To quantify effectiveness of lifestyle interventions for hypertension.
Electronic bibliographic databases from 1998 onwards, existing guidelines, systematic reviews.
We included randomized, ...controlled trials with at least 8 weeks' follow-up, comparing lifestyle with control interventions, enrolling adults with blood pressure at least 140/85 mmHg. Primary outcome measures were systolic and diastolic blood pressure. Two independent reviewers selected trials and abstracted data; differences were resolved by discussion.
We categorized trials by type of intervention and used random effects meta-analysis to combine mean differences between endpoint blood pressure in treatment and control groups in 105 trials randomizing 6805 participants. Robust statistically significant effects were found for improved diet, aerobic exercise, alcohol and sodium restriction, and fish oil supplements: mean reductions in systolic blood pressure of 5.0 mmHg 95% confidence interval (CI): 3.1-7.0, 4.6 mmHg (95% CI: 2.0-7.1), 3.8 mmHg (95% CI: 1.4-6.1), 3.6 mmHg (95% CI: 2.5-4.6) and 2.3 mmHg (95% CI: 0.2-4.3), respectively, with corresponding reductions in diastolic blood pressure. Relaxation significantly reduced blood pressure only when compared with non-intervention controls. We found no robust evidence of any important effect on blood pressure of potassium, magnesium or calcium supplements.
Patients with elevated blood pressure should follow a weight-reducing diet, take regular exercise, and restrict alcohol and salt intake. Available evidence does not support relaxation therapies, calcium, magnesium or potassium supplements to reduce blood pressure.
ABSTRACT During the planet formation process, billions of comets are created and ejected into interstellar space. The detection and characterization of such interstellar comets (ICs) (also known as ...extra-solar planetesimals or extra-solar comets) would give us in situ information about the efficiency and properties of planet formation throughout the galaxy. However, no ICs have ever been detected, despite the fact that their hyperbolic orbits would make them readily identifiable as unrelated to the solar system. Moro-Martín et al. have made a detailed and reasonable estimate of the properties of the IC population. We extend their estimates of detectability with a numerical model that allows us to consider "close" ICs, e.g., those that come within the orbit of Jupiter. We include several constraints on a "detectable" object that allow for realistic estimates of the frequency of detections expected from the Large Synoptic Survey Telescope (LSST) and other surveys. The influence of several of the assumed model parameters on the frequency of detections is explored in detail. Based on the expectation from Moro-Martín et al., we expect that LSST will detect 0.001-10 ICs during its nominal 10 year lifetime, with most of the uncertainty from the unknown number density of small (nuclei of ∼0.1-1 km) ICs. Both asteroid and comet cases are considered, where the latter includes various empirical prescriptions of brightening. Using simulated LSST-like astrometric data, we study the problem of orbit determination for these bodies, finding that LSST could identify their orbits as hyperbolic and determine an ephemeris sufficiently accurate for follow-up in about 4-7 days. We give the hyperbolic orbital parameters of the most detectable ICs. Taking the results into consideration, we give recommendations to future searches for ICs.
Semelparous Pacific salmon (Onchorynchus spp.) serve as an excellent model for examining the relationships between life history, behavior and individual variation in glucocorticoid (GC) stress ...hormone levels because reproductive behaviors are highly variable between individuals and failure to reproduce results in zero fitness. Pink salmon (O. gorbuscha) were intercepted upon arrival at the spawning grounds across three time periods. Pre-stress and stress-induced plasma cortisol concentrations were assessed in relation to behavior, longevity and reproductive success. Results revealed differences between sexes and with arrival time. The study period marked a year of high reproductive success and only nine females (12% of sample) failed to spawn. Female pre-spawn mortalities were characterized by significantly elevated stress-induced cortisol concentrations and decreased longevity as well as pre-stress cortisol above the normal range in pink salmon from the study area. Interestingly, reproductive behaviors were only associated with pre-stress cortisol levels. For females, aggression and mate interaction time were reduced in individuals with elevated pre-stress cortisol concentrations. In males, a similar negative relationship between pre-stress cortisol concentration and mate interaction time was detected. The observed behavioral correlations are likely a factor of social status where dominant individuals, known to have higher reproductive success, are characterized by lower cortisol levels relative to subordinate conspecifics. Findings show both elevated pre-stress and stress-induced cortisol concentrations at arrival to the spawning grounds to be associated with reduced survival.
► We related stress physiology to spawning success in pink salmon. ► We assessed relationships between individual behavior and cortisol concentrations. ► Non-spawning females had greater stress-induced cortisol and decreased longevity. ► Dominant fish of both sexes had reduced baseline cortisol concentrations. ► Results show fitness correlates of both baseline and stress-induced cortisol.
In low-incidence regions, tuberculosis (TB) often affects vulnerable populations. Guidelines recommend active case finding (ACF) in homeless populations, but there is no consensus on a preferred ...screening method.
We performed a systematic review and meta-analysis to evaluate the use of chest X-ray (CXR) screening in ACF for TB in homeless populations.
Articles were identified through EMBASE, Medline and the Cochrane Library. Studies using symptom screens, CXRs, sputum sweeps, tuberculin skin tests and/or interferon-gamma release assays to detect active TB in homeless populations were sought. Data were extracted using a standardised method by two reviewers and validated with an objective tool.
Sixteen studies addressing CXR screening of homeless populations for active TB in low-incidence regions were analysed. The pooled prevalence of active TB in the 16 study cohorts was 931 per 100 000 population screened (95%CI 565-1534) and 782/100 000 CXR performed (95%CI 566-1079). Six of seven longitudinal screening programs reported a reduction in regional TB incidence after implementation of the CXR-based ACF programme.
Our data suggest that CXR screening is a good tool for ACF in homeless populations in low-incidence regions.
English is increasingly becoming the world's lingua franca. If we are not native speakers of one of the many varieties of English, then we may be students of English, or use English regularly for ...academic or business purposes. The English Language series, which is international in focus, aims to synthesize the wealth of existing linguistic research both on and in English. Each volume in the series is designed to present these findings in an accessible, enlightening and entertaining way not only to students of English linguistics but to learners and users of English across the globe.The English Writing System describes how writing is not simply ancillary to other aspects of language but vitally important to almost everything we do, from signing our wills to sending a text message. This book discusses the mechanics of the writing systems of English; the different ways people process words on a page and the mistakes they can make; how children and second language learners acquire these systems; the historical development of the language and the progress of writing technology: in short, the effectiveness of the writing systems of English.Combining an academic perspective from linguistics and psychology with insights into everyday spelling mistakes, The English Writing System will interest students and teachers of linguistics, literature, the English language, psychology and education.
This book looks at how people learn and use a 2nd language writing system, arguing that they are affected by characteristics of the 1st and 2nd writing systems, to a certain extent independently of ...the languages involved.It presents the effects of writing systems on language reading and writing and on language awareness.
Yukon Territory (YT) is a remote region in northern Canada with ongoing spread of tuberculosis (TB). To explore the utility of whole genome sequencing (WGS) for TB surveillance and monitoring in a ...setting with detailed contact tracing and interview data, we used a mixed-methods approach. Our analysis included all culture-confirmed cases in YT (2005-2014) and incorporated data from 24-locus Mycobacterial Interspersed Repetitive Units-Variable Number of Tandem Repeats (MIRU-VNTR) genotyping, WGS and contact tracing. We compared field-based (contact investigation (CI) data + MIRU-VNTR) and genomic-based (WGS + MIRU-VNTR + basic case data) investigations to identify the most likely source of each person's TB and assessed the knowledge, attitudes and practices of programme personnel around genotyping and genomics using online, multiple-choice surveys (n = 4) and an in-person group interview (n = 5). Field- and genomics-based approaches agreed for 26 of 32 (81%) cases on likely location of TB acquisition. There was less agreement in the identification of specific source cases (13/22 or 59% of cases). Single-locus MIRU-VNTR variants and limited genetic diversity complicated the analysis. Qualitative data indicated that participants viewed genomic epidemiology as a useful tool to streamline investigations, particularly in differentiating latent TB reactivation from the recent transmission. Based on this, genomic data could be used to enhance CIs, focus resources, target interventions and aid in TB programme evaluation.
Few studies have used genomic epidemiology to understand tuberculosis (TB) transmission in rural and remote settings - regions often unique in history, geography and demographics. To improve our ...understanding of TB transmission dynamics in Yukon Territory (YT), a circumpolar Canadian territory, we conducted a retrospective analysis in which we combined epidemiological data collected through routine contact investigations with clinical and laboratory results. Mycobacterium tuberculosis isolates from all culture-confirmed TB cases in YT (2005-2014) were genotyped using 24-locus Mycobacterial Interspersed Repetitive Units-Variable Number of Tandem Repeats (MIRU-VNTR) and compared to each other and to those from the neighbouring province of British Columbia (BC). Whole genome sequencing (WGS) of genotypically clustered isolates revealed three sustained transmission networks within YT, two of which also involved BC isolates. While each network had distinct characteristics, all had at least one individual acting as the probable source of three or more culture-positive cases. Overall, WGS revealed that TB transmission dynamics in YT are distinct from patterns of spread in other, more remote Northern Canadian regions, and that the combination of WGS and epidemiological data can provide actionable information to local public health teams.
Structured
Objectives
To investigate the accuracy and reliability of cone beam computed tomography (CBCT) measurements of buccal alveolar bone height (BBH) and thickness (BBT) using custom ...acquisition settings.
Settings and Sample Population
School of Dentistry, Oregon Health & Science University. Twelve embalmed cadavers.
Materials and Methods
Cadaver heads were imaged by CBCT (i‐CAT® 17–19, Imaging Sciences International, Hatfield, PA) using a ‘long scan’ (LS) setting with 619 projection images, 360° revolution, 26.9 s duration, and 0.2 mm voxel size, and using a ‘short scan’ (SS) setting with 169 projection images, 180° rotation, 4.8 s duration, and 0.3 mm voxel size. BBH and BBT were measured with 65 teeth, indirectly from CBCT images and directly through dissection. Comparisons were assessed using paired t‐tests (p ≤ 0.05). Level of agreement was assessed by concordance correlation coefficients, Pearson's correlation coefficients, and Bland–Altman plots.
Results
Mean differences in measurements compared to direct measurements were as follows, LS 0.17 ± 0.12 (BBH) and 0.10 ± 0.07 mm (BBT), and SS 0.41 ± 0.32 (BBH) and 0.12 ± 0.11 mm (BBT). No statistical differences were found with any of BBH or BBT measurements. Correlation coefficients and Bland–Altman plots showed agreement was high between direct and indirect measurement methods, although agreement was stronger for measurements of BBH than BBT.
Conclusions
Compared to the LS, the similarity in results with the reduced scan times and hence reduced effective radiation dose, favors use of shorter scans, unless other purposes for higher resolution imaging can be defined.
Cyanobacteria are the most prevalent bloom-forming harmful algae in freshwater systems around the world. Adequate sampling of affected systems is limited spatially, temporally, and fiscally. Remote ...sensing using space- or ground-based systems in large water bodies at spatial and temporal scales that are cost-prohibitive to standard water quality monitoring has proven to be useful in detecting and quantifying cyanobacterial harmful algal blooms. This study aimed to identify a regional ‘universal’ multispectral reflectance model that could be used for rapid, remote detection and quantification of cyanoHABs in small- to medium-sized productive reservoirs, such as those typical of Oklahoma, USA. We aimed to include these small waterbodies in our study as they are typically overlooked in larger, continental wide studies, yet are widely distributed and used for recreation and drinking water supply. We used Landsat satellite reflectance and in-situ pigment data spanning 16 years from 38 reservoirs in Oklahoma to construct empirical linear models for predicting concentrations of chlorophyll-a and phycocyanin, two key algal pigments commonly used for assessing total and cyanobacterial algal abundances, respectively. We also used ground-based hyperspectral reflectance and in-situ pigment data from seven reservoirs across five years in Oklahoma to build multispectral models predicting algal pigments from newly defined reflectance bands. Our Oklahoma-derived Landsat- and ground-based models outperformed established reflectance-pigment models on Oklahoma reservoirs. Importantly, our results demonstrate that ground-based multispectral models were far superior to Landsat-based models and the Cyanobacteria Index (CI) for detecting cyanoHABs in highly productive, small- to mid-sized reservoirs in Oklahoma, providing a valuable tool for water management and public health. While satellite-based remote sensing approaches have proven effective for relatively large systems, our novel results indicate that ground-based remote sensing may offer better cyanoHAB monitoring for small or highly dendritic turbid lakes, such as those throughout the southern Great Plains, and thus prove beneficial to efforts aimed at minimizing public health risks associated with cyanoHABs in supply and recreational waters.
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