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Non-pharmacological interventions for the reduction and maintenance of blood pressure in people with prehypertension: A systematic review protocol
Get PDFIntroduction
Prehypertension is defined as blood pressure that is above the normal range but not high enough to be classed as hypertension. Prehypertension is a warning of development of hypertension as well as a risk for cardiovascular disease, heart attack and stroke. In the UK, non-pharmacological interventions are recommended for prehypertension management, but no reviews have focused on the effectiveness of these types of interventions solely in people with prehypertension. Therefore, the proposed systematic review will assess the clinical- and cost–effectiveness of non-pharmacological interventions in reducing or maintaining blood pressure in pre-hypertensive people.
Methods and analysis
This systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The databases/ trial registries that will be searched to identify relevant randomised controlled trials (RCTs) and economic evaluations include Medline, EMBASE, CINAHL, PsycINFO, CENTRAL, the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov, Cochrane Library, Scopus, and the International HTA Database. Search terms have been identified by the team including an information specialist. Three reviewers will be involved in the study selection process. Risk of bias will be evaluated using the Cochrane risk-of-bias tool for RCTs, and the Consensus Health Economic Criteria list for economic evaluations. Findings from the included studies will be tabulated and synthesised narratively. Heterogeneity will be assessed through visual inspection of forest plots and the calculation of the Chi2 and I2 statistics, and causes of heterogeneity will be assessed where sufficient data are available. If possible, we plan to investigate differential effects on specific sub-groups and from different types of interventions using meta-regression. Where relevant, the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) will be used to assess the certainty of the evidence found.
Ethics and dissemination
Ethical approval is not needed. Results will be published in a peer-reviewed journal, disseminated via the wider study website and shared with the study sites and participants.
Registration details: The review is registered with Prospero (CRD420232433047
On the potential origin of the circumbinary planet Delorme 1 (AB)b
Get PDFMany circumbinary gas giant planets have been recently discovered. The formation mechanism of circumbinary planets on wide orbits is unclear. We investigate the formation of Delorme 1 (AB)b, a 13 ± 5 MJ planet, orbiting its host binary at 84 AU. The planet is accreting while having an estimated age of 40 Myr, which is unexpected, as this process should have ceased due to the dissipation of the protoplanetary disc. Using the Smoothed Particle Hydrodynamics code SEREN, we model three formation scenarios for this planet. In Scenario I the planet forms in-situ on a wide orbit in a massive disc (by gravitational instability), in Scenario II closer to the binary in a massive disc (by gravitational instability), and in Scenario III much closer to the binary in a less massive disc (by core accretion). Planets in Scenario I stay at the observed separation, have mass accretion rates consistent with observed value, but their final mass is too high. In Scenario II, the planet reaches the observed separation through outward migration or scattering by the binary, and has mass accretion rate comparable to the observed; however, the planet mass is above the observed value. In Scenario III, the planet’s final mass and mass accretion rate are comparable to the observed ones but the planet’s separation is smaller. We conclude that all models may explain some features of the observations but not all of them, raising questions about how gas is accreted onto the planet from its circumplanetary disc, and of the presumed age of the system
Formative qualitative evaluation of an improvement programme delivered in an English hospital trust to reduce harm from pressure ulcers
Get PDFPressure ulcers (PUs) are a leading cause of preventable harm globally and can cause patients significant pain, infection and, in rare incidents, death. There is a strong evidence base for how to improve PUs and one UK healthcare trust used this evidence to develop a quality improvement (QI) programme using the Institute of Healthcare Improvement’s Breakthrough Series collaborative model. 20 teams, from both acute and community settings, participated in the first two phases of the collaborative. The delivery of both phases used virtual delivery using the Institute of Healthcare Improvement’s improvement model. This study sought to formatively evaluate the early phases of the collaborative, to support learning and continual improvements to the collaborative programme and other collaboratives delivered by the organisation based on the formative evaluation.
Methods Semi-structured interviews were conducted with purposively sampled participants to explore their perspectives about the implementation of the programme, interventions tested as part of the ‘change package’ provided and the pandemic’s impact.
Results A total of seven participants were interviewed, including acute ward managers, a charge nurse (deputy ward manager), a wound healing community nurse and a team leader community nurse. Interview durations varied from 9 min to 28 min. The interviews were kept short and stopped when data saturation was achieved as it was an extremely pressurised time for the organisation where the highest escalation alert was triggered on numerous occasions.
