Home Blood Pressure Measurement – Epidemiology and Clinical Application

Verenpaineen kotimittaus − epidemiologia ja kliininen käyttö Kohonnutta verenpainetta, maailmanlaajuisesti merkittävintä ennenaikaiselle kuolemalle altistavaa riskitekijää, ei voida tunnistaa tai hoitaa ilman tarkkoja ja käytännöllisiä verenpaineen mittausmenetelmiä. Verenpaineen kotimittaus on saavuttanut suuren suosion potilaiden keskuudessa. Lääkärit eivät ole kuitenkaan vielä täysin hyväksyneet verenpaineen kotimittausta, sillä riittävä todistusaineisto sen toimivuudesta ja eduista on puuttunut. Tämän tutkimuksen tarkoituksena oli osoittaa, että kotona mitattu verenpaine (kotipaine) on perinteistä vastaanotolla mitattua verenpainetta (vastaanottopaine) tarkempi, ja että se on tehokas myös kliinisessä käytössä. Tutkimme kotipaineen käyttöä verenpainetaudin diagnosoinnissa ja hoidossa. Lisäksi tarkastelimme kotipaineen yhteyttä verenpainetaudin aiheuttamiin kohde-elinvaurioihin. Ensimmäinen aineisto, joka oli edustava otos Suomen aikuisväestöstä, koostui 2 120 45–74-vuotiaasta tutkimushenkilöstä. Tutkittavat mittasivat kotipainettaan viikon ajan ja osallistuivat terveystarkastukseen, johon sisältyi kliinisen tutkimuksen ja haastattelun lisäksi sydänfilmin otto ja vastaanottopaineen mittaus. 758 tutkittavalle suoritettiin lisäksi kaulavaltimon seinämän intima-mediakerroksen paksuuden (valtimonkovettumataudin mittari) mittaus ja 237:lle valtimon pulssiaallon nopeuden (valtimojäykkyyden mittari) mittaus. Toisessa aineistossa, joka koostui 98 verenpainetautia sairastavasta potilaasta, hoitoa ohjattiin satunnaistamisesta riippuen joko ambulatorisen eli vuorokausirekisteröinnillä mitatun verenpaineen tai kotipaineen perusteella. Vastaanottopaine oli kotipainetta merkittävästi korkeampi (systolisen/diastolisen paineen keskiarvoero oli 8/3 mmHg) ja yksimielisyys verenpainetaudin diagnoosissa kahden menetelmän välillä oli korkeintaan kohtalainen (75 %). 593 tutkittavasta, joilla oli kohonnut verenpaine vastaanotolla, 38 %:lla oli normaali verenpaine kotona eli ns. valkotakkiverenpaine. Verenpainetauti voidaan siis ylidiagnosoida joka kolmannella potilaalla seulontatilanteessa. Valkotakkiverenpaine oli yhteydessä lievästi kohonneeseen verenpaineeseen, matalaan painoindeksiin ja tupakoimattomuuteen, muttei psykiatriseen sairastavuuteen. Valkotakkiverenpaine ei kuitenkaan vaikuttaisi olevan täysin vaaraton ilmiö ja voi ennustaa tulevaa verenpainetautia, sillä siitä kärsivien sydän- ja verisuonitautien riskitekijäprofiili oli normaalipaineisten ja todellisten verenpainetautisten riskitekijäprofiilien välissä. Kotipaineella oli vastaanottopainetta vahvempi yhteys verenpainetaudin aiheuttamiin kohde-elinvaurioihin (intima-mediakerroksen paksuus, pulssiaallon nopeus ja sydänfilmistä todettu vasemman kammion suureneminen). Kotipaine oli tehokas verenpainetaudin hoidon ohjaaja, sillä kotipaineeseen ja ambulatoriseen paineeseen, jota on pidetty verenpainemittauksen ”kultaisena standardina”, perustuva lääkehoidon ohjaus johti yhtä hyvään verenpaineen hallintaan. Tämän ja aikaisempien tutkimusten tulosten pohjalta voidaan todeta, että verenpaineen kotimittaus on selkeä parannus perinteiseen vastaanotolla tapahtuvaan verenpainemittaukseen verrattuna. Verenpaineen kotimittaus on käytännöllinen, tarkka ja laajasti saatavilla oleva menetelmä, josta voi tulla jopa ensisijainen vaihtoehto verenpainetautia diagnosoitaessa ja hoitaessa. Verenpaineen mittauskäytäntöön tarvitaan muutos, sillä näyttöön perustuvan lääketieteen perusteella vaikuttaa, että vastaanotolla tapahtuvaa verenpainemittausta tulisi käyttää vain seulontatarkoitukseen.

Financial performance of segments in the intelligent home network

The goal of this study is to examine the intelligent home business network in order to determine which part of the network has the best financial abilities to produce new business models and products/services by using financial statement analysis. A group of 377 studied limited companies is divided into four examined segments based on their offering in producing intelligent homes. The segments are customer service providers, system integrators, subsystem suppliers and component suppliers. Eight different key figures are calculated from each of the companies to get a comprehensive view of their financial performances, after which each of the segments is studied statistically to determine the performances of the whole segments. The actual performance differences between the segments are calculated by using the multi-criteria decision analysis method in which the performances of the key figures are graded and each key figure is weighted according to its importance for the goal of the study. The results of this analysis showed that subsystem suppliers have the best financial performance. Second best are system integrators, third are customer service providers and fourth component suppliers. None of the segments were strikingly poor, but even component suppliers were rather reasonable in their performance; so, it can be said that no part of the intelligent home business network has remarkably inadequate financial abilities to develop new business models and products/services.

Second Welland Canal - Book 2, Survey Map 9 - Back Water Bodies in Thorold

Survey map of the Second Welland Canal created by the Welland Canal Company showing the Back Water bodies in Thorold Township. The surveyors' measurements and notes can be seen in red and black ink and pencil. A number of trees along the shores presumably used in the measurements are labelled. Local area landmarks are also identified and include streets and roads(ex. Road to Beaverdams), Shriner's Dwelling Home, a barn, and the Back Water bodies. Properties and property owners of note are: Lots 27, 28, and 29, W. Bouck, D. Shriner, and Rev. T. B. Fuller.

Quality of Life Issues and Second-Generation Migration: the Case of 'Bajan-Brit Returnees'

This paper forms part of research that is investigating the migration of young Bajan-Brits to Barbados. Specifically, it explores the role of quality of life issues in the decision-making processes of young Bajan-Brits as they negotiate their 'return' to Barbados. The research, based on 51 in-depth qualitative interviews conducted with an under-researched cohort of young Bajan-Brits living in Barbados, argues from a 'lure of home' conceptualisation that the return of young Bajan-Brits to Barbados can best be understood from the context of a search for a better quality of life in the face of social and economic disenfranchisement in the UK context. Subsequently, the paper examines the extent to which the quality of life factors which formed the basis of return to Barbados have in fact been realised on the part of young Bajan-Brits in their adjustment to life in Barbados. The paper ultimately argues that despite problems of adjustment, young Bajan-Brits have generally been successful in actualising a better quality of life in Barbados. Copyright (C) 2009 John Wiley & Sons, Ltd.

How to make active interactions in Japanese as a second language.

This paper analyzes Japanese language classes at Dalarna University in Sweden that are held through a web conferencing system. It discusses how students’ learning and language acquisition can be supported by making better use of the available features of using a web conferencing system for language lessons. Of particular interest is the existence of an “information gap” among students, created because of the limits posed by distance communication. Students who take Japanese courses at Dalarna University usually access classes from their home, which are located all over Sweden or even abroad. This fact can be utilized in language classes because the “information gap” can lead to interactions that are essential for language learning. In order to make use of this natural “information gap” and turn it into an opportunity for communication, our classes used a teaching method called “personalization” [Kawaguchi, 2004].  “Personalization” aims to persuade students to express their own ideas, opinions, feelings and preferences. The present analysis suggests that “personalization” in web-based language classes is a surprisingly effective teaching method. By making students explain about things at home (why they have them, what they use them for, or why they are important), students become motivated to express themselves in Japanese. This makes communication meaningful and enhances students’ interest in improving their vocabulary. Furthermore, by knowing each other, it becomes easier to create a ”supportive classroom environment” [Nuibe, 2001] in which students feel able to express themselves. The analysis suggests that that web-based education can be seen not simply as a supplement to traditional face-to face classroom education, but as a unique and effective educational platform in itself.

Assessment of PD Speech Anomalies @ Home

Background: Voice processing in real-time is challenging. A drawback of previous work for Hypokinetic Dysarthria (HKD) recognition is the requirement of controlled settings in a laboratory environment. A personal digital assistant (PDA) has been developed for home assessment of PD patients. The PDA offers sound processing capabilities, which allow for developing a module for recognition and quantification HKD. Objective: To compose an algorithm for assessment of PD speech severity in the home environment based on a review synthesis. Methods: A two-tier review methodology is utilized. The first tier focuses on real-time problems in speech detection. In the second tier, acoustics features that are robust to medication changes in Levodopa-responsive patients are investigated for HKD recognition. Keywords such as Hypokinetic Dysarthria , and Speech recognition in real time were used in the search engines. IEEE explorer produced the most useful search hits as compared to Google Scholar, ELIN, EBRARY, PubMed and LIBRIS. Results: Vowel and consonant formants are the most relevant acoustic parameters to reflect PD medication changes. Since relevant speech segments (consonants and vowels) contains minority of speech energy, intelligibility can be improved by amplifying the voice signal using amplitude compression. Pause detection and peak to average power rate calculations for voice segmentation produce rich voice features in real time. Enhancements in voice segmentation can be done by inducing Zero-Crossing rate (ZCR). Consonants have high ZCR whereas vowels have low ZCR. Wavelet transform is found promising for voice analysis since it quantizes non-stationary voice signals over time-series using scale and translation parameters. In this way voice intelligibility in the waveforms can be analyzed in each time frame. Conclusions: This review evaluated HKD recognition algorithms to develop a tool for PD speech home-assessment using modern mobile technology. An algorithm that tackles realtime constraints in HKD recognition based on the review synthesis is proposed. We suggest that speech features may be further processed using wavelet transforms and used with a neural network for detection and quantification of speech anomalies related to PD. Based on this model, patients' speech can be automatically categorized according to UPDRS speech ratings.

Efect of an educative action on relatives' knowledge about childhood burns at home

O objetivo deste trabalho foi avaliar o efeito de ação educativa sobre o conhecimento de familiares de crianças a respeito de queimaduras em ambiente doméstico. Participaram 40 familiares de crianças menores de quatro anos, divididos igualmente em grupos intervenção e controle. Foram realizadas entrevista inicial, ação educativa com folder de queimaduras e entrevista após uma semana. As respostas foram comparadas, utilizando-se teste estatístico de Fisher. Na primeira entrevista, registrou-se 60 respostas de situações de risco no grupo controle e 62 no grupo intervenção; na segunda, aumentou para 61 e 80 indicações, respectivamente. Na primeira entrevista, 90% dos participantes do grupo controle e 80% do grupo intervenção verbalizaram acreditar que a queimadura infantil pode ser evitada; na segunda, a indicação diminuiu para 84% e aumentou para 100%, respectivamente. Este estudo mostrou a importância da orientação com folder de queimaduras em ambiente doméstico.

"Ripple Effects" and Forecasting Home Prices in Los Angeles, Las Vegas, and Phoenix

We examine the time-series relationship between housing prices in Los Angeles, Las Vegas, and Phoenix. First, temporal Granger causality tests reveal that Los Angeles housing prices cause housing prices in Las Vegas (directly) and Phoenix (indirectly). In addition, Las Vegas housing prices cause housing prices in Phoenix. Los Angeles housing prices prove exogenous in a temporal sense and Phoenix housing prices do not cause prices in the other two markets. Second, we calculate out-of-sample forecasts in each market, using various vector autoregessive (VAR) and vector error-correction (VEC) models, as well as Bayesian, spatial, and causality versions of these models with various priors. Different specifications provide superior forecasts in the different cities. Finally, we consider the ability of theses time-series models to provide accurate out-of-sample predictions of turning points in housing prices that occurred in 2006:Q4. Recursive forecasts, where the sample is updated each quarter, provide reasonably good forecasts of turning points.

Educational orientation regarding vocabulary and literacy access : Evaluating the impact of an intervention program designed to promote early learning at home

El estudio evalúa el impacto de un programa de promoción del desarrollo lingüístico y cognitivo para niños de 5 años implementado según dos modalidades: una que implicó acciones de alfabetización familiar en los hogares de los niños (modalidad intensiva) y otra que incluyó la participación de los niños en las salas de jardín de infantes (modalidad extensiva). La evaluación del impacto se realizó por medio de un diseño pre-test ? post-test. Se tomaron pruebas de vocabulario receptivo (VR), producción de categorías (PC) y escritura a una muestra de 214 niños participantes de la modalidad intensiva, 69 participantes de la modalidad extensiva y un grupo control de no participó del programa (49 niños). Los resultados mostraron que la participación en la modalidad intensiva implicó un mayor incremento en las habilidades infantiles de VR, PC que en la modalidad extensiva. A su vez ambas modalidades experimentales mostraron un mayor incremento en las variables examinadas respecto de las observadas en el grupo control. No se detectaron efectos de la escolaridad de la madre y la asistencia previa al jardín. Los resultados mostraron correlaciones significativas entre todas las variables analizadas y el valor predictivo de los puntajes en VR a principio de año respecto de los puntajes en VR y escritura a fin de año.

Educational orientation regarding vocabulary and literacy access : Evaluating the impact of an intervention program designed to promote early learning at home

El estudio evalúa el impacto de un programa de promoción del desarrollo lingüístico y cognitivo para niños de 5 años implementado según dos modalidades: una que implicó acciones de alfabetización familiar en los hogares de los niños (modalidad intensiva) y otra que incluyó la participación de los niños en las salas de jardín de infantes (modalidad extensiva). La evaluación del impacto se realizó por medio de un diseño pre-test ? post-test. Se tomaron pruebas de vocabulario receptivo (VR), producción de categorías (PC) y escritura a una muestra de 214 niños participantes de la modalidad intensiva, 69 participantes de la modalidad extensiva y un grupo control de no participó del programa (49 niños). Los resultados mostraron que la participación en la modalidad intensiva implicó un mayor incremento en las habilidades infantiles de VR, PC que en la modalidad extensiva. A su vez ambas modalidades experimentales mostraron un mayor incremento en las variables examinadas respecto de las observadas en el grupo control. No se detectaron efectos de la escolaridad de la madre y la asistencia previa al jardín. Los resultados mostraron correlaciones significativas entre todas las variables analizadas y el valor predictivo de los puntajes en VR a principio de año respecto de los puntajes en VR y escritura a fin de año.

Educational orientation regarding vocabulary and literacy access : Evaluating the impact of an intervention program designed to promote early learning at home

El estudio evalúa el impacto de un programa de promoción del desarrollo lingüístico y cognitivo para niños de 5 años implementado según dos modalidades: una que implicó acciones de alfabetización familiar en los hogares de los niños (modalidad intensiva) y otra que incluyó la participación de los niños en las salas de jardín de infantes (modalidad extensiva). La evaluación del impacto se realizó por medio de un diseño pre-test ? post-test. Se tomaron pruebas de vocabulario receptivo (VR), producción de categorías (PC) y escritura a una muestra de 214 niños participantes de la modalidad intensiva, 69 participantes de la modalidad extensiva y un grupo control de no participó del programa (49 niños). Los resultados mostraron que la participación en la modalidad intensiva implicó un mayor incremento en las habilidades infantiles de VR, PC que en la modalidad extensiva. A su vez ambas modalidades experimentales mostraron un mayor incremento en las variables examinadas respecto de las observadas en el grupo control. No se detectaron efectos de la escolaridad de la madre y la asistencia previa al jardín. Los resultados mostraron correlaciones significativas entre todas las variables analizadas y el valor predictivo de los puntajes en VR a principio de año respecto de los puntajes en VR y escritura a fin de año.

