Temporal trends in the incidence, treatment patterns, and outcomes of coronary artery disease and peripheral artery disease in the UK, 2006–2015

Aims Most reports estimating national incidence rates of coronary (CAD) and peripheral arterial disease (PAD) have focused on stable outpatients or acute or elective hospital admissions, but not on the overall burden of disease. In this study, we report the changing trends in the population-level incidence of CAD and PAD, respectively from 2006 to 2015, statin utilization for secondary prevention and survival outcomes using multiple nationally representative data sources from the UK (primary care encounters, hospital admissions, and procedure-level data). Methods and results A nationally representative study of linked primary and secondary care electronic health records of 4.6 million individuals from the UK. We calculated crude and standardized annual incidence rates separately for CAD and PAD. Statin use for secondary prevention, trends in annual major vascular event rates, and mortality between 2006 and 2015, were estimated for CAD and PAD, respectively. We identified 160 376 and 70 753 patients with incident CAD and PAD, respectively. The age- and sex-standardized incidence of CAD was similar in 2006 (443 per 100 000 person-years) and 2015 [436 per 100 000 person-years; adjusted incidence rate ratio (IRR) 0.98, 95% confidence interval (CI) 0.96–1.00]. In contrast, there was a 15% decline in the standardized incidence of PAD (236 per 100 000 person-years in 2006 to 202 per 100 000 person-years in 2015; adjusted IRR 0.85, 95% CI 0.82–0.88). The proportion of incident CAD and PAD patients prescribed long-term statins, was only 66% and 55%, respectively and was less common amongst women, patients aged >70 years, with heart failure, chronic lung disease, or depression. Cardiovascular mortality declined by 43% for incident CAD (adjusted IRR 0.57, 95% CI 0.50–0.64) between 2006 and 2015 but did not decline for incident PAD (adjusted IRR 0.84, 95% CI 0.70–1.00). Conclusion and relevance In the UK, the standardized incidence of CAD appears stable but mortality rates are falling, whereas the standardized incidence of PAD is falling but mortality rates are not

Health economic evaluation of rivaroxaban in the treatment of patients with chronic coronary artery disease or peripheral artery disease

AIMS: In the COMPASS trial, rivaroxaban 2.5 mg twice daily (bid) plus acetylsalicylic acid (ASA) 100 mg once daily (od) performed better than ASA 100 mg od alone in reducing the rate of cardiovascular disease, stroke, or myocardial infarction (MI) in patients with coronary artery disease (CAD) and peripheral artery disease (PAD). A Markov model was developed to assess the cost-effectiveness of rivaroxaban plus ASA vs. ASA alone over a lifetime horizon, from the UK National Health System perspective. METHODS AND RESULTS: The base case analysis assumed that patients entered the model in the event-free health state, with the possibility to experience ≤2 events, transitioning every three-month cycle, through acute and post-acute health states of MI, ischaemic stroke (IS), or intracranial haemorrhage (ICH), and death. Costs, quality-adjusted life-years (QALYs), life years-all discounted at 3.5%-and incremental cost-effectiveness ratios (ICERs) were calculated. Deterministic and probabilistic sensitivity analyses were conducted, as well as scenario analyses. In the model, patients on rivaroxaban plus ASA lived for an average of 14.0 years with no IS/MI/ICH, and gained 9.7 QALYs at a cost of £13 947, while those receiving ASA alone lived for an average of 12.7 years and gained 9.3 QALYs at a cost of £8126. The ICER was £16 360 per QALY. This treatment was cost-effective in 98% of 5000 iterations at a willingness-to-pay threshold of £30 000 per QALY. CONCLUSION: This Markov model suggests that rivaroxaban 2.5 mg bid plus ASA is a cost-effective alternative to ASA alone in patients with chronic CAD or PAD

Binary systems of neutral mesons in Quantum Field Theory

Quasi-degenerate binary systems of neutral mesons of the kaon type are investigated in Quantum Field Theory (QFT). General constraints cast by analyticity and discrete symmetries P, C, CP, TCP on the propagator (and on its spectral function) are deduced. Its poles are the physical masses; this unambiguously defines the propagating eigenstates. It is diagonalized and its spectrum thoroughly investigated. The role of ``spurious'' states, of zero norm at the poles, is emphasized, in particular for unitarity and for the realization of TCP symmetry. The K_L-K_S mass splitting triggers a tiny difference between their CP violating parameters \epsilon_L and \epsilon_S, without any violation of TCP. A constant mass matrix like used in Quantum Mechanics (QM) can only be introduced in a linear approximation to the inverse propagator, which respects its analyticity and positivity properties; it is however unable to faithfully describe all features of neutral mesons as we determine them in QFT, nor to provide any sensible parameterization of eventual effects of TCP violation. The suitable way to diagonalize the propagator makes use of a bi-orthogonal basis; it is inequivalent to a bi-unitary transformation (unless the propagator is normal, which cannot occur here). Problems linked with the existence of different ``in'' and ``out'' eigenstates are smoothed out. We study phenomenological consequences of the differences between the QFT and QM treatments. The non-vanishing of semi-leptonic asymmetry \delta_S - \delta_L does not signal, unlike usually claimed, TCP violation, while A_TCP keeps vanishing when TCP is realized. We provide expressions invariant by the rephasing of K0 and K0bar.Comment: 44 pages, 2 figures. Version to appear in Int. J. Mod. Phys.

The remittances behaviour of the second generation in Europe: altruism or self-interest?

Whereas most research on remittances focuses on first-generation migrants, the aim of this paper is to investigate the remitting behaviour of the host country-born children of migrants - the second generation - in various European cities. Some important studies found that migrant transnationalism is not only a phenomenon for the first generation, but also apply to the second and higher generations, through, among other things, family visits, elder care, and remittances. At the same time, the maintenance of a strong ethnic identity in the ‘host’ society does not necessarily mean that second-generation migrants have strong transnational ties to their ‘home’ country. The data used in this paper is from “The Integration of the European Second Generation” (TIES) project. The survey collected information on approximately 6,250 individuals aged 18-35 with at least one migrant parent from Morocco, Turkey or former Yugoslavia, in 15 European cities, regrouped in 8 ‘countries’. For the purpose of this paper, only analyses for Austria (Linz and Vienna); Switzerland (Basle and Zurich); Germany (Berlin and Frankfurt); France (Paris and Strasbourg); the Netherlands (Amsterdam and Rotterdam); Spain (Barcelona and Madrid); and Sweden (Stockholm) will be presented.

Sexual exploitation in children: Nature, prevalence and distinguishing characteristics reported in young adulthood

The aim of this study was to explore the nature and extent of sexual exploitation in a university student sample, whilst being clear that sexual exploitation is sexual abuse. Overall, 47% of participants (96 out of 204) reported having been approached by an adult in a sexual manner when they were under the age of 16. The study predicted that a number of individual characteristics would increase a young person’s vulnerability for sexual exploitation. These included low self-esteem, external locus of control, social loneliness and insecure attachment. Results indicated lower levels of self-esteem among those who had been approached sexually, although it is not clear in terms of causality. There were no differences in scores for locus of control or loneliness. Relationship anxiety was significantly linked with children having engaged in sexual behaviours with an adult. The implications of these findings are discussed in terms of emerging individual characteristics relating to a risk of sexual exploitation

Determination of the D0 -> K+pi- Relative Strong Phase Using Quantum-Correlated Measurements in e+e- -> D0 D0bar at CLEO

We exploit the quantum coherence between pair-produced D0 and D0bar in psi(3770) decays to study charm mixing, which is characterized by the parameters x and y, and to make a first determination of the relative strong phase \delta between doubly Cabibbo-suppressed D0 -> K+pi- and Cabibbo-favored D0bar -> K+pi-. We analyze a sample of 1.0 million D0D0bar pairs from 281 pb^-1 of e+e- collision data collected with the CLEO-c detector at E_cm = 3.77 GeV. By combining CLEO-c measurements with branching fraction input and time-integrated measurements of R_M = (x^2+y^2)/2 and R_{WS} = Gamma(D0 -> K+pi-)/Gamma(D0bar -> K+pi-) from other experiments, we find \cos\delta = 1.03 +0.31-0.17 +- 0.06, where the uncertainties are statistical and systematic, respectively. In addition, by further including external measurements of charm mixing parameters, we obtain an alternate measurement of \cos\delta = 1.10 +- 0.35 +- 0.07, as well as x\sin\delta = (4.4 +2.7-1.8 +- 2.9) x 10^-3 and \delta = 22 +11-12 +9-11 degrees.Comment: 37 pages, also available through http://www.lns.cornell.edu/public/CLNS/2007/. Incorporated referee's comment

Measurement of the eta-Meson Mass using psi(2S) --> eta J/psi

We measure the mass of the eta meson using psi(2S) --> eta J/psi events acquired with the CLEO-c detector operating at the CESR e+e- collider. Using the four decay modes eta --> gamma gamma, 3pi0, pi+pi-pi0, and pi+pi-gamma, we find M(eta)=547.785 +- 0.017 +- 0.057 MeV, in which the first uncertainty is statistical and the second systematic. This result has an uncertainty comparable to the two most precise previous measurements and is consistent with that of NA48, but is inconsistent at the level of 6.5sigma with the much smaller mass obtained by GEM.Comment: 10 pages postscript,also available through http://www.lns.cornell.edu/public/CLNS/2007/, Submitted to PR

Suppressed Decays of D_s^+ Mesons to Two Pseudoscalar Mesons

Using data collected near the Ds*+ Ds- peak production energy Ecm = 4170 MeV by the CLEO-c detector, we study the decays of Ds+ mesons to two pseudoscalar mesons. We report on searches for the singly-Cabibbo-suppressed Ds+ decay modes K+ eta, K+ eta', pi+ K0S, K+ pi0, and the isospin-forbidden decay mode Ds+ to pi+ pi0. We normalize with respect to the Cabibbo-favored Ds+ modes pi+ eta, pi+ eta', and K+ K0S, and obtain ratios of branching fractions: Ds+ to K+ eta / Ds+ to pi+ eta = (8.9 +- 1.5 +- 0.4)%, Ds+ to K+ eta' / Ds+ to pi+ eta' = (4.2 +- 1.3 +- 0.3)%, Ds+ to pi+ K0S / Ds+ to K+ K0S = (8.2 +- 0.9 +- 0.2)%, Ds+ to K+ pi0 / Ds+ to K+ K0S = (5.0 +- 1.2 +- 0.6)%, and Ds+ to pi+ pi0 / Ds+ to K+ K0S < 4.1% at 90% CL, where the uncertainties are statistical and systematic, respectively.Comment: 9 pages postscript,also available through http://www.lns.cornell.edu/public/CLNS/2007/, Submitted to PR

Charmless two-body B decays: A global analysis with QCD factorization

In this paper, we perform a global analysis of $B \to PP$ and $PV$ decays with the QCD factorization approach. It is encouraging to observe that the predictions of QCD factorization are in good agreement with experiment. The best fit $\gamma$ is around $79^\circ$. The penguin-to-tree ratio $|P_{\pi \pi}/T_{\pi \pi}|$ of $\pi^+ \pi^-$ decays is preferred to be larger than 0.3. We also show the confidence levels for some interesting channels: $B^0 \to \pi^0 \pi^0$, $K^+ K^-$ and $B^+ \to \omega \pi^+$, $\omega K^+$. For $B \to \pi K^\ast$ decays, they are expected to have smaller branching ratios with more precise measurements.Comment: 20 pages, 4 figures, version to appear in Phys. Rev.