Psychological stress and cardiovascular disease: empirical demonstration of bias in a prospective observational study of Scottish men

Objectives: To examine the association between self perceived psychological stress and cardiovascular disease in a population where stress was not associated with social disadvantage. Design: Prospective observational study with follow up of 21 years and repeat screening of half the cohort 5 years from baseline. Measures included perceived psychological stress, coronary risk factors, self reported angina, and ischaemia detected by electrocardiography. Setting: 27 workplaces in Scotland. Participants: 5606 men (mean age 48 years) at first screening and 2623 men at second screening with complete data on all measures Main outcome measures: Prevalence of angina and ischaemia at baseline, odds ratio for incident angina and ischaemia at second screening, rate ratios for cause specific hospital admission, and hazard ratios for cause specific mortality. Results: Both prevalence and incidence of angina increased with increasing perceived stress (fully adjusted odds ratio for incident angina, high versus low stress 2.66, 95% confidence interval 1.61 to 4.41; P for trend <0.001). Prevalence and incidence of ischaemia showed weak trends in the opposite direction. High stress was associated with a higher rate of admissions to hospital generally and for admissions related to cardiovascular disease and psychiatric disorders (fully adjusted rate ratios for any general hospital admission 1.13, 1.01 to 1.27, cardiovascular disease 1.20, 1.00 to 1.45, and psychiatric disorders 2.34, 1.41 to 3.91). High stress was not associated with increased admission for coronary heart disease (1.00, 0.76-1.32) and showed an inverse relation with all cause mortality, mortality from cardiovascular disease, and mortality from coronary heart disease, that was attenuated by adjustment for occupational class (fully adjusted hazard ratio for all cause mortality 0.94, 0.81 to 1.11, cardiovascular mortality 0.91, 0.78 to 1.06, and mortality from coronary heart disease 0.98, 0.75 to 1.27). Conclusions: The relation between higher stress, angina, and some categories of hospital admissions probably resulted from the tendency of participants reporting higher stress to also report more symptoms. The lack of a corresponding relation with objective indices of heart disease suggests that these symptoms did not reflect physical disease. The data suggest that associations between psychosocial measures and disease outcomes reported from some other studies may be spurious

Limitations of adjustment for reporting tendency in observational studies of stress and self reported coronary heart disease

Recently, observational evidence has been suggested to show a causal association between various "psychosocial" exposures, including psychological stress, and heart disease. Much of this evidence derives from studies in which a self reported psychosocial exposure is related to an outcome dependent on the subjective experience of coronary heart disease (CHD) symptoms. Such outcomes may be measured using standard symptom questionnaires (like the Rose angina schedule). Alternatively they may use diagnoses of disease from medical records, which depend on an individual perceiving symptoms and reporting them to a health worker. In these situations, reporting bias may generate spurious exposure-outcome associations. For example if people who perceive and report their life as most stressful also over-report symptoms of cardiovascular disease then an artefactual association between stress and heart disease will result

Evaluation of telerobotic systems using an instrumented task board

An instrumented task board was developed at NASA Marshall Space Flight Center (MSFC). An overview of the task board design, and current development status is presented. The task board was originally developed to evaluate operator performance using the Protoflight Manipulator Arm (PFMA) at MSFC. The task board evaluates tasks for Orbital Replacement Unit (ORU), fluid connect and transfers, electrical connect/disconnect, bolt running, and other basic tasks. The instrumented task board measures the 3-D forces and torques placed on the board, determines the robot arm's 3-D position relative to the task board using IR optics, and provides the information in real-time. The PFMA joint input signals can also be measured from a breakout box to evaluate the sensitivity or response of the arm operation to control commands. The data processing system provides the capability for post processing of time-history graphics and plots of the PFMA positions, the operator's actions, and the PFMA servo reactions in addition to real-time force/torque data presentation. The instrumented task board's most promising use is developing benchmarks for NASA centers for comparison and evaluation of telerobotic performance

Buoyant Venus station mission feasibility study for 1972 and 1973 launch opportunities. Volume 3 - Configuration definition. Part 1 - Configuration Final report

Configuration definitions for buoyant Venus station missions for 1972 - 1973 launch perio

Rippled Cosmological Dark Matter from Damped Oscillating Newton Constant

Let the reciprocal Newton 'constant' be an apparently non-dynamical Brans-Dicke scalar field damped oscillating towards its General Relativistic VEV. We show, without introducing additional matter fields or dust, that the corresponding cosmological evolution averagely resembles, in the Jordan frame, the familiar dark radiation -> dark matter -> dark energy domination sequence. The fingerprints of our theory are fine ripples, hopefully testable, in the FRW scale factor; they die away at the General Relativity limit. The possibility that the Brans-Dicke scalar also serves as the inflaton is favorably examined.Comment: RevTex4, 12 pages, 5 figures; Minor revision, References adde

Law and Cyber War

The internet has created enormous global changes. People can interact with others anyplace, anytime almost instantly. Much of the infrastructure including energy, healthcare, and telecommunications is interconnected globally. The world has added another domain to international conflicts: Cyber War. In this paper, we explore legal principles which would be involved in a cyber attack. Existing laws of warfare applied in the physical realm do not translate equally as well in the cyber domain. Due to the difficulty of attribution, the invisibility of borders and the need to react quickly, we may need to develop legal principles that allow immediate and appropriate responses. This is an area that needs very careful and thoughtful revie

Cyber Law Workshop: Adding a Course to Your Curriculum

The internet has created enormous changes in a number of areas including our laws. An emerging specialty within law is cyber law. Our legal system has evolved in a physical and visual world, but cyber space is largely invisible and virtual. Past legal decisions or legal precedence has been important in our system and reasoning by analogy has been used extensively. In many cases the laws applied in the physical realm do not translate equally well into cyber space. This workshop will discuss the importance of this area to an MIS/CIS/IT program, legal issues that need to be addressed, and provide a sample syllabus and other resources

Diagnosis of Clostridium difficile infection: An ongoing conundrum for clinicians and for clinical laboratories

SUMMARY: Clostridium difficile is a formidable nosocomial and community-acquired pathogen, causing clinical presentations ranging from asymptomatic colonization to self-limiting diarrhea to toxic megacolon and fulminant colitis. Since the early 2000s, the incidence of C. difficile disease has increased dramatically, and this is thought to be due to the emergence of new strain types. For many years, the mainstay of C. difficile disease diagnosis was enzyme immunoassays for detection of the C. difficile toxin(s), although it is now generally accepted that these assays lack sensitivity. A number of molecular assays are commercially available for the detection of C. difficile. This review covers the history and biology of C. difficile and provides an in-depth discussion of the laboratory methods used for the diagnosis of C. difficile infection (CDI). In addition, strain typing methods for C. difficile and the evolving epidemiology of colonization and infection with this organism are discussed. Finally, considerations for diagnosing C. difficile disease in special patient populations, such as children, oncology patients, transplant patients, and patients with inflammatory bowel disease, are described. As detection of C. difficile in clinical specimens does not always equate with disease, the diagnosis of C. difficile infection continues to be a challenge for both laboratories and clinicians

A comparison of the quality of life of vulnerable young males with severe emotional and behaviour difficulties in a residential setting and young males in mainstream schooling: QoL of vulnerable young males

Accessible summary: The findings from this study reveal that the notion of anticipated and deleterious differences in quality of life (QoL) between children with severe emotional and behavioural problems and those without such difficulties is not supported. Indeed, results reveal counter-intuitive findings with children with emotional and behavioural problems reporting better QoL than those without such presenting problems on a number of QoL subscales. The type of QoL measure and related subscales appears to be sensitive to differing aspects of self-report QoL, with in some instances, some QoL subscales being more discriminatory between groups compared with other QoL subscales. Consequently, the choice of QoL measure is critically important in accurately and reliably determining QoL in children with significant emotional and behavioural problems. One hundred and seventy-four males completed a quality of life (QoL) assessment utilizing, a generic paediatric quality of life inventory (PedsQL) and the short form (36) health survey (SF36). The adolescents aged 13-16 years were in a Scottish Centre for young males with social, emotional, behavioural and educational problems. To identify similarities and differences, a comparison group (n = 110) of males in the third and fourth year in a mainstream secondary school were also administered the PedsQL and the SF36 self-rating scales. The effectiveness of the PedsQL and the SF36 for assessing QoL for adolescent males was investigated. There were significant differences between the groups in the Centre and between the Centre groups and the comparison group in terms of their QoL. The results between the groups were found in the PedsQL subscales 'physical functioning' where secure > comparison (P = 0.04); secure > residential (P = 0.008); and PedsQL subscale 'social functioning' day > comparison (P = 0.026); secure > comparison (P = 0.037). SF36 subscales 'role physical functioning' secure > residential (P residential (P residential (P = 0.001). This study provides a unique insight into the complex dimensions influencing the QoL of this specific group of young people. © 2013 John Wiley & Sons Ltd