Conclusion A sustained reduction in PUs was achieved during the evaluation period and participants felt that the approach helped to achieve this, regardless of the adaptations made to the delivery method due to the pandemic. To support improvements, it is vital to ensure systems such as data collection are accurate and timely. The necessity for building strong foundations for QI capability must not be underestimated, as greater QI knowledge leads to better engagement and outcomes
Effect of leachate on the geotechnical properties of soils at Gbagede Dumpsite Ilorin, Kwara State Nigeria
Get PDFThe increasing request for space for private buildings was brought about by the utilization of the previous dumpsites. If the issue of leachate infiltration into the soil isn't legitimately controlled it'll lead to future harm in construction works. The objectives are to compare the geotechnical properties of soil of the contaminated and uncontaminated regions region of the dump site and evaluate if the effect of leachate on the geotechnical properties of soil changes with depth. Laboratory soil tests were conducted on the soil samples obtained and compared the effect of these leachates at the dump site. These methods are Natural water content, Bulk Density, Specific Gravity, Shear strength, and Consolidation tests. The soil samples were obtained from the contaminated region, and the uncontaminated region (i.e. at 100 m away from the dumpsite). All soil samples were obtained at depths 0.5m, 1.0m, and 1.5m below the ground level, to know the effect of leachate on the soil at the dumpsite and also to know if the effects of leachate changes with depth as it goes down the soil. The results obtained show that samples at 0.5m and 1m depth have been affected by leachates but the effects are not so significant at 1.5m depth, thereby making the soil at depths 0.5m and 1m unfit for construction purposes. This result was useful to check the land requirement in urban areas and guide the geotechnical engineers when designing and constructing foundations for buildings and other related structures on these types of soils
Path planning algorithms in the autonomous driving system: A comprehensive review
Get PDFThis comprehensive review focuses on the Autonomous Driving System (ADS), which aims to reduce human errors that are the reason for about 95% of car accidents. The ADS consists of six stages: sensors, perception, localization, assessment, path planning, and control. We explain the main state-of-the-art techniques used in each stage, analyzing 275 papers, with 162 specifically on path planning due to its complexity, NP-hard optimization nature, and pivotal role in ADS. This paper categorizes path planning techniques into three primary groups: traditional (graph-based, sampling-based, gradient-based, optimization-based, interpolation curve algorithms), machine and deep learning, and meta-heuristic optimization, detailing their advantages and drawbacks. Findings show that meta-heuristic optimization methods, representing 23% of our study, are preferred for being general problem solvers capable of handling complex problems. In addition, they have faster convergence and reduced risk of local minima. Machine and deep learning techniques, accounting for 25%, are favored for their learning capabilities and fast responses to known scenarios. The trend toward hybrid algorithms (27%) combines various methods, merging each algorithm’s benefits and overcoming the other’s drawbacks. Moreover, adaptive parameter tuning is crucial to enhance efficiency, applicability, and balancing the search capability. This review sheds light on the future of path planning in autonomous driving systems, helping to tackle current challenges and unlock the full capabilities of autonomous vehicles
Benign Paroxysmal Positional Vertigo After Joint Replacement Surgeries: Case Series
Get PDFBenign paroxysmal positional vertigo (BPPV) is characterized by brief episodes of vertigo triggered by changes in head position caused by the displacement of otoliths from the utricle to the semicircular canals, particularly the posterior canal. This study explored the potential link between BPPV, the patient's preexisting conditions, and surgery-related factors including surgical positioning, duration of the procedure, exposure to vibratory forces, and anesthesia effects. This report presents two cases of BPPV following major joint replacement surgery. The first case involved a 65-year-old male with a history of diet-controlled diabetes who had undergone right-sided total hip replacement. The second case was that of a 60-year-old female with a history of osteoporosis managed with bisphosphonate therapy and left-sided knee replacement. Both patients developed vertigo symptoms one day postoperatively and were diagnosed with BPPV. In both cases, the Dix-Hallpike test confirmed the right-sided posterior canal BPPV diagnosis, and the patients were successfully treated using the Epley maneuver. Notably, there was no recurrence of vertigo at the four-week follow-up. These cases highlight the importance of considering BPPV in patients presenting with vertigo symptoms after joint replacement surgery, especially in the presence of comorbidities like diabetes and osteoporosis which possibly increase susceptibility to BPPV. This article presents two cases of benign paroxysmal positional vertigo (BPPV) following non-otologic surgery. It explores the pathophysiological mechanism underlying BPPV after such surgeries and also discusses the diagnosis and treatment approaches. This underscores the need for prompt diagnosis and treatment of BPPV to improve postoperative outcomes
