Teenage Pregnancy, Professional Agendas, and Problem Definitions

Many of the adverse consequences associated with adolescent childbearing are due to poverty and inadequate health care. Historically, definitions of the problem have emphasized individual, female culpability. Underlying social and economic factors have received less attention. For many adolescents, the early initiation of sexual activity and the failure to use birth control is associated with their perception of limited life opportunities, as well as sex role socialization inhibiting contraceptive initiative. This paper considers the role of professional groups and service advocates in defining the problem and developing policy alternatives. It examines the processes through which an issue having significant redistributive implications has been defined as one of individual female deviance

Galaxy Counterparts of metal-rich Damped Lyman-alpha Absorbers - I: The case of the z=2.35 DLA towards Q2222-0946

We have initiated a survey using the newly commissioned X-shooter spectrograph to target candidate relatively metal-rich damped Lyman-alpha absorbers (DLAs). The spectral coverage of X-shooter allows us to search for not only Lyman-alpha emission, but also rest-frame optical emission lines. We have chosen DLAs where the strongest rest-frame optical lines ([OII], [OIII], Hbeta and Halpha) fall in the NIR atmospheric transmission bands. In this first paper resulting from the survey, we report on the discovery of the galaxy counterpart of the z_abs = 2.354 DLA towards the z=2.926 quasar Q2222$-0946. This DLA is amongst the most metal-rich z>2 DLAs studied so far at comparable redshifts and there is evidence for substantial depletion of refractory elements onto dust grains. We measure metallicities from ZnII, SiII, NiII, MnII and FeII of -0.46+/-0.07, -0.51+/-0.06, -0.85+/-0.06, -1.23+/-0.06, and -0.99+/-0.06, respectively. The galaxy is detected in the Lyman-alpha, [OIII] lambda4959,5007 Halpha emission lines at an impact parameter of about 0.8 arcsec (6 kpc at z_abs = 2.354). We infer a star-formation rate of 10 M_sun yr^-1, which is a lower limit due to the possibility of slit-loss. Compared to the recently determined Halpha luminosity function for z=2.2 galaxies the DLA-galaxy counterpart has a luminosity of L~0.1L^*_Halpha. The emission-line ratios are 4.0 (Lyalpha/Halpha) and 1.2 ([OIII]/Halpha). The Lyalpha line shows clear evidence for resonant scattering effects, namely an asymmetric, redshifted (relative to the systemic redshift) component and a much weaker blueshifted component. The fact that the blueshifted component is relatively weak indicates the presence of a galactic wind. The properties of the galaxy counterpart of this DLA is consistent with the prediction that metal-rich DLAs are associated with the most luminous of the DLA-galaxy counterparts.Comment: 9 pages, 7 figures. Accepted for publication in MNRA

Rolofylline, an adenosine A1−receptor antagonist, in acute heart failure

Background: Worsening renal function, which is associated with adverse outcomes, often develops in patients with acute heart failure. Experimental and clinical studies suggest that counterregulatory responses mediated by adenosine may be involved. We tested the hypothesis that the use of rolofylline, an adenosine A1−receptor antagonist, would improve dyspnea, reduce the risk of worsening renal function, and lead to a more favorable clinical course in patients with acute heart failure. Methods: We conducted a multicenter, double-blind, placebo-controlled trial involving patients hospitalized for acute heart failure with impaired renal function. Within 24 hours after presentation, 2033 patients were randomly assigned, in a 2:1 ratio, to receive daily intravenous rolofylline (30 mg) or placebo for up to 3 days. The primary end point was treatment success, treatment failure, or no change in the patient’s clinical condition; this end point was defined according to survival, heart-failure status, and changes in renal function. Secondary end points were the post-treatment development of persistent renal impairment and the 60-day rate of death or readmission for cardiovascular or renal causes. Results: Rolofylline, as compared with placebo, did not provide a benefit with respect to the primary end point (odds ratio, 0.92; 95% confidence interval, 0.78 to 1.09; P=0.35). Persistent renal impairment developed in 15.0% of patients in the rolofylline group and in 13.7% of patients in the placebo group (P=0.44). By 60 days, death or readmission for cardiovascular or renal causes had occurred in similar proportions of patients assigned to rolofylline and placebo (30.7% and 31.9%, respectively; P=0.86). Adverse-event rates were similar overall; however, only patients in the rolofylline group had seizures, a known potential adverse effect of A1-receptor antagonists. Conclusions: Rolofylline did not have a favorable effect with respect to the primary clinical composite end point, nor did it improve renal function or 60-day outcomes. It does not show promise in the treatment of acute heart failure with renal dysfunction. (Funded by NovaCardia, a subsidiary of Merck; ClinicalTrials.gov numbers, NCT00328692 and NCT00354458.

Comparing open-source DEM frameworks for simulations of common bulk processes

Multiple software frameworks based on the Discrete Element Method (DEM) are available for simulating granular materials. All of them employ the same principles of explicit time integration, with each time step consisting of three main steps: contact detection, calculation of interactions, and integration of the equations of motion. However, there exist significant algorithmic differences, such as the choice of contact models, particle and wall shapes, and data analysis methods. Further differences can be observed in the practical implementation, including data structures, architecture, parallelization and domain decomposition techniques, user interaction, and the documentation of resources. This study compares, verifies, and benchmarks nine widely-used software frameworks. Only open-source packages were considered, as these are freely available and their underlying algorithms can be reviewed, edited, and tested. The benchmark consists of three common bulk processes: silo emptying, drum mixing, and particle impact. To keep it simple and comparable, only standard features were used, such as spherical particles and the Hertz-Mindlin model for dry contacts. Scripts for running the benchmarks in each software are provided as a dataset.</p

Explanations for the Lower Rates of Diabetic Neuropathy in Indian Asians Versus Europeans

OBJECTIVE - Risks of diabetes and cardiovascular disease are elevated worldwide in Indian Asians. However, risks of other diabetes-related complications, i.e., foot ulceration and amputation, also with a vascular basis, are substantially lower in Asians than in white Europeans in the U.K., possibly due to less neuropathy. We therefore compared signs, symptoms, and objective quantitative measures of diabetic neuropathy and their risk factors in Indian Asians and Europeans. RESEARCH DESIGN AND METHODS - This was a cross-sectional study of a population-based sample of age- and sex-matched adults with type 2 diabetes of European (95 male and 85 female) and Asian (96 male and 84 female) descent in the U.K. Patients were assessed for neuropathic symptoms, signs, nerve conduction, autonomic function, and quantitative sensory testing. Peripheral vascular function and other potential risk factors for neuropathy were measured. RESULTS - Mean nerve conduction velocity Z scores were better in Asians (mean ± SD 0.07 ± 0.62) than in Europeans (-0.11 ± 0.60; P = 0.007) and were explained by the shorter height, fewer pack-years smoked, and higher transcutaneous oxygen levels (TCpO2) in Indian Asians (P value for ethnic comparison attenuated to 0.2). Small fiber neuropathy was less prevalent in Indian Asians compared with Europeans (odds ratio 0.58 [95% CI 0.37-0.93]; P = 0.02) and was primarily accounted for by better TCpO2 (0.70 [0.40-1.21]; P = 0.2). CONCLUSIONS - Asians with diabetes have substantially less large and small fiber neuropathy than Europeans, despite comparable traditional risk factors. Independent from smoking, the lower risk of neuropathy in Asians is due to better skin microvascularization and may help explain the substantially reduced Asian foot ulcer risk. © 2010 by the American Diabetes Association

Dyspnoea and worsening heart failure in patients with acute heart failure: results from the Pre-RELAX-AHF study

Although dyspnoea is the most common cause of admission for acute heart failure (AHF), more needs to be known about its clinical course and prognostic significance. The Pre-RELAX-AHF study randomized 232 subjects with AHF to placebo or four doses of relaxin and evaluated early (6-24 h Likert scale) and persistent [change in visual analogue scale area under the curve (VAS AUC) through Day 5] dyspnoea relief. Worsening heart failure (WHF) was defined as worsening AHF signs and symptoms requiring additional therapy. Patients were followed until Day 180. Early dyspnoea relief was observed in only 25% of all patients, and VAS AUC at 5 days was 45% over baseline values in all patients (32% placebo; 50% all relaxin-treated patients). Worsening heart failure to Day 5 was observed in 16% of all patients (21% placebo; 14% relaxin). Lack of persistent dyspnoea relief and WHF were associated with a longer length of initial hospital stay and worse 60-day outcomes. Dyspnoea relief in patients admitted with AHF is often incomplete, and many may show WHF after the initial stabilization. Both lack of persistent dyspnoea relief and in-hospital WHF predict a longer length of stay and worse outcome

Cosmic crystallography using short-lived objects - active galactic nuclei

Cosmic crystallography is based on the principle that peaks in the pair separation histogram (PSH) of objects in a catalogue should be induced by the high number of topologically lensed pairs that are separated by Clifford translations, in excess to ``random'' pairs of objects. Here we present modifications of this method that successively improve the signal-to-noise ratio by removing a large part of the noise and then false signals induced by selection effects. Given the transient nature of the most readily available tracer objects, active galactic nuclei (AGNs), the former is possible because a natural filter for removing many of the noise pairs is available: when counting pairs of objects in order to create PSHs, only those with nearly identical redshifts need to be counted. This redshift filter (a maximum value of $\Delta z/z = 0.005$) was applied to a compilation of AGN catalogues. Further noise was removed by applying a second filter, a maximum angle $\Delta \theta =0.075$ rad, and a minimum number of pairs \protect\npairs=3 to find each ``bunch of pairs'' (BoP) where the {\em vectors} (in Euclidean comoving space) defined by pairs are required to be nearly equal, whereas in the PSH only the {\em lengths} must be nearly equal. These filters reveal significant signals, which, however, are due to selection effects. A third filter, a minimum length \Lselec=150 {\hMpc} between the (parallel) vectors in a BoP, is found to effectively remove these selection effect pairs. After application of these successive filters, no significant topological signal was found.Comment: 9 pages, 8 figures, matches the version accepted by Astronomy & Astrophysic

Mantle plume capture, anchoring, and outflow during Galápagos plume-ridge interaction

Compositions of basalts erupted between the main zone of Galápagos plume upwelling and adjacent Galápagos Spreading Center (GSC) provide important constraints on dynamic processes involved in transfer of deep-mantle-sourced material to mid-ocean ridges. We examine recent basalts from central and northeast Galápagos including some that have less radiogenic Sr, Nd, and Pb isotopic compositions than plume-influenced basalts (E-MORB) from the nearby ridge. We show that the location of E-MORB, greatest crustal thickness, and elevated topography on the GSC correlates with a confined zone of low-velocity, high-temperature mantle connecting the plume stem and ridge at depths of ∼100 km. At this site on the ridge, plume-driven upwelling involving deep melting of partially dehydrated, recycled ancient oceanic crust, plus plate-limited shallow melting of anhydrous peridotite, generate E-MORB and larger amounts of melt than elsewhere on the GSC. The first-order control on plume stem to ridge flow is rheological rather than gravitational, and strongly influenced by flow regimes initiated when the plume was on axis (>5 Ma). During subsequent northeast ridge migration material upwelling in the plume stem appears to have remained “anchored” to a contact point on the GSC. This deep, confined NE plume stem-to-ridge flow occurs via a network of melt channels, embedded within the normal spreading and advection of plume material beneath the Nazca plate, and coincides with locations of historic volcanism. Our observations require a more dynamically complex model than proposed by most studies, which rely on radial solid-state outflow of heterogeneous plume material to the ridge.We thank Galápagos National Park authorities and CDRS for permitting fieldwork in Galápagos. D. Villagomez and D. Toomey generously shared their extensive seismic data set for Galápagos, and D. McKenzie kindly provided help with temperature calculations. End-member compositions of Galápagos mantle reservoirs in Figure 4 were estimated from principal component analysis; data related to these calculations are available in the supporting information. We are grateful to Kaj Hoernle and two anonymous reviewers for their constructive comments on an earlier version of this manuscript. The research was funded by the University of Cambridge, Geological Society of London, NERC (RG57434), and NSF (EAR 0838461, EAR 0944229, and EAR-11452711).This is the final published version of the article. It first appeared at http://dx.doi.org/10.1002/2015GC00572

