Modeled state-level estimates of hypertension prevalence and undiagnosed hypertension among US adults during 2013-2015

Hypertension affects about one in three US adults, from recent surveillance, or four in nine based on the 2017 ACC/AHA Hypertension Guideline; about half of them have their blood pressure controlled, and nearly one in six are unaware of their hypertension status. National estimates of hypertension awareness, treatment, and control in the United States are traditionally based on measured BP from National Health and Nutrition Examination Survey (NHANES); however, at the state level, only self-reported hypertension awareness and treatment are available from BRFSS. We used national- and state-level representative samples of adults (≥20 years) from NHANES 2011-2014 and BRFSS 2013 and 2015, respectively. The authors generated multivariable logistic regression models using NHANES to predict the probability of hypertension and undiagnosed hypertension and then applied the fitted model parameters to BRFSS to generate state-level estimates. The predicted prevalence of hypertension was highest in Mississippi among adults (42.4%; 95% CI: 41.8-43.0) and among women (42.6%; 41.8-43.4) and highest in West Virginia among men (43.4%; 42.2-44.6). The predicted prevalence was lowest in Utah 23.7% (22.8-24.6), 26.4% (25.0-27.7), and 21.0% (20.0-22.1) for adults, men, and women, respectively. Hypertension predicted prevalence was higher in most Southern states and higher among men than women in all states except Mississippi and DC. The predicted prevalence of undiagnosed hypertension ranged from 4.1% (3.4-4.8; Kentucky) to 6.5% (5.5-7.5; Hawaii) among adults, from 5.0% (4.0-5.9; Kentucky) to 8.3% (6.9-9.7; Hawaii) among men, and from 3.3% (2.5-4.1; Kentucky) to 4.8% (3.4-6.1; Vermont) among women. Undiagnosed hypertension was more prevalent among men than women in all states and DC.

Contact networks in the emergency department: Effects of time, environment, patient characteristics, and staff role

Emergency departments play a critical role in the public health system, particularly in times of pandemic. Infectious patients presenting to emergency departments bring a risk of cross-infection to other patients and staff through close proximity interactions or contacts. To understand factors associated with cross-infection risk, we measured close proximity interactions of emergency department staff and patients by radiofrequency identification in a working emergency department. The number of contacts (degree) is not related to patient demographic characteristics. However, the amount of time in close proximity (weighted degree) of patients with ED personnel did differ, with black patients having approximately 15 min more contact with staff than non-white patients. Patients arriving by EMS had fewer contacts with other patients than patients arriving by other means. There are differences in the number of contacts based on staff role and arrival mode. When crowding is low, providers have the most contact time with patients, while administrative staff have the least. However, when crowding is high, this differential is reversed. The effect of arrival mode is modified by the extent of crowding. When crowding is low, patients arriving by EMS had longer contact with administrative staff, compared to patients arriving by other means. However, when crowding is high, patients arriving by EMS had less contact with administrative staff compared to patients arriving by other means. Our findings should help designers of emergency care focus on higher risk situations for transmission of dangerous pathogens in an emergency department. For instance, the effects of arrival and crowding should be considered as targets for engineering or architectural interventions that could artificially increase social distances.

Physical activity and functional abilities in adult males with haemophilia: a cross-sectional survey from a single US haemophilia treatment centre

Physical activity and functional ability are important determinants of quality of life and these metrics are affected by both haemophilia and ageing. Outside haemophilic arthropathy, risk factors leading to reduced physical activity and function in people with haemophilia (PWH) are under-explored. The purpose of this analysis was to determine risk factors for reduced physical activity and functional limitations in PWH. A secondary analysis was conducted on data indexing physical activity and functioning of 88 PWH using data originally collected as part of a cross-sectional study at a single large haemophilia treatment centre. The Framingham Physical Activities Index (PAI), the Hemophilia Activities List (HAL) and the Timed Up-and-Go Test (TUG) were the outcome measures. The World Federation of Haemophilia (WFH) orthopaedic joint score was used as a measure of arthropathy. Multiple linear regression analysis was used to assess the relationship between the outcome measures and covariates. Worsening WFH joint score was independently associated with all three outcome measures (P < 0.05). Increasing age was associated with reduced PAI and increased TUG time (P < 0.05). The HAL summary score was decreased in patients with chronic liver disease (P = 0.006). The adjusted R(2) for each model was ≤ 0.35. This study provides evidence for the relationship between arthropathy and reduced physical functioning/activity, but also highlights that much of the variation in physical functioning/activity is not explained by haemophilia-related characteristics.

Dynamic observation of pulmonary perfusion using continuous arterial spin-labeling in a pig model

The continuous arterial spin-labeling (CASL) method of perfusion MRI is used to observe pulmonary perfusion dynamically in an animal model. Specifically, a respiratory-triggered implementation of the CASL method is used with approximate spatial resolution of 0.9 x 1.8 x 5.0 mm (0.008 cc) and 2-minute temporal resolution. Perfusion MRI is performed dynamically during repeated balloon occlusion of a segmental pulmonary artery, as well as during pharmacological stimulation. A total of three Yorkshire pigs were studied. The results demonstrate the ability of the endogenous spin-labeling method to characterize the dynamic changes in pulmonary perfusion that occur during important physiological alterations.

Detection and localization of pulmonary air leaks using laser-polarized (3)He MRI

Pulmonary air leaks were created in the lungs of Yorkshire pigs. Dynamic, 3D MRI of laser-polarized (3)He gas was then performed using a gradient-echo pulse sequence. Coronal magnitude images of the helium distribution were acquired during gas inhalation with a voxel resolution of approximately 1.2 x 2.5 x 8 mm, and a time resolution of 5 sec. In each animal, the ventilation images reveal focal high-signal intensity within the pleural cavity at the site of the air leaks. In addition, a wedge-shaped region of increased parenchymal signal intensity was observed adjacent to the site of the air leak in one animal. (3)He MRI may prove helpful in the management of patients with pulmonary air leaks.

Core cooling by central venous infusion of ice-cold (4 degrees C and 20 degrees C) fluid: isolation of core and peripheral thermal compartments

BACKGROUND

Central venous infusion of cold fluid may be a useful method of inducing therapeutic hypothermia. The aim of this study was to quantify systemic heat balance and regional distribution of body heat during and after central infusion of cold fluid.

METHODS

The authors studied nine volunteers, each on two separate days. Anesthesia was maintained with use of isoflurane, and on each day 40 ml/kg saline was infused centrally over 30 min. On one day, the fluid was 20 degrees C and on the other it was 4 degrees C. By use of a tympanic membrane probe core (trunk and head) temperature and heat content were evaluated. Peripheral compartment (arm and leg) temperature and heat content were estimated with use of fourth-order regressions and integration over volume from 18 intramuscular thermocouples, nine skin temperatures, and "deep" hand and foot temperature. Oxygen consumption and cutaneous heat flux estimated systemic heat balance.

RESULTS

After 30-min infusion of 4 degrees C or 20 degrees C fluid, core temperature decreased 2.5 +/- 0.4 degrees C and 1.4 +/- 0.2 degrees C, respectively. This reduction in core temperature was 0.8 degrees C and 0.4 degrees C more than would be expected if the change in body heat content were distributed in proportion to body mass. Reduced core temperature resulted from three factors: (1) 10-20% because cutaneous heat loss exceeded metabolic heat production; (2) 50-55% from the systemic effects of the cold fluid per se; and (3) approximately 30% because the reduction in core heat content remained partially constrained to core tissues. The postinfusion period was associated with a rapid and spontaneous recovery of core temperature. This increase in core temperature was not associated with a peripheral-to-core redistribution of body heat because core temperature remained warmer than peripheral tissues even at the end of the infusion. Instead, it resulted from constraint of metabolic heat to the core thermal compartment.

CONCLUSIONS

Central venous infusion of cold fluid decreases core temperature more than would be expected were the reduction in body heat content proportionately distributed. It thus appears to be an effective method of rapidly inducing therapeutic hypothermia. When the infusion is complete, there is a spontaneous partial recovery in core temperature that facilitates rewarming to normothermia.

Constraints on the origin of the Moon's atmosphere from observations during a lunar eclipse

The properties of the Moon's rarefied atmosphere, which can be traced through observations of sodium and potassium, provide important insights into the formation and maintenance of atmospheres on other primitive Solar System bodies. The lunar atmosphere is believed to be composed of atoms from the surface rocks and soil, which might have been sputtered by micrometeorites, by ions in the solar wind, or by photons. It might also form by the evaporation of atoms from the hot, illuminated surface. Here we report the detection of sodium emission from the Moon's atmosphere during a total lunar eclipse (which occurs when the Moon is full). The sodium atmosphere is considerably more extended at full Moon than expected--it extends to at least nine lunar radii--and its brightness distribution is incompatible with sources involving either solar-wind or micrometeorite sputtering. This leaves photon sputtering or thermal desorption as the preferred explanations for the lunar atmosphere, and suggests that sunlight might also be responsible for the transient atmospheres of other primitive bodies (such as Mercury).

Imaging Obsearvations of Jupiter's Sodium Magneto-Nebula During the Ulysses Encounter

Jupiter's great sodium nebula represents the largest visible structure traversed by the Ulysses spacecraft during its encounter with the planet in February 1992. Ground-based imaging conducted on Mount Haleakala, Hawaii, revealed a nebula that extended to at least +/-300 Jovian radii (spanning approximately 50 million kilometers); it was somewhat smaller in scale and less bright than previously observed. Analysis of observations and results of modeling studies suggest reduced volcanic activity on the moon lo, higher ion temperatures in the plasma torus, lower total plasma content in the torus, and fast neutral atomic clouds along the Ulysses inbound trajectory through the magnetosphere. Far fewer neutrals were encountered by the spacecraft along its postencounter, out-of-ecliptic trajectory.

Spacelab-2 Plasma Depletion Experiments for Ionospheric and Radio Astronomical Studies

The Spacelab-2 Plasma Depletion Experiments were a series of studies to examine shuttle-induced perturbations in the ionosphere and their application to ground-based radio astronomy. The space shuttle Challenger fired its orbital maneuvering subsystem engines on 30 July and 5 August 1985, releasing large amounts of exhaust molecules (water, hydrogen, and carbon dioxide) that caused the electrons and ions in Earth's upper atmosphere to chemically recombine, thereby creating so-called "ionospheric holes." Two burns conducted over New England produced ionospheric peak depletions ranging from 25 to 50 percent, affected the ionosphere over a 200-kilometer altitude range, and covered 1 degrees to 2 degrees of latitude. Optical emissions associated with the hole spanned an area of several hundred thousand square kilometers. A third burn was conducted over a low-frequency radio observatory in Hobart, Australia, to create an "artificial window" for ground-based observations at frequencies normally below the natural ionospheric cutoff (penetration) frequency. The Hobart experiment succeeded in making high-resolution observations at 1.7 megahertz through the induced ionospheric hole.