Facilitators and barriers to hypertension self-management in urban African Americans: perspectives of patients and family members.

INTRODUCTION: We aimed to inform the design of behavioral interventions by identifying patients' and their family members' perceived facilitators and barriers to hypertension self-management. MATERIALS AND METHODS: We conducted focus groups of African American patients with hypertension and their family members to elicit their views about factors influencing patients' hypertension self-management. We recruited African American patients with hypertension (n = 18) and their family members (n = 12) from an urban, community-based clinical practice in Baltimore, Maryland. We conducted four separate 90-minute focus groups among patients with controlled (one group) and uncontrolled (one group) hypertension, as well as their family members (two groups). Trained moderators used open-ended questions to assess participants' perceptions regarding patient, family, clinic, and community-level factors influencing patients' effective hypertension self-management. RESULTS: Patient participants identified several facilitators (including family members' support and positive relationships with doctors) and barriers (including competing health priorities, lack of knowledge about hypertension, and poor access to community resources) that influence their hypertension self-management. Family members also identified several facilitators (including their participation in patients' doctor's visits and discussions with patients' doctors outside of visits) and barriers (including their own limited health knowledge and patients' lack of motivation to sustain hypertension self-management behaviors) that affect their efforts to support patients' hypertension self-management. CONCLUSION: African American patients with hypertension and their family members reported numerous patient, family, clinic, and community-level facilitators and barriers to patients' hypertension self-management. Patients' and their family members' views may help guide efforts to tailor behavioral interventions designed to improve hypertension self-management behaviors and hypertension control in minority populations.

Numerical and experimental studies of a substructural identification strategy

For structural health monitoring it is impractical to identify a large structure with complete measurement due to limited number of sensors and difficulty in field instrumentation. Furthermore, it is not desirable to identify a large number of unknown parameters in a full system because of numerical difficulty in convergence. A novel substructural strategy was presented for identification of stiffness matrices and damage assessment with incomplete measurement. The substructural approach was employed to identify large systems in a divide-and-conquer manner. In addition, the concept of model condensation was invoked to avoid the need for complete measurement, and the recovery process to obtain the full set of parameters was formulated. The efficiency of the proposed method is demonstrated numerically through multi-storey shear buildings subjected to random force. A fairly large structural system with 50 DOFs was identified with good results, taking into consideration the effects of noisy signals and the limited number of sensors. Two variations of the method were applied, depending on whether the sensor could be repositioned. The proposed strategy was further substantiated experimentally using an eight-storey steel plane frame model subjected to shaker and impulse hammer excitations. Both numerical and experimental results have shown that the proposed substructural strategy gave reasonably accurate identification in terms of locating and quantifying structural damage.

Local public finance in Central and Eastern Europe: assessing the first decade

[Taken from book jacket] This book explores the system of financing local governments in selected countries of Central and Eastern Europe. Using evidence from the last two decades, the authors, experts on their particular countries, describe the development of the current local government finance system in each nation, and the major challenges and policy options they face. The contributions in this book provide comprehensive coverage of a transitional Europe that encompasses both modern local public finance theory and specific applications in the target countries.

Ecological And Metabolic Studies On Free-Living Nematodes From An Estuarine Mud-Flat

Nematodes from a mud-flat in the river Lynher estuary, Cornwall, U.K., have a population density ranging between 8 and 9 × 106 m−2 in the winter months, corresponding to a dry weight of 1·4 and 1·6 g m−2. They reach a peak abundance of 22·86 × 106 m−2 (3·4 g) in May. About 40 species are present, and the species composition remained seasonally stable over the period of study. Analysis of age-structure suggests that the major species have continuous asynchronous reproduction. Respiration rates of 16 species have been determined at 20 °C using Cartesian diver respirometry. For five species, respiration/body size regressions were obtained in the form log10R = log10a+b log10V, where R = respiration in nl O2 ind−1 h−1 and V = body volume in nl: Mesotheristus setosus (log10a = −0·04,b = 0·74), Sphaerolaimus hirsutus (log10a = 0·11, b = 0·68), Axonolaimus paraspinosus (log10a = 0·00, b = 0·79), Metachromadora vivipara (log10a = −0·59, b = 1·07), Praeacanthonchus punctatus (log10a = 0·00, b = 0·55). For the remaining 11 species, several animals were used in each diver and, by assuming b = 0·75, log10a′ values were calculated: Viscosia viscosa (log10a′ = 0·188), Innocuonema tentabundum (−0·012), Ptycholaimellus ponticus (−0·081), Odontophora setosa (−0·092), Sphaerolaimus balticus (−0·112), Dichromadora cephalata (−0·133), Atrochromadora microlaima (−0·142), Cylindrotheristus normandicus (−0·150), Terschellingialongicaudata (−0·170), Sabatieria pulchra (−0·197), Terschellingia communis (−0·277). These values are compared with recalculated values for other species from the literature. Annual respiration of the nematode community is 28·01 O2 m−2, equivalent to 11·2 g carbon metabolised. Community respiration is compared with figures from N. American saltmarshes. At 20 °C, a respiration of about 61 O2 m−2 year−1 g−1 wet weight of nematodes appears to be typical. Annual production is estimated to be 6·6 g C m−2. The correlation between feeding-group, body-size, habitat and the repiration rate of individual species is discussed.

Measurement Of The Responses Of Individuals To Environmental-Stress And Pollution - Studies With Bivalve Mollusks

Certain physiological differences between individuals in different populations of the mussel, Mytilus edulis, are described. In particular, the scope for growth differs in space and time and may be used to assess the animals' physiological condition. When the required measurements are made in the field, the rates of growth predicted from the physiological data agree well with observed rates of growth. An alternative approach utilizes mussels transplanted to various waters, with indices of condition then measured in the laboratory under standard conditions; an example of this approach is illustrated. Laboratory experiments are used to equate various levels of physiological condition with fecundity, in an attempt to equate physiological effects on the individual with likely population damage. A cytochemical index of stress is described, based on the latency of lysosomal enzymes; spatial variability in this index, and its relation with the scope for growth, are discussed. Finally, the results of some experiments on the effects of petroleum hydrocarbons on mussels are described and the presence of inducible activity of NADPH-dependent tetrazolium reductase in the blood cells is demonstrated. Certain considerations that apply in adopting similar measurements of biological effects of pollution in environmental monitoring programmes are discussed.

Parental Responsibility and the Duty to Consult - the public's view

This article considers the imposition, by the courts, of a parental duty to consult on matters of importance in a child’s life. The results of a survey of 2,300 respondents, who were asked to respond to a number of scenarios, are analysed and discussed. The survey provides some interesting reflections on the views of the general public as to who should be ‘in control’ over decision making for children.

National identification and anti-immigrant prejudice: Individual and contextual effects of national definitions

In this study, we examined the relationship between national identification and anti-immigrant prejudice in a multilevel analysis of ISSP survey data from 37,030 individuals in 31 countries. We argue that this relationship depends on how national groups are defined by their members. Across the 31 national samples, the correlation between national identification and prejudice ranged from weakly negative (-.06) to moderately positive (.37). The relationship was significantly stronger in countries where people on average endorsed a definition of national belonging based on language, and weaker where people on average defined the nation in terms of citizenship. These effects occurred at a national rather than individual level, supporting an explanation in terms of the construction of nationality that prevails in a given context. Endorsement of the ancestry-based criteria for nationality was positively associated with prejudice, but only at the individual level.