The Effects of Irradiation on Structure and Leaching of Pure and Doped Thin-Film Ceria SIMFUEL Models Prepared via Polymer-Templated Deposition
Get PDFWhen studying hazardous materials such as spent nuclear fuel (SNF), minimisation of sample volumes is essential, together with the use of chemically-similar surrogates where possible. For example, the bulk behaviour of urania (UO2) can be mimicked by appropriately-engineered thin films of sufficient thickness and inactive materials such as ceria (CeO2) can be used to study effects within radioactive systems used to fuel nuclear fission. However, thin film properties are sensitive to the preparative method, many of which require the use of highly toxic precursors and specialised apparatus e.g. chemical vapour deposition. To address this, we present the development of a flexible, tuneable, scalable method for the preparation of thin-film CeO2 SIMFUEL models with a thickness of ≈ 5 μm. The effects of γ irradiation (up to 100 kGy) and dopants including trivalent lanthanides (Ln3+) and simulant ε-particles on the structure and long-term leaching of these systems under SNF storage conditions are explored, alongside the context of this within further work. It was found that the sensitivity of CeO2 films to reduction upon irradiation, particularly in the presence of simulant ε-particles results in increased leaching of Ce (as CeIII), while trivalent lanthanides (Nd3+ and Eu3+) have minimal effect on Ce leaching
A 39 GHz Doherty-Like Power Amplifier with 22dBm Output Power and 21% Power-Added Efficiency at 6dB Power Back-Off
No full textThe design of a Doherty-like power amplifier for millimetre-wave (mm-wave) applications is presented in this work. The designed power amplifier employs a novel symmetrical load-modulated balanced amplifier (S-LMBA) architecture. This design is advantageous in minimizing the undesired impedance interaction often encountered in the classic LMBA approach. Such interactions are typically due to the use of a non-50 Ω load at the isolation port of the output quadrature coupler. Moreover, magnitude and phase control networks are carefully designed to generate the specific magnitude and phase information for the designed S-LMBA. To demonstrate the proposed ideas, the S-LMBA is fabricated in a 45-nm CMOS SOI technology. At 39 GHz, a 22.1 dBm saturated output power (Psat) with a maximum power-added efficiency (PAE) of 25.7% is achieved. In addition, 1.68 times drain efficiency enhancement is obtained over an ideal Class-B operation, when the designed S-LMBA is operated at 6 dB power back-off. An average output power of 13.1 dBm with a PAE of 14.4% at an error vector magnitude (EVMrms) above -22.5 dB and adjacent channel power ratio (ACPR) of -23 dBc is also achieved, when a 200 MHz single carrier 64-quadrature-amplitude-modulation (QAM) signal is used. Including all testing pads, the footprint of the designed S-LMBA is only 1.56 mm 2
Building Breastfeeding Research Relations and Beyond: An Interview With Fiona Dykes
No full textProfessor Fiona Dykes is Professor Emerita of Maternal and Infant Health at the University of Central Lancashire in the United Kingdom (UCLAN). Fiona has a particular interest in the global, sociocultural, and political influences upon infant and young child feeding practices; her methodological expertise is in ethnography and other qualitative research methods. She founded the Maternal and Infant Nutrition and Nurture Unit (MAINN) in 2000 which she led until she retired from her full-time professorship in 2020. Fiona established the associated MAINN Conference in 2007. The MAINN conference is a 3 day, international, peer reviewed event held bi-annually in the United Kingdom and, more recently, in alternate years overseas (Sydney, Australia; Falun, Dalarna, Sweden; and Florida, United States). The conference draws together key researchers in the field of infant and young child feeding from around the world. Fiona was a founding member of the journal Maternal and Child Nutrition. She is author of Breastfeeding in Hospital: Mothers, Midwives and the Production Line (Routledge) and co-author, with Dr Tanya Cassidy, of Banking on Milk: An Ethnography of Donor Human Milk Relations (Routledge). She is also joint editor of several books including Infant and Young Child Feeding: Challenges to Implementing a Global Strategy (Wiley-Blackwell) and Ethnographic Research in Maternal and Child Health (Routledge). This interview was conducted on April 20, 2023, by Dr. Tanya Cassidy, and is based on a verbatim transcription and edited for readability