Preeclampsia and Cardiovascular Disease in a Large UK Pregnancy Cohort of Linked Electronic Health Records: A CALIBER Study.

BACKGROUND: The associations between pregnancy hypertensive disorders and common cardiovascular disorders have not been investigated at scale in a contemporaneous population. We aimed to investigate the association between preeclampsia, hypertensive disorders of pregnancy, and subsequent diagnosis of 12 different cardiovascular disorders. METHODS: We used linked electronic health records from 1997 to 2016 to recreate a UK population-based cohort of 1.3 million women, mean age at delivery 28 years, with nearly 1.9 million completed pregnancies. We used multivariable Cox models to determine the associations between hypertensive disorders of pregnancy, and preeclampsia alone (term and preterm), with 12 cardiovascular disorders in addition to chronic hypertension. We estimated the cumulative incidence of a composite end point of any cardiovascular disorder according to preeclampsia exposure. RESULTS: During the 20-year study period, 18 624 incident cardiovascular disorders were observed, 65% of which had occurred in women under 40 years. Compared to women without hypertension in pregnancy, women who had 1 or more pregnancies affected by preeclampsia had a hazard ratio of 1.9 (95% confidence interval 1.53-2.35) for any stroke, 1.67 (1.54-1.81) for cardiac atherosclerotic events, 1.82 (1.34-2.46) for peripheral events, 2.13 (1.64-2.76) for heart failure, 1.73 (1.38-2.16) for atrial fibrillation, 2.12 (1.49-2.99) for cardiovascular deaths, and 4.47 (4.32-4.62) for chronic hypertension. Differences in cumulative incidence curves, according to preeclampsia status, were apparent within 1 year of the first index pregnancy. Similar patterns of association were observed for hypertensive disorders of pregnancy, while preterm preeclampsia conferred slightly further elevated risks. CONCLUSIONS: Hypertensive disorders of pregnancy, including preeclampsia, have a similar pattern of increased risk across all 12 cardiovascular disorders and chronic hypertension, and the impact was evident soon after pregnancy. Hypertensive disorders of pregnancy should be considered as a natural screening tool for cardiovascular events, enabling cardiovascular risk prevention through national initiatives

General Relativity as an Attractor in Scalar-Tensor Stochastic Inflation

Quantum fluctuations of scalar fields during inflation could determine the very large-scale structure of the universe. In the case of general scalar-tensor gravity theories these fluctuations lead to the diffusion of fundamental constants like the Planck mass and the effective Brans--Dicke parameter, $\omega$. In the particular case of Brans--Dicke gravity, where $\omega$ is constant, this leads to runaway solutions with infinitely large values of the Planck mass. However, in a theory with variable $\omega$ we find stationary probability distributions with a finite value of the Planck mass peaked at exponentially large values of $\omega$ after inflation. We conclude that general relativity is an attractor during the quantum diffusion of the fields.Comment: LaTeX (with RevTex) 11 pages, 2 uuencoded figures appended, also available on WWW via http://star.maps.susx.ac.uk/index.htm

Evaluación multidisciplinar 3D de una estructura kárstica asociada a colapso y subsidencia (Cuenca del Ebro)

La propagación de cavidades de disolución localizadas por debajo de series aluviales genera una serie de evidencias cuya representación superficial, en ocasiones, puede no ser indicativa de su extensión real en profundidad. La propagación de cavidades a través de medios heterogéneos, en los que pueden existir niveles cementados, puede producir cambios en la progresión de dichas cavidades y la identificación en superficie de grietas, colapsos, o zonas de subsidencia que pueden involucrar decenas de miles de metros cúbicos de material inestable. Cualquier tipo de evaluación de soluciones mitigadoras en estos contextos debe considerar la amplitud de estos volúmenes y el origen del proceso con independencia de la actividad registrada en superficie. En este trabajo se aborda un estudio integrado con el objetivo de determinar la estructura de un sector con evidencias de actividad kárstica superficial y evaluar su extensión y desarrollo tridimensional integrando el análisis geomorfológico, de inspección de campo, geofísica (GPR) y sondeos. The propagation of solution cavities located below alluvial deposits produce surficial evidences that, in some cases, cannot be representative of their actual extension at depth. Cavity propagation through heterogeneous media, for example with interbedded cemented levels, can produce changes in the propagation of deformation producing the identification of cracks, collapses or subsidence zones at the surface. These processes can involve thousands of cubic meters of unstable materials. Any evaluation of mitigation tasks, in this context, needs to consider: i) the amplitude of the affected volumes and ii) the in depth origin with independence of the surficial recorded activity In this work an integrated analysis is developed to evaluate the size and 3D structure of a sector with surficial evidences of karstic activity integrating geomorphological analysis, field inspection, geophysics (GPR) and boreholes

Mobile phone text messaging to improve medication adherence in secondary prevention of cardiovascular disease.

BACKGROUND: Worldwide at least 100 million people are thought to have prevalent cardiovascular disease (CVD). This population has a five times greater chance of suffering a recurrent cardiovascular event than people without known CVD. Secondary CVD prevention is defined as action aimed to reduce the probability of recurrence of such events. Drug interventions have been shown to be cost-effective in reducing this risk and are recommended in international guidelines. However, adherence to recommended treatments remains sub-optimal. In order to influence non-adherence, there is a need to develop scalable and cost-effective behaviour-change interventions. OBJECTIVES: To assess the effects of mobile phone text messaging in patients with established arterial occlusive events on adherence to treatment, fatal and non-fatal cardiovascular events, and adverse effects. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, the Conference Proceedings Citation Index - Science on Web of Science on 7 November 2016, and two clinical trial registers on 12 November 2016. We contacted authors of included studies for missing information and searched reference lists of relevant papers. We applied no language or date restrictions. SELECTION CRITERIA: We included randomised trials with at least 50% of the participants with established arterial occlusive events. We included trials investigating interventions using short message service (SMS) or multimedia messaging service (MMS) with the aim to improve adherence to medication for the secondary prevention of cardiovascular events. Eligible comparators were no intervention or other modes of communication. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. In addition, we attempted to contact all authors on how the SMS were developed. MAIN RESULTS: We included seven trials (reported in 13 reports) with 1310 participants randomised. Follow-up ranged from one month to 12 months. Due to heterogeneity in the methods, population and outcome measures, we were unable to conduct meta-analysis on these studies. All seven studies reported on adherence, but using different methods and scales. Six out of seven trials showed a beneficial effect of mobile phone text messaging for medication adherence. Dale 2015a, reported significantly greater medication adherence score in the intervention group (Mean Difference (MD) 0.58, 95% confidence interval (CI) 0.19 to 0.97; 123 participants randomised) at six months. Khonsari 2015 reported less adