Abstract Purpose Twenty-four–hour ambulatory blood pressure (ABP) is the reference standard of blood pressure control. Home blood pressure (HBP) is superior to clinic blood pressure for assessing ...control, but a barrier to its use is the need for physicians to calculate average blood pressure from patient diaries. We sought to develop a quick and pragmatic method to assess blood pressure control from patients' HBP diaries. Methods Seven-day HBP and 24-hour ABP were measured in 286 patients with uncomplicated treated hypertension (aged 64 ± 8 years; 53% female). We determined the optimal ratio of home systolic blood pressure readings above threshold (≥135 mm Hg) for the last 10 recorded that would best predict elevated 24-hour ABP. Uncontrolled blood pressure was defined as 24-hour ABP systolic blood pressure ≥130 mm Hg or 24-hour ABP daytime systolic blood pressure ≥135 mm Hg. Validation by corroborative evidence was tested by association with markers of end-organ disease. Results The best predictor of 24-hour ABP systolic blood pressure above treatment/target threshold was having 3 or more (≥30%) of the last 10 home systolic blood pressure readings ≥135 mm Hg (area under the receiver operating characteristic curve = 0.71). Importantly, patients meeting this criterion had evidence of target organ disease, with significantly higher aortic stiffness, left ventricular relative wall thickness, and left atrial area, and lower left ventricular ejection fraction, compared with those who did not meet this criterion. Conclusions To facilitate uptake of HBP monitoring, we propose that physicians can determine the percentage of the last 10 home systolic blood pressure values ≥135 mm Hg for a patient and tailor management accordingly.
We examine whether information in footnotes might lack reliability because auditors permit more misstatement in disclosed, as opposed to recognized, amounts. In both the stock-compensation and lease ...settings, audit partners require greater correction of misstatements in recognized amounts than in the equivalent disclosed amounts. Debriefing questions indicate that the partners make these decisions knowingly, even though they expect greater client resistance to correcting recognized amounts, because they view recognized amounts as more material. Partners also spend more time on correction decisions for recognized information. While prior literature suggests that amounts are often relegated to footnotes because they are less reliable, our results suggest that the actual choice to disclose versus recognize can also reduce information reliability. These results have implications for the interpretation of prior research on the reliability of recognized and disclosed numbers, for financial-accounting standard setters who may want to consider the reliability effects of their recognition versus disclosure decisions, and for auditing standard setters who may wish to clarify auditors' responsibilities for preventing misstatements in disclosed amounts.
The purpose of this study was to compare the ability of various body-composition assessment techniques to detect changes in soft tissue in older, weight-stable women (50–70 y of age) completing a 1-y ...randomized, controlled trial of progressive resistance training. The intervention group (n = 20) performed high-intensity strength-training 2 d/wk with five different exercises; the control group (n = 19) was untreated. Hydrostatic weighing, 24-h urinary creatinine, computed tomography of thigh sections, total body potassium, and tritium dilution techniques were used to measure increases in total fat-free mass (FFM) and the muscle and water components of FFM. A decrease in fat mass (by hydrostatic weighing) was seen in the strength-trained women compared with the control subjects (P - 0.01-0.0001). Anthropometry, bioelectric impedance, dual-energy X-ray absorptiometry, and total body nitrogen and carbon did not measure any significant change in soft tissue. The choice of a body-composition technique is important when designing a study expected to affect soft tissue, because not all techniques available are precise enough to detect small changes.
To determine differences in the mix of patients among medical specialties and among organizational systems of care.
Cross-sectional analysis of 20,158 adults (greater than or equal to 18 years of ...age) who visited providers' offices during 9-day screening periods in 1986. Patient and physician information was obtained by self-administered, standardized questionnaires.
Offices of 349 physicians practicing family medicine, internal medicine, endocrinology, and cardiology within health maintenance organizations, large multispecialty groups, and solo or small single-specialty group practices in three major US cities.
Demographic characteristics, prevalence of chronic disease, disease-specific severity of illness, and functional status and well-being.
Among patients with selected physician-reported chronic illnesses (diabetes, hypertension, recent myocardial infarction, or congestive heart failure), increasing levels of severity were associated with decreasing levels of functional status and well-being and with increased hospitalizations, more physician visits, and higher numbers of prescription drugs. Compared with patients of general internists, patients of cardiologists were older (56 vs 47 years, P less than .01), had worse functional status and well-being scores (P less than .01), and carried more chronic diagnoses (mean 1.32 vs 1.02, P less than .01); patients of family practitioners were younger (40 vs 47 years, P less than .01) and more functional (P less than .01), carried fewer chronic diagnoses (0.70 vs 1.02, P less than .01), and (among diabetic patients only) had lower disease-specific severity scores (2.06 vs 2.30 on a five-point scale, P less than .01). Compared with patients in health maintenance organizations, patients visiting solo practitioners under fee-for-service payment were older (50 vs 45 years, P less than .01) and sicker (had worse physical functioning) and had a higher mean number of chronic diagnoses (1.10 vs 0.93, P less than .01).
Patient mix is related to utilization and differs significantly across medical specialties and systems of care. These differences must be taken into account when interpreting variations in utilization and outcomes across specialties and systems, and when considering alternative policies for payment.
Incontinentia Pigmenti 2 (IP2) is an X-linked dominant disorder with male lethality. Affected females display a characteristic skin eruption that evolves through four classic stages, frequently ...accompanied by dental and retinal abnormalities. Non-random (skewed) X-inactivation in peripheral blood leukocytes and in fibroblasts has been observed in females with IP2; however, sample sizes have been small and methods of analysis varied. We have examined X-inactivation in a large group of multigenerational IP2 families, in smaller families, and in isolated cases. Ninety-eight percent of affected females in multigenerational IP2 pedigrees show completely skewed patterns of X-inactivation, while only ∼10% of a normal control population is skewed. Results both in small families and in new mutation cases with subsequent segregation consistent with Xq28 linkage are similar. Isolated cases show a lower percentage (85%) of skewed affected individuals; this difference may be due to inaccurate clinical ascertainment. The parent of origin of new mutations could be determined in 15 families; paternal new mutations were twice as common as maternal. Fibro-blast subclones from a biopsy at the boundary of a skin lesion in a newborn IP2 patient were isolated, and clones with either one or the other X active were identified, demonstrating that cells with the active disease-bearing X chromosome are still present in stage I skin lesions.
In 1997 the Sun and the Earth passed through the equatorial plane of Jupiter and therefore through the orbital planes of its main satellites. During this period, mutual eclipses and occultations ...occurred and were observed. We investigate the precision of the catalogue to produce improved data for the development of dynamical models. Light curves of mutual eclipses and occultations were recorded by the observers of the international campaign PHEMU97 organized by the Institut de Mécanique Céleste, Paris, France. We made 275 observations of 148 mutual events from 42 sites. For each observation, information is given about the telescope, the receiver, the site and the observational conditions. This paper gathers together the data and gives a first estimate of the precision. The catalogue of these rare events represents a collection of improved accurate astrometric data useful for the development of dynamical models.
The in situ stress tensor has been evaluated in the West Tuna area of the Gippsland Basin based on petroleum well data. Borehole breakouts and drilling-induced tensile fractures interpreted on image ...logs from six wells constrain the maximum horizontal stress orientation to ∼138°N. Four leak-off pressures and one closure pressure suggest the upper bound to the minimum horizontal stress in the West Tuna area is ∼20 MPa/km. The vertical stress was derived from checkshot velocity, density and sonic log data and the average value from sea-level is 20 MPa/km to 1km and 22 MPa/km to 3km depth. Formation test pressures indicate that pore pressure in the West Tuna area is hydrostatic above 2800 m. The maximum horizontal stress magnitude was constrained to 39 - 42 MPa/km based on the occurrence of drilling-induced tensile fractures on the West Tuna image logs. The in situ stress regime in the West Tuna area is therefore interpreted to lie on the boundary of strike-slip and reverse faulting (S
Hmax
> S
v
≈ S
hmin
). The maximum horizontal stress orientation determined herein is broadly consistent with previous orientations derived from 4-arm caliper logs from nine other fields across the Gippsland Basin. The consistent northeast - southwest orientation suggests that large-scale tectonic forces are the primary control on the in situ stress tensor in the Gippsland Basin and indeed elsewhere in southeastern Australia. The horizontal stress magnitude in the Gippsland Basin with the minimum horizontal stress approximately equal to the vertical stress, are significantly higher than in other Australian basins including the Otway Basin. The (oblique compressional) plate boundary at New Zealand may be primarily responsible for the horizontal stress orientation and high horizontal stress magnitude in the Gippsland Basin and is discussed herein.
