as to obtain measurements of horizontal winds in the thermosphere. In this paper we report the most recent results from continuous 24-hour observations of these thermospheric parameters.

  14. Twenty-four-hour ambulatory blood pressure in children with sleep-disordered breathing.

    PubMed

    Amin, Raouf S; Carroll, John L; Jeffries, Jenny L; Grone, Charles; Bean, Judy A; Chini, Barbara; Bokulic, Ronald; Daniels, Stephen R

    2004-04-15

    Obstructive sleep apnea causes intermittent elevation of systemic blood pressure (BP) during sleep. To determine whether obstructive apnea in children has a tonic effect on diurnal BP, 24-hour ambulatory blood pressure was obtained from 60 children with mean age of 10.8 +/- 3.5 years. Thirty-nine children had obstructive apnea and 21 had primary snoring. Children with obstructive apnea had significantly greater mean BP variability during wakefulness and sleep, a higher night-to-day systolic BP, and a smaller nocturnal dipping of mean BP. Variability of mean arterial pressure during wakefulness was predicted by the desaturation, body mass, and arousal indices, whereas variability during sleep was predicted by apnea-hypopnea and body mass indices. Nocturnal BP dipping was predicted by the desaturation index. There were no significant differences in systolic, diastolic, or mean arterial BP during sleep between the groups. Diastolic BP during wakefulness was significantly different between the groups and correlated negatively with apnea-hypopnea index. We conclude that obstructive apnea in children is associated with 24-hour BP dysregulation and that, independent of obesity, the frequency of obstructive apnea, oxygen desaturation, and arousal contributes to abnormal BP control.

  15. 29 CFR 785.22 - Duty of 24 hours or more.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Sleeping Time and Certain Other Activities § 785.22 Duty of 24 hours or more. (a) General. Where an... bona fide meal periods and a bona fide regularly scheduled sleeping period of not more than 8 hours from hours worked, provided adequate sleeping facilities are furnished by the employer and the...

  16. 29 CFR 785.22 - Duty of 24 hours or more.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Sleeping Time and Certain Other Activities § 785.22 Duty of 24 hours or more. (a) General. Where an... bona fide meal periods and a bona fide regularly scheduled sleeping period of not more than 8 hours from hours worked, provided adequate sleeping facilities are furnished by the employer and the...

  17. 24-Hour Access: Responding to Students' Need for Late Library Hours at the University of Denver

    ERIC Educational Resources Information Center

    Sewell, Bethany B.

    2013-01-01

    The University of Denver's Penrose Library saw a substantial increase in use as a result of several new and enhanced services over a six-year period. In turn, longer operating hours and increased staffing for a 24-hours-a-day, five-days-a-week (24 x 5) operating schedule was funded. This case study analyzes student need for longer library hours…

  18. Assessing dietary intake in childhood cancer survivors: Food frequency questionnaire versus 24-hour diet recalls

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Cancer diagnosis and treatment may influence dietary intake. The validity of using self-reported methods to quantify dietary intake has not been evaluated in childhood cancer survivors. We validated total energy intake (EI) reported from Food Frequency Questionnaire (FFQ) and repeated 24-hour diet r...

  19. Mood-Dependent Cognitive Change in a Man with Bipolar Disorder Who Cycles Every 24 Hours

    ERIC Educational Resources Information Center

    Lam, Dominic; Mansell, Warren

    2008-01-01

    A case study of a bipolar patient whose mood changes every 24 hours is described to illustrate the changes in cognitive processing and content during different phases of bipolar disorder. The participant completed a battery of questionnaires and tasks on 4 separate occasions: twice when depressed and twice when manic. Depression tended to be…

  20. The Three-Continent, 24-Hour Help Desk: An Academic First?

    ERIC Educational Resources Information Center

    Sykes, Jean

    2002-01-01

    Describes Follow the Sun, a computer help-desk service that takes advantage of time differences around the world to permit four universities (University of Colorado Boulder, Australia's Macquarie and Newcastle universities, and the London School of Economics) to share services and provide 24-hour support to users. (EV)

  1. 29 CFR 785.22 - Duty of 24 hours or more.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... Sleeping Time and Certain Other Activities § 785.22 Duty of 24 hours or more. (a) General. Where an... bona fide meal periods and a bona fide regularly scheduled sleeping period of not more than 8 hours from hours worked, provided adequate sleeping facilities are furnished by the employer and the...

  2. 29 CFR 785.22 - Duty of 24 hours or more.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... Sleeping Time and Certain Other Activities § 785.22 Duty of 24 hours or more. (a) General. Where an... bona fide meal periods and a bona fide regularly scheduled sleeping period of not more than 8 hours from hours worked, provided adequate sleeping facilities are furnished by the employer and the...

  3. 29 CFR 785.22 - Duty of 24 hours or more.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... Sleeping Time and Certain Other Activities § 785.22 Duty of 24 hours or more. (a) General. Where an... bona fide meal periods and a bona fide regularly scheduled sleeping period of not more than 8 hours from hours worked, provided adequate sleeping facilities are furnished by the employer and the...

  4. 24 Hours of Sleep, Sedentary Behavior, and Physical Activity with Nine Wearable Devices

    PubMed Central

    Rosenberger, Mary E.; Buman, Matthew P.; Haskell, William L.; McConnell, Michael V.; Carstensen, Laura L.

    2015-01-01

    Getting enough sleep, exercising and limiting sedentary activities can greatly contribute to disease prevention and overall health and longevity. Measuring the full 24-hour activity cycle - sleep, sedentary behavior (SED), light intensity physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) - may now be feasible using small wearable devices. PURPOSE This study compares nine devices for accuracy in 24-hour activity measurement. METHODS Adults (N=40, 47% male) wore nine devices for 24-hours: Actigraph GT3X+, activPAL, Fitbit One, GENEactiv, Jawbone Up, LUMOback, Nike Fuelband, Omron pedometer, and Z-Machine. Comparisons (to standards) were made for total sleep time (Z-machine), time spent in SED (activPAL), LPA (GT3x+), MVPA (GT3x+), and steps (Omron). Analysis included mean absolute percent error, equivalence testing, and Bland-Altman plots. RESULTS Error rates ranged from 8.1–16.9% for sleep; 9.5–65.8% for SED; 19.7–28.0% for LPA; 51.8–92% for MVPA; and 14.1–29.9% for steps. Equivalence testing indicated only two comparisons were significantly equivalent to standards: the LUMOback for sedentary behavior and the GT3X+ for sleep. Bland-Altman plots indicated GT3X+ had the closest measurement for sleep, LUMOback for sedentary behavior, GENEactiv for LPA, Fitbit for MVPA and GT3X+ for steps. CONCLUSIONS Currently, no device accurately captures activity data across the entire 24-hour day, but the future of activity measurement should aim for accurate 24-hour measurement as a goal. Researchers should continue to select measurement devices based on their primary outcomes of interest. PMID:26484953

  5. The Relation between Hot Flashes and Ambulatory Blood Pressure: The Hilo Women’s Health Study

    PubMed Central

    Brown, Daniel E.; Sievert, Lynnette L.; Morrison, Lynn A.; Rahberg, Nichole; Reza, Angela

    2011-01-01

    Objectives Hot flashes (HFs) have been associated with elevated blood pressure, but studies have not examined the relationship between objectively measured HFs and blood pressure during normal daily activities. The objectives of this study are to examine ambulatory blood pressure (BP) differences between women who report HFs and those who do not, and to observe whether an objectively measured HF is associated with transient changes in BP. Methods A sample of 202 women in Hilo, Hawaii aged 45–55 years were asked to fill out a questionnaire that included demographic information and an inventory of symptoms. The women underwent simultaneous 24-hour monitoring of ambulatory BP and HFs, while keeping a diary that included mood and HF reports. Results No significant difference was present in mean BP between women who reported having a HF during the past 2 weeks and those who did not. When measurements controlled for negative mood reports and posture, there was a highly significant elevation in Z scores of systolic BP when a measured, objective HF occurred within 10 minutes preceding a BP reading, and a significant elevation of Z scores of diastolic BP when a subjectively reported HF occurred within 10 minutes after a BP reading. Conclusions These results suggest that objectively measured HFs precede transient elevations of systolic BP, but it is unclear if there is a causal relationship. These results also suggest that women experience subjective HFs within 10 minutes after a transient increase in diastolic BP. Again, the causal relationship is not understood. PMID:21183716

  6. Experiences of 24-hour advice line services: a framework for good practice and meeting NICE guidelines.

    PubMed

    Yardley, Sarah J; Codling, Jan; Roberts, Dai; O Donnell, Valerie; Taylor, Sue

    2009-06-01

    This article presents a framework for the practical implementation of a 24-hour specialist palliative care advice line, illustrated by two case examples from the authors' experience. In the UK, National Institute for Health and Clinical Excellence guidance requires provision of 24-hour access to specialist palliative care advice for healthcare professionals and carers regardless of a patient's location. Effective implementation of a telephone advice line for specialist advice is one approach to addressing the current variability in palliative care service provision, both in the UK and elsewhere. The authors were unable to identify a model with documentation for ensuring adequate clinical governance of an advice line in the literature and so present their own. The accompanying case examples demonstrate the difference between 'evolution of services by demand' and taking a systemic approach to service design. Key recommendations for practice are outlined for an effective advice line service which incorporates training and education into the clinical governance structures of the host organization.

  7. Exercising in the Fasted State Reduced 24-Hour Energy Intake in Active Male Adults

    PubMed Central

    Deitrick, Ronald W.; Hillman, Angela R.

    2016-01-01

    The effect of fasting prior to morning exercise on 24-hour energy intake was examined using a randomized, counterbalanced design. Participants (12 active, white males, 20.8 ± 3.0 years old, VO2max: 59.1 ± 5.7 mL/kg/min) fasted (NoBK) or received breakfast (BK) and then ran for 60 minutes at 60%  VO2max. All food was weighed and measured for 24 hours. Measures of blood glucose and hunger were collected at 5 time points. Respiratory quotient (RQ) was measured during exercise. Generalized linear mixed models and paired sample t-tests examined differences between the conditions. Total 24-hour (BK: 19172 ± 4542 kJ versus NoBK: 15312 ± 4513 kJ; p < 0.001) and evening (BK: 12265 ± 4278 kJ versus NoBK: 10833 ± 4065; p = 0.039) energy intake and RQ (BK: 0.90 ± 0.03 versus NoBK: 0.86 ± 0.03; p < 0.001) were significantly higher in BK than NoBK. Blood glucose was significantly higher in BK than NoBK before exercise (5.2 ± 0.7 versus 4.5 ± 0.6 mmol/L; p = 0.025). Hunger was significantly lower for BK than NoBK before exercise, after exercise, and before lunch. Blood glucose and hunger were not associated with energy intake. Fasting before morning exercise decreased 24-hour energy intake and increased fat oxidation during exercise. Completing exercise in the morning in the fasted state may have implications for weight management. PMID:27738523

  8. Circadian polymorphisms in night owls, in bipolars, and in non-24-hour sleep cycles.

    PubMed

    Kripke, Daniel F; Klimecki, Walter T; Nievergelt, Caroline M; Rex, Katharine M; Murray, Sarah S; Shekhtman, Tatyana; Tranah, Gregory J; Loving, Richard T; Lee, Heon-Jeong; Rhee, Min Kyu; Shadan, Farhad F; Poceta, J Steven; Jamil, Shazia M; Kline, Lawrence E; Kelsoe, John R

    2014-10-01

    People called night owls habitually have late bedtimes and late times of arising, sometimes suffering a heritable circadian disturbance called delayed sleep phase syndrome (DSPS). Those with DSPS, those with more severe progressively-late non-24-hour sleep-wake cycles, and those with bipolar disorder may share genetic tendencies for slowed or delayed circadian cycles. We searched for polymorphisms associated with DSPS in a case-control study of DSPS research participants and a separate study of Sleep Center patients undergoing polysomnography. In 45 participants, we resequenced portions of 15 circadian genes to identify unknown polymorphisms that might be associated with DSPS, non-24-hour rhythms, or bipolar comorbidities. We then genotyped single nucleotide polymorphisms (SNPs) in both larger samples, using Illumina Golden Gate assays. Associations of SNPs with the DSPS phenotype and with the morningness-eveningness parametric phenotype were computed for both samples, then combined for meta-analyses. Delayed sleep and "eveningness" were inversely associated with loci in circadian genes NFIL3 (rs2482705) and RORC (rs3828057). A group of haplotypes overlapping BHLHE40 was associated with non-24-hour sleep-wake cycles, and less robustly, with delayed sleep and bipolar disorder (e.g., rs34883305, rs34870629, rs74439275, and rs3750275 were associated with n=37, p=4.58E-09, Bonferroni p=2.95E-06). Bright light and melatonin can palliate circadian disorders, and genetics may clarify the underlying circadian photoperiodic mechanisms. After further replication and identification of the causal polymorphisms, these findings may point to future treatments for DSPS, non-24-hour rhythms, and possibly bipolar disorder or depression.

  9. Iodine Excretion in 24-hour Urine Collection and Its Dietary Determinants in Healthy Japanese Adults

    PubMed Central

    Katagiri, Ryoko; Asakura, Keiko; Uechi, Ken; Masayasu, Shizuko; Sasaki, Satoshi

    2016-01-01

    Background Since seaweed is a common component of the Japanese diet, iodine intake in Japanese is expected to be high. However, urinary iodine excretion, measured using 24-hour urine samples, and its dietary determinants are not known. Methods Apparently healthy adults aged 20 to 69 years living in 20 areas throughout Japan were recruited in February and March, 2013. Urinary iodine excretion was evaluated using 24-hour urine collected from 713 subjects (362 men and 351 women), and the difference among age groups was assessed. The association between dietary intake of food groups and urinary iodine excretion was assessed among 358 subjects who completed a semi-weighed 4-day diet record (DR) and urine collection. The correlations between iodine intake and iodine excretion were also evaluated, and correlation coefficients were calculated for iodine intake in the DR of the overlapping day or the DR 1 day before and after urine collection. Results Median iodine excretion in 24-hour urine was 365 µg, and excretion was significantly higher in older subjects. Iodine intake estimated by the DRs was significantly correlated with urinary iodine excretion when DRs and urine collection were obtained on the same day (r = 0.37). After adjustment for confounding factors, iodine excretion was significantly associated with intakes of kelp and soup stock from kelp and fish. Conclusions Although multiple measurements for urinary iodine are required to confirm our results, this study showed the current iodine status of healthy Japanese adults. The results suggest that kelp and fish are the main contributors to Japanese iodine status measured by 24-hour urine. PMID:27374137

  10. 24-hour-restraint stress induces long-term depressive-like phenotypes in mice

    PubMed Central

    Zhou, Ying; Hu, Zhiqiang; Lou, Jingyu; Song, Wei; Li, Jing; Liang, Xiao; Chen, Chen; Wang, Shuai; Yang, Beimeng; Chen, Lei; Zhang, Xu; Song, Jinjing; Dong, Yujie; Chen, Shiqing; He, Lin; Xie, Qingguo; Chen, Xiaoping; Li, Weidong

    2016-01-01

    There is an increasing risk of mental disorders, such as acute stress disorder (ASD), post-traumatic stress disorder (PTSD) and depression among survivors who were trapped in rubble during earthquake. Such long-term impaction of a single acute restraint stress has not been extensively explored. In this study, we subjected mice to 24-hour-restraint to simulate the trapping episode, and investigated the acute (2 days after the restraint) and long-term (35 days after the restraint) impacts. Surprisingly, we found that the mice displayed depression-like behaviors, decreased glucose uptake in brain and reduced adult hippocampal neurogenesis 35 days after the restraint. Differential expression profiling based on microarrays suggested that genes and pathways related to depression and other mental disorders were differentially expressed in both PFC and hippocampus. Furthermore, the depression-like phenotypes induced by 24-hour-restraint could be reversed by fluoxetine, a type of antidepressant drug. These findings demonstrated that a single severe stressful event could produce long-term depressive-like phenotypes. Moreover, the 24-hour-restraint stress mice could also be used for further studies on mood disorders. PMID:27609090

  11. [24-hour energy metabolism in the human: circadian rhythm, relation to body weight and nutrition].

    PubMed

    Steiniger, J

    1985-04-15

    In 7 men with normal weight and 9 man with overweight and healthy metabolism the resting and fasting energy expenditure was indirectly calorimetrically pursued in the open system over 24 hours. The total energy expenditure over 24 hours revealed an ascertained dependence on body-weight and nutrition. The persons with overweight had a higher absolute energy expenditure, however, the activity of the energy metabolism of the body mass free from fat and the active body mass, respectively, decreased with increasing overweight. The resting and fasting energy expenditure showed in all measured parameters (oxygen consumption, respiratory quotient and nitrogen excretion in the urine) an ascertained daily periodicity (circadian rhythm), which was widely independent of body weight. Only the average daily level C0 (rhythm adjusted level) of the resting and fasting energy expenditure was positively correlated with the body weight and the food energy intake. A negative energy balance (reduction 1.2 MJ/d over 28 days) influenced only the total energy and substrate balance over 24 hours and the daily average level, respectively. The circadian conditions remained unchanged (Chossat's phenomenon). The variability in daily rhythm of the energy expenditure of nearly 25% of the daily average should be taken into consideration in the judgment of exogenically stimulated changes in the energy metabolism.

  12. Validation of triple pass 24-hour dietary recall in Ugandan children by simultaneous weighed food assessment

    PubMed Central

    Olupot-Olupot, Peter; Engoru, Charles; Ssenyondo, Tonny; Nteziyaremye, Julius; Amorut, Denis; Nakuya, Margaret; Arimi, Margaret; Frost, Gary; Maitland, Kathryn

    2016-01-01

    Background Undernutrition remains highly prevalent in African children, highlighting the need for accurately assessing dietary intake. In order to do so, the assessment method must be validated in the target population. A triple pass 24 hour dietary recall with volumetric portion size estimation has been described but not previously validated in African children. This study aimed to establish the relative validity of 24-hour dietary recalls of daily food consumption in healthy African children living in Mbale and Soroti, eastern Uganda compared to simultaneous weighed food records. Methods Quantitative assessment of daily food consumption by weighed food records followed by two independent assessments using triple pass 24-hour dietary recall on the following day. In conjunction with household measures and standard food sizes, volumes of liquid, dry rice, or play dough were used to aid portion size estimation. Inter-assessor agreement, and agreement with weighed food records was conducted primarily by Bland-Altman analysis and secondly by intraclass correlation coefficients and quartile cross-classification. Results 19 healthy children aged 6 months to 12 years were included in the study. Bland-Altman analysis showed 24-hour recall only marginally under-estimated energy (mean difference of 149kJ or 2.8%; limits of agreement -1618 to 1321kJ), protein (2.9g or 9.4%; -12.6 to 6.7g), and iron (0.43mg or 8.3%; -3.1 to 2.3mg). Quartile cross-classification was correct in 79% of cases for energy intake, and 89% for both protein and iron. The intraclass correlation coefficient between the separate dietary recalls for energy was 0.801 (95% CI, 0.429-0.933), indicating acceptable inter-observer agreement. Conclusions Dietary assessment using 24-hour dietary recall with volumetric portion size estimation resulted in similar and acceptable estimates of dietary intake compared with weighed food records and thus is considered a valid method for daily dietary intake assessment of

  13. Static stretching can impair explosive performance for at least 24 hours.

    PubMed

    Haddad, Monoem; Dridi, Amir; Chtara, Moktar; Chaouachi, Anis; Wong, Del P; Behm, David; Chamari, Karim

    2014-01-01

    The aim of this study was to compare the effects of static vs. dynamic stretching (DS) on explosive performances and repeated sprint ability (RSA) after a 24-hour delay. Sixteen young male soccer players performed 15 minutes of static stretching (SS), DS, or a no-stretch control condition (CC) 24 hours before performing explosive performances and RSA tests. This was a within-subject repeated measures study with SS, DS, and CC being counterbalanced. Stretching protocols included 2 sets of 7 minutes 30 seconds (2 repetitions of 30 seconds with a 15-second passive recovery) for 5 muscle groups (quadriceps, hamstring, calves, adductors, and hip flexors). Twenty-four hours later (without any kind of stretching in warm-up), the players were tested for the 30-m sprint test (with 10- and 20-m lap times), 5 jump test (5JT), and RSA test. Significant differences were observed between CC, SS, and DS with 5JT (F = 9.99, p < 0.00, effect size [ES] = 0.40), 10-m sprint time (F = 46.52, p < 0.00, ES = 0.76), 20-m sprint time (F = 18.44, p < 0.000, ES = 0.55), and 30-m sprint time (F = 34.25, p < 0.000, ES = 0.70). The significantly better performance (p < 0.05) was observed after DS as compared with that after CC and SS in 5JT, and sprint times for 10, 20, and 30 m. In contrast, significantly worse performance (p < 0.05) was observed after SS as compared with that after CC in 5JT, and sprint times for 10, 20, and 30 m. With RSA, no significant difference was observed between different stretching protocols in the total time (F = 1.55, p > 0.05), average time (F = 1.53, p > 0.05), and fastest time (F = 2.30, p > 0.05), except for the decline index (F = 3.54, p < 0.04, ES = 0.19). Therefore, the SS of the lower limbs and hip muscles had a negative effect on explosive performances up to 24 hours poststretching with no major effects on the RSA. Conversely, the DS of the same muscle groups are highly recommended 24 hours before performing sprint and long-jump performances. In

  14. Ambulatory Phlebectomy

    MedlinePlus

    ... Stretch Marks Sun-damaged Skin Unwanted Hair Unwanted Tattoos Varicose Veins Vitiligo Wrinkles Treatments and Procedures Ambulatory ... Stretch Marks Sun-damaged Skin Unwanted Hair Unwanted Tattoos Varicose Veins Vitiligo Wrinkles Treatments and Procedures Ambulatory ...

  15. Treating allergic conjunctivitis: A once-daily medication that provides 24-hour symptom relief

    PubMed Central

    Schaeffer, Jack; Donnenfeld, Eric

    2016-01-01

    Background: Allergic conjunctivitis (AC) is a common ocular inflammatory manifestation of allergen exposure in sensitized individuals. Signs and symptoms of AC can decrease quality of life, interfere with productivity, and lead to considerable economic burden. Consistent suppression of conjunctival inflammation is necessary for managing AC, but currently available medications require frequent administration and exhibit limited duration of action. Methods: In this review, we summarized AC pathogenesis, diagnosis, and current treatment options as well as their limitations. Findings from the literature were discussed in the context of the unmet need for a once-daily medication with sustained 24-hour effectiveness. Results: Topical pharmacologic treatments are the most common approach for managing extant AC; however, most available medications require multiple daily instillations. Dual-acting antihistamine-mast cell stabilizing agents are currently considered first-line therapeutics for AC because they provide acute relief of signs and symptoms and block persistent inflammation to promote regression of AC. Recent studies of a newly-developed, higher-concentration formulation of a dual-acting antihistamine-mast cell stabilizer have demonstrated that this formulation provides a 24-hour duration of action with once-daily dosing. Conclusions: Dual-acting AC medications exhibit a high degree of overall effectiveness and are well tolerated for chronic use. A newly available once-daily medication that manages signs and symptoms of AC for a full 24 hours may be considered a treatment of choice for patients experiencing seasonal or perennial AC. ClinicalTrials.gov NCT01743027 and NCT01479374 PMID:27466061

  16. Bioenergetical and Cardiac Adaptations of Pilots to a 24-Hour Team Kart Race.

    PubMed

    Durand, Sylvain; Ripamonti, Michael; Rahmani, Abderrahmane; Beaune, Bruno

    2015-11-01

    This study aimed to evaluate energy expenditure (EE) and heart rate (HR) response in kart pilots to successive driving bouts during a 24-hour team race. Eight adult male pilots (22.8 ± 4.1 years) participated to a team 24-hour speedway kart race in Le Mans (France). They alternatively piloted a 390 cm kart. Each relay was 45 minutes long and each pilot performed 4 relays. For each pilot, mean speeds were calculated from lap-to-lap duration recordings using a telemetric infrared timing device. Heart rate values were recorded continuously on 5-second intervals using a portable cardiometric device. Total energy expenditure (EET) and physical activity ratio (PAR) were determined by accelerometry. To pilot a kart during 45 minutes at a mean speed around 62 km·h induces a 300-kcal EET, corresponding to a 5.6-Mets PAR. This effort is responsive for a 73 b·min increase in HR, from 84.1 ± 7.6 to 157.4 ± 11.0 b·min (82% maximal heart rate intensity). However, during this relay period, HR values seemed independent to mean speed performance and bioenergetical values. Thus, in the context of the 24-hour team race, the variability in effort made during each relay and relay succession did not alter bioenergetical adaptation of pilots to kart driving. The high EE and HR values would be better explained by both emotional stress and environmental constraints such as speedway configuration and vibrations. The way how these factors specifically influence bioenergetical demand, and their relative importance, has to be specified to optimize training procedure and recommendations.

  17. Heterogeneity of Prognostic Studies of 24-Hour Blood Pressure Variability: Systematic Review and Meta-Analysis

    PubMed Central

    Taylor, Kathryn S.; Heneghan, Carl J.; Stevens, Richard J.; Adams, Emily C.; Nunan, David; Ward, Alison

    2015-01-01

    In addition to mean blood pressure, blood pressure variability is hypothesized to have important prognostic value in evaluating cardiovascular risk. We aimed to assess the prognostic value of blood pressure variability within 24 hours. Using MEDLINE, EMBASE and Cochrane Library to April 2013, we conducted a systematic review of prospective studies of adults, with at least one year follow-up and any day, night or 24-hour blood pressure variability measure as a predictor of one or more of the following outcomes: all-cause mortality, cardiovascular mortality, all cardiovascular events, stroke and coronary heart disease. We examined how blood pressure variability is defined and how its prognostic use is reported. We analysed relative risks adjusted for covariates including the appropriate mean blood pressure and considered the potential for meta-analysis. Our analysis of methods included 24 studies and analysis of predictions included 16 studies. There were 36 different measures of blood pressure variability and 13 definitions of night- and day-time periods. Median follow-up was 5.5 years (interquartile range 4.2–7.0). Comparing measures of dispersion, coefficient of variation was less well researched than standard deviation. Night dipping based on percentage change was the most researched measure and the only measure for which data could be meaningfully pooled. Night dipping or lower night-time blood pressure was associated with lower risk of cardiovascular events. The interpretation and use in clinical practice of 24-hour blood pressure variability, as an important prognostic indicator of cardiovascular events, is hampered by insufficient evidence and divergent methodologies. We recommend greater standardisation of methods. PMID:25984791

  18. Heterogeneity of prognostic studies of 24-hour blood pressure variability: systematic review and meta-analysis.

    PubMed

    Taylor, Kathryn S; Heneghan, Carl J; Stevens, Richard J; Adams, Emily C; Nunan, David; Ward, Alison

    2015-01-01

    In addition to mean blood pressure, blood pressure variability is hypothesized to have important prognostic value in evaluating cardiovascular risk. We aimed to assess the prognostic value of blood pressure variability within 24 hours. Using MEDLINE, EMBASE and Cochrane Library to April 2013, we conducted a systematic review of prospective studies of adults, with at least one year follow-up and any day, night or 24-hour blood pressure variability measure as a predictor of one or more of the following outcomes: all-cause mortality, cardiovascular mortality, all cardiovascular events, stroke and coronary heart disease. We examined how blood pressure variability is defined and how its prognostic use is reported. We analysed relative risks adjusted for covariates including the appropriate mean blood pressure and considered the potential for meta-analysis. Our analysis of methods included 24 studies and analysis of predictions included 16 studies. There were 36 different measures of blood pressure variability and 13 definitions of night- and day-time periods. Median follow-up was 5.5 years (interquartile range 4.2-7.0). Comparing measures of dispersion, coefficient of variation was less well researched than standard deviation. Night dipping based on percentage change was the most researched measure and the only measure for which data could be meaningfully pooled. Night dipping or lower night-time blood pressure was associated with lower risk of cardiovascular events. The interpretation and use in clinical practice of 24-hour blood pressure variability, as an important prognostic indicator of cardiovascular events, is hampered by insufficient evidence and divergent methodologies. We recommend greater standardisation of methods.

  19. Lack of effect of a 24-hour infusion of iloprost in intermittent claudication.

    PubMed

    Hay, C R; Waller, P C; Carter, C; Cameron, H A; Parnell, L; Ramsay, L E; Preston, F E; Greaves, M

    1987-04-15

    24 hour infusion of iloprost was compared with placebo infusion in 19 patients with stable intermittent claudication using a double blind, balanced crossover design. Despite significant inhibition of platelet aggregation to ADP and collagen (p less than 0.001) and the typical cardiovascular and gastrointestinal side effects, there was no significant effect on treadmill exercise times at any time up to 6 weeks after infusion. The 95% confidence limits indicated that an improvement of more than 25% was unlikely to occur. No significant changes in B thromboglobulin, platelet aggregate ratio, bleeding time, whole blood viscosity and euglobulin clot lysis time were demonstrated.

  20. [The changes in mental working capacity of operators during 24-hour shift work conditions].

    PubMed

    Kal'nysh, V V; Shvets', A V; Ieshchenko, O I

    2011-01-01

    Psychophysiological peculiarities of influence of a 24-hour shift work on the efficiency of operators have been discussed. It was shown that servicemen operators develop significant fatigue as a result of 24 hrs duty services. The informative psychophysiological characteristics which can be reliable indicators of fatigue level are highlighted. Individual psychophysiological indicators of fatigue level, according to different mechanisms of its development, have been proposed. The hypothesis about the existence of several compensatory mechanisms for maintenance of long duty operators' working capacity has been formulated.

  1. Assessing Dietary Intake in Childhood Cancer Survivors: Food Frequency Questionnaire Versus 24-Hour Diet Recalls.

    PubMed

    Zhang, Fang Fang; Roberts, Susan B; Must, Aviva; Wong, William W; Gilhooly, Cheryl H; Kelly, Michael J; Parsons, Susan K; Saltzman, Edward

    2015-10-01

    Cancer diagnosis and treatment may influence dietary intake. The validity of using self-reported methods to quantify dietary intake has not been evaluated in childhood cancer survivors. We validated total energy intake (EI) reported from Food Frequency Questionnaire (FFQ) and repeated 24-hour diet recalls (24HRs) against total energy expenditure (TEE) measured using the doubly labeled water method in 16 childhood cancer survivors. Dietary underreporting, assessed by (EI-TEE)/TEE × 100%, was 22% for FFQ and 1% for repeated 24HRs. FFQ significantly underestimates dietary intake and should not be used to assess the absolute intake of foods and nutrients in childhood cancer survivors.

  2. The Application of a Contact Lens Sensor in Detecting 24-Hour Intraocular Pressure-Related Patterns

    PubMed Central

    2016-01-01

    Glaucoma is one of the leading causes of blindness worldwide. Recent studies suggest that intraocular pressure (IOP) fluctuations, peaks, and rhythm are important factors in disease advancement. Yet, current glaucoma management remains hinged on single IOP measurements during clinic hours. To overcome this limitation, 24-hour IOP monitoring devices have been employed and include self-tonometry, permanent IOP, and temporary IOP monitoring. This review discusses each IOP measuring strategy and focuses on the recently FDA-approved contact lens sensor (CLS). The CLS records IOP-related ocular patterns for 24 hours continuously. Using the CLS, IOP-related parameters have been found to be associated with the rate of visual field progression in primary open-angle glaucoma, disease progression in primary angle-closure glaucoma, and various clinical variables in ocular hypertension. The CLS has been used to quantify blink rate and limbal strain and measure the circadian rhythm in a variety of disease states including normal-tension glaucoma and thyroid eye disease. The effects of various IOP-lowering interventions were also characterized using the CLS. CLS provides a unique, safe, and well-tolerated way to study IOP-related patterns in a wide range of disease states. IOP-related patterns may help identify patients most at risk for disease progression and assist with the development of tailored treatments. PMID:27525110

  3. Deviation of innate circadian period from 24 hours reduces longevity in mice

    PubMed Central

    Libert, Sergiy; Bonkowski, Michael S.; Pointer, Kelli; Pletcher, Scott D.; Guarente, Leonard

    2012-01-01

    Summary The variation of individual lifespans, even in highly inbred cohorts of animals and under strictly controlled environmental conditions, is substantial and not well understood. This variation in part could be due to epigenetic variation, which later affects the animal’s physiology and ultimately longevity. Identification of the physiological properties that impact health and lifespan is crucial for longevity research and the development of anti-aging therapies. Here we measured individual circadian and metabolic characteristics in a cohort of inbred F1 hybrid mice and correlated these parameters to their lifespans. We found that mice with innate circadian periods close to 24 hours (revealed during 30 days of housing in total darkness) enjoyed nearly 20% longer lifespans than their littermates, which had shorter or longer innate circadian periods. These findings show that maintenance of a 24 hour intrinsic circadian period is a positive predictor of longevity. Our data suggest that circadian period may be used to predict individual longevity and that processes that control innate circadian period affect aging. PMID:22702406

  4. Validity of 24-hour dietary recall interviews conducted among volunteers in an adult working community.

    PubMed

    Kahn, H A; Whelton, P K; Appel, L J; Kumanyika, S K; Meneses, J L; Hebert, P R; Woods, M

    1995-11-01

    There is considerable uncertainty regarding the validity of dietary data collected from free-living populations. Nevertheless, few attempts have been made to validate dietary assessment instruments. To address this issue, we compared average daily protein intake estimated from 24-hour dietary recall interviews to protein intake estimated from urinary nitrogen excretion in 24-hour samples. Among 244 community-dwelling adults who volunteered for a hypertension study, men (n = 139) overreported dietary protein intake by 12 to 19%. In contrast, women (n = 105) reported a dietary protein intake almost exactly in agreement with estimates based on urinary nitrogen levels. Thin men reported about one-third more protein intake than was reflected in their urinary nitrogen measurements. Our results suggest that the accuracy of dietary recall estimates may vary across subgroups of the population. Additional information from sufficiently large validation studies would be helpful in determining the role of dietary assessment instruments which are already in wide use in epidemiologic research. Until such information is obtained, doubts will remain regarding the validity of inferences drawn from nutritional epidemiologic studies.

  5. Comparison of 24-hour intragastric pH using four liquid formulations of lansoprazole and omeprazole.

    PubMed

    Sharma, V K

    1999-12-01

    The results of previous studies evaluating the effect of four liquid formulations of proton-pump inhibitors on 24-hour intragastric pH are described. Patients with a gastrostomy who were resident in a Veterans Affairs medical center or its affiliated nursing home were eligible for enrollment in one of four open-label studies in which each patient served as his own control. Patients underwent 24-hour intragastric pH studies before and after receiving seven consecutive days of one of the following liquid formulations of a proton-pump inhibitor administered once daily: omeprazole granules 20 mg in orange juice, lansoprazole granules 30 mg in orange juice, simplified omeprazole suspension 20 mg, and simplified lansoprazole suspension 30 mg. The suspensions were prepared with 10 mL of 8.4% sodium bicarbonate solution. Mean intragastric pH was measured, as was the time pH stayed above 3.0 and 4.0 during the 24-hour period. Six to 14 patients participated in each study. The mean posttreatment pH was 4.9+/-0.8, 4.7+/-0.6, 4.1+/-1.5, and 5.1+/-1.1 for omeprazole granules in orange juice, lansoprazole granules in orange juice, simplified omeprazole suspension, and simplified lansoprazole suspension, respectively. Both drugs in orange juice maintained pH above 4.0 longer than 14 hours and above 3.0 for close to 20 hours, which are the levels deemed optimal for healing erosive esophagitis and duodenal ulcers, respectively. Simplified lansoprazole suspension maintained pH above those thresholds for the optimal times, but simplified omeprazole suspension did not (20 and 15 hr above 3.0, 17 and 12 hr above 4.0 for lansoprazole and omeprazole, respectively). Further development of liquid formulations of proton-pump inhibitors may have important implications for the treatment of acid-related diseases in patients, including children, who are unable to swallow capsules.

  6. Azilsartan medoxomil plus chlorthalidone reduces blood pressure more effectively than olmesartan plus hydrochlorothiazide in stage 2 systolic hypertension.

    PubMed

    Cushman, William C; Bakris, George L; White, William B; Weber, Michael A; Sica, Domenic; Roberts, Andrew; Lloyd, Eric; Kupfer, Stuart

    2012-08-01

    Azilsartan medoxomil, an effective, long-acting angiotensin II receptor blocker, is a new treatment for hypertension that is also being developed in fixed-dose combinations with chlorthalidone, a potent, long-acting thiazide-like diuretic. We compared once-daily fixed-dose combinations of azilsartan medoxomil/chlorthalidone force titrated to a high dose of either 40/25 mg or 80/25 mg with a fixed-dose combination of the angiotensin II receptor blocker olmesartan medoxomil plus the thiazide diuretic hydrochlorothiazide force titrated to 40/25 mg. The design was a randomized, 3-arm, double-blind, 12-week study of 1071 participants with baseline clinic systolic blood pressure 160 to 190 mm Hg and diastolic blood pressure ≤119 mm Hg. Patients had a mean age of 57 years; 59% were men, 73% were white, and 22% were black. At baseline, mean clinic blood pressure was 165/96 mm Hg and 24-hour mean blood pressure was 150/88 mm Hg. Changes in clinic (primary end point) and ambulatory systolic blood pressures at week 12 were significantly greater in both azilsartan medoxomil/chlorthalidone arms than in the olmesartan/hydrochlorothiazide arm (P<0.001). Changes in clinic systolic blood pressure (mean±SE) were -42.5±0.8, -44.0±0.8, and -37.1±0.8 mm Hg, respectively. Changes in 24-hour ambulatory systolic blood pressure were -33.9±0.8, -36.3±0.8, and -27.5±0.8 mm Hg, respectively. Adverse events leading to permanent drug discontinuation occurred in 7.9%, 14.5%, and 7.1% of the groups given azilsartan medoxomil/chlorthalidone 40/25 mg, azilsartan medoxomil/chlorthalidone 80/25 mg, and olmesartan/hydrochlorothiazide 40/25 mg, respectively. This large, forced-titration study has demonstrated superior antihypertensive efficacy of azilsartan medoxomil/chlorthalidone fixed-dose combinations compared with the maximum approved dose of olmesartan/hydrochlorothiazide.

  7. Estimating 24-hour urinary sodium excretion from casual urinary sodium concentrations in Western populations: the INTERSALT study.

    PubMed

    Brown, Ian J; Dyer, Alan R; Chan, Queenie; Cogswell, Mary E; Ueshima, Hirotsugu; Stamler, Jeremiah; Elliott, Paul

    2013-06-01

    High intakes of dietary sodium are associated with elevated blood pressure levels and an increased risk of cardiovascular disease. National and international guidelines recommend reduced sodium intake in the general population, which necessitates population-wide surveillance. We assessed the utility of casual (spot) urine specimens in estimating 24-hour urinary sodium excretion as a marker of sodium intake in the International Cooperative Study on Salt, Other Factors, and Blood Pressure. There were 5,693 participants recruited in 1984-1987 at the ages of 20-59 years from 29 North American and European samples. Participants were randomly assigned to test or validation data sets. Equations derived from casual urinary sodium concentration and other variables in the test data were applied to the validation data set. Correlations between observed and estimated 24-hour sodium excretion were 0.50 for individual men and 0.51 for individual women; the values were 0.79 and 0.71, respectively, for population samples. Bias in mean values (observed minus estimated) was small; for men and women, the values were -1.6 mmol per 24 hours and 2.3 mmol per 24 hours, respectively, at the individual level and -1.8 mmol per 24 hours and 2.2 mmol per 24 hours, respectively, at the population level. Proportions of individuals with urinary 24-hour sodium excretion above the recommended levels were slightly overestimated by the models. Casual urine specimens may be a useful, low-burden, low-cost alternative to 24-hour urine collections for estimation of population sodium intakes; ongoing calibration with study-specific 24-hour urinary collections is recommended to increase validity.

  8. Setting Spacecraft Maximum Allowable Concentrations for 1 hour or 24 hour contingency exposures to airborne chemicals

    NASA Technical Reports Server (NTRS)

    Garcia, Hector D.; Limero, Thomas F.; James, John T.

    1992-01-01

    Since the early years of the manned space program, NASA has developed and used exposure limits called Spacecraft Maximum Allowable Concentrations (SMACs) to help protect astronauts from airborne toxicants. Most of these SMACS are based on an exposure duration of 7 days, since this is the duration of a 'typical' mission. A set of 'contingency SMACs' is also being developed for scenarios involving brief (1-hour or 24- hour) exposures to relatively high levels of airborne toxicants from event-related 'contingency' releases of contaminants. The emergency nature of contingency exposures dictates the use of different criteria for setting exposure limits. The NASA JSC Toxicology Group recently began a program to document the rationales used to set new SMACs and plans to review the older, 7-day SMACs. In cooperation with the National Research Council's Committee on Toxicology, a standard procedure has been developed for researching, setting, and documenting SMAC values.

  9. New method for assessing cardiac parasympathetic activity using 24 hour electrocardiograms.

    PubMed Central

    Ewing, D J; Neilson, J M; Travis, P

    1984-01-01

    Cardiac parasympathetic activity was assessed using 24 hour electrocardiographic recordings by measuring the incidence of larger changes in successive RR intervals, which in normal subjects occur frequently but irregularly. In 25 normal subjects the mean number of times per hour in which the change in successive RR interval was greater than 50 ms was 150-250 during waking and 350-450 during sleeping. By contrast, 30 diabetics with medically denervated hearts (12 with cardiovascular reflex evidence of parasympathetic damage and 18 with additional sympathetic damage) and six cardiac transplant patients with surgically denervated hearts had extremely low counts. Additionally, of 20 diabetics with normal cardiovascular reflexes, about half had abnormally low counts, suggesting that this method is better than currently available reflex tests in detecting early cardiac parasympathetic damage. This technique provides a valid and sensitive way of monitoring cardiac parasympathetic activity over prolonged periods. PMID:6383446

  10. After 24-hour scrub, another tower rollback for the Boeing Delta II rocket carrying Stardust

    NASA Technical Reports Server (NTRS)

    1999-01-01

    As tower rollback begins, the Boeing Delta II rocket carrying the Stardust spacecraft waits on Launch Pad 17-A, Cape Canaveral Air Station, for the second launch attempt at 4:04 p.m. EST. The original launch was scrubbed on Feb. 6 for 24 hours. Stardust is destined for a close encounter with the comet Wild 2 in January 2004. Using a silicon-based substance called aerogel, Stardust will capture comet particles flying off the nucleus of the comet. The spacecraft also will bring back samples of interstellar dust. These materials consist of ancient pre-solar interstellar grains and other remnants left over from the formation of the solar system. Scientists expect their analysis to provide important insights into the evolution of the sun and planets and possibly into the origin of life itself. The collected samples will return to Earth in a sample return capsule to be jettisoned as Stardust swings by Earth in January 2006.

  11. Mice increased target biting behaviors 24 hours after co-administration of alcohol and fluoxetine.

    PubMed

    Mamiya, Ping Chao; Matray-Devoti, Judith; Fisher, Hans; Wagner, George C

    2017-02-10

    Increased alcohol consumption has been linked to social isolation. Individuals showed heightened aggression following social isolation. Animals treated with alcohol following social separation showed higher aggression and lower serotonin transmission. Although reduced serotonin transmission in the brain may be related to alcohol induced heightened aggression, it remains unclear whether there are specific brain regions where changes in serotonin transmission are critical for animal aggression following alcohol treatment. In the present study, we isolated mice for 4 - 6 weeks and injected them with alcohol, fluoxetine and alcohol with fluoxetine. We studied their aggression by using two types of behavioral paradigms: isolation-induced attack behavior towards a naïve mouse in a neutral cage, or shock-induced target biting aggression. We observed that alcohol administered at 500 mg/kg significantly increased animal attack behaviors towards naïve mice 30 minutes after injections. This dose of alcohol co-administered with a low dose of fluoxetine (2 mg/kg) further increased the attack behaviors, but with higher doses of fluoxetine decreased the attack behaviors. Alcohol administered at a dose of 1,000 mg/kg significantly decreased the shock-induced target biting rates 24 hours after injections. Interestingly, we observed a significant increase in target biting rates when alcohol was co-administered with fluoxetine at a dose of 16 mg/kg 24 hours after injections. We also observed the same heightened target biting rates when animals were injected with fluoxetine alone. This heightened biting attack engendered by the fluoxetine (alone or in combination with the alcohol) occurred at a time when brain serotonin activity was reduced by these drugs in the frontal lobe and hypothalamus. These observations indicate that heightened biting attack behavior may be associated with reduced serotonergic activity in brain regions regulating aggression.

  12. Effects of exenatide and liraglutide on 24-hour glucose fluctuations in type 2 diabetes.

    PubMed

    Nagakura, Jo; Yamakawa, Tadashi; Taguri, Masataka; Tsuchiya, Hirohisa; Shigematsu, Erina; Suzuki, Jun; Morita, Satoshi; Kadonosono, Kazuaki; Terauchi, Yasuo

    2016-01-01

    We evaluated the influence of short-term treatment with exenatide twice daily or liraglutide once daily on daily blood glucose fluctuations in 40 patients with type 2 diabetes inadequately controlled by sulfonylureas. The patients in a multicenter, open-label trial were randomly assigned to receive add-on exenatide (10 μg/day, n = 21) or add-on liraglutide (0.3-0.9 mg/day, n = 19), and underwent 24-hour continuous subcutaneous glucose monitoring. There was no significant between-group difference in glucose fluctuations during the day, as assessed by calculating mean amplitude of glycemic excursion (MAGE) and standard deviation (SD). However, the mean blood glucose levels at 3 hours after breakfast and dinner were significantly lower in the exenatide group than the liraglutide group (breakfast: 127.3 ± 24.1 vs. 153.4 ± 28.7 mg/dL; p = 0.006, dinner: 108.7 ± 17.3 vs. 141.9 ± 24.2 mg/dL; p < 0.001). In contrast, mean blood glucose levels and their SD were significantly lower between 0000 h and 0600 h in the liraglutide group than the exenatide group (average glucose: 126.9 ± 27.1 vs. 107.1 ± 24.0 mg/dL; p = 0.029, SD: 15.2 ± 10.5 vs. 8.7 ± 3.8; p = 0.020). Both groups had similar glucose fluctuations despite differences in 24-hour blood glucose profiles. Therefore, each of these agents may have advantages or disadvantages and should be selected according to the blood glucose profile of the patient.

  13. The effect of Operation 24 Hours on reducing collision in the City of Edmonton.

    PubMed

    Halim, Siana; Jiang, Heming

    2013-09-01

    In the City of Edmonton, in order to reduce the prevalence of collisions, the Operation 24 Hours program (OPS24) was developed by using existing police and transportation services resources. The program uses traditional manned police speed enforcement method, which are supplemented by traffic safety messages displayed on permanent and mobile dynamic messaging signs (DMS). In this paper, collision data analysis was performed by looking at the daily number of collisions from 2008 to 2011 that covers 28 Operation 24 Hours (OPS24) events. The objective of the collision data analysis is to analyze if there is a reduction in collision frequencies after OPS24 was held and examined how long the collision reduction effect last. Weather factors such as temperature, thickness of snow, and wind gust have been considered by many as a great influence on collision occurrences, especially in a city with long and cold winter such as Edmonton. Therefore, collision modeling was performed by considering these external weather factors. To analyze the linear and periodic trend of different collision types (injury, fatal, and property damage only (PDO)) and examine the influence of weather factors on collisions, negative binomial time series model that accounts for seasonality and weather factors was used to model daily collision data. The modeling also considered collision proportion to account for missing traffic volume data; the Gaussian time series model that accounts for seasonality and weather factors was used to model collision proportion. To estimate the collision trend and test for changes in collision levels before/after OPS24, interrupted time series model with segmented regression was used. While for estimating how long the effect of the OPS24 last, change point method was applied.

  14. Estimation of 24-hour urinary sodium excretion using spot urine samples.

    PubMed

    Rhee, Moo-Yong; Kim, Ji-Hyun; Shin, Sung-Joon; Gu, Namyi; Nah, Deuk-Young; Hong, Kyung-Soon; Cho, Eun-Joo; Sung, Ki-Chul

    2014-06-20

    The present study evaluated the reliability of equations using spot urine (SU) samples in the estimation of 24-hour urine sodium excretion (24-HUNa). Equations estimating 24-HUNa from SU samples were derived from first-morning SU of 101 participants (52.4 ± 11.1 years, range 24-70 years). Equations developed by us and other investigators were validated with SU samples from a separate group of participants (n = 224, 51.0 ± 10.9 years, range 24-70 years). Linear, quadratic, and cubic equations were derived from first-morning SU samples because these samples had a sodium/creatinine ratio having the highest correlation coefficient for 24-HUNa/creatinine ratio (r = 0.728, p < 0.001). In the validation group, the estimated 24-HUNa showed significant correlations with measured 24-HUNa values. The estimated 24-HUNa by the linear, quadratic, and cubic equations developed from our study were not significantly different from measured 24-HUNa, while estimated 24-HUNa by previously developed equations were significantly different from measured 24-HUNa values. The limits of agreement between measured and estimated 24-HUNa by six equations exceeded 100 mmol/24-hour in the Bland-Altman analysis. All equations showed a tendency of under- or over-estimation of 24-HUNa, depending on the level of measured 24-HUNa. Estimation of 24-HUNa from single SU by equations as tested in the present study was found to be inadequate for the estimation of an individual's 24-HUNa.

  15. Dietary restraint and disinhibition do not affect accuracy of 24-hour recall in a multiethnic population.

    PubMed

    Ard, Jamy D; Desmond, Renee Ann; Allison, David B; Conway, Joan Marie

    2006-03-01

    Some psychological predictors of eating behaviors have been shown to affect usefulness of methods for dietary assessment. Therefore, this study was conducted to determine the association of dietary restraint and disinhibition with dietary recall accuracy for total energy, fat, carbohydrate, and protein. In a cross-sectional study, data were obtained from 79 male and 71 female non-Hispanic whites and African-American volunteers. Participants selected and consumed all foods for a 1-day period under observation and actual intake was determined. The following day, each participant completed a telephone 24-hour recall using the US Department of Agriculture Multiple-Pass method to obtain recalled intake. The Eating Inventory, which measures dietary restraint and disinhibition, was administered prior to eating any food in the study. Repeated measures analyses of variance were used to determine if dietary restraint or disinhibition were independent predictors of recall accuracy. The mean (+/-standard deviation) age and body mass index of the participants was 43+/-12 years and 29+/-5.5 (calculated as kg/m2), respectively. On average, men overreported intake of energy by 265 kcal and women by 250 kcal; both groups also overreported intake of protein, carbohydrate, and fat. When controlling for body mass index, sex, and race, restraint was a significant independent predictor of energy intake (P=0.004) and negatively correlated with energy intake (r=-0.23, P<0.001). Unlike intake of carbohydrate or protein, fat intake was significantly and negatively associated with dietary restraint (P<0.001; r=-0.3). Dietary restraint did not affect accuracy of recall of intake of energy, fat, carbohydrate, or protein, but was significantly associated with intake of energy and fat. Disinhibition was not related to intake or accuracy. Dietetics professionals should consider dietary restraint a possible reason for a lower than expected estimate of energy intake when using 24-hour recalls.

  16. Attempt Quit Smoking 24+ Hours Maps and Data of Model-Based Small Area Estimates - Small Area Estimates

    Cancer.gov

    Attempt Quit Smoking 24+ Hours is defined as a person 18 years of age or older who must have reported smoking at least 100 cigarettes in his/her life, and now does not smoke at all but it has been less than 365 days since completely stopped smoking cigarettes, or now smoke everyday or some days but reported that have made attempt of quitting for more than 24 hours in the past 12 months.

  17. Time-Based Measurement of Personal Mite Allergen Bioaerosol Exposure over 24 Hour Periods

    PubMed Central

    Tovey, Euan R.; Liu-Brennan, Damien; Garden, Frances L.; Oliver, Brian G.; Perzanowski, Matthew S.; Marks, Guy B.

    2016-01-01

    Allergic diseases such as asthma and rhinitis are common in many countries. Globally the most common allergen associated with symptoms is produced by house dust mites. Although the bed has often been cited as the main site of exposure to mite allergens, surprisingly this has not yet been directly established by measurement due to a lack of suitable methods. Here we report on the development of novel methods to determine the pattern of personal exposure to mite allergen bioaerosols over 24-hour periods and applied this in a small field study using 10 normal adults. Air was sampled using a miniature time-based air-sampler of in-house design located close to the breathing zone of the participants, co-located with a miniature time-lapse camera. Airborne particles, drawn into the sampler at 2L/min via a narrow slot, were impacted onto the peripheral surface of a disk mounted on the hour-hand of either a 12 or 24 hour clock motor. The impaction surface was either an electret cloth, or an adhesive film; both novel for these purposes. Following a review of the time-lapse images, disks were post-hoc cut into subsamples corresponding to eight predetermined categories of indoor or outdoor location, extracted and analysed for mite allergen Der p 1 by an amplified ELISA. Allergen was detected in 57.2% of the total of 353 subsamples collected during 20 days of sampling. Exposure patterns varied over time. Higher concentrations of airborne mite allergen were typically measured in samples collected from domestic locations in the day and evening. Indoor domestic Der p 1 exposures accounted for 59.5% of total exposure, whereas total in-bed-asleep exposure, which varied 80 fold between individuals, accounted overall for 9.85% of total exposure, suggesting beds are not often the main site of exposure. This study establishes the feasibility of novel methods for determining the time-geography of personal exposure to many bioaerosols and identifies new areas for future technical

  18. Non-24-Hour Sleep-Wake Disorder Revisited – A Case Study

    PubMed Central

    Garbazza, Corrado; Bromundt, Vivien; Eckert, Anne; Brunner, Daniel P.; Meier, Fides; Hackethal, Sandra; Cajochen, Christian

    2016-01-01

    The human sleep-wake cycle is governed by two major factors: a homeostatic hourglass process (process S), which rises linearly during the day, and a circadian process C, which determines the timing of sleep in a ~24-h rhythm in accordance to the external light–dark (LD) cycle. While both individual processes are fairly well characterized, the exact nature of their interaction remains unclear. The circadian rhythm is generated by the suprachiasmatic nucleus (“master clock”) of the anterior hypothalamus, through cell-autonomous feedback loops of DNA transcription and translation. While the phase length (tau) of the cycle is relatively stable and genetically determined, the phase of the clock is reset by external stimuli (“zeitgebers”), the most important being the LD cycle. Misalignments of the internal rhythm with the LD cycle can lead to various somatic complaints and to the development of circadian rhythm sleep disorders (CRSD). Non-24-hour sleep-wake disorders (N24HSWD) is a CRSD affecting up to 50% of totally blind patients and characterized by the inability to maintain a stable entrainment of the typically long circadian rhythm (tau > 24.5 h) to the LD cycle. The disease is rare in sighted individuals and the pathophysiology less well understood. Here, we present the case of a 40-year-old sighted male, who developed a misalignment of the internal clock with the external LD cycle following the treatment for Hodgkin’s lymphoma (ABVD regimen, four cycles and AVD regimen, four cycles). A thorough clinical assessment, including actigraphy, melatonin profiles and polysomnography led to the diagnosis of non-24-hour sleep-wake disorders (N24HSWD) with a free-running rhythm of tau = 25.27 h. A therapeutic intervention with bright light therapy (30 min, 10,000 lux) in the morning and melatonin administration (0.5–0.75 mg) in the evening failed to entrain the free-running rhythm, although a longer treatment duration and more intense therapy

  19. Gender differences in the relationship between resting heart rate variability and 24-hour blood pressure variability.

    PubMed

    Thayer, Julian F; Sollers, John J; Friedman, Bruce H; Koenig, Julian

    2016-01-01

    The study explored the relationship between time- and frequency-domain indices of cardiac autonomic control and 24 h blood pressure variability (BPV) in a sample of healthy men and women. Vagally mediated cardiac control was inversely related to 24 h BPV, and measures of cardiac autonomic control were better predictors of systolic BPV in men and better predictors of diastolic BPV in women. These findings may help researchers to understand the disparity in cardiovascular disease morbidity and mortality between men and women.

  20. SLEEP DURATION AND AMBULATORY BLOOD PRESSURE IN BLACK AND WHITE ADOLESCENTS

    PubMed Central

    Mezick, Elizabeth J; Hall, Martica; Matthews, Karen A

    2012-01-01

    Self-reported short sleep duration is linked to higher blood pressure and incident hypertension in adults. Few studies have examined sleep and blood pressure in younger samples. We evaluated the associations between actigraphy-assessed time spent asleep and ambulatory blood pressure in adolescents. Participants were 246 black and white adolescents (mean age = 15.7) who were free from cardiovascular or kidney disease and were not taking sleep, cardiovascular, or psychiatric medications. Sleep duration and efficiency were assessed with in-home wrist actigraphy and sleep diaries across one week; ambulatory blood pressure monitoring was used to obtain 24-hour, sleep, wake blood pressure, and sleep-wake blood pressure ratios across two full days and nights. Results showed that shorter actigraphy-assessed sleep across one week was related to higher 48-hour blood pressure and higher nighttime blood pressure. Shorter sleep was also related to a higher systolic blood pressure sleep-wake ratio. These results were independent of age, race, sex, and body mass index. Follow-up analyses by race revealed that associations between sleep duration and blood pressure were largely present in white, but not black, adolescents. These data are consistent with the hypothesis that the cardiovascular consequences of short sleep may begin as early as adolescence. PMID:22275538

  1. Ambulatory Arterial Stiffness Index Is Higher in Hypertensive Patients with Chronic Kidney Disease

    PubMed Central

    Gismondi, Ronaldo Altenburg; Neves, Mario Fritsch; Oigman, Wille; Bregman, Rachel

    2012-01-01

    Ambulatory arterial stiffness index (AASI) is a parameter obtained from ambulatory blood pressure monitoring (ABPM) that correlates with clinical endpoints. The aim of this study was to compare AASI in nondiabetic hypertensive patients with and without chronic kidney disease (CKD). Subjects with systemic arterial hypertension (SAH, n = 30) with normal renal function, aged 40 to 75 years, were compared to hypertensive patients with CKD (n = 30) presenting estimated glomerular filtration rate (eGFR) <60 mL/min by MDRD formula. ABPM was carried out in all patients. In CKD group, eGFR was 35.3 ± 2.8 ml/min. The mean 24-hour systolic and diastolic blood pressure (BP) was similar in both groups. AASI was significantly higher in CKD group (0.45 ± 0.03 versus 0.37 ± 0.02, P < 0.05), positively correlated to age (r = 0.38, P < 0.01) and pulse pressure (r = 0.43, P < 0.01) and negatively correlated to nocturnal BP fall (r = -0.28, P = 0.03). These findings indicate the presence of stiffer vessels in CKD hypertensive patients. PMID:22675608

  2. [Left ventricular relaxation and ambulatory blood pressure in mild, untreated arterial hypertension].

    PubMed

    Herpin, D; Raynier, P; Ciber, M; Amiel, A; Boutaud, P; Demange, J

    1989-03-01

    Twenty patients with mild, untreated arterial hypertension had ambulatory blood pressure recordings and a digitized echocardiographic study of the left ventricle with measurement of its mass (LVM) and of relaxation parameters. A significant correlation was found between LVM and ambulatory systolic pressure during daytime (r = 0.64; p less than 0.01; n = 20) and during 24 hours (r = 0.79; p less than 0.001; n = 16). One of the relaxation parameters studied, the time taken to reach maximal speed of left ventricular enlargement, was closely related to the diurnal diastolic blood pressure (r = 0.58; p less than 0.01; n = 20), whereas in this population with mild arterial blood pressure none of the parameters was related to the amount of increase of LVM. One may therefore consider the abnormalities of left ventricular relaxation as likely to appear at an early stage of arterial hypertension; their discovery may antedate that of LVM and confirm that the hypertensive disease is real. However, the methodological problems encountered with type of exploration ought to be stressed: left ventricular relaxation is a multifactorial phenomenon, and its echocardiographic approach is subject to many hazards.

  3. Low mean impedance in 24-hour tracings and esophagitis in children: a strong connection.

    PubMed

    Salvatore, S; Salvatoni, A; Ummarino, D; Ghanma, A; Van der Pol, R; Rongen, A; Fuoti, M; Meneghin, F; Benninga, M Alexander; Vandenplas, Y

    2016-01-01

    Esophageal multiple intraluminal impedance baseline is an additional impedance parameter that was recently related to esophageal integrity. The aim of this study was to assess the relationship between mean esophageal impedance value and endoscopic findings in a large group of children. Children with symptoms of gastroesophageal reflux submitted to both endoscopy and impedance were included. Esophagitis was graded according to the Los Angeles classification. Mean impedance value was automatically calculated over 24-hour tracings. Data were adjusted for age through z-score transformation using percentiles normalized by the LMS (Lambda for the skew, Mu for the median, and Sigma for the generalized coefficient of variation) method. Nonparametric Mann-Whitney and Kruskal-Wallis tests, multiple, and stepwise regression were used. P-value <0.05 was considered as statistically significant. A total of 298 impedance tracings were analyzed. Endoscopic and histological esophagitis were detected in 30 and 29% patients, respectively. Median baseline z-score was significantly decreased both in proximal (P = 0.02) and distal (P = 0.01) esophagus in patients with endoscopic (but not histological) esophagitis. Patients with more severe esophagitis showed the lowest z-score. Bolus exposure index and the number of reflux episodes were the variables that were significantly associated with the baseline z-score. Impedance z-score is significantly decreased in infants and children with endoscopic esophagitis. Severity of esophagitis, bolus exposure index, and number of reflux episodes are factors influencing mean esophageal impedance.

  4. Deep venous thrombophlebitis: detection with 4-hour versus 24-hour platelet scintigraphy

    SciTech Connect

    Seabold, J.E.; Conrad, G.R.; Ponto, J.A.; Kimball, D.A.; Frey, E.E.; Ahmed, F.; Coughlan, J.D.; Jensen, K.C.

    1987-11-01

    Thirty-one nonheparinized patients with suspected deep venous thrombophlebitis (DVT) underwent contrast venography and indium-111 platelet scintigraphy (In-111 PS). Venography permitted identification of acute DVT in 12 of 31 cases (39%). One additional patient was considered to have acute DVT despite nonconclusive venography results. In-111 PS results were positive at 4 hours in nine of 13 cases (69%) and at 24 hours in 12 of 13 cases (92%). Two of four patients with false-negative 4-hour In-111 PS studies had received warfarin. Thus, the sensitivity of 4-hour In-111 PS in patients not receiving anticoagulants was 82%. Venography results were negative for acute DVT in 18 cases, and 4-hour In-111 PS studies were negative or equivocal in each. In-111 PS is an alternative to contrast venography for detecting acute DVT. If 4-hour In-111 PS results are positive, anticoagulation can be initiated. Delayed images are necessary if the 4-hour images are negative or equivocal.

  5. Neonatal family care for 24 hours per day: effects on maternal confidence and breast-feeding.

    PubMed

    Wataker, Heidi; Meberg, Alf; Nestaas, Eirik

    2012-01-01

    In family care (FC) program for neonatal intensive care units (NICUs), parents are encouraged to reside together with their infant for 24 hours a day to actively be involved in the care. The aim of this study was to assess the impact of FC on maternal confidence and breast-feeding. Maternal confidence and rate of breast-feeding were assessed in 31 mothers offered FC that included special family rooms in the NICU, and in 30 mothers from a comparable NICU providing traditional care without such facilities. One week prior to hospital discharge, mothers in the FC group felt better informed regarding nursing issues and had more confidence in interpretation of the infants regarding feeding issues and in caregiving without staff attendance (P < .05). They also reported a higher level of empowerment (P < .05). Three months after discharge, the mothers in the FC group had a higher self-reported skill level for interpretation of the infant's signals and knowledge about breast-feeding (P < .05). Despite similar rate of breast-feeding at discharge, more infants in the FC group were breastfed 3 months after discharge (P < .05). An FC program in the NICU promoted better maternal confidence during the hospital stay and 3 months after discharge compared with traditional care.

  6. The Canadian 24-Hour Movement Guidelines for Children and Youth: Implications for practitioners, professionals, and organizations.