The role of home and host country characteristics in FDI: firm-level evidence from Japan, Korea and Taiwan

There is a large and growing empirical literature that investigates the determinants of outward foreign direct investment (FDI). This literature examines primarily the effect of host country characteristics on FDI even though home country characteristics also influence the decision of firms to invest abroad. In this paper, we examine the role of both host and home country characteristics in FDI. To do so, we constructed a firm-level database of outward FDI from Japan, Korea, and Taiwan. Our empirical analysis yields two main findings. First, host countries with better environment for FDI, in terms of larger market size, smaller fixed entry costs, and lower wages, attract more foreign investors. Second, firms from home countries with higher wages are more likely to invest abroad. An interesting and significant policy implication of our empirical evidence is that policymakers seeking to promote FDI inflows should prioritize countries with higher wages.

A two-dimensional analysis of the impact of outward FDI on performance at home: evidence from Japanese manufacturing firms

This paper empirically investigates two areas of changes in firm behavior and performance at home before and after investing abroad. The first change is dependent upon the type of foreign direct investment (FDI): horizontal FDI or vertical FDI. The second change is dependent upon the firm’s domestic activities: production activities or non-production activities. From a theoretical standpoint, the impact of outward FDIs differs not only by type, but according to the firm’s activities. By exploiting two types of firm-level data that enable us to distinguish between production and non-production activities, our paper provides a detailed picture of the intra-firm changes in behavior and performance that occur as a result of production globalization.

Neighborhood mobility: A Long-Gone Pardigm? Approaching proximity and land use mix using data from home based surveys.

El WCTR es un congreso de reconocido prestigio internacional en el ámbito de la investigación del transporte y aunque las actas publicadas están en formato digital y sin ISSN ni ISBN, lo consideramos lo suficientemente importante como para que se considere en los indicadores. Policies trying to increase walking within urban mobility modal split usually highlight the importance of the functional patterns and the environmental quality of the urban space as major drivers of citizens modal choices. Functional characteristics would be mainly associated to an appropriate mix of land uses within neighbourhoods, whereas environmental quality would be associated to the characteristics of urban spaces. The purpose of this research is threefold: first, to identify relevant proxy indicators, which could characterize pedestrian-friendly land use mix and environmental quality. Second, to assess, for both traits, existing disparities among neighbourhoods in a major metropolitan area. And finally, to explore the association between both indicators and children mobility patterns: according to their built environment, which neighbourhoods have a greater proportion of children and, how is their mobility? Using data from the 2004 household mobility survey in the 128 neighbourhoods of the municipality of Madrid, this paper concludes that potentially favourable conditions at the neighbourhood level seem to have only a modest influence in,mobility patterns , in terms of both, selection of closer destinations and a higher share of walking within modal split. The citys policy choices, with intensive investment in road and public transport infrastructure may explain why short-distance mobility is not as important as it could have been expected in those neighbourhoods with more pedestrian-friendly conditions. The metropolitan transport system is providing mobility conditions, which make far-away destinations attractive to most citizens.

Neighbourhood mobility: a longgone Paradigm? Approaching "proximity" and "land use mix" using data from home-based surveys

Policies trying to increase walking within urban mobility modal split usually highlight the importance of the functional patterns and the environmental quality of the urban space as major drivers of citizens modal choices. Functional characteristics would be mainly associated to an appropriate mix of land uses within neighbourhoods, whereas environmental quality would be associated to the characteristics of urban spaces. The purpose of this research is threefold: first, to identify relevant proxy indicators, which could characterize pedestrian-friendly land use mix and environmental quality. Second, to assess, for both traits, existing disparities among neighbourhoods in a major metropolitan area. And finally, to explore the association between both indicators and children mobility patterns: according to their built environment, which neighbourhoods have a greater proportion of children and, how is their mobility? Using data from the 2004 household mobility survey in the 128 neighbourhoods of the municipality of Madrid, this paper concludes that potentially favourable conditions at the neighbourhood level seem to have only a modest influence in,mobility patterns , in terms of both, selection of closer destinations and a higher share of walking within modal split. The city s policy choices, with intensive investment in road and public transport infrastructure may explain why short-distance mobility is not as important as it could have been expected in those neighbourhoods with more pedestrian-friendly conditions. The metropolitan transport system is providing mobility conditions, which make far-away destinations attractive to most citizens.