People with peripheral artery disease and transfemoral amputations had fewer falls and improved balance confidence and walking performance when using prostheses with MK.
Both methods of regional anaesthesia are acceptable for carotid artery surgery. CPB is associated with a significantly lower frequency of anaesthesia-related complications and should therefore be considered the anaesthetic of choice. CE anaesthesia should not be performed except in extenuating circumstances such as variant anatomy or the requirement for more extensive surgery.
A daily watershed model of the Sacramento River Basin of northern California was developed to simulate streamflow and suspended sediment transport to the San Francisco Bay-Delta. To compensate for sparse data, a unique combination of model inputs was developed, including meteorological variables, potential evapotranspiration, and parameters defining hydraulic geometry. A slight decreasing trend of sediment loads and concentrations was statistically significant in the lowest 50% of flows, supporting the observed historical sediment decline. Historical changes in climate, including seasonality and decline of snowpack, contribute to changes in streamflow, and are a significant component describing the mechanisms responsible for the decline in sediment. Several wet and dry hypothetical climate change scenarios with temperature changes of 1.5 • C and 4.5 • C were applied to the base historical conditions to assess the model sensitivity of streamflow and sediment to changes in climate. Of the scenarios evaluated, sediment discharge for the Sacramento River Basin increased the most with increased storm magnitude and frequency and decreased the most with increases in air temperature, regardless of changes in precipitation. The model will be used to develop projections of potential hydrologic and sediment trends to the Bay-Delta in response to potential future climate scenarios, which will help assess the hydrological and ecological health of the Bay-Delta into the next century.
BackgroundBlack and Hispanic stroke survivors experience higher rates of recurrent stroke than whites. This disparity is partly explained by disproportionately higher rates of uncontrolled hypertension in these populations. Home blood pressure telemonitoring (HBPTM) and nurse case management (NCM) have proven efficacy in addressing the multilevel barriers to blood pressure (BP) control and reducing BP. However, the effectiveness of these interventions has not been evaluated in stroke patients. This study is designed to evaluate the comparative effectiveness, cost-effectiveness and sustainability of these two telehealth interventions in reducing BP and recurrent stroke among high-risk Black and Hispanic stroke survivors with uncontrolled hypertension.Methods/DesignA total of 450 Black and Hispanic patients with recent nondisabling stroke and uncontrolled hypertension are randomly assigned to one of two 12-month interventions: 1) HBPTM with wireless feedback to primary care providers or 2) HBPTM plus individualized, culturally-tailored, telephone-based NCM. Patients are recruited from stroke centers and primary care practices within the Health and Hospital Corporations (HHC) Network in New York City. Study visits occur at baseline, 6, 12 and 24 months. The primary outcomes are within-patient change in systolic BP at 12 months, and the rate of stroke recurrence at 24 months. The secondary outcome is the comparative cost-effectiveness of the interventions at 12 and 24 months; and exploratory outcomes include changes in stroke risk factors, health behaviors and treatment intensification. Recruitment for the stroke telemonitoring hypertension trial is currently ongoing.DiscussionThe combination of two established and effective interventions along with the utilization of health information technology supports the sustainability of the HBPTM + NCM intervention and feasibility of its widespread implementation. Results of this trial will provide strong empirical evidence to inform clinical guidelines for management of stroke in minority stroke survivors with uncontrolled hypertension. If effective among Black and Hispanic stroke survivors, these interventions have the potential to substantially mitigate racial and ethnic disparities in stroke recurrence.Trial registrationClinicalTrials.gov NCT02011685. Registered 10 December 2013.
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