The association of the ankle-brachial index with incident coronary heart disease: the Atherosclerosis Risk In Communities (ARIC) study, 1987-2001

Abstract Background Peripheral arterial disease (PAD), defined by a low ankle-brachial index (ABI), is associated with an increased risk of cardiovascular events, but the risk of coronary heart disease (CHD) over the range of the ABI is not well characterized, nor described for African Americans. Methods The ABI was measured in 12186 white and African American men and women in the Atherosclerosis Risk in Communities Study in 1987–89. Fatal and non-fatal CHD events were ascertained through annual telephone contacts, surveys of hospital discharge lists and death certificate data, and clinical examinations, including electrocardiograms, every 3 years. Participants were followed for a median of 13.1 years. Age- and field-center-adjusted hazard ratios (HRs) were estimated using Cox regression models. Results Over a median 13.1 years follow-up, 964 fatal or non-fatal CHD events accrued. In whites, the age- and field-center-adjusted CHD hazard ratio (HR, 95% CI) for PAD (ABI 1.0, in all race-gender subgroups. The association between the ABI and CHD relative risk was similar for men and women in both race groups. A 0.10 lower ABI increased the CHD hazard by 25% (95% CI 17–34%) in white men, by 20% (8–33%) in white women, by 34% (19–50%) in African American men, and by 32% (17–50%) in African American women. Conclusion African American members of the ARIC cohort had higher prevalences of PAD and greater risk of CHD associated with ABI-defined PAD than did white participants. Unlike in other cohorts, in ARIC the CHD risk failed to increase at high (>1.3) ABI values. We conclude that at this time high ABI values should not be routinely considered a marker for increased CVD risk in the general population. Further research is needed on the value of the ABI at specific cutpoints for risk stratification in the context of traditional risk factors

The significance of the largest scale CMB fluctuations in WMAP

We investigate anomalies reported in the Cosmic Microwave Background maps from the Wilkinson Microwave Anisotropy Probe (WMAP) satellite on very large angular scales and discuss possible interpretations. Three independent anomalies involve the quadrupole and octopole: 1. The cosmic quadrupole on its own is anomalous at the 1-in-20 level by being low (the cut-sky quadrupole measured by the WMAP team is more strikingly low, apparently due to a coincidence in the orientation of our Galaxy of no cosmological significance); 2. The cosmic octopole on its own is anomalous at the 1-in-20 level by being very planar; 3. The alignment between the quadrupole and octopole is anomalous at the 1-in-60 level. Although the a priori chance of all three occurring is 1 in 24000, the multitude of alternative anomalies one could have looked for dilutes the significance of such a posteriori statistics. The simplest small universe model where the universe has toroidal topology with one small dimension of order half the horizon scale, in the direction towards Virgo, could explain the three items above. However, we rule this model out using two topological tests: the S-statistic and the matched circle test.Comment: N.B. that our results do not rule out the recently proposed dodecahedron model of Luminet, Weeks, Riazuelo, Lehoucq & Uzan, which has a 36 degree twist between matched circles. 12 pages, 5 figs; more info at http://www.hep.upenn.edu/~angelica/topology.htm