    PubMed

    Latimer-Cheung, Amy E; Copeland, Jennifer L; Fowles, Jonathon; Zehr, Lori; Duggan, Mary; Tremblay, Mark S

    2016-06-01

    The new Canadian 24-Hour Movement Guidelines for Children and Youth emphasize the integration of all movement behaviours that occur over a whole day (i.e., light, moderate, and vigorous physical activity, sedentary behaviour, and sleep). These guidelines shift the paradigm away from considering each behaviour in isolation. This concept of the "whole day matters" not only calls for a change in thinking about movement but also for redevelopment of dissemination and implementation practice. Past guideline launch activities largely have aimed to create awareness through passive dissemination strategies (e.g., Website posts, distribution of print resources). For the integrated guidelines to have public health impact, we must move beyond dissemination and raising of awareness to implementation and behaviour change. Shifting this focus requires new, innovative approaches to intervention, including interdisciplinary collaboration, policy change, and refocused service provision. The purpose of this paper is to identify practitioners, professionals, and organizations with potential to disseminate and/or implement the guidelines, discuss possible implementation strategies for each of these groups, and describe the few resources being developed and those needed to support dissemination and implementation efforts. This discussion makes readily apparent the need for a well-funded, comprehensive, long-term dissemination, implementation, and evaluation plan to ensure uptake and activation of the guidelines.

  7. After 24-hour scrub, the Boeing Delta II rocket carrying Stardust waits for launch

    NASA Technical Reports Server (NTRS)

    1999-01-01

    In the late morning light at Launch Pad 17-A, Cape Cananveral Air Station, the fixed utility tower (right) casts a long shadow across the base of the Boeing Delta II rocket (left) waiting to launch the Stardust spacecraft. After a 24-hour scrub, the new targeted launch time is 4:04 p.m. EST. Stardust is destined for a close encounter with the comet Wild 2 in January 2004. Using a silicon-based substance called aerogel, Stardust will capture comet particles flying off the nucleus of the comet. The spacecraft also will bring back samples of interstellar dust. These materials consist of ancient pre-solar interstellar grains and other remnants left over from the formation of the solar system. Scientists expect their analysis to provide important insights into the evolution of the sun and planets and possibly into the origin of life itself. The collected samples will return to Earth in a sample return capsule to be jettisoned as Stardust swings by Earth in January 2006.

  8. Obtaining liver tridimensional scaffold through the decellularization of rabbit whole liver in 24 hours

    NASA Astrophysics Data System (ADS)

    Federico, Schliamser; Ayelen, Rinaldi; Romina, Comin; Alba Nelly, Borchert; Adrian, Nari Gustavo; Alicia, Salvatierra Nancy; Mariana Paula, Cid

    2016-04-01

    In the present work, we development a new protocol for liver decellularization in which the hole decellularization was reached over 24 h. Introduction: the availability of transplantable livers is not sufficient to fulfill the current demand for grafts, with the search for therapeutic alternatives having generated different lines of research, one of which is the use of decellularized three-dimensional biological matrices and subsequent cell seeding to obtain a functional organ. Objective: to produce a decellularization protocol from rabbit liver to generate a three-dimensional matrixin which the time period involved didn't pass 24 h. Methods: The decellularization is obtained through the use of water and SDS (0,1-0,3 %), after freezing at -80 degrees, is the best alternative of different physical and/or chemical mechanisms to break down organ cells and leave only the extracellular matriz. After 24 h of retrograde perfusion, a decellularized translucent matrix was generated. To evaluate if the decellularization protocol was successful, with the extracellular matrix being preserved, we carried out histological (light microscopy) and biochemical (DNA quantification) studies. Results: the decellularization process was verified by macroscopic observation of the organ using microscopic observation corroborated the macroscopic results, with the hematoxylin-eosin and Masson staining showing no cells or nuclear material. In addition, the DNA quantification was less than 10% in the decellularized liver compared to control. Finally,the time taken to develop the decellularization protocol was less than 24 hours.

  9. Comparison of effects of amphotericin B deoxycholate infused over 4 or 24 hours: randomised controlled trial

    PubMed Central

    Eriksson, Urs; Seifert, Burkhard; Schaffner, Andreas

    2001-01-01

    Objective To test the hypothesis that amphotericin B deoxycholate is less toxic when given by continuous infusion than by conventional rapid infusion. Design Randomised, controlled, non-blinded, single centre study. Setting University hospital providing tertiary clinical care. Patients 80 mostly neutropenic patients with refractory fever and suspected or proved invasive fungal infections. Intervention Patients were randomised to receive 0.97 mg/kg amphotericin B by continuous infusion over 24 hours or 0.95 mg/kg by rapid infusion over four hours. Main outcome measures Patients were evaluated for side effects related to infusion, nephrotoxicity, and mortality up to three months after treatment. Analysis was on an intention to treat basis. Results Patients in the continuous infusion group had fewer side effects and significantly reduced nephrotoxicity than those in the rapid infusion group. Overall mortality was higher during treatment and after three months' follow up in the rapid infusion than in the continuous infusion group. Conclusion Continuous infusions of amphotericin B reduce nephrotoxicity and side effects related to infusion without increasing mortality. PMID:11238151

  10. What and how much do we eat? 24-hour dietary recall method.

    PubMed

    Salvador Castell, Gemma; Serra-Majem, Lluis; Ribas-Barba, Lourdes

    2015-02-26

    Diet, along with lifestyle factors, is an important determinant of the health status of an individual and of a community. Dietary assessment at the population level provides us with key information on the frequency and distribution of possible inadequate diets and/or nutritional status. It is also useful as input into the elaboration of food and nutrition policies aiming to improve dietary habits and the health status of a community. This article reviews the characteristics, advantages and limitations of the 24-hour dietary recall method (24hDR), which is one of the most widely used tools in nutrition epidemiology to identify food, energy and nutrient intake in national nutrition surveys, cross-sectional studies, clinical trials and cohort studies as well as in the evaluation of individual dietary intake and Total Diet assessment. To reduce the key factors associated with bias, the importance of previously trained interviewers is highlighted, as well as the role of support materials and the contribution of novel technologies.

  11. After 24-hour scrub, the Boeing Delta II rocket carrying Stardust waits for launch

    NASA Technical Reports Server (NTRS)

    1999-01-01

    After a 24-hour postponement, the Boeing Delta II rocket carrying the Stardust spacecraft waits on Launch Pad 17-A, Cape Canaveral Air Station, for its scheduled launch at 4:04 p.m. EST. Umbilical lines (at top) still attached to the fixed utility tower (at right) feed electricity, air conditioning and coolants for the Stardust spacecraft inside the fairing (enclosing the upper stage) before launch. Stardust is destined for a close encounter with the comet Wild 2 in January 2004. Using a silicon-based substance called aerogel, Stardust will capture comet particles flying off the nucleus of the comet. The spacecraft also will bring back samples of interstellar dust. These materials consist of ancient pre-solar interstellar grains and other remnants left over from the formation of the solar system. Scientists expect their analysis to provide important insights into the evolution of the sun and planets and possibly into the origin of life itself. The collected samples will return to Earth in a sample return capsule to be jettisoned as Stardust swings by Earth in January 2006.

  12. After 24-hour scrub, the Boeing Delta II rocket carrying Stardust launches on time

    NASA Technical Reports Server (NTRS)

    1999-01-01

    Flames sear the pristine blue sky behind the Boeing Delta II rocket carrying the Stardust spacecraft after the 4:04:15 p.m. launch from Launch Pad 17-A, Cape Canaveral Air Station. A 24- hour scrub postponed the launch from the originally scheduled date of Feb. 6. Stardust is destined for a close encounter with the comet Wild 2 in January 2004. Using a silicon-based substance called aerogel, Stardust will capture comet particles flying off the nucleus of the comet. The spacecraft also will bring back samples of interstellar dust. These materials consist of ancient pre-solar interstellar grains and other remnants left over from the formation of the solar system. Scientists expect their analysis to provide important insights into the evolution of the sun and planets and possibly into the origin of life itself. The collected samples will return to Earth in a sample return capsule to be jettisoned as Stardust swings by Earth in January 2006.

  13. A 24-hour study to investigate persistent chemical exposures associated with clandestine methamphetamine laboratories.

    PubMed

    VanDyke, Mike; Erb, Nicola; Arbuckle, Shawn; Martyny, John

    2009-02-01

    The clandestine manufacture of methamphetamine continues to be a concern across the United States. Although the exposures associated with the actual production process have been evaluated, the persistence of those exposures in a residential setting have not been investigated. This study was designed to document the contamination associated with two red phosphorous methamphetamine "cooks" conducted in a residence and the associated exposures up to 24 hours after the cook. The two cooks were conducted on the first day of the study, and exposures associated with different occupant activity levels were measured the following day. Airborne methamphetamine levels during the cook ranged from 520 microg/m(3) to 760 microg/m(3). On Day 2, airborne levels of methamphetamine ranged from 70 microg/m(3) to 210 microg/m(3) and increased with moderate to high activity levels within the residence. The majority of the methamphetamine measured during both days had a particle size of less than 1 mum, suggesting that the methamphetamine is formed as a condensation aerosol and is readily resuspended from contaminated surfaces. Significant methamphetamine contamination was found in the carpeting and likely was associated with the elevated levels of methamphetamine during activity. Levels of hydrogen chloride and iodine were also detected on Day 2 of the project although at very low levels. The study concluded that exposures may still present a significant inhalation exposure well after the actual cook.

  14. Hypotension based on office and ambulatory monitoring blood pressure. Prevalence and clinical profile among a cohort of 70,997 treated hypertensives.

    PubMed

    Divisón-Garrote, Juan A; Banegas, José R; De la Cruz, Juan J; Escobar-Cervantes, Carlos; De la Sierra, Alejandro; Gorostidi, Manuel; Vinyoles, Ernest; Abellán-Aleman, José; Segura, Julián; Ruilope, Luis M

    2016-09-01

    We aimed to determine the prevalence of hypotension and factors associated with the presence of this condition in treated hypertensive patients undergoing ambulatory blood pressure monitoring (ABPM). Data were taken from the Spanish ABPM Registry. Office blood pressure (BP) and ABPM were determined using validated devices under standardized conditions. Based on previous studies, hypotension was defined as office systolic/diastolic BP <110 and/or 70 mm Hg, daytime ABPM <105 and/or 65 mm Hg, nighttime ABPM <90 and/or 50 mm Hg, and 24-hour ABPM <100 and/or 60 mm Hg. Multivariable logistic regression was performed to determine the variables associated with the presence of hypotension. A total of 70,997 hypertensive patients on treatment (mean age 61.8 years, 52.5% men) were included in the study. The prevalence of hypotension was 8.2% with office BP, 12.2% with daytime ABPM, 3.9% with nighttime ABPM, and 6.8% with 24-hour ABPM. Low diastolic BP values were responsible for the majority of cases of hypotension. Some 68% of the hypotension cases detected by daytime ABPM did not correspond to hypotension according to office BP. The variables independently and consistently associated with higher likelihood of office, daytime, and 24 hour-based hypotension were age, female gender, history of ischemic heart disease, and body mass index <30 kg/m(2) (P < .05). In conclusion, in this large cohort of patients in usual daily practice, one in eight treated hypertensive patients are at risk of hypotension according to daytime BP. Two-thirds of them are not adequately identified with office BP. ABPM could be especially helpful for identifying ambulatory hypotension, in particular in patients who are older, women, or with previous ischemic heart disease where antihypertensive treatment should be especially individualized and cautious.

  15. Effects of dietary fish and weight reduction on ambulatory blood pressure in overweight hypertensives.

    PubMed

    Bao, D Q; Mori, T A; Burke, V; Puddey, I B; Beilin, L J

    1998-10-01

    Obesity is a major factor contributing to hypertension and increased risk of cardiovascular disease. Regular consumption of dietary fish and omega3 fatty acids of marine origin can lower blood pressure (BP) levels and reduce cardiovascular risk. This study examined the potential effects of combining dietary fish rich in omega3 fatty acids with a weight loss regimen in overweight hypertensive subjects, with ambulatory BP levels as the primary end point. Using a factorial design, 69 overweight medication-treated hypertensives were randomized to a daily fish meal (3.65 g omega3 fatty acids), weight reduction, the 2 regimens combined, or a control regimen for 16 weeks. Sixty-three subjects with a mean+/-SEM body mass index of 31.6+/-0.5 kg/m2 completed the study. Weight fell by 5.6+/-0.8 kg with energy restriction. Dietary fish and weight loss had significant independent and additive effects on 24-hour ambulatory BP. Effects were greatest on awake systolic and diastolic BP (P<0.01); relative to control, awake pressures fell 6.0/3.0 mm Hg with dietary fish alone, 5.5/2.2 mm Hg with weight reduction alone, and 13.0/9.3 mm Hg with fish and weight loss combined. These results also remained significant after further adjustment for changes in urinary sodium, potassium, or the sodium/potassium ratio, as well as dietary macronutrients. Dietary fish also significantly reduced 24-hour (-3.1+/-1.4 bpm, P=0.036) and awake (-4.2+/-1.6 bpm, P=0. 013) ambulatory heart rates. Weight reduction had a significant effect on sleeping heart rate only (-3.2+/-1.7 bpm, P=0.037). Combining a daily fish meal with a weight-reducing regimen led to additive effects on ambulatory BP and decreased heart rate. The effects were large, suggesting that cardiovascular risk and antihypertensive drug requirements are likely to be reduced substantially by combining dietary fish meals rich in omega3 fatty acids with weight-loss regimens in overweight medication-treated hypertensives. The reduction in heart

  16. No Enhancement of 24-Hour Visuomotor Skill Retention by Post-Practice Caffeine Administration

    PubMed Central

    Hussain, Sara J.; Cole, Kelly J.

    2015-01-01

    Caffeine is widely consumed throughout the world and appears to indirectly facilitate learning and memory through effects on attention and motivation. Animal work indicates that post-training caffeine administration augments inhibitory avoidance memory, spatial memory, and object memory. In humans, post-training caffeine administration enhances the ability to discern between familiar images and new, similar images. However, the effect of post-training caffeine administration on motor memory has not been examined. Therefore, we tested two groups of low caffeine consumers (average weekly consumption ≤500 mg) in a double-blind, placebo-controlled study involving acquisition of a continuous isometric visuomotor tracking skill. On Day 1, subjects completed 5 blocks (150 repetitions) of training on the continuous isometric visuomotor skill and subsequently ingested either 200 mg of caffeine or placebo. On day 2, subjects completed an additional 5 blocks of training. Day 1 mean performance and performance variability were both similar between groups, suggesting that both groups acquired the motor skill similarly. For mean performance on Day 2, patterns of re-learning, mean performance learning magnitudes, mean performance learning rates, and mean performance retention magnitudes were all similar between groups. For performance variability on Day 2, there was a small trend towards increased variability in the caffeine group during re-learning, but performance variability learning magnitudes and performance variability retention magnitudes did not differ between groups. Because motor skill acquisition can also be conceptualized as a reduction in performance variability, these results suggest that there may be a small negative effect of post-practice caffeine administration on memory of a newly-learned visuomotor skill. Overall, we found no evidence to suggest that post-training caffeine administration enhances 24-hour retention of a newly-learned continuous visuomotor

  17. No Enhancement of 24-Hour Visuomotor Skill Retention by Post-Practice Caffeine Administration.

    PubMed

    Hussain, Sara J; Cole, Kelly J

    2015-01-01

    Caffeine is widely consumed throughout the world and appears to indirectly facilitate learning and memory through effects on attention and motivation. Animal work indicates that post-training caffeine administration augments inhibitory avoidance memory, spatial memory, and object memory. In humans, post-training caffeine administration enhances the ability to discern between familiar images and new, similar images. However, the effect of post-training caffeine administration on motor memory has not been examined. Therefore, we tested two groups of low caffeine consumers (average weekly consumption ≤500 mg) in a double-blind, placebo-controlled study involving acquisition of a continuous isometric visuomotor tracking skill. On Day 1, subjects completed 5 blocks (150 repetitions) of training on the continuous isometric visuomotor skill and subsequently ingested either 200 mg of caffeine or placebo. On day 2, subjects completed an additional 5 blocks of training. Day 1 mean performance and performance variability were both similar between groups, suggesting that both groups acquired the motor skill similarly. For mean performance on Day 2, patterns of re-learning, mean performance learning magnitudes, mean performance learning rates, and mean performance retention magnitudes were all similar between groups. For performance variability on Day 2, there was a small trend towards increased variability in the caffeine group during re-learning, but performance variability learning magnitudes and performance variability retention magnitudes did not differ between groups. Because motor skill acquisition can also be conceptualized as a reduction in performance variability, these results suggest that there may be a small negative effect of post-practice caffeine administration on memory of a newly-learned visuomotor skill. Overall, we found no evidence to suggest that post-training caffeine administration enhances 24-hour retention of a newly-learned continuous visuomotor

  18. Endothelial function in postmenopausal women with nighttime systolic hypertension

    PubMed Central

    Routledge, Faye S.; Hinderliter, Alan L.; McFetridge-Durdle, Judith; Blumenthal, James A.; Paine, Nicola J.; Sherwood, Andrew

    2014-01-01

    Objective Hypertension becomes more prevalent in women during their postmenopausal years. Nighttime systolic blood pressure (SBP) is especially predictive of adverse cardiac events and the relationship between rising nighttime SBP and cardiovascular risk increases more rapidly in women compared to men. The reasons for the prognostic significance of nighttime SBP are not completely known, but may involve vascular endothelial dysfunction. The purpose of this study was to examine the relationship of nighttime SBP and endothelial function, assessed by brachial artery flow-mediated dilation (FMD) and to determine whether postmenopausal women with nighttime hypertension (SBP≥120 mm Hg) evidenced greater endothelial dysfunction compared to women with normal nighttime SBP. Methods One-hundred postmenopausal women (mean age: 65.8 ± 7.5 years, body mass index: 28.3 ± 4.7 kg/m2, hypertension: 47%, coronary artery disease: 51%, mean clinic BP 137 ± 17/67 ± 11 mm Hg, 34 with nighttime hypertension) underwent 24-hour ambulatory BP monitoring, actigraphy, and brachial artery FMD assessments. Results Multivariate regression models showed that higher nighttime SBP and larger baseline artery diameter were inversely related to FMD. Nighttime SBP and baseline artery diameter accounted for 23% of the variance in FMD. After adjusting for baseline artery diameter, women with nighttime hypertension had lower FMD than women with normal nighttime SBP (2.95%±0.65 vs 5.52%±0.46, p = .002). Conclusions In postmenopausal women, nighttime hypertension was associated with reduced endothelial function. Research examining the therapeutic benefits of treating nighttime hypertension on endothelial function and future cardiovascular risk in postmenopausal women is warranted. PMID:25563797

  19. The Impact of Using Different Methods to Assess Completeness of 24-Hour Urine Collection on Estimating Dietary Sodium.

    PubMed

    Wielgosz, Andreas; Robinson, Christopher; Mao, Yang; Jiang, Ying; Campbell, Norm R C; Muthuri, Stella; Morrison, Howard

    2016-06-01

    The standard for population-based surveillance of dietary sodium intake is 24-hour urine testing; however, this may be affected by incomplete urine collection. The impact of different indirect methods of assessing completeness of collection on estimated sodium ingestion has not been established. The authors enlisted 507 participants from an existing community study in 2009 to collect 24-hour urine samples. Several methods of assessing completeness of urine collection were tested. Mean sodium intake varied between 3648 mg/24 h and 7210 mg/24 h depending on the method used. Excluding urine samples collected for longer or shorter than 24 hours increased the estimated urine sodium excretion, even when corrections for the variation in timed collections were applied. Until an accurate method of indirectly assessing completeness of urine collection is identified, the gold standard of administering para-aminobenzoic acid is recommended. Efforts to ensure participants collect complete urine samples are also warranted.

  20. Non-24-hour sleep–wake syndrome improved by low-dose valproic acid: a case report

    PubMed Central

    Kurita, Masatake; Moriya, Takahiro; Nishino, Satoshi; Hirata, Eishin; Hirasawa, Noriyasu; Okubo, Yoshiro; Sato, Tadahiro

    2016-01-01

    A woman was diagnosed with non-24-hour sleep–wake syndrome and depressive symptoms. Her depressive symptoms did not respond to standard doses of several antidepressants or mood stabilizers. Furthermore, her sleep–wake cycle remained non-entrained despite treatment with a melatonin-related drug, vitamin B12, and phototherapy. Ultimately, her sleep–wake rhythm was restored to a 24-hour pattern with a low dose of valproic acid, and her depressive symptoms tended to improve as a result of synchronization without antidepressants. Low-dose valproic acid appears to be one of the effective means of entraining circadian rhythms in patients with non-24-hour sleep–wake syndrome, which in turn likely improves associated depressive symptoms. PMID:28008257

  1. Acute effects of nasal continuous positive airway pressure on 24-hour blood pressure and catecholamines in patients with obstructive sleep apnea.

    PubMed

    Minemura, H; Akashiba, T; Yamamoto, H; Akahoshi, T; Kosaka, N; Horie, T

    1998-12-01

    To assess the acute effects of nasal continuous positive airway pressure (CPAP) on the 24-hour blood pressure and the secretion of catecholamines in urine and plasma, we investigated the changes in the 24-hour blood pressure and urinary and plasma concentrations of epinephrine (E) and norepinephrine (NE) in 26 men with obstructive sleep apnea (OSA) with and without nasal CPAP. Nasal CPAP resulted in significant decreases in the daytime diastolic pressure (from 86 +/-16 mmHg to 83+/-12 mmHg), the nighttime diastolic pressure (from 81+/-12 mmHg to 77+/-9 mmHg) and the nighttime systolic pressures (from 125+/-15 mmHg to 120+/-10 mmHg). There was no significant difference between patients with and without CPAP in the daytime or nighttime urinary E level, but patients who received CPAP showed a significant decrease in daytime urinary NE level (from 156+/-112 microg/14h to 119+/-101 microg/14h) and nighttime urinary NE level (from 143+/-91 microg/10h to 112+/-65 microg/10h). The morning plasma level of NE also decreased (from 371+/-181 pg/ml to 273 +/-148 pg/ml) in patients who received nasal CPAP (p<0.02), but the plasma level of E remained unchanged. There were no correlations between PSG parameters and the reductions in blood pressure and the catecholamine levels induced by nasal CPAP. These findings suggest that OSA contributes, at least in part, to the development of systemic hypertension by increasing sympathetic nervous activity.

  2. [Indices of static and dynamic components of pressure load (assessed by 24-hour blood pressure monitoring) and the state of renal function in patients with essential hypertension].

    PubMed

    Zelveian, P A; Buniatian, M S; Oshchepkova, E V; Lazareva, N V; Rogoza, A N

    2011-01-01

    Aim of this study was to evaluate possible relationship between parameters of blood pressure (BP) profile and glomerular filtration rate in patients (pts) with I-II stage essential hypertension (EH). Material and methods. We studied 120 pts (97 men), aged 23-65 (50,2+/-0,6) years with I (n=98) and II (n=22) stage EH. In BP profile (SL-90207) we calculated 24-hour, daytime, nighttime values of systolic, diastolic, pulse pressures (SBP, DBP, PP), time load (TL), variability and nocturnal fall (NF) of BP. The state of renal function was assessed by measurement of glomerular filtration rate (GFR) calculated by the Cockcroft formula. Results. After nonlinear statistical analysis by Gauss-Newton all patients were divided into three groups according to GFR tertiles. Significant differences were found between these groups by 24-hour, nighttime and daytime values of SBP and DBP. Values of SBP were the lowest in group II. In group II lowest values of PP were also observed, but statistically significant differences were found only in nocturnal PP values between groups II and III. There were no significant differences between groups by TL and NF of BP. In group Ill (high GFR) variability of daytime values of SBP and DBF were significantly higher. Univariate correlation analysis showed statistically significant negative relationship between GFR and nocturnal PP in patients with lowest level of GFR. Positive correlations between nocturnal values of PP and GFR in groups II and III were also observed. Conclusion. These results indicated the presence of strong relationship between high values of nocturnal PP and decreasing of glomerular filtration rate in patients with EH and thus confirmed significance of "constant" and "dynamic" components of pressure load as a marker of impairment of renal function.

  3. To Compare the Microleakage Among Experimental Adhesives Containing Nanoclay Fillers after the Storages of 24 Hours and 6 Months

    PubMed Central

    Mousavinasab, Seyed Mostafa; Atai, Mohammad; Alavi, Bagher

    2011-01-01

    Objectives: To compare the microleakage among experimental adhesives containing nanoclay fillers after the storages of 24 hours and 6 months. Materials and Methods: Class V cavities were prepared on extracted human molars with the occlusal margins located in enamel and the cervical margins in cementum. Phosphoric acid was applied to the enamel and dentin margins.Subsequently, the cavities were treated using four groups of experimental adhesive systems and restored with a resin composite. Adper Single Bond® was used as control group. After 24- hour and 6- month storages, the samples were subjected to thermocycling shocks and then immersed in silver nitrate as well as developer solution and finally evaluated for leakage. The data were analyzed using SPSS software. Results: Based on Kruskal –Wallis test, significant differences were found between groups regarding microleakage. The Mann- Whitney test showed that Leakage was significantly lower in Adper Single Bond® compared to the other groups in dentinal margins after 24 hours and 6 months and in enamel margins after 6 months. The Wilcoxon Signed Ranks test showed that the enamel leakage in experimental adhesives was significantly lower than dentinal leakage after 24 hours as well as enamel leakage in Adper Single Bond and adhesive with 0.5% PMAA-g-nanoclay was significantly lower than dentinal margins after storage period of 6 months. Conclusion: All the experimental adhesives were effective in reducing enamel leakage after 24 hours, but were not effective in reducing dentinal leakage after 24 hours as well as in enamel and dentinal leakage after a 6-month storage. No improvement was observed in the microleakage in dentin in both short (24 hrs) and long times (6 months). The high microleakage in the adhesives is probably attributed to the high concentration of HEMA in the recipe of the bonding agent. PMID:21566692

  4. Executive Functions are not Affected by 24 Hours of Sleep Deprivation: A Color-Word Stroop Task Study

    PubMed Central

    Dixit, Abhinav; Mittal, Tushar

    2015-01-01

    Background: Sleep is an important factor affecting cognitive performance. Sleep deprivation results in fatigue, lack of concentration, confusion and sleepiness along with anxiety, depression and irritability. Sleep deprivation can have serious consequences in professions like armed forces and medicine where quick decisions and actions need to be taken. Color-Word Stroop task is one of the reliable tests to assess attention and it analyzes the processing of information in two dimensions i.e., reading of words and naming of colour. The evidence regarding the effect of sleep deprivation on Stroop interference is conflicting. The present study evaluated the effect of 24 hours of sleep deprivation on reaction time and interference in Stroop task. Materials and Methods: The present study was done on 30 healthy male medical student volunteers in the age group of 18-25 years after taking their consent and clearance from Institute Ethics Committee. Recordings of Stroop task were at three times: baseline (between 7-9 am), after 12 hours (7-9 pm) and after 24 hours (7-9 am, next day). The subjects were allowed to perform normal daily activities. Results: The study revealed a significant increase in reaction time after 24 hours of sleep deprivation in comparison to baseline and after 12 hours of sleep deprivation. There was no significant change in interference and facilitation after sleep deprivation in comparison to baseline. The number of errors also did not show any significant change after sleep deprivation. Conclusion: The study indicated that there was slowing of responses without change in executive functions after 24 hours of sleep deprivation. It is probable that 24 hours of sleep deprivation does not bring about change in areas of brain affecting executive functions in healthy individuals who have normal sleep cycle. The present study indicated that in professions like armed forces and medicine working 24 hours at a stretch can lead to decrease in motor responses

  5. Interchangeability between 24-hour collection and single spot urines for vanillylmandelic and homovanillic acid levels in the diagnosis of neuroblastoma.

    PubMed

    Cangemi, Giuliana; Barco, Sebastiano; Reggiardo, Giorgio; Viscardi, Elisabetta; Di Cataldo, Andrea; Garaventa, Alberto; Melioli, Giovanni; Conte, Massimo

    2013-12-01

    The determination of the two urinary catecholamine metabolites homovanillic acid (HVA) and vanillylmandelic acid (VMA) is of crucial importance for the diagnosis and follow-up of neuroblastoma (NB). The standard practice for their measurement requires the use of 24-hour collections that are time consuming and difficult to obtain. In this article, we directly demonstrate that 24-hour collections and single spot urines are interchangeable for the determination of HVA and VMA expressed as ratio on creatinine concentration. This study can be useful for a faster management of NB at onset.

  6. The Effects of Rilmenidine and Perindopril on Arousal Blood Pressure during 24 Hour Recordings in SHR

    PubMed Central

    Lim, Kyungjoon; Jackson, Kristy L.; Burke, Sandra L.; Head, Geoffrey A.

    2016-01-01

    The surge in arterial pressure during arousal in the waking period is thought to be largely due to activation of the sympathetic nervous system. In this study we compared in SHR the effects of chronic administration of the centrally acting sympatholytic agent rilmenidine with an angiotensin converting enzyme inhibitor perindopril on the rate of rise and power of the surge in mean arterial pressure (MAP) that occurs with arousal associated with the onset of night. Recordings were made using radiotelemetry in 17 adult SHR before and after treatment with rilmenidine (2mg/kg/day), perindopril (1mg/kg/day) or vehicle in the drinking water for 2 weeks. Rilmenidine reduced MAP by 7.2 ± 1.7mmHg while perindopril reduced MAP by 19 ± 3mmHg. Double logistic curve fit analysis showed that the rate and power of increase in systolic pressure during the transition from light to dark was reduced by 50% and 65%, respectively, but had no effect on diastolic pressure. Rilmenidine also reduced blood pressure variability in the autonomic frequency in the active period as assessed by spectral analysis which is consistent with reduction in sympathetic nervous system activity. Perindopril had no effect on the rate or power of the arousal surge in either systolic or diastolic pressure. These results suggest that the arousal induced surge in blood pressure can largely be reduced by an antihypertensive agent that inhibits the sympathetic nervous system and that angiotensin converting enzyme inhibition, while effective in reducing blood pressure, does not alter the rate or power of the surge associated with arousal. PMID:28002478

  7. Relationship of office, home, and ambulatory blood pressure to blood glucose and lipid variables in the PAMELA population.

    PubMed

    Mancia, Giuseppe; Facchetti, Rita; Bombelli, Michele; Polo Friz, Hernan; Grassi, Guido; Giannattasio, Cristina; Sega, Roberto

    2005-06-01

    Alterations in blood glucose and cholesterol are more frequently detectable in hypertensive than in normotensive conditions. However, no information exists as to whether this phenomenon involves only office or also home and 24-hour ambulatory blood pressure (ie, when values are representative of daily life). In 2045 subjects enrolled in the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study, we measured home, 24-hour, and office blood pressure. Measurements also included fasting blood glucose and serum total and HDL cholesterol values. Prevalence of diabetes (> or =126 mg/dL or use of antidiabetic drugs), impaired fasting blood glucose (> or =110 to <126 mg/dL), and hypercholesterolemia (serum total cholesterol > or =240 mg/dL or 200 mg/dL) increased progressively from "optimal" to "normal," "high-normal," and "elevated" office systolic or diastolic blood pressure. Fasting blood glucose and total serum cholesterol also increased progressively from the first to the fourth group, with HDL cholesterol values showing a concomitant progressive decrease. This was also the case for quartiles of office, home, and 24-hour blood pressure. In the whole population, there was a positive correlation between serum cholesterol or blood glucose and all blood pressure values (P always <0.0001), with a much smaller and less consistent relationship with heart rate. In a multivariate analysis that included gender, body mass index, age, and antihypertensive treatment, all blood pressure values remained highly significantly related to values of either metabolic variables. Thus, in the PAMELA population, glucose and lipid values are independently related to blood pressure. This is also the case when daily life blood pressure values are considered.

  8. 77 FR 65310 - Additional Air Quality Designations for the 2006 24-Hour Fine Particle National Ambient Air...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-26

    ... AGENCY 40 CFR Part 81 Additional Air Quality Designations for the 2006 24-Hour Fine Particle National Ambient Air Quality Standards AGENCY: Environmental Protection Agency (EPA). ACTION: Supplemental... particle (PM 2.5 ) national ambient air quality standards (NAAQS) air quality designations for the...

  9. Accuracy and Usefulness of Select Methods for Assessing Complete Collection of 24-Hour Urine: A Systematic Review.

    PubMed

    John, Katherine A; Cogswell, Mary E; Campbell, Norm R; Nowson, Caryl A; Legetic, Branka; Hennis, Anselm J M; Patel, Sheena M

    2016-05-01

    Twenty-four-hour urine collection is the recommended method for estimating sodium intake. To investigate the strengths and limitations of methods used to assess completion of 24-hour urine collection, the authors systematically reviewed the literature on the accuracy and usefulness of methods vs para-aminobenzoic acid (PABA) recovery (referent). The percentage of incomplete collections, based on PABA, was 6% to 47% (n=8 studies). The sensitivity and specificity for identifying incomplete collection using creatinine criteria (n=4 studies) was 6% to 63% and 57% to 99.7%, respectively. The most sensitive method for removing incomplete collections was a creatinine index <0.7. In pooled analysis (≥2 studies), mean urine creatinine excretion and volume were higher among participants with complete collection (P<.05); whereas, self-reported collection time did not differ by completion status. Compared with participants with incomplete collection, mean 24-hour sodium excretion was 19.6 mmol higher (n=1781 specimens, 5 studies) in patients with complete collection. Sodium excretion may be underestimated by inclusion of incomplete 24-hour urine collections. None of the current approaches reliably assess completion of 24-hour urine collection.

  10. Population Pharmacokinetic Model Characterizing 24-Hour Variation in the Pharmacokinetics of Oral and Intravenous Midazolam in Healthy Volunteers

    PubMed Central

    van Rongen, A; Kervezee, L; Brill, MJE; van Meir, H; den Hartigh, J; Guchelaar, H-J; Meijer, JH; Burggraaf, J; van Oosterhout, F

    2015-01-01

    Daily rhythms in physiology may affect the pharmacokinetics of a drug. The aim of this study was to evaluate 24-hour variation in the pharmacokinetics of the CYP3A substrate midazolam. Oral (2 mg) and intravenous (1 mg) midazolam was administered at six timepoints throughout the 24-hour period in 12 healthy volunteers. Oral bioavailability (population mean value [RSE%] of 0.28 (7.1%)) showed 24-hour variation that was best parameterized as a cosine function with an amplitude of 0.04 (17.3%) and a peak at 12:14 in the afternoon. The absorption rate constant was 1.41 (4.7%) times increased after drug administration at 14:00. Clearance (0.38 L/min (4.8%)) showed a minor 24-hour variation with an amplitude of 0.03 (14.8%) L/min and a peak at 18:50. Simulations show that dosing time minimally affects the concentration time profiles after intravenous administration, while concentrations are higher during the day compared to the night after oral dosing, reflecting considerable variation in intestinal processes. PMID:26380154

  11. Correlations of beta-aminoisobutyric acid in 8 hour and 24 hour urinary samples determined by dual column gas chromatography.

    PubMed

    Sjölin, K E; Nyholm, K K

    1980-05-01

    The correlations of beta-aminoisobutyric acid values in 8 hour and 24 hour urinary samples from 23 healthy persons were determined. beta-AIB in the 8 hour urinary samples was measured by gas chromatography and the 24 hour excretion was calculated from the results of three 8 hour determinations. Simultaneous determinations of urinary creatinine were performed by Jaffe's reaction. Based on the 8 hour values of urinary beta-AIB the results demonstrated a constant excretion of beta-aminoisobutyric acid within the 24 hour periods in both low and high excretors. The precision in distinguishing low and high 24 hour excretors of beta-AIB by using 8 hour values was 91%. If 8 hour values of beta-AIB were related to creatinine the same precision for this calculated ratio was 96.5%. However, for high excretors of beta-AIB, failures were 24.5% by using the 8 hour excretion of beta-AIB as indicator, but only 6.5% by using the ratio.

  12. Urinary saturation and risk factors for calcium oxalate stone disease based on spot and 24-hour urine specimens.

    PubMed

    Ogawa, Yoshihide; Yonou, Hiroyuki; Hokama, Sanehiro; Oda, Masami; Morozumi, Makoto; Sugaya, Kimio

    2003-09-01

    In 222 random spot urine specimens, the calcium concentration and calcium oxalate saturation [DG(CaOx)] were significantly higher among stone formers than among non-stone formers, while the citrate and creatinine-corrected citrate concentrations were lower. In 188 24-hour urine specimens, magnesium excretion was lower among stone formers than non-stone formers, while the creatinine-corrected calcium concentration and DG(CaOx) were higher. Among stone formers, there was no gender difference in the urinary concentrations of calcium, oxalate, citrate, magnesium, and DG(CaOx), but the creatinine-corrected calcium, citrate, and magnesium concentrations were higher in women, as well as 24-hour citrate excretion. The levels of calcium and oxalate have a major influence on DG(CaOx), while citrate and magnesium levels have a minor influence. DG(CaOx) was correlated with calcium and oxalate excretion, as well as with the creatinine-corrected calcium and oxalate concentrations. Approximately 5% of 24-hour urine specimens showed critical supersaturation, 80% showed metastable supersaturation, and 15% were unsaturated. Hypercalciuria or hyperoxaluria was fairly common (30% and 40%) in critically supersaturated urine, while it was less common (22.4% and 8.6%) in metastably supersaturated urine and was not detected in unsaturated urine. Hypocitraturia and/or hypomagnesiuria was more common (63.8-80%) at any saturation. The urinary calcium, oxalate, and citrate concentrations, as well as the creatinine-corrected calcium, oxalate, citrate, and magnesium concentrations and DG(CaOx), showed a significant correlation between 57 paired early morning spot urine and 24-hour urine specimens. The creatinine-corrected calcium and citrate concentrations of the early morning urine specimens were significantly correlated with the levels of calcium and citrate excretion in the paired 24-hour urine specimens. In conclusion, no parameter other than urinary saturation gives more than a vague

  13. Irregular 24-hour Activity Rhythms and the Metabolic Syndrome in Older Adults

    PubMed Central

    Sohail, Shahmir; Yu, Lei; Bennett, David A.; Buchman, Aron S.; Lim, Andrew S.P.

    2015-01-01

    Circadian rhythms – near 24-hour intrinsic biological rhythms – modulate many aspects of human physiology and hence disruption of circadian rhythms may have an important impact on human health. Experimental work supports a potential link between irregular circadian rhythms and several key risk factors for cardiovascular disease including hypertension, obesity, diabetes, and dyslipidemia, collectively termed the metabolic syndrome. While several epidemiological studies have demonstrated an association between shift-work and the components of the metabolic syndrome in working-age adults, there is a relative paucity of data concerning the impact of non-occupational circadian irregularity in older women and men. To address this question, we studied 7 days of actigraphic data from 1137 older woman and men participating in the Rush Memory and Aging Project, a community-based cohort study of the chronic conditions of aging. The regularity of activity rhythms was quantified using the nonparametric interdaily stability metric, and was related to the metabolic syndrome and its components obesity, hypertension, diabetes, and dyslipidemia. More regular activity rhythms were associated with a lower odds of having the metabolic syndrome (OR=0.69, 95%CI=0.60–0.80, p=5.8×10−7), being obese (OR=0.73, 95%CI=0.63–0.85, p=2.5×10−5), diabetic (OR=0.76, 95%CI=0.65–0.90, p=9.3×10−4), hypertensive (OR=0.78, 95%CI=0.66–0.91, p=2.0×10−3), or dyslipidemic (OR=0.82, 95%CI=0.72–0.92, p=1.2×10−3). These associations were independent of differences in objectively measured total daily physical activity or rest, and were not accounted for by prevalent coronary artery disease, stroke, or peripheral artery disease. Moreover, more regular activity rhythms were associated with lower odds of having cardiovascular disease (OR=0.83; 95%CI=0.73–0.95, p=5.7×10−3), an effect that was statistically mediated by the metabolic syndrome. We conclude that irregular activity

  14. Changes in platelet morphology and function during 24 hours of storage.

    PubMed

    Braune, S; Walter, M; Schulze, F; Lendlein, A; Jung, F

    2014-01-01

    aggregates could be visualized microscopically. After four hours, first debris and very small aggregates occurred. After 24 hours, platelet aggregates and also debris progressively increased. In accordance to this, the CASY system revealed an increase of platelet aggregates (up to 90 μm diameter) with increasing storage time. The percentage of CD62P positive platelets and PF4 increased significantly with storage time in resting PRP. When soluble ADP was added to stored PRP samples, the number of activatable platelets decreased significantly over storage time. The present study reveals the importance of a consequent standardization in the preparation of WB and PRP. Platelet morphology and function, particularly platelet reactivity to adherent or soluble agonists in their surrounding milieu, changed rapidly outside the vascular system. This knowledge is of crucial interest, particularly in the field of biomaterial development for cardiovascular applications, and may help to define common standards in the in vitro hemocompatibility testing of biomaterials.

  15. Neighborhood socioeconomic disadvantage is associated with higher ratio of 24-hour urinary sodium to potassium in young Japanese women.

    PubMed

    Murakami, Kentaro; Sasaki, Satoshi; Takahashi, Yoshiko; Uenishi, Kazuhiro

    2009-09-01

    Information on the relationship of neighborhood characteristics to objective indicators of dietary intake is extremely limited. The aim of this observational cross-sectional study was to examine the association between neighborhood socioeconomic status (SES) and 24-hour urinary excretion of sodium and potassium in a population with a high ratio of urinary sodium to potassium. Subjects were 1,032 female Japanese dietetics students aged 18 to 22 years, residing in 293 municipalities in Japan. Neighborhood SES index was defined by seven municipal-level variables, namely unemployment, household overcrowding, poverty, education, income, home ownership, and vulnerable groups, with an increasing index signifying increasing neighborhood socioeconomic disadvantage. Urinary excretion of sodium and potassium was estimated from a single 24-hour urine sample. Neighborhood SES index was not significantly associated with 24-hour urinary excretion of sodium (mean value for each quartile of neighborhood SES: 133.5, 135.2, 126.5, and 141.7 mmol/day, respectively; P for trend 0.10) or potassium (mean value for each quartile: 43.5, 42.2, 38.4, and 42.5 mmol/day, respectively; P for trend 0.44). However, neighborhood SES index was significantly positively associated with the ratio of 24-hour urinary sodium to potassium (mean value for each quartile: 3.14, 3.28, 3.37, and 3.41, respectively; P for trend 0.03). This significant association remained after adjustment for household SES variables (mean value for each quartile: 3.15, 3.35, 3.29, and 3.41, respectively; P for trend 0.04). Neighborhood socioeconomic disadvantage was associated with higher ratio of 24-hour urinary sodium to potassium in young Japanese women.

  16. Microleakage of Two Self-Adhesive Cements in the Enamel and Dentin After 24 Hours and Two Months

    PubMed Central

    Jaberi Ansari, Zahra; Kalantar Motamedi, Mojdeh

    2014-01-01

    Objective: Microleakage is a main cause of restorative treatment failure. In this study, we compared occlusal and cervical microleakage of two self-adhesive cements after 24 hours and two months. Materials and Methods: In this in-vitro experimental study, class II inlay cavities were prepared on 60 sound human third molars. Composite inlays were fabricated with Z100 composite resin. The teeth were randomly assigned to six groups. RelyX-Arc (control), RelyX-Unicem and Maxcem were used for the first three groups and specimens were stored in distilled water at 37°C for 24 hours. The same cements were used for the remaining three groups, but the specimens were stored for 2 months. The teeth were subjected to 500 thermal cycles (5°C and 55°C) and immersed in 0.5% basic fuchsin for 24 hours and then sectioned mesiodistally and dye penetration was evaluated in a class II cavity with occlusal and cervical margins using X20 magnification stereomicroscope. Data were analyzed using Kruskal Wallis and Mann-Whitney U tests. Results: After 24 hours, cements had significant differences only in cervical margin microleakage (P=0.0001) and microleakage of RelyX-Unicem and Maxcem was significantly more than that of RelyX-Arc (both P=0.0001). Cervical microleakage in RelyX-Unicem and Maxcem was greater than occlusal (P=0.0001 and P=0.001, respectively). Microleakage was not significantly different between the occlusal and cervical margins after 2 months. Conclusion: Cervical microleakage was greater than occlusal in RelyX-Unicem and Maxcem after 24h. The greatest microleakage was reported for the cervical margin of RelyX-Unicem after 24 hours. PMID:25584053

  17. Effects of para-aminobenzoic acid (PABA) form and administration mode on PABA recovery in 24-hour urine collections.

    PubMed

    Sharma, Rashmi S; Joy, Raechel C; Boushey, Carol J; Ferruzzi, Mario G; Leonov, Alexei P; McCrory, Megan A

    2014-03-01

    Para-aminobenzoic acid (PABA) has long been used as an objective measure to assess completeness of 24-hour urine collections. However, pharmaceutical-grade PABA for human ingestion is not available in the United States. An alternative, the potassium salt of PABA, aminobenzoate potassium, can be obtained for clinical use, although it has not yet been validated in this role. Both PABA and aminobenzoate potassium can be directly ingested in their tablet or capsule forms or added to food before consumption. Our aim was to investigate the effect of form (PABA vs aminobenzoate potassium) and administration mode (directly ingested as a tablet/capsule vs added to food) on urinary PABA recovery levels. Twenty healthy participants underwent 3 test days separated by two 24-hour wash-out periods. Three test conditions, one on each test day, were investigated in randomized order: PABA tablet, aminobenzoate potassium capsule, and PABA or aminobenzoate potassium in food. Ingestion of each dose was supervised and participants performed the 24-hour urine collections while free-living. The 24-hour urine collections were analyzed for PABA recovery (%R) levels using a colorimetric assay. Recoveries 85% to 110% were deemed complete and those >110% were reanalyzed by high pressure liquid chromatography and mass spectrometry. Only complete collections (>85%R) were included in analyses. The recovery for the PABA tablet, aminobenzoate potassium capsule, and PABA/aminobenzoate potassium in food were similar at 98.8%R±2.0%R, 95.1%R±2.3%R, and 93.2%R±2.1%R, respectively, and did not differ significantly. These results suggest that aminobenzoate potassium may be used as an alternative to PABA for assessing the completeness of 24-hour urine collections and to track compliance with consuming provided diets in community-dwelling studies.

  18. Estimation of daily salt intake through a 24-hour urine collection in Pohang, Korea.

    PubMed

    Kim, Yong Chul; Koo, Ho Seok; Kim, Suhnggwon; Chin, Ho Jun

    2014-09-01

    There is an established relationship between a high salt diet and public health problems, especially hypertension and cardiovascular disease. We estimated daily salt intake in a group of adults and assessed its association with related variables in Pohang, Korea. We conducted a cross-sectional survey in 2013 with 242 adults. Urine was collected for 24 hr to estimate daily salt intake, and questionnaires about salt preference were administered. The mean daily salt intake was 9.9±4.6 g. There was no difference in salt intake between high systolic blood pressure (SBP) participants and normal SBP participants (10.5±4.7 g/d vs. 9.6±4.3 g/d, P=0.339), but high diastolic blood pressure (DBP) participants reported more salt intake than normal DBP participants (10.4±4.9 g/d vs. 9.7±4.1 g/d, P=0.049). Salt intake and body mass index demonstrated a positive correlation (P=0.001). A preference for Korean soup or stew was associated with high salt intake (P=0.038). Dietary salt intake in Korean adults is still higher than the recommendation from the World Health Organization. More efforts should be made to reduce the salt consumption of Korean adults.

  19. Resistance training decreases 24-hour blood pressure in women with metabolic syndrome

    PubMed Central

    2013-01-01

    Background The purpose of this study was to verify the effects of eight weeks of resistance training (RT) on 24 hour blood pressure (BP) in patients with and without metabolic syndrome (MetS). Methods Seventeen women volunteered to participate in this study, 9 with MetS (37.0 ± 8.7 yrs; body mass 77.3 ± 9.7 kg; body mass index 30.3 ± 4.2 kg · m-2) and 8 without MetS (35.1 ± 7.2 yrs; body mass 61.3 ± 8.1 kg; body mass index 24.2 ± 2.5 kg · m-2). Individuals were subjected to eight weeks (3 times/week) of whole body RT comprised of one exercise for each main muscle group with three sets of 8–12 repetitions of each subject’s maximal load . A rest interval of one minute was allowed between sets and exercises. Twenty-four hour BP was measured by ambulatory blood pressure monitoring. Results Mean and diastolic night-time BP decreased (−3.9 mmHg, p = 0.04; -5.5 mmHg, p = 0.03, respectively) after eight weeks of training in MetS patients. This decrease was observed at 11:00 pm, 02:00 am (only diastolic), 07:00 am, and 6:00 pm. There was no training effect on BP in women without MetS. Conclusions Considering the elevation of BP as a contributor to the pathogenesis of MetS, and also to the increase of cardiovascular risk, this study supports RT as a non-pharmacological therapy in the management of BP control for MetS. PMID:23711286

  20. Changes in foot volume, body composition, and hydration status in male and female 24-hour ultra-mountain bikers

    PubMed Central

    2014-01-01

    Background The effects of running and cycling on changes in hydration status and body composition during a 24-hour race have been described previously, but data for 24-hour ultra-mountain bikers are missing. The present study investigated changes in foot volume, body composition, and hydration status in male and female 24-hour ultra-mountain bikers. Methods We compared in 49 (37 men and 12 women) 24-hour ultra-mountain bikers (ultra-MTBers) changes (Δ) in body mass (BM). Fat mass (FM), percent body fat (%BF) and skeletal muscle mass (SM) were estimated using anthropometric methods. Changes in total body water (TBW), extracellular fluid (ECF) and intracellular fluid (ICF) were determined using bioelectrical impedance and changes in foot volume using plethysmography. Haematocrit, plasma [Na+], plasma urea, plasma osmolality, urine urea, urine specific gravity and urine osmolality were measured in a subgroup of 25 ultra-MTBers (16 men and 9 women). Results In male 24-hour ultra-MTBers, BM (P < 0.001), FM (P < 0.001), %BF (P < 0.001) and ECF (P < 0.05) decreased whereas SM and TBW did not change (P > 0.05). A significant correlation was found between post-race BM and post-race FM (r = 0.63, P < 0.001). In female ultra-MTBers, BM (P < 0.05), %BF (P < 0.05) and FM (P < 0.001) decreased, whereas SM, ECF and TBW remained stable (P > 0.05). Absolute ranking in the race was related to Δ%BM (P < 0.001) and Δ%FM in men (P < 0.001) and to Δ%BM (P < 0.05) in women. In male ultra-MTBers, increased post-race plasma urea (P < 0.001) was negatively related to absolute ranking in the race, Δ%BM, post-race FM and Δ%ECF (P < 0.05). Foot volume remained stable in both sexes (P > 0.05). Conclusions Male and female 24-hour ultra-MTBers experienced a significant loss in BM and FM, whereas SM remained stable. Body weight changes and increases in plasma urea do not reflect a change in body hydration status. No oedema

  1. Higher ambulatory blood pressure is associated with aortic valve calcification in the elderly: a population-based study.

    PubMed

    Iwata, Shinichi; Russo, Cesare; Jin, Zhezhen; Schwartz, Joseph E; Homma, Shunichi; Elkind, Mitchell S V; Rundek, Tatjana; Sacco, Ralph L; Di Tullio, Marco R

    2013-01-01

    Aortic valve calcification (AVC) without outflow obstruction (stenosis) is common in the elderly and increases the risk of cardiovascular morbidity and mortality. Although high blood pressure (BP) measured at the doctor's office is known to be associated with AVC, little is known about the association between 24-hour ambulatory BP (ABP) and AVC. Our objective was to clarify the association between ABP variables and AVC. The study population consisted of 737 patients (mean age, 71±9 years) participating in the Cardiovascular Abnormalities and Brain Lesions study who underwent 24-hour ABP monitoring. Each aortic valve leaflet was graded on a scale of 0 (normal) to 3 (severe calcification). A total valve score (values 0-9) was calculated as the sum of all leaflet scores. Advanced AVC (score ≥4) was present in 77 subjects (10.4%). All of the systolic ABP variables (except systolic BP nocturnal decline) and mean asleep diastolic BP were positively associated with advanced calcification, whereas normal dipping status and diastolic BP nocturnal decline were negatively associated. Multiple regression analysis indicated that mean awake diastolic BP (odds ratio, 1.31 [95% CI, 1.01-1.71]) and asleep diastolic BP (odds ratio, 1.34 [95% CI, 1.04-1.72]) remained independently associated with advanced calcification after adjustment for age, sex, cigarette smoking, diabetes mellitus, hypercholesterolemia, hypertension, serum creatinine, and any degree of aortic insufficiency. Diastolic ABP is independently associated with advanced calcification. This finding may have important implications in gaining further insight into the mechanism of AVC.

  2. Study on Operation Optimization of Pumping Station's 24 Hours Operation under Influences of Tides and Peak-Valley Electricity Prices

    NASA Astrophysics Data System (ADS)

    Yi, Gong; Jilin, Cheng; Lihua, Zhang; Rentian, Zhang

    2010-06-01

    According to different processes of tides and peak-valley electricity prices, this paper determines the optimal start up time in pumping station's 24 hours operation between the rating state and adjusting blade angle state respectively based on the optimization objective function and optimization model for single-unit pump's 24 hours operation taking JiangDu No.4 Pumping Station for example. In the meantime, this paper proposes the following regularities between optimal start up time of pumping station and the process of tides and peak-valley electricity prices each day within a month: (1) In the rating and adjusting blade angle state, the optimal start up time in pumping station's 24 hours operation which depends on the tide generation at the same day varies with the process of tides. There are mainly two kinds of optimal start up time which include the time at tide generation and 12 hours after it. (2) In the rating state, the optimal start up time on each day in a month exhibits a rule of symmetry from 29 to 28 of next month in the lunar calendar. The time of tide generation usually exists in the period of peak electricity price or the valley one. The higher electricity price corresponds to the higher minimum cost of water pumping at unit, which means that the minimum cost of water pumping at unit depends on the peak-valley electricity price at the time of tide generation on the same day. (3) In the adjusting blade angle state, the minimum cost of water pumping at unit in pumping station's 24 hour operation depends on the process of peak-valley electricity prices. And in the adjusting blade angle state, 4.85%˜5.37% of the minimum cost of water pumping at unit will be saved than that of in the rating state.

  3. Dipstick Spot urine pH does not accurately represent 24 hour urine PH measured by an electrode

    PubMed Central

    Omar, Mohamed; Sarkissian, Carl; Jianbo, Li; Calle, Juan; Monga, Manoj

    2016-01-01

    ABSTRACT Objectives To determine whether spot urine pH measured by dipstick is an accurate representation of 24 hours urine pH measured by an electrode. Materials and Methods We retrospectively reviewed urine pH results of patients who presented to the urology stone clinic. For each patient we recorded the most recent pH result measured by dipstick from a spot urine sample that preceded the result of a 24-hour urine pH measured by the use of a pH electrode. Patients were excluded if there was a change in medications or dietary recommendations or if the two samples were more than 4 months apart. A difference of more than 0.5 pH was considered an inaccurate result. Results A total 600 patients were retrospectively reviewed for the pH results. The mean difference in pH between spot urine value and the 24 hours collection values was 0.52±0.45 pH. Higher pH was associated with lower accuracy (p<0.001). The accuracy of spot urine samples to predict 24-hour pH values of <5.5 was 68.9%, 68.2% for 5.5 to 6.5 and 35% for >6.5. Samples taken more than 75 days apart had only 49% the accuracy of more recent samples (p<0.002). The overall accuracy is lower than 80% (p<0.001). Influence of diurnal variation was not significant (p=0.588). Conclusions Spot urine pH by dipstick is not an accurate method for evaluation of the patients with urolithiasis. Patients with alkaline urine are more prone to error with reliance on spot urine pH. PMID:27286119

  4. Antimicrobial Prophylaxis in Instrumented Spinal Fusion Surgery: A Comparative Analysis of 24-Hour and 72-Hour Dosages

    PubMed Central

    Abraham, Vineet Thomas; Ravichandran, Mirunalini; Achimuthu, Rajamani

    2016-01-01

    Study Design Prospective study. Purpose To compare the efficacy of 24-hour and 72-hour antibiotic prophylaxis in preventing surgical site infections (SSIs). Overview of Literature Antimicrobial prophylaxis in surgical practice has become a universally accepted protocol for minimizing postoperative complications related to infections. Although prophylaxis is an accepted practice, a debate exists with regard to the antibiotic type and its administration duration for various surgical procedures. Methods Our institute is a tertiary care hospital with more than 100 spinal surgeries per year for various spine disorders in the department of orthopedics. We conducted this prospective study in our department from June 2012 to January 2015. A total of 326 patients were enrolled in this study, with 156 patients in the 72-hour antibiotic prophylaxis group (group A) and 170 patients in the 24-hour group (group B). Cefazolin was the antibiotic used in both groups. Two surgeons were involved in conducting all the spinal procedures. Our study compared SSIs among patients undergoing instrumented spinal fusion. Results The overall rate of SSIs was 1.8% with no statistical difference between the two groups. Conclusions The 24-hour antimicrobial prophylaxis is as effective as the 72-hour dosage in instrumented spinal fusion surgery. PMID:27994776

  5. Vanilmandelic acid and homovanillic acid levels in patients with neural crest tumor: 24-hour urine collection versus random sample.

    PubMed

    Gregianin, L J; McGill, A C; Pinheiro, C M; Brunetto, A L

    1997-01-01

    Neuroblastoma is the most common solid tumor in childhood and is the most frequent neural crest tumor (NCT). More than 90% of the patients excrete high levels of vanilmandelic acid (VMA) and homovanillic acid (HVA) in the urine. Original biochemical methods for measuring these two metabolites of catecholamines employed a collection of urine for 24 hours to avoid errors related to circadian cycle variations. More recently, attempts have been made to replace the 24-hour collections by random samples (RSs). This has practical advantages particularly for young children. The objective of this study is to assess whether urinary VMA related to urinary creatinine levels can be determined reliably by the method of Pisano et al. from RSs in patients with NCT. The determination of the consumption of VMA in urine stored for prolonged periods of time was also studied. We found a good correlation between the values of metabolites of catecholamines in RSs compared with 24-hour urine collections. There was consumption of VMA in urine samples after storage. We conclude that determination of VMA in RSs of urine by Pisano's method may identify NCT production of catecholamines and that the consumption of these catecholamines is an important factor to consider in the interpretation of values obtained with stored urine specimens.

  6. Assessment of 24-hours Aldosterone Administration on Protein Abundances in Fluorescence-Sorted Mouse Distal Renal Tubules by Mass Spectrometry

    PubMed Central

    Jensen, Thomas B; Pisitkun, Trairak; Hoffert, Jason D; Jensen, Uffe B; Fenton, Robert A; Praetorius, Helle A; Knepper, Mark A; Praetorius, Jeppe

    2013-01-01

    Background/Aims Aldosterone exerts multiple long-term effects in the distal renal tubules. The aim of this study was to establish a method for identifying proteins in these tubules that change in abundance by only 24-hours aldosterone administration. Methods Mice endogenously expressing green fluorescent protein (eGFP) in the connecting tubule and cortical collecting ducts were treated with a subcutaneous injection of 2.0 mg/kg aldosterone or vehicle (n=5), and sacrificed 24 hours later. Suspensions of single cells were obtained enzymatically, and eGFP positive cells were isolated by fluorescence activated cell sorting (FACS). Samples of 100 μg proteins were digested with trypsin and labeled with 8-plex iTRAQ reagents and processed for liquid chromatography tandem mass spectrometry (LC-MS/MS). Results FACS yielded 1.4 million cells per mouse. The LC-MS/MS spectra were matched to peptides by the SEQUEST search algorithm, which identified 3002 peptides corresponding to 506 unique proteins of which 20 significantly changed abundance 24-hours after aldosterone injection. Conclusion We find the method suitable and useful for studying hormonal effects on protein abundance in distal tubular segments. PMID:23428628

  7. A randomized controlled trial comparing the effects of yoga with an active control on ambulatory blood pressure in individuals with prehypertension and stage 1 hypertension.

    PubMed

    Hagins, Marshall; Rundle, Andrew; Consedine, Nathan S; Khalsa, Sat Bir S

    2014-01-01

    The purpose of this study was to compare the effects of yoga with an active control (nonaerobic exercise) in individuals with prehypertension and stage 1 hypertension. A randomized clinical trial was performed using two arms: (1) yoga and (2) active control. Primary outcomes were 24-hour day and night ambulatory systolic and diastolic blood pressures. Within-group and between-group analyses were performed using paired t tests and repeated-measures analysis of variance (time × group), respectively. Eighty-four participants enrolled, with 68 participants completing the trial. Within-group analyses found 24-hour diastolic, night diastolic, and mean arterial pressure all significantly reduced in the yoga group (-3.93, -4.7, -4.23 mm Hg, respectively) but no significant within-group changes in the active control group. Direct comparisons of the yoga intervention with the control group found a single blood pressure variable (diastolic night) to be significantly different (P=.038). This study has demonstrated that a yoga intervention can lower blood pressure in patients with mild hypertension. Although this study was not adequately powered to show between-group differences, the size of the yoga-induced blood pressure reduction appears to justify performing a definitive trial of this intervention to test whether it can provide meaningful therapeutic value for the management of hypertension.

  8. A randomized controlled trial comparing the effects of yoga to an active control on ambulatory blood pressure in individuals with Pre- and Stage 1 Hypertension

    PubMed Central

    Hagins, Marshall; Rundle, Andrew; Consedine, Nathan S.; Khalsa, Sat Bir S.

    2013-01-01

    The purpose of this study was to compare the effects of yoga to an active control (non-aerobic exercise) in individuals with pre- and Stage 1 hypertension. A randomized clinical trial was performed using two arms: 1) yoga and 2) active control. Primary outcomes were 24-hour, day and night ambulatory systolic and diastolic blood pressures. Within-group and between-group analyses were performed using paired t-tests and repeated measures ANOVAs (time x group), respectively. Eighty-four participants enrolled with 68 participants completing the trial. Within-group analyses found 24-hour diastolic, night diastolic, and mean arterial pressure all significantly reduced in the yoga group (−3.93, −4.7, −4.23 mmHg, respectively) but no significant within-group changes in the active control group. Direct comparisons of the yoga intervention to the control group found a single blood pressure variable (diastolic night) to be significantly different (p =.038). This study has demonstrated that a yoga intervention can lower blood pressure in patients with mild hypertension. Although this study was not adequately powered to show between-group differences, the size of the yoga-induced blood pressure reduction we observed appears to justify performing a definitive trial of this intervention to test whether it can provide meaningful therapeutic value for the management of hypertension. PMID:24387700

  9. Ambulatory glucose profile: Flash glucose monitoring.

    PubMed

    Kalra, Sanjay; Gupta, Yashdeep

    2015-12-01

    Ambulatory glucose profile (AGP) is a novel way of assessing glycaemic levels on a 24 hour basis, through a minimally invasive method, known as flash glucose monitoring. This review describes the unique features of AGP, differentiates it from existing methods of glucose monitoring, and explains how it helps pursue the glycaemic pentad. The review suggests pragmatic usage of this technology, including pre-test, intra-test, and post-test counselling, and lists specific clinical scenarios where the investigation seems to be of immense benefit.

  10. Society for Ambulatory Anesthesia

    MedlinePlus

    ... We Represent Ambulatory and Office-Based Anesthesia The Society for Ambulatory Anesthesia provides educational opportunities, encourages research ... 6620 | E-mail: info@sambahq.org Copyright | 2017 Society for Ambulatory Anesthesia Home | Search | Terms | Privacy Policy | ...

  11. Use of ambulatory blood pressure monitoring to compare antihypertensive efficacy and safety of two angiotensin II receptor antagonists, losartan and valsartan. Losartan Trial Investigators.

    PubMed

    Monterroso, V H; Rodriguez Chavez, V; Carbajal, E T; Vogel, D R; Aroca Martinez, G J; Garcia, L H; Cuevas, J H; Lara Teran, J; Hitzenberger, G; Leao Neves, P; Middlemost, S J; Dumortier, T; Bunt, A M; Smith, R D

    2000-01-01

    The efficacy and safety of losartan and valsartan were evaluated in a multicenter, double-blind, randomized trial in patients with mild to moderate essential hypertension. Blood pressure responses to once-daily treatment with either losartan 50 mg (n = 93) or valsartan 80 mg (n = 94) for 6 weeks were assessed through measurements taken in the clinic and by 24-hour ambulatory blood pressure monitoring (ABPM). Both drugs significantly reduced clinic sitting systolic (SiSBP) and diastolic blood pressure (SiDBP) at 2, 4, and 6 weeks. Maximum reductions from baseline in SiSBP and SiDBP on 24-hour ABPM were also significant with the two treatments. The reduction in blood pressure was more consistent across patients in the losartan group, as indicated by a numerically smaller variability in change from baseline on all ABPM measures, which achieved significance at peak (P = .017) and during the day (P = .002). In addition, the numerically larger smoothness index with losartan suggested a more homogeneous antihypertensive effect throughout the 24-hour dosing interval. The antihypertensive response rate was 54% with losartan and 46% with valsartan. Three days after discontinuation of therapy, SiDBP remained below baseline in 73% of losartan and 63% of valsartan patients. Both agents were generally well tolerated. Losartan, but not valsartan, significantly decreased serum uric acid an average 0.4 mg/dL at week 6. In conclusion, once-daily losartan 50 mg and valsartan 80 mg had similar antihypertensive effects in patients with mild to moderate essential hypertension. Losartan produced a more consistent blood pressure-lowering response and significantly lowered uric acid, suggesting potentially meaningful differences between these two A II receptor antagonists.

  12. Caffeine does not entrain the circadian clock but improves daytime alertness in blind patients with non-24-hour rhythms

    PubMed Central

    St. Hilaire, Melissa A.; Lockley, Steven W.

    2015-01-01

    Objective/Background Totally blind individuals are highly likely to suffer from Non-24-Hour Sleep-Wake Disorder due to a failure of light to reset the circadian pacemaker in the suprachiasmatic nuclei. In this outpatient case series, we investigated whether daily caffeine administration could entrain the circadian pacemaker in non-entrained blind patients to alleviate symptoms of non-24-hour sleep–wake disorder. Patients/Methods Three totally blind males (63.0 ± 7.5 years old) were studied at home over ~4 months. Urinary 6-sulphatoxymelatonin (aMT6s) rhythms were measured for 48 h every 1–2 weeks. Participants completed daily sleep–wake logs, and rated their alertness and mood using nine-point scales every ~2–4 h while awake on urine sampling days. Caffeine capsules (150 mg per os) were self-administered daily at 10 a.m. for approximately one circadian beat cycle based on each participant's endogenous circadian period τ and compared to placebo (n = 2) or no treatment (n = 1) in a single-masked manner. Results Non-24-h aMT6s rhythms were confirmed in all three participants (τ range = 24.32–24.57 h). Daily administration of 150 mg caffeine did not entrain the circadian clock. Caffeine treatment significantly improved daytime alertness at adverse circadian phases (p < 0.0001) but did not decrease the occurrence of daytime naps compared with placebo. Conclusions Although caffeine was able to improve daytime alertness acutely and may therefore provide temporary symptomatic relief, the inability of caffeine to correct the underlying circadian disorder means that an entraining agent is required to treat Non-24-Hour Sleep–Wake Disorder in the blind appropriately. PMID:25891543

  13. Effects of Fibrinogen Concentrate on Thrombin Generation, Thromboelastometry Parameters, and Laboratory Coagulation Testing in a 24-Hour Porcine Trauma Model

    PubMed Central

    Zentai, Christian; Solomon, Cristina; van der Meijden, Paola E. J.; Spronk, Henri M. H.; Schnabel, Jonas; Rossaint, Rolf

    2015-01-01

    Introduction: In a 24-hour porcine model of liver injury, we showed that fibrinogen supplementation does not downregulate endogenous fibrinogen synthesis. Here we report data from the same study showing the impact of fibrinogen on coagulation variables. Materials and Methods: Coagulopathy was induced in 20 German land race pigs by hemodilution and blunt liver injury. Animals randomly received fibrinogen concentrate (100 mg/kg) or saline. Coagulation parameters were assessed and thromboelastometry (ROTEM) was performed. Results: Fibrinogen concentrate significantly reduced the prolongations of EXTEM clotting time, EXTEM clot formation time, and prothrombin time induced by hemodilution and liver injury. A decrease in clot strength was also ameliorated. Endogenous thrombin potential was significantly higher in the fibrinogen group than in the control group, 20 minutes (353 ± 24 vs 289 ± 22 nmol/L·min; P < .05) and 100 minutes (315 ± 40 vs 263 ± 38 nmol/L·min; P < .05) after the start of infusion. However, no significant between-group differences were seen in other thrombin generation parameters or in d-dimer or thrombin–antithrombin levels. Fibrinogen–platelet binding was reduced following liver injury, with no significant differences between groups. No significant between-group differences were observed in any parameter at ∼12 and ∼24 hours. Conclusion: This study suggests that, in trauma, fibrinogen supplementation may shorten some measurements of the speed of coagulation initiation and produce a short-lived increase in endogenous thrombin potential, potentially through increased clotting substrate availability. Approximately 12 and 24 hours after starting fibrinogen concentrate/saline infusion, all parameters measured in this study were comparable in the 2 study groups. PMID:25948634

  14. Reliability and predictive validity of energy intake measures from the 24-hour dietary recalls of homebound older adults.

    PubMed

    Sun, Yanhui; Roth, David L; Ritchie, Christine S; Burgio, Kathryn L; Locher, Julie L

    2010-05-01

    Twenty-four-hour dietary recalls are used frequently to study homebound older adults' eating behaviors. However, the reliability and predictive validity of this method have not been established in this population. The purpose of this study was to examine whether homebound older adults provide reliable and valid measures of total energy intake in 24-hour dietary recalls. Two hundred thirty homebound older adults were interviewed in their homes using a questionnaire to assess eating behaviors and factors that could affect those behaviors. Participants completed three 24-hour dietary recalls at baseline and again at 6-month follow-up. Two subsamples were identified for analyses. For participants who were not hospitalized during the 6-month interval and had their weight measured at both assessments (n=52), sufficient test-retest reliability of energy intake was observed (r=0.59), but energy intake deficiencies relative to estimated energy requirements did not predict actual weight loss (r=0.08). When this sample was supplemented with 91 participants who experienced any adverse event (weight loss of 2.5% or more, hospitalization, institutionalization, or mortality) in the 6-month period (n=143), adverse events were more likely to occur for those with insufficient energy intake (odds ratio 3.49, P=0.009), and in white participants compared to African-American participants (odds ratio 3.13, P=0.016). Adequate test-retest reliability of the 24-hour dietary recall was demonstrated, but additional research with larger samples and longer follow-up intervals is needed to better evaluate the predictive validity of energy intake measures for this population.

  15. Extent and Determinants of Thermogenic Responses to 24 Hours of Fasting, Energy Balance, and Five Different Overfeeding Diets in Humans

    PubMed Central

    Pannacciulli, Nicola; Bonfiglio, Susan; Pacak, Karel; Krakoff, Jonathan

    2013-01-01

    Context: Individual variation in the ability to convert excess calories to heat and the effects of dietary macronutrient composition are unclear. Objective: Stability and determinants of the energy expenditure (EE) response to overconsumption were assessed. Design, Setting, and Participants: Twenty subjects (75% male) with normal glucose regulation were evaluated during 24 hours each of energy balance, fasting, and 5 different diets with 200% energy requirements in a clinical research unit. Interventions: Five 1-day overfeeding diets were given in random order: high carbohydrate (75%) and low protein (3%); high carbohydrate and normal protein (20%); high fat (46%) and low protein; high fat (60%) and normal protein; and balanced (50% carbohydrates, 20% protein). Main Outcome Measures: The 24-hour EE, sleeping EE, and thermic effect of food (TEF) during each diet were measured with a metabolic chamber. Appetitive hormones were measured before and after the diets. Results: The EE response to overfeeding exhibited good intraindividual reproducibility. Similar increases above eucaloric feeding in 24-hour EE (mean 10.7 ± 5.7%, P < .001; range 2.9–18.8%) and sleeping EE (14.4 ± 11.3%, P < .001; range 1.0–45.1%) occurred when overfeeding diets containing 20% protein, despite differences in fat and carbohydrate content, but the EE response during overfeeding diets containing 3% protein was attenuated. The percent body fat negatively correlated with TEF during normal protein overfeeding (r = −0.53, P < .01). Fasting peptide YY negatively correlated with TEF (r = −0.56, P < .01) and the increase in sleeping EE (r = −0.54, P < .01) during overfeeding. Conclusions: There is an intrinsic EE response to overfeeding that negatively associates with adiposity, although it represents a small percentage of consumed calories. PMID:23666976

  16. The Automated Self-Administered 24-Hour Dietary Recall for Children, 2012 version, for youth aged 9 to 11 Years: A validation study

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Our objective was to validate the 2012 version of the Automated Self-Administered 24-Hour Dietary Recall for Children (ASA24-Kids-2012), a self-administered web-based 24-hour dietary recall (24hDR) instrument, among children aged 9 to 11 years, in two sites using a quasiexperimental design. In one s...

  17. Clinical characteristics of resistant hypertension evaluated by ambulatory blood pressure monitoring.

    PubMed

    Kansui, Yasuo; Matsumura, Kiyoshi; Kida, Haruko; Sakata, Satoko; Ohtsubo, Toshio; Ibaraki, Ai; Kitazono, Takanari

    2014-01-01

    Strict control of blood pressure is important to prevent cardiovascular disease, although it is sometimes difficult to decrease blood pressure to target levels. The aim of this study was to investigate the clinical characteristics of resistant hypertension evaluated by ambulatory blood pressure monitoring. One hundred in-hospital patients, whose 24-hour average blood pressure was higher than 130/80 mmHg even after treatment with more than three antihypertensive drugs, were included in the present analysis. Circadian variation of blood pressure was evaluated by nocturnal fall in systolic blood pressure. Average blood pressures of all patients were high in both daytime and nighttime, 150.0/82.9 and 143.8/78.2 mmHg, respectively. Twenty patients had been treated with hemodialysis or peritoneal dialysis. In 63 patients out of the other 80 patients (79%), estimated glomerular filtration rate (eGFR) was also decreased (<60 mL/min/1.73 m²). The patients classified into dipper, non-dipper, riser and extreme-dipper were 20%, 43%, 34% and 3%, respectively. In addition, in 17 patients whose eGFR was preserved, 12 patients showed a non-dipper or riser pattern, suggesting that it was difficult to account for this altered circadian blood pressure variation only by renal dysfunction. These results show that a large number of the patients with resistant hypertension suffered from renal dysfunction, although it was difficult to explain altered circadian blood pressure variation based on renal dysfunction alone.

  18. A Hot-Line Emergency Service for the Ambulatory Frail Elderly.

    ERIC Educational Resources Information Center

    Wolf-Klein, Gisele P.; Silverstone, Felix A.

    1987-01-01

    Surveyed patients and families who used hotline emergency service in ambulatory day treatment center for frail elderly. Results revealed appropriate use of service: Most calls required medical intervention, including hospitalization in 31 percent of cases. Findings suggest that 24-hour medical coverage is necessary and cost efficient. (Author/NB)

  19. Determination of and correlation between urine protein excretion and urine protein-to-creatinine ratio values during a 24-hour period in healthy horses and ponies.

    PubMed

    Uberti, Benjamin; Eberle, D Bernard; Pressler, Barrak M; Moore, George E; Sojka, Janice E

    2009-12-01

    OBJECTIVE-To determine whether urine protein-to-creatinine (UP:C) ratio assessment provides an estimate of urine protein excretion (UPE) over a 24-hour period in horses and ponies, establish a preliminary UP:C ratio reference range, and determine UP:C ratio variation over time in healthy equids. ANIMALS-11 female horses and 6 female ponies. PROCEDURES-Urine was collected from all equids at 4-hour intervals for 24 hours. Total 24-hour UPE (mg of protein/kg of body weight) and UP:C ratio were determined; these variables were also assessed in aliquots of urine collected at 4-hour intervals. On 2 additional days, urine samples were also obtained from 6 horses (1 sample/horse/d) to determine day-to-day variation in UP:C ratio. Correlation between 4-hour or 24-hour UPE and UP:C ratio values was assessed. Reference ranges for 24-hour UPE, 24-hour UP:C ratio, and 4-hour UP:C ratios were calculated as central 95th percentiles of observed values. RESULTS-Mean 24-hour UPE (4.28 +/- 2.99 mg/kg) and 24-hour UP:C ratio (0.0 to 0.37) had excellent correlation (R = 0.826; P < 0.001) in both horses and ponies; analysis of 4-hour data also revealed good correlation (R = 0.782; P < 0.001) with these variables. Calculated UPE and UP:C ratio reference ranges were similar to established ranges in other species. Day-to-day variability in UP:C ratio was minimal, and all results were within the reference range calculated by use of the 24-hour urine samples. CONCLUSIONS AND CLINICAL RELEVANCE-Assessment of the UP:C ratio appears to be a reliable method for estimating 24-hour UPE in horses and ponies.

  20. Preventing Misdiagnosis of Ambulatory Hypertension: Algorithm Using Office and Home Blood Pressures

    PubMed Central

    Shimbo, Daichi; Kuruvilla, Sujith; Haas, Donald; Pickering, Thomas G.; Schwartz, Joseph E.; Gerin, William

    2009-01-01

    Objectives An algorithm for making a differential diagnosis between sustained and white coat hypertension (SH and WCH) has been proposed–patients with office hypertension undergo home blood pressure monitoring (HBPM) and those with normal HBP levels undergo ambulatory blood pressure monitoring (ABPM). We tested whether incorporating an upper office blood pressure (OBP) cutoff in the algorithm, higher than the traditional 140/90 mmHg, reduces the need for HBPM and ABPM. Methods 229 normotensive and untreated mildly hypertensive participants (mean age 52.5 ± 14.6, 54% female) underwent OBP measurements, HBPM, and 24-hour ABPM. Using the algorithm, sensitivity (SN), specificity (SP), and positive and negative predictive values (PPV, NPV) for SH and WCH were assessed. We then modified the algorithm utilizing a systolic and diastolic OBP cutoff at a SP of 95% for ambulatory hypertension –those with office hypertension but OBP levels below the upper cutoff undergo HBPM and subsequent ABPM if appropriate. Results Using the original algorithm, SN and PPV for SH were 100% and 93.8%. Despite a SP of 44.4%, NPV was 100%. These values correspond to SP, NPV, SN, and PPV for WCH respectively. Using the modified algorithm, the diagnostic accuracy for SH and WCH did not change. However, far fewer participants needed HBPM (29 vs. 84) and ABPM (8 vs. 15). Conclusions In this sample, the original and modified algorithms are excellent at diagnosing SH and WCH. However, the latter requires far fewer subjects to undergo HBPM and ABPM. These findings have important implications for the cost-effective diagnosis of SH and WCH. PMID:19491703

  1. Increased salt sensitivity of ambulatory blood pressure in women with a history of severe preeclampsia.

    PubMed

    Martillotti, Gabriella; Ditisheim, Agnès; Burnier, Michel; Wagner, Ghislaine; Boulvain, Michel; Irion, Olivier; Pechère-Bertschi, Antoinette

    2013-10-01

    Cardiovascular diseases are the principal cause of death in women in developed countries and are importantly promoted by hypertension. The salt sensitivity of blood pressure (BP) is considered as an important cardiovascular risk factor at any BP level. Preeclampsia is a hypertensive disorder of pregnancy that arises as a risk factor for cardiovascular diseases. This study measured the salt sensitivity of BP in women with a severe preeclampsia compared with women with no pregnancy hypertensive complications. Forty premenopausal women were recruited 10 years after delivery in a case-control study. Salt sensitivity was defined as an increase of >4 mm Hg in 24-hour ambulatory BP on a high-sodium diet. The ambulatory BP response to salt was significantly increased in women with a history of preeclampsia compared with that of controls. The mean (95% confidence interval) daytime systolic/diastolic BP increased significantly from 115 (109-118)/79 (76-82) mm Hg on low-salt diet to 123 (116-130)/80 (76-84) on a high-salt diet in women with preeclampsia, but not in the control group (from 111 [104-119]/77 [72-82] to 111 [106-116]/75 [72-79], respectively, P<0.05). The sodium sensitivity index (SSI=Δmean arterial pressure/Δurinary Na excretion×1000) was 51.2 (19.1-66.2) in women with preeclampsia and 6.6 (5.8-18.1) mm Hg/mol per day in controls (P=0.015). The nocturnal dip was blunted on a high-salt diet in women with preeclampsia. Our study shows that women who have developed preeclampsia are salt sensitive before their menopause, a finding that may contribute to their increased cardiovascular risk. Women with a history of severe preeclampsia should be targeted at an early stage for preventive measures of cardiovascular diseases.

  2. Urine 24-hour volume

    MedlinePlus

    ... in a day, such as: Creatinine Sodium Potassium Nitrogen Protein This test may also be done if ... disease Potassium urine test Sodium urine test Urea nitrogen urine test Urination - excessive amount Urine output - decreased ...

  3. 24-hour urine protein

    MedlinePlus

    ... your doctor may be able to order a test that is done on just one urine sample (protein-to-creatinine ratio). Normal Results The normal value is less than 100 milligrams per day or less than 10 milligrams per deciliter ... of these tests. Normal value ranges may vary slightly among different ...

  4. Ambulatory Assessment

    PubMed Central

    Trull, Timothy J.; Ebner-Priemer, Ulrich

    2014-01-01

    Ambulatory assessment (AA) covers a wide range of assessment methods to study people in their natural environment, including self-report, observational, and biological/physiological/behavioral. AA methods minimize retrospective biases while gathering ecologically valid data from patients’ everyday life in real time or near real time. Here, we report on the major characteristics of AA, and we provide examples of applications of AA in clinical psychology (a) to investigate mechanisms and dynamics of symptoms, (b) to predict the future recurrence or onset of symptoms, (c) to monitor treatment effects, (d) to predict treatment success, (e) to prevent relapse, and (f) as interventions. In addition, we present and discuss the most pressing and compelling future AA applications: technological developments (the smartphone), improved ecological validity of laboratory results by combined lab-field studies, and investigating gene-environment interactions. We conclude with a discussion of acceptability, compliance, privacy, and ethical issues. PMID:23157450

  5. Ultra-Rapid dUT1 Measurements on Japan-Fennoscandian Baselines - Application to 24-hour Sessions

    NASA Technical Reports Server (NTRS)

    Matsuzaka, Shigeru; Kurihara, Shinobu; Sekido, Mamoru; Hobiger, Thomas; Haas, Rudiger; Ritakari, Jouko; Wagner, Jan

    2010-01-01

    GSI, NICT, OSO, and MRO have been engaged in Ultra-rapid dUT1 experiments since 2007 aiming at the technological possibility of real-time dUT1 results using the e-VLBI technique. We have already successfully determined dUT1 in less than four minutes after the end of an experimental Intensive session in 2008, and at present we routinely get the results within 30 minutes for regular Intensives. In 2009 we applied the technique to 24-hour sessions and continuously obtained dUT1 values by processing and analyzing Tsukuba Onsala data in near real-time. It showed a detailed behavior of UT1 variations, which could be very valuable for scientific study as well as for precise prediction of UT1-UTC.

  6. 24-hour energy expenditure and substrate oxidation rates are unaffected by body fat distribution in obese women.

    PubMed

    Buemann, B; Astrup, A; Quaade, F; Madsen, J

    1994-01-01

    Twenty-four-hour energy expenditure (EE) and nonprotein respiratory quotient (RQnp) were measured by indirect calorimetry in 19 upper-body-obese (UBO) and 15 lower-body-obese (LBO) women with similar body mass index (BMI) and body fat percent. The measurements were performed in a respiration chamber on a predetermined physical activity program and a controlled diet. No differences between the UBO and LBO groups were found in 24-hour, daytime, and sleeping EE after adjustment for differences in fat-free mass (FFM). Furthermore, no group effect was observed in RQnp, but a positive correlation was found between RQnp and age. Despite the fact that an increased free fatty acid (FFA) turnover has been found in UBO subjects, the present study does not support the contention that upper-body obesity is accompanied by an increased lipid oxidation.

  7. Prognostic Significance of Initial Serum Albumin and 24 Hour Daily Protein Excretion before Treatment in Multiple Myeloma.

    PubMed

    Chen, Jia-Hong; Hsu, Shun-Neng; Huang, Tzu-Chuan; Wu, Yi-Ying; Lin, Chin; Chang, Ping-Ying; Chen, Yeu-Chin; Ho, Ching-Liang

    2015-01-01

    Renal failure is a common morbidity in multiple myeloma (MM). Although proteinuria has been increasingly reported in malignancies, it is not routinely used to refine risk estimates of survival outcomes in patients with MM. Here we aimed to investigate initial serum albumin and 24-hour daily protein excretion (24-h DPE) before treatment as prognostic factors in patients with MM. We conducted a retrospective analysis of 102 patients with myeloma who were ineligible for haematopoietic stem cell transplantation between October 2000 and December 2012. Initial proteinuria was assessed before treatment by quantitative analysis of 24-hour urine samples. The demographic and laboratory characteristics, survival outcome, and significance of pre-treatment 24-h DPE and albumin in the new staging system of MM were analyzed. Pre-treatment proteinuria (>300 mg/day) was present in 66 patients (64.7%). The optimal cut-off value of 24-h DPE before treatment was 500 mg/day. Analysis of the time-dependent area under the curve showed that the serum albumin and 24-h DPE before treatment were better than 24-h creatinine clearance rate and β2-microglobulin. A subgroup analysis showed that an initial excess proteinuria (24-h DPE ≥ 500 mg) was associated with poor survival status (17.51 vs. 34.24 months, p = 0.002). Furthermore, initial serum albumin was an independent risk factor on multivariate analysis (<2.8 vs. ≥ 2.8, hazard ratio = 0.486, p = 0.029). Using the A-DPE staging system, there was a significant survival difference among patients with stage I, II, and III MM (p < 0.001). Initial serum albumin and 24-h DPE before treatment showed significant prognostic factors in patients with MM, and the new A-DPE staging system may be utilized instead of the International Staging System. Its efficacy should be evaluated by further large prospective studies.

  8. Biomechanical evaluation of three fixation modalities for preperitoneal inguinal hernia repair: a 24-hour postoperative study in pigs

    PubMed Central

    Guérin, Gaëtan; Bourges, Xavier; Turquier, Frédéric

    2014-01-01

    Purpose Tacks and sutures ensure a strong fixation of meshes, but they can be associated with pain and discomfort. Less invasive methods are now available. Three fixation modalities were compared: the ProGrip™ laparoscopic self-fixating mesh; the fibrin glue Tisseel™ with Bard™ Soft Mesh; and the SorbaFix™ absorbable fixation system with Bard™ Soft Mesh. Materials and methods Meshes (6 cm ×6 cm) were implanted in the preperitoneal space of swine. Samples were explanted 24 hours after surgery. Centered defects were created, and samples (either ten or eleven per fixation type) were loaded in a pressure chamber. For each sample, the pressure, the mesh displacement through the defect, and the measurements of the contact area were recorded. Results At all pressures tested, the ProGrip™ laparoscopic self-fixating mesh both exhibited a significantly lower displacement through the defect and retained a significantly higher percentage of its initial contact area than either the Bard™ Soft Mesh with Tisseel™ system or the Bard™ Soft Mesh with SorbaFix™ absorbable fixation system. Dislocations occurred with the Bard™ Soft Mesh with Tisseel™ system and with the Bard™ Soft Mesh with SorbaFix™ absorbable fixation system at physiological pressure (,225 mmHg). No dislocation was recorded for the ProGrip™ laparoscopic self-fixating mesh. Conclusion At 24 hours after implantation, the mechanical fixation of the ProGrip™ laparoscopic self-fixating mesh was found to be significantly better than the fixation of the Tisseel™ system or the SorbaFix™ absorbable fixation system. PMID:25525396

  9. Self-esteem and the acute effect of anxiety on ambulatory blood pressure

    PubMed Central

    Edmondson, Donald; Arndt, Jamie; Alcántara, Carmela; Chaplin, William; Schwartz, Joseph E

    2015-01-01

    Objective Recent research suggests that self-esteem may be associated with improved parasympathetic nervous system functioning. This study tested whether high self-esteem is associated with decreased ambulatory systolic blood pressure (ASBP) reactivity to anxiety in healthy adults during the waking hours of a normal day. Methods Each of 858 participants completed a short version of the Rosenberg Self-Esteem Scale and then wore an ABP monitor which took two blood pressure readings per hour for 24 hours. Immediately after each blood pressure reading, participants completed an electronic diary report that included an anxiety rating on a 100-point visual analog scale (VAS). Using multilevel models, we assessed the association of momentary anxiety, high trait self-esteem, and their interaction on momentary ASBP, with adjustment for age, sex, race, ethnicity, and body mass index. Sensitivity analyses were conducted examining psychological factors associated with self-esteem: sense of mastery, optimism, social support, and depressive symptoms. Results On average, a 1-point increase in cube root-transformed anxiety was associated with a 0.80 mmHg (SE=0.09, p<0.001) increase in ASBP, and the interaction of high self-esteem and momentary anxiety was significant, such that this effect was 0.48 (SE=0.20, p=0.015) less in individuals with high self-esteem compared to all others. Results for self-esteem remained significant when adjusting for sex and psychological factors. Conclusions Momentary increases in anxiety are associated with acute increases in ASBP, and high self-esteem buffers the effect of momentary anxiety on blood pressure. Thus, high self-esteem may confer cardiovascular benefit by reducing the acute effects of anxiety on systolic blood pressure. PMID:26230481

  10. The prevalence of exercise-associated hyponatremia in 24-hour ultra-mountain bikers, 24-hour ultra-runners and multi-stage ultra-mountain bikers in the Czech Republic

    PubMed Central

    2014-01-01

    Background To assess the prevalence of exercise-associated hyponatremia (EAH) in two 24-hour mountain bike (MTB) (R1,R2), one 24-hour running (R3) and one multi-stage MTB (R4) races held in the Czech Republic in a cluster of four cross-sectional studies. Methods In 27 ultra-mountain bikers (ultra-MTBers), 12 ultra-runners, and 14 multi-stage MTBers, fluid intake, changes (Δ) in body mass, hematocrit, plasma volume, plasma [Na+], plasma [K+], plasma osmolality, urine [Na+], urine [K+], urine specific gravity, urine osmolality, K+/Na+ ratio in urine, transtubular potassium gradient and glomerular filtration rate were measured and calculated. The use of non-steroidal anti-inflammatory drugs and symptoms of EAH were recorded using post-race questionnaires. Results Of the 53 finishers, three (5.7%) developed post-race EAH, thereof one (3.7%) ultra-MTBer, one (8.3%) ultra-runner and one (7.1%) multi-stage MTBer. Plasma [Na+] decreased significantly (p < 0.001) only in R4. Urine osmolality (R1, R3, R4 p < 0.001; R2 p < 0.05) and glomerular filtration rate (p < 0.001) increased, and body mass decreased in all races (p < 0.05). Δ body mass was inversely related to the number of kilometers achieved (p < 0.001) in R2 where better ultra-MTBers tended to lose more weight. Δ body mass (p < 0.001) and %Δ body mass (p = 0.05) were positively related to lower post-race plasma [Na+] in R3 that was associated with increased loss in body mass. Fluid intake was positively related to race performance in R1 and R2 (R1: p = 0.04; R2: p = 0.01) where ultra-MTBers in R1 and R2 who drank more finished ahead of those who drank less. Post-race plasma [Na+] was negatively associated with race performance in ultra-MTBers in R2 (p < 0.05), similarly ultra-runners in R3 (p < 0.05) where finishers with more kilometres had lower post-race plasma [Na+]. Conclusions The prevalence of EAH in the Czech Republic was no higher compared to existing reports on ultra-endurance athletes in other countries

  11. Extracorporeal membrane oxygenation improves survival in a novel 24-hour pig model of severe acute respiratory distress syndrome

    PubMed Central

    Araos, Joaquín; Alegría, Leyla; García, Patricio; Damiani, Felipe; Tapia, Pablo; Soto, Dagoberto; Salomon, Tatiana; Rodriguez, Felipe; Amthauer, Macarena; Erranz, Benjamín; Castro, Gabriel; Carreño, Pamela; Medina, Tania; Retamal, Jaime; Cruces, Pablo; Bugedo, Guillermo; Bruhn, Alejandro

    2016-01-01

    Extracorporeal membrane oxygenation (ECMO) is increasingly being used to treat severe acute respiratory distress syndrome (ARDS). However, there is limited clinical evidence about how to optimize the technique. Experimental research can provide an alternative to fill the actual knowledge gap. The purpose of the present study was to develop and validate an animal model of acute lung injury (ALI) which resembled severe ARDS, and which could be successfully supported with ECMO. Eighteen pigs were randomly allocated into three groups: sham, ALI, and ALI + ECMO. ALI was induced by a double-hit consisting in repeated saline lavage followed by a 2-hour period of injurious ventilation. All animals were followed up to 24 hours while being ventilated with conventional ventilation (tidal volume 10 ml/kg). The lung injury model resulted in severe hypoxemia, increased airway pressures, pulmonary hypertension, and altered alveolar membrane barrier function, as indicated by an increased protein concentration in bronchoalveolar fluid, and increased wet/dry lung weight ratio. Histologic examination revealed severe diffuse alveolar damage, characteristic of ARDS. Veno-venous ECMO was started at the end of lung injury induction with a flow > 60 ml/kg/min resulting in rapid reversal of hypoxemia and pulmonary hypertension. Mortality was 0, 66.6 and 16.6% in the SHAM, ALI and ALI + ECMO groups, respectively (p < 0.05). This is a novel clinically relevant animal model that can be used to optimize the approach to ECMO and foster translational research in extracorporeal lung support. PMID:27398166

  12. Dietary quality varies according to data collection instrument: a comparison between a food frequency questionnaire and 24-hour recall.

    PubMed

    Rodrigues, Paulo Rogério Melo; de Souza, Rita Adriana Gomes; De Cnop, Mara Lima; Monteiro, Luana Silva; Coura, Camila Pinheiro; Brito, Alessandra Page; Pereira, Rosangela Alves

    2016-02-01

    The objective of this study was to assess the agreement between the Brazilian Healthy Eating Index - Revised (BHEI-R), estimated by a food frequency questionnaire (FFQ) and multiple 24-hour recalls (24h-R). The Wilcoxon paired test, partial correlations (PC), intraclass correlation coefficient (ICC), and Bland-Altman method were used. The total BHEI-R scores and its components ("total fruits", "whole fruits", "total vegetables", "integral cereals", "saturated fat", "sodium", and "energy intake derived from solid fat, added sugar, and alcoholic beverages") were statistically different, with the ICC and PC indicating poor concordance and correlation. The mean concordance estimated for the total BHEI-R and its components varied from 68% for "integral cereals" to 147% for "whole fruits". The suitable concordance limits were violated for most of the components of the BHEI-R. Poor concordance was observed between the BHEI-R estimated by the FFQ and by multiple 24h-R, which indicated a strong reliability of the BHEI-R on the instrument used to collect information on food consumption.

  13. Extracorporeal membrane oxygenation improves survival in a novel 24-hour pig model of severe acute respiratory distress syndrome.

    PubMed

    Araos, Joaquín; Alegría, Leyla; García, Patricio; Damiani, Felipe; Tapia, Pablo; Soto, Dagoberto; Salomon, Tatiana; Rodriguez, Felipe; Amthauer, Macarena; Erranz, Benjamín; Castro, Gabriel; Carreño, Pamela; Medina, Tania; Retamal, Jaime; Cruces, Pablo; Bugedo, Guillermo; Bruhn, Alejandro

    2016-01-01

    Extracorporeal membrane oxygenation (ECMO) is increasingly being used to treat severe acute respiratory distress syndrome (ARDS). However, there is limited clinical evidence about how to optimize the technique. Experimental research can provide an alternative to fill the actual knowledge gap. The purpose of the present study was to develop and validate an animal model of acute lung injury (ALI) which resembled severe ARDS, and which could be successfully supported with ECMO. Eighteen pigs were randomly allocated into three groups: sham, ALI, and ALI + ECMO. ALI was induced by a double-hit consisting in repeated saline lavage followed by a 2-hour period of injurious ventilation. All animals were followed up to 24 hours while being ventilated with conventional ventilation (tidal volume 10 ml/kg). The lung injury model resulted in severe hypoxemia, increased airway pressures, pulmonary hypertension, and altered alveolar membrane barrier function, as indicated by an increased protein concentration in bronchoalveolar fluid, and increased wet/dry lung weight ratio. Histologic examination revealed severe diffuse alveolar damage, characteristic of ARDS. Veno-venous ECMO was started at the end of lung injury induction with a flow > 60 ml/kg/min resulting in rapid reversal of hypoxemia and pulmonary hypertension. Mortality was 0, 66.6 and 16.6% in the SHAM, ALI and ALI + ECMO groups, respectively (p < 0.05). This is a novel clinically relevant animal model that can be used to optimize the approach to ECMO and foster translational research in extracorporeal lung support.

  14. Lessons from Studies to Evaluate an Online 24-Hour Recall for Use with Children and Adults in Canada.

    PubMed

    Kirkpatrick, Sharon I; Gilsing, Anne M; Hobin, Erin; Solbak, Nathan M; Wallace, Angela; Haines, Jess; Mayhew, Alexandra J; Orr, Sarah K; Raina, Parminder; Robson, Paula J; Sacco, Jocelyn E; Whelan, Heather K

    2017-01-31

    With technological innovation, comprehensive dietary intake data can be collected in a wide range of studies and settings. The Automated Self-Administered 24-hour (ASA24) Dietary Assessment Tool is a web-based system that guides respondents through 24-h recalls. The purpose of this paper is to describe lessons learned from five studies that assessed the feasibility and validity of ASA24 for capturing recall data among several population subgroups in Canada. These studies were conducted within a childcare setting (preschool children with reporting by parents), in public schools (children in grades 5-8; aged 10-13 years), and with community-based samples drawn from existing cohorts of adults and older adults. Themes emerged across studies regarding receptivity to completing ASA24, user experiences with the interface, and practical considerations for different populations. Overall, we found high acceptance of ASA24 among these diverse samples. However, the ASA24 interface was not intuitive for some participants, particularly young children and older adults. As well, technological challenges were encountered. These observations underscore the importance of piloting protocols using online tools, as well as consideration of the potential need for tailored resources to support study participants. Lessons gleaned can inform the effective use of technology-enabled dietary assessment tools in research.

  15. Global empirical model of TEC response to geomagnetic activity: Short-term (24 hours ahead) prediction model

    NASA Astrophysics Data System (ADS)

    Andonov, Borislav

    2013-04-01

    A global empirical model of the rTEC=(TECobs-TECmed)/TECmed depending on the geomagnetic activity (described by the Kp-index) and at a given moment is built by using global TEC data for full 13 years between 1999 and 2011.The data are downloaded from the CODE (Center for Orbit Determination in Europe) database in the Astronomical Institute, University of Bern. By using a 2D cross-correlation analysis it is found that the ionospheric response to the geomagnetic activity revealed both positive and negative phases of the response. The both phases of the ionospheric response have different duration and time delay with respect to the geomagnetic storm. It was found that these two parameters of the ionospheric response depend on the season, geographical/geomagnetic coordinates and local time. The rTEC response is represented by 2D (longitude-time) sine waves with different zonal wavenumbers and periods being harmonics of the diurnal period. The input data for the current and predicted geomagnetic activity are obtained from the MAK model developed in NIGGG-BAS, which uses the solar wind measurements from the ACE satellite. The background condition is defined by the recent CODE TEC maps. For each current hour the model provides predicted global TEC maps in geographic frame for the next 24 hours.

  16. Office and ambulatory blood pressure control in hypertensive patients treated with different two-drug and three-drug combinations.

    PubMed

    de la Sierra, Alejandro; Banegas, José R; Vinyoles, Ernest; Gorostidi, Manuel; Segura, Julián; de la Cruz, Juan J; Ruilope, Luis M

    There is scarce information regarding ambulatory blood pressure (BP) achieved in daily practice with a wide range of antihypertensive drug combinations. We looked for differences in office and ambulatory BP among major drug combinations of two and three antihypertensive agents from a different drugs class. A total of 17187 patients treated with six types of two-drug combinations and 9724 treated with six types of three-drug combinations from the Spanish ABPM Registry were analyzed. We compared achieved office and ambulatory BP, as well as office (< 140/90 mmHg) and ambulatory (24-hour BP < 130/80; day BP < 135/85, and night BP < 120/70 mmHg) BP control among groups. The combination of renin-angiotensin system (RAS) blockers with diuretics and the triple combination of RAS blockers with diuretics and calcium channel blockers (CCB) were associated with lower values of 24-hour, daytime and nighttime BP, as well as more pronounced nocturnal BP dip. Compared with such combinations (reference), other double combinations had lower rates of ambulatory BP control. Moreover, triple combinations containing alpha blockers also had lower rates of ambulatory BP control. We conclude that even with similar office BP control, differences exist among antihypertensive two-drug and three-drug combinations with respect to ambulatory BP control achieved during treatment, with RAS blockers/diuretics and RAS blockers/CCBs/diuretics obtaining better control rates. This can help physicians choose among drug combinations in order to obtain further ambulatory BP reductions.

  17. Low-Glycemic-Index Foods Can Decrease Systolic and Diastolic Blood Pressure in the Short Term

    PubMed Central

    Hosseininasab, Mina; Norouzy, Abdolreza; Nematy, Mohsen; Bonakdaran, Shokoufeh

    2015-01-01

    Background. We aimed to compare the effects of low- and high-GI foods on 24-hour ambulatory blood pressure. Methods. This longitudinal study was performed on 30 women, aged 18 to 40 years, during 24 hours. In the first leg of study all recruited subjects were assigned to LGI period for 24 hours and, after a 2-week washout period, all subjects were assigned to HGI period. BP was measured every hour during the 24-hour monitoring. Results. After the intervention, there were significant decreases in SBP and DBP in the LGI period (102.26 ± 14.18 mmHg versus 112.86 ± 9.33 mmHg for SBP and 66.96 ± 10.39 mmHg versus 74.46 ± 7.61 mmHg for DBP) (P = 0.00 and P = 0.002, resp.). However, in the HGI period, there was no significant change in SBP or DBP (110.66 ± 9.85 versus 111.80 ± 9.57 for SBP and 71.16 ± 9.16 versus 74.26 ± 10.09 for DBP) (P = 0.6 and P = 0.06, resp.). Conclusion. The results suggest that LGI foods may be beneficial in reducing 24-hour BP. PMID:26509082

  18. Personal black carbon exposure influences ambulatory blood pressure: air pollution and cardiometabolic disease (AIRCMD-China) study.

    PubMed

    Zhao, Xiaoyi; Sun, Zhichao; Ruan, Yanping; Yan, Jianhua; Mukherjee, Bhramar; Yang, Fumo; Duan, Fengkui; Sun, Lixian; Liang, Ruijuan; Lian, Hui; Zhang, Shuyang; Fang, Quan; Gu, Dongfeng; Brook, Jeffrey R; Sun, Qinghua; Brook, Robert D; Rajagopalan, Sanjay; Fan, Zhongjie

    2014-04-01

    Few prospective studies have assessed the blood pressure effect of extremely high air pollution encountered in Asia's megacities. The objective of this study was to evaluate the association between combustion-related air pollution with ambulatory blood pressure and autonomic function. During February to July 2012, personal black carbon was determined for 5 consecutive days using microaethalometers in patients with metabolic syndrome in Beijing, China. Simultaneous ambient fine particulate matter concentration was obtained from the Beijing Municipal Environmental Monitoring Center and the US Embassy. Twenty-four-hour ambulatory blood pressure and heart rate variability were measured from day 4. Arterial stiffness and endothelial function were obtained at the end of day 5. For statistical analysis, we used generalized additive mixed models for repeated outcomes and generalized linear models for single/summary outcomes. Mean (SD) of personal black carbon and fine particulate matter during 24 hours was 4.66 (2.89) and 64.2 (36.9) μg/m(3). Exposure to high levels of black carbon in the preceding hours was associated significantly with adverse cardiovascular responses. A unit increase in personal black carbon during the previous 10 hours was associated with an increase in systolic blood pressure of 0.53 mm Hg and diastolic blood pressure of 0.37 mm Hg (95% confidence interval, 0.17-0.89 and 0.10-0.65 mm Hg, respectively), a percentage change in low frequency to high frequency ratio of 5.11 and mean interbeat interval of -0.06 (95% confidence interval, 0.62-9.60 and -0.11 to -0.01, respectively). These findings highlight the public health effect of air pollution and the importance of reducing air pollution.

  19. Canadian 24-Hour Movement Guidelines for Children and Youth: An Integration of Physical Activity, Sedentary Behaviour, and Sleep.

    PubMed

    Tremblay, Mark S; Carson, Valerie; Chaput, Jean-Philippe; Connor Gorber, Sarah; Dinh, Thy; Duggan, Mary; Faulkner, Guy; Gray, Casey E; Gruber, Reut; Janson, Katherine; Janssen, Ian; Katzmarzyk, Peter T; Kho, Michelle E; Latimer-Cheung, Amy E; LeBlanc, Claire; Okely, Anthony D; Olds, Timothy; Pate, Russell R; Phillips, Andrea; Poitras, Veronica J; Rodenburg, Sophie; Sampson, Margaret; Saunders, Travis J; Stone, James A; Stratton, Gareth; Weiss, Shelly K; Zehr, Lori

    2016-06-01

    Leaders from the Canadian Society for Exercise Physiology convened representatives of national organizations, content experts, methodologists, stakeholders, and end-users who followed rigorous and transparent guideline development procedures to create the Canadian 24-Hour Movement Guidelines for Children and Youth: An Integration of Physical Activity, Sedentary Behaviour, and Sleep. These novel guidelines for children and youth aged 5-17 years respect the natural and intuitive integration of movement behaviours across the whole day (24-h period). The development process was guided by the Appraisal of Guidelines for Research Evaluation (AGREE) II instrument and systematic reviews of evidence informing the guidelines were assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Four systematic reviews (physical activity, sedentary behaviour, sleep, integrated behaviours) examining the relationships between and among movement behaviours and several health indicators were completed and interpreted by expert consensus. Complementary compositional analyses were performed using Canadian Health Measures Survey data to examine the relationships between movement behaviours and health indicators. A stakeholder survey was employed (n = 590) and 28 focus groups/stakeholder interviews (n = 104) were completed to gather feedback on draft guidelines. Following an introductory preamble, the guidelines provide evidence-informed recommendations for a healthy day (24 h), comprising a combination of sleep, sedentary behaviours, light-, moderate-, and vigorous-intensity physical activity. Proactive dissemination, promotion, implementation, and evaluation plans have been prepared in an effort to optimize uptake and activation of the new guidelines. Future research should consider the integrated relationships among movement behaviours, and similar integrated guidelines for other age groups should be developed.

  20. The 24-hour shelf-life of cytapheresis platelet concentrates stored in polyvinyl chloride containers should be extended only with caution.

    PubMed

    Strauss, R G; Snyder, E L; Eckermann, I; Stewart, L

    1987-01-01

    A recent publication suggested that the 24-hour allowable shelf-life of apheresis platelet concentrates collected by open-system techniques be extended to 48 hours because platelets collected in this fashion usually remain sterile for that length of time. The current studies, however, show that the quality of platelet concentrates deteriorates rapidly after storage for more than 24 hours in the relatively small-volume, polyvinyl chloride containers of currently marketed, open-system software, as evidenced by the falling pH, the disintegration of platelets, and the inability of platelets to recover from hypotonic shock. Platelets were markedly defective within 48 hours. Thus, it seems unwise to extend the shelf-life of such platelet concentrates beyond 24 hours solely because they are likely to remain sterile. Collection techniques and software must also be modified to ensure satisfactory platelet quality before the period of storage should be extended.

  1. Effect of aging on 24-hour changes in dopamine and serotonin turnover and amino acid and somatostatin contents of rat corpus striatum.

    PubMed

    Esquifino, Ana I; Cano, Pilar; Chacon, Fernando; Reyes Toso, Carlos F; Cardinali, Daniel P

    2002-01-01

    This study examined the 24-hour changes in a number of transmitters in the corpus striatum of young and middle-aged male Wistar rats. The contents of excitatory amino acids (glutamate, aspartate) and inhibitory amino acids (gamma-aminobutyric acid, GABA; taurine, glycine) and of somatostatin were measured in 2-month- and 18- to 20-month-old rats killed at six different time points along the 24-hour cycle. The striatal serotonin and dopamine turnover was also measured. Both young and middle-aged rats showed significant 24-hour variations in striatal glutamate and aspartate contents; only in young rats these variations fitted a cosine function, with acrophase during the first part of rest span. Mesor values of striatal excitatory amino acid contents were lowest in middle-aged rats. Significant 24-hour variations in striatal contents of GABA, taurine, and glycine occurred in young rats, while only striatal GABA exhibited 24-hour changes in middle- aged rats (acrophases during the first part of rest span). For every inhibitory transmitter, the mesor values in middle-aged rats were significantly lower than in young rats. The 24-hour variation of the striatal somatostatin content showed acrophase during the first part of rest span, mesor values and amplitude being lowest in middle-aged rats. Aging rats exhibited significantly higher mesor values of striatal serotonin turnover (34% increase) and lower mesor values of dopamine turnover (69% decrease) than their younger counterparts. Some of the circadian modifications of motor function seen in aging rats could be related to the striatal transmitter changes reported herein.

  2. The relatively poor correlation between random and 24-hour urine protein excretion in patients with biopsy-proven glomerular diseases.

    PubMed

    Hogan, Marie C; Reich, Heather N; Nelson, Peter J; Adler, Sharon G; Cattran, Daniel C; Appel, Gerald B; Gipson, Debbie S; Kretzler, Matthias; Troost, Jonathan P; Lieske, John C

    2016-11-01

    Random urine protein creatinine ratios are used to estimate 24-hour urine protein excretion, which is considered a diagnostic gold standard. However, few studies are available of the sensitivity and specificity of this estimation in patients with glomerular proteinuria. To clarify this, we measured the urine protein and creatinine centrally in random and 24-hour urine collections at biopsy and longitudinally every 6 months in individuals participating in the Nephrotic Syndrome Study Network (NEPTUNE) cohort with glomerular disease. In the initial developmental cohort, 302 patients had same day random and 24-hour samples with a total of 827 paired measurements across all visits. The protein excretion (g/day) was higher in adult than pediatric patients. The correlation between the random urine protein creatinine ratio and 24-hour urine protein excretion was moderate in both groups (r of 0.60 and 0.67, respectively). However, the log10 transformation of values strengthened correlations in both groups (r of 0.85 and 0.82, respectively). Associations were moderately stronger among obese patients. Prediction equations were developed and validated in 232 unique cases from NEPTUNE (R(2) of 0.65). Thus, in patients with glomerular disease and proteinuria, the urine protein creatinine ratio correlates only moderately with 24-hour urine protein excretion. However an estimating equation was developed to derive 24-hour urine protein excretion from random urine protein creatinine ratio values with improved precision. The long-term prognostic value of log10-transformed random protein creatinine ratios values requires future study.

  3. Jack Healy Remembers - Anecdotal Evidence for the Origin of the Approximate 24-hour Urine Sampling Protocol Used for Worker Bioassay Monitoring

    SciTech Connect

    Carbaugh, Eugene H.

    2008-10-01

    The origin of the approximate 24-hour urine sampling protocol used at Hanford for routine bioassay is attributed to an informal study done in the mid-1940s. While the actual data were never published and have been lost, anecdotal recollections by staff involved in the initial bioassay program design and administration suggest that the sampling protocol had a solid scientific basis. Numerous alternate methods for normalizing partial day samples to represent a total 24-hour collection have since been proposed and used, but no one method is obviously preferred.

  4. Investigations into the source of two fungicides measured in the air for 24 hours following application to a cereal crop.

    PubMed

    Ellis, M C Butler; Lane, A G; O'Sullivan, C M; Miller, P C H

    2009-01-01

    Airborne pesticides can be detected near to recently-treated arable fields for a period of days following the application. Identifying the source of such pesticides is important in developing predictive models for use in exposure and risk assessments. Previous work showed levels of pesticide in the air that were higher than expected for a low-vapour-pressure active ingredient, epoxiconazole, and comparable with an active ingredient of a significantly higher vapour pressure, fenpropidin. It was possible that the measured concentrations could be attributed to 'dust' particles emitted from the crop, either biological material contaminated with pesticide or solid dried deposits of active ingredient and other formulation components. A second experiment was therefore undertaken to measure airborne concentrations of the same active ingredients and to determine whether some or all of the measured airborne pesticide could be attributed to particles, using a Marple personal cascade impactor, which collects particles in the range 0.3 - 50 microm. Such samplers are not optimised to give good sampling efficiencies under the proposed field conditions, so some initial tests were undertaken in the Silsoe wind tunnel to assess its ability to sample particles in an air flow. In the subsequent field trial, a 192 m square plot in a commercially established winter cereal crop was sprayed with a tank mix of commercial formulations of epoxiconazole and fenpropidin. Measurements of airborne pesticides were made for 24 hours following the application with suction samplers attached to tenax tubes to evaluate vapour concentrations and with the cascade impactor to determine whether contaminated airborne particles were present. The concentrations of pesticide measured with the tenax tubes were significantly higher than the particulate component detected on the cascade impactor plates and it is therefore it was very unlikely that there was a significant contribution from pesticide

  5. Perfusion-CT - Can We Predict Acute Pancreatitis Outcome within the First 24 Hours from the Onset of Symptoms?

    PubMed Central

    Pieńkowska, Joanna; Gwoździewicz, Katarzyna; Skrobisz-Balandowska, Katarzyna; Marek, Iwona; Kostro, Justyna; Szurowska, Edyta; Studniarek, Michał

    2016-01-01

    Purpose Severe acute pancreatitis (AP) is still a significant clinical problem which is associated with a highly mortality. The aim of this study was the evaluation of prognostic value of CT regional perfusion measurement performed on the first day of onset of symptoms of AP, in assessing the risk of developing severe form of acute pancreatitis. Material and Methods 79 patients with clinical symptoms and biochemical criteria indicative of acute pancreatitis (acute upper abdominal pain, elevated levels of serum amylase and lipase) underwent perfusion CT within 24 hours after onset of symptoms. The follow-up examinations were performed after 4–6 days to detect progression of the disease. Perfusion parameters were compared in 41 people who developed severe form of AP (pancreatic and/or peripancreatic tissue necrosis) with parameters in 38 consecutive patients in whom course of AP was mild. Blood flow, blood volume, mean transit time and permeability surface area product were calculated in the three anatomic pancreatic subdivisions (head, body and tail). At the same time the patient's clinical status was assessed by APACHE II score and laboratory parameters such as CRP, serum lipase and amylase, AST, ALT, GGT, ALP and bilirubin were compared. Results Statistical differences in the perfusion parameters between the group of patients with mild and severe AP were shown. Blood flow, blood volume and mean transit time were significantly lower and permeability surface area product was significantly higher in patients who develop severe acute pancreatitis and presence of pancreatic and/or peripancreatic necrosis due to pancreatic ischemia. There were no statistically significant differences between the two groups in terms of evaluated on admission severity of pancreatitis assessed using APACHE II score and laboratory tests. Conclusions CT perfusion is a very useful indicator for prediction and selection patients in early stages of acute pancreatitis who are at risk of

  6. Bath water contamination with Legionella and nontuberculous mycobacteria in 24-hour home baths, hot springs, and public bathhouses of Nagano Prefecture, Japan.

    PubMed

    Kobayashi, Michiko; Oana, Kozue; Kawakami, Yoshiyuki

    2014-01-01

    Bath water samples were collected from 116 hot springs, 197 public bathhouses, and 38 24-hour home baths in Nagano Prefecture, Japan, during the period of April 2009 to November 2011, for determining the presence and extent of contamination with Legionella and nontuberculous mycobacteria. Cultures positive for Legionella were observed in 123 of the 3,314 bath water samples examined. The distribution and abundance of Legionella and/or combined contamination with Legionella and nontuberculous mycobacteria were investigated to clarify the contamination levels. The abundance of Legionella was demonstrated to correlate considerably with the levels of combined contamination with Legionella and nontuberculous mycobacteria. Legionella spp. were obtained from 61% of the water samples from 24-hour home baths, but only from 3% of the samples from public bathhouses and hot springs. This is despite the fact that a few outbreaks of Legionnaires' disease in Nagano Prefecture as well as other regions of Japan have been traced to bath water contamination. The comparatively higher rate of contamination of the 24-hour home baths is a matter of concern. It is therefore advisable to routinely implement good maintenance of the water basins, particularly of the 24-hour home baths.

  7. 49 CFR 375.607 - What must I do if I am able to tender a shipment for final delivery more than 24 hours before a...

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 5 2011-10-01 2011-10-01 false What must I do if I am able to tender a shipment for final delivery more than 24 hours before a specified date? 375.607 Section 375.607 Transportation Other Regulations Relating to Transportation (Continued) FEDERAL MOTOR CARRIER SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION FEDERAL...

  8. Effect of one week of CPAP treatment of obstructive sleep apnoea on 24-hour profiles of glucose, insulin and counter-regulatory hormones in type 2 diabetes.

    PubMed

    Mokhlesi, Babak; Grimaldi, Daniela; Beccuti, Guglielmo; Van Cauter, Eve

    2017-03-01

    Studies examining the impact of CPAP treatment on glycaemic control have yielded conflicting results, partly because of insufficient nightly CPAP use. We examined the 24-hour profiles of glucose, insulin and counter-regulatory hormones in 12 subjects with type 2 diabetes and OSA before and after 1 week of effective in-laboratory CPAP therapy over an entire 8-hour night thus ensuring optimal CPAP compliance. Blood samples were collected every 15 to 30 minutes for 24 hours under controlled conditions. The 24-hour mean glucose decreased from 153.2 ± 33.0 to 139.7 ± 24.2 mg/dL with CPAP (-13.5 ± 13.5 mg/dL; P = .005) without change in insulin levels. Morning fasting glucose levels decreased by 14.6 ± 3 mg/dL (P = .001) and the dawn phenomenon decreased by 7.8 ± 9.8 mg/dL (P = .019). CPAP treatment decreased norepinephrine levels while the 24-hour profiles of growth hormone and cortisol remained unchanged. In conclusion, 1 week of effective treatment of OSA over an entire 8-hour night results in a clinically significant improvement in glycaemic control via an amelioration of evening fasting glucose metabolism and a reduction in the dawn phenomenon, a late-night glucose increase that is not adequately treated by oral medications. Clinical Trials Information: ClinicalTrials.gov Identifier: NCT01136785.

  9. The effect of low level radiofrequency electromagnetic radiation on the excretion rates of stress hormones in operators during 24-hour shifts.

    PubMed

    Vangelova, K; Israel, M; Mihaylov, S

    2002-06-01

    The aim of the study was to investigate the effect of long term exposure to low level radiofrequency (RF) electromagnetic (EM) radiation on the excretion rates of stress hormones in satellite station operators during 24-hour shifts. Twelve male operators at a satellite station for TV communications and space research were studied during 24-hour shifts. Dosimetric evaluation of the exposure was carried out and showed low level exposure with specific absorption of 0.1127 J.kg-1. A control group of 12 unexposed male operators with similar job task and the same shift system were studied, too. The 11-oxycorticosteroids (11-OCS), adrenaline and noradrenaline were followed by spectrofluorimetric methods on 3-hour intervals during the 24-hour shifts. The data were analyzed by tests for interindividual analysis, Cosinor analysis and analysis of variance (ANOVA). Significant increase in the 24-hour excretion of 11-OCS and disorders in its circadian rhythm, manifested by increase in the mesor, decrease in the amplitude and shift in the acrophase were found in the exposed operators. The changes in the excretion rates of the catecholamines were significant and showed greater variability of both variables. The long term effect of the exposure to low-level RF EM radiation evoked pronounced stress reaction with changes in the circadian rhythm of 11-OCS and increased variability of catecholamines secretion. The possible health hazards associated with observed alteration in the stress system need to be clarified by identification of their significance and prognostic relevance.

  10. Validation of the automated self-administered 24-hour dietary recall for children (ASA24-Kids) among 9- to 11-year-old youth

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Our purpose was to validate ASA24-Kids-2012, a self-administered web-based 24-hour dietary recall (24hDR) among 9- to 11-year-old children. Sixty-nine children in two sites participated in the study. In one site, trained staff observed and recorded types and portions of foods and drinks consumed by ...

  11. Characterization of pulmonary protein profiles in response to zinc oxide nanoparticles in mice: a 24-hour and 28-day follow-up study

    PubMed Central

    Pan, Chih-Hong; Chuang, Kai-Jen; Chen, Jen-Kun; Hsiao, Ta-Chih; Lai, Ching-Huang; Jones, Tim P; BéruBé, Kelly A; Hong, Gui-Bing; Ho, Kin-Fai; Chuang, Hsiao-Chi

    2015-01-01

    Although zinc oxide nanoparticles (ZnONPs) are recognized to cause systemic disorders, little is known about the mechanisms that underlie the time-dependent differences that occur after exposure. The objective of this study was to investigate the mechanistic differences at 24 hours and 28 days after the exposure of BALB/c mice to ZnONPs via intratracheal instillation. An isobaric tag for the relative and absolute quantitation coupled with liquid chromatography/tandem mass spectrometry was used to identify the differential protein expression, biological processes, molecular functions, and pathways. A total of 18 and 14 proteins displayed significant changes in the lung tissues at 24 hours and 28 days after exposure, respectively, with the most striking changes being observed for S100-A9 protein. Metabolic processes and catalytic activity were the main biological processes and molecular functions, respectively, in the responses at the 24-hour and 28-day follow-up times. The glycolysis/gluconeogenesis pathway was continuously downregulated from 24 hours to 28 days, whereas detoxification pathways were activated at the 28-day time-point after exposure. A comprehensive understanding of the potential time-dependent effects of exposure to ZnONPs was provided, which highlights the metabolic mechanisms that may be important in the responses to ZnONP. PMID:26251593

  12. Identifying nutrients that are under-reported by an automated 24-hour dietary recall method in overweight and obese women after weight loss

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Underreporting of energy intake by 15-50% is a common problem in dietary assessment. Evidence suggests overweight/obese respondents are more likely to under-report than normal weight. This study compared Automated Self-Administered 24-hour recall (ASA24)-reported dietary intake to true intake in ove...

  13. 24-HOUR DIFFUSIVE SAMPLING OF 1,3-BUTADIENE IN AIR ONTO CARBONPAK X SOLID ADSORBENT WITH THEMAL DESORPTION/GC/MS ANALYSIS - FEASIBILITY STUDIES

    EPA Science Inventory

    Diffusive sampling of 1,3-butadiene for 24 hours onto the graphitic adsorbent Carbopack X contained in a stainless steel tube badge (6.3 mm OD, 5 mm ID, and 90 mm in length) with analysis by thermal desorption/GC/MS has been evaluated in controlled tests. A test matrix of 42 tr...

  14. Characterization of pulmonary protein profiles in response to zinc oxide nanoparticles in mice: a 24-hour and 28-day follow-up study.

    PubMed

    Pan, Chih-Hong; Chuang, Kai-Jen; Chen, Jen-Kun; Hsiao, Ta-Chih; Lai, Ching-Huang; Jones, Tim P; BéruBé, Kelly A; Hong, Gui-Bing; Ho, Kin-Fai; Chuang, Hsiao-Chi

    2015-01-01

    Although zinc oxide nanoparticles (ZnONPs) are recognized to cause systemic disorders, little is known about the mechanisms that underlie the time-dependent differences that occur after exposure. The objective of this study was to investigate the mechanistic differences at 24 hours and 28 days after the exposure of BALB/c mice to ZnONPs via intratracheal instillation. An isobaric tag for the relative and absolute quantitation coupled with liquid chromatography/tandem mass spectrometry was used to identify the differential protein expression, biological processes, molecular functions, and pathways. A total of 18 and 14 proteins displayed significant changes in the lung tissues at 24 hours and 28 days after exposure, respectively, with the most striking changes being observed for S100-A9 protein. Metabolic processes and catalytic activity were the main biological processes and molecular functions, respectively, in the responses at the 24-hour and 28-day follow-up times. The glycolysis/gluconeogenesis pathway was continuously downregulated from 24 hours to 28 days, whereas detoxification pathways were activated at the 28-day time-point after exposure. A comprehensive understanding of the potential time-dependent effects of exposure to ZnONPs was provided, which highlights the metabolic mechanisms that may be important in the responses to ZnONP.

  15. Effect of captopril and melatonin on fibrotic rebuilding of the aorta in 24 hour light-induced hypertension.

    PubMed

    Repová-Bednárová, K; Aziriová, S; Hrenák, J; Krajčírovičová, K; Adamcová, M; Paulis, L; Simko, F

    2013-01-01

    Chronic continuous light exposure leads to melatonin deficiency along with complex neurohumoral activation resulting in hypertension development in rats. The aim of this study was to show, whether continuous light induces fibrotic rebuilding of the aorta and whether the treatment with melatonin or angiotensin converting enzyme inhibitor captopril can prevent these potential alterations. In a six-week experiment, 3-month-old Wistar rats were divided into 4 groups (ten per group): controls, rats exposed to continuous light, exposed to continuous light plus treated with captopril (100 mg/kg/24 h) and exposed to continuous light plus treated with melatonin (10 mg/kg/24 h). Systolic blood pressure (SBP) and collagen type I and III in the media of thoracic aorta were measured. Continuous light induced hypertension and fibrotic rebuilding of the aorta in terms of enhancement of collagen I and III concentration in the aortic media. Both captopril and melatonin prevented SBP rise and reduced collagen III concentration in the aorta. However, only melatonin reduced collagen I and the sum of collagen I and III in the aortic tissue. We conclude that in continuous light-induced hypertension, administration of melatonin, along with SBP reduction, decreases collagen I and III concentration in the aorta. It is suggested that antifibrotic effect of melatonin may reduce the stiffness of the aorta and small arteries and beneficially influence the nature of the pulse wave and peripheral vascular resistance.

  16. Relationship between Ambulatory BP and Clinical Outcomes in Patients with Hypertensive CKD

    PubMed Central

    Rahman, Mahboob; Hu, Bo; Appel, Lawrence J.; Charleston, Jeanne; Contreras, Gabriel; Faulkner, Marquetta L.; Hiremath, Leena; Jamerson, Kenneth A.; Lea, Janice P.; Lipkowitz, Michael S.; Pogue, Velvie A.; Rostand, Stephen G.; Smogorzewski, Miroslaw J.; Wright, Jackson T.; Greene, Tom; Gassman, Jennifer; Wang, Xuelei; Phillips, Robert A.

    2012-01-01

    Summary Background and objectives Abnormal ambulatory BP (ABP) profiles are commonplace in CKD, yet the prognostic value of ABP for renal and cardiovascular outcomes is uncertain. This study assessed the relationship of baseline ABP profiles with CKD progression and subsequent cardiovascular outcomes to determine the prognostic value of ABP beyond that of clinic BP measurements. Design, setting, participants, & measurements Between 2002 and 2003, 617 African Americans with hypertensive CKD treated to a clinic BP goal of <130/80 mmHg were enrolled in this prospective, observational study. Participants were followed for a median of 5 years. Primary renal outcome was a composite of doubling of serum creatinine, ESRD, or death. The primary cardiovascular outcome was a composite of myocardial infarction, hospitalized congestive heart failure, stroke, revascularization procedures, cardiovascular death, and ESRD. Results Multivariable Cox proportional hazard analysis showed that higher 24-hour systolic BP (SBP), daytime, night-time, and clinic SBP were each associated with subsequent renal (hazard ratio, 1.17–1.28; P<0.001) and cardiovascular outcomes (hazard ratio, 1.22–1.32; P<0.001). After controlling for clinic SBP, ABP measures were predictive of renal outcomes in participants with clinic SBP <130 mmHg (P<0.05 for interaction). ABP predicted cardiovascular outcomes with no interaction based on clinic BP control. Conclusions ABP provides additional information beyond that of multiple clinic BP measures in predicting renal and cardiovascular outcomes in African Americans with hypertensive CKD. The primary utility of ABP in these CKD patients was to identify high-risk individuals among those patients with controlled clinic BP. PMID:22935847

  17. [Comparison of the data of 24-hour ECG monitoring and the condition of the coronary bed in patients with the variants of the course of unstable stenocardia].

    PubMed

    Karpov, Iu A; Pomerantsev, E V; Shibleva, V V; Merkulova, I N; Khakimov, A G; Podinovskaia, Ia A; Setin, V F

    1992-03-01

    A total of 232 patients with various clinical types of unstable angina pectoris were examined. All the patients underwent coronary angiographic studies, 24-hour ECG monitoring. In 40.5% of the patients, 24-hour monitoring revealed transient ST segment changes which were not accompanied by pain in 47% of the cases. ST segment changes were equally encountered in patients with one-, two-, and three-vessel disease in the presence or absence of pain. Ischemic ST segment changes generally occurred with an anginal episode in patients with crescendo unstable angina, whereas in those with more prolonged and intensified pain and angina at rest in particular, silent myocardial ischemic episodes were significantly more frequently recorded, which were more common in these patients with multivessel disease.

  18. Value of random urinary homovanillic acid and vanillylmandelic acid levels in the diagnosis and management of patients with neuroblastoma: comparison with 24-hour urine collections.

    PubMed

    Tuchman, M; Morris, C L; Ramnaraine, M L; Bowers, L D; Krivit, W

    1985-02-01

    Urinary homovanillic acid (HVA) and vanillylmandelic acid (VMA) levels were determined in random samples and in 24-hour collections from 13 patients with neuroblastoma and 22 patients without neuroblastoma. Random sample levels were compared with levels in 24-hour collections and showed a positive correlation of 95% for HVA (N = 59) and 93% for VMA (N = 52). No false positives or false negatives occurred using random samples for diagnosis. Nonneuroblastoma (normal) HVA (N = 126) and VMA (N = 119) levels are reported for different age groups. Sequential random HVA and VMA determinations in patients with neuroblastoma during and after therapy are shown. Random urinary HVA and VMA levels are shown to be adequate for utilization in the diagnosis of neuroblastoma and sequential determinations of random HVA and VMA are shown to be helpful in the follow-up of those patients.

  19. Differences in Nighttime and Daytime Ambulatory Blood Pressure When Diurnal Periods Are Defined by Self-report, Fixed-Times and Actigraphy: Improving the Detection of Hypertension Study

    PubMed Central

    BOOTH, John N.; MUNTNER, Paul; ABDALLA, Marwah; DIAZ, Keith M.; VIERA, Anthony J.; REYNOLDS, Kristi; SCHWARTZ, Joseph E.; SHIMBO, Daichi

    2016-01-01

    Objectives To determine whether defining diurnal periods by self-report, fixed-time or actigraphy produce different estimates of nighttime and daytime ambulatory blood pressure (ABP). Methods Over a median of 28 days, 330 participants completed two 24-hour ABP and actigraphy monitoring periods with sleep diaries. Fixed nighttime and daytime periods were defined as 00:00–06:00 and 10:00–20:00, respectively. Using the first ABP period, within-individual differences for mean nighttime and daytime ABP and Kappa statistics for nighttime and daytime hypertension (systolic/diastolic ABP ≥120/70 mmHg and ≥135/85 mmHg, respectively) were estimated comparing self-report, fixed-time or actigraphy for defining diurnal periods. Reproducibility of ABP was also estimated. Results Within-individual mean differences in nighttime systolic ABP were small, suggesting little bias, when comparing the three approaches used to define diurnal periods. The distribution of differences, represented by 95% confidence intervals (CI), in nighttime systolic and diastolic ABP and daytime systolic and diastolic ABP was narrowest for self-report versus actigraphy. For example, mean differences (95% CI) in nighttime systolic ABP for self-report versus fixed-time was −0.53 (−6.61,+5.56) mmHg, self-report versus actigraphy was 0.91 (−3.61,+5.43) mmHg and fixed-time versus actigraphy was 1.43 (−5.59,+8.46) mmHg. Agreement for nighttime and daytime hypertension was highest for self-report versus actigraphy: Kappa statistic (95% CI)=0.91 (0.86,0.96) and 1.00 (0.98,1.00), respectively. The reproducibility of mean ABP and hypertension categories was similar using each approach. Conclusion Given the high agreement with actigraphy, these data support using self-report to define diurnal periods on ABP monitoring. Further, the use of fixed-time periods may be a reasonable alternative approach. PMID:26867054

  20. In vitro study of 24-hour and 30-day shear bond strengths of three resin-glass ionomer cements used to bond orthodontic brackets.

    PubMed

    Lippitz, S J; Staley, R N; Jakobsen, J R

    1998-06-01

    Interest in using composite resin-glass ionomer hybrid cements as orthodontic bracket adhesives has grown because of their potential for fluoride release. The purpose of this pilot study was to compare shear bond strengths of three resin-glass ionomer cements (Advance, Fuji Duet, Fuji Ortho LC) used as bracket adhesives with a composite resin 24 hours and 30 days after bonding. The amount of adhesive remaining on the debonded enamel surface was scored for each adhesive. Mesh-backed stainless-steel brackets were bonded to 100 extracted human premolars, which were stored in artificial saliva at 37 degrees C until being tested to failure in a testing machine. The hybrid cements, with one exception, had bond strengths similar to those of the composite resin at 24 hours and 30 days. Fuji Ortho LC had significantly lower bond strengths (ANOVA p < or = 0.05) than the other adhesives at 24 hours and 30 days when it was bonded to unetched, water-moistened enamel. Adhesive-remnant scores were similar for all cements, except for cement Fuji Ortho LC when it was bonded to unetched enamel. The resin-glass ionomer cements we tested appear to have bond strengths suitable for routine use as orthodontic bracket-bonding adhesives.

  1. Deconvolution of insulin secretion, insulin hepatic extraction post-hepatic delivery rates and sensitivity during 24-hour standardized meals: time course of glucose homeostasis in leptin replacement treatment.

    PubMed

    Andreev, V P; Paz-Filho, G; Wong, M-L; Licinio, J

    2009-02-01

    Minimally invasive methodology, mathematical model, and software for analysis of glucose homeostasis by deconvolution of insulin secretion, hepatic extraction, post-hepatic delivery, and sensitivity from 24-hour standardized meals test have been developed and illustrated by the study of glucose homeostasis of a genetically based leptin-deficient patient before and after leptin replacement treatment. The only genetically leptin-deficient adult man identified in the world was treated for 24 months with recombinant methionyl human leptin. Blood was collected every 7 minutes for 24 hours, with standardized meals consumed during the 4 visits: at baseline, one-week, 18-months, and 24-months after initiation of the treatment. Concentrations of insulin, C-peptide, and plasma glucose were measured. Insulin secretion was obtained by deconvolution of C-peptide data. Hepatic insulin extraction was determined based on our modifications of the insulin kinetics model . Insulin sensitivity for each of the four meals was calculated by using the minimal glucose model approach. Hepatic extraction of insulin was the first element of glucose homeostasis to respond to leptin replacement treatment and increased 2-fold after one week of treatment. Insulin secretion and delivery rates decreased more than 2-fold and insulin sensitivity increased 10-fold after 24 months of treatment. Computer programs for analysis of 24-hour insulin secretion, extraction, delivery, and action are available upon request.

  2. Effects of transdermal scopolamine, alone or in combination with cimetidine, on total 24 hour gastric acid secretion in patients with duodenal ulcer.

    PubMed Central

    Richardson, C T; Feldman, M

    1986-01-01

    Transdermal scopolamine is an antimuscarinic preparation approved for use in the United States for prevention of motion sickness. A recent study using this drug (0.5 mg/patch) suggested that enough scopolamine was absorbed through the skin to reduce basal gastric acid secretion in patients with duodenal ulcer. We have compared the effect of transdermal scopolamine and oral cimetidine (400 mg twice daily) in seven men with chronic duodenal ulcer, both alone and in combination, on acid secretion throughout an entire 24 hour period in a placebo-controlled, randomised, double blinded cross over study. The effect of these drugs on basal, interprandial, and nocturnal gastric juice volume and hydrogen ion concentration also was measured. Transdermal scopolamine had no significant effect on mean 24 hour acid secretion (placebo, 409.4 mmol/day; scopolamine, 364.0 mmol/day) nor did it have a significant effect on gastric juice volume or hydrogen ion concentration. The combination of transdermal scopolamine plus cimetidine was not more effective than cimetidine alone in reducing total 24 hour acid secretion (mean, 231.8 versus 235.3 mmol/day) nor in reducing gastric juice volume or hydrogen ion concentration. PMID:3804025

  3. Factors Associated With High Sodium Intake Based on Estimated 24-Hour Urinary Sodium Excretion: The 2009-2011 Korea National Health and Nutrition Examination Survey.

    PubMed

    Hong, Jae Won; Noh, Jung Hyun; Kim, Dong-Jun

    2016-03-01

    Although reducing dietary salt consumption is the most cost-effective strategy for preventing progression of cardiovascular and renal disease, policy-based approaches to monitor sodium intake accurately and the understanding factors associated with excessive sodium intake for the improvement of public health are lacking. We investigated factors associated with high sodium intake based on the estimated 24-hour urinary sodium excretion, using data from the 2009 to 2011 Korea National Health and Nutrition Examination Survey (KNHANES). Among 21,199 adults (≥19 years of age) who participated in the 2009 to 2011 KNHANES, 18,000 participants (weighted n = 33,969,783) who completed urinary sodium and creatinine evaluations were analyzed in this study. The 24-hour urinary sodium excretion was estimated using Tanaka equation. The mean estimated 24-hour urinary sodium excretion level was 4349 (4286-4413) mg per day. Only 18.5% (weighted n = 6,298,481/3,396,973, unweighted n = 2898/18,000) of the study participants consumed less the 2000 mg sodium per day. Female gender (P < 0.001), older age (P < 0.001), total energy intake ≥50 percentile (P < 0.005), and obesity (P < 0.001) were associated with high sodium intake, even after adjusting for potential confounders. Senior high school/college graduation in education and managers/professionals in occupation were associated with lower sodium intake (P < 0.001). According to hypertension management status, those who had hypertension without medication consumed more sodium than those who were normotensive. However, those who receiving treatment for hypertension consumed less sodium than those who were normotensive (P < 0.001). The number of family members, household income, and alcohol drinking did not affect 24-hour urinary sodium excretion. The logistic regression analysis for the highest estimated 24-hour urinary sodium excretion quartile (>6033 mg/day) using the abovementioned variables

  4. 24 Hours to Save the NHS - The Chief Executive's Account of Reform 2000 to 2006 Crisp Nigel 24 Hours to Save the NHS - The Chief Executive's Account of Reform 2000 to 2006 248pp Oxford University Press 9780199639953 0199639957 [Formula: see text].

    PubMed

    2012-02-22

    The title of this book comes from Tony Blair's political slogan on the eve of the 1997 election when he told voters they had '24 hours to save the NHS' by voting for a Labour government. The new millennium, however, still found the NHS in decline.

  5. Development and validity of a 3-day smartphone assisted 24-hour recall to assess beverage consumption in a Chinese population: a randomized cross-over study.

    PubMed

    Smith, Lindsey P; Hua, Jenna; Seto, Edmund; Du, Shufa; Zang, Jiajie; Zou, Shurong; Popkin, Barry M; Mendez, Michelle A

    2014-01-01

    This paper addresses the need for diet assessment methods that capture the rapidly changing beverage consumption patterns in China. The objective of this study was to develop a 3-day smartphone-assisted 24-hour recall to improve the quantification of beverage intake amongst young Chinese adults (n=110) and validate, in a small subset (n=34), the extent to which the written record and smartphone-assisted recalls adequately estimated total fluid intake, using 24-hour urine samples. The smartphone-assisted method showed improved validity compared with the written record-assisted method, when comparing reported total fluid intake to total urine volume. However, participants reported consuming fewer beverages on the smartphone-assisted method compared with the written record-assisted method, primarily due to decreased consumption of traditional zero-energy beverages (i.e. water, tea) in the smartphone-assisted method. It is unclear why participants reported fewer beverages in the smartphone-assisted method than the written record -assisted method. One possibility is that participants found the smartphone method too cumbersome, and responded by decreasing beverage intake. These results suggest that smartphone-assisted 24-hour recalls perform comparably but do not appear to substantially improve beverage quantification compared with the current written record-based approach. In addition, we piloted a beverage screener to identify consumers of episodically consumed SSBs. As expected, a substantially higher proportion of consumers reported consuming SSBs on the beverage screener compared with either recall type, suggesting that a beverage screener may be useful in characterizing consumption of episodically consumed beverages in China's dynamic food and beverage landscape.

  6. Differences in the Slope of the QT-RR Relation Based on 24-Hour Holter ECG Recordings between Cardioembolic and Atherosclerotic Stroke

    PubMed Central

    Fujiki, Akira; Sakabe, Masao

    2016-01-01

    Objective Detecting paroxysmal atrial fibrillation in patients with ischemic stroke presenting in sinus rhythm is difficult because such episodes are often short, and they are also frequently asymptomatic. It is possible that the ventricular repolarization dynamics may reflect atrial vulnerability and cardioembolic stroke. Hence, we compared the QT-RR relation between cardioembolic stroke and atherosclerotic stroke during sinus rhythm. Methods The subjects comprised 62 consecutive ischemic stroke patients including 31 with cardioembolic strokes (71.8±12.7 years, 17 men) and 31 with atherosclerotic strokes (74.8±10.8 years, 23 men). The QT and RR intervals were measured from ECG waves based on a 15-sec averaged ECG during 24-hour Holter recording using an automatic QT analyzing system. The QT interval dependence on the RR interval was analyzed using a linear regression line for each subject ([QT]=A[RR]+B; where A is the slope and B is the y-intercept). Results The mean slope of the QT-RR relation was significantly greater in cardioembolic stroke than in atherosclerotic stroke (0.187±0.044 vs. 0.142±0.045, p<0.001). The mean QT, RR, or QTc during 24-hour Holter recordings did not differ between them. An increased slope (≥0.14) of the QT-RR regression line could predict cardioembolic stroke with 97% sensitivity, 55% specificity and a positive predictive value of 64%. Conclusion The increased slope of the QT-RR linear regression line based on 24-hour Holter ECG in patients with ischemic stroke presenting in sinus rhythm may therefore be a simple and useful marker for cardioembolic stroke. PMID:27746427

  7. Prognostic indices among hypertensive heart failure patients in Nigeria: the roles of 24-hour Holter electrocardiography and 6-minute walk test

    PubMed Central

    Mene-Afejuku, Tuoyo O; Balogun, Michael O; Akintomide, Anthony O; Adebayo, Rasaaq A

    2017-01-01

    Background Hypertensive heart failure (HHF) is associated with a poor prognosis. There is paucity of data in Nigeria on prognosis among HHF patients elucidating the role of 24-hour Holter electrocardiogram (ECG) in concert with other risk factors. Objective The aim of this study was to determine the prognostic utility of 24-hour Holter ECG, the 6-minute walk test (6-MWT), echocardiography, clinical and laboratory parameters among HHF patients. Methods A total of 113 HHF patients were recruited and followed up for 6 months. Thirteen of these patients were lost to follow-up, and as a result only 100 HHF patients were analyzed. All the patients underwent baseline laboratory tests, echocardiography, 24-hour Holter ECG and the 6-MWT. HHF patients were analyzed as “mortality vs alive” and as “events vs no-events” based on the outcome at the end of 6 months. Events was defined as HHF patients who were rehospitalized for heart failure (HF), had prolonged hospital stay or died. No-events group was defined as HHF patients who did not meet the criteria for the events group. Results HHF patients in the mortality group (n = 7) had significantly higher serum urea (5.71 ± 2.07 mmol/L vs 3.93 ± 1.45 mmol/L, p = 0.003) than that in those alive. After logistic regression, high serum urea conferred increased mortality risk (p = 0.035). Significant premature ventricular complexes (PVCs) on 24-hour Holter ECG following logistic regression were also significantly higher (p = 0.015) in the mortality group than in the “alive” group (n = 93) at the end of the 6-month follow-up period. The 6-minute walk distance (6-MWD) was least among the HHF patients who died (167.26 m ± 85.24 m). However, following logistic regression, the 6-MWT was not significant (p = 0.777) for predicting adverse outcomes among HHF patients. Patients in the events group (n = 41) had significantly higher New York Heart Association (NYHA) class (p = 0.001), Holter-detected ventricular tachycardia (VT; p

  8. Correlation of random urine protein creatinine (P-C) ratio with 24-hour urine protein and P-C ratio, based on physical activity: a pilot study.

    PubMed

    Sadjadi, Seyed-Ali; Jaipaul, Navin

    2010-09-07

    Quantification of proteinuria is usually predicated upon 24-hour urine collection. Multiple factors influence urine collection and the rate of protein and creatinine excretion. Urine collection is often incomplete, and therefore creatinine and protein excretion rates are underestimated. A random urine protein-creatinine (P-C) ratio has been shown over the years to be a reliable alternative to the 24-hour collection for detection and follow up of proteinuria. However, urine protein excretion may be influenced by physical activity. We studied 48 patients with proteinuria and varying levels of physical activity to determine the correlation between the measures of urine protein excretion. The correlation coefficient (r) between 24-hour urine total protein and random urine P-C ratio was 0.75 (P < 0.01) in the overall study population, but varied according to the level of proteinuria and physical activity in a stratified analysis: r = 0.99 (P < 0.001) and r = 0.95 (P < 0.01) in bedridden patients; r = 0.44 (P = not significant [NS]) and r = 0.54 (P = NS) in semiactive patients; and r = 0.44 (P = NS) and r = 0.58 (P < 0.05) in active patients with nephrotic- (>3500 mg/day) and non-nephrotic (<3500 mg/day) range proteinuria, respectively. The correlation appeared to be stronger between random urine and 24-hour urine P-C ratio for the overall study population (r = 0.84; P < 0.001), and when stratified according to the level of proteinuria and physical activity: r = 0.99 (P < 0.001) and r = 0.92 (P < 0.01) in bedridden patients; r = 0.61 (P = NS) and r = 0.54 (P = NS) in semiactive patients; and r = 0.64 (P < 0.02) and r = 0.52 (P < 0.05) in active patients with nephrotic and non-nephrotic range proteinuria, respectively. We conclude that the random urine P-C ratio is a reliable and practical way of estimating and following proteinuria, but its precision and accuracy may be affected by the level of patient physical activity.

  9. Variability of Urinary Concentrations of Polycyclic Aromatic Hydrocarbon Metabolite in General Population and Comparison of Spot, First-Morning, and 24-Hour Void Sampling

    PubMed Central

    Li, Zheng; Romanoff, Lovisa C.; Lewin, Michael D; Porter, Erin N; Trinidad, Debra A; Needham, Larry L; Patterson, Donald G; Sjödin, Andreas

    2015-01-01

    Urinary hydroxy polycyclic aromatic hydrocarbons (OH-PAHs) are commonly used in biomonitoring to assess exposure to polycyclic aromatic hydrocarbons (PAHs). Similar to other biologically non-persistent chemicals, OH-PAHs have relatively short biological half-lives (4.4–35 hours). Little information is available on their variability in urinary concentrations over time in non- occupationally exposed subjects. This study was designed to (i) study the variability of 9 urinary OH-PAH metabolite concentrations over time and (ii) calculate sample size requirements for future epidemiological studies based on spot urine, first morning void and 24-hour void sampling. Individual urine samples (n = 427) were collected during one week from 8 non-occupationally exposed adults. We recorded the time and volume of each urine excretion, dietary details, and the driving activities of the participants. Within subjects, the coefficients of variation (CV) for the wet-weight concentration of OH-PAHs in all samples ranged from 45% to 297%; creatinine adjustment reduced the CV to 19–288% (p < 0.001; paired t-test). The simulated 24-hour void concentrations were the least variable measure, with CVs ranging 13–182% for the 9 OH-PAHs. Within-day variability contributed on average 84%, and between-day variability accounted for 16% of the total variance of 1-hydroxypyrene (1-PYR). Intraclass correlation coefficients (ICC) of 1-PYR levels were 0.55 for spot urine samples, 0.60 for first-morning voids, and 0.76 for 24-hour voids, indicating a high degree of correlation between urine measurements collected from the same subject over time. Sample size calculations were performed to estimate the number of subjects needed for detecting differences in geometric mean at a statistical power of 80% for spot urine, first-morning, and 24-hour void sampling. These data will aid in the design of future studies of PAHs and possibly other biologically non-persistent chemicals and the interpretation of

  10. Low adherence to exclusive breastfeeding in Eastern Uganda: A community-based cross-sectional study comparing dietary recall since birth with 24-hour recall

    PubMed Central

    Engebretsen, Ingunn Marie S; Wamani, Henry; Karamagi, Charles; Semiyaga, Nulu; Tumwine, James; Tylleskär, Thorkild

    2007-01-01

    Background Exclusive breastfeeding is recommended as the best feeding alternative for infants up to six months and has a protective effect against mortality and morbidity. It also seems to lower HIV-1 transmission compared to mixed feeding. We studied infant feeding practices comparing dietary recall since birth with 24-hour dietary recall. Methods A cross-sectional survey on infant feeding practices was performed in Mbale District, Eastern Uganda in 2003 and 727 mother-infant (0–11 months) pairs were analysed. Four feeding categories were made based on WHO's definitions: 1) exclusive breastfeeding, 2) predominant breastfeeding, 3) complementary feeding and 4) replacement feeding. We analyzed when the infant fell into another feeding category for the first time. This was based on the recall since birth. Life-table analysis was made for the different feeding categories and Cox regression analysis was done to control for potential associated factors with the different practices. Prelacteal feeding practices were also addressed. Results Breastfeeding was practiced by 99% of the mothers. Dietary recall since birth showed that 7% and 0% practiced exclusive breastfeeding by 3 and 6 months, respectively, while 30% and 3% practiced predominant breastfeeding and had not started complementary feeding at the same points in time. The difference between the 24-hour recall and the recall since birth for the introduction of complementary feeds was 46 percentage points at two months and 59 percentage points at four months. Prelacteal feeding was given to 57% of the children. High education and formal marriage were protective factors against prelacteal feeding (adjusted OR 0.5, 0.2 – 1.0 and 0.5, 0.3 – 0.8, respectively). Conclusion Even if breastfeeding is practiced at a very high rate, the use of prelacteal feeding and early introduction of other food items is the norm. The 24-hour recall gives a higher estimate of exclusive breastfeeding and predominant breastfeeding than

  11. What is a Systolic Algorithm?

    NASA Astrophysics Data System (ADS)

    Rao, Sailesh K.; Kollath, T.

    1986-07-01

    In this paper, we show that every systolic array executes a Regular Iterative Algorithm with a strongly separating hyperplane and conversely, that every such algorithm can be implemented on a systolic array. This characterization provides us with an unified framework for describing the contributions of other authors. It also exposes the relevance of many fundamental concepts that were introduced in the sixties by Hennie, Waite and Karp, Miller and Winograd, to the present day concern of systolic array

  12. Ambulatory Blood Pressure Monitoring Phenotypes among Individuals With and Without Diabetes Taking Antihypertensive Medication: The Jackson Heart Study

    PubMed Central

    Bromfield, Samantha G.; Shimbo, Daichi; Bertoni, Alain G.; Sims, Mario; Carson, April P.; Muntner, Paul

    2017-01-01

    Ambulatory blood pressure monitoring (ABPM) can detect phenotypes associated with increased cardiovascular disease (CVD) risk. Diabetes is associated with increased CVD risk but few data are available documenting whether blood pressure (BP) phenotypes, detected by ABPM, differ between individuals with versus without diabetes. We conducted a cross-sectional analysis of 567 participants in the Jackson Heart Study, a population-based study of African Americans, taking antihypertensive medication to evaluate the association between diabetes and ABPM phenotypes. Two clinic BP measurements were taken at baseline following a standardized protocol. ABPM was performed for 24 hours following the clinic visit. ABPM phenotypes included daytime, sustained, nocturnal, and isolated nocturnal hypertension, a non-dipping BP pattern, and white coat, masked, and masked isolated nocturnal hypertension. Diabetes was defined as fasting glucose ≥126 mg/dL, hemoglobin A1c ≥6.5% (48 mmol/mol), or use of insulin or oral hypoglycemic medications. Of the included participants (mean age 62.3 years, 71.8% female), 196 (34.6%) had diabetes. After multivariable adjustment, participants with diabetes were more likely to have daytime hypertension (prevalence ratio [PR]: 1.32; 95% CI: 1.09–1.60), masked hypertension (PR: 1.46; 95% CI: 1.11–1.93), and masked isolated nocturnal hypertension (PR: 1.39; 95% CI: 1.02–1.89). Although nocturnal hypertension was more common among participants with versus without diabetes, this association was not present after adjustment for daytime systolic BP. Diabetes was not associated with the other ABPM phenotypes investigated. This study highlights the high prevalence of ABPM phenotypes among individuals with diabetes taking antihypertensive medication. PMID:27169827

  13. Treatment of burns in the first 24 hours: simple and practical guide by answering 10 questions in a step-by-step form

    PubMed Central

    2012-01-01

    Residents in training, medical students and other staff in surgical sector, emergency room (ER) and intensive care unit (ICU) or Burn Unit face a multitude of questions regarding burn care. Treatment of burns is not always straightforward. Furthermore, National and International guidelines differ from one region to another. On one hand, it is important to understand pathophysiology, classification of burns, surgical treatment, and the latest updates in burn science. On the other hand, the clinical situation for treating these cases needs clear guidelines to cover every single aspect during the treatment procedure. Thus, 10 questions have been organised and discussed in a step-by-step form in order to achieve the excellence of education and the optimal treatment of burn injuries in the first 24 hours. These 10 questions will clearly discuss referral criteria to the burn unit, primary and secondary survey, estimation of the total burned surface area (%TBSA) and the degree of burns as well as resuscitation process, routine interventions, laboratory tests, indications of Bronchoscopy and special considerations for Inhalation trauma, immediate consultations and referrals, emergency surgery and admission orders. Understanding and answering the 10 questions will not only cover the management process of Burns during the first 24 hours but also seems to be an interactive clear guide for education purpose. PMID:22583548

  14. Sodium and potassium intake in South Africa: an evaluation of 24-hour urine collections in a white, black, and Indian population.

    PubMed

    Swanepoel, Bianca; Schutte, Aletta E; Cockeran, Marike; Steyn, Krisela; Wentzel-Viljoen, Edelweiss

    2016-11-01

    Limited number of studies on salt intake has been conducted in the South Africa. The present study established the sodium and potassium excretion (24-hour urine collection) of three different South African populations. In total, 692 successful 24-hour urine collections were analyzed for sodium, potassium, and iodine levels. The median sodium and potassium excretion was 122.9 and 33.5 mmol/d, respectively, and the median salt intake was 7.2 g/d. The majority (92.8%) of the population did not meet the recommended potassium intake/d, and 65.6% consumed more than 6 g of salt/d. Potassium excretion showed a linear relationship with salt intake (P-trend ≤ .001). The median sodium-to-potassium ratio was 3.5. These findings support the South African government's sodium reduction legislation, as well as global initiatives. More consideration should be given to promoting the intake of potassium-rich foods, as this may have a greater public health impact than focusing only on dietary sodium reduction.

  15. Treatment of burns in the first 24 hours: simple and practical guide by answering 10 questions in a step-by-step form.

    PubMed

    Alharbi, Ziyad; Piatkowski, Andrzej; Dembinski, Rolf; Reckort, Sven; Grieb, Gerrit; Kauczok, Jens; Pallua, Norbert

    2012-05-14

    Residents in training, medical students and other staff in surgical sector, emergency room (ER) and intensive care unit (ICU) or Burn Unit face a multitude of questions regarding burn care. Treatment of burns is not always straightforward. Furthermore, National and International guidelines differ from one region to another. On one hand, it is important to understand pathophysiology, classification of burns, surgical treatment, and the latest updates in burn science. On the other hand, the clinical situation for treating these cases needs clear guidelines to cover every single aspect during the treatment procedure. Thus, 10 questions have been organised and discussed in a step-by-step form in order to achieve the excellence of education and the optimal treatment of burn injuries in the first 24 hours. These 10 questions will clearly discuss referral criteria to the burn unit, primary and secondary survey, estimation of the total burned surface area (%TBSA) and the degree of burns as well as resuscitation process, routine interventions, laboratory tests, indications of Bronchoscopy and special considerations for Inhalation trauma, immediate consultations and referrals, emergency surgery and admission orders. Understanding and answering the 10 questions will not only cover the management process of Burns during the first 24 hours but also seems to be an interactive clear guide for education purpose.

  16. Comparison between two standardized cultural methods and 24 hour duplex SYBR green real-time PCR assay for Salmonella detectionin meat samples.

    PubMed

    Delibato, Elisabetta; Fiore, Alfonsina; Anniballi, Fabrizio; Auricchio, Bruna; Filetici, Emma; Orefice, Leucio; Losio, Marina Nadia; De Medici, Dario

    2011-07-01

    Food-borne diseases caused by Salmonella represent a worldwide public health problem. Salmonella must be absent in an established amount depending on the kind of the product and usually cultural methods have to be applied to evaluate the compliance of the products. ISO 6579:2002 in Europe and FSIS MLG 4.04.:2008 in the USA have usually been employed to detect Salmonella in meat, poultry and egg products. A Real Time PCR method using probes has recently been validated against the NMKL (Nordic Committee on Food Analysis) standard method. This method has been modified using the less expensive Sybr Green Real Time PCR approach and applied directly in the 18 hours preenrichment broth for the purpose of detecting Salmonella in meat products in less than 24 hours. The purpose of this study was to: - compare the effectiveness of ISO and FSIS cultural methods; - develop a new 24 hour duplex Sybr Green Real Time PCR-melting curve analysis; - evaluate the performance of Salmonella, Standard Method, Rapid Method, SYBR Green Real Time PCR. The equivalence between ISO and FSIS methods was demonstrated and the use of SYBR Green Real Time PCR as a screening tool for negative results seems appealing especially to evaluate compliance with the HACCP systems.

  17. A Case Report on Dyskinesia Following Rivastigmine Patch 13.3 mg/24 hours for Alzheimer's Disease: Perspective in the Movement Disorders Spectrum Following Use of Cholinesterase Inhibitors.

    PubMed

    Diaz, Maria Cristina B; Rosales, Raymond L

    2015-08-01

    Current reports on movement disorder adverse effects of acetylcholinesterase inhibitors only include extrapyramidal symptoms and myoclonus.Here is a case of an 81-year-old female Filipino with dementia who presented with first-onset generalized choreiform movements.The etiology of the clinical finding of dyskinesia was investigated through laboratories, neuroimaging, and electroencephalogram, all of which yielded negative results. Review of her medications included the rivastigmine (Exelon) patch, which had just been increased to 13.3 mg/24-hour-dose 3 months prior. With all other possible causes excluded, a trial discontinuation of rivastigmine, showed decreased frequency of the dyskinesia 48 hours after, with complete resolution after 6 days, and no recurrence since then.This case thus presents a probable association or causality between the choreiform movement and rivastigmine at 13.3 mg/24-hour-dose patch because of clear temporal proximity, lack of alternative explanations, and a reversal of the dyskinesia upon medicament discontinuation.

  18. Effect of current and lifetime posttraumatic stress disorder on 24-hour urinary catecholamines and cortisol: results from the Mind Your Heart Study

    PubMed Central

    Wingenfeld, Katja; Whooley, Mary A.; Neylan, Thomas C.; Otte, Christian; Cohen, Beth E.

    2014-01-01

    Summary Posttraumatic stress disorder (PTSD) is associated with an increased risk of cardiovascular disease and several other chronic illnesses. Alterations in the sympathetic nervous system (SNS) and the hypothalamic-pituitary-adrenal (HPA) axis in PTSD might contribute to these associations but findings regarding SNS and HPA activity in PTSD are heterogeneous. We measured 24-hour urinary catecholamines and cortisol in a large cohort of adult outpatients recruited from 2 Veterans Affairs medical centers. 24-hour urinary norepinephrine, epinephrine, dopamine and cortisol were measured by tandem mass spectrometry. Lifetime and current PTSD were assessed with the Clinician Administered PTSD Scale using DSM-IV-TR criteria. Out of 613 participants, 199 (32.5%) had current PTSD, 100 (16.3%) had lifetime but not current PTSD, and 314 (51.2%) never had PTSD. Patients with current PTSD had significantly higher norepinephrine secretion compared to those without PTSD. Patients in the lifetime PTSD group exhibited lower cortisol values compared to those without PTSD. Participants who never had PTSD showed the lowest norepinephrine and the highest cortisol values. All results remained stable when controlling for potentially confounding variables. This study provides evidence for increased norepinephrine secretion and decreased cortisol in PTSD. Future longitudinal studies are needed to determine whether these changes contribute to adverse health outcomes in patients with PTSD. PMID:25459895

  19. 24-hour urine copper test

    MedlinePlus

    ... associated with providing a urine sample. Alternative Names Quantitative urinary copper Images Copper urine test References McPherson ... for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis ...

  20. A systolic array parallelizing compiler

    SciTech Connect

    Tseng, P.S. )

    1990-01-01

    This book presents a completely new approach to the problem of systolic array parallelizing compiler. It describes the AL parallelizing compiler for the Warp systolic array, the first working systolic array parallelizing compiler which can generate efficient parallel code for complete LINPACK routines. This book begins by analyzing the architectural strength of the Warp systolic array. It proposes a model for mapping programs onto the machine and introduces the notion of data relations for optimizing the program mapping. Also presented are successful applications of the AL compiler in matrix computation and image processing. A complete listing of the source program and compiler-generated parallel code are given to clarify the overall picture of the compiler. The book concludes that systolic array parallelizing compiler can produce efficient parallel code, almost identical to what the user would have written by hand.

  1. Antiplatelet Effect Durability of a Novel, 24-Hour, Extended-Release Prescription Formulation of Acetylsalicylic Acid in Patients With Type 2 Diabetes Mellitus.

    PubMed

    Gurbel, Paul A; Bliden, Kevin P; Chaudhary, Rahul; Patrick, Jeff; Liu, Fang; Chen, Gailing; McLeod, Christopher; Tantry, Udaya S

    2016-12-15

    High platelet reactivity and high platelet turnover have been implicated in incomplete platelet inhibition during immediate-release acetylsalicylic acid therapy in patients with type 2 diabetes mellitus (DM). An extended-release acetylsalicylic acid (ER-ASA; Durlaza) formulation was developed to provide 24-hour antithrombotic effects with once-daily dosing. The objective of the study was to evaluate the antiplatelet effects of ER-ASA in patients with DM. In this open-label, single-center study, patients with DM (n = 40) and multiple cardiovascular risk factors received ER-ASA 162.5 mg/day for 14 ± 4 days. Multiple platelet function tests, serum and urinary thromboxane B2 metabolites, prostacyclin metabolite, and high-sensitive C-reactive protein levels were assessed at 1, 12, 16, and 24 hours post-dose. Patients with high platelet turnover and/or high platelet reactivity were treated with ER-ASA 325 mg/day for 14 ± 4 days, and laboratory analyses were repeated. All patients responded to ER-ASA 162.5 mg/day as measured by arachidonic acid-induced aggregation, and there was no loss of the platelet inhibitory effect of ER-ASA 162.5 mg/day over 24 hours post-dose (p = not significant). The antiplatelet effect was sustained over 24 hours for all platelet function measurements. Mean 1- to 24-hour serum thromboxane B2 levels were low with both doses and were lower with ER-ASA 325 mg/day compared with 162.5 mg/day therapy (p = 0.002). In conclusion, ER-ASA 162.5 mg daily dose provided sustained antiplatelet effects over 24 hours in patients with type 2 DM and multiple cardiovascular risk factors and had a favorable tolerability profile.

  2. Validity of a multipass, web-based, 24-hour self-administered recall for assessment of total energy intake in blacks and whites.

    PubMed

    Arab, Lenore; Tseng, Chi-Hong; Ang, Alfonso; Jardack, Patricia

    2011-12-01

    To date, Web-based 24-hour recalls have not been validated using objective biomarkers. From 2006 to 2009, the validity of 6 Web-based DietDay 24-hour recalls was tested among 115 black and 118 white healthy adults from Los Angeles, California, by using the doubly labeled water method, and the results were compared with the results of the Diet History Questionnaire, a food frequency questionnaire developed by the National Cancer Institute. The authors performed repeated measurements in a subset of 53 subjects approximately 6 months later to estimate the stability of the doubly labeled water measurement. The attenuation factors for the DietDay recall were 0.30 for blacks and 0.26 for whites. For the Diet History Questionnaire, the attenuation factors were 0.15 and 0.17 for blacks and whites, respectively. Adjusted correlations between true energy intake and the recalls were 0.50 and 0.47 for blacks and whites, respectively, for the DietDay recall. For the Diet History Questionnaire, they were 0.34 and 0.36 for blacks and whites, respectively. The rate of underreporting of more than 30% of calories was lower with the recalls than with the questionnaire (25% and 41% vs. 34% and 52% for blacks and whites, respectively). These findings suggest that Web-based DietDay dietary recalls offer an inexpensive and widely accessible dietary assessment alternative, the validity of which is equally strong among black and white adults. The validity of the Web-administered recall was superior to that of the paper food frequency questionnaire.

  3. Electronic Dietary Intake Assessment (e-DIA): Comparison of a Mobile Phone Digital Entry App for Dietary Data Collection With 24-Hour Dietary Recalls

    PubMed Central

    O'Connor, Sarah; Giannelli, Valentina; Yap, Megan LH; Tang, Lie Ming; Roy, Rajshri; Louie, Jimmy Chun Yu; Hebden, Lana; Kay, Judy; Allman-Farinelli, Margaret

    2015-01-01

    Background The electronic Dietary Intake Assessment (e-DIA), a digital entry food record mobile phone app, was developed to measure energy and nutrient intake prospectively. This can be used in monitoring population intakes or intervention studies in young adults. Objective The objective was to assess the relative validity of e-DIA as a dietary assessment tool for energy and nutrient intakes using the 24-hour dietary recall as a reference method. Methods University students aged 19 to 24 years recorded their food and drink intake on the e-DIA for five days consecutively and completed 24-hour dietary recalls on three random days during this 5-day study period. Mean differences in energy, macro-, and micronutrient intakes were evaluated between the methods using paired t tests or Wilcoxon signed-rank tests, and correlation coefficients were calculated on unadjusted, energy-adjusted, and deattenuated values. Bland-Altman plots and cross-classification into quartiles were used to assess agreement between the two methods. Results Eighty participants completed the study (38% male). No significant differences were found between the two methods for mean intakes of energy or nutrients. Deattenuated correlation coefficients ranged from 0.55 to 0.79 (mean 0.68). Bland-Altman plots showed wide limits of agreement between the methods but without obvious bias. Cross-classification into same or adjacent quartiles ranged from 75% to 93% (mean 85%). Conclusions The e-DIA shows potential as a dietary intake assessment tool at a group level with good ranking agreement for energy and all nutrients. PMID:26508282

  4. Correlation of Occupational Stress Index with 24-hour Urine Cortisol and Serum DHEA Sulfate among City Bus Drivers: A Cross-sectional Study

    PubMed Central

    Lin, Mia Chihya; Lu, Luo; Tai, John Jen

    2011-01-01

    Objectives The questionnaire of occupational stress index (OSI) has been popular in the workplace, and it has been tailored for bus drivers in Taiwan. Nevertheless, its outcomes for participants are based on self-evaluations, thus validation by their physiological stress biomarker is warranted and this is the main goal of this study. Methods A cross-sectional study of sixty-three city bus drivers and fifty-four supporting staffs for comparison was conducted. Questionnaire surveys, 24-hour urine cortisol testing, and blood draws for dehydroepiandrosterone-sulfate (DHEA-S) testing were performed. The measured concentrations of these biological measures were logarithmically transformed before the statistical analysis where various scores of stressor factors, moderators, and stress effects of each OSI domain were analyzed by applying multiple linear regression models. Results For drivers, the elevated 24-hour urine cortisol level was associated with a worker's relationship with their supervisor and any life change events in the most recent 3 months. The DHEA-S level was higher in drivers of younger age as well as drivers with more concerns relating to their salary and bonuses. Non-drivers showed no association between any stressor or satisfaction and urine cortisol and blood DHEA-S levels. Conclusion Measurements of biomarkers may offer additional stress evaluations with OSI questionnaires for bus drivers. Increased DHEA-S and cortisol levels may result from stressors like income security. Prevention efforts towards occupational stress and life events and health promotional efforts for aged driver were important anti-stress remedies. PMID:22953199

  5. ED 03-2 HOME BLOOD PRESSURE MONITORING IS BETTER THAN OFFICE BP AND AMBULATORY BP: UPDATE.

    PubMed

    Kario, Kazuomi

    2016-09-01

    cardiovascular events was revealed to be 144 mmHg, and approx. 125 mmHg was shown to be the minimum risk. There was no J-curve of morning systolic BP until around 100 mmHg. In a sub-analysis of the HONEST patient series with data separated for stroke and coronary events, the morning home BP values were a strong predictor of coronary events similarly to stroke events, but the predictive power of office systolic BP was weaker for coronary events than for stroke event (Kario, et al. J Am Coll Cardiol 2016;67:1519-1527). In addition, a J-curve was not observed in the relationship between morning home BP for coronary events or for stroke events.Nocturnal BP has traditionally been measured only by ABPM, and the clinical evidence of nocturnal hypertension is established based on the ABPM data. However, nocturnal BP can now be measured by HBPM as an alternative to ABPM. In our nationwide Japanese cohort, the Japan Morning Surge Home Blood Pressure (J-HOP) Study, we measured nocturnal BP by HBPM (Kario. J Clin Hypertens 2015;17:340-348). Morning home BP was the predictor of stroke event (Hoshide, Kario, et al. Hypertension 2016;68:54-61), while uncontrolled nocturnal hypertension was significantly associated with cardiovascular events. Since Asians show greater morning BP surges (Hoshide, Kario, Parati et al. Hypertension 2016;68:54-61), it is particularly important for Asians to achieve 'perfect 24-hr BP control,' i.e., the 24-hr BP level, nocturnal BP dipping, and BP variability including morning surge (Kario. Ann Glob Health 2016;82:254-273). We are developing the new ICT-based BP monitoring such as "IT-based home nocturnal BP monitoring" (Kario. Hypertens Res 2013;36:478-484) and "hypoxia-triggered home nocturnal BP monitoring (TNP)" (Kuwabara, Kario, et al. J Clin Hypertens 2016, in press) to clarify the clinical relevance of 24-hour BP control.A morning home BP-guided staged approach is the first step toward perfect 24-hr BP control, followed by the control of nocturnal

  6. Peripheral Augmentation Index is Associated With the Ambulatory Arterial Stiffness Index in Patients With Hypertension

    PubMed Central

    Heffernan, Kevin S.; Patvardhan, Eshan A.; Karas, Richard H.; Kuvin, Jeffrey T.

    2011-01-01

    Background Vascular dysfunction is highly prevalent if not ubiquitous in patients with hypertension. We compared two different measures of vascular function obtained from digital volume waveforms with measures of ventricular-vascular load derived from 24-hour blood pressure (BP) recordings in patients with hypertension. Methods Digital pulsatile volume waveforms were captured via plethysmography (peripheral arterial tone, PAT) and used to derive augmentation index (a measure of ventricular-vascular coupling) and the pulse wave amplitude-reactive hyperemia index (a measure of microvascular reactivity). Ambulatory arterial stiffness index (AASI) and the BP variability ratio (BPVR) were derived from 24-hour ambulatory BP recordings. Results There was a positive association between PAT-AIx and AASI (r = 0.52, P < 0.05). There was also a positive association between PAT-AIx and BPVR (r = 0.37, P < 0.05). PAT-AIx was not associated with PWA-RHI (r = -0.14, P > 0.05). PWA-RHI was not associated with AASI or BPVR (P > 0.05). Conclusions PAT-AIx is associated with ambulatory measures of vascular function and may offer clinical insight into vascular burden and cardiovascular disease risk in patients with hypertension independent of information obtained from PWA-RHI.

  7. Dynamically Reconfigurable Systolic Array Accelorators

    NASA Technical Reports Server (NTRS)

    Dasu, Aravind (Inventor); Barnes, Robert C. (Inventor)

    2014-01-01

    A polymorphic systolic array framework that works in conjunction with an embedded microprocessor on an FPGA, that allows for dynamic and complimentary scaling of acceleration levels of two algorithms active concurrently on the FPGA. Use is made of systolic arrays and hardware-software co-design to obtain an efficient multi-application acceleration system. The flexible and simple framework allows hosting of a broader range of algorithms and extendable to more complex applications in the area of aerospace embedded systems.

  8. A Pre-Screening Questionnaire to Predict Non-24-Hour Sleep-Wake Rhythm Disorder (N24HSWD) among the Blind

    PubMed Central

    Flynn-Evans, Erin E.; Lockley, Steven W.

    2016-01-01

    Study Objectives: There is currently no questionnaire-based pre-screening tool available to detect non-24-hour sleep-wake rhythm disorder (N24HSWD) among blind patients. Our goal was to develop such a tool, derived from gold standard, objective hormonal measures of circadian entrainment status, for the detection of N24HSWD among those with visual impairment. Methods: We evaluated the contribution of 40 variables in their ability to predict N24HSWD among 127 blind women, classified using urinary 6-sulfatoxymelatonin period, an objective marker of circadian entrainment status in this population. We subjected the 40 candidate predictors to 1,000 bootstrapped iterations of a logistic regression forward selection model to predict N24HSWD, with model inclusion set at the p < 0.05 level. We removed any predictors that were not selected at least 1% of the time in the 1,000 bootstrapped models and applied a second round of 1,000 bootstrapped logistic regression forward selection models to the remaining 23 candidate predictors. We included all questions that were selected at least 10% of the time in the final model. We subjected the selected predictors to a final logistic regression model to predict N24SWD over 1,000 bootstrapped models to calculate the concordance statistic and adjusted optimism of the final model. We used this information to generate a predictive model and determined the sensitivity and specificity of the model. Finally, we applied the model to a cohort of 1,262 blind women who completed the survey, but did not collect urine samples. Results: The final model consisted of eight questions. The concordance statistic, adjusted for bootstrapping, was 0.85. The positive predictive value was 88%, the negative predictive value was 79%. Applying this model to our larger dataset of women, we found that 61% of those without light perception, and 27% with some degree of light perception, would be referred for further screening for N24HSWD. Conclusions: Our model has

  9. Metabolic Engineering of Light and Dark Biochemical Pathways in Wild-Type and Mutant Strains of Synechocystis PCC 6803 for Maximal, 24-Hour Production of Hydrogen Gas

    SciTech Connect

    Ely, Roger L.; Chaplen, Frank W.R.

    2014-03-11

    This project used the cyanobacterial species Synechocystis PCC 6803 to pursue two lines of inquiry, with each line addressing one of the two main factors affecting hydrogen (H2) production in Synechocystis PCC 6803: NADPH availability and O2 sensitivity. H2 production in Synechocystis PCC 6803 requires a very high NADPH:NADP+ ratio, that is, the NADP pool must be highly reduced, which can be problematic because several metabolic pathways potentially can act to raise or lower NADPH levels. Also, though the [NiFe]-hydrogenase in PCC 6803 is constitutively expressed, it is reversibly inactivated at very low O2 concentrations. Largely because of this O2 sensitivity and the requirement for high NADPH levels, a major portion of overall H2 production occurs under anoxic conditions in the dark, supported by breakdown of glycogen or other organic substrates accumulated during photosynthesis. Also, other factors, such as N or S limitation, pH changes, presence of other substances, or deletion of particular respiratory components, can affect light or dark H2 production. Therefore, in the first line of inquiry, under a number of culture conditions with wild type (WT) Synechocystis PCC 6803 cells and a mutant with impaired type I NADPH-dehydrogenase (NDH-1) function, we used H2 production profiling and metabolic flux analysis, with and without specific inhibitors, to examine systematically the pathways involved in light and dark H2 production. Results from this work provided rational bases for metabolic engineering to maximize photobiological H2 production on a 24-hour basis. In the second line of inquiry, we used site-directed mutagenesis to create mutants with hydrogenase enzymes exhibiting greater O2 tolerance. The research addressed the following four tasks: 1. Evaluate the effects of various culture conditions (N, S, or P limitation; light/dark; pH; exogenous organic carbon) on H2 production profiles of WT cells and an NDH-1 mutant; 2. Conduct metabolic flux analyses for

  10. Ambulatory Feedback System

    NASA Technical Reports Server (NTRS)

    Finger, Herbert; Weeks, Bill

    1985-01-01

    This presentation discusses instrumentation that will be used for a specific event, which we hope will carry on to future events within the Space Shuttle program. The experiment is the Autogenic Feedback Training Experiment (AFTE) scheduled for Spacelab 3, currently scheduled to be launched in November, 1984. The objectives of the AFTE are to determine the effectiveness of autogenic feedback in preventing or reducing space adaptation syndrome (SAS), to monitor and record in-flight data from the crew, to determine if prediction criteria for SAS can be established, and, finally, to develop an ambulatory instrument package to mount the crew throughout the mission. The purpose of the Ambulatory Feedback System (AFS) is to record the responses of the subject during a provocative event in space and provide a real-time feedback display to reinforce the training.

  11. Bias and variability in blood pressure measurement with ambulatory recorders.

    PubMed

    Pannarale, G; Bebb, G; Clark, S; Sullivan, A; Foster, C; Coats, A J

    1993-10-01

    This study sought to determine whether patient characteristics such as age, sex, blood pressure, and pulse pressure differently affect the accuracy of an oscillometric (SpaceLabs 90207) and a microphonic (TM2420 version 7) blood pressure monitor. Blood pressure recorded by two oscillometric and two microphonic ambulatory monitors was compared with simultaneous readings by two pairs of trained, blinded observers using random-zero sphygmomanometry. One hundred and eighteen subjects (53 men and 65 women, aged 17 to 94 years; systolic pressure, 89 to 211 mm Hg; diastolic, 44 to 116 mm Hg) were studied. There were no significant differences within each observer pair or between the two observer pairs as well as no correlation between interobserver differences and patient characteristics. The differences between the monitor and trained observers' readings were 2.8 +/- 9.9 mm Hg systolic and 3.9 +/- 6.8 mm Hg diastolic for the SpaceLabs and 5.0 +/- 5.2 mm Hg systolic and 3.4 +/- 6.1 mm Hg diastolic for the TM2420. Patient characteristics that predicted measurement error were defined by multiple regression. For oscillometry, systolic measurement error was highly correlated with systolic pressure, pulse pressure, and subject age. The diastolic error was significantly correlated with pulse pressure, diastolic pressure, and subject sex. For the oscillometric monitor, patient characteristics accounted for 36.6% of the variation of the systolic error and 34.7% of the variation of the diastolic error. For the microphonic monitor, only age correlated with diastolic error, and no significant correlations were seen with systolic error. Patient characteristics accounted for only 1.2% of the systolic and 8.9% of the diastolic error.(ABSTRACT TRUNCATED AT 250 WORDS)

  12. Office and ambulatory blood pressure are independently associated with albuminuria in older subjects with type 2 diabetes.

    PubMed

    Moran, Andrew; Palmas, Walter; Pickering, Thomas G; Schwartz, Joseph E; Field, Lesley; Weinstock, Ruth S; Shea, Steven

    2006-05-01

    Blood pressure strongly predicts microalbuminuria and later progression to renal failure in people with diabetes. Ambulatory blood pressure monitoring seems to be superior to office blood pressure in predicting progression to microalbuminuria in type 1 diabetes. The associations of ambulatory blood pressure with office blood pressure and microalbuminuria in type 2 diabetes remain unclear. We studied the association of office blood pressure taken with an automated device and ambulatory blood pressure with spot urine albumin:creatinine ratio in 1180 older people with type 2 diabetes participating in the Informatics for Diabetes Education and Telemedicine Study. Office and awake systolic blood pressure were independently associated with albuminuria (P<0.001 for both) in a multivariate linear regression analysis that adjusted for age, gender, duration of diabetes, hemoglobin A1c, number of antihypertensive medications, and use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Twelve percent of participants had well-controlled office blood pressure but not ambulatory blood pressure, whereas 14% had well-controlled ambulatory but not office blood pressure. The prevalence of microalbuminuria and macroalbuminuria in these subgroups was intermediate between those with well-controlled or uncontrolled blood pressure by both methods. We found, in a multiethnic group of older subjects with type 2 diabetes, that office systolic blood pressure and awake systolic ambulatory blood pressure exhibited independent associations with degree of albuminuria.

  13. EXTRAPOLATION TECHNIQUES EVALUATING 24 HOURS OF AVERAGE ELECTROMAGNETIC FIELD EMITTED BY RADIO BASE STATION INSTALLATIONS: SPECTRUM ANALYZER MEASUREMENTS OF LTE AND UMTS SIGNALS.

    PubMed

    Mossetti, Stefano; de Bartolo, Daniela; Veronese, Ivan; Cantone, Marie Claire; Cosenza, Cristina; Nava, Elisa

    2016-12-01

    International and national organizations have formulated guidelines establishing limits for occupational and residential electromagnetic field (EMF) exposure at high-frequency fields. Italian legislation fixed 20 V/m as a limit for public protection from exposure to EMFs in the frequency range 0.1 MHz-3 GHz and 6 V/m as a reference level. Recently, the law was changed and the reference level must now be evaluated as the 24-hour average value, instead of the previous highest 6 minutes in a day. The law refers to a technical guide (CEI 211-7/E published in 2013) for the extrapolation techniques that public authorities have to use when assessing exposure for compliance with limits. In this work, we present measurements carried out with a vectorial spectrum analyzer to identify technical critical aspects in these extrapolation techniques, when applied to UMTS and LTE signals. We focused also on finding a good balance between statistically significant values and logistic managements in control activity, as the signal trend in situ is not known. Measurements were repeated several times over several months and for different mobile companies. The outcome presented in this article allowed us to evaluate the reliability of the extrapolation results obtained and to have a starting point for defining operating procedures.

  14. Control of bleeding by silk ligation and diathermy coagulation during tonsillectomy: A comparison of efficacy of the two techniques in the first 24 hours after surgery

    PubMed Central

    Anwar, Khurshid; Ahmad, Rafiq; Khan, Muneeb

    2015-01-01

    Objective: To assess and compare the relative efficacy of silk ligation and diathermy coagulation techniques in controlling bleeding during tonsillectomy in the first 24 hours. Methods: This prospective study was conducted at the Department of ENT, Khalifa Gul Nawaz Teaching Hospital, Bannu and this department related consultants’ private clinics from January 1, 2012 to December 31, 2014. The study included 180 cases. All patients included were having history of recurrent, acute tonsillitis, with more than 6–7 episodes in one year, five episodes per year for two years, or three episodes per year for three years. All the surgeries were performed by dissection method. Haemostasis during the procedure was secured by either ligation with silk 1 or using diathermy. The results were analyzed using SPSS 16.0 for windows. Results: A total of180 cases were included in the study. The ages of the patients ranged from 5 to 40 years with the mean age of 15.56 years and a std.deviation of +/- 8.24. The male to female ratio was 1.25:1. The number of hemorrhages occurring was greater in the ‘diathermy coagulation’ group as compared to the ‘silk ligation’ group. However, the observed difference was statistically insignificant (p >.05). Conclusion: Primary haemorrhage occurring during tonsillectomy is a serious threat and control of bleeding during the procedure should therefore be meticulous. Both suture ligation and coagulation diathermy for control of bleeders during the procedure by dissection method are equally effective. PMID:26430438

  15. Computer simulation of the effect of dDAVP with saline loading on fluid balance after 24-hour head-down tilt

    NASA Technical Reports Server (NTRS)

    Srinivasan, R. S.; Simanonok, K. E.; Charles, J. B.

    1994-01-01

    Fluid loading (FL) before Shuttle reentry is a countermeasure currently in use by NASA to improve the orthostatic tolerance of astronauts during reentry and postflight. The fluid load consists of water and salt tablets equivalent to 32 oz (946 ml) of isotonic saline. However, the effectiveness of this countermeasure has been observed to decrease with the duration of spaceflight. The countermeasure's effectiveness may be improved by enhancing fluid retention using analogs of vasopressin such as lypressin (LVP) and desmopressin (dDAVP). In a computer simulation study reported previously, we attempted to assess the improvement in fluid retention obtained by the use of LVP administered before FL. The present study is concerned with the use of dDAVP. In a recent 24-hour, 6 degree head-down tilt (HDT) study involving seven men, dDAVP was found to improve orthostatic tolerance as assessed by both lower body negative pressure (LBNP) and stand tests. The treatment restored Luft's cumulative stress index (cumulative product of magnitude and duration of LBNP) to nearly pre-bedrest level. The heart rate was lower and stroke volume was marginally higher at the same LBNP levels with administration of dDAVP compared to placebo. Lower heart rates were also observed with dDAVP during stand test, despite the lower level of cardiovascular stress. These improvements were seen with only a small but significant increase in plasma volume of approximately 3 percent. This paper presents a computer simulation analysis of some of the results of this HDT study.

  16. Canadian 24-Hour Movement Guidelines for Children and Youth: Exploring the perceptions of stakeholders regarding their acceptability, barriers to uptake, and dissemination.

    PubMed

    Faulkner, Guy; White, Lauren; Riazi, Negin; Latimer-Cheung, Amy E; Tremblay, Mark S

    2016-06-01

    Engaging stakeholders in the development of guidelines and plans for implementation is vital. The purpose of this study was to examine stakeholders' (parents, teachers, exercise professionals, paediatricians, and youth) perceptions of the Canadian 24-Hour Movement Behaviour Guidelines for Children and Youth ("Movement Guidelines"). Stakeholders (n = 104) engaged in semi-structured focus groups or interviews to discuss the perceived acceptability of the guidelines, potential barriers to implementation, and preferred methods and messengers of dissemination. A thematic analysis was conducted. Overall, there was consistent support across all stakeholder groups, with the exception of youth participants, for the Movement Guidelines. Stakeholders identified a range of barriers to the uptake of the guidelines including concerns with accurately defining key terms such as "recreational" screen time; everyday challenges such as financial and time constraints; and the possibility of the Movement Guidelines becoming just another source of stress and guilt for already busy and overwhelmed parents. Participants identified a range of recommended methods and messengers for future dissemination. School and medical settings were the most commonly recommended settings through which dissemination efforts should be delivered. Overall, participants representing a range of stakeholder groups were receptive to the new Movement Guidelines and endorsed their value. In complementing the Movement Guidelines, messaging and resources will need to be developed that address common concerns participants had regarding their dissemination and implementation.

  17. Donor-reactive CD8 Memory T Cells Infiltrate Cardiac Allografts Within 24 Hours Post-Transplant in Naïve Recipients

    PubMed Central

    Schenk, A.D.; Nozaki, T.; Rabant, M.; Valujskikh, A.; Fairchild, R.L.

    2008-01-01

    Normal immune responses stimulated by pathogenic and environmental antigens generate memory T cells that react with donor antigens and no currently used immunosuppressive drug completely inhibits memory T cell function. While donor-reactive memory T cells clearly compromise graft outcomes, mechanisms utilized by memory T cells to promote rejection are largely unknown. In the current study we investigated how early endogenous memory cells infiltrate and express effector function in cardiac allografts. Endogenous CD8 memory T cells in non-sensitized recipients distinguish syngeneic vs. allogeneic cardiac allografts within 24 hours of reperfusion. CD8-dependent production of IFN-γ and CXCL9/Mig was observed 24–72 hours post-transplant in allografts but not isografts. CXCL9 was produced by donor cells in response to IFN-γ made by recipient CD8 T cells reactive to donor class I MHC molecules. Activated CD8 T cells were detected in allografts at least three days before donor-specific effector T cells producing IFN-γ were detected in the recipient spleen. Early inflammation mediated by donor-reactive CD8 memory T cells greatly enhanced primed effector T cell infiltration into allografts. These results suggest that strategies for optimal inhibition of alloimmunity should include neutralization of infiltrating CD8 memory T cells within a very narrow window after transplantation. PMID:18557725

  18. Influence of irrigation protocols on the bond strength of fiber posts cemented with a self-adhesive luting agent 24 hours after endodontic treatment.

    PubMed

    Lima, Jessica Ferraz Carvalho; Lima, Adriano Fonseca; Humel, Maria Malerba Colombi; Paulillo, Luis Alexandre Maffei Sartini; Marchi, Giselle Maria; Ferraz, Caio Cezar Randi

    2015-01-01

    The aim of this in vitro study was to evaluate the influence of different irrigation protocols on the bond strength, at different root depths, of fiber posts cemented with a self-adhesive cement 24 hours after endodontic treatment. Fifty-six bovine incisor roots were endodontically prepared and separated into 7 groups (n = 8) according to irrigation protocols: group 1, sterile saline (control); group 2, chlorhexidine (CHX) gel 2% and saline; group 3, sodium hypochlorite (NaOCl) 5.25% and saline; group 4, CHX and saline (final irrigation with ethylenediaminetetraacetic acid [EDTA] 17%); group 5, NaOCl and saline (final irrigation with EDTA); group 6, CHX and saline (final irrigation with NaOCl and EDTA); and group 7, NaOCl (final irrigation with CHX and EDTA). No statistically significant difference was found among the groups. Within the limitations of this study, it can be concluded that the different irrigation protocols did not influence the bond strength of self-adhesive resin cement, which presented similar behaviors at the 3 root depths studied.

  19. Gastroesophageal and pharyngeal reflux detection using impedance and 24-hour pH monitoring in asymptomatic subjects: defining the normal environment.

    PubMed

    Oelschlager, Brant K; Quiroga, Elina; Isch, John A; Cuenca-Abente, Federico

    2006-01-01

    Airway symptoms are often caused by aspiration of refluxed materials into the larynx. In this study we sought to define the frequency, character, and proximal extent of refluxed contents - including nonacid reflux-in normal subjects using intraluminal impedance to improve our understanding of the relationship between reflux and aspiration. Ten subjects, who had no symptoms of gastroesophageal reflux disease or airway disease, underwent impedance/pH monitoring with a catheter that allowed simultaneous esophageal and pharyngeal monitoring. Impedance detected 496 gastroesophageal reflux episodes in the 10 subjects during 240 hours of study. The majority, 399 (81% of the total) were acid reflux episodes (pH < 4). Ninety-seven were nonacid (pH > 4). Most reflux episodes (348 of 496) reached the mid esophagus (9 cm above lower esophageal sphincter). There were 51 reflux episodes that reached the pharynx (PR). Only 13 (25%) of PR were acidic (pH < 4), while 38 were nonacid. Twenty-six PR episodes were liquid and 25 were mixed (liquid and gas). The median number of PR episodes measured with impedance was 5 (0-10). In asymptomatic subjects, most episodes of gastroesophageal reflux are acidic and reach the midesophagus. Reflux into the PR appears to be more common than previously believed, and most of these episodes are not acidic. Thus, traditional 24-hour pH monitoring may underestimate the presence of pharyngeal reflux. The combination of impedance with pH monitoring markedly enhances our ability to accurately detect potential microaspiration.

  20. Systoles in discrete dynamical systems

    NASA Astrophysics Data System (ADS)

    Fernandes, Sara; Grácio, Clara; Ramos, Carlos Correia

    2013-01-01

    The fruitful relationship between Geometry and Graph Theory has been explored by several authors benefiting also the Theory of discrete dynamical systems seen as Markov chains in graphs. In this work we will further explore the relation between these areas, giving a geometrical interpretation of notions from dynamical systems. In particular, we relate the topological entropy with the systole, here defined in the context of discrete dynamical systems. We show that for continuous interval maps the systole is trivial; however, for the class of interval maps with one discontinuity point the systole acquires relevance from the point of view of the dynamical behavior. Moreover, we define the geodesic length spectrum associated to a Markov interval map and we compute the referred spectrum in several examples.

  1. Dynamically Reconfigurable Systolic Array Accelerator

    NASA Technical Reports Server (NTRS)

    Dasu, Aravind; Barnes, Robert

    2012-01-01

    A polymorphic systolic array framework has been developed that works in conjunction with an embedded microprocessor on a field-programmable gate array (FPGA), which allows for dynamic and complimentary scaling of acceleration levels of two algorithms active concurrently on the FPGA. Use is made of systolic arrays and a hardware-software co-design to obtain an efficient multi-application acceleration system. The flexible and simple framework allows hosting of a broader range of algorithms, and is extendable to more complex applications in the area of aerospace embedded systems. FPGA chips can be responsive to realtime demands for changing applications needs, but only if the electronic fabric can respond fast enough. This systolic array framework allows for rapid partial and dynamic reconfiguration of the chip in response to the real-time needs of scalability, and adaptability of executables.

  2. 2001: A Space Odyssey Revisited: The Feasibility of 24 Hour Commuter Flights to the Moon Using NTR Propulsion with LUNOX Afterburners. Revised

    NASA Technical Reports Server (NTRS)

    Borowski, Stanley; Dudzinski, Leonard A.

    2003-01-01

    The prospects for 24 hour commuter flights to the Moon, similar to that portrayed in 2001: A Space Odyssey but on a more Spartan scale, are examined using two near term, high leverage technologies: liquid oxygen (LOX)-augmented nuclear thermal rocket (NTR) propulsion and lunar-derived oxygen (LUNOX) production. Iron-rich volcanic glass, or orange soil, discovered during the Apollo 17 mission to Taurus-Littrow, has produced a 4 percent oxygen yield in recent NASA experiments using hydrogen reduction. LUNOX development and utilization would eliminate the need to transport oxygen supplies from Earth and is expected to dramatically reduce the size, cost and complexity of space transportation systems. The LOX-augmented NTR concept (LANTR) exploits the high performance capability of the conventional liquid hydrogen (LH2)-cooled NTR and the mission leverage provided by LUNOX in a unique way. LANTR utilizes the large divergent section of its nozzle as an afterburner into which oxygen is injected and supersonically combusted with nuclear preheated hydrogen emerging from the engine's choked sonic throat, essentially scramjet propulsion in reverse. By varying the oxygen-to-hydrogen mixture ratio, the LANTR engine can operate over a wide range of thrust and specific impulse (Isp) values while the reactor core power level remains relatively constant. The thrust augmentation feature of LANTR means that big engine performance can be obtained using smaller, more affordable, easier to test NTR engines. The use of high-density LOX in place of low density LH2 also reduces hydrogen mass and tank volume resulting in smaller space vehicles. An implementation strategy and evolutionary lunar mission architecture is outlined which requires only Shuttle C or in-line Shuttle-derived launch vehicles, and utilizes conventional NTR-powered lunar transfer vehicles (LTVs), operating in an expendable mode initially, to maximize delivered surface payload on each mission. The increased payload is

  3. "2001: A Space Odyssey" Revisited: The Feasibility of 24 Hour Commuter Flights to the Moon Using NTR Propulsion with LUNOX Afterburners. Revised

    NASA Technical Reports Server (NTRS)

    Borowski, Stanley K.; Dudzinski, Leonard A.

    2001-01-01

    The prospects for "24 hour" commuter flights to the Moon. similar to that portrayed in 2001: A Space Odyssey but on a more Spartan scale. are examined using two near term. "high leverage" technologies-liquid oxygen (LOX)-augmented nuclear thermal rocket (NTR) propulsion and "lunar-derived" oxygen (LUNOX) production. Iron-rich volcanic glass. or "orange soil," discovered during the Apollo 17 mission to Taurus-Littrow. has produced a 4% oxygen yield in recent NASA experiments using hydrogen reduction. LUNOX development and utilization would eliminate the need to transport oxygen supplies from Earth and is expected to dramatically reduce the size, cost and complexity of space transportation systems. The LOX-augmented NTR concept (LANTR) exploits the high performance capability of the conventional liquid hydrogen (LH2)-cooled NTR and the mission leverage provided by LUNOX in a unique way. LANTR utilizes the large divergent section of its nozzle as an "afterburner" into which oxygen is injected and supersonically combusted with nuclear preheated hydrogen emerging from the engine's choked sonic throat-essentially "scramjet propulsion in reverse." By varying the oxygen-to-hydrogen mixture ratio, the LANTR engine can operate over a wide range of thrust and specific impulse (Isp) values while the reactor core power level remains relatively constant. The thrust augmentation feature of LANTR means that "big engine" performance can be obtained using smaller. more affordable. easier to test NTR engines. The use of high-density LOX in place of low-density LH2 also reduces hydrogen mass and tank volume resulting in smaller space vehicles. An implementation strategy and evolutionary lunar mission architecture is outlined which requires only Shuttle C or "in-line" Shuttle-derived launch vehicles, and utilizes conventional NTR-powered lunar transfer vehicles (LTVs), operating in an "expendable mode" initially, to maximize delivered surface payload on each mission. The increased

  4. "2001: A Space Odyssey" Revisited--The Feasibility of 24 Hour Commuter Flights to the Moon Using NTR Propulsion with LUNOX Afterburners

    NASA Technical Reports Server (NTRS)

    Borowski, Stanley K.; Dudzinski, Leonard A.

    1998-01-01

    The prospects for "24 hour" commuter flights to the Moon, similar to that portrayed in 2001: A Space Odyssey but on a more Spartan scale, are examined using two near term, "high leverage" technologies--liquid oxygen (LOX)-augmented nuclear thermal rocket (NTR) propulsion and "lunar-derived" oxygen (LUNOX) production. Ironrich volcanic glass, or "orange soil," discovered during the Apollo 17 mission to Taurus-Littrow, has produced a 4% oxygen yield in recent NASA experiments using hydrogen reduction. LUNOX development and utilization would eliminate the need to transport oxygen supplies from Earth and is expected to dramatically reduce the size, cost and complexity of space transportation systems. The LOX-augmented NTR concept (LANTR) exploits the high performance capability of the conventional liquid hydrogen (LH2)-cooled NTR and the mission leverage provided by LUNOX in a unique way, LANTR utilizes the large divergent section of its nozzle as an "afterburner" into which oxygen is injected and supersonically combusted with nuclear preheated hydrogen emerging front the engine's choked sonic throat--essentially "scramjet propulsion in reverse." By varying the oxygen-to-hydrogen mixture ratio, the LANTR engine can operate over a wide range of thrust and specific impulse (Isp) values while the reactor core power level remains relatively constant. The thrust augmentation feature of LANTR means that "big engine" performance can be obtained using smaller, more affordable, easier to test NTR engines. The use of high-density LOX in place of low-density LH2 also reduces hydrogen mass and tank volume resulting in smaller space vehicles. An implementation strategy and evolutionary lunar mission architecture is outlined which requires only Shuttle C or "in-line" Shuttle-derived launch vehicles, and utilizes conventional NTR-powered lunar transfer vehicles (LTVs), operating in an "expendable mode" initially, to maximize delivered surface payload on each mission. The increased

  5. Epidemiology of Urban Traffic Accident Victims Hospitalized More Than 24 Hours in a Level III Trauma Center, Kashan County, Iran, During 2012-2013

    PubMed Central

    Mahdian, Mehrdad; Sehat, Mojtaba; Fazel, Mohammad Reza; Moraveji, Alireza; Mohammadzadeh, Mahdi

    2015-01-01

    Background: Urban traffic accidents are an extensively significant problem in small and busy towns in Iran. This study tried to explore the epidemiological pattern of urban traffic accidents in Kashan and Aran-Bidgol cities, Iran. Objectives: This study aimed to assess various epidemiological factors affecting victims of trauma admitted to a main trauma center in Iran. Patients and Methods: During a retrospective study, data including age, sex, injury type and pattern, outcome, hospital stay and treatment expenditures regarding urban Road Traffic Accidents (RTAs) for one year (March 2012-March 2013) were obtained from the registry of trauma research center, emergency medical services and deputy of health of Kashan University of Medical Sciences. One-way ANOVA and chi-square tests were used to analyze data using SPSS version 16.0. P value < 0.05 was considered significant. Results: A total of 1723 victims (82.6% male, sex ratio of almost 5:1) were considered in this study. Mortality rate in trauma cases hospitalized more than 24 hours during our study was 0.8%. Young motorcyclist men with the rate of more than 103 per 10000 were the most vulnerable group. The most common injury was head injury (73.6%) followed by lower limb injury (33.2%). A significant association was found between mechanism of injury and head, lower limb, multiple injuries and high risk age group. Conclusions: Urban RTAs are one of the most important problems in Kashan and Aran-Bidgol cities, which impose a great economic burden on health system. Motorcyclists are the most vulnerable victims and multiple trauma and head injury are seen among them extensively. PMID:26101765

  6. Spatial characteristics of extreme rainfall over China with hourly through 24-hour accumulation periods based on national-level hourly rain gauge data

    NASA Astrophysics Data System (ADS)

    Zheng, Yongguang; Xue, Ming; Li, Bo; Chen, Jiong; Tao, Zuyu

    2016-11-01

    Hourly rainfall measurements of 1919 national-level meteorological stations from 1981 through 2012 are used to document, for the first time, the climatology of extreme rainfall in hourly through 24-h accumulation periods in China. Rainfall amounts for 3-, 6-, 12- and 24-h periods at each station are constructed through running accumulation from hourly rainfall data that have been screened by proper quality control procedures. For each station and for each accumulation period, the historical maximum is found, and the corresponding 50-year return values are estimated using generalized extreme value theory. Based on the percentiles of the two types of extreme rainfall values among all the stations, standard thresholds separating Grade I, Grade II and Grade III extreme rainfall are established, which roughly correspond to the 70th and 90th percentiles for each of the accumulation periods. The spatial characteristics of the two types of extreme rainfall are then examined for different accumulation periods. The spatial distributions of extreme rainfall in hourly through 6-h periods are more similar than those of 12- and 24-h periods. Grade III rainfall is mostly found over South China, the western Sichuan Basin, along the southern and eastern coastlines, and in the large river basins and plains. There are similar numbers of stations with Grade III extreme hourly rainfall north and south of 30°N, but the percentage increases to about 70% south of 30°N as the accumulation period increases to 24 hours, reflecting richer moisture and more prolonged rain events in southern China. Potential applications of the extreme rainfall climatology and classification standards are suggested at the end.

  7. Establishing normal plasma and 24-hour urinary biochemistry ranges in C3H, BALB/c and C57BL/6J mice following acclimatization in metabolic cages.

    PubMed

    Stechman, Michael J; Ahmad, Bushra N; Loh, Nellie Y; Reed, Anita A C; Stewart, Michelle; Wells, Sara; Hough, Tertius; Bentley, Liz; Cox, Roger D; Brown, Steve D M; Thakker, Rajesh V

    2010-07-01

    Physiological studies of mice are facilitated by normal plasma and 24-hour urinary reference ranges, but variability of these parameters may increase due to stress that is induced by housing in metabolic cages. We assessed daily weight, food and water intake, urine volume and final day measurements of the following: plasma sodium, potassium, chloride, urea, creatinine, calcium, phosphate, alkaline phosphatase, albumin, cholesterol and glucose; and urinary sodium, potassium, calcium, phosphate, glucose and protein in 24- to 30-week-old C3H/HeH, BALB/cAnNCrl and C57BL/6J mice. Between 15 and 20 mice of each sex from all three strains were individually housed in metabolic cages with ad libitum feeding for up to seven days. Acclimatization was evaluated using general linear modelling for repeated measures and comparison of biochemical data was by unpaired t-test and analysis of variance (SPSS version 12.0.1). Following an initial 5-10% fall in body weight, daily dietary intake, urinary output and weight in all three strains reached stable values after 3-4 days of confinement. Significant differences in plasma glucose, cholesterol, urea, chloride, calcium and albumin, and urinary glucose, sodium, phosphate, calcium and protein were observed between strains and genders. Thus, these results provide normal reference values for plasma and urinary biochemistry in three strains housed in metabolic cages and demonstrate that 3-4 days are required to reach equilibrium in metabolic cage studies. These variations due to strain and gender have significant implications for selecting the appropriate strain upon which to breed genetically-altered models of metabolic and renal disease.

  8. External Beam Radiotherapy Plus 24-Hour Continuous Infusion of Gemcitabine in Unresectable Pancreatic Carcinoma: Long-Term Results of a Phase II Study

    SciTech Connect

    Mattiucci, Gian C.; Morganti, Alessio G.; Valentini, Vincenzo; Ippolito, Edy; Alfieri, Sergio; Antinori, Armando; Crucitti, Antonio; D'Agostino, Giuseppe R.; Di Lullo, Liberato; Luzi, Stefano; Mantini, Giovanna; Smaniotto, Daniela; Doglietto, Gian B.; Cellini, Numa

    2010-03-01

    Purpose: To evaluate the efficacy of gemcitabine-based chemoradiation (CT-RT) in treating patients (pts) affected by locally advanced pancreatic cancers (LAPC). Methods and Materials: Weekly gemcitabine (100 mg/m{sup 2}) was given as a 24-hour infusion during the course of three-dimensional radiotherapy (50.4 Gy to the tumor, 39.6 Gy to the nodes). After CT-RT, pts received five cycles of sequential chemotherapy with gemcitabine (1000 mg/m{sup 2}; 1, 8, q21). Response rate was assessed according to World Health Organization criteria 6 weeks after the end of CT-RT. Local control (LC), time to progression (TTP), metastases-free survival (MFS), and overall survival (OS) were analyzed by the Kaplan Meier method. Results: Forty pts (male/female 22/18; median age 62 years, range, 36-76) were treated from 2000 to 2005. The majority had T4 tumour (n = 34, 85%), six pts (15%) had T3 tumour. Sixteen pts (40%) were node positive at diagnosis. Grade 3-4 acute toxicity was observed in 21 pts (52.5%). Thirty pts (75%) completed the treatment schedule. A clinical response was achieved in 12 pts (30%). With a median follow-up of 76 months (range, 32-98), 2-year LC was 39.6% (median, 12 months), 2-year TTP was 18.4% (median, 10 months), and 2-year MFS was 29.7% (median, 10 months). Two-year OS (25%; median, 15.5 months) compared with our previous study on 5-fluorouracil-based CT-RT (2.8%) was significantly improved (p <0.001). Conclusions: Gemcitabine CT-RT seems correlated with improved outcomes. Healthier patients who are likely to complete the treatment schedule may benefit most from this therapy.

  9. Effects of cigarette smoking on ambulatory blood pressure, heart rate, and heart rate variability in treated hypertensive patients.

    PubMed

    Ohta, Yuko; Kawano, Yuhei; Hayashi, Shinichiro; Iwashima, Yoshio; Yoshihara, Fumiki; Nakamura, Satoko

    We investigated the influence of cigarette smoking on the levels and circadian patterns of blood pressure (BP), heart rate (HR), and HR variability (HRV) in hypertensive patients. Sixteen hypertensive smokers (57 ± 2 years old) receiving antihypertensive treatments participated in this study. Ambulatory monitoring of BP, HR, and electrocardiograms was performed every 30 min for 24 hours on a smoking day and nonsmoking day in a randomized crossover manner. Average 24-hour BP and daytime BP were significantly higher in the smoking period than in the nonsmoking period. No significant differences were observed in nighttime BP between the two periods. Average 24-hour and daytime HR, but not nighttime HR, were also higher in the smoking period than in the nonsmoking period. The daytime high frequency (HF) component of HRV was attenuated more in the smoking period than in the nonsmoking period. No significant differences were observed in the low frequency (LF) components of HRV or LF/HF ratio between the two periods. These results demonstrated that cigarette smoking increased the daytime and average 24-hour BP and HR, and the increases observed in daytime BP and HR were associated with the attenuation of parasympathetic nerve activity.

  10. [White coat hypertension under outpatient conditions: indications for ambulatory monitoring of arterial pressure].

    PubMed

    Calderón Montero, A; Palma Gámiz, J L

    1997-01-01

    Ambulatory blood pressure monitoring (ABPM) is to be considered an excellent diagnostic tool, progressively used by the clinicians in their routine medical practice, in order to assess both medical diagnosis and antihypertensive treatment efficacy. ABPM permits to distinguish with a high level of accuracy the true hypertensives, from the false hypertensives or from subjects with isolated clinical hypertension, the old so-called "white coat hypertension". Prognostic implications of hypertension and target organ involvement can be assessed more accurately with ABPM than with basal blood pressure measurement. ABPM also permits an excellent approach to 24-hour blood pressure load, establishing different categories of circadian curves. In the same way, the 24-hour monitoring observation period during a normal daily life, helps to identify the hot moments of circadian period, correlating them, with changes in blood pressure, and subsequently with cardiovascular events, particularly in the early morning hours, during the so-called circadian vulnerable period, in which a significant increase in both cardiovascular events and stroke are usually observed. Nevertheless, some limitations are still linked to ABPM systems and equipments; on the one hand, the lack of a cut-off point, to establish the limits of true normally, and on the other one; the today intermittent character of ABPM measurements, do not permit an exact assessment of 24-hour blood pressure profile, containing all the hemodynamic changes. Several ongoing studies, will bring in the near future the very necessary answers to all these interrogants.

  11. Ambulatory Blood Pressure Monitoring: Five Decades of More Light and Less Shadows

    PubMed Central

    Nobre, Fernando; Mion Junior, Décio

    2016-01-01

    Casual blood pressure measurements have been extensively questioned over the last five decades. A significant percentage of patients have different blood pressure readings when examined in the office or outside it. For this reason, a change in the paradigm of the best manner to assess blood pressure has been observed. The method that has been most widely used is the Ambulatory Blood Pressure Monitoring - ABPM. The method allows recording blood pressure measures in 24 hours and evaluating various parameters such as mean BP, pressure loads, areas under the curve, variations between daytime and nighttime, pulse pressure variability etc. Blood pressure measurements obtained by ABPM are better correlated, for example, with the risks of hypertension. The main indications for ABPM are: suspected white coat hypertension and masked hypertension, evaluation of the efficacy of the antihypertensive therapy in 24 hours, and evaluation of symptoms. There is increasing evidence that the use of ABPM has contributed to the assessment of blood pressure behaviors, establishment of diagnoses, prognosis and the efficacy of antihypertensive therapy. There is no doubt that the study of 24-hour blood pressure behavior and its variations by ABPM has brought more light and less darkness to the field, which justifies the title of this review. PMID:27168473

  12. Performance of the Automated Self-Administered 24-hour Recall relative to a measure of true intakes and to an interviewer-administered 24-h recall123

    PubMed Central

    Kirkpatrick, Sharon I; Subar, Amy F; Douglass, Deirdre; Zimmerman, Thea P; Thompson, Frances E; Kahle, Lisa L; George, Stephanie M; Dodd, Kevin W; Potischman, Nancy

    2014-01-01

    Background: The Automated Self-Administered 24-hour Recall (ASA24), a freely available Web-based tool, was developed to enhance the feasibility of collecting high-quality dietary intake data from large samples. Objective: The purpose of this study was to assess the criterion validity of ASA24 through a feeding study in which the true intake for 3 meals was known. Design: True intake and plate waste from 3 meals were ascertained for 81 adults by inconspicuously weighing foods and beverages offered at a buffet before and after each participant served him- or herself. Participants were randomly assigned to complete an ASA24 or an interviewer-administered Automated Multiple-Pass Method (AMPM) recall the following day. With the use of linear and Poisson regression analysis, we examined the associations between recall mode and 1) the proportions of items consumed for which a match was reported and that were excluded, 2) the number of intrusions (items reported but not consumed), and 3) differences between energy, nutrient, food group, and portion size estimates based on true and reported intakes. Results: Respondents completing ASA24 reported 80% of items truly consumed compared with 83% in AMPM (P = 0.07). For both ASA24 and AMPM, additions to or ingredients in multicomponent foods and drinks were more frequently omitted than were main foods or drinks. The number of intrusions was higher in ASA24 (P < 0.01). Little evidence of differences by recall mode was found in the gap between true and reported energy, nutrient, and food group intakes or portion sizes. Conclusions: Although the interviewer-administered AMPM performed somewhat better relative to true intakes for matches, exclusions, and intrusions, ASA24 performed well. Given the substantial cost savings that ASA24 offers, it has the potential to make important contributions to research aimed at describing the diets of populations, assessing the effect of interventions on diet, and elucidating diet and health

  13. Sex and age-related differences in performance in a 24-hour ultra-cycling draft-legal event – a cross-sectional data analysis

    PubMed Central

    2014-01-01

    Background The purpose of this study was to examine the sex and age-related differences in performance in a draft-legal ultra-cycling event. Methods Age-related changes in performance across years were investigated in the 24-hour draft-legal cycling event held in Schötz, Switzerland, between 2000 and 2011 using multi-level regression analyses including age, repeated participation and environmental temperatures as co-variables. Results For all finishers, the age of peak cycling performance decreased significantly (β = −0.273, p = 0.036) from 38 ± 10 to 35 ± 6 years in females but remained unchanged (β = −0.035, p = 0.906) at 41.0 ± 10.3 years in males. For the annual fastest females and males, the age of peak cycling performance remained unchanged at 37.3 ± 8.5 and 38.3 ± 5.4 years, respectively. For all female and male finishers, males improved significantly (β = 7.010, p = 0.006) the cycling distance from 497.8 ± 219.6 km to 546.7 ± 205.0 km whereas females (β = −0.085, p = 0.987) showed an unchanged performance of 593.7 ± 132.3 km. The mean cycling distance achieved by the male winners of 960.5 ± 51.9 km was significantly (p < 0.001) greater than the distance covered by the female winners with 769.7 ± 65.7 km but was not different between the sexes (p > 0.05). The sex difference in performance for the annual winners of 19.7 ± 7.8% remained unchanged across years (p > 0.05). The achieved cycling distance decreased in a curvilinear manner with advancing age. There was a significant age effect (F = 28.4, p < 0.0001) for cycling performance where the fastest cyclists were in age group 35–39 years. Conclusion In this 24-h cycling draft-legal event, performance in females remained unchanged while their age of peak cycling performance decreased and performance in males improved while their age of peak cycling performance remained unchanged. The annual fastest females and males were 37.3 ± 8.5 and 38.3 ± 5.4 years old, respectively. The sex

  14. Urinary catecholamines in essential hypertension: results of 24-hour urine catecholamine analyses from patients in the Medical Research Council trial for mild hypertension and from matched controls.

    PubMed

    Brown, M J; Causon, R C; Barnes, V F; Brennan, P; Barnes, G; Greenberg, G

    1985-10-01

    Four consecutive 24-h urine samples were collected from 134 male and 134 female placebo-treated patients in the Medical Research Council Trial for Mild Hypertension. Similar samples were collected from age and sex-matched normotensive controls. On the fourth day noradrenaline excretion was 22.05 +/- 1.01 nmol/mmol creatinine in the hypertensives compared with 22.22 +/- 1.16 nmol/mmol creatinine in the controls. Adrenaline excretion on the same day was 6.13 +/- 0.33 nmol/mmol creatinine in the hypertensive subjects compared with 6.32 +/- 0.38 nmol/mmol creatinine in the controls. There was no significant difference for either catecholamine between the two groups. However, in the control group there was a highly significant correlation between excretion of adrenaline and systolic blood pressure (r = 0.218, p = 0.0004) and between noradrenaline excretion and systolic blood pressure (r = 0.200, p = 0.001). Catecholamine excretion and blood pressure were not significantly correlated in the hypertensive patients. There were no significant correlations in either group between catecholamine excretion and heart rate, caffeine intake, nicotine consumption or the Bortner self-assessment score of personality type. This study has found no evidence of elevated sympathoadrenal activity in mild hypertensives. The correlations in the control group may reflect the role of sympathoadrenal activity in acute fluctuations in blood pressure or may suggest that the level of blood pressure within the 'normal' range depends in part on the level of sympathoadrenal activity.

  15. Comparison of an in-pharmacy automated blood pressure kiosk to daytime ambulatory blood pressure in hypertensive subjects.

    PubMed

    Padwal, Raj S; Townsend, Raymond R; Trudeau, Luc; Hamilton, Peter G; Gelfer, Mark

    2015-02-01

    The objective of this study was to compare serial readings from an in-pharmacy automated blood pressure (BP) kiosk to mean daytime ambulatory BP. A total of 100 community-dwelling adults with hypertension underwent (1) three baseline automated office readings; (2) three in-pharmacy readings on each of four visits (12 total) using the PharmaSmart PS-2000 kiosk; and (3) 24-hour ambulatory BP monitoring between in-pharmacy visits two and three. Paired t-tests, Bland-Altman plots, and Pearson correlation coefficients were used for analysis. Mean BPs were 137.8 ± 13.7/81.9 ± 12.2 mm Hg for in-pharmacy and 135.5 ± 11.7/79.7 ± 10.0 mm Hg for daytime ambulatory (difference of 2.3 ± 9.5/2.2 ± 6.9 mm Hg [P ≤ .05]). Bland-Altman plots depicted a high degree of BP variability but did not show clinically important systematic BP differences. With ambulatory BP as the reference standard, in-pharmacy device results were similar to automated office results. The PharmaSmart PS-2000 closely approximated mean daytime ambulatory BP, supporting the use of serial readings from this device in the assessment of BP.

  16. Systolic VLSI for Kalman filters

    NASA Technical Reports Server (NTRS)

    Yeh, H.-G.; Chang, J. J.

    1986-01-01

    A novel two-dimensional parallel computing method for real-time Kalman filtering is presented. The mathematical formulation of a Kalman filter algorithm is rearranged to be the type of Faddeev algorithm for generalizing signal processing. The data flow mapping from the Faddeev algorithm to a two-dimensional concurrent computing structure is developed. The architecture of the resulting processor cells is regular, simple, expandable, and therefore naturally suitable for VLSI chip implementation. The computing methodology and the two-dimensional systolic arrays are useful for Kalman filter applications as well as other matrix/vector based algebraic computations.

  17. Ambulatory blood pressure and heart rate during shuttle flight, entry and landing

    NASA Technical Reports Server (NTRS)

    Thornton, W.; Moore, T. P.; Uri, J.

    1993-01-01

    Ambulatory blood pressures (BP) and heart rates (HR) were recorded on a series of early Shuttle flights during preflight and pre-entry, entry, landing and egress. There were no significant differences between flight and preflight values during routine activity. Systolic blood pressure was slightly elevated in the deorbit period and systolic and diastolic blood pressure and heart rates were all elevated with onset of gravitoinertial loads and remained so through egress. Two of seven subjects had orthostatic problems in egress but their data did not show significant differences from others except in heart rate. Comparison of this data to that from recent studies show even larger increase in HR/BP values during current deorbit and entry phases which is consistent with increased heat and weight loads imposed by added survival gear. Both value and limitations of ambulatory heart rate/blood pressure data in this situation are demonstrated.

  18. Antiproteinuric effect of cilnidipine in hypertensive Japanese treated with renin-angiotensin-system inhibitors - a multicenter, open, randomized trial using 24-hour urine collection.

    PubMed

    Miwa, Yoshikazu; Tsuchihashi, Takuya; Ohta, Yuko; Tominaga, Mitsuhiro; Kawano, Yuhei; Sasaguri, Toshiyuki; Ueno, Michio; Matsuoka, Hiroaki

    2010-01-01

    Sustained proteinuria is an important risk factor for not only renal but also cardiovascular morbidity and mortality. Although inhibitors of the renin-angiotensin system (RAS) have been shown to reduce proteinuria. Monotherapy with those drugs is often insufficient for optimal blood pressure (BP)-lowering and therefore, combined therapy is needed. Recent reports suggested that cilnidipine, a dual L-/N-type calcium channel blocker, has renoprotective effect by dilating both efferent and afferent arterioles. In this study, a multicenter, open, randomized trial was designed to compare the antiproteinuric effect between cilnidipine and amlodipine when coupled with RAS inhibitors in hypertensive patients with significant proteinuria. Proteinuria was evaluated by 24-h home urine collection for all patients. A total of 35 proteinuric (>0.1 g/day) patients with uncontrolled BP (>135/85 mmHg) were randomized to receive either cilnidipine (n = 18) or amlodipine (n = 17) after a 6-month treatment with RAS inhibitors and were followed for 48 weeks. At baseline, the cilnidipine group was older and had lower body mass index (BMI) compared to the amlodipine group. After 32 weeks of treatment, diastolic blood pressure (DBP) was slightly, but significantly reduced, in the cilnidipine group, although systolic blood pressure (SBP) and mean BP did not differ. The urinary protein did not differ at baseline (cilnidipine group 0.48 g/day, amlodipine group 0.52 g/day); however, it significantly decreased in the cilnidipine group (0.22 g/day) compared to the amlodipine group (0.50 g/day) after 48 weeks of treatment. Our findings suggest that cilnidipine is superior to amlodipine in preventing the progression of proteinuria in hypertensive patients even undergoing treatment with RAS inhibitors.

  19. Estimated 24-hour urine sodium excretion is correlated with blood pressure in Korean population: 2009-2011 Korean National Health and Nutritional Examination Survey.

    PubMed

    Oh, Jieun; Lee, Jeonghwan; Koo, Ho Seok; Kim, Suhnggwon; Chin, Ho Jun

    2014-09-01

    No large-scale studies have investigated the association between salt intake and hypertension in Korean population. To investigate the relationship of blood pressure to salt consumption, we analyzed data from 19,476 participants in the 2009-2011 Korean National Health and Nutritional Examination Survey (KNHANES). Urinary sodium excretion over 24-hr (24HUNa) was estimated from spot urine tests using Tanaka's equation. The study subjects were stratified into hypertensive and normotensive groups. Hypertensive participants (n=6,552, 33.6%) had higher estimated 24HUNa, 150.4±38.8 mEq/day, than normotensive participants, 140.5±34.6 mEq/day (P<0.001). The association between 24HUNa and blood pressure outcomes was not affected by adjustment for other risk factors for hypertension (odds ratio 0.001; 95% confidence interval 0.001-0.003; P<0.001). Increases in 24HUNa of 100 mEq/day were associated with a 6.1±0.3/2.9±0.2 mmHg increase in systolic/diastolic blood pressure in all participants. This effect was stronger in hypertensive participants (increase of 8.1±0.5/3.4±0.3 mmHg per 100 mEq/day) and smaller in normotensive participants (2.9±0.3/1.3±0.2 mmHg). These results support recommendations for low salt intake in Korean population to prevent and control adverse blood pressure levels.

  20. The ST segment of the ambulatory electrocardiogram in a normal population.

    PubMed Central

    Kohli, R S; Cashman, P M; Lahiri, A; Raftery, E B

    1988-01-01

    The behaviour of the ST segment in everyday life was studied by ambulatory electrocardiography in 111 normal volunteers. Fifteen were excluded because of abnormal exercise responses (10 subjects) and significant postural ST segment shifts (five subjects). This left 62 men and 34 women, mean (SD) age 40.5 (12.6) years (range 20-67 years). Ambulatory monitoring of leads CM5 and CC5 for 24 hours was followed by a maximal treadmill exercise test. The tapes of the ambulatory monitoring were analysed by a computer aided system. The computer printed trend plots of the ST segment (measured both at the J point and at J + 60 ms) to detect episodes of ST segment elevation and depression, which were confirmed by visual analysis of real time printouts. Twelve subjects showed "ischaemic" ST segment depression and nine subjects showed ST segment elevation. Eight people with ambulatory ST segment changes were studied during exercise by radionuclide ventriculography and thallium-201 imaging scans. Although seven of the eight thallium studies were normal, radionuclide ventriculography showed functional impairment in five cases. Seven of the 10 subjects with abnormal exercise tests were similarly investigated and their results followed the same pattern, with normal thallium images in six and functional impairment in four. Ambulatory electrocardiography was repeated in 20 people after a median of 20 days. The ST segment changes were reproducible. ST segment changes of an apparently ischaemic nature occur even in a carefully defined normal population but they do not necessarily represent latent clinically significant coronary artery disease. This indicates that ST segment changes seen in patients with known obstructive coronary artery disease should be interpreted with caution. PMID:3408617

  1. [Ambulatory blood pressure profiles of patients with permanent or occasional hypertension. Correlation with clinical data].

    PubMed

    Herpin, D; Amiel, A; Boutaud, P; Ciber, M A; Demange, J

    1987-06-01

    Ambulatory blood pressure (BP) recording was performed in 57 untreated hypertensive patients by means of the "Spacelabs" non-invasive apparatus. Patients were divided into two groups according to BP measurements previously made during medical consultation. Group I comprised 25 "permanently hypertensive" patients (diastolic BP always above 95 mmHg) and group II, 32 "occasionally hypertensive" patients (diastolic BP sometimes normal, sometimes above 95 mmHg). The same circadian rhythm was observed in both groups. The mean ambulatory BP level was significantly higher (p less than 0.001) in group I patients than in group II patients, either over the whole of the 24-hour period (142.0/88.0 versus 122.7/75.3 mmHg), or in day time (149.0/92.5 versus 128.2/78.9 mmHg) or at night (128.0/80.1 versus 111.5/68.0 mmHg). In contrast, there did not seem to be any significant difference between the two groups in relative long-term variability of BP, expressed as the standard deviation/mean BP values ratio. Comparison with clinical data showed that BP values measured during consultation (160/103 mmHg in group I, 143/94 mmHg in group II) were higher than ambulatory values and, chiefly, that there was very poor correlation between the two measurement methods, precluding any extrapolation. Automatic ambulatory BP recording provides for more accurate evaluation of hypertensive patients, enabling emotional "artefacts" to be excluded and patients "reactivity" to their socio-professional environment to be assessed. However, in the absence of sufficient epidemiological data, doctors should not feel authorized to base their therapeutic decisions on the sole data supplied by ambulatory BP recordings.

  2. Remifentanil patient-controlled analgesia for labor – monitoring of newborn heart rate, blood pressure and oxygen saturation during the first 24 hours after delivery

    PubMed Central

    Konefał, Halina; Jaskot, Brygida; Pastuszka, Joanna

    2012-01-01

    Introduction There is no available information about the effects of remifentanil labor analgesia on newborns’ vital signs in the first hours after delivery. The aim of the study was to assess changes in the heart rate, blood pressure and oxygen saturation during the first 24 h of neonatal life after using remifentanil patient-controlled analgesia (PCA) for labor analgesia. Material and methods Forty-four full-term neonates, 23 from intravenous PCA remifentanil labor anesthesia 0.2 µg/kg, repeated not more frequently than every 2 min, and 21 born to mothers without any pharmacological forms of analgesia, were studied. Heart rate, oxygen saturation, and systolic (SBP) and diastolic blood pressure (DBP) were monitored using a Nellcor Oxi Max monitor N5500 (Tyco Healthcare), and recorded at 1 h, 6 h, 12 h and 24 h. Results No significant differences in heart rate (p = 0.54; p = 0.26; p = 0.60; p = 0.83), oxygen saturation (p = 0.21; p = 0.27; p = 0.61; p = 0.9) and DBP (p = 0.98; p = 0.31; p = 0.83; p = 0.58) between the groups at 1 h, 6 h, 12 h and 24 h. Newborns from the remifentanil group had lower SBP at 1 h of life (59 mm Hg vs. 68.5 mm Hg) but the difference was just on the borderline of statistical significance (p > 0.06). There were no significant differences in SBP between the groups at 6 h (p = 0.65), 12 h (p = 0.11), and 24 h (p = 0.89) of life. Conclusions Remifentanil PCA analgesia during labor does not significantly modify the oxygen saturation, heart rate and blood pressure in infants during the first day of their life. Therefore, further studies are needed to explain the observed trend for arterial hypotension in the first hour of life in infants born to mothers treated with remifentanil. PMID:24049531

  3. High daytime and nighttime ambulatory pulse pressure predict poor cognitive function and mild cognitive impairment in hypertensive individuals

    PubMed Central

    Riba-Llena, Iolanda; Nafría, Cristina; Filomena, Josefina; Tovar, José L; Vinyoles, Ernest; Mundet, Xavier; Jarca, Carmen I; Vilar-Bergua, Andrea; Montaner, Joan

    2016-01-01

    High blood pressure accelerates normal aging stiffness process. Arterial stiffness (AS) has been previously associated with impaired cognitive function and dementia. Our aims are to study how cognitive function and status (mild cognitive impairment, MCI and normal cognitive aging, NCA) relate to AS in a community-based population of hypertensive participants assessed with office and 24-hour ambulatory blood pressure measurements. Six hundred ninety-nine participants were studied, 71 had MCI and the rest had NCA. Office pulse pressure (PP), carotid–femoral pulse wave velocity, and 24-hour ambulatory PP monitoring were collected. Also, participants underwent a brain magnetic resonance to study cerebral small–vessel disease (cSVD) lesions. Multivariate analysis–related cognitive function and cognitive status to AS measurements after adjusting for demographic, vascular risk factors, and cSVD. Carotid–femoral pulse wave velocity and PP at different periods were inversely correlated with several cognitive domains, but only awake PP measurements were associated with attention after correcting for confounders (beta = −0.22, 95% confidence interval (CI) −0.41, −0.03). All ambulatory PP measurements were related to MCI, which was independently associated with nocturnal PP (odds ratio (OR) = 2.552, 95% CI 1.137, 5.728) and also related to the presence of deep white matter hyperintensities (OR = 1.903, 1.096, 3.306). Therefore, higher day and night ambulatory PP measurements are associated with poor cognitive outcomes. PMID:25966945

  4. Vascular Health Assessment of The Hypertensive Patients (VASOTENS) Registry: Study Protocol of an International, Web-Based Telemonitoring Registry for Ambulatory Blood Pressure and Arterial Stiffness

    PubMed Central

    Parati, Gianfranco; Avolio, Alberto; Rogoza, Anatoly N; Kotovskaya, Yulia V; Mulè, Giuseppe; Muiesan, Maria Lorenza; Orlova, Iana A; Grigoricheva, Elena A; Cardona Muñoz, Ernesto; Zelveian, Parounak H; Pereira, Telmo; Peixoto Maldonado, João Manuel

    2016-01-01

    Background Hypertension guidelines recommend ambulatory blood pressure (ABP), central aortic pressure (CAP), and pulse wave velocity (PWV) as parameters for estimating blood pressure (BP) control and vascular impairment. Recent advances in technology have enabled devices to combine non-invasive estimation of these parameters over the 24-hour ABP monitoring. However, currently there is limited evidence on the usefulness of such an approach for routine hypertension management. Objective We recently launched an investigator-initiated, international, multicenter, observational, prospective study, the Vascular health Assessment Of The Hypertensive patients (VASOTENS) Registry, aimed at (1) evaluating non-invasive 24-hour ABP and arterial stiffness estimates (through 24-hour pulse wave analysis, PWA) in hypertensive subjects undergoing ambulatory blood pressure monitoring (ABPM) for clinical reasons; (2) assessing the changes in estimates following treatment; (3) weighing the impact of 24-hour PWA on target organ damage and cardiovascular prognosis; (4) assessing the relationship between arterial stiffness, BP absolute mean level and variability, and prognosis; and (5) validating the use of a 24-hour PWA electronic health (e-health) solution for hypertension screening. Methods Approximately 2000 subjects, referred to 20 hypertension clinics for routine diagnostic evaluation and follow-up of hypertension of any severity or stage, will be recruited. Data collection will include ABPM, performed with a device allowing simultaneous non-invasive assessment of 24-hour CAP and arterial stiffness (BPLab), and clinical data (including cardiovascular outcomes). As recommended by current guidelines, each patient will be followed-up with visits occurring at regular intervals (ideally every 6 months, and not less than once a year depending on disease severity). A Web-based telemedicine platform (THOLOMEUS) will be used for data collection. The use of the telemedicine system will allow

  5. Biomedical Wireless Ambulatory Crew Monitor

    NASA Technical Reports Server (NTRS)

    Chmiel, Alan; Humphreys, Brad

    2009-01-01

    A compact, ambulatory biometric data acquisition system has been developed for space and commercial terrestrial use. BioWATCH (Bio medical Wireless and Ambulatory Telemetry for Crew Health) acquires signals from biomedical sensors using acquisition modules attached to a common data and power bus. Several slots allow the user to configure the unit by inserting sensor-specific modules. The data are then sent real-time from the unit over any commercially implemented wireless network including 802.11b/g, WCDMA, 3G. This system has a distributed computing hierarchy and has a common data controller on each sensor module. This allows for the modularity of the device along with the tailored ability to control the cards using a relatively small master processor. The distributed nature of this system affords the modularity, size, and power consumption that betters the current state of the art in medical ambulatory data acquisition. A new company was created to market this technology.

  6. Systematic review and meta-analysis of preterm birth and later systolic blood pressure.

    PubMed

    de Jong, Femke; Monuteaux, Michael C; van Elburg, Ruurd M; Gillman, Matthew W; Belfort, Mandy B

    2012-02-01

    Lower birth weight because of fetal growth restriction is associated with higher blood pressure later in life, but the extent to which preterm birth (<37 completed weeks' gestation) or very low birth weight (<1500 g) predicts higher blood pressure is less clear. We performed a systematic review of 27 observational studies that compared the resting or ambulatory systolic blood pressure or diagnosis of hypertension among children, adolescents, and adults born preterm or very low birth weight with those born at term. We performed a meta-analysis with the subset of 10 studies that reported the resting systolic blood pressure difference in millimeters of mercury with 95% CIs or SEs. We assessed methodologic quality with a modified Newcastle-Ottawa Scale. The 10 studies were composed of 1342 preterm or very low birth weight and 1738 term participants from 8 countries. The mean gestational age at birth of the preterm participants was 30.2 weeks (range: 28.8-34.1 weeks), birth weight was 1280 g (range: 1098-1958 g), and age at systolic blood pressure measurement was 17.8 years (range: 6.3-22.4 years). Former preterm or very low birth weight infants had higher systolic blood pressure than term infants (pooled estimate: 2.5 mm Hg [95% CI: 1.7-3.3 mm Hg]). For the 5 highest quality studies, the systolic blood pressure difference was slightly greater, at 3.8 mm Hg (95% CI: 2.6-5.0 mm Hg). We conclude that infants who are born preterm or very low birth weight have modestly higher systolic blood pressure later in life and may be at increased risk for developing hypertension and its sequelae.

  7. Cross sectional longitudinal study of spot morning urine protein:creatinine ratio, 24 hour urine protein excretion rate, glomerular filtration rate, and end stage renal failure in chronic renal disease in patients without diabetes.

    PubMed Central

    Ruggenenti, P.; Gaspari, F.; Perna, A.; Remuzzi, G.

    1998-01-01

    OBJECTIVE: To evaluate whether the protein:creatinine ratio in spot morning urine samples is a reliable indicator of 24 hour urinary protein excretion and predicts the rate of decline of glomerular filtration rate and progression to end stage renal failure in non-diabetic patients with chronic nephropathy. DESIGN: Cross sectional correlation between the ratio and urinary protein excretion rate. Univariate and multivariate analysis of baseline predictors, including the ratio and 24 hour urinary protein, of decline in glomerular filtration rate and end stage renal failure in the long term. SETTING: Research centre in Italy. SUBJECTS: 177 non-diabetic outpatients with chronic renal disease screened for participation in the ramipril efficacy in nephropathy study. MAIN OUTCOME MEASURES: Rate of decline in filtration rate evaluated by repeated measurements of unlabelled iohexol plasma clearance and rate of progression to renal failure. RESULTS: Protein:creatinine ratio was significantly correlated with absolute and log transformed 24 hour urinary protein values (P = 0.0001 and P < 0.0001, respectively.) Ratios also had high predictive value for rate of decline of the glomerular filtration rate (univariate P = 0.0003, multivariate P = 0.004) and end stage renal failure (P = 0.002 and P = 0.04). Baseline protein:creatinine ratios and rate of decline of the glomerular filtration rate were also significantly correlated (P < 0.0005). In the lowest third of the protein:creatinine ratio (< 1.7) there was 3% renal failure compared with 21.2% in the highest third (> 2.7) (P < 0.05). CONCLUSIONS: Protein:creatinine ratio in spot morning urine samples is a precise indicator of proteinuria and a reliable predictor of progression of disease in non-diabetic patients with chronic nephropathies and represents a simple and inexpensive procedure in establishing severity of renal disease and prognosis. PMID:9501711

  8. Index Blood Tests and National Early Warning Scores within 24 Hours of Emergency Admission Can Predict the Risk of In-Hospital Mortality: A Model Development and Validation Study

    PubMed Central

    Mohammed, Mohammed A.; Rudge, Gavin; Watson, Duncan; Wood, Gordon; Smith, Gary B.; Prytherch, David R.; Girling, Alan; Stevens, Andrew

    2013-01-01

    Background We explored the use of routine blood tests and national early warning scores (NEWS) reported within ±24 hours of admission to predict in-hospital mortality in emergency admissions, using empirical decision Tree models because they are intuitive and may ultimately be used to support clinical decision making. Methodology A retrospective analysis of adult emergency admissions to a large acute hospital during April 2009 to March 2010 in the West Midlands, England, with a full set of index blood tests results (albumin, creatinine, haemoglobin, potassium, sodium, urea, white cell count and an index NEWS undertaken within ±24 hours of admission). We developed a Tree model by randomly splitting the admissions into a training (50%) and validation dataset (50%) and assessed its accuracy using the concordance (c-) statistic. Emergency admissions (about 30%) did not have a full set of index blood tests and/or NEWS and so were not included in our analysis. Results There were 23248 emergency admissions with a full set of blood tests and NEWS with an in-hospital mortality of 5.69%. The Tree model identified age, NEWS, albumin, sodium, white cell count and urea as significant (p<0.001) predictors of death, which described 17 homogeneous subgroups of admissions with mortality ranging from 0.2% to 60%. The c-statistic for the training model was 0.864 (95%CI 0.852 to 0.87) and when applied to the testing data set this was 0.853 (95%CI 0.840 to 0.866). Conclusions An easy to interpret validated risk adjustment Tree model using blood test and NEWS taken within ±24 hours of admission provides good discrimination and offers a novel approach to risk adjustment which may potentially support clinical decision making. Given the nature of the clinical data, the results are likely to be generalisable but further research is required to investigate this promising approach. PMID:23734195

  9. Daily Energy Expenditure and Its Relation to Health Care Costs in Patients Undergoing Ambulatory Electrocardiographic Monitoring.

    PubMed

    George, Jason; Abdulla, Rami Khoury; Yeow, Raymond; Aggarwal, Anshul; Boura, Judith; Wegner, James; Franklin, Barry A

    2017-02-15

    Our increasingly sedentary lifestyle is associated with a heightened risk of obesity, diabetes, heart disease, and cardiovascular mortality. Using the recently developed heart rate index formula in 843 patients (mean ± SD age 62.3 ± 15.7 years) who underwent 24-hour ambulatory electrocardiographic (ECG) monitoring, we estimated average and peak daily energy expenditure, expressed as metabolic equivalents (METs), and related these data to subsequent hospital encounters and health care costs. In this cohort, estimated daily average and peak METs were 1.7 ± 0.7 and 5.5 ± 2.1, respectively. Patients who achieved daily bouts of peak energy expenditure ≥5 METs had fewer hospital encounters (p = 0.006) and median health care costs that were nearly 50% lower (p <0.001) than their counterparts who attained <5 METs. In patients whose body mass index was ≥30 kg/m(2), there were significant differences in health care costs depending on whether they achieved <5 or ≥5 METs estimated by ambulatory ECG monitoring (p = 0.005). Interestingly, patients who achieved ≥5 METs had lower and no significant difference in their health care costs, regardless of their body mass index (p = 0.46). Patients with previous percutaneous coronary intervention who achieved ≥5 METs had lower health care costs (p = 0.044) and fewer hospital encounters (p = 0.004) than those who achieved <5 METs. In conclusion, average and peak daily energy expenditures estimated from ambulatory ECG monitoring may provide useful information regarding health care utilization in patients with and without previous percutaneous coronary intervention, irrespective of body habitus. Our findings are the first to link lower intensities of peak daily energy expenditure, estimated from ambulatory ECG monitoring, with increased health care utilization.

  10. Improved Oxygenation 24 Hours After Transition to Airway Pressure Release Ventilation or High-Frequency Oscillatory Ventilation Accurately Discriminates Survival in Immunocompromised Pediatric Patients With Acute Respiratory Distress Syndrome*

    PubMed Central

    Yehya, Nadir; Topjian, Alexis A.; Thomas, Neal J.; Friess, Stuart H.

    2014-01-01

    Objectives Children with an immunocompromised condition and requiring invasive mechanical ventilation have high risk of death. Such patients are commonly transitioned to rescue modes of non-conventional ventilation, including airway pressure release ventilation and high-frequency oscillatory ventilation, for acute respiratory distress syndrome refractory to conventional ventilation. Our aim was to describe our experience with airway pressure release ventilation and high-frequency oscillatory ventilation in children with an immunocompromised condition and acute respiratory distress syndrome refractory to conventional ventilation and to identify factors associated with survival. Design Retrospective cohort study. Setting Tertiary care, university-affiliated PICU. Patients Sixty pediatric patients with an immunocompromised condition and acute respiratory distress syndrome refractory to conventional ventilation transitioned to either airway pressure release ventilation or high-frequency oscillatory ventilation. Interventions None. Measurements and Main Results Demographic data, ventilator settings, arterial blood gases, oxygenation index, and Pao2/Fio2 were recorded before transition to either mode of nonconventional ventilation and at predetermined intervals after transition for up to 5 days. Mortality in the entire cohort was 63% and did not differ between patients transitioned to airway pressure release ventilation and high-frequency oscillatory ventilation. For both airway pressure release ventilation and high-frequency oscillatory ventilation, improvements in oxygenation index and Pao2/Fio2 at 24 hours expressed as a fraction of pretransition values (oxygenation index24/oxygenation indexpre and Pao2/Fio224/Pao2/FIO2pre) reliably discriminated nonsurvivors from survivors, with receiver operating characteristic areas under the curves between 0.89 and 0.95 (p for all curves < 0.001). Sensitivity-specificity analysis suggested that less than 15% reduction in

  11. Differential Gene Expression in Explanted Human Retinal Pigment Epithelial Cells 24-Hours Post-Exposure to 532 nm, 3.0 ns Pulsed Laser Light and 1064 nm, 170 ps Pulsed Laser Light 12-Hours Post-Exposure: Results Compendium

    DTIC Science & Technology

    2004-06-01

    Laser Light and 1064 nm, 170 ps Pulsed Laser Light 12-hours Post-Exposure: Results Compendium John W. Obringer Martin D. Johnson Laser and Optics...Explanted Human Retinal Pigment Epithelial Cells 12-hours Post-Exposure to 532 nm, 3.0 ns Pulsed Laser Light and 1064 nm, 170 ps Pulsed Laser Lightl2-hours...Explanted Human Retinal Pigment Epithelial USAFA F05611-02-P-0471 Cells 24-Hours Post-Exposure to 532 nm, 3.0 ns Pulsed Laser-Light and 1064nm, 170 ps Pulsed

  12. Association of uremic pruritus in hemodialysis patients with the number of days of high mean 24-hour particulate matter with a diameter of <2.5 μm

    PubMed Central

    Liu, Ming-Hui; Chan, Ming-Jen; Hsu, Ching-Wei; Weng, Cheng-Hao; Yen, Tzung-Hai; Huang, Wen-Hung

    2017-01-01

    Uremic pruritus (UP) is a common and incapacitating symptom in patients undergoing hemodialysis (HD). The pathogenesis of UP is multifactorial and complex. Particulate matter (PM), a major air pollutant, is a mixture of particles with various chemical compositions. PM is associated with several allergic diseases, including dermatitis. To assess the role of PM (PM with a diameter of <10 μm [PM10] and PM with a diameter of <2.5 μm [PM2.5]) and other clinical variables in UP in patients on HD, we recruited 866 patients on maintenance HD (MHD). We analyzed the number of days of mean 24-hour PM10 ≥125 μg/m3/12 months (NDPM10) or the number of days of mean 24-hour PM2.5 ≥35 μg/m3/12 months (NDPM2.5) exceeding the standard level in the past 12 months respectively to determine the association with UP. In a multivariate logistic regression, HD duration, serum ferritin levels, low-density lipoprotein (LDL) levels, and NDPM2.5 ≥116 days/12 months were positively associated with UP. This cross-sectional study showed that the number of days on which the environmental PM2.5 exceeds the standard level might be associated with UP in patients on MHD. PMID:28260912

  13. Communication in acute ambulatory care.

    PubMed

    Dean, Marleah; Oetzel, John; Sklar, David P

    2014-12-01

    Effective communication has been linked to better health outcomes, higher patient satisfaction, and treatment adherence. Communication in ambulatory care contexts is even more crucial, as providers typically do not know patients' medical histories or have established relationships, conversations are time constrained, interruptions are frequent, and the seriousness of patients' medical conditions may create additional tension during interactions. Yet, health communication often unduly emphasizes information exchange-the transmission and receipt of messages leading to a mutual understanding of a patient's condition, needs, and treatments. This approach does not take into account the importance of rapport building and contextual issues, and may ultimately limit the amount of information exchanged.The authors share the perspective of communication scientists to enrich the current approach to medical communication in ambulatory health care contexts, broadening the under standing of medical communication beyond information exchange to a more holistic, multilayered viewpoint, which includes rapport and contextual issues. The authors propose a socio-ecological model for understanding communication in acute ambulatory care. This model recognizes the relationship of individuals to their environment and emphasizes the importance of individual and contextual factors that influence patient-provider interactions. Its key elements include message exchange and individual, organizational, societal, and cultural factors. Using this model, and following the authors' recommendations, providers and medical educators can treat communication as a holistic process shaped by multiple layers. This is a step toward being able to negotiate conflicting demands, resolve tensions, and create encounters that lead to positive health outcomes.

  14. Learning From Errors in Ambulatory Pediatrics

    DTIC Science & Technology

    2005-01-01

    355 Learning from Errors in Ambulatory Pediatrics Julie J. Mohr, Carole M. Lannon, Kathleen A. Thoma, Donna Woods, Eric J. Slora, Richard C...Wasserman, Lynne Uhring Abstract Background: Approximately 70 percent of pediatric care occurs in ambulatory settings, yet there has been little...research on errors and harm in these settings. Given the importance of understanding harm in ambulatory pediatrics , this study was funded by the Agency

  15. The association of night-time systolic blood pressure with ultrasound markers of subclinical cardiac and vascular disease

    PubMed Central

    Ho, Emily; Dolan, Eamon; Curtin, Ronan J.; Kearney, Patricia M.

    2017-01-01

    Introduction The aim of this study was to examine the association of night-time systolic blood pressure (BP) with subclinical cardiac dysfunction measured by global longitudinal strain (GLS) and subclinical vascular damage measured by carotid intima–media thickness (CIMT) and carotid plaques. Methods GLS was measured by speckle-tracking analysis of echocardiogram images. CIMT was measured at the distal 1 cm of the common carotid artery. The presence of carotid plaques was recorded. Philips QLAB cardiac and vascular ultrasound quantification software was used for analysis. The association of night-time systolic BP with GLS, CIMT and carotid plaques was assessed using linear and logistic regression. Results Fifty (response rate 63%) individuals took part in this study. In univariable models, night-time systolic BP was significantly associated with GLS [β coefficient 0.85 for every 10 mmHg increase, 95% confidence interval (CI): 0.3–1.4] and carotid plaques (odds ratio 1.9 for every 10 mmHg increase, 95% CI: 1.1–3.2). Univariable analysis of daytime systolic BP did not show any statistically significant associations. In age-adjusted and sex-adjusted models, the association for night-time systolic BP and GLS remained significant (β coefficient 0.68 for every 10 mmHg increase, 95% CI: 0.1–1.3). The association for carotid plaques was no longer statistically significant. In multivariable models, findings were diminished. Discussion Our results suggest a trend towards an association between night-time systolic BP and subclinical cardiac and vascular disease. When assessing ambulatory blood pressure monitoring results, the absolute night-time systolic BP seems to be a better prognostic parameter than daytime systolic BP, but ultimately a large randomised controlled trial involving chronotherapy is necessary to fully address this. PMID:27845956

  16. 24-hour urinary aldosterone excretion test

    MedlinePlus

    ... sodium is in your diet Whether your kidneys work properly The condition being diagnosed Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your doctor ...

  17. Long-term EEG in adults: sleep-deprived EEG (SDE), ambulatory EEG (Amb-EEG) and long-term video-EEG recording (LTVER).

    PubMed

    Michel, V; Mazzola, L; Lemesle, M; Vercueil, L

    2015-03-01

    Long-term EEG in adults includes three modalities: sleep deprived-EEG lasting 1 to 3 hours, 24 hours ambulatory-EEG and continuous prolonged video-EEG lasting from several hours to several days. The main indications of long-term EEG are: syndromic classification of epilepsy; search for interictal discharges when epilepsy is suspected or for the purpose of therapeutic evaluation; positive diagnosis of paroxysmal clinical events; and pre-surgical evaluation of drug-resistant epilepsy. Sleep deprived-EEG and ambulatory-EEG are indicated to detect interictal discharges in order to validate a syndromic classification of epilepsy when standard EEG is negative. These exams can help in evaluating treatment efficacy, especially when clinical evaluation is difficult. Long-term video EEG is indicated for drug-resistant epilepsy, to analyze electro-clinical correlations in a pre-surgical evaluation context, and to refine a positive diagnosis when paroxysmal clinical events are frequent.

  18. Cross-Sectional Study of 24-Hour Urinary Electrolyte Excretion and Associated Health Outcomes in a Convenience Sample of Australian Primary Schoolchildren: The Salt and Other Nutrients in Children (SONIC) Study Protocol

    PubMed Central

    Baxter, Janet R; Campbell, Karen J; Riddell, Lynn J; Rigo, Manuela; Liem, Djin Gie; Keast, Russell S; He, Feng J; Nowson, Caryl A

    2015-01-01

    Background Dietary sodium and potassium are involved in the pathogenesis of cardiovascular disease. Data exploring the cardiovascular outcomes associated with these electrolytes within Australian children is sparse. Furthermore, an objective measure of sodium and potassium intake within this group is lacking. Objective The primary aim of the Salt and Other Nutrient Intakes in Children (“SONIC”) study was to measure sodium and potassium intakes in a sample of primary schoolchildren located in Victoria, Australia, using 24-hour urine collections. Secondary aims were to identify the dietary sources of sodium and potassium, examine the association between these electrolytes and cardiovascular risk factors, and assess children’s taste preferences and saltiness perception of manufactured foods. Methods A cross-sectional study was conducted in a convenience sample of schoolchildren attending primary schools in Victoria, Australia. Participants completed one 24-hour urine collection, which was analyzed for sodium, potassium, and creatinine. Completeness of collections was assessed using collection time, total volume, and urinary creatinine. One 24-hour dietary recall was completed to assess dietary intake. Other data collected included blood pressure, body weight, height, waist and hip circumference. Children were also presented with high and low sodium variants of food products and asked to discriminate salt level and choose their preferred variant. Parents provided demographic information and information on use of discretionary salt. Descriptive statistics will be used to describe sodium and potassium intakes. Linear and logistic regression models with clustered robust standard errors will be used to assess the association between electrolyte intake and health outcomes (blood pressure and body mass index/BMI z-score and waist circumference) and to assess differences in taste preference and discrimination between high and low sodium foods, and correlations between

  19. The relationship between dietary salt intake and ambulatory blood pressure variability in non-diabetic hypertensive patients.

    PubMed

    Ozkayar, Nihal; Dede, Fatih; Ates, Ihsan; Akyel, Fatma; Yildirim, Tolga; Altun, Bulent

    High dietary salt intake was reported to increase blood pressure by numerous studies, but no study has investigated the effect of dietary salt intake on blood pressure variability (BPV). This study aimed to determine if daily salt intake is related to ambulatory BPV. The study included 136 primary hypertensive patients (92 male, 44 female) with a mean age of 50.7±11.1 years. All the patients underwent 24-h ambulatory blood pressure monitoring to determine both the 24-h systolic and 24-h diastolic BPV. 24-h urine sodium was measured. The correlation between BPV and 24-h urinary sodium was investigated. Logarithmic transformation of 24-h urinary sodium [log(24-h urinary sodium)] was positively correlated with the mean 24-h systolic ARV, and nighttime systolic ARV (r=0.371 and p=0.001, r=0.329 and p=0.028, respectively). Similarly, log(24-h urinary sodium) was positively correlated with mean 24-h diastolic ARV and nighttime diastolic ARV (r=0.381 and p=0.001, r=0.320 and p=0.020 respectively). Log(24-h urinary sodium) was an independent predictor of BPV based on multivariate regression analysis. Dietary salt intake might play a role in the pathogenesis of ambulatory BPV.

  20. Metadata - National Hospital Ambulatory Medical Care Survey (NHAMCS)

    EPA Pesticide Factsheets

    The National Hospital Ambulatory Medical Care Survey (NHAMCS) is designed to collect information on the services provided in hospital emergency and outpatient departments and in ambulatory surgery centers.

  1. Exposure to Racial Discrimination and Ambulatory Blood Pressure in Women with Type 2 Diabetes.

    PubMed

    Wagner, Julie; Tennen, Howard; Finan, Patrick; Feinn, Richard; Burg, Matthew M; Seawell, Asani; White, William B

    2016-10-01

    Diabetes is the only disorder in which women's risk for heart disease exceeds men's. Elevated blood pressure (BP) increases cardiovascular risk in people with type 2 diabetes. Racial discrimination and neuroticism are both associated with BP levels but have not been examined in concert. This study investigated self-reported racial discrimination, neuroticism and ambulatory BP in women with type 2 diabetes. Thirty-nine Black and 38 White women completed a race-neutral version of the Schedule of Racist Events; BP was evaluated using ambulatory monitoring devices. Actigraphy and diaries were used to document times of sleep and wakefulness. Racial discrimination interacted with neuroticism to predict systolic and diastolic BP both while awake and during sleep, after adjustment for covariates. For each, the influence of racist events was stronger at lower levels of neuroticism. Racial discrimination is associated with higher levels of 24-h BP in diabetic women who are low in neuroticism. Copyright © 2015 John Wiley & Sons, Ltd.

  2. A single session of low-volume high-intensity interval exercise reduces ambulatory blood pressure in normotensive males.

    PubMed

    Dantas, Teresa C B; Farias Júnior, Luiz F; Frazão, Danniel T; Silva, Paulo H M; Sousa Junior, Altieres E; Costa, Ingrid B B; Ritti-Dias, Raphael M; Forjaz, Cláudia L M; Duhamel, Todd A; Costa, Eduardo C

    2016-10-17

    The magnitude and duration of post-exercise hypotension (PEH) may provide valuable information on the efficacy of an exercise approach to blood pressure (BP) control. We investigated the acute effect of a time-efficient high-intensity interval exercise (HIIE) on ambulatory BP. Twenty-one normotensive males (23.6 ± 3.6 years) completed two experimental sessions in a randomized order: 1) control (no exercise); and 2) low-volume HIIE: 10 x 1 min at 100% of maximal treadmill velocity interspersed with 1 min of recovery. After each experimental session, an ambulatory BP monitoring was initiated. Paired sample t-test was used to compare BP averages for awake, asleep and 20h periods between the control and the low-volume HIIE sessions. A two-way repeated measures ANOVA was used to analyze hourly BP following both experimental sessions. BP averages during the awake (systolic: 118 ± 6 vs. 122 ± 6 mmHg; diastolic: 65 ± 7 vs. 67 ± 7 mmHg) and 20h (systolic: 115 ± 7 vs. 118 ± 6 mmHg; diastolic: 62 ± 7 vs. 64 ± 7 mmHg) periods were lower following the low-volume HIIE compared to the control (p<0.05). Systolic and diastolic PEH presented medium (Cohen's d = 0.50-0.67) and small (Cohen's d = 0.29) effect sizes, respectively. Systolic PEH occurred in a greater magnitude during the first five hours (3-5 mmHg). No changes were found in asleep BP (p>0.05). In conclusion, a single session of low-volume HIIE reduced ambulatory BP in normotensive males. PEH occurred mainly in systolic BP during the first five hours post-exercise.

  3. Big Data and Ambulatory Care

    PubMed Central

    Thorpe, Jane Hyatt; Gray, Elizabeth Alexandra

    2015-01-01

    Big data is heralded as having the potential to revolutionize health care by making large amounts of data available to support care delivery, population health, and patient engagement. Critics argue that big data's transformative potential is inhibited by privacy requirements that restrict health information exchange. However, there are a variety of permissible activities involving use and disclosure of patient information that support care delivery and management. This article presents an overview of the legal framework governing health information, dispels misconceptions about privacy regulations, and highlights how ambulatory care providers in particular can maximize the utility of big data to improve care. PMID:25401945

  4. [The influence of citoflavin on molecular mechanisms of hypertensive encephalopathy development in patients with systolic arterial hypertension].