We present preliminary evidence for a ∼10,000-year earthquake record
from two major fault systems based on sediment cores collected along the
continental margins of western North America. New ...stratigraphic evidence from
Cascadia demonstrates that 13 earthquakes ruptured the entire margin from
Vancouver Island to at least the California border since the eruption of the
Mazama ash 7700 years ago. The 13 events above this prominent stratigraphic
marker have an average repeat time of 600 years, and the youngest event
∼300 years ago coincides with the coastal record. We also extend the record
of past earthquakes to the base of the Holocene (at least 9800 years ago),
during which 18 events correlate along the same region. The sequence of
Holocene events in Cascadia appears to contain a repeating pattern of events, a
tantalizing first look at what may be the long-term behavior of a major fault
system.
The northern California margin cores show a cyclic record of turbidite beds
that may represent Holocene earthquakes on the northern segment of the San
Andreas Fault. Preliminary results are in reasonably good agreement with
onshore paleoseismic data that indicate an age for the penultimate event in the
mid-1600s at several sites and the most likely age for the third event of
∼AD 1300.
The intertidal portion of Mexico's Colorado River Delta is a dynamic environment subject to complex interactions of tectonic, fluvial, and tidal forces at the head of the Gulf of California. We ...review the historical interactions of these forces, use sequential satellite images, overflights, ground observations, and interferometric synthetic aperture radar (InSAR) data to study the effects of the 2010 Mw 7.2 El Mayor-Cucapah Earthquake on changing patterns of tidal inundation within the Delta, and assess effects of these changes to the fluvial/hydrological regime of the Colorado River estuary and nearby Ciénega de Santa Clara wetland. The objectives of this study are to highlight for environmental scientists, land managers, and ecological engineers the contribution of tectonic forces in shaping the intertidal Delta environment and to provide information on the effects of the 2010 earthquake which will be of practical value in planning and designing management measures and restoration projects for the estuary and Ciénega.
The Colorado River estuary is at present blocked by a tidal sand bar which restricts access by marine species to the upper estuary and obstructs the flow of fresh water into the lower estuary. Located 13km east of the estuary, the Ciénega is a 6000ha wetland supported by agricultural drain water from Arizona and Mexico. South of the Ciénega is the Santa Clara Slough, an unvegetated 26,000ha basin subject to periodic inundation from the northern Gulf's high amplitude tides, which have historically reached the margins of the Ciénega several times each year.
The El Mayor-Cucapah earthquake ruptured the previously unknown Indiviso Fault which extends into the intertidal zone just west of the Ciénega. The Ciénega experienced only minor surface deformation having no direct effects to the wetland. Most of the significant ground movement and surface deformation occurred west of the Indiviso Fault adjacent to the estuary, where portions of the intertidal flats underwent extensive liquefaction, northward coseismic displacement and post-seismic subsidence. These surface deformations changed the pattern of tidal inundation, triggering development of a new system of natural tidal channels and creating conditions favorable for installation of projects to restore connectivity between the upper and lower estuary. The changed pattern of tidal inundation may also have contributed to an observed reduction in the occurrence of tidal flooding along the southwestern margin of the Ciénega following the earthquake.
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