    PubMed

    Kartashova, E A; Romantsov, M G; Sarvilina, I V

    2014-01-01

    The molecular pharmacological effects of cytoflavin in patients with hypertensive encephalopathy (HE) and isolated systolic arterial hypertension (ISAH) have been investigated using the following methods: assessment of complaints, 24-hour arterial pressure monitoring, ultrasound diagnostics including echocardiography, measurement of lipid profiles and coagulograms, and molecular phenotyping by MALDI-TOF/TOF-MS. A combination of cytoflavin administration with standard therapy of HE and ISAH led to the most expressed return development of clinical symptoms, restoration of the hemodynamic, structural, and geometrical parameters of cardiovascular system, and normalization of the indices of lipid profiles and coagulograms in comparison to patients with HE and ISAH, which accepted only standard therapy. Molecular mechanisms of cytoflavin action have been revealed, which include control of the activity of cellular signaling pathways by means of intermolecular interactions. The optimized therapy of HE and ISAH is recommended for clinical application, which assumes a combined use of standard therapy and cytoflavin and provides a geroprotective action upon the cardiovascular system.

  5. Fasting in paediatric ambulatory surgery.

    PubMed

    Klemetti, Seija; Suominen, Tarja

    2008-02-01

    The purpose of this descriptive study was to examine how preoperative fasting and postoperative termination of the fast was experienced in ambulatory surgery by child patients and their mothers. The target group consisted of children (n = 12, age 2-10 years) who had undergone tonsillectomy/adenoidectomy, and their mothers. In the interviews, the mothers were asked to describe the problems connected with their child's preoperative fast and postoperative termination of the fast, as well as the things that went well in the process. Content analysis was carried out inductively. Preoperatively, the children were thirsty and anxious, but understood the fasting situation well. In some cases, there were conflicts between the child and his/her parent if fasting was prolonged. Parents also had doubts about their ability to implement the child's fast. Postoperatively, children had pains in their throats and stomachs, suffered from nausea, and had difficulty taking in nutrition and medication. Parents had worries about their child's home care, such as food intake and administration of pain medication. The possibility of postoperative bleeding and exacerbation of the child's condition was also worrying for the parents. The most evident result of the study was that parents need more information before their child's operation. Preparing the child for the operation by giving him/her nutrition as long as permitted enhances postoperative recovery and improves parents' control over the ambulatory surgical experience. Nurses should take a more active part in children's perioperative fasting and preoperative preparation of children and their parents. In further research, experimental studies should be designed in order to receive more evidence-based information for clinical practice.

  6. Helping You Choose Quality Ambulatory Care

    MedlinePlus

    ... Quality Check ® at www. qualitycheck. org to find Joint Commission accredited ambulatory care centers. • Can you get a ... Helping Your Choose series is published by The Joint Commission, the largest health care accrediting body in the ...

  7. Ambulatory cleft lip surgery: A value analysis

    PubMed Central

    Arneja, Jugpal S; Mitton, Craig

    2013-01-01

    BACKGROUND: Socialized health systems face fiscal constraints due to a limited supply of resources and few reliable ways to control patient demand. Some form of prioritization must occur as to what services to offer and which programs to fund. A data-driven approach to decision making that incorporates outcomes, including safety and quality, in the setting of fiscal prudence is required. A value model championed by Michael Porter encompasses these parameters, in which value is defined as outcomes divided by cost. OBJECTIVES: To assess ambulatory cleft lip surgery from a quality and safety perspective, and to assess the costs associated with ambulatory cleft lip surgery in North America. Conclusions will be drawn as to how the overall value of cleft lip surgery may be enhanced. METHODS: A value analysis of published articles related to ambulatory cleft lip repair over the past 30 years was performed to determine what percentage of patients would be candidates for ambulatory cleft lip repair from a quality and safety perspective. An economic model was constructed based on costs associated with the inpatient stay related to cleft lip repair. RESULTS: On analysis of the published reports in the literature, a minority (28%) of patients are currently discharged in an ambulatory fashion following cleft lip repair. Further analysis suggests that 88.9% of patients would be safe candidates for same-day discharge. From an economic perspective, the mean cost per patient for the overnight admission component of ambulatory cleft surgery to the health care system in the United States was USD$2,390 and $1,800 in Canada. CONCLUSIONS: The present analysis reviewed germane publications over a 30-year period, ultimately suggesting that ambulatory cleft lip surgery results in preservation of quality and safety metrics for most patients. The financial model illustrates a potential cost saving through the adoption of such a practice change. For appropriately selected patients, ambulatory

  8. Automated measurement of office, home and ambulatory blood pressure in atrial fibrillation.

    PubMed

    Kollias, Anastasios; Stergiou, George S

    2014-01-01

    1. Hypertension and atrial fibrillation (AF) often coexist and are strong risk factors for stroke. Current guidelines for blood pressure (BP) measurement in AF recommend repeated measurements using the auscultatory method, whereas the accuracy of the automated devices is regarded as questionable. This review presents the current evidence on the feasibility and accuracy of automated BP measurement in the presence of AF and the potential for automated detection of undiagnosed AF during such measurements. 2. Studies evaluating the use of automated BP monitors in AF are limited and have significant heterogeneity in methodology and protocols. Overall, the oscillometric method is feasible for static (office or home) and ambulatory use and appears to be more accurate for systolic than diastolic BP measurement. 3. Given that systolic hypertension is particularly common and important in the elderly, the automated BP measurement method may be acceptable for self-home and ambulatory monitoring, but not for professional office or clinic measurement. 4. An embedded algorithm for the detection of asymptomatic AF during routine automated BP measurement with high diagnostic accuracy has been developed and appears to be a useful screening tool for elderly hypertensives.

  9. Renal sympathetic denervation in patients with treatment-resistant hypertension after witnessed intake of medication before qualifying ambulatory blood pressure.

    PubMed

    Fadl Elmula, Fadl Elmula Mohamed; Hoffmann, Pavel; Fossum, Eigil; Brekke, Magne; Gjønnæss, Eyvind; Hjørnholm, Ulla; Kjær, Vibeke N; Rostrup, Morten; Kjeldsen, Sverre E; Os, Ingrid; Stenehjem, Aud-E; Høieggen, Aud

    2013-09-01

    It is unknown whether the decline in blood pressure (BP) after renal denervation (RDN) is caused by denervation itself or concomitantly improved drug adherence. We aimed to investigate the BP lowering effect of RDN in true treatment-resistant hypertension by excluding patients with poor drug adherence. Patients with resistant hypertension (n=18) were referred for a thorough clinical and laboratory work-up. Treatment-resistant hypertension was defined as office systolic BP>140 mm Hg, despite maximally tolerated doses of ≥ 3 antihypertensive drugs, including a diuretic. In addition, ambulatory daytime systolic BP>135 mm Hg was required after witnessed intake of antihypertensive drugs to qualify. RDN (n=6) was performed with Symplicity Catheter System. The mean office and ambulatory BPs remained unchanged at 1, 3, and 6 months in the 6 patients, whereas there was no known change in antihypertensive medication. Two patients, however, had a fall in both office and ambulatory BPs. Our findings question whether BP falls in response to RDN in patients with true treatment-resistant hypertension. Additional research must aim to verify potential BP lowering effect and identify a priori responders to RDN before this invasive method can routinely be applied to patients with drug-resistant hypertension. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT01673516.

  10. Long-Term Continuous Ambulatory ECG Monitors and External Cardiac Loop Recorders for Cardiac Arrhythmia: A Health Technology Assessment

    PubMed Central

    Kabali, Conrad; Xie, Xuanqian; Higgins, Caroline

    2017-01-01

    Background Ambulatory electrocardiography (ECG) monitors are often used to detect cardiac arrhythmia. For patients with symptoms, an external cardiac loop recorder will often be recommended. The improved recording capacity of newer Holter monitors and similar devices, collectively known as longterm continuous ambulatory ECG monitors, suggests that they will perform just as well as, or better than, external loop recorders. This health technology assessment aimed to evaluate the effectiveness, cost-effectiveness, and budget impact of longterm continuous ECG monitors compared with external loop recorders in detecting symptoms of cardiac arrhythmia. Methods Based on our systematic search for studies published up to January 15, 2016, we did not identify any studies directly comparing the clinical effectiveness of longterm continuous ECG monitors and external loop recorders. Therefore, we conducted an indirect comparison, using a 24-hour Holter monitor as a common comparator. We used a meta-regression model to control for bias due to variation in device-wearing time and baseline syncope rate across studies. We conducted a similar systematic search for cost-utility and cost-effectiveness studies comparing the two types of devices; none were found. Finally, we used historical claims data (2006–2014) to estimate the future 5-year budget impact in Ontario, Canada, of continued public funding for both types of longterm ambulatory ECG monitors. Results Our clinical literature search yielded 7,815 non-duplicate citations, of which 12 cohort studies were eligible for indirect comparison. Seven studies assessed the effectiveness of longterm continuous monitors and five assessed external loop recorders. Both types of devices were more effective than a 24-hour Holter monitor, and we found no substantial difference between them in their ability to detect symptoms (risk difference 0.01; 95% confidence interval −0.18, 0.20). Using GRADE for network meta-analysis, we evaluated the

  11. Methodological Considerations in Ambulatory Skin Conductance Monitoring

    PubMed Central

    Doberenz, Sigrun; Roth, Walton T.; Maslowski, Nina I.; Wollburg, Eileen; Kim, Sunyoung

    2011-01-01

    Little is known how much skin conductance (SC) recordings from the fingers are affected by factors such as electrode site deterioration, ambient temperature (TMP), or physical activity (ACT), or by age, sex, race, or body mass index. We recorded SC, TMP, and ACT in 48 healthy control subjects for a 24-hour period, and calculated SC level (SCL), its standard deviation, the coefficient of SC variation, and frequency and amplitude of non-specific SC fluctuations. One method of assessing electrode site deterioration showed an average decline of 20 %, while a second method found no significant change. All SC measures were higher during waking than sleep. Other factors influenced different measures in different ways. Thus, 24-hour SC recording outside the laboratory is feasible, but some measures need to be corrected for the influence of confounding variables. PMID:21320551

  12. Ambulatory blood pressure monitoring in a nonacademic setting. Effects of age and sex.

    PubMed

    Khoury, S; Yarows, S A; O'Brien, T K; Sowers, J R

    1992-09-01

    Twenty-four-hour ambulatory blood pressure measurements (ABPM) are likely to eliminate the stress of visits and observer bias in office blood pressure (BP) recordings, allow consideration of the circadian variability in BP, and correlate well with target organ damage. To define the prevalence of "white coat" hypertension in a rural community to a nonacademic setting, and to assess age and sex related differences, we studied 131 patients who had more than two prior office diastolic BP measurements greater than 90 mm Hg and less than 115 mm Hg. Blood pressure was measured every 10 to 60 min for 24 h using the SpaceLabs 90207 device. Office BP readings were higher than ABPM in the group as a whole, in individual age groups, and in both sexes. The differences were more pronounced at night. Average differences between office and ambulatory BP ranged between 14.4 +/- 1.7/2.9 +/- 2.0 (ABPM at 10:00), and 33.8 +/- 2.3/22.8 +/- 1.5 mm Hg (systolic/diastolic +/- SE) (ABPM at 01:00). The nighttime drop in systolic BP was not apparent in subjects more than 65 years old. Women had a proportionately higher mean office BP than men (115.0 +/- 0.9 office v 110.2 +/- 1.3 mm Hg ABPM in women and 112.3 +/- 0.9 v 104.3 +/- 1.1 mm Hg in men) (P = .013), and the elderly did not display the relationship between ambulatory and office mean BP seen in younger subjects (r = 0.15, P = .30 v r = 0.36, P = .0004, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

  13. Comparison of thrombolysis in myocardial infarction, Global Registry of Acute Coronary Events, and Acute Physiology and Chronic Health Evaluation II risk scores in patients with acute myocardial infarction who require mechanical ventilation for more than 24 hours.

    PubMed

    Eran, Oren; Novack, Victor; Gilutz, Harel; Zahger, Doron

    2011-02-01

    The ability to provide an accurate prognosis in an intensive care unit is of major importance. Numerous risk scores have been developed to predict hospital mortality based on demographic, physiologic, and clinical data. These scores were universally developed in general medical or surgical intensive care units. Patients admitted to a cardiac care unit differ in many aspects from those admitted to general medical intensive care units. Few patients require mechanical ventilation and prolonged intensive care. Performance of risk scores developed for patients with acute myocardial infarction (AMI) in this subgroup is unknown. We prospectively studied 51 consecutive patients who were admitted to a cardiac care unit from September 2006 to March 2008 for AMI and received mechanical ventilation for >24 hours. Acute Physiology and Chronic Health Evaluation II (APACHE II), Thrombolysis In Myocardial Infarction, and Global Registry of Acute Coronary Events risk scores were calculated for each patient. Mortality rates were extrapolated based on these 3 risk scores. Twenty-two of 51 patients (43%) died in hospital. Age, mean arterial pressure, urea, albumin, hemoglobin, need for vasopressors, and estimated glomerular filtration rate were predictive of mortality. APACHE II and Global Registry of Acute Coronary Events scores were higher in nonsurvivors but Thrombolysis In Myocardial Infarction risk score was not predictive of mortality. APACHE II score had the highest value for area under receiver operator characteristics curve for mortality prediction. In conclusion, patients with AMI requiring mechanical ventilation have a high mortality rate. This risk is predicted by co-morbidities better than by direct cardiac parameters. Consequently, conventional AMI risk scores do not perform well in this very sick population and the APACHE II score better predicts their short-term outcome.

  14. Predicting ambulatory blood pressure during school: effectiveness of social and nonsocial reactivity tasks in black and white adolescents.

    PubMed

    Ewart, C K; Kolodner, K B

    1993-01-01

    We evaluated a newly developed stress task, the Social Competence Interview, and three nonsocial tasks (video game, mirror drawing, mental arithmetic) for ability to predict ambulatory blood pressure in 237 black and white adolescents. Blood pressure was measured in laboratory, classroom, and transition (between-class) settings. A resting laboratory baseline explained 10-49% of the variance in ambulatory blood pressure levels; the ability of the stress tasks to explain additional variance was assessed in multiple regression analyses. Only the blood pressure response to the interview enhanced prediction of classroom and transition systolic and diastolic pressures in the total sample and in blacks, whites, females, and males--even when the interview data were entered into a hierarchical regression model after those for the other three tasks were entered. Mirror drawing improved prediction of transition systolic blood pressure in the total sample, and mental arithmetic plus the interview improved prediction of classroom diastolic pressure in black males; however, video game failed to enter any predictive equation. Racial subgroup analyses disclosed that the interview data predicted systolic pressure in whites but predicted diastolic pressure in blacks, indicating biological differences in blood pressure regulation. An interview that elicits characteristic thoughts and social behaviors appears to represent a promising approach to examining environmental influences on blood pressure.

  15. What are the approaches for evaluating antihypertensive treatment by 24 h ambulatory blood pressure monitoring?

    PubMed

    Neutel, J M; Smith, D H; Weber, M A

    1999-01-01

    Measurements of trough blood pressure in a clinic setting have been the traditional method of assessing the efficacy of antihypertensive agents. The duration of action of antihypertensive drugs has been assessed by calculation of a trough-to-peak ratio; drugs with a trough-to-peak ratio greater than 50% are typically given once-a-day indications. However, the use of clinical measurements to assess antihypertensive agents can be misleading. Ambulatory blood pressure monitoring is a simple technique that provides accurate and reproducible data on both the efficacy and duration of action of antihypertensive agents. Although several complicated techniques have been used for the analysis of ambulatory blood pressure data, studies have demonstrated that calculation of simple blood pressure means (24 h mean, day-time mean and night-time mean) will provide all the data required to assess the efficacy of a drug. Calculations of systolic and diastolic load also provide useful information, and the index correlates closely with target-organ damage. Assessing the reduction of blood pressure during the last 2-6 h of the dosing interval provides critical information on the duration of action of agents with once-a-day dosing. Trough-to-peak ratio can also be calculated from an ambulatory blood pressure monitor. Furthermore, a simple line graph constructed from hourly means makes available, at a simple glance, a large amount of information about a drug. The reproducibility of ambulatory monitoring, together with the absence of placebo effect and the ability to exclude patients with white-coat hypertension, make the technique an extremely powerful tool for the assessment of antihypertensive agents that clearly provides more data on the efficacy and duration of action of an antihypertensive agent than do traditional clinical measurements.

  16. Temporal Differential Gene Expression in Explanted Human Retinal Pigment Epithelial Cells at 0.5, 1.0, 3.0, 6.0, 12 and 24 Hours Post-Exposure to 1064 nm, 3.6 ns Pulsed Laser Light

    DTIC Science & Technology

    2005-05-01

    USAFA TR 2005-05 Temporal Differential Gene Expression in Explanted Human Retinal Pigment Epithelial Cells at 0.5, 1.0, 3.0, 6.0, 12 and 24 Hours...AIR FORCE ACADEMY COLORADO 80840 20050630 417 USAFA TR 2005-05 This article, "Temporal Differential Gene Expression in Explanted Human Retinal ...Differential Gene Expression in Explanted Human Retinal Pigment USAFA F05611-02-P-0471 Epithelial Cells at 0.5, 1.0, 3.0, 6.0, 12 and 24-Hours Post-Exposure

  17. New horizons in ambulatory electroencephalography.

    PubMed

    Waterhouse, Elizabeth

    2003-01-01

    Since its inception 30 years ago, AEEG has continued to evolve--from four-channel tape recorders to 32-channel digital recorders with sophisticated automatic spike and seizure detection algorithms. AEEG remains an important tool in epilepsy evaluation. In the near future, smaller, faster, and more sophisticated AEEGs will be developed. Seizure detection/anticipation systems will allow the wearer to be forewarned of a seizure so that appropriate safety measures can be taken. With further refinement in our understanding of nonlinear dynamic analysis to define the pre-ictal state, AEEG will be coupled with an accurate seizure anticipation device in a closed-loop system, providing a time window during which therapeutic intervention can occur, to prevent a seizure. The therapeutic intervention will most likely involve vagus nerve or deep brain stimulation. An alternative is that the patient may learn to recognize early symptoms of the pre-ictal state and use behavioral biofeedback interventions to avoid a clinical seizure. In order to achieve convenient ambulatory recording and seizure detection that could realistically improve the lives of patients with refractory epilepsy, the process of miniaturization of such a device to a convenient size must be accomplished. One of the aspects of epilepsy that patients find most frustrating, and that most limits activities, is the vulnerability to sudden unexpected incapacitation due to the occurrence of a seizure. With miniaturization of AEEG and seizure anticipation technology, and advancements in our ability to identify the transition from pre-ictal to ictal state, there is realistic hope that patients with refractory epilepsy may gain control over their seizures and enjoy significantly improved quality of life.

  18. The Preoperative Patient With a Systolic Murmur

    PubMed Central

    Cowie, Brian

    2015-01-01

    Context: Patients with undifferentiated systolic murmurs present commonly during the perioperative period. Traditional bedside assessment and auscultation has not changed significantly in almost 200 years and relies on interpreting indirect acoustic events as a means of evaluating underlying cardiac pathology. This is notoriously inaccurate, even in expert cardiology hands, since many different valvular and cardiac diseases present with a similar auditory signal. Evidence Acquisition: The data on systolic murmurs, physical examination, perioperative valvular disease in the setting of non-cardiac surgery is reviewed. Results: Significant valvular heart disease increases perioperative risk in major non-cardiac surgery and increases long term patient morbidity and mortality. We propose a more modern approach to physical examination that incorporates the use of focused echocardiography to allow direct visualization of cardiac structure and function. This improves the diagnostic accuracy of clinical assessment, allows rational planning of surgery and anaesthesia technique, risk stratification, postoperative monitoring and appropriate referral to physicians and cardiologists. Conclusions: With a thorough preoperative assessment incorporating focused echocardiography, anaesthetists are in the unique position to enhance their role as perioperative physicians and influence short and long term outcomes of their patients. PMID:26705529

  19. Diagnostic Errors in Ambulatory Care: Dimensions and Preventive Strategies

    ERIC Educational Resources Information Center

    Singh, Hardeep; Weingart, Saul N.

    2009-01-01

    Despite an increasing focus on patient safety in ambulatory care, progress in understanding and reducing diagnostic errors in this setting lag behind many other safety concerns such as medication errors. To explore the extent and nature of diagnostic errors in ambulatory care, we identified five dimensions of ambulatory care from which errors may…

  20. Ambulatory blood pressure monitoring during pregnancy with a new, small, easily concealed monitor.

    PubMed

    Tape, T G; Rayburn, W F; Bremer, K D; Schnoor, T A

    1994-12-01

    Before establishing the utility of ambulatory blood pressure monitoring during pregnancy, we evaluated the accuracy of a small, easily concealed monitor. The 59 normotensive pregnant patients were between 13 and 26 gestational weeks. For each monitor reading, two trained observers independently and simultaneously recorded blood pressures using a mercury manometer connected to the monitor cuff. Seven readings in three positions (sitting upright, semirecumbent, standing) were performed on each patient. Averaged differences between the observers' and monitor readings varied from -2.2 to -0.9 mm Hg (systolic) and from -2.8 to -0.6 (fifth-phase diastolic), indicating slight but clinically unimportant overestimation by the monitor. Correlations between averaged observers' readings and the monitor ranged from 0.79 to 0.92 (systolic) and from 0.85 to 0.92 (fifth-phase diastolic). Overall, the observers agreed with the monitor within 5 mm Hg on 94% of systolic readings and 99% of fifth-phase diastolic readings. There was no statistically significant difference in accuracy with changes in body position. We conclude that this small, quiet, noninvasive device accurately determined blood pressures during pregnancy.

  1. Correlations of plasma renin activity and aldosterone concentration with ambulatory blood pressure responses to nebivolol and valsartan, alone and in combination, in hypertension.

    PubMed

    Giles, Thomas D; Bakris, George; Oparil, Suzanne; Weber, Michael A; Li, Huiling; Mallick, Madhuja; Bharucha, David B; Chen, ChunLin; Ferguson, William G

    2015-11-01

    After demonstration of the antihypertensive efficacy of the combination of the beta-blocker nebivolol and the angiotensin receptor blocker valsartan in an 8-week, randomized, placebo-controlled trial (N = 4161), we now report the effects of this treatment on the renin-angiotensin-aldosterone system in a substudy (n = 805). Plasma renin activity increased with valsartan (54%-73%) and decreased with nebivolol (51%-65%) and the combination treatment (17%-39%). Plasma aldosterone decreased with individual treatments (valsartan, 11%-22%; nebivolol, 20%-26%), with the largest reduction (35%) observed with maximum combination dose (20 mg nebivolol/320 mg valsartan). Baseline ln(plasma renin activity) correlated with the 8-week reductions in 24-hour systolic and diastolic BP following treatments with the combination (all doses combined, P = .003 and P < .001) and nebivolol (both, P < .001), but not with valsartan. Baseline ln(aldosterone) correlated with 24-hour systolic and diastolic BP reductions following combination treatment only (P < .001 and P = .005). The implications of the renin-angiotensin-aldosterone system effects of this beta blocker-angiotensin receptor blocker combination should be explored further.

  2. A Logical Characterization of Systolic Languages

    NASA Astrophysics Data System (ADS)

    Monti, Angelo; Peron, Adriano

    In this paper we study, in the framework of mathematical logic, ℒ(SBTA) i.e. the class of languages accepted by Systolic Binary Tree Automata. We set a correspondence (in the style of Büchi Theorem for regular languages) between ℒ(SBTA) and MSO[Sig], i.e. a decidable Monadic Second Order logic over a suitable infinite signature Sig. We also introduce a natural subclass of ℒ(SBTA) which still properly contains the class of regular languages and which is proved to be characterized by Monadic Second Order logic over a finite signature Sig' ⊂ Sig. Finally, in the style of McNaughton Theorem for star free regular languages, we introduce an expression language which precisely denotes the class of languages defined by the first order fragment of MSO[Sig'].

  3. Singular value decomposition with systolic arrays

    NASA Technical Reports Server (NTRS)

    Ipsen, I. C. F.

    1984-01-01

    Systolic arrays for determining the singular value decomposition of a mxn, m n, matrix A of bandwidth w are presented. After A has been reduced to bidiagonal form B by means of Givens plane rotations, the singular values of B are computed by the Golub-Reinsch iteration. The products of plane rotations form the matrices of left and right singular vectors. Assuming each processor can compute or supply a plane rotation, O(wn) processors accomplish the reduction to bidiagonal form in O(np) steps, where p is the number of superdiagonals. A constant number of processors then determines each singular value in about 6n steps. The singular vectors are computed by rerouting the rotations through the arrays used for the reduction to bidiagonal form, or else along the way by employing another rectangular array of O(wm) processors.

  4. Business planning for ambulatory surgical services.

    PubMed

    Burns, L A

    1987-08-01

    Successful responses to the rapid expansion of ambulatory surgical services in the United States require careful planning on the part of current and potential providers. The recommended approach to business' planning includes development of a detailed business concept, assessment of market and competitive characteristics, and analysis of current and projected financial performance.

  5. Clinical Assessment Applications of Ambulatory Biosensors

    ERIC Educational Resources Information Center

    Haynes, Stephen N.; Yoshioka, Dawn T.

    2007-01-01

    Ambulatory biosensor assessment includes a diverse set of rapidly developing and increasingly technologically sophisticated strategies to acquire minimally disruptive measures of physiological and motor variables of persons in their natural environments. Numerous studies have measured cardiovascular variables, physical activity, and biochemicals…

  6. Memo to: Ambulatory Health Care Planners.

    ERIC Educational Resources Information Center

    Educational Facilities Labs., Inc., New York, NY.

    Planning for changing types of health professions and a changing clientele necessitates designing flexible facilities. Findings from a recently completed analysis of ambulatory care facilities are directed to planners in the form of 16 memos. Approaches to planning and design considerations are made that attempt to humanize these facilities.…

  7. Ambulatory care: a decade of evolution.

    PubMed

    Welch, Leslie

    2009-01-01

    Leslie Welch, a director at HLM Architects, explains how new generation, well-equipped ambulatory and emergency care centres, a relatively new development in the UK, are offering local day care patients a holistic healthcare service in a high quality setting, while reducing pressure on general hospitals and cutting waiting times.

  8. Predicting recovery at home after Ambulatory Surgery

    PubMed Central

    2011-01-01

    The correct implementation of Ambulatory Surgery must be accompanied by an accurate monitoring of the patient post-discharge state. We fit different statistical models to predict the first hours postoperative status of a discharged patient. We will also be able to predict, for any discharged patient, the probability of needing a closer follow-up, or of having a normal progress at home. Background The status of a discharged patient is predicted during the first 48 hours after discharge by using variables routinely used in Ambulatory Surgery. The models fitted will provide the physician with an insight into the post-discharge progress. These models will provide valuable information to assist in educating the patient and their carers about what to expect after discharge as well as to improve their overall level of satisfaction. Methods A total of 922 patients from the Ambulatory Surgery Unit of the Dr. Peset University Hospital (Valencia, Spain) were selected for this study. Their post-discharge status was evaluated through a phone questionnaire. We pretend to predict four variables which were self-reported via phone interviews with the discharged patient: sleep, pain, oral tolerance of fluid/food and bleeding status. A fifth variable called phone score will be built as the sum of these four ordinal variables. The number of phone interviews varies between patients, depending on the evolution. The proportional odds model was used. The predictors were age, sex, ASA status, surgical time, discharge time, type of anaesthesia, surgical specialty and ambulatory surgical incapacity (ASI). This last variable reflects, before the operation, the state of incapacity and severity of symptoms in the discharged patient. Results Age, ambulatory surgical incapacity and the surgical specialty are significant to explain the level of pain at the first call. For the first two phone calls, ambulatory surgical incapacity is significant as a predictor for all responses except for sleep at

  9. Recursive least squares estimation and Kalman filtering by systolic arrays

    NASA Technical Reports Server (NTRS)

    Chen, M. J.; Yao, K.

    1988-01-01

    One of the most promising new directions for high-throughput-rate problems is that based on systolic arrays. In this paper, using the matrix-decomposition approach, a systolic Kalman filter is formulated as a modified square-root information filter consisting of a whitening filter followed by a simple least-squares operation based on the systolic QR algorithm. By proper skewing of the input data, a fully pipelined time and measurement update systolic Kalman filter can be achieved with O(n squared) processing cells, resulting in a system throughput rate of O (n).

  10. Accuracy of the Spacelabs 90217 Ambulatory Blood Pressure Monitor in a Pediatric Population

    PubMed Central

    Redwine, Karen M.; James, Laura P.; O'Riordan, MaryAnn; Sullivan, Janice E.; Blumer, Jeffrey L.

    2015-01-01

    Ambulatory Blood Pressure Measurement (ABPM) techniques provide unique advantages for diagnosing hypertension although few devices have been independently validated in the pediatric population. We sought to validate the accuracy of the Spacelabs 90217 ABPM in children using a modified British Hypertension Society protocol. A total of 112 children, age 6-17 years, completed the study at one of 3 participating centers. Overall, the monitor earned an “A” for systolic blood pressure and “B” for diastolic blood pressure. It performed slightly better among 6-12 year olds (“A/A”) than 13-17 year olds (“A/B”). We conclude that the Spacelabs 90217 monitor is in an appropriate monitor for use in children 6 years of age and older. PMID:26529437

  11. Bio-telemetric device for measurement of left ventricular pressure-volume loops using the admittance technique in conscious, ambulatory rats

    PubMed Central

    Raghavan, Karthik; Feldman, Marc D; Porterfield, John E; Larson, Erik R; Jenkins, J Travis; Escobedo, Daniel; Pearce, John A

    2011-01-01

    This paper presents the design, construction and testing of a device to measure pressure volume loops in the left ventricle of conscious, ambulatory rats. Pressure is measured with a standard sensor, but volume is derived from data collected from a tetrapolar electrode catheter using a novel admittance technique. There are two main advantages of the admittance technique to measure volume. First, the contribution from the adjacent muscle can be instantaneously removed. Second, the admittance technique incorporates the nonlinear relationship between the electric field generated by the catheter and the blood volume. A low power instrument weighing 27 g was designed, which takes pressure-volume loops every 2 minutes and runs for 24 hours. Pressure-volume data are transmitted wirelessly to a base station. The device was first validated in thirteen rats with an acute preparation with 2-D echocardiography used to measure true volume. From an accuracy standpoint, the admittance technique is superior to both the conductance technique calibrated with hypertonic saline injections, and calibrated with cuvettes. The device was then tested in six rats with a 24-hour chronic preparation. Stability of the animal preparation and careful calibration are important factors affecting the success of the device. PMID:21606560

  12. Galectin-3 Reflects Mitral Annular Plane Systolic Excursion Being Assessed by Cardiovascular Magnetic Resonance Imaging

    PubMed Central

    Kim, Seung-Hyun; Natale, Michele; Hoffmann, Julia; Reckord, Nadine; Hoffmann, Ursula; Budjan, Johannes; Henzler, Thomas; Papavassiliu, Theano; Borggrefe, Martin; Bertsch, Thomas; Akin, Ibrahim

    2016-01-01

    Background. This study investigates whether serum levels of galectin-3 may reflect impaired mitral annular plane systolic excursion (MAPSE) in patients undergoing cardiac magnetic resonance imaging (cMRI). Methods. Patients undergoing cMRI during routine clinical care were included prospectively within an all-comers design. Blood samples for biomarker measurements were collected within 24 hours following cMRI. Statistical analyses were performed in all patients and in three subgroups according to MAPSE (MAPSE I: ≥11 mm, MAPSE II: ≥8 mm–<11 mm, and MAPSE III: <8 mm). Patients with right ventricular dysfunction (<50%) were excluded. Results. 84 patients were included in the study. Median LVEF was 59% (IQR 51–64%). Galectin-3 correlated significantly with NT-proBNP (r = 0.42, p = 0.0001). Galectin-3 increased significantly according to the different stages of impaired MAPSE (p = 0.006) and was able to discriminate both patients with impaired MAPSE <11 mm (area under the curve (AUC) = 0.645, p = 0.024) and <8 mm (AUC = 0.733, p = 0.003). Combining galectin-3 with NT-proBNP improved discrimination of MAPSE <8 mm (AUC 0.803, p = 0.0001). In multivariable logistic regression models galectin-3 was still associated with impaired MAPSE (MAPSE < 11 mm: odds ratio (OR) = 3.53, p = 0.018; MAPSE < 8 mm: OR = 3.18, p = 0.06). Conclusions. Galectin-3 reflects MAPSE being assessed by cardiac MRI. PMID:28044067

  13. Conventional and Ambulatory Blood Pressure as Predictors of Retinal Arteriolar Narrowing.

    PubMed

    Wei, Fang-Fei; Zhang, Zhen-Yu; Thijs, Lutgarde; Yang, Wen-Yi; Jacobs, Lotte; Cauwenberghs, Nicholas; Gu, Yu-Mei; Kuznetsova, Tatiana; Allegaert, Karel; Verhamme, Peter; Li, Yan; Struijker-Boudier, Harry A J; Staessen, Jan A

    2016-08-01

    At variance with the long established paradigm that retinal arteriolar narrowing trails hypertension, several longitudinal studies, all based on conventional blood pressure (CBP) measurement, proposed that retinal arteriolar narrowing indicates heightened microvascular resistance and precedes hypertension. In 783 randomly recruited Flemish (mean age, 38.2 years; 51.3% women), we investigated to what extent CBP and daytime (10 am to 8 pm) ambulatory blood pressure (ABP) measured at baseline (1989-2008) predicted the central retinal arteriolar equivalent (CRAE) in retinal photographs obtained at follow-up (2008-2015). Systolic/diastolic hypertension thresholds were 140/90 mm Hg for CBP and 135/85 mm Hg for ABP. In multivariable-adjusted models including both baseline CBP and ABP, CRAE after 10.3 years (median) of follow-up was unrelated to CBP (P≥0.14), whereas ABP predicted CRAE narrowing (P≤0.011). Per 1-SD increment in systolic/diastolic blood pressure, the association sizes were -0.95 µm (95% confidence interval, -2.20 to 0.30)/-0.75 µm (-1.93 to 0.42) for CBP and -1.76 µm (-2.95 to -0.58)/-1.48 µm (-2.61 to -0.34) for ABP. Patients with ambulatory hypertension at baseline (17.0%) had smaller CRAE (146.5 versus 152.6 µm; P<0.001) at follow-up. CRAE was not different (P≥0.31) between true normotension (normal CBP and ABP; prevalence, 77.6%) and white-coat hypertension (elevated CBP and normal ABP, 5.4%) and between masked hypertension (normal CBP and elevated ABP, 10.2%) and hypertension (elevated CBP and ABP, 6.8%). In conclusion, the paradigm that retinal arteriolar narrowing precedes hypertension can be explained by the limitations of CBP measurement, including nonidentification of masked and white-coat hypertension.

  14. Efficient algorithm and systolic architecture for modular division

    NASA Astrophysics Data System (ADS)

    Chen, Chuanpeng; Qin, Zhongping

    2011-06-01

    A new efficient modular division algorithm suitable for systolic implementation and its systolic architecture is proposed in this article. With a new exit condition of while loop and a new updating method of a control variable, the new algorithm reduces the average of iteration numbers by more than 14.3% compared to the algorithm proposed by Chen, Bai and Chen. Based on the new algorithm, we design a fast systolic architecture with an optimised core computing cell. Compared to the architecture proposed by Chen, Bai and Chen, our systolic architecture has reduced the critical path delay by about 18% and the total computational time for one modular division by almost 30%, with the cost of about 1% more cells. Moreover, by the addition of a flag signal and three logic gates, the proposed systolic architecture can also perform Montgomery modular multiplication and a fast unified modular divider/multiplier is realised.

  15. Seasonal changes in ambulatory blood pressure in employees under different indoor temperatures.

    PubMed Central

    Kristal-Boneh, E; Harari, G; Green, M S; Ribak, J

    1995-01-01

    OBJECTIVE--The effect of indoor temperature control on summer and winter ambulatory blood pressure levels at work was studied. METHOD--Ambulatory systolic blood pressure (SBP) and diastolic blood pressure (DBP) were monitored once in summer and once in winter in 101 healthy normotensive subjects aged 28-63 years, engaged in similar physical work, from two plants with and three without air conditioning. Subjects were interviewed about health related habits, and measurements of environmental and occupational conditions were obtained. RESULTS--After controlling for possible confounders, mean SBP and DBP during work were significantly higher in winter than in summer (delta SBP = 3.4 mm Hg, P = 0.035; delta DBP = 3.3 mm Hg, P < 0.003). The seasonal change in SBP and DBP showed an independent association with the presence or absence of air conditioning of the industrial plants (SBP: beta = 0.194, P < 0.0001; DBP: beta = 0.054, P = 0.038). The percentage of subjects with increases of more than 10 mm Hg from summer to winter was higher in plants without than with air conditioning. CONCLUSIONS--(1) In normotensive subjects ambulatory working BP varies by season, with higher values in winter. If validated for hypertensive subjects, it may be necessary to tailor drug treatment to these variations. (2) The findings make it clear that drawing valid conclusions from comparisons of BPs between groups requires controlling for several factors, particularly season of the year. (3) Climatic conditions in the industrial plant influence the magnitude of seasonal variations in BP. Work in plants without air conditioning places a considerable added load on the employee's cardiovascular system. PMID:8535490

  16. Anticoagulation management in the ambulatory surgical setting.

    PubMed

    Eisenstein, Diana Hill

    2012-04-01

    Many people receiving maintenance anticoagulation therapy require surgery each year in ambulatory surgery centers. National safety organizations focus attention toward improving anticoagulation management, and the American College of Chest Physicians has established guidelines for appropriate anticoagulation management to balance the risk of thromboembolism when warfarin is discontinued with the risk of bleeding when anticoagulation therapy is maintained. The guidelines recommend that patients at high or moderate risk for thromboembolism should be bridged with subcutaneous low-molecular-weight heparin or IV unfractionated heparin with the interruption of warfarin, and low-risk patients may require subcutaneous low-molecular-weight heparin or no bridging with the interruption of warfarin. The guidelines recommend the continuation of warfarin for patients who are undergoing minor dermatologic or dental procedures or cataract removal. The literature reveals, however, that there is not adequate adherence to these recommendations and guidelines. Management of anticoagulation therapy by a nurse practitioner may improve compliance and safety in ambulatory surgery centers.

  17. Measuring and improving ambulatory surgery patients' satisfaction.

    PubMed

    Farber, Janice

    2010-09-01

    The pressure on perioperative services to improve quality for health care consumers creates both challenges and opportunities. To make positive changes, many health care organizations contract with Press Ganey (PG), which processes an extensive database of more than 9.5 million surveys annually and provides benchmark reports to same-type organizations. To measure and improve ambulatory surgery patient satisfaction at one health care network in northeastern Pennsylvania, the nursing leaders in the ambulatory surgery center and OR undertook a quality improvement project focused on educating perioperative nurses on the use of PG reports. After we reviewed the PG reports and implemented changes with nursing staff members in perioperative areas, PG patient satisfaction scores improved regarding information about delays (4.1%) and center attractiveness (0.2%).

  18. Systolic array IC for genetic computation

    NASA Astrophysics Data System (ADS)

    Anderson, D.

    Measuring similarities between large sequences of genetic information is a formidable task requiring enormous amounts of computer time. Geneticists claim that nearly two months of CRAY-2 time are required to run a single comparison of the known database against the new bases that will be found this year, and more than a CRAY-2 year for next year's genetic discoveries, and so on. The DNA IC, designed at HP-ICBD in cooperation with the California Institute of Technology and the Jet Propulsion Laboratory, is being implemented in order to move the task of genetic comparison onto workstations and personal computers, while vastly improving performance. The chip is a systolic (pumped) array comprised of 16 processors, control logic, and global RAM, totaling 400,000 FETS. At 12 MHz, each chip performs 2.7 billion 16 bit operations per second. Using 35 of these chips in series on one PC board (performing nearly 100 billion operations per second), a sequence of 560 bases can be compared against the eventual total genome of 3 billion bases, in minutes--on a personal computer. While the designed purpose of the DNA chip is for genetic research, other disciplines requiring similarity measurements between strings of 7 bit encoded data could make use of this chip as well. Cryptography and speech recognition are two examples. A mix of full custom design and standard cells, in CMOS34, were used to achieve these goals. Innovative test methods were developed to enhance controllability and observability in the array. This paper describes these techniques as well as the chip's functionality. This chip was designed in the 1989-90 timeframe.

  19. Systolic array IC for genetic computation

    NASA Technical Reports Server (NTRS)

    Anderson, D.

    1991-01-01

    Measuring similarities between large sequences of genetic information is a formidable task requiring enormous amounts of computer time. Geneticists claim that nearly two months of CRAY-2 time are required to run a single comparison of the known database against the new bases that will be found this year, and more than a CRAY-2 year for next year's genetic discoveries, and so on. The DNA IC, designed at HP-ICBD in cooperation with the California Institute of Technology and the Jet Propulsion Laboratory, is being implemented in order to move the task of genetic comparison onto workstations and personal computers, while vastly improving performance. The chip is a systolic (pumped) array comprised of 16 processors, control logic, and global RAM, totaling 400,000 FETS. At 12 MHz, each chip performs 2.7 billion 16 bit operations per second. Using 35 of these chips in series on one PC board (performing nearly 100 billion operations per second), a sequence of 560 bases can be compared against the eventual total genome of 3 billion bases, in minutes--on a personal computer. While the designed purpose of the DNA chip is for genetic research, other disciplines requiring similarity measurements between strings of 7 bit encoded data could make use of this chip as well. Cryptography and speech recognition are two examples. A mix of full custom design and standard cells, in CMOS34, were used to achieve these goals. Innovative test methods were developed to enhance controllability and observability in the array. This paper describes these techniques as well as the chip's functionality. This chip was designed in the 1989-90 timeframe.

  20. The evolution of ambulatory ECG monitoring.

    PubMed

    Kennedy, Harold L

    2013-01-01

    Ambulatory Holter electrocardiographic (ECG) monitoring has undergone continuous technological evolution since its invention and development in the 1950s era. With commercial introduction in 1963, there has been an evolution of Holter recorders from 1 channel to 12 channel recorders with increasingly smaller storage media, and there has evolved Holter analysis systems employing increasingly technologically advanced electronics providing a myriad of data displays. This evolution of smaller physical instruments with increasing technological capacity has characterized the development of electronics over the past 50 years. Currently the technology has been focused upon the conventional continuous 24 to 48 hour ambulatory ECG examination, and conventional extended ambulatory monitoring strategies for infrequent to rare arrhythmic events. However, the emergence of the Internet, Wi-Fi, cellular networks, and broad-band transmission has positioned these modalities at the doorway of the digital world. This has led to an adoption of more cost-effective strategies to these conventional methods of performing the examination. As a result, the emergence of the mobile smartphone coupled with this digital capacity is leading to the recent development of Holter smartphone applications. The potential of point-of-care applications utilizing the Holter smartphone and a vast array of new non-invasive sensors is evident in the not too distant future. The Holter smartphone is anticipated to contribute significantly in the future to the field of global health.

  1. Data logging technology in ambulatory medical instrumentation.

    PubMed

    Anderson, R; Lyons, G M

    2001-05-01

    This paper reviews the advancements made in ambulatory data logging used in the study of human subjects since the inception of the analogue tape based data logger in the 1960s. Research into the area of ambulatory monitoring has been rejuvenated due to the development of novel storage technologies during the 1990s. Data logging systems that were previously impractical due to lack of processing power, practical size and cost are now available to the practitioner. An overview of the requirements of present day ambulatory data logging is presented and analogue tape, solid-state memory and disk drive storage recording systems that have been described in the literature are investigated in detail. It is proposed that digital based technology offers the best solution to the problems encountered during human based data logging. The appearance of novel digital storage media will continue the trend of increased recording durations, signal resolution and number of parameters thus allowing the momentum gained throughout the last several decades to continue.

  2. Perioperative Management of the Ambulatory Anorectal Surgery Patient

    PubMed Central

    Shaw, Darcy; Ternent, Charles A.

    2016-01-01

    Ambulatory surgery is appropriate for most anorectal pathology. Ambulatory anorectal surgery can be performed at reduced cost compared with inpatient procedures with excellent safety, improved efficiency, and high levels of patient satisfaction. Several perioperative strategies are employed to control pain and avoid urinary retention, including the use of a multimodal pain regimen and restriction of intravenous fluids. Ambulatory anorectal surgery often utilizes standardized order sets and discharge instructions. PMID:26929746

  3. Effect of oral nitrates on pulse pressure and arterial elasticity in patients aged over 65 years with refractory isolated systolic hypertension: study protocol for a randomized controlled trial

    PubMed Central

    2013-01-01

    Background Isolated systolic hypertension is a highly prevalent disease among the elderly. The little available evidence on the efficacy of nitrates for treating the disease is based on small experimental studies. Methods/design We performed a multicenter, randomized, double-blind, phase III, placebo-controlled trial in 154 patients aged over 65 years with refractory isolated systolic hypertension. Patients were randomized to placebo or 40 mg/day of extended-release isosorbide mononitrate added to standard therapy and titrated to 60 mg/day at week 6 if blood pressure exceeded 140/90 mmHg. The primary objective was to assess the effect on clinical pulse pressure of extended-release isosorbide mononitrate added to standard therapy in patients aged over 65 years with refractory isolated systolic hypertension after 3 months of treatment. The secondary objectives were as follows: to quantify the effect of adding the study drug on central blood pressure and vascular compliance using the augmentation index and pulse wave velocity; to evaluate the safety profile by recording adverse effects (frequency, type, severity) and the percentage of patients who had to withdraw from the trial because of adverse events; to quantify the percentage of patients who reach a clinical systolic blood pressure <140 mmHg or <130 mmHg measured by ambulatory blood pressure monitoring; and to quantify the change in pulse pressure measured by ambulatory blood pressure monitoring. Discussion Few clinical trials have been carried out to test the effect of oral nitrates on isolated systolic hypertension, even though these agents seem to be effective. Treatment with extended-release isosorbide mononitrate could improve control of systolic blood pressure without severe side effects, thus helping to reduce the morbidity and mortality of the disease. Trial registration EUDRACT Number: 2012-002988-10 PMID:24228894

  4. Evaluation of the antihypertensive effect of barnidipine, a dihydropyridine calcium entry blocker, as determined by the ambulatory blood pressure level averaged for 24 h, daytime, and nighttime. Barnidipine Study Group.

    PubMed

    Imai, Y; Abe, K; Nishiyama, A; Sekino, M; Yoshinaga, K

    1997-12-01

    We evaluated the effect of barnidipine, a dihydropyridine calcium antagonist, administered once daily in the morning in a dose of 5, 10, or 15 mg on ambulatory blood pressure (BP) in 34 patients (51.3+/-9.6 years). Hypertension was diagnosed based on the clinic BP. The patients were classified into groups according to the ambulatory BP: group 1, dippers with true hypertension; group 2, nondippers with true hypertension; group 3, dippers with false hypertension; and Group 4, nondippers with false hypertension. Barnidipine reduced the clinic systolic BP (SBP) and diastolic BP (DBP) in all groups and significantly reduced the average 24 h ambulatory BP (133.0+/-16.5/90.7+/-12.3 mm Hg v 119.7+/-13.7/81.8+/-10.3 mm Hg, P < .0001 for both SBP and DBP). Barnidipine significantly reduced the daytime ambulatory SBP in groups 1, 2, and 3, but not in group 4, and significantly reduced daytime ambulatory DBP in group 1 but not in groups 2, 3, and 4. Barnidipine significantly reduced the nighttime ambulatory SBP only in group 2 and the nighttime ambulatory DBP in groups 2 and 4. Once-a-day administration of barnidipine influenced 24 h BP on true hypertensives (the ratio of the trough to peak effect > 50%), but had minimal effect on low BP such as the nocturnal BP in dippers and the ambulatory BP in false hypertensives. These findings suggest that barnidipine can be used safely in patients with isolated clinic ("white coat") hypertension and in those with dipping patterns of circadian BP variation whose nocturnal BP is low before treatment.

  5. 76 FR 66929 - Medicare and Medicaid Programs; The American Association for Accreditation of Ambulatory Surgery...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-28

    ... Association for Accreditation of Ambulatory Surgery Facilities for Approval of Deeming Authority for Rural... American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) for recognition as a... of Ambulatory Surgery Facilities (AAAASF's) request for deeming authority for RHCs. This notice...

  6. Long-term impact of systolic blood pressure and glycemia on the development of microalbuminuria in essential hypertension.

    PubMed

    Pascual, Jose Maria; Rodilla, Enrique; Gonzalez, Carmen; Pérez-Hoyos, Santiago; Redon, Josep

    2005-06-01

    The objective was to assess the temporal impact of factors related to the development of microalbuminuria during the follow-up of young adult normoalbuminurics with high-normal blood pressure or at stage 1 of essential hypertension. Prospective follow-up was conducted on 245 normoalbuminuric hypertensive subjects (mean age 40.9 years; 134 men; blood pressure 139.7/88.6 mm Hg; body mass index 28.5 kg/m2) never treated previously with antihypertensive drugs, with yearly urinary albumin excretion measurements, until the development of microalbuminuria. After enrollment, patients were placed on usual care including nonpharmacological treatment or with an antihypertensive drug regime to achieve a blood pressure of <135/85 mm Hg. Thirty subjects (12.2%) developed microalbuminuria after a mean follow-up of 29.9 months (range 12 to 144 months), 2.5 per 100 patients per year. Baseline urinary albumin excretion (hazard ratio, 1.07; P=0.006) and systolic blood pressure during the follow-up (hazard ratio, 1.03; P=0.008) were independent factors related to the follow-up urinary albumin excretion in a Cox proportional hazard model. A significant increase in the risk of developing microalbuminuria for urinary albumin excretion at baseline >15 mg per 24-hour systolic blood pressure >139 mm Hg and a positive trend in fasting glucose were observed in the univariate analyses. However, in the multivariate analysis, only the baseline urinary albumin excretion and the trend of fasting glucose were independently related to the risk of developing microalbuminuria. In mild hypertensives, the development of microalbuminuria was linked to insufficient blood pressure control and to a progressive increment of glucose values.

  7. DB 01-3 TREATMENT TARGET OF SYSTOLIC BLOOD PRESSURE IN DIABETES MAY DIFFER ACCORDING TO ETHNICITY (PRO).

    PubMed

    Kario, Kazuomi

    2016-09-01

    Asians have specific characteristics of hypertension and related cardiovascular disease. Stroke is more common than coronary artery disease in Eastern Asian countries, while the coronary artery disease is more common than stroke in Western countries. The association slope between higher blood pressure (BP) and the risk of cardiovascular events is steeper in Asians than in Caucasians. This may partly explained by the recent result demonstrating that the morning BP surge in Asians is more extended (Hoshide, Kario, Parati et al. Hypertension 2016;68:54-61). Thus, 24-hr BP control including night-time and morning periods is especially important for Asian hypertensive patients (Kario. Essential manual of 24 hour blood pressure management. Wiley, UK, pp.1-158.2016).The existing direct evidence from Asian studies are limited than the accumulated evidence from Western countries. In the ACCORD BP trial which enrolled 4733 participants with type 2 diabetes and randomized them to a target systolic BP <120mmHg (intensive BP control) or <140mmHg (standard BP control). Despite the significant difference in the achieved systolic BP, there was no significant difference in the incidence of primary cardiovascular outcomes. Based on this evidence, the target systolic BP for diabetics has been revised from 130 mmHg to 140 mmHg in the majority of Western guidelines. However, in the ACCORD study, the intensive BP control was associated with significant reduction in both total stroke and nonfatal stroke. In addition, the ONTARGET study, which showed that in diabetic patients, the risk of stroke continued to decrease down to achieved SBP <115mmHg with no evidence of J curve.The new guidelines of the Japanese Society of Hypertension regarding the management of hypertension (JSH2014) were published in 2014 (Hypertens Res 2014;37:253-390). The JSH2014 guidelines use the systolic BP value 130 mmHg, a lower target clinic BP compared to the Western guidelines (140 mmHg), for hypertensive

  8. A comparison of two ambulatory blood pressure monitors worn at the same time.

    PubMed

    Kallem, Radhakrishna R; Meyers, Kevin E C; Sawinski, Deirdre L; Townsend, Raymond R

    2013-05-01

    There are limited data in the literature comparing two simultaneously worn ambulatory blood pressure (BP) monitoring (ABPM) devices. The authors compared BPs from two monitors (Mobil-O-Graph [I.E.M., Stolberg, Germany] and Spacelabs 90207 [Spacelabs Medical, Issequah, WA]). In the nonrandomized component of the study, simultaneous 8-hour BP and heart rate data were measured by Mobil-O-Graph, consistently applied to the nondominant arm, and Spacelabs to the dominant arm on 12 untreated adults. Simultaneous 8-hour BP and heart data were obtained by the same monitors randomly assigned to a dominant or nondominant arm on 12 other untreated adults. Oscillometric BP profiles were obtained in the dominant and nondominant arms of the above 24 patients using an Accutorr (Datascope, Mahwah, NJ) device. The Spacelabs monitor recorded a 10.2-mm Hg higher systolic pressure in the nonrandomized (P=.0016) and a 7.9-mm Hg higher systolic pressure in the randomized studies (P=.00008) compared with the Mobil-O-Graph. The mean arterial pressures were 1 mm Hg to 2 mm Hg different between monitors in the two studies, and heart rates were nearly identical. Our observations, if confirmed in larger cohorts, support the concern that ABPM device manufacturers consider developing normative databases for their devices.

  9. Social support and ambulatory blood pressure: an examination of both receiving and giving.

    PubMed

    Piferi, Rachel L; Lawler, Kathleen A

    2006-11-01

    The relationship between the social network and physical health has been studied extensively and it has consistently been shown that individuals live longer, have fewer physical symptoms of illness, and have lower blood pressure when they are a member of a social network than when they are isolated. Much of the research has focused on the benefits of receiving social support from the network and the effects of giving to others within the network have been neglected. The goal of the present research was to systematically investigate the relationship between giving and ambulatory blood pressure. Systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate were recorded every 30 min during the day and every 60 min at night during a 24-h period. Linear mixed models analyses revealed that lower systolic and diastolic blood pressure and mean arterial pressure were related to giving social support. Furthermore, correlational analyses revealed that participants with a higher tendency to give social support reported greater received social support, greater self-efficacy, greater self-esteem, less depression, and less stress than participants with a lower tendency to give social support to others. Structural equation modeling was also used to test a proposed model that giving and receiving social support represent separate pathways predicting blood pressure and health. From this study, it appears that giving social support may represent a unique construct from receiving social support and may exert a unique effect on health.

  10. Chronobiologically Interpreted Ambulatory Blood Pressure Monitoring in Health and Disease

    PubMed Central

    Cornélissen, Germaine; Hillman, Dewayne; Beaty, Larry A.; Hong, Shiyu; Schwartzkopff, Othild; Watanabe, Yoshihiko; Otsuka, Kuniaki; Siegelova, Jarmila

    2012-01-01

    To detect vascular variability anomalies (VVAs), a blood pressure and heart rate profile around the clock for at least 7 days is a start. As a minimum, measurement every 60 or preferably 30 minutes for a week is needed, to be continued if abnormality is found, to assess the about 24-hour (circadian) variability that exists in all individuals. As a first dividend, one then also obtains a glimpse of 2 of the very many longer-than-circadian periodicities, the biological half-week and week. Certainly if we can have sensors and computer chips in our cars that continuously monitor the pressure over a tire's life, we should be able to do the same job for ourselves for diagnostic and therapeutic decisions. Healthcare today emphasizes wellness with recommendations for exercise and a proper diet, yet these evaluations may not be adequate. BP may be measured at a visit to the doctor or before an exercise session, along with measuring body weight and performing a physical exam. The seeds of disease are planted long before they are visible, and what appears to be normal from a conventional point of view may in fact be abnormal. Hidden alterations of physiological function, masked by the body's remarkable adaptive capabilities, may become visible through a new diagnostic and therapeutic realm—chronobiology—that reveals hitherto unseen abnormalities. The tools of chronobiology may yield additional dividends, such as the detection of physiological “loads” related to stress and stress relief and the undesirable effects of space weather upon personal events such as sudden cardiac death, societal events like terrorism and war, and natural disasters. Chronobiologically interpreted automatic ambulatory BP and heart rate (HR) monitoring (C-ABPM) may detect the antecedents of these types of events. C-ABPM is of interest in preventive cardiology, since it reveals new diagnoses as vascular variability anomalies (VVAs) and renders previous conventional diagnoses more reliable, such

  11. Chronobiologically Interpreted Ambulatory Blood Pressure Monitoring in Health and Disease.

    PubMed

    Halberg, Franz; Mult, Hc; Cornélissen, Germaine; Hillman, Dewayne; Beaty, Larry A; Hong, Shiyu; Schwartzkopff, Othild; Watanabe, Yoshihiko; Otsuka, Kuniaki; Siegelova, Jarmila

    2012-05-01

    To detect vascular variability anomalies (VVAs), a blood pressure and heart rate profile around the clock for at least 7 days is a start. As a minimum, measurement every 60 or preferably 30 minutes for a week is needed, to be continued if abnormality is found, to assess the about 24-hour (circadian) variability that exists in all individuals. As a first dividend, one then also obtains a glimpse of 2 of the very many longer-than-circadian periodicities, the biological half-week and week. Certainly if we can have sensors and computer chips in our cars that continuously monitor the pressure over a tire's life, we should be able to do the same job for ourselves for diagnostic and therapeutic decisions. Healthcare today emphasizes wellness with recommendations for exercise and a proper diet, yet these evaluations may not be adequate. BP may be measured at a visit to the doctor or before an exercise session, along with measuring body weight and performing a physical exam. The seeds of disease are planted long before they are visible, and what appears to be normal from a conventional point of view may in fact actually be abnormal. Hidden alterations of physiological function, masked by the body's remarkable adaptive capabilities, may become visible through a new diagnostic and therapeutic realm-chronobiology-that reveals hitherto unseen abnormalities. The tools of chronobiology may yield additional dividends, such as the detection of physiological "loads" related to stress and stress relief and the undesirable effcts of space weather upon personal events such as sudden cardiac death, societal events like terrorism and war, and natural disasters. Chronobiologi cally interpreted automatic ambulatory BP and heart rate (HR) monitoring (C-ABPM) may detect the antecedents of these types of events. C-ABPM is of interest in preventive cardiology, since it reveals new diagnoses as vascular variability anomalies (VVAs) and renders previous conventional diagnoses more reliable, such

  12. The effect of music therapy on postoperative pain, heart rate, systolic blood pressures and analgesic use following nasal surgery.

    PubMed

    Tse, Mimi M Y; Chan, M F; Benzie, Iris F F

    2005-01-01

    The prevalence of unrelieved postoperative pain is high and may lead to adverse effects including prolonged hospitalization and delayed recovery. Distraction may be an effective pain-relieving strategy, and can be implemented by several means including affective imaging, games, and possibly music. The aim of this study was to explore the effect of music therapy on postoperative pain. Fifty-seven patients (24 females, 33 males; mean +/- SD age 39.9 +/- 14.35 years [range 15 to 69 years] were matched for age and sex and then nonselectively assigned to either an experimental (n = 27) or a control (n = 30) group. Music was played intermittently to members of the experimental group during the first 24 hour postoperative period. Pain intensity was measured using the Pain Verbal Rating Scales (VRS). Significant decreases in pain intensity over time were found in the experimental group compared to the control group (p < 0.0001). In addition, the experimental group had a lower systolic blood pressure and heart rate, and took fewer oral analgesics for pain. These findings suggest that music therapy is an effective nonpharmacologic approach for postoperative pain management.

  13. Relationship between 24-h urine sodium/potassium ratio and central aortic systolic blood pressure in hypertensive patients.

    PubMed

    Rhee, Moo-Yong; Shin, Sung-Joon; Gu, Namyi; Nah, Deuk-Young; Kim, Byong-Kyu; Hong, Kyung-Soon; Cho, Eun-Joo; Sung, Ki-Chul; Lee, Sim-Yeol; Kim, Kwang-Il

    2016-11-24

    Studies evaluating the relationship between measured 24-h urine sodium (24HUNa), potassium (24HUK) and aortic blood pressure (BP) are rare, and no such study has been performed with an Asian population. We evaluated the relationship between 24HUNa, 24HUK, casual BP, 24-h ambulatory BP and aortic BP by analyzing data from 524 participants with valid 24-h urine collection, 24-h ambulatory BP and central BP measurements (mean age 48.1±9.8 years, 193 men). Hypertension was defined as a 24-h ambulatory BP ⩾130/80 mm Hg or current treatment for hypertension (n=219). The participants with hypertension and high 24HUNa (mean 210.5±52.0 mmol  per day, range 151.0-432.0) showed higher 24-h systolic (P=0.037) and diastolic BP (P=0.037) and aortic systolic BP (AoSBP, P=0.038) than the participants with hypertension and low 24HUNa (mean 115.7±25.0 mmol per day, range 45.6-150.0), adjusted for confounders. The participants with hypertension and a high ratio of 24HUNa and 24HUK (24HUNa/24HUK, mean 4.03±1.00, range 2.93-7.96) had higher AoSBP than the participants with hypertension and a low 24HUNa/24HUK ratio (mean 2.13±0.54, range 0.53-2.91), adjusted for confounders (P=0.026). The participants with hypertension demonstrated a significant linear relationship between AoSBP and 24HUNa/24HUK ratio that was independent of 24HUNa, according to the multiple regression analysis (P=0.047). In hypertensive patients, 24HUNa/24HUK was positively and more strongly related to AoSBP compared with 24HUNa alone. The result indicates that high sodium and low potassium intake may increase the subsequent risk of cardiovascular disease by elevating AoSBP.Hypertension Research advance online publication, 24 November 2016; doi:10.1038/hr.2016.161.

  14. Prediction of hypertensive crisis based on average, variability and approximate entropy of 24-h ambulatory blood pressure monitoring.

    PubMed

    Schoenenberger, A W; Erne, P; Ammann, S; Perrig, M; Bürgi, U; Stuck, A E

    2008-01-01

    Approximate entropy (ApEn) of blood pressure (BP) can be easily measured based on software analysing 24-h ambulatory BP monitoring (ABPM), but the clinical value of this measure is unknown. In a prospective study we investigated whether ApEn of BP predicts, in addition to average and variability of BP, the risk of hypertensive crisis. In 57 patients with known hypertension we measured ApEn, average and variability of systolic and diastolic BP based on 24-h ABPM. Eight of these fifty-seven patients developed hypertensive crisis during follow-up (mean follow-up duration 726 days). In bivariate regression analysis, ApEn of systolic BP (P<0.01), average of systolic BP (P=0.02) and average of diastolic BP (P=0.03) were significant predictors of hypertensive crisis. The incidence rate ratio of hypertensive crisis was 14.0 (95% confidence interval (CI) 1.8, 631.5; P<0.01) for high ApEn of systolic BP as compared to low values. In multivariable regression analysis, ApEn of systolic (P=0.01) and average of diastolic BP (P<0.01) were independent predictors of hypertensive crisis. A combination of these two measures had a positive predictive value of 75%, and a negative predictive value of 91%, respectively. ApEn, combined with other measures of 24-h ABPM, is a potentially powerful predictor of hypertensive crisis. If confirmed in independent samples, these findings have major clinical implications since measures predicting the risk of hypertensive crisis define patients requiring intensive follow-up and intensified therapy.

  15. Systolic hypertension in the elderly: long-term lacidipine treatment. Objective, protocol, and organization. SHELL Study Group.

    PubMed

    Malacco, E; Gnemmi, A E; Romagnoli, A; Coppini, A

    1994-01-01

    Isolated systolic hypertension (ISH) is a definite risk factor for cardiovascular complications (i.e., cardiac failure, coronary artery disease, and stroke) independent of diastolic elevation. The prevalence of ISH is estimated to be approximately 15-20% in the population above the age of 60 years, and increases with advancing age. The Systolic Hypertension in the Elderly (SHELL) study is planned to evaluate the efficacy and tolerability of lacidipine, matched with the diuretic chlorthalidone, in treatment of ISH in elderly hypertensive patients (EHP). One hundred fifteen Italian centers will participate in the study. Fifty centers are associated with the Società Italiana di Geriatria Ospedaliera and 65 centers are departments of internal medicine or outpatient clinics for management of hypertension. A total of 4,800 patients will be enrolled in the trial. Two subprojects will consist of periodical echocardiographic evaluation and 24-h ambulatory blood pressure monitoring. The primary end point of the SHELL study is the incidence of cardiovascular and cerebrovascular events in EHP with ISH, treated with either lacidipine or chlorthalidone. In particular, the SHELL trial is intended to determine whether lacidipine treatment will significantly reduce fatal myocardial events and total cardiovascular mortality.

  16. Ambulatory and Challenge-Associated Heart Rate Variability Measures Predict Cardiac Responses to “Real-World” Acute Emotional Stress

    PubMed Central

    Dikecligil, GN; Mujica-Parodi, LR

    2010-01-01

    Background Heart rate variability (HRV) measures homeostatic regulation of the autonomic nervous system in response to perturbation, and has been previously shown to quantify risk for cardiac events. In spite of known interactions between stress vulnerability, psychiatric illness, and cardiac health, however, to our knowledge this is the first study to directly compare the value of laboratory HRV in predicting autonomic modulation of “real-world” emotional stress. Methods We recorded ECG on 56 subjects: first, within the laboratory, and then during an acute emotional stressor: a first-time skydive. Laboratory sessions included two five-minute ECG recordings separated by one ambulatory 24-hour recording. To test the efficacy of introducing a mild emotional challenge, during each of the five-minute laboratory recordings subjects viewed either aversive or benign images. Following the laboratory session, subjects participated in the acute stressor wearing a holter ECG. Artifact-free ECGs (N=33) were analyzed for HRV, then statistically compared across laboratory and acute stress sessions. Results There were robust correlations (r=0.7-0.8) between the laboratory and acute stress HRV, indicating that the two most useful paradigms (long-term wake, followed by short-term challenge) also were most sensitive to distinct components of the acute stressor: the former correlated with the fine-tuned regulatory modulation occurring immediately prior and following the acute stressor, while the latter correlated with gross amplitude and recovery. Conclusions Our results confirmed the efficacy of laboratory-acquired HRV in predicting autonomic response to acute emotional stress, and suggest that ambulatory and challenge protocols enhance predictive value. PMID:20299007

  17. Effects of aerobic exercise intensity on 24-h ambulatory blood pressure in individuals with type 2 diabetes and prehypertension

    PubMed Central

    Karoline de Morais, Pâmella; Sales, Marcelo Magalhães; Alves de Almeida, Jeeser; Motta-Santos, Daisy; Victor de Sousa, Caio; Simões, Herbert Gustavo

    2015-01-01

    [Purpose] To verify the effects of different intensities of aerobic exercise on 24-hour ambulatory blood pressure (BP) responses in individuals with type 2 diabetes mellitus (T2D) and prehypertension. [Subjects and Methods] Ten individuals with T2D and prehypertension (55.8 ± 7.7 years old; blood glucose 133.0 ± 36.7 mg·dL−1 and awake BP 130.6 ± 1.6/ 80.5 ± 1.8 mmHg) completed three randomly assigned experiments: non-exercise control (CON) and exercise at moderate (MOD) and maximal (MAX) intensities. Heart rate (HR), BP, blood lactate concentrations ([Lac]), oxygen uptake (VO2), and rate of perceived exertion (RPE) were measured at rest, during the experimental sessions, and during the 60 min recovery period. After this period, ambulatory blood pressure was monitored for 24 h. [Results] The results indicate that [Lac] (MAX: 6.7±2.0 vs. MOD: 3.8±1.2 mM), RPE (MAX: 19±1.3 vs. MOD: 11±2.3) and VO2peak (MAX: 20.2±4.1 vs. MOD: 14.0±3.0 mL·kg−1·min−1) were highest following the MAX session. Compared with CON, only MAX elicited post-exercise BP reduction that lasted for 8 h after exercise and during sleep. [Conclusion] A single session of aerobic exercise resulted in 24 h BP reductions in individuals with T2D, especially while sleeping, and this reduction seems to be dependent on the intensity of the exercise performed. PMID:25642036

  18. Renal disease in pregnancy ambulatory issues.

    PubMed

    Phelan, Sharon T

    2012-09-01

    Acute and chronic renal disease will complicate prenatal care. Normal physiological changes during pregnancy make the urinary tract system more vulnerable to infectious complications or worsening of preexisting disease. Much of the focus of prenatal care includes screening for these concerns both at the onset of prenatal care and through the pregnancy and postpartum course. With careful and attentive care, the pregnancy outcome for women with significant renal disease has improved and the occurrence of renal injury or obstetric complications due to infectious insults has decreased. This manuscript reviews the current ambulatory prenatal care as it relates to the urinary tract in pregnancy.

  19. Ambulatory blood pressure monitoring in children.

    PubMed

    Sinha, Rajiv; Dionne, Janis

    2011-02-01

    Recently there have been great advances in the use of ambulatory blood pressure monitoring (ABPM) in children. A major boost has been the publication of normative data for blood pressure in children. ABPM has been able to detect significant differences in blood pressure in many disease states including chronic renal failure, polycystic kidney disease and post renal transplantation and has helped in identifying both white coat hypertension and masked hypertension. Current evidence does suggest that sole reliance on clinic blood pressure might not be always appropriate and ABPM has a definite role in pediatric hypertension.

  20. An Ambulatory Program for Surgical Residents and Medical Students.

    ERIC Educational Resources Information Center

    Levy, Margaret

    1988-01-01

    A pilot program based in a freestanding ambulatory surgery center at the Chicago Medical School Department of Surgery is described, its curriculum outlined, and the daily activities of the residents and medical students are detailed. A brief history of ambulatory surgery is given. (Author/MLW)

  1. An assessment of discriminatory power of office blood pressure measurements in predicting optimal ambulatory blood pressure control in people with type 2 diabetes

    PubMed Central

    Kengne, Andre Pascal; Libend, Christelle Nong; Dzudie, Anastase; Menanga, Alain; Dehayem, Mesmin Yefou; Kingue, Samuel; Sobngwi, Eugene

    2014-01-01

    Introduction Ambulatory blood pressure (BP) measurements (ABPM) predict health outcomes better than office BP, and are recommended for assessing BP control, particularly in high-risk patients. We assessed the performance of office BP in predicting optimal ambulatory BP control in sub-Saharan Africans with type 2 diabetes (T2DM). Methods Participants were a random sample of 51 T2DM patients (25 men) drug-treated for hypertension, receiving care in a referral diabetes clinic in Yaounde, Cameroon. A quality control group included 46 non-diabetic individuals with hypertension. Targets for BP control were systolic (and diastolic) BP. Results Mean age of diabetic participants was 60 years (standard deviation: 10) and median duration of diabetes was 6 years (min-max: 0-29). Correlation coefficients between each office-based variable and the 24-h ABPM equivalent (diabetic vs. non-diabetic participants) were 0.571 and 0.601 for systolic (SBP), 0.520 and 0.539 for diastolic (DBP), 0.631 and 0.549 for pulse pressure (PP), and 0.522 and 0.583 for mean arterial pressure (MAP). The c-statistic for the prediction of optimal ambulatory control from office-BP in diabetic participants was 0.717 for SBP, 0.494 for DBP, 0.712 for PP, 0.582 for MAP, and 0.721 for either SBP + DBP or PP + MAP. Equivalents in diabetes-free participants were 0.805, 0.763, 0.695, 0.801 and 0.813. Conclusion Office DBP was ineffective in discriminating optimal ambulatory BP control in diabetic patients, and did not improve predictions based on office SBP alone. Targeting ABPM to those T2DM patients who are already at optimal office-based SBP would likely be more cost effective in this setting. PMID:25838859

  2. Gastrointestinal transit and prolonged ambulatory colonic motility in health and faecal incontinence

    PubMed Central

    Herbst, F; Kamm, M; Morris, G; Britton, K; Woloszko, J; Nicholls, R

    1997-01-01

    Background—Colonic motor function has not been studied in the ambulatory setting over a prolonged period in the unprepared state. Furthermore, the disturbance of this function in patients with faecal incontinence is unknown. 
Aim—To study colonic function over two to three days in the ambulatory, unprepared state in health and in patients with idiopathic faecal incontinence. 
Methods—Six healthy women and six women with faecal incontinence and a structurally intact anal sphincter ingested a dual radioisotope meal, and had a six sensor, solid state manometric probe colonoscopically inserted into the left colon. Scanning was performed until radioisotope left the gut and pressure was recorded for a median of 44hours. 
Results—Three of six patients showed abnormal gastric emptying. Patients showed no disturbance of colonic radioisotope transit. Controls had a median of 12, whereas patients had a median of 16, high amplitude propagated waves per 24 hours. In three patients urge incontinence was associated with high amplitude (up to 500 cm water) propagated waves which often reached the rectum. These high pressure waves were identical to those occuring in healthy subjects, the only difference being the lack of adequate sphincter response. Passive incontinence was not associated with colonic motor activity. Defaecation in all subjects was associated with identical propagated waves, and distal movement of 13% (median) of right colonic content and excretion of 32% from the left colon and rectum. The urge to defaecate was associated with either propagated waves (45%) or non-propagated contractions (55%). Rectal motor complexes were recorded in both groups of subjects, but similar rhythmic activity was also recorded in the sigmoid and descending colon. 
Conclusions—Normal colonic function consists of frequent high pressure propagated waves. Rhythmic activity occurs both proximal to and in the rectum. Defaecation is characterised by high pressure propagated

  3. Effect of home blood pressure telemonitoring with self-care support on uncontrolled systolic hypertension in diabetics.

    PubMed

    Logan, Alexander G; Irvine, M Jane; McIsaac, Warren J; Tisler, Andras; Rossos, Peter G; Easty, Anthony; Feig, Denice S; Cafazzo, Joseph A

    2012-07-01

    Lowering blood pressure reduces cardiovascular risk, yet hypertension is poorly controlled in diabetic patients. In a pilot study we demonstrated that a home blood pressure telemonitoring system, which provided self-care messages on the smartphone of hypertensive diabetic patients immediately after each reading, improved blood pressure control. Messages were based on care paths defined by running averages of transmitted readings. The present study tests the system's effectiveness in a randomized, controlled trial in diabetic patients with uncontrolled systolic hypertension. Of 244 subjects screened for eligibility, 110 (45%) were randomly allocated to the intervention (n = 55) or control (n = 55) group, and 105 (95.5%) completed the 1-year outcome visit. In the intention-to-treat analysis, mean daytime ambulatory systolic blood pressure, the primary end point, decreased significantly only in the intervention group by 9.1 ± 15.6 mmHg (SD; P < 0.0001), and the mean between-group difference was 7.1 ± 2.3 mmHg (SE; P < 0.005). Furthermore, 51% of intervention subjects achieved the guideline recommended target of <130/80 mmHg compared with 31% of control subjects (P < 0.05). These improvements were obtained without the use of more or different antihypertensive medications or additional clinic visits to physicians. Providing self-care support did not affect anxiety but worsened depression on the Hospital Anxiety and Depression Scale (baseline, 4.1 ± 3.76; exit, 5.2 ± 4.30; P = 0.014). This study demonstrated that home blood pressure telemonitoring combined with automated self-care support reduced the blood pressure of diabetic patients with uncontrolled systolic hypertension and improved hypertension control. Home blood pressure monitoring alone had no effect on blood pressure. Promoting patient self-care may have negative psychological effects.

  4. Relationship between IL-17 serum level and ambulatory blood pressure in women with polycystic ovary syndrome

    PubMed Central

    Foroozanfard, Fatemeh; Soleimani, Alireza; Arbab, Elham; Samimi, Mansooreh; Tamadon, Mohammad Reza

    2017-01-01

    Background Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders with an inflammatory basis. It is associated with hyperandrogenism in women and can be also associated with increased activity of the renin-angiotensin system (RAS). Approximately 5% to 10% of women of reproductive age are affected by this disease. This syndrome is the main cause of infertility. Blood pressure may be one of the complications of the syndrome. Objectives In this study, we sought to assess the role of the IL-17 inflammatory cytokine in increasing blood pressure in patients with PCOS. Patients and Methods In this cross-sectional study, after obtaining informed consent, we evaluated 85 patients with PCOS. IL-17 serum level was measured after separating the serum via ELISA method. The results obtained for the two groups of patients with high blood pressure and normal blood pressure were compared with each other. Results The daytime blood pressure was abnormal in eight patients, while it was normal in 72 patients. The blood pressure during the day had a direct correlation with the IL-17serum level; as a result, the mean IL-17 serum level in patients with high blood pressure was 77.10 ± 17.94 ρ g/ml while in those with normal blood pressure it was 55.20 ± 13.71 ρ g/ml (P = 0.001). High blood pressure during the night also showed a direct relation with theIL-17 serum level (P = 0.001). In addition, increasing of ambulatory 24-hourblood pressure was significantly related with IL-17 serum level, in such a way that the IL-17 serum level of people with high blood pressure rose by almost 22 ρg/ml during 24 hours (P = 0.001). Conclusions Our results showed an association between PCO syndrome and inflammatory factors. The IL-17 serum level was directly associated with the increase in blood pressure. PMID:28042549

  5. A comparison study of brachial blood pressure recorded with Spacelabs 90217A and Mobil-O-Graph NG devices under static and ambulatory conditions.

    PubMed

    Sarafidis, P A; Lazaridis, A A; Imprialos, K P; Georgianos, P I; Avranas, K A; Protogerou, A D; Doumas, M N; Athyros, V G; Karagiannis, A I

    2016-12-01

    Ambulatory blood pressure monitoring is an important tool in hypertension diagnosis and management. Although several ambulatory devices exist, comparative studies are scarce. This study aimed to compare for the first time brachial blood pressure levels of Spacelabs 90217A and Mobil-O-Graph NG, under static and ambulatory conditions. We examined 40 healthy individuals under static (study A) and ambulatory (study B) conditions. In study A, participants were randomized into two groups that included blood pressure measurements with mercury sphygmomanometer, Spacelabs and Mobil-O-Graph devices with reverse order of recordings. In study B, simultaneous 6-h recordings with both devices were performed with participants randomized in two sequences of device positioning with arm reversal at 3 h. Finally, all the participants filled in a questionnaire rating their overall preference for a device. In study A, brachial systolic blood pressure (117.2±10.3 vs 117.1±9.8 mm Hg, P=0.943) and diastolic blood pressure (73.3±9.4 mm Hg vs 74.1±9.4 mm Hg, P=0.611) did not differ between Spacelabs and Mobil-O-Graph or vs sphygmomanometer (117.8±11.1 mm Hg, P=0.791 vs Spacelabs, P=0.753 vs Mobil-O-Graph). Similarly, no differences were found in ambulatory systolic blood pressure (117.9±11.4 vs 118.3±11.0 mm Hg, P=0.864), diastolic blood pressure (73.7±7.4 vs 74.7±8.0 mm Hg, P=0.571), mean blood pressure and heart rate between Spacelabs and Mobil-O-Graph. Correlation analyses and Bland-Altman plots showed agreement between the monitors. Overall, the participants showed a preference for the Mobil-O-Graph. Spacelabs 90217A and Mobil-O-Graph NG provide practically identical measurements during the static and ambulatory conditions in healthy individuals and can be rather used interchangeably in clinical practice.

  6. Predictors of exercise participation in ambulatory and non-ambulatory older people with multiple sclerosis

    PubMed Central

    Harris, Chelsea; Wallack, Elizabeth M.; Drodge, Olivia; Beaulieu, Serge; Mayo, Nancy

    2015-01-01

    Background. Exercise at moderate intensity may confer neuroprotective benefits in multiple sclerosis (MS), however it has been reported that people with MS (PwMS) exercise less than national guideline recommendations. We aimed to determine predictors of moderate to vigorous exercise among a sample of older Canadians with MS who were divided into ambulatory (less disabled) and non-ambulatory (more disabled) groups. Methods. We analysed data collected as part of a national survey of health, lifestyle and aging with MS. Participants (n = 743) were Canadians over 55 years of age with MS for 20 or more years. We identified ‘a priori’ variables (demographic, personal, socioeconomic, physical health, exercise history and health care support) that may predict exercise at moderate to vigorous intensity (>6.75 metabolic equivalent hours/week). Predictive variables were entered into stepwise logistic regression until best fit was achieved. Results. There was no difference in explanatory models between ambulatory and non-ambulatory groups. The model predicting exercise included the ability to walk independently (OR 1.90, 95% CI [1.24–2.91]); low disability (OR 1.50, 95% CI [1.34–1.68] for each 10 point difference in Barthel Index score), perseverance (OR 1.17, 95% CI [1.08–1.26] for each additional point on the scale of 0–14), less fatigue (OR 2.01, 95% CI [1.32–3.07] for those in the lowest quartile), fewer years since MS diagnosis (OR 1.58, 95% CI [1.11–2.23] below the median of 23 years) and fewer cardiovascular comorbidities (OR 1.55 95% CI [1.02–2.35] one or no comorbidities). It was also notable that the factors, age, gender, social support, health care support and financial status were not predictive of exercise. Conclusions. This is the first examination of exercise and exercise predictors among older, more disabled PwMS. Disability is a major predictor of exercise participation (at moderate to vigorous levels) in both ambulatory and non-ambulatory

  7. The effect of abnormal birth history on ambulatory blood pressure and disease progression in children with chronic kidney disease

    PubMed Central

    Flynn, Joseph T; Ng, Derek K; Chan, Grace J; Samuels, Joshua; Furth, Susan; Warady, Bradley; Greenbaum, Larry A.

    2014-01-01

    Objective To examine the associations between abnormal birth history (birth weight [BW] <2500 grams, gestational age <36 weeks, or small for gestational age), BP, and renal function among 332 participants (97 with abnormal and 235 with normal birth history) in the Chronic Kidney Disease in Children (CKiD) Study, a cohort of children with chronic kidney disease (CKD). Study design Casual and 24-hour ambulatory BP were obtained. Glomerular filtration rate (GFR) was determined by iohexol disappearance. Confounders (birth and maternal characteristics, socioeconomic status) were used to generate predicted probabilities of abnormal birth history for propensity score matching. Weighted linear and logistic regression models with adjustment for quintiles of propensity scores and CKD diagnosis were used to assess the impact of birth history on BP and GFR. Results Age at enrollment, percent with glomerular disease, and baseline GFR were similar between the groups. Those with abnormal birth history were more likely to be female, of Black race or Hispanic ethnicity, to have low household income, or part of a multiple birth. Unadjusted BP measurements, baseline GFR and change in GFR did not differ significantly between the groups; no differences were seen after adjusting for confounders by propensity score matching. Conclusions Abnormal birth history does not appear to have exerted a significant influence on BP or GFR in this cohort of children with CKD. The absence of an observed association is likely secondary to the dominant effects of underlying CKD and its treatment. PMID:24698454

  8. Genetics and genomics of dilated cardiomyopathy and systolic heart failure.

    PubMed

    Tayal, Upasana; Prasad, Sanjay; Cook, Stuart A

    2017-02-22

    Heart failure is a major health burden, affecting 40 million people globally. One of the main causes of systolic heart failure is dilated cardiomyopathy (DCM), the leading global indication for heart transplantation. Our understanding of the genetic basis of both DCM and systolic heart failure has improved in recent years with the application of next-generation sequencing and genome-wide association studies (GWAS). This has enabled rapid sequencing at scale, leading to the discovery of many novel rare variants in DCM and of common variants in both systolic heart failure and DCM. Identifying rare and common genetic variants contributing to systolic heart failure has been challenging given its diverse and multiple etiologies. DCM, however, although rarer, is a reasonably specific and well-defined condition, leading to the identification of many rare genetic variants. Truncating variants in titin represent the single largest genetic cause of DCM. Here, we review the progress and challenges in the detection of rare and common variants in DCM and systolic heart failure, and the particular challenges in accurate and informed variant interpretation, and in understanding the effects of these variants. We also discuss how our increasing genetic knowledge is changing clinical management. Harnessing genetic data and translating it to improve risk stratification and the development of novel therapeutics represents a major challenge and unmet critical need for patients with heart failure and their families.

  9. 77 FR 37680 - Medicare and Medicaid Programs; Application From the Accreditation Association for Ambulatory...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-22

    ... the Accreditation Association for Ambulatory Health Care for Continued Approval of Its Ambulatory... Association for Ambulatory Health Care for continued recognition as a national accrediting organization for... 6 years or as determined by CMS. The Accreditation Association for Ambulatory Health Care...

  10. Invasively Measured Aortic Systolic Blood Pressure and Office Systolic Blood Pressure in Cardiovascular Risk Assessment: A Prospective Cohort Study.

    PubMed

    Laugesen, Esben; Knudsen, Søren T; Hansen, Klavs W; Rossen, Niklas B; Jensen, Lisette Okkels; Hansen, Michael G; Munkholm, Henrik; Thomsen, Kristian K; Søndergaard, Hanne; Bøttcher, Morten; Raungaard, Bent; Madsen, Morten; Hulman, Adam; Witte, Daniel; Bøtker, Hans Erik; Poulsen, Per L

    2016-09-01

    Aortic systolic blood pressure (BP) represents the hemodynamic cardiac and cerebral burden more directly than office systolic BP. Whether invasively measured aortic systolic BP confers additional prognostic value beyond office BP remains debated. In this study, office systolic BP and invasively measured aortic systolic BP were recorded in 21 908 patients (mean age: 63 years; 58% men; 14% with diabetes mellitus) with stable angina pectoris undergoing elective coronary angiography during January 2001 to December 2012. Multivariate Cox models were used to assess the association with incident myocardial infarction, stroke, and death. Discrimination and reclassification were assessed using Harrell's C and the Continuous Net Reclassification Index. Data were analyzed with and without stratification by diabetes mellitus status. During a median follow-up period of 3.7 years (range: 0.1-10.8 years), 422 strokes, 511 myocardial infarctions, and 1530 deaths occurred. Both office and aortic systolic BP were associated with stroke in patients with diabetes mellitus (hazard ratio per 10 mm Hg, 1.18 [95% confidence interval, 1.07-1.30] and 1.14 [95% confidence interval, 1.05-1.24], respectively) and with myocardial infarction in patients without diabetes mellitus (hazard ratio, 1.07 [95% confidence interval, 1.02-1.12] and 1.05 [95% confidence interval, 1.01-1.10], respectively). In models including both BP measurements, aortic BP lost statistical significance and aortic BP did not confer improvement in either C-statistics or net reclassification analysis. In conclusion, invasively measured aortic systolic BP does not add prognostic information about cardiovascular outcomes and all-cause mortality compared with office BP in patients with stable angina pectoris, either with or without diabetes mellitus.

  11. Application of Mitral Annular Systolic Displacements and Velocities for the Evaluation of Left Ventricular Systolic Function and Reserve

    PubMed Central

    Sharif, Dawod; Sharif-Rasslan, Amal; Shahla, Camilia; Rosenschein, Uri

    2011-01-01

    Background Mitral annular systolic displacement from M-mode echocardiography and velocity from tissue Doppler imaging reflect subendocardial longitudinal systolic LV performance and may precede radial abnormalities. The aim of this study is to evaluate the utility of mitral annular systolic displacement (D) and velocity (V) during dobutamine stress echocardiography (DSE) in detecting left ventricular (LV) functional reserve and wall motion abnormality (WMA). Methods and Results Fifty-nine subjects, 15 with resting WMA, underwent DSE and measurement of mitral systolic (D) and (V) before and immediately after DSE. Annular septal (D) was lower in those with WMA than in those without, at rest 10.5 ± 4 cm versus 13.2 ± 2 cm, p = 0.015, and after DSE, 11.7 ± 3.8 cm versus 14 ± 2.25 cm, p = 0.036, but without significant change after stress. Annular systolic (V) at rest with WMA was 9.7 ± 1.8 cm/sec and similar to those without, 11.25 ± 2.7 cm/sec. In both groups the velocity increased after DSE, 14.5 ± 4.5 cm/sec, p = 0.025 with WMA and 17.8 ± 3.2 cm/sec, p = 1.99 x 10-10 in those without WMA. Velocities after DSE were lower in those with WMA, p = 2.25 x 10-6. Conclusions To evaluate LV systolic performance mitral annular systolic longitudinal displacement is valuable at rest, but for assessment of LV functional reserve after stress velocities are better.

  12. Short-term exposure to noise, fine particulate matter and nitrogen oxides on ambulatory blood pressure: A repeated-measure study.

    PubMed

    Chang, Li-Te; Chuang, Kai-Jen; Yang, Wei-Ting; Wang, Ven-Shing; Chuang, Hsiao-Chi; Bao, Bo-Ying; Liu, Chiu-Shong; Chang, Ta-Yuan

    2015-07-01

    Exposure to road traffic noise, fine particulate matter (aerodynamic diameter ≤2.5 μm; PM2.5) and nitrogen oxides (NOx) has been associated with transient changes in blood pressure, but whether an interaction exists remains unclear. This panel study investigated whether noise, PM2.5 and NOx exposure were independently associated with changes in 24-h ambulatory blood pressure. We recruited 33 males and 33 females aged 18-32 years as study subjects. Personal noise exposure and ambulatory blood pressure were monitored simultaneously in 2007. During the data collection periods, 24-h data on PM2.5 and NOx from five air-quality monitors within 6 km of participants' home addresses were used to estimate their individual exposures. Linear mixed-effects regression models were used to estimate single and combined effects on ambulatory blood pressure. Exposure to both noise and PM2.5 was significantly associated with increased systolic blood pressure (SBP) and diastolic blood pressure (DBP) over 24h; NOx exposure was only significantly related to elevated DBP. Twenty-four-hour ambulatory blood pressure increased with the current noise exposure of 5 A-weighted decibels (dBA) (SBP 1.44 [95% confidence interval: 1.16, 1.71] mmHg and DBP 1.40 [1.18, 1.61] mmHg) and PM2.5 exposure of 10-µg/m(3) (SBP 0.81 [0.19, 1.43] mmHg and DBP 0.63 [0.17, 1.10] mmHg), as well as the current NOx exposure of 10-ppb (DBP 0.54 [0.12, 0.97] mmHg) after simultaneous adjustment. These findings suggest that exposure to noise and air pollutants may independently increase ambulatory blood pressure and the risk of cardiovascular diseases.

  13. Chronic Kidney Disease Is Characterized by “Double Trouble” Higher Pulse Pressure plus Night-Time Systolic Blood Pressure and More Severe Cardiac Damage

    PubMed Central

    Fedecostante, Massimiliano; Spannella, Francesco; Cola, Giovanna; Espinosa, Emma; Dessì-Fulgheri, Paolo; Sarzani, Riccardo

    2014-01-01

    Background Hypertension plays a key role in chronic kidney disease (CKD), but CKD itself affects the blood pressure (BP) profile. The aim of this study was to assess the association of BP profile with CKD and the presence of cardiac organ damage. Methods We studied 1805 patients, referred to our Hypertension Centre, in whom ABPM, blood tests, and echocardiography were clinically indicated. The glomerular filtration rate was estimated (eGFR) using the MDRD equation and CKD was defined as eGFR<60 mL/min/1.73 m2. Cardiac organ damage was evaluated by echocardiography. Results Among patients with CKD there were higher systolic blood pressure (SBP) during the night-time, greater prevalence of non-dippers (OR: 1.8) and increased pulse pressure (PP) during 24-hour period, daytime and night-time (all p<0.001). Patients with CKD had a greater LVM/h2.7 index, and a higher prevalence of left ventricular hypertrophy and diastolic dysfunction (all p<0.001). Nocturnal SBP and PP correlated more strongly with cardiac organ damage (p<0.001). Patients with CKD had a greater Treatment Intensity Score (p<0.001) in the absence of a significantly greater BP control. Conclusions CKD patients have an altered night-time pressure profile and higher PP that translate into a more severe cardiac organ damage. In spite of a greater intensity of treatment in most patients with CKD, BP control was similar to patients without CKD. Our findings indicate the need of a better antihypertensive therapy in CKD, better selected drugs, dosages and posology to provide optimal coverage of 24 hours and night-time BP. PMID:24465931

  14. FFT Computation with Systolic Arrays, A New Architecture

    NASA Technical Reports Server (NTRS)

    Boriakoff, Valentin

    1994-01-01

    The use of the Cooley-Tukey algorithm for computing the l-d FFT lends itself to a particular matrix factorization which suggests direct implementation by linearly-connected systolic arrays. Here we present a new systolic architecture that embodies this algorithm. This implementation requires a smaller number of processors and a smaller number of memory cells than other recent implementations, as well as having all the advantages of systolic arrays. For the implementation of the decimation-in-frequency case, word-serial data input allows continuous real-time operation without the need of a serial-to-parallel conversion device. No control or data stream switching is necessary. Computer simulation of this architecture was done in the context of a 1024 point DFT with a fixed point processor, and CMOS processor implementation has started.

  15. Growing ambulatory care nurse leaders in a multigenerational workforce.

    PubMed

    Moye, Janet P; Swan, Beth Ann

    2009-01-01

    Ambulatory care faces challenges in sustaining a nursing workforce in the future as newly licensed nurses are heavily recruited to inpatient settings and retirements will impact ambulatory care sooner than other areas. Building a diverse team by recruiting nurses of different ages (generations) and skills may result in a more successful and robust organization. Knowledge about generational characteristics and preferences will aid nurse leaders and recruiters in attracting high-quality, talented nurses. Nurses of Generations X and Y can increase their likelihood of success in ambulatory care by better understanding intergenerational issues.

  16. Implementing university hospital ambulatory care evaluation.

    PubMed

    Goldberg, G A

    1975-05-01

    The clinics of a single university hospital center were observed to determine a practical rationale for and impediments to implementing a medical care evaluation program. A quality assurance mechanism is especially important in the ambulatory care setting because of problems with patient compliance, lack of policy continuity, lack of intercommunication among care providers, no counterpart for most inpatient quality-oriented activities, structural defects in many clinics, and general emphasis on the inpatient medicine. Impediments to implementing quality assurance programs include the condition of clinic records and individual charts, lack of established criteria for care, problems of care provider intercommunication during the evaluation process, manpower availability, choice of evaluation method, and method of implementing resulting plans for corrective action.

  17. Resource requirements for evaluating ambulatory health care.

    PubMed Central

    Thompson, M S; Palmer, R H; Rothrock, J K; Strain, R; Brachman, L H; Wright, E A

    1984-01-01

    We implemented the most frequently used form of quality assurance activity: abstracting information on the quality of patient care from medical records and communicating findings to providers in 16 ambulatory care groups. Site providers accepted the evaluation criteria, agreed that deficiencies in care were detected, and, for some medical tasks, effected improvements in care. Direct costs in 1980 dollars for the quality assurance cycle including data system development were $46 per evaluated case. Per-case costs varied considerably among tasks, decreased with larger numbers of cases and as experience grew, and were reduced through computerization. Measured costs were high due to: a demanding research design; our extended accounting of direct, indirect, and induced costs; and the substantial resource requirements of rigorously performed evaluations. PMID:6496817

  18. Ambulatory setting for peritoneal dialysis catheter placement.

    PubMed

    Maya, Ivan D

    2008-01-01

    A modified fluoroscopic technique by adding ultrasound-assistance ensuring entry into the abdominal cavity and avoiding the risk of epigastric artery injury under direct ultrasound visualization was recently published. This study demonstrated that the technique was minimally invasive and allowed for accurate assessment of entry into the abdominal cavity and avoidance of vascular injury. In the current analysis, we report the impact of this technique on hospital stay during a peritoneal dialysis (PD) catheter insertion. Twenty-six PD catheters have been placed on an outpatient basis using this technique. All catheter insertions were successful. Patients were discharge on the same day of the procedure. There were no procedure-related complication or related to short hospital stay. An ambulatory setting allows for a short hospital stay without compromising patient care. This brief paper explains in detail the pre, peri and postoperative period and follow-up.

  19. Antibiotic stewardship: a focus on ambulatory care.

    PubMed

    Gangat, M Azhar; Hsu, Jennifer L

    2015-01-01

    Antibiotic resistance is one of the major health threats facing modern medicine. While there are many tactics to address this issue, antibiotic stewardship has been shown effective in reducing antimicrobial resistance, adverse drug effects, mortality and health care cost. Most antibiotic stewardship programs have evolved within acute care settings where the bulk of resistant infections are identified. Unfortunately, hospitals are just the tip of the iceberg in terms of overall antibiotic use. The vast majority of the antibiotic prescriptions are dispensed in ambulatory care settings, making this a critical target for stewardship programs. This article discusses the global need for antibiotic stewardship, highlights the importance of outpatient stewardship, and discusses strategies and challenges for implementation of stewardship in community settings.

  20. Low Power Systolic Array Based Digital Filter for DSP Applications

    PubMed Central

    Karthick, S.; Valarmathy, S.; Prabhu, E.

    2015-01-01

    Main concepts in DSP include filtering, averaging, modulating, and correlating the signals in digital form to estimate characteristic parameter of a signal into a desirable form. This paper presents a brief concept of low power datapath impact for Digital Signal Processing (DSP) based biomedical application. Systolic array based digital filter used in signal processing of electrocardiogram analysis is presented with datapath architectural innovations in low power consumption perspective. Implementation was done with ASIC design methodology using TSMC 65 nm technological library node. The proposed systolic array filter has reduced leakage power up to 8.5% than the existing filter architectures. PMID:25922854

  1. Systolic time interval data acquisition system. Specialized cardiovascular studies

    NASA Technical Reports Server (NTRS)

    Baker, J. T.

    1976-01-01

    The development of a data acquisition system for noninvasive measurement of systolic time intervals is described. R-R interval from the ECG determines instantaneous heart rate prior to the beat to be measured. Total electromechanical systole (Q-S2) is measured from the onset of the ECG Q-wave to the onset of the second heart sound (S2). Ejection time (ET or LVET) is measured from the onset of carotid upstroke to the incisure. Pre-ejection period (PEP) is computed by subtracting ET from Q-S2. PEP/ET ratio is computed directly.

  2. Low Power Systolic Array Based Digital Filter for DSP Applications.

    PubMed

    Karthick, S; Valarmathy, S; Prabhu, E

    2015-01-01

    Main concepts in DSP include filtering, averaging, modulating, and correlating the signals in digital form to estimate characteristic parameter of a signal into a desirable form. This paper presents a brief concept of low power datapath impact for Digital Signal Processing (DSP) based biomedical application. Systolic array based digital filter used in signal processing of electrocardiogram analysis is presented with datapath architectural innovations in low power consumption perspective. Implementation was done with ASIC design methodology using TSMC 65 nm technological library node. The proposed systolic array filter has reduced leakage power up to 8.5% than the existing filter architectures.

  3. Ambulatory Blood Pressure Monitoring (ABPM) as the reference standard for diagnosis of hypertension and assessment of vascular risk in adults.

    PubMed

    Hermida, Ramón C; Smolensky, Michael H; Ayala, Diana E; Portaluppi, Francesco

    2015-01-01

    New information has become available since the ISC, AAMCC, and SECAC released their first extensive guidedelines to improve the diagnosis and treatment of adult arterial hypertension. A critical assessment of evidence and a comparison of what international guidelines now propose are the basis for the following statements, which update the recommendations first issued in 2013. Office blood pressure (BP) measurements should no longer be considered to be the "gold standard" for the diagnosis of hypertension and assessment of cardiovascular risk. Relying on office BP, even when supplemented with at-home wake-time self-measurements, to identify high-risk individuals, disregarding circadian BP patterning and asleep BP level, leads to potential misclassification of 50% of all evaluated persons. Accordingly, ambulatory BP monitoring is the recommended reference standard for the diagnosis of true hypertension and accurate assessment of cardiovascular risk in all adults ≥18 yrs of age, regardless of whether office BP is normal or elevated. Asleep systolic BP mean is the most significant independent predictor of cardiovascular events. The sleep-time relative SBP decline adds prognostic value to the statistical model that already includes the asleep systolic BP mean and corrected for relevant confounding variables. Accordingly, the asleep systolic BP mean is the recommended protocol to diagnose hypertension, assess cardiovascular risk, and predict cardiovascular event-free interval. In men, and in the absence of compelling clinical conditions, reference thresholds for diagnosing hypertension are 120/70 mmHg for the asleep systolic/diastolic BP means derived from ambulatory BP monitoring. However, in women, in the absence of complicating co-morbidities, the same thresholds are lower by 10/5 mmHg, i.e., 110/65 mmHg for the asleep means. In high-risk patients, including those diagnosed with diabetes or chronic kidney disease, and/or those having experienced past

  4. Mapping technique for VLSI/WSI implementation of multidimensional systolic arrays

    NASA Astrophysics Data System (ADS)

    Abdelrazik, Mohamed B.

    1990-09-01

    This paper describes a niapping technique for transforming a linear systolic array into multidimensional systolic arrays in order to achieve high-speed with less overhead. This technique is systematic therefore it would be useful for logic synthesis. The application of this technique in DSP and numerical computations reduces the design time which results in low design cost. This technique produces various structures (semi-systolic quasi-systolic and pure systolic arrays) which could be considered as application specific array processors.

  5. Development of Quality Metrics in Ambulatory Pediatric Cardiology.

    PubMed

    Chowdhury, Devyani; Gurvitz, Michelle; Marelli, Ariane; Anderson, Jeffrey; Baker-Smith, Carissa; Diab, Karim A; Edwards, Thomas C; Hougen, Tom; Jedeikin, Roy; Johnson, Jonathan N; Karpawich, Peter; Lai, Wyman; Lu, Jimmy C; Mitchell, Stephanie; Newburger, Jane W; Penny, Daniel J; Portman, Michael A; Satou, Gary; Teitel, David; Villafane, Juan; Williams, Roberta; Jenkins, Kathy

    2017-02-07

    The American College of Cardiology Adult Congenital and Pediatric Cardiology (ACPC) Section had attempted to create quality metrics (QM) for ambulatory pediatric practice, but limited evidence made the process difficult. The ACPC sought to develop QMs for ambulatory pediatric cardiology practice. Five areas of interest were identified, and QMs were developed in a 2-step review process. In the first step, an expert panel, using the modified RAND-UCLA methodology, rated each QM for feasibility and validity. The second step sought input from ACPC Section members; final approval was by a vote of the ACPC Council. Work groups proposed a total of 44 QMs. Thirty-one metrics passed the RAND process and, after the open comment period, the ACPC council approved 18 metrics. The project resulted in successful development of QMs in ambulatory pediatric cardiology for a range of ambulatory domains.

  6. Sun Blasts 6 CMEs in 24 Hour Period

    NASA Video Gallery

    This movie from the chronograph on board the SOlar and Heliospheric Observatory (SOHO), shows the sun's atmosphere – the corona – from September 17 to September 20. The sun let loose with at ...

  7. Rethinking the Youth Weight Debate: The 24 Hour Day

    ERIC Educational Resources Information Center

    Dodd, Graham; Biggs, Sarah; Agley, Daniel; Dollman, James; Lushington, Kurt

    2008-01-01

    Approaches to weight management have traditionally focussed on caloric intake versus caloric expenditure. Despite a range of interventions based on these approaches, the proportion of overweight children and adolescents continues to rise. There are increasing indications that other factors, such as sleep duration, may be at play. This commentary…

  8. Newborn Infants' Memory for Speech Sounds Retained over 24 Hours.

    ERIC Educational Resources Information Center

    Swain, Irina U.; And Others

    1993-01-01

    Neonates who were exposed to the same or different words on two consecutive days habituated to the sound on day one and recovered head turning on day two. Infants who heard the same word again on day two responded less well than infants exposed to the word for the first time on day two. (BC)

  9. Knighthelm 24-hour HMD: from development to production

    NASA Astrophysics Data System (ADS)

    White, John; Cameron, Alexander A.

    2001-08-01

    The BAE SYSTEMS Knighthelm HMD is a unique two-part helmet design, using a form fitted inner helmet with an outer display module. It has been refined and enhanced, as part of an extensive development program, for the German Army Tiger helicopter, and is optimized for the attack helicopter application. The design optically mixes the output of an Image Intensifier Tube with Cathode Ray Tube imagery. This provides a flexible display of symbology overlaid on NVG imagery or symbology overlaid on FLIR video viewed as a collimated image in the see through combiner eyepiece in front of the users eyes.

  10. Perceptually relevant remapping of human somatotopy in 24 hours

    PubMed Central

    Kolasinski, James; Makin, Tamar R; Logan, John P; Jbabdi, Saad; Clare, Stuart; Stagg, Charlotte J; Johansen-Berg, Heidi

    2016-01-01

    Experience-dependent reorganisation of functional maps in the cerebral cortex is well described in the primary sensory cortices. However, there is relatively little evidence for such cortical reorganisation over the short-term. Using human somatosensory cortex as a model, we investigated the effects of a 24 hr gluing manipulation in which the right index and right middle fingers (digits 2 and 3) were adjoined with surgical glue. Somatotopic representations, assessed with two 7 tesla fMRI protocols, revealed rapid off-target reorganisation in the non-manipulated fingers following gluing, with the representation of the ring finger (digit 4) shifted towards the little finger (digit 5) and away from the middle finger (digit 3). These shifts were also evident in two behavioural tasks conducted in an independent cohort, showing reduced sensitivity for discriminating the temporal order of stimuli to the ring and little fingers, and increased substitution errors across this pair on a speeded reaction time task. DOI: http://dx.doi.org/10.7554/eLife.17280.001 PMID:28035900

  11. A 24-hour remote surveillance system for terrestrial wildlife studies

    USGS Publications Warehouse

    Sykes, P.W.; Ryman, W.E.; Kepler, C.B.; Hardy, J.W.

    1995-01-01

    The configuration, components, specifications and costs of a state-of-the-art closed-circuit television system with wide application for wildlife research and management are described. The principal system components consist of color CCTV camera with zoom lens, pan/tilt system, infrared illuminator, heavy duty tripod, coaxial cable, coaxitron system, half-duplex equalizing video/control amplifier, timelapse video cassette recorder, color video monitor, VHS video cassettes, portable generator, fuel tank and power cable. This system was developed and used in a study of Mississippi sandhiIl Crane (Grus canadensis pratensis) behaviors during incubation, hatching and fledging. The main advantages of the system are minimal downtime where a complete record of every event, its time of occurrence and duration, are permanently recorded and can be replayed as many times as necessary thereafter to retrieve the data. The system is particularly applicable for studies of behavior and predation, for counting individuals, or recording difficult to observe activities. The system can be run continuously for several weeks by two people, reducing personnel costs. This paper is intended to provide biologists who have litte knowledge of electronics with a system that might be useful to their specific needs. The disadvantages of this system are the initial costs (about $9800 basic, 1990-1991 U.S. dollars) and the time required to playback video cassette tapes for data retrieval, but the playback can be sped up when litte or no activity of interest is taking place. In our study, the positive aspects of the system far outweighed the negative.

  12. Conventional and Ambulatory Blood Pressure as Predictors of Retinal Arteriolar Narrowing

    PubMed Central

    Wei, Fang-Fei; Zhang, Zhen-Yu; Thijs, Lutgarde; Yang, Wen-Yi; Jacobs, Lotte; Cauwenberghs, Nicholas; Gu, Yu-Mei; Kuznetsova, Tatiana; Allegaert, Karel; Verhamme, Peter; Li, Yan; Struijker-Boudier, Harry A.J.

    2016-01-01

    At variance with the long established paradigm that retinal arteriolar narrowing trails hypertension, several longitudinal studies, all based on conventional blood pressure (CBP) measurement, proposed that retinal arteriolar narrowing indicates heightened microvascular resistance and precedes hypertension. In 783 randomly recruited Flemish (mean age, 38.2 years; 51.3% women), we investigated to what extent CBP and daytime (10 am to 8 pm) ambulatory blood pressure (ABP) measured at baseline (1989–2008) predicted the central retinal arteriolar equivalent (CRAE) in retinal photographs obtained at follow-up (2008–2015). Systolic/diastolic hypertension thresholds were 140/90 mm Hg for CBP and 135/85 mm Hg for ABP. In multivariable-adjusted models including both baseline CBP and ABP, CRAE after 10.3 years (median) of follow-up was unrelated to CBP (P≥0.14), whereas ABP predicted CRAE narrowing (P≤0.011). Per 1-SD increment in systolic/diastolic blood pressure, the association sizes were −0.95 µm (95% confidence interval, −2.20 to 0.30)/−0.75 µm (−1.93 to 0.42) for CBP and −1.76 µm (−2.95 to −0.58)/−1.48 µm (−2.61 to −0.34) for ABP. Patients with ambulatory hypertension at baseline (17.0%) had smaller CRAE (146.5 versus 152.6 µm; P<0.001) at follow-up. CRAE was not different (P≥0.31) between true normotension (normal CBP and ABP; prevalence, 77.6%) and white-coat hypertension (elevated CBP and normal ABP, 5.4%) and between masked hypertension (normal CBP and elevated ABP, 10.2%) and hypertension (elevated CBP and ABP, 6.8%). In conclusion, the paradigm that retinal arteriolar narrowing precedes hypertension can be explained by the limitations of CBP measurement, including nonidentification of masked and white-coat hypertension. PMID:27324224

  13. Platelet activation of mechanical versus bioprosthetic heart valves during systole.

    PubMed

    Hedayat, Mohammadali; Asgharzadeh, Hafez; Borazjani, Iman

    2017-03-11

    Thrombus formation is a major concern for recipients of mechanical heart valves (MHVs), which requires them to take anticoagulant drugs for the rest of their lives. Bioprosthetic heart valves (BHVs) do not require life-long anticoagulant therapy but deteriorate after 10-15years. The thrombus formation is initiated by the platelet activation which is thought to be mainly generated in MHVs by the flow through the hinge and the leakage flow during the diastole. However, our results show that the activation in the bulk flow during the systole phase might play an essential role as well. This is based on our results obtained by comparing the thrombogenic performance of a MHV and a BHV (as control) in terms of shear induced platelet activation under exactly the same conditions. Three different mathematical activation models including linear level of activation, damage accumulation, and Soares model are tested to quantify the platelet activation during systole using the previous simulations of the flow through MHV and BHV in a straight aorta under the same physiologic flow conditions. Results indicate that the platelet activation in the MHV at the beginning of the systole phase is slightly less than the BHV. However, at the end of the systole phase the platelet activation by the bulk flow for the MHV is several folds (1.41, 5.12, and 2.81 for linear level of activation, damage accumulation, and Soares model, respectively) higher than the BHV for all tested platelet activation models.

  14. Pros and cons of the ambulatory surgery center joint venture.

    PubMed

    Giannini, Deborah

    2008-01-01

    If a physician group has determined that it has a realistic patient base to establish an ambulatory surgery center, it may be beneficial to consider a partner to share the costs and risks of this new joint venture. Joint ventures can be a benefit or liability in the establishment of an ambulatory surgery center. This article discusses the advantages and disadvantages of a hospital physician-group joint venture.

  15. Benazepril versus felodipine as supplement to bendroflumethiazide: evaluation by office and ambulatory blood pressure.

    PubMed

    Kristensen; Wiinberg; Høegholm; Kornerup; Svendsen; Mølby; Pindborg; Nielsen

    1998-04-01

    OBJECTIVE: To compare a combination of a thiazide diuretic and an angiotensin converting enzyme inhibitor with a thiazide diuretic and a calcium antagonist. DESIGN: A double-blind randomized trial with subjects in two parallel groups administered either 10-20 mg benazepril once daily or 5-10 mg extended-release felodipine once daily, both titrated according to diastolic office blood pressure. During run-in and all 12 weeks of the study members of both groups were administered 2.5 mg bendroflumethiazide once daily. We measured 24 h ambulatory blood pressure with thiazide alone and after 12 weeks of combination therapy. SETTING: General practices. PATIENTS: We studied 96 hypertensive patients (50 women and 46 men), aged 25-75 years, whose blood pressures were insufficiently regulated (i.e. office diastolic blood pressure >/= 95 mmHg) despite treatment with a thiazide diuretic for at least 3 months. RESULTS: The responses of office blood pressure after 12 weeks of treatment did not differ between the groups and neither did the proportions of responders. The ambulatory recordings revealed, after 12 weeks of treatment, a fall in daytime blood pressure of 16.3/10.3 mmHg in members of the benazepril group compared with a fall of 8.5/5.2 mmHg in members of the felodipine group (P < 0.001/<0.001). Analysis of variance showed that the systolic but not the diastolic office blood pressure in members of the benazepril group was significantly lower during the 12-week study period. When evaluating rising single quote, left (low)white-coat-positive' patients separately, there was a tendency for there to be a more pronounced reduction of their (normal) blood pressure with benazepril therapy. There was a significant reduction in weight of patients in the benazepril group (by 0.9 kg), but not of patients in the felodipine group. We observed no difference in side effects between the two treatment groups.CONCLUSION: Add-on therapies both with benazepril and with felodipine are

  16. Comparison of ambulatory blood pressure parameters of hypertensive patients with and without chronic kidney disease.

    PubMed

    Mojón, Artemio; Ayala, Diana E; Piñeiro, Luis; Otero, Alfonso; Crespo, Juan J; Moyá, Ana; Bóveda, Julia; de Lis, Jesús Pérez; Fernández, José R; Hermida, Ramón C

    2013-03-01

    There is strong association between chronic kidney disease (CKD) and increased prevalence of hypertension, risk of end-organ damage, and cardiovascular disease (CVD). Non-dipping, as determined by ambulatory blood pressure (BP) monitoring (ABPM), is frequent in CKD and has also been consistently associated with increased CVD risk. The reported prevalence of non-dipping in CKD is highly variable, probably due to relatively small sample sizes, reliance only on a single, low-reproducibility, 24-h ABPM evaluation per participant, and definition of daytime and nighttime periods by arbitrary fixed clock-hour spans. Accordingly, we assessed the circadian BP pattern of patients with and without CKD by 48-h ABPM to increase reproducibility of the results. This cross-sectional study involved 10 271 hypertensive patients (5506 men/4765 women), 58.0 ± 14.2 (mean ± SD) yrs of age, enrolled in the Hygia Project. Among the participants, 3227 (1925 men/1302 women) had CKD. At the time of recruitment, 568/2234 patients with/without CKD were untreated for hypertension. Patients with than without CKD were more likely to be men and of older age, have diagnoses of obstructive sleep apnea, metabolic syndrome, diabetes, and/or obesity, plus have higher glucose, creatinine, uric acid, and triglyceride, but lower cholesterol, concentrations. In patients with CKD, ambulatory systolic BP (SBP) was significantly elevated (p < .001), mainly during the hours of nighttime sleep, independent of presence/absence of BP-lowering treatment. In patients without CKD, ambulatory diastolic BP (DBP), however, was significantly higher (p < .001), mainly during the daytime. Differing trends for SBP and DBP between groups resulted in large differences in ambulatory pulse pressure (PP), it being significantly greater (p < .001) for the entire 24 h in patients with CKD. Prevalence of non-dipping was significantly higher in patients with than without CKD (60.6% vs. 43.2%; p < .001

  17. Factors influencing validation of ambulatory blood pressure measuring devices.

    PubMed

    O'Brien, E; Atkins, N; Staessen, J

    1995-11-01

    With the introduction of 24 h ambulatory blood pressure monitoring into clinical practice a vast market for ambulatory blood pressure monitoring devices has been created. To satisfy this market manufacturers are producing an array of ambulatory blood pressure monitoring devices. There is no obligation on manufacturers to have such devices validated independently, even though two national protocols, one from the British Hypertension Society (BHS) and the other from the Association for the Advancement of Medical Instrumentation (AAMI), call for independent validation and state the means of doing so. However, many factors can influence the validation procedure. They include compliance to the protocol being employed; the accuracy of the standard; establishing precisely the model being validated; the influences of blood pressure level, age and exercise on device accuracy; the provisions necessary for special populations, such as pregnant women, the elderly and children; the influence of oscillometric versus Korotkoff sound detection and electrocardiographic gating on comparative measurements; the assessment of performance as distinct from accuracy; and the relevance of general factors, such as the algorithm being employed and computer compatibility. Forty-three ambulatory blood pressure monitoring devices have been marketed for ambulatory blood pressure measurement and of those only 18 have been validated according to either the BHS or the AAMI protocol. The influence of the factors listed above on the validation studies of those devices will be considered and the relevance of validation procedures to the clinical use of ambulatory blood pressure monitoring devices will be discussed.

  18. Automatic noninvasive measurement of systolic blood pressure using photoplethysmography

    PubMed Central

    Nitzan, Meir; Patron, Amikam; Glik, Zehava; Weiss, Abraham T

    2009-01-01

    Background Automatic measurement of arterial blood pressure is important, but the available commercial automatic blood pressure meters, mostly based on oscillometry, are of low accuracy. Methods In this study, we present a cuff-based technique for automatic measurement of systolic blood pressure, based on photoplethysmographic signals measured simultaneously in fingers of both hands. After inflating the pressure cuff to a level above systolic blood pressure in a relatively slow rate, it is slowly deflated. The cuff pressure for which the photoplethysmographic signal reappeared during the deflation of the pressure-cuff was taken as the systolic blood pressure. The algorithm for the detection of the photoplethysmographic signal involves: (1) determination of the time-segments in which the photoplethysmographic signal distal to the cuff is expected to appear, utilizing the photoplethysmographic signal in the free hand, and (2) discrimination between random fluctuations and photoplethysmographic pattern. The detected pulses in the time-segments were identified as photoplethysmographic pulses if they met two criteria, based on the pulse waveform and on the correlation between the signal in each segment and the signal in the two neighboring segments. Results Comparison of the photoplethysmographic-based automatic technique to sphygmomanometry, the reference standard, shows that the standard deviation of their differences was 3.7 mmHg. For subjects with systolic blood pressure above 130 mmHg the standard deviation was even lower, 2.9 mmHg. These values are much lower than the 8 mmHg value imposed by AAMI standard for automatic blood pressure meters. Conclusion The photoplethysmographic-based technique for automatic measurement of systolic blood pressure, and the algorithm which was presented in this study, seems to be accurate. PMID:19857254

  19. How many clinic BP readings are needed to predict cardiovascular events as accurately as ambulatory BP monitoring?

    PubMed

    Eguchi, K; Hoshide, S; Shimada, K; Kario, K

    2014-12-01

    We tested the hypothesis that multiple clinic blood pressure (BP) readings over an extended baseline period would be as predictive as ambulatory BP (ABP) for cardiovascular disease (CVD). Clinic and ABP monitoring were performed in 457 hypertensive patients at baseline. Clinic BP was measured monthly and the means of the first 3, 5 and 10 clinic BP readings were taken as the multiple clinic BP readings. The subjects were followed up, and stroke, HARD CVD, and ALL CVD events were determined as outcomes. In multivariate Cox regression analyses, ambulatory systolic BP (SBP) best predicted three outcomes independently of baseline and multiple clinic SBP readings. The mean of 10 clinic SBP readings predicted stroke (hazards ratio (HR)=1.39, 95% confidence interval (CI)=1.02-1.90, P=0.04) and ALL CVD (HR=1.41, 95% CI=1.13-1.74, P=0.002) independently of baseline clinic SBP. Clinic SBPs by three and five readings were not associated with any CVD events, except that clinic SBP by three readings was associated with ALL CVD (P=0.015). Besides ABP values, the mean of the first 10 clinic SBP values was a significant predictor of stroke and ALL CVD events. It is important to take more than several clinic BP readings early after the baseline period for the risk stratification of future CVD events.

  20. Association of ambulatory heart rate and atherosclerosis risk factors with blood pressure in young non-hypertensive adults

    PubMed Central

    Cheng, Cynthia; Daskalakis, Constantine

    2016-01-01

    Objective The study objective was to assess the association between 24 h ambulatory heart rate (HR), atherosclerosis risk factors and blood pressure (BP) in young non-hypertensive patients. Methods We recruited 186 participants aged 18–45 years from a large urban academic Family Medicine outpatient practice, serving 40 000 individuals for this observational study. The main analyses were based on multiple linear regression, with mean 24 h BP (systolic BP (SBP) or diastolic BP (DBP)) as the outcomes, mean 24 h HR as the main predictor of interest, and controlling for age, gender, race, insulin sensitivity/resistance and endothelial function measured by strain gauge venous occlusion plethysmography. Results HR was independently associated with mean 24 h SBP and DBP (SBP and DBP: p=0.042 and 0.001, respectively). In our analyses, associations were markedly stronger for ambulatory compared with office BP measurements. Endothelial dysfunction was associated with higher SBP (p=0.013); plasminogen activator inhibitor-1 was significantly associated with both SBP and DBP (p=0.041 and 0.015, respectively), while insulin resistance was not associated with either SBP or DBP. Insulin resistance and C reactive protein were significant predictors of HR (p=0.013 and 0.007, respectively). Conclusions These findings suggest that HR may be a potential marker of elevated cardiovascular risk in young asymptomatic individuals, prior to the development of clinical hypertension or cardiovascular disease. PMID:26925242

  1. The impact of fertilization on the chicken egg yolk plasma and granule proteome 24 hours post-lay at room temperature: capitalizing on high-pH/low-pH reverse phase chromatography in conjunction with tandem mass tag (TMT) technology.

    PubMed

    Padliya, Neerav D; Qian, Meiqian; Mimi Roy, Sushmita; Chu, Patrick; Zheng, Haiyan; Tess, Alex; Dariani, Maghsoud; Hariri, Robert J

    2015-07-01

    Chicken egg yolk is a rich source of nutrients providing high quality proteins, vitamins, minerals, carotenoids and antioxidants. Chicken egg yolk, recovered from whole egg within 24 hours post-lay has been utilized as a starting material in the preparation of a dietary supplement that has been demonstrated to lead to gains in muscle mass in a human clinical study. Further, an oil derived from chicken egg yolk has been utilized as a topical agent to treat third degree burn injury. The molecular changes that take place in fertilized, chicken egg yolk during the first 24 hours post-lay are not well understood. By studying how the protein composition of egg yolk varies with fertility status, one can utilize this knowledge to develop egg yolk-based products that have been optimized for specific applications. In this study, a direct quantitative comparison was made between the proteome of fertilized chicken egg yolk and the proteome of unfertilized chicken egg yolk, both maintained at 20 °C and analyzed within 24 hours post-lay. Egg yolk proteins from each fertility state were digested with trypsin, labeled with distinct chemical labels (tandem mass tag reagents) and then combined in a 1 : 1 ratio. A TMT-labeled tryptic digest derived from chicken egg yolk proteins (fertilized and unfertilized) was separated using high-pH/low-pH reverse-phase chromatography and analyzed using mass spectrometry. 225 protein identifications were made from this TMT-labeled tryptic digest based on a minimum of 2 unique peptides observed per protein. 9 proteins increased in abundance in fertilized egg yolk relative to unfertilized egg yolk and 9 proteins decreased in abundance in fertilized egg yolk relative to unfertilized egg yolk. Some proteins that increased in abundance in fertilized egg yolk play an important role in angiogenesis (pleiotrophin, histidine rich glycoprotein) and defense against pathogens (mannose-binding lectin, β-defensin 11, serum amyloid P-component, ovostatin

  2. Higher Blood Pressure Variability in White Coat Hypertension; from the Korean Ambulatory Blood Pressure Monitoring Registry

    PubMed Central

    Kang, In Sook; Shin, Jinho; Ihm, Sang-Hyun; Kim, Ju Han; Park, Sungha; Kim, Kwang-Il; Kim, Woo-Shik; Kim, Soon Gil; Shin, Gil Ja

    2016-01-01

    Background and Objectives Blood pressure variability (BPV) was recently shown to be a risk factor of stroke. White coat hypertension (WCH) used to be regarded as innocuous, but one long-term follow-up study reported that WCH increased stroke rate compared to normotension (NT). In this study, we aimed to evaluate the relationship between WCH and BPV. Subjects and Methods We analyzed 1398 subjects from the Korean Ambulatory Blood Pressure Registry, who were divided into NT (n=364), masked hypertension (n=122), white coat hypertension (n=254), and sustained hypertension (n=658) groups. Results Baseline characteristics were similar among groups. The average real variability (ARV), a highly sensitive BPV parameter, was highest in the WCH group, followed by the sustained hypertension, masked hypertension, and NT groups. The results persisted after being adjusted for covariates. The WCH vs. sustained hypertension results (adjusted mean±standard error) were as follows: 24-h systolic ARV, 22.9±0.8 vs. 19.4±0.6; 24-h diastolic ARV, 16.8±0.6 vs. 14.3±0.5; daytime systolic ARV, 21.8±0.8 vs. 16.8±0.6; and daytime diastolic ARV, 16.2±0.6 vs. 13.4±0.5 (p<0.001 for all comparisons). Conclusion From the registry data, we found that subjects with WCH or masked hypertension had higher BPV than NT. However, long-term follow-up data assessing the clinical influences of WCH on stroke are needed. PMID:27275173

  3. The value of the mean peak systolic velocity of the superior thyroidal artery in the differential diagnosis of thyrotoxicosis

    PubMed Central

    Kim, Tae Kyoon; Lee, Eun Ju

    2015-01-01

    Purpose: The aim of this study was to validate the superior thyroidal artery mean peak systolic velocity (STA-mPSV) as an alternative to other diagnostic parameters in the differentiation of the causes of thyrotoxicosis in Korean patients. Methods: This study was conducted with newly diagnosed and untreated thyrotoxic patients. Forty patients were diagnosed with Graves disease (GD) and 20 patients with destructive thyroiditis (DT). Another 60 healthy subjects without thyroid disease participated as the control group. Blood samples were taken to evaluate the thyroid function and thyroid autoantibodies (TRAb). Twenty-four hour radioactive iodine uptake (RAIU) scanning was performed to confirm GD or DT. The STA-mPSV was measured using color Doppler ultrasonography. Results: The STA-mPSV was significantly higher in the untreated GD group than in the DT group (GD, 78.96±29.04 cm/sec; DT, 29.97±14.67 cm/sec; control, 17.55±4.99 cm/sec; P<0.001). The area under the curve (AUC) of the STA-mPSV for the differential diagnosis of untreated GD and DT was 0.9506 (optimal cutoff value, 41.3 cm/sec; sensitivity, 95%, 38/40; specificity, 85%, 17/20) in the receiver operating characteristic analysis. The AUC values of the STA-mPSV, RAIU, and TRAb were 0.9506, 1, and 0.9988, respectively (P=0.159). Conclusion: In clinical practice, the STA-mPSV has a diagnostic value similar to that of the TRAb and 24-hour RAIU in the differential diagnosis of newly diagnosed Korean thyrotoxic patients. PMID:25971899

  4. A comparison of systolic blood pressure measurement obtained using a pulse oximeter, and direct systolic pressure measurement in anesthetized sows.

    PubMed Central

    Caulkett, N A; Duke, T; Bailey, J V

    1994-01-01

    Systolic blood pressure measurement obtained with a pulse oximeter has been compared to values obtained by other indirect methods in man. Direct pressure measurement is subject to less error than indirect techniques. This study was designed to compare systolic pressure values obtained using a pulse oximeter, with values obtained by direct arterial pressure measurement. The pulse oximeter waveform was used as an indication of perfusion. A blood pressure cuff was applied proximal to the pulse oximeter probe. The cuff was inflated until the oximeter waveform disappeared, this value was recorded as the systolic pressure at the disappearance of the waveform (SPD). The cuff was inflated to a pressure > 200 mmHg, then gradually deflated until the waveform reappeared, this value was recorded as the systolic pressure at reappearance of the waveform (SPR). The average of the two values, SPD and SPR, was calculated and recorded as SPA. The study was performed in sows (n = 21) undergoing cesarean section under epidural anesthesia and IV sedation. A total of 280 measurements were made of SPD, SPR and SPA. Regression analysis of SPA and direct measurement revealed a correlation coefficient (r) of 0.81. Calculation of mean difference (bias) and standard deviation of the bias (precision) for direct pressure--SPA revealed a value of 1.3 +/- 12.1. When compared with direct measurement, the correlation of this technique was similar to that recorded for other indirect techniques used in small animals. This indicates that this technique would be useful for following systolic pressure trends.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8004540

  5. Salary survey of ambulatory care clinical pharmacists.

    PubMed

    Anastasio, G D; Shaughnessy, A F

    1997-01-01

    To determine salary and selected fringe benefits of members of the Ambulatory Care Practice and Research Network of the American College of Clinical Pharmacy, we developed a self-administered questionnaire that surveyed demographic information, schooling and training, academic appointments, yearly salary (as of February 1, 1995), source of salary, outside income, annual raise, vacation time, financial support for continuing education, and board certification. Ninety-nine surveys were returned (return rate 46%). Respondents were mostly women (58%), their average age was 34 years (range 25-51 yrs), and they had a median of 5 years in the work force. Most respondents (67%) had residency training, whereas only 21% had fellowship experience. Board certification was reported by 46%. The median salary was $53,500 (average $55,861, range $35-90 k), with progression for academic rank. The last salary increase averaged 3.7%. Most (93%) respondents received an average of $1509 for travel. The survey represents a young work force. The salaries vary but show progression for accomplishment.

  6. Continuous ambulatory peritoneal dialysis: no longer experimental.

    PubMed Central

    Wu, G.; Khanna, R.; Vas, S. I.; Digenis, G.; Oreopoulos, D. G.

    1984-01-01

    Many patients with end-stage renal disease have now been maintained for 5 years or more with continuous ambulatory peritoneal dialysis (CAPD). Viewed initially as an experimental alternative to be used only when hemodialysis was not feasible, CAPD is now seen as the treatment of choice in an increasing number of situations. CAPD is suitable for self-care. The main concern in the early years--peritonitis--is now less frightening and less frequent (one episode occurring every 18 patient-months as compared with every 8 initially), and this has allowed chronic complications of CAPD, such as malnutrition and loss of the peritoneum's capacity for ultrafiltration, to come to light. As would be expected, among patients of advanced age and those who have heart disease or diabetes, survival rates tend to be lower than among other CAPD patients. However, hypertension seems to be more easily controlled, pre-existing anemia can be significantly ameliorated, and young children grow more normally than they do with hemodialysis. Diabetes-related changes in vision stabilize in most CAPD patients, and control of the blood glucose level is good; insulin is administered intraperitoneally. CAPD is thus showing itself to be a feasible form of long-term treatment for end-stage renal disease. Images Fig. 1 PMID:6697277

  7. Continuous ambulatory peritoneal dialysis: Indian scenario.

    PubMed

    Abraham, Georgi; Mathew, Milli; Hinduja, Anish; Padma, G

    2002-03-01

    Chronic peritoneal dialysis (CPD) has been initiated as a treatment modality for chronic renal failure patients in the Indian subcontinent since 1990. Over a period of 9 years both continuous ambulatory peritoneal dialysis (CAPD) and continuous cyclic peritoneal dialysis (CCPD) have emerged as accepted forms of renal replacement therapy in our country. Although there were government restrictions on import of dialysis fluid until 1993, the availability of locally manufactured fluid in collapsible bags had facilitated the expansion of the programme to the far corners of the country and in neighbouring countries. Initially majority (78%) of the patients who were started on this programme were diabetics with other comorbid conditions who were drop-outs from haemodialysis and unfit for transplantation. Both CAPD and CCPD have been used for all age groups and for men and women. Majority of the patients do 3 x 2 l exchanges a day on CAPD; 8-10 l using a cycler at night those who are onCCPD. Peritonitis rate was 1 episode every 18 patient months. With the introduction of new connection and disposable sets the incidence of peritonitis is dropping down. The major cause of drop-out is cardiovascular death followed by peritonitis. Malnutrition is a major problem in both CAPD and haemodialysis patients. The programme has been expanded and there are over one thousand patients on this treatment in the country. The introduction of CPD had a major impact on the treatment of renal failure in India.

  8. Systolic Signal Processor/High Frequency Direction Finding

    DTIC Science & Technology

    1990-10-01

    MUSIC ) algorithm and the finite impulse response (FIR) filter onto the testbed hardware was supported by joint sponsorship of the block and major bid...computational throughput. The systolic implementations of a four-channel finite impulse response (FIR) filter and multiple signal classification ( MUSIC ... MUSIC ) algorithm was mated to a bank of finite impulse response (FIR) filters and a four-channel data acquisition subsystem. A complete description

  9. Socioeconomic status and health: education and income are independent and joint predictors of ambulatory blood pressure.

    PubMed

    Cundiff, Jenny M; Uchino, Bert N; Smith, Timothy W; Birmingham, Wendy

    2015-02-01

    Epidemiological research suggests that different indicators of socioeconomic status (SES) such as income and education may have independent and/or interactive effects on health outcomes. In this study, we examined both simple and more complex associations (i.e., interactions) between different indicators of SES and ambulatory blood pressure (ABP) during daily life. Our sample consisted of 94 married couples who completed a one-day ABP protocol. Both income and education were independently related to systolic blood pressure and only income was significantly related to diastolic blood pressure. There were also statistical interactions such that individuals with high levels of both income and education evidenced the lowest ABP. Gender moderated these findings. Three-way interactions revealed that, in general, women appear to benefit from either indicator of SES, whereas men appear to benefit more from income. The findings are consistent with epidemiological research and suggest one important physiological mechanism by which income and education may have independent and interactive effects on health.

  10. Artificial Gravity with Ergometric Exercise Training Improves Cardiovascular Function in Ambulatory Men

    NASA Astrophysics Data System (ADS)

    Sun, Xi-Qing; Zhu, Chao; Shang, Shu; Yao, Yong-Jie

    2008-06-01

    The necessity of preventing physiological deconditioning in astronauts exposed to long-term space flights is well known. Artificial gravity training via short-arm centrifugation as a countermeasure to microgravity has been considered for many years. However, an optimal duration, level and rate of exposure to artificial gravity have not yet been determined. The purpose of the present study was to investigate the cardiovascular effects of three weeks of intermittent artificial gravity with ergometric exercise training on normal ambulatory men. During 3 weeks experiment, eight healthy male subjects received alternate +1 to +2 Gz (at the foot) short-arm centrifuge training with 30 W ergometric exercise for 30 min per day. Cardiac function, heart rate variability, heart rate and blood pressure were measured before and after training. Stroke volume and total peripheral resistance increased significantly after 3 weeks training, compared with the pre-training baseline. Left ventricular ejection time (LVET) and ejection fraction increased significantly after 3 weeks training, while heart rate, the ratio of pre-ejection period to LVET, and the ratio of low frequency to high frequency power decreased significantly after 3 weeks training. These results suggest that three weeks short-arm centrifuge training with ergometric exercise could improve human cardiac systolic and pumping functions, and increase cardiac vagal modulation.

  11. It’s Complicated: Marital Ambivalence on Ambulatory Blood Pressure and Daily Interpersonal Functioning

    PubMed Central

    Uchino, Bert N.; Smith, Timothy W.; Light, Kathleen C.; Butner, Jonathan

    2015-01-01

    Background Marriage decreases cardiovascular morbidity although relationship quality matters. While some marriages contain highly positive aspects (supportive), marriages may also simultaneously contain both positive and negative aspects (ambivalent). Individuals whose spouses or own behavior is ambivalent may not experience the same cardiovascular-protective benefits of marriage. Purpose The purpose of this study is to elucidate the physiological pathways by which marital quality may influence long-term health and examine ambivalent behavior on interpersonal-functioning and ambulatory blood pressure (ABP). Methods Interpersonal functioning and ABP were examined in 94 couples. Results Spousal and own ambivalent behavior was associated with lower intimacy (ps<.01) and higher systolic ABP (ps <.01). Spousal ambivalent behavior was associated with lower ratings of partner responsiveness (p<.01) and less self- and spousal-disclosure (ps<.05). Mediational analyses indicated that own behavior mediated links between spousal ambivalent behavior and ABP. Conclusions Despite the positivity in relationships, individuals whose spouses’ or own behavior is ambivalent may not receive cardiovascular protection from this positivity. PMID:25964001

  12. Effect of tumor necrosis factor-α inhibitors on ambulatory 24-h blood pressure.

    PubMed

    Grossman, Chagai; Bornstein, Gil; Leibowitz, Avshalom; Ben-Zvi, Ilan; Grossman, Ehud

    2017-02-01

    Tumor necrosis factor alpha (TNF-α) inhibitors are increasingly being used in inflammatory rheumatic diseases (IRD). The risk of cardiovascular disease is elevated in patients with IRD and TNF-α inhibitors reduce this risk. We assessed whether the beneficial effect of TNF-α inhibitors on cardiovascular risk is mediated by blood pressure reduction. We measured blood pressure levels with 24-h ambulatory blood pressure measurements device in patients with IRD before and 3 months after treatment with TNF-α inhibitors. The study population consisted of 15 subjects (6 men; mean age 45.9 ± 14.1 years). Most patients had either rheumatoid arthritis or psoriatic arthritis and adalimumab was the most common TNF-α inhibitor used. Mean 24-h systolic and diastolic blood pressure levels remained the same after treatment (121 ± 12/66 ± 7 before and 123 ± 11/67 ± 10 mm Hg after; p = 0.88 and 0.66, respectively). The study demonstrates that TNF-α inhibitors have no effect on blood pressure levels.

  13. Systolic time intervals in children with heart disease.

    PubMed

    Hedvall, G

    1983-03-01

    Of the systolic time intervals, the preejection period is known to correlate well with invasively measured isometric contraction time, and increase of the quotient preejection period/left ventricular ejection time (PEP/LVET) is considered to be of a good indicator of left ventricular failure. The different systolic time intervals have been recorded from the carotid pulse curve from 40 normal children, 20 aged five and 20 aged ten years. Their PEP/LVET was 0.31 +/- 0.04. Seventy-eight children with different heart diseases were then investigated. In patients with congenital total heart block or extrasystoles, there was a negative correlation between PEP/LVET and the R-R interval, in accordance with the Frank-Starling law. In patients with ventricular septal defects PEP/LVET differentiates between small and large shunts; the increased PEP/LVET of the latter normalizes after operation. The increased PEP/RVET of children with transposition of the great arteries is an expression of the inadequacy of the right ventricle as a systemic chamber. In aortic stenosis "normalization" of a previously decreased PEP/LVET may indicate early left ventricular failure. In primary myocardial disease registration of the systolic time intervals enables us to follow the left ventricular function more closely than is possible with invasive techniques.

  14. Coronary MR Angiography at 3T During Diastole and Systole

    PubMed Central

    Gharib, Ahmed M.; Herzka, Daniel A.; Ustun, Ali O.; Desai, Milind Y.; Locklin, Julia; Pettigrew, Roderic I.; Stuber, Matthias

    2016-01-01

    Purpose To investigate the impact of end-systolic imaging on quality of right coronary magnetic resonance angiography (MRA) in comparison to diastolic and to study the effect of RR interval variability on image quality. Materials and Methods The right coronary artery (RCA) of 10 normal volunteers was imaged at 3T using parallel imaging (sensitivity encoding [SENSE]). Navigator-gated three-dimensional (3D) gradient echo was used three times: 1) end-systolic short acquisition (SS): 35-msec window; 2) diastolic short (DS): middiastolic acquisition using 35-msec window; and 3) diastolic long (DL): 75-msec diastolic acquisition window. Vectorcardiogram (VCG) data was used to analyze RR variability. Vessel sharpness, length, and diameter were compared to each other and correlated with RR variability. Blinded qualitative image scores of the images were compared. Results Quantitative and qualitative parameters were not significantly different and showed no significant correlation with RR variability. Conclusion Imaging the RCA at 3T during the end-systolic rest period using SENSE is possible without significant detrimental effect on image quality. Breaking away from the standard of imaging only during diastole can potentially improve image quality in tachycardic patients or used for simultaneous imaging during both periods in a single scan. PMID:17896391

  15. Diuretics enhance effects of increased dose of candesartan on ambulatory blood pressure reduction in Japanese patients with uncontrolled hypertension treated with medium-dose angiotensin II receptor blockers.

    PubMed

    Sakima, Atsushi; Kita, Toshihiro; Nakada, Seigo; Yokota, Naoto; Tamaki, Noboru; Etoh, Takuma; Shimokubo, Toru; Kitamura, Kazuo; Takishita, Shuichi; Ohya, Yusuke

    2014-01-01

    Abstract Although blockade of the renin-angiotensin system by increasing the dose of angiotensin II receptor blockers (ARBs) is recommended to achieve clinical benefits in terms of blood pressure (BP) control and cardiovascular and renal outcomes, the effect of this increased dose on ambulatory BP monitoring has not been evaluated completely in Japanese patients with uncontrolled hypertension undergoing medium-dose ARB therapy. The primary objective of this study was to examine the effect of the relatively high dose of the ARB candesartan (12 mg/day) on 24-h systolic BP and the attainment of target BP levels in uncontrolled hypertension treated with a medium dose of ARBs. A total of 146 hypertensive patients (age: 69.9 ± 9.3 years; females: 65.8%) completed the study. After switching to candesartan at 12 mg/day, all these BP measurements decreased significantly (p<0.001). Attainment of the target office BP (p=0.0014) and 24-h BP levels (p=0.0296) also improved significantly. Subgroup analysis indicated that the reduction of 24-h systolic BP was larger in patients treated with diuretics than those without (p=0.0206). Multivariate analysis revealed a significant correlation between the combined ARB and diuretic therapy, and the change in 24-h systolic BP irrespective of preceding ARBs. In conclusion, the switching therapy to increased dose of candesartan caused significant reductions in office and ambulatory BP levels, and improved the attainment of target BP levels in patients with uncontrolled hypertension treated with a medium dose of ARBs. Combination with diuretics enhanced this effect.

  16. [Ambulatory surgery in urology: first numbers of a successful program].

    PubMed

    Espiridião, P; Amorim, R; Costa, L; Oliveira, V; Xambre, L; Pereira, M; Amaral, L; Ferraz, L

    2009-01-01

    The ambulatory surgery includes those surgical procedures that require a small period of post-operative recovery so that the patients will be discharged from the hospital in the same day of the surgical intervention. In Urology, the vast amount of pathology that allows the cure with medium and low complexity surgical procedures makes this specialty a privileged one in which ambulatory surgery is concerned. In this paper the authors propose to describe how their Urology group works in the ambulatory field. 472 patients where reviewed in an evaluation period from January 2006 to April 2008. The medical appointment protocol is summarized as well as the most common surgical procedures and complications. Annually we operate an average of 200 ambulatory patients and this represents about 22% of the hole surgical activity of the Urology group. The majority of the surgeries are circumcisions and vasectomies (always associated with other small procedures). There is a 5 hours weakly period where a total of 5 to 6 patients are operated. Surgical complications represented 1.6% of total procedures, all of them late ones. With this specific ambulatory program our service managed to reduce drastically the waiting time for this kind of procedures (now-a-days is about 3-4 weeks), with a satisfaction rate of about 95%. According to the great outcomes, low complications rate and great acceptance of the patients, the development of this unit is without doubt a winning project in patients care.

  17. Understanding the Diffusion of Ambulatory Surgery Centers

    PubMed Central

    Suskind, Anne M.; Zhang, Yun; Dunn, Rodney L.; Hollingsworth, John M.; Strope, Seth A.; Hollenbeck, Brent K.

    2015-01-01

    Background Outpatient surgery is increasingly delivered at freestanding ambulatory surgery centers (ASCs), which are thought to deliver quality care at lower costs per episode. The objective of this study was to understand potential facilitators and/or barriers to the introduction of freestanding ASCs in the United States. Methods This is an observational study conducted from 2008–2010 using a 20% sample of Medicare claims. Potential determinants of ASC dissemination, including population, system, and legal factors, were compared between markets that always had ASCs, never had ASCs, and those that had new ASCs open during the study. Multivariable logistic regression was used to determine characteristics of markets associated with the opening of a new facility in a previously naïve market. Results New ASCs opened in 67 previously naïve markets between 2008 and 2010. ASCs were more likely to open in HSAs that were urban (adjusted OR 4.10; 95% CI 1.51–10.96), had higher per capita income (adjusted OR 3.83; 95% CI 1.43–10.45), and had less competition for outpatient surgery (adjusted OR 2.13; 95% CI 1.02–4.45). Legal considerations and latent need, as measured by case volumes of hospital-based outpatient surgery in 2007, were not associated with the opening of a new ASC. Conclusions Freestanding ASCs opened in advantageous socioeconomic environments with the least amount of competition. Because of their associated efficiency advantages, policymakers might consider strategies to promote ASC diffusion in disadvantaged markets to potentially improve access and reduce costs. PMID:25143440

  18. The fraud and abuse statute and investor-owned ambulatory surgery centers.

    PubMed

    Becker, Scott; Harned, Nicholas

    2002-04-01

    The growth in the number of ambulatory surgery centers, coupled with the unique guidance provided by the OIG in this area, provide a fascinating legal and regulatory environment for ambulatory surgery centers.

  19. A Unified Approach to the Analysis and Synthesis of Systolic Arrays.

    DTIC Science & Technology

    1985-04-01

    ANALYSIS AND SYNTHESIS OF SYSTOLIC ARRAYS... Analysis and Synthesis of Systolic Arrays N/A N/A N/A N/A 12. PERSONAL AUTHOR($) Hornick, Scot Wayne 13&. TYP OF REPORT K-J 1131L TIME COVERIO 14. OATS OF...frame- work to unify the analysis and synthesis of systolic networks. We describe a class of transformations on systolic networks that alter

  20. Designing appointment scheduling systems for ambulatory care services.

    PubMed

    Cayirli, Tugba; Veral, Emre; Rosen, Harry

    2006-02-01

    The current climate in the health care industry demands efficiency and patient satisfaction in medical care delivery. These two demands intersect in scheduling of ambulatory care visits. This paper uses patient and doctor-related measures to assess ambulatory care performance and investigates the interactions among appointment system elements and patient panel characteristics. Analysis methodology involves simulation modeling of clinic sessions where empirical data forms the basis of model design and assumptions. Results indicate that patient sequencing has a greater effect on ambulatory care performance than the choice of an appointment rule, and that panel characteristics such as walk-ins, no-shows, punctuality and overall session volume, influence the effectiveness of appointment systems.

  1. Ambulatory surgery centers best practices for the 90s.

    PubMed

    Hoover, J A

    1994-05-01

    Outpatient surgery will be the driving force in the continued growth of ambulatory care in the 1990s. Providing efficient, high-quality ambulatory surgical services should therefore be a priority among healthcare providers. Arthur Andersen conducted a survey to discover best practices in ambulatory surgical service. General success characteristics of best performers were business-focused relationships with physicians, the use of clinical protocols, patient convenience, cost management, strong leadership, teamwork, streamlined processes and efficient design. Other important factors included scheduling to maximize OR room use; achieving surgical efficiencies through reduced case pack assembly errors and equipment availability; a focus on cost capture rather than charge capture; sound materiel management practices, such as standardization and vendor teaming; and the appropriate use of automated systems. It is important to evaluate whether the best practices are applicable to your environment and what specific changes to your current processes would be necessary to adopt them.

  2. Ambulatory measurement of the ECG T-wave amplitude.

    PubMed

    van Lien, René; Neijts, Melanie; Willemsen, Gonneke; de Geus, Eco J C

    2015-02-01

    Ambulatory recording of the preejection period (PEP) can be used to measure changes in cardiac sympathetic nervous system (SNS) activity under naturalistic conditions. Here, we test the ECG T-wave amplitude (TWA) as an alternative measure, using 24-h ambulatory monitoring of PEP and TWA in a sample of 564 healthy adults. The TWA showed a decrease in response to mental stress and a monotonic decrease from nighttime sleep to daytime sitting and more physically active behaviors. Within-participant changes in TWA were correlated with changes in the PEP across the standardized stressors (r = .42) and the unstandardized naturalistic conditions (mean r = .35). Partialling out changes in heart rate and vagal effects attenuated these correlations, but they remained significant. Ambulatory TWA cannot replace PEP, but simultaneous recording of TWA and PEP provides a more comprehensive picture of changes in cardiac SNS activity in real-life settings.

  3. A Twelve-Year Experience in Ambulatory Surgery within Urology

    PubMed Central

    Navalón, Pedro; Pallás, Yoni; Navalón, Victor; Ordoño, Felipe; Monllor, Elisa

    2012-01-01

    Purpose. The aim of this study is to show you the results we obtained through the integration of the Urology Department into the Ambulatory Surgery Unit for the very first twelve years. Scope. We will explain both the criteria we followed for patients to join in and the surgical and anesthetic procedures we used with those 1544 patients who were ambulatory subjected to urological diseases. After those patients were treated, they reached up to 95% of reasonable results. Conclusions. Most of urological patients liable to have surgical treatment are bound to be included in an ambulatory surgery program, which implies neither a worse healthcare service standard nor a worse satisfaction in patients. PMID:22530152

  4. Pediatric ambulatory blood pressure monitoring: indications and interpretations.

    PubMed

    Flynn, Joseph T; Urbina, Elaine M

    2012-06-01

    The prevalence of hypertension in children and adolescents is increasing, especially in obese and ethnic children. The adverse long-term effects of hypertension beginning in youth are known; therefore, it is important to identify young patients who need intervention. Unfortunately, measuring blood pressure (BP) is difficult due to the variety of techniques available and innate biologic variation in BP levels. Ambulatory BP monitoring may overcome some of the challenges clinicians face when attempting to categorize a young patient's BP levels. In this article, the authors review the use of ambulatory BP monitoring in pediatrics, discuss interpretation of ambulatory BP monitoring, and discuss gaps in knowledge in usage of this technique in the management of pediatric hypertension.

  5. 77 FR 70783 - Medicare and Medicaid Programs; Approval of the Accreditation Association for Ambulatory Health...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-27

    ... Accreditation Association for Ambulatory Health Care (AAAHC) Application for Continuing CMS Approval of Its... Association for Ambulatory Health Care (AAAHC) for continued recognition as a national accrediting... by CMS. The Ambulatory Health Care's (AAAHC) current term of approval for their ASC...

  6. The Ambulatory Semi-Poikilothermic Dog (Poikilothermic Against Cold)

    DTIC Science & Technology

    1952-06-10

    aK 12 pp a ii Abstract; Report No. 84 From Project No. 5-6/i-12-C2^ THE AMBULATORY SEt-H-POIKILOq^’jIRrac ..- DOG ; (Poikilothermic Against 13625...evaluating partial impairment of thermo-regulatory functions. _-; ’’•••, Ambulatory semi-poikilothermic dogs \\ xe pre.pared.’.i3r’selec-; tive...SEMI-POIKILOTHERMIC DOG * (Poikilothermic Against Cold) Dy Allen D. Keller, Physiologist and Henry Batsel, Physiologist with the technical

  7. A System for Coding the Presenting Requests of Ambulatory Patients

    PubMed Central

    Weinstein, Philip; Gordon, Michael J.; Gilson, John S.

    1977-01-01

    Effective methods developed to review and study the care of patients in hospital have not been applicable to ambulatory care, in which definitive diagnosis is the exception rather than the rule. A reasonable alternative to using diagnosis as the basis for assessing ambulatory care is to use the problems or requests presented by the patients themselves. A system has been developed for classifying and coding this information for flexible computer retrieval. Testing indicates that the system is simple in design, easily mastered by nonphysicians and provides reliable, useful data at a low cost. PMID:855324

  8. An ambulatory care classification system: design, development and evaluation.

    PubMed Central

    Schneider, D

    1979-01-01

    A medical classification system for coding a patient's reason for visit has been developed for use in the National Ambulatory Medical Care Survey and for ambulatory care settings. The code is developed in a modular structure and includes modules for Symptoms; Diseases; Diagnostic, Screening and Preventive Procedures; Therapeutic Procedures, Process Problems and Counseling; Injuries and Adverse Effects; Follow-ups for Test Results; and Administrative Reasons for Visits. The system was evaluated in coding tests, through review by medical societies representing the major specialties, and by other health care providers. An extensive coding index is available. PMID:468555

  9. Predialysis systolic BP variability and outcomes in hemodialysis patients.

    PubMed

    Shafi, Tariq; Sozio, Stephen M; Bandeen-Roche, Karen J; Ephraim, Patti L; Luly, Jason R; St Peter, Wendy L; McDermott, Aidan; Scialla, Julia J; Crews, Deidra C; Tangri, Navdeep; Miskulin, Dana C; Michels, Wieneke M; Jaar, Bernard G; Herzog, Charles A; Zager, Philip G; Meyer, Klemens B; Wu, Albert W; Boulware, L Ebony

    2014-04-01

    BP variability (BPV) is an important predictor of outcomes in the general population, but its association with clinical outcomes in hemodialysis patients is not clear. We identified 11,291 patients starting dialysis in 2003-2008 and followed them through December 31, 2008 (median=22 months). Predialysis systolic BPV was assessed over monthly intervals. Outcomes included factors associated with BPV, mortality (all-cause and cardiovascular), and first cardiovascular event (cardiovascular death or hospitalization). Patients' mean age was 62 years, 55% of patients were men, and 58% of patients were white. Modifiable factors associated with higher BPV included obesity, higher calcium-phosphate product levels, and lower hemoglobin concentration; factors associated with lower BPV included greater fluid removal, achievement of prescribed dry weight during dialysis, higher hemoglobin concentration, and antihypertensive regimens without β-blockers or renin-angiotensin system blocking agents. In total, 3200 deaths occurred, including 1592 cardiovascular deaths. After adjustment for demographics, comorbidities, and clinical factors, higher predialysis BPV was associated with increased risk of all-cause mortality (hazard ratio [HR], 1.18; 95% confidence interval [95% CI] per 1 SD increase in BPV, 1.13 to 1.22), cardiovascular mortality (HR, 1.18; 95% CI, 1.12 to 1.24), and first cardiovascular event (HR, 1.11; 95% CI, 1.07 to 1.15). Results were similar when BPV was categorized in tertiles and patients were stratified by baseline systolic BP. In summary, predialysis systolic BPV is an important, potentially modifiable risk factor for death and cardiovascular outcomes in incident hemodialysis patients. Studies of BP management in dialysis patients should focus on both absolute BP and BPV.

  10. Equine wellness care in ambulatory practice.

    PubMed

    Sandoval, Claudia; True, Claudia

    2012-04-01

    Clients want dependable veterinary care and to understand how the services will benefit and meet their horse’s needs. Wellness visits provide ambulatory practitioners with great opportunities to strengthen the doctor-client-patient bond; effective communication with clients during wellness visits, where new literature or facts can be presented, can offer opportunities for demonstrating the value of having the veterinarian maintain a primary role in disease control. The criteria for selecting vaccines, interpreting FECs, and diagnosing dental pathology require the continued need for veterinary involvement. When providing wellness services, veterinarians should discuss those services, the reasons for them, as well as the possibility of adverse reactions. In so doing, the veterinarian is able to clearly distinguish himself or herself from a technician who is merely giving a "shot." Although some of these services can be performed by clients and lay professionals, the knowledge and training that veterinarians bring to these tasks add benefits to the horse beyond the services provided. For example, by targeting treatment and conveying the goals and limitations of FECs and deworming to clients, the speed at which anthelmintic resistance occurs will be diminished, and veterinarians will regain control over equine parasite management. Additional client education, such as demonstrating dental pathology to clients and how veterinary treatment benefits their horse, will not only improve the health of the horse further but also solidify the veterinarian’s role in preventative medicine. While all components of a wellness program were not detailed here, services such as nutritional consultation, blood work, and lameness evaluation should be offered based on the practice’s equine population. With the increasing population of geriatric horses, dentistry, nutrition, blood work, and lameness should be assessed annually or biannually. Each practice has its own set of criteria

  11. [Current aspects of ambulatory long-term oxygen therapy].

    PubMed

    Russi, W

    1988-03-19

    Longterm O2-therapy increases life expectancy in hypoxemic patients suffering from chronic obstructive pulmonary disease and may improve their quality of life as well. The efficiency of this treatment modality depends upon the duration of oxygen administration within 24 hours. Measures which prolong mobility through a long-lasting oxygen source improve patient compliance. Transtracheal oxygen delivery is a genuine advance in longterm O2-therapy. Other oxygen-conserving methods are of interest, but experience is lacking to assess their efficiency in longterm practice.

  12. Clinical Practice Guideline for the Treatment of Intrinsic Circadian Rhythm Sleep-Wake Disorders: Advanced Sleep-Wake Phase Disorder (ASWPD), Delayed Sleep-Wake Phase Disorder (DSWPD), Non-24-Hour Sleep-Wake Rhythm Disorder (N24SWD), and Irregular Sleep-Wake Rhythm Disorder (ISWRD). An Update for 2015

    PubMed Central

    Auger, R. Robert; Burgess, Helen J.; Emens, Jonathan S.; Deriy, Ludmila V.; Thomas, Sherene M.; Sharkey, Katherine M.

    2015-01-01

    A systematic literature review and meta-analyses (where appropriate) were performed and the GRADE approach was used to update the previous American Academy of Sleep Medicine Practice Parameters on the treatment of intrinsic circadian rhythm sleep-wake disorders. Available data allowed for positive endorsement (at a second-tier degree of confidence) of strategically timed melatonin (for the treatment of DSWPD, blind adults with N24SWD, and children/ adolescents with ISWRD and comorbid neurological disorders), and light therapy with or without accompanying behavioral interventions (adults with ASWPD, children/adolescents with DSWPD, and elderly with dementia). Recommendations against the use of melatonin and discrete sleep-promoting medications are provided for demented elderly patients, at a second- and first-tier degree of confidence, respectively. No recommendations were provided for remaining treatments/ populations, due to either insufficient or absent data. Areas where further research is needed are discussed. Citation: Auger RR, Burgess HJ, Emens JS, Deriy LV, Thomas SM, Sharkey KM. Clinical practice guideline for the treatment of intrinsic circadian rhythm sleep-wake disorders: advanced sleep-wake phase disorder (ASWPD), delayed sleep-wake phase disorder (DSWPD), non-24-hour sleep-wake rhythm disorder (N24SWD), and irregular sleep-wake rhythm disorder (ISWRD). An update for 2015. J Clin Sleep Med 2015;11(10):1199–1236. PMID:26414986

  13. [The shift towards ambulatory care, from wishful thinking to practice].

    PubMed

    Pierru, Frédéric

    2016-01-01

    For several years, there has been a distinct political will for the development of home care. However, this shift to ambulatory care, a source of financial savings for the health system and comfort for the patient, requires sociological debate. Notable issues for discussion are the social inequalities caused by this evolution and the role of the family in the care.

  14. Teaching Interdisciplinary Geriatrics Ambulatory Care: A Case Study

    ERIC Educational Resources Information Center

    Williams, Brent C.; Remington, Tami L.; Foulk, Mariko A.; Whall, Ann L.

    2006-01-01

    Interdisciplinary health care training is advocated by numerous government and philanthropic organizations. Educators in the health professions are increasingly offering training in interdisciplinary health care in a variety of contexts, including ambulatory settings. This paper describes a three-year program to teach skills in interdisciplinary…

  15. Ambulatory care centers: structure, services, and marketing techniques.

    PubMed

    Phillips, J H; Reeder, C E

    1987-12-01

    A generic definition for an ambulatory care center (ACC) is not apparent. ACCs differ in ownership, primary function, and services offered. ACCs are attempting to expand their patient base by providing nonemergency care, contracting with provider organizations (e.g., HMOs and PPOs), and using aggressive marketing techniques.

  16. Planning for ambulatory care: simple methods for improving patient flow.

    PubMed

    Schuh, S E; Tolins, I; Westphal, M C; Miller, M C

    1977-06-01

    A combined patient flow and work sampling study was done at the Ambulatory Pediatric Service of the Medical University of South Carolina. The biggest problem was that almost two thirds of the patient's time was spent waiting to see the doctor. Reasons for delay included too few examining rooms, the single block appointment system, and design of the facility.

  17. The ten successful elements of an ambulatory care center.

    PubMed

    Watkins, G

    1997-01-01

    Experts in healthcare predict that in the future, over 80% of all care will be provided either in the home or ambulatory care centers. How radiology facilities position themselves for this shifting market is critical to their long-term success, even though it appears there are endless opportunities for providing care in this atmosphere. The ten most critical elements that healthcare providers must address to ensure their preparedness are discussed. Location is critical, particularly since patients no longer want to travel to regional medical centers. The most aggressive providers are building local care centers to serve specific populations. Ambulatory care centers should project a high tech, high touch atmosphere. Patient comfort and the appeal of the overall environment must be considered. Centers need to focus on their customers' needs in multiple areas of care. A quick and easy registration process, providing dressing gowns in patient areas, clear billing functions--these are all important areas that centers should develop. Physicians practicing in the ambulatory care center are key to its overall success and can set the tone for all staff members. Staff members must be friendly and professional in their work with patients. The hours offered by the center must meet the needs of its client base, perhaps by offering evening and weekend appointments. Keeping appointments on schedule is critical if a center wants satisfied customers. It's important to identify the target before developing your marketing plan. Where do your referrals come from? Look to such sources as referring physicians, managed care plans and patients themselves. Careful billing is critical for survival in the ambulatory care world. Costs are important and systems that can track cost per exam are useful. Know your bottom line. Service remains the central focus of all successful ambulatory care center functions.

  18. "Sawfish" systolic narrowing of the left anterior descending coronary artery: an angiographic sign of hypertrophic cardiomyopathy.

    PubMed

    Brugada, P; Bär, F W; de Zwaan, C; Roy, D; Green, M; Wellens, H J

    1982-10-01

    The morphologic characteristics at coronary arteriography of systolic narrowing of the left anterior descending coronary artery (LAD) were evaluated in 14 patients. Six patients had systolic narrowing of the LAD not associated with other cardiac abnormalities (group A) and eight patients had systolic narrowing of the LAD associated with hypertrophic cardiomyopathy (group B). Patients in group A showed a smooth and progressive constriction of the vessel up to the point of maximal stenosis, giving it a "rat-tail" appearance. There was no systolic narrowing of septal branches or of other epicardial vessels in this group. In patients of group B, systolic narrowing of the LAD had a "saw-fish" appearance. Seven patients had systolic narrowing of the septal branches, and five had systolic narrowing of other epicardial vessels. These data indicate that systolic narrowing of the LAD in patients with hypertrophic cardiomyopathy differs angiographically from systolic narrowing due to an intramural course of a part of the vessel (as in group A patients). We postulate that in patients with hypertropic cardiomyopathy, fiber hypertrophy and disarray in the vicinity of the coronary vessels is responsible for the morphology and the widespread distribution of systolic narrowing.

  19. Long-term blood pressure changes induced by the 2009 L'Aquila earthquake: assessment by 24 h ambulatory monitoring.

    PubMed

    Giorgini, Paolo; Striuli, Rinaldo; Petrarca, Marco; Petrazzi, Luisa; Pasqualetti, Paolo; Properzi, Giuliana; Desideri, Giovambattista; Omboni, Stefano; Parati, Gianfranco; Ferri, Claudio

    2013-09-01

    An increased rate of cardiovascular and cerebrovascular events has been described during and immediately after earthquakes. In this regard, few data are available on long-term blood pressure control in hypertensive outpatients after an earthquake. We evaluated the long-term effects of the April 2009 L'Aquila earthquake on blood pressure levels, as detected by 24 h ambulatory blood pressure monitoring. Before/after (mean±s.d. 6.9±4.5/14.2±5.1 months, respectively) the earthquake, the available 24 h ambulatory blood pressure monitoring data for the same patients were extracted from our database. Quake-related daily life discomforts were evaluated through interviews. We enrolled 47 patients (25 female, age 52±14 years), divided into three groups according to antihypertensive therapy changes after versus before the earthquake: unchanged therapy (n=24), increased therapy (n=17) and reduced therapy (n=6). Compared with before the quake, in the unchanged therapy group marked increases in 24 h (P=0.004), daytime (P=0.01) and nighttime (P=0.02) systolic blood pressure were observed after the quake. Corresponding changes in 24 h (P=0.005), daytime (P=0.01) and nighttime (P=0.009) diastolic blood pressure were observed. Daily life discomforts were reported more frequently in the unchanged therapy and increased therapy groups than the reduced therapy group (P=0.025 and P=0.018, respectively). In conclusion, this study shows that patients with unchanged therapy display marked blood pressure increments up to more than 1 year after an earthquake, as well as long-term quake-related discomfort. Our data suggest that particular attention to blood pressure levels and adequate therapy modifications should be considered after an earthquake, not only early after the event but also months later.

  20. Real-time neuronal networks reconstruction using hierarchical systolic arrays.

    PubMed

    Yu, Bo; Mak, Terrence; Sun, Yihe; Poon, Chi-Sang

    2011-01-01

    The correlation network of neurons emerges as an important mathematical framework for a spectrum of applications including neural modeling, brain disease prediction and brain-machine interface. However, construction of correlation network is computationally expensive, especially when the number of neurons is large and this prohibits realtime applications. This paper proposes a hardware architecture using hierarchical systolic arrays to reconstruct the correlation network. Through mapping an efficient algorithm for cross-correlation onto a massively parallel structure, the hardware can accomplish the network construction with extremely small delay. The proposed structure is evaluated using Field Programmable Gate Array (FPGA). Results show that our method is three orders of magnitudes faster than the software approach using desktop computer. This new method enables real-time network construction and leads to future novel devices of realtime neuronal network monitoring and rehabilitation.

  1. Acute cardiovascular effects of the Wenchuan earthquake: ambulatory blood pressure monitoring of hypertensive patients.

    PubMed

    Chen, Yucheng; Li, Jing; Xian, Hong; Li, JiangBo; Liu, Si; Liu, GuanJian; Lin, JianNan; Han, Jun; Zeng, Zhi

    2009-09-01

    An increased incidence of cardiovascular events and sudden death occurs after an earthquake. However, the mechanism underlying this is not clear. Previous studies attributed this phenomenon to earthquake-induced elevation of sympathetic activity. This study investigated the acute cardiovascular effects of the Wenchuan earthquake on hypertensive or suspected hypertensive patients. We studied the role of earthquake-induced changes in blood pressure and heart rate in the occurrence of post-earthquake cardiovascular events. This study included 11 patients who were undergoing ambulatory blood pressure monitoring when the Wenchuan earthquake occurred. Trends in blood pressure and heart rate were analyzed, and blood pressure variability (BPV) data were obtained. The mean post-earthquake blood pressure rose rapidly from 125.8+/-17.3/72.1+/-11.9 to 150.5+/-20.3/98+/-10.6 mm Hg (average time of first measurement was 13.8+/-6.3 min after the first tremor), and blood pressure remained high until 6 h after the earthquake. Nighttime blood pressure declined to the mean pre-earthquake daytime levels. The mean daytime blood pressure after the earthquake was greater than the pre-earthquake daytime mean (systolic blood pressure: 138.9+/-14.6 vs. 129.5+/-13.6 mm Hg, P=0.009; diastolic blood pressure (DBP): 81.8+/-13.1 vs. 76.9+/-11.9 mm Hg, P=0.011). Pre- and post-earthquake BPV differed among individuals, but circadian variation was absent in all cases and nightly decreases were less than 10%. These data strongly suggest that significant post-earthquake elevation of blood pressure and abnormal circadian variation of blood pressure are related to the occurrence of post-earthquake cardiovascular events.

  2. Ambulatory heart rate range predicts mode-specific mortality and hospitalisation in chronic heart failure

    PubMed Central

    Cubbon, Richard M; Ruff, Naomi; Groves, David; Eleuteri, Antonio; Denby, Christine; Kearney, Lorraine; Ali, Noman; Walker, Andrew M N; Jamil, Haqeel; Gierula, John; Gale, Chris P; Batin, Phillip D; Nolan, James; Shah, Ajay M; Fox, Keith A A; Sapsford, Robert J; Witte, Klaus K; Kearney, Mark T

    2016-01-01

    Objective We aimed to define the prognostic value of the heart rate range during a 24 h period in patients with chronic heart failure (CHF). Methods Prospective observational cohort study of 791 patients with CHF associated with left ventricular systolic dysfunction. Mode-specific mortality and hospitalisation were linked with ambulatory heart rate range (AHRR; calculated as maximum minus minimum heart rate using 24 h Holter monitor data, including paced and non-sinus complexes) in univariate and multivariate analyses. Findings were then corroborated in a validation cohort of 408 patients with CHF with preserved or reduced left ventricular ejection fraction. Results After a mean 4.1 years of follow-up, increasing AHRR was associated with reduced risk of all-cause, sudden, non-cardiovascular and progressive heart failure death in univariate analyses. After accounting for characteristics that differed between groups above and below median AHRR using multivariate analysis, AHRR remained strongly associated with all-cause mortality (HR 0.991/bpm increase in AHRR (95% CI 0.999 to 0.982); p=0.046). AHRR was not associated with the risk of any non-elective hospitalisation, but was associated with heart-failure-related hospitalisation. AHRR was modestly associated with the SD of normal-to-normal beats (R2=0.2; p<0.001) and with peak exercise-test heart rate (R2=0.33; p<0.001). Analysis of the validation cohort revealed AHRR to be associated with all-cause and mode-specific death as described in the derivation cohort. Conclusions AHRR is a novel and readily available prognosticator in patients with CHF, which may reflect autonomic tone and exercise capacity. PMID:26674986

  3. Fluid shifts, vasodilatation and ambulatory blood pressure reduction during long duration spaceflight

    PubMed Central

    Norsk, Peter; Asmar, Ali; Damgaard, Morten; Christensen, Niels Juel

    2015-01-01

    Acute weightlessness in space induces a fluid shift leading to central volume expansion. Simultaneously, blood pressure is either unchanged or decreased slightly. Whether these effects persist for months in space is unclear. Twenty-four hour ambulatory brachial arterial pressures were automatically recorded at 1–2 h intervals with portable equipment in eight male astronauts: once before launch, once between 85 and 192 days in space on the International Space Station and, finally, once at least 2 months after flight. During the same 24 h, cardiac output (rebreathing method) was measured two to five times (on the ground seated), and venous blood was sampled once (also seated on the ground) for determination of plasma catecholamine concentrations. The 24 h average systolic, diastolic and mean arterial pressures (mean ± se) in space were reduced by 8 ± 2 mmHg (P = 0.01; ANOVA), 9 ± 2 mmHg (P < 0.001) and 10 ± 3 mmHg (P = 0.006), respectively. The nightly blood pressure dip of 8 ± 3 mmHg (P = 0.015) was maintained. Cardiac stroke volume and output increased by 35 ± 10% and 41 ± 9% (P < 0.001); heart rate and catecholamine concentrations were unchanged; and systemic vascular resistance was reduced by 39 ± 4% (P < 0.001). The increase in cardiac stroke volume and output is more than previously observed during short duration flights and might be a precipitator for some of the vision problems encountered by the astronauts. The spaceflight vasodilatation mechanism needs to be explored further. PMID:25774397

  4. Ambulatory blood pressure thresholds for diagnosis of hypertension in patients with and without type 2 diabetes based on cardiovascular outcomes.

    PubMed

    Hermida, Ramón C; Ayala, Diana E; Mojón, Artemio; Fernández, José R

    2013-03-01

    Currently recommended ambulatory blood pressure (BP) monitoring (ABPM) thresholds for diagnosis of hypertension do not differentiate, as international guidelines do for clinic BP, uncomplicated persons at low risk from those at higher risk, e.g., patients with diabetes, for target injury and cardiovascular disease (CVD) risk. We aimed to derive diagnostic thresholds for the awake and asleep systolic (SBP) and diastolic (DBP) BP means based upon CVD outcomes (death from all causes, myocardial infarction, angina pectoris, coronary revascularization, heart failure, acute arterial occlusion of the lower extremities, thrombotic occlusion of the retinal artery, hemorrhagic stroke, ischemic stroke, and transient ischemic attack) for patients with and without diabetes. We prospectively studied 3344 subjects (1718 men/1626 women), 52.6 ± 14.5 (mean ± SD) yrs of age, 607 with type 2 diabetes, during a median follow-up of 5.6 yrs. Those with hypertension at baseline were randomized to ingest all their prescribed hypertension medications upon awakening or the entire daily dose of ≥1 of them at bedtime. At baseline, BP was measured at 20-min intervals from 07:00 to 23:00 h and at 30-min intervals at night for 48 h, and physical activity was simultaneously monitored every minute by wrist actigraphy to accurately derive the awake and asleep BP means. Identical assessment was scheduled annually and more frequently (quarterly) if treatment adjustment was required. Cox regression analysis was used to derive outcome-based reference thresholds for ABPM in subjects with and without diabetes. CVD risk was consistently greater in patients with than without diabetes for awake SBP/DBP means ≥130/75 mm Hg and asleep means ≥110/65 mm Hg. Derived outcome-based reference thresholds for persons without diabetes were 135/85 mm Hg for the awake and 120/70 mm Hg for the asleep SBP/DBP means. In terms of CVD outcome, the equivalent cutoff threshold values for patients

  5. Systolic Blood Pressure Accuracy Enhancement in the Electronic Palpation Method Using Pulse Waveform

    DTIC Science & Technology

    2007-11-02

    1 of 4 SYSTOLIC BLOOD PRESSURE ACCURACY ENHANCEMENT IN THE ELECTRONIC PALPATION METHOD USING PULSE WAVEFORM H. S. S. Sorvoja1, R. A. Myllylä1...systolic blood pressure measurements based on pulse waveform. A set of measurement was carried out with elderly cardiac surgery patients. The experiments... blood pressure . Systolic pressure errors were defined and correlations with other specific values, like pressure rise time, pulse wave velocity

  6. [Left ventricular systolic function: how to understand it and analyze it].

    PubMed

    Fernández-Pérez, G C; Franco López, A; García Fernández, M Á; Corral de la Calle, M Á; Encinas de la Iglesia, J; Velasco Casares, M

    2014-01-01

    In cardiac magnetic resonance imaging studies, left ventricular systolic function is usually calculated automatically. To understand and interpret parameters of left ventricular systolic function correctly, it is fundamental to understand how each parameter is obtained and why values obtained with different techniques, for example, ultrasonography and magnetic resonance imaging, can differ. This article provides details about the usual analysis of systolic function from the quantitative and qualitative points of view; it also explains other methods that do not require specific software. Moreover, we provide a file that we designed for use with Microsoft Excel(®) to enable simple, intuitive analysis of systolic function. Readers can use this file freely.

  7. Association between central obesity and circadian parameters of blood pressure from the korean ambulatory blood pressure monitoring registry: Kor-ABP registry.

    PubMed

    Kang, In Sook; Pyun, Wook Bum; Shin, Jinho; Kim, Ju Han; Kim, Soon Gil; Shin, Gil Ja

    2013-10-01

    Central obesity has been reported as a risk for atherosclerosis and metabolic syndrome. The influence of central obesity on diurnal blood pressure (BP) has not been established. In this study, we investigated the influence of central obesity on the circadian parameters of BP by 24 hr ambulatory BP monitoring. Total 1,290 subjects were enrolled from the Korean Ambulatory BP registry. Central obesity was defined as having a waist circumference≥90 cm in males and ≥85 cm in females. The central-obese group had higher daytime systolic BP (SBP), nighttime SBP and diastolic BP (DBP) than the non-obese group (all, P<0.001). There were no differences in nocturnal dipping (ND) patterns between the groups. Female participants showed a higher BP mean difference (MD) than male participants with concerns of central obesity (daytime SBP MD 5.28 vs 4.27, nighttime SBP MD 6.48 vs 2.72) and wider pulse pressure (PP). Central obesity within the elderly (≥65 yr) also showed a higher BP MD than within the younger group (daytime SBP MD 8.23 vs 3.87, daytime DBP 4.10 vs 1.59). In conclusion, central obesity has no influence on nocturnal dipping patterns. However, higher SBP and wider PP are associated with central obesity, which is accentuated in women.

  8. Ambulatory assessment in panic disorder and specific phobia.

    PubMed

    Alpers, Georg W

    2009-12-01

    Anxiety disorders are among the most prevalent mental disorders. In panic disorder, panic attacks often occur at unpredictable times, making it difficult to study these episodes in the laboratory. In specific phobias, symptoms occur in very circumscribed situations and specific triggers are sometimes difficult to reproduce in the laboratory. Ambulatory assessment, or ecological momentary assessment, can further the understanding of the natural course and scope of symptoms under ecologically valid circumstances. Because bodily symptoms are integral to the diagnosis of anxiety disorders, the objective assessment of physiological responses in the patients' natural environment is particularly important. On the one hand, research has highlighted intriguing discrepancies between the experience of symptoms and physiology during panic attacks. On the other hand, it has validated symptom reporting during therapeutic exposure to phobic situations. Therefore, ambulatory assessment can yield useful information about the psychopathology of anxiety disorders, and it can be used to monitor change during clinical interventions.

  9. Ambulatory oesophageal bile reflux monitoring in Barrett's oesophagus.

    PubMed

    Caldwell, M T; Lawlor, P; Byrne, P J; Walsh, T N; Hennessy, T P

    1995-05-01

    Bile reflux has been implicated in the pathogenesis of Barrett's oesophagus but evaluation remains difficult. Bilitec 2000 is an ambulatory system that detects bilirubin based on its spectrophotometric properties. Oesophageal bile exposure was evaluated in three groups of patients. Group 1 (n = 11) were normal controls, group 2 (n = 13) were patients with uncomplicated gastro-oesophageal reflux and group 3 (n = 12) were patients with Barrett's oesophagus. Bile reflux was greater in patients with Barrett's mucosa than in controls or those with uncomplicated reflux. This difference was seen in the supine and interdigestive periods. The percentage of time at which gastric pH was greater than 4 and oesophageal pH was above 7 did not differ between the groups. Bilitec 2000 detects greater bile reflux in patients with Barrett's oesophagus. No corresponding gastric or oesophageal alkaline shift is found. This ambulatory bile reflux monitoring system may be a useful tool in clinical practice.

  10. LED power reduction trade-offs for ambulatory pulse oximetry.

    PubMed

    Peláez, Eduardo Aguilar; Villegas, Esther Rodríguez

    2007-01-01

    The development of ambulatory arterial pulse oximetry is key to longer term monitoring and treatment of cardiovascular and respiratory conditions. The investigation presented in this paper will assist the designer of an ambulatory pulse oximetry monitor in minimizing the overall LED power consumption (P LED,TOT) levels by analyzing the lowest achievable limit as constrained by the optical components, circuitry implementation and final SpO2 reading accuracy required. LED duty cycle (D LED) reduction and light power (P LED,ON) minimization are proposed as methods to reduce P LED,TOT. Bandwidth and signal quality calculations are carried out in order to determine the required P LED,TOT as a function of the different noise sources.

  11. Interdisciplinary Shared Governance in Ambulatory Care: One Health System's Journey.

    PubMed

    Powers, Sharon; Bacon, Cynthia Thornton

    2016-01-01

    The implementation of shared governance structures in acute care has illustrated the positive relationship between shared decision making and nurse empowerment and positive nurse and patient outcomes. Little is known, however, about interdisciplinary shared governance, and even less is known about shared governance in ambulatory care. This article details one health system's experience with the implementation of an interdisciplinary shared governance structure in ambulatory care over a 4-year period. The authors report lessons learned, positive health system outcomes that resulted including improved communication, better preparedness for accreditation visits, improved assessment of fall risk, and a streamlined documentation system. Also discussed are mechanisms to enhance sustainability of the structure and discussion of future opportunities and challenges.

  12. Improving adherence to the Epic Beacon ambulatory workflow.

    PubMed

    Chackunkal, Ellen; Dhanapal Vogel, Vishnuprabha; Grycki, Meredith; Kostoff, Diana

    2016-03-16

    Computerized physician order entry has been shown to significantly improve chemotherapy safety by reducing the number of prescribing errors. Epic's Beacon Oncology Information System of computerized physician order entry and electronic medication administration was implemented in Henry Ford Health System's ambulatory oncology infusion centers on 9 November 2013. Since that time, compliance to the infusion workflow had not been assessed. The objective of this study was to optimize the current workflow and improve the compliance to this workflow in the ambulatory oncology setting. This study was a retrospective, quasi-experimental study which analyzed the composite workflow compliance rate of patient encounters from 9 to 23 November 2014. Based on this analysis, an intervention was identified and implemented in February 2015 to improve workflow compliance. The primary endpoint was to compare the composite compliance rate to the Beacon workflow before and after a pharmacy-initiated intervention. The intervention, which was education of infusion center staff, was initiated by ambulatory-based, oncology pharmacists and implemented by a multi-disciplinary team of pharmacists and nurses. The composite compliance rate was then reassessed for patient encounters from 2 to 13 March 2015 in order to analyze the effects of the determined intervention on compliance. The initial analysis in November 2014 revealed a composite compliance rate of 38%, and data analysis after the intervention revealed a statistically significant increase in the composite compliance rate to 83% (p < 0.001). This study supports a pharmacist-initiated educational intervention can improve compliance to an ambulatory, oncology infusion workflow.

  13. Hospitalization of older adults due to ambulatory care sensitive conditions

    PubMed Central

    Marques, Aline Pinto; Montilla, Dalia Elena Romero; de Almeida, Wanessa da Silva; de Andrade, Carla Lourenço Tavares

    2014-01-01

    OBJECTIVE To analyze the temporal evolution of the hospitalization of older adults due to ambulatory care sensitive conditions according to their structure, magnitude and causes. METHODS Cross-sectional study based on data from the Hospital Information System of the Brazilian Unified Health System and from the Primary Care Information System, referring to people aged 60 to 74 years living in the state of Rio de Janeiro, Souhteastern Brazil. The proportion and rate of hospitalizations due to ambulatory care sensitive conditions were calculated, both the global rate and, according to diagnoses, the most prevalent ones. The coverage of the Family Health Strategy and the number of medical consultations attended by older adults in primary care were estimated. To analyze the indicators’ impact on hospitalizations, a linear correlation test was used. RESULTS We found an intense reduction in hospitalizations due to ambulatory care sensitive conditions for all causes and age groups. Heart failure, cerebrovascular diseases and chronic obstructive pulmonary diseases concentrated 50.0% of the hospitalizations. Adults older than 69 years had a higher risk of hospitalization due to one of these causes. We observed a higher risk of hospitalization among men. A negative correlation was found between the hospitalizations and the indicators of access to primary care. CONCLUSIONS Primary healthcare in the state of Rio de Janeiro has been significantly impacting the hospital morbidity of the older population. Studies of hospitalizations due to ambulatory care sensitive conditions can aid the identification of the main causes that are sensitive to the intervention of the health services, in order to indicate which actions are more effective to reduce hospitalizations and to increase the population’s quality of life. PMID:25372173

  14. The Perioperative Experience of the Ambulatory Surgery Patient

    DTIC Science & Technology

    2000-10-01

    Preparation of Patients 10 Non-Pharmacological Preparation of Patients 10 Contemporary Health Care Delivery 12 Summary 16 CHAPTER III: METHOD OF...the challenges posed by the Triservice Nursing Research Program Advisory Council who have identified health care delivery systems and ambulatory...White, 1997). This normal expected response is often viewed as a problem, thus health care personnel make efforts to reduce anxiety. Anxiety is an

  15. Redesigning ambulatory care business processes supporting clinical care delivery.

    PubMed

    Patterson, C; Sinkewich, M; Short, J; Callas, E

    1997-04-01

    The first step in redesigning the health care delivery process for ambulatory care begins with the patient and the business processes that support the patient. Patient-related business processes include patient access, service documentation, billing, follow-up, collection, and payment. Access is the portal to the clinical delivery and care management process. Service documentation, charge capture, and payment and collection are supporting processes to care delivery. Realigned provider networks now demand realigned patient business services to provide their members/customers/patients with improved service delivery at less cost. Purchaser mandates for cost containment, health maintenance, and enhanced quality of care have created an environment where every aspect of the delivery system, especially ambulatory care, is being judged. Business processes supporting the outpatient are therefore being reexamined for better efficiency and customer satisfaction. Many health care systems have made major investments in their ambulatory care environment, but have pursued traditional supporting business practices--such as multiple access points, lack of integrated patient appointment scheduling and registration, and multiple patient bills. These are areas that are appropriate for redesign efforts--all with the customer's needs and convenience in mind. Similarly, setting unrealistic expectations, underestimating the effort required, and ignoring the human elements of a patient-focused business service redesign effort can sabotage the very sound reasons for executing such an endeavor. Pitfalls can be avoided if a structured methodology, coupled with a change management process, are employed. Deloitte & Touche Consulting Group has been involved in several major efforts, all with ambulatory care settings to assist with the redesign of their business practices to consider the patient as the driver, instead of the institution providing the care.

  16. [Current clinical aspects of ambulatory blood pressure monitoring].

    PubMed

    Sauza-Sosa, Julio César; Cuéllar-Álvarez, José; Villegas-Herrera, Karla Montserrat; Sierra-Galán, Lilia Mercedes

    2016-01-01

    Systemic arterial hypertension is the prevalentest disease worldwide that significantly increases cardiovascular risk. An early diagnosis together to achieve goals decreases the risk of complications significatly. Recently have been updated the diagnostic criteria for hypertension and the introduction of ambulatory blood pressure monitoring. The introduction into clinical practice of ambulatory blood pressure monitoring was to assist the diagnosis of «white coat hypertension» and «masked hypertension». Today has also shown that ambulatory blood pressure monitoring is better than the traditional method of recording blood pressure in the office, to the diagnosis and to adequate control and adjustment of drug treatment. Also there have been introduced important new concepts such as isloted nocturnal hypertension, morning blood pressure elevation altered and altered patterns of nocturnal dip in blood pressure; which have been associated with increased cardiovascular risk. Several studies have shown significant prognostic value in some stocks. There are still other concepts on which further study is needed to properly establish their introduction to clinical practice as hypertensive load variability, pulse pressure and arterial stiffness. In addition to setting values according to further clinical studies in populations such as elderly and children.

  17. Pathway to Best Practice in Spirometry in the Ambulatory Setting.

    PubMed

    Peracchio, Carol

    2016-01-01

    Spirometry performed in the ambulatory setting is an invaluable tool for diagnosis, monitoring, and evaluation of respiratory health in patients with chronic lung disease. If spirometry is not performed according to American Thoracic Society (ATS) guidelines, unnecessary repeated testing, increased expenditure of time and money, and increased patient and family anxiety may result. Two respiratory therapists at Mission Health System in Asheville, NC, identified an increase in patients arriving at the pulmonary function testing (PFT) laboratories with abnormal spirometry results obtained in the ambulatory setting. These abnormal results were due to incorrect testing procedure, not chronic lung disease. Three training methods were developed to increase knowledge of correct spirometry testing procedure in the ambulatory setting. The therapists also created a plan to educate offices that do not perform spirometry on the importance and availability of PFT services at our hospital for the population of patients with chronic lung disease. Notable improvements in posttraining test results were demonstrated. The education process was evaluated by a leading respiratory expert, with improvements suggested and implemented. Next steps are listed.

  18. Predictors of static balance in ambulatory persons with multiple sclerosis.

    PubMed

    Fry, Donna K; Huang, Min H; Rodda, Becky J

    2016-03-01

    People with multiple sclerosis (MS) experience a high rate of falls and have decreased static and dynamic balance. The purpose of this study was to determine best predictors of static standing balance, as measured by a single limb stance (SLS) timed test, in ambulatory persons with MS (PwMS) from among commonly used medical and rehabilitation clinical tests. Ambulatory PwMS participated in a single test session. Medical exam data gathered included the Function System (FS) neurologic exam and Expanded Disability Status Score (EDSS). A variety of commonly administered rehabilitation clinical tests addressing static balance, dynamic balance, gait endurance, functional lower extremity strength, abdominal and respiratory muscle strength were completed. Descriptive statistics, Pearson product moment correlations, and forward step-wise linear regressions were calculated. Twenty-eight ambulatory PwMS completed this study. Mean age was 54.74 years. Mean SLS score was 14.6 s. Pyramidal, sensory, bowel/bladder, and visual FS scores and the EDSS were significantly correlated with SLS. Maximal step length scores were significantly correlated with SLS at P less than 0.05 and the Functional Stair Test (FST) and 6-min walk test were correlated with SLS at P less than 0.10. Medical exam data EDSS and FS sensory explain 72.1% of the variance in SLS scores. Rehabilitation exam data FS sensory and FST explain 68.8% of the variance. The FS sensory, EDSS, and FST together explain 73.3% of the variance.

  19. Role of ambulatory blood pressure monitoring in resistant hypertension.

    PubMed

    Grassi, Guido; Bombelli, Michele; Seravalle, Gino; Brambilla, Gianmaria; Dell'oro, Raffaella; Mancia, Giuseppe

    2013-06-01

    Ambulatory blood pressure monitoring has gained growing popularity in the diagnosis and treatment of essential hypertension for several reasons, such as the lack of the so-called white-coat effect, the greater reproducibility as compared with clinic blood pressure, the ability to provide information on blood pressure phenomena of prognostic value and the closer relationship with the risk of cardiovascular morbidity and mortality. All the above-mentioned main features of ambulatory blood pressure monitoring are also true for resistant hypertension. In addition, however, in resistant hypertension, blood pressure monitoring allows one to precisely define the diagnosis of this clinical condition, by excluding the presence of white-coat hypertension, which is responsible for a consistent number of "false" resistant hypertensive cases. The approach also allows one to define the patterns of blood pressure variability in this clinical condition, as well as its relationships with target organ damage. Finally, it allows one to assess the effects of therapeutic interventions, such as renal nerves ablation, aimed at improving blood pressure control in this hypertensive state. The present paper will critically review the main features of ambulatory blood pressure monitoring in resistant hypertension, with particular emphasis on the diagnosis and treatment of this high-risk hypertensive state.

  20. Annotated Bibliography: Understanding Ambulatory Care Practices in the Context of Patient Safety and Quality Improvement.

    PubMed

    Montano, Maria F; Mehdi, Harshal; Nash, David B

    2016-11-01

    The ambulatory care setting is an increasingly important component of the patient safety conversation. Inpatient safety is the primary focus of the vast majority of safety research and interventions, but the ambulatory setting is actually where most medical care is administered. Recent attention has shifted toward examining ambulatory care in order to implement better health care quality and safety practices. This annotated bibliography was created to analyze and augment the current literature on ambulatory care practices with regard to patient safety and quality improvement. By providing a thorough examination of current practices, potential improvement strategies in ambulatory care health care settings can be suggested. A better understanding of the myriad factors that influence delivery of patient care will catalyze future health care system development and implementation in the ambulatory setting.

  1. Right ventricular systolic function is not the sole determinant of tricuspid annular motion.

    PubMed

    López-Candales, Angel; Rajagopalan, Navin; Saxena, Neil; Gulyasy, Beth; Edelman, Kathy; Bazaz, Raveen

    2006-10-01

    Maximal tricuspid annular plane systolic excursion (TAPSE) correlates well with right ventricular (RV) function; however, little is known regarding the impact of left ventricular (LV) systolic function on TAPSE. Consequently, TAPSE was examined in 206 patients (105 men; mean age 56 +/- 17 years), and the data were analyzed with respect to RV (RV fractional area change 45 +/- 19%) and LV (56 +/- 17%) systolic function. The mean TAPSE for the population studied was 1.97 +/- 0.72 cm. Although a strong linear correlation was noted between RV fractional area change and TAPSE (r = 0.73, p <0.0001), relative differences with regard to TAPSE were also found. First, the greatest TAPSE was noted only when RV and LV systolic function were normal (2.46 +/- 0.50 cm). Second, patients with reduced RV systolic function had the smallest TAPSE (1.28 +/- 0.48 cm, p <0.0001). Third, patients with normal RV function but reduced LV systolic function had TAPSE (1.91 +/- 0.54 cm, p <0.0001) that was intermediate between that of patients with normal RV and LV systolic function and those with abnormal RV systolic function. Fourth, patients with reduced biventricular function had the smallest TAPSE (1.16 +/- 0.41 cm, p <0.0001). In conclusion, TAPSE is not only determined by RV systolic function but also appears to depend on LV systolic function. TAPSE <2.0 cm is associated with some degree of either RV or LV dysfunction, whereas a value >2.0 cm suggests normal biventricular systolic function.

  2. Evaluation of Ambulatory Care Classification Systems for the Military Health Care System

    DTIC Science & Technology

    1990-12-01

    reports will be directed to the following: U.S. Department of Commerce C) eu urNational Tecnical Information Services (NTIS) (peD ntu5285 Port RoyalRoad p s...of those examined for possible evaluation. Subzequent phases will focus on PACs with an ambulatory surgery component included called Products of...Ambulatory Surgery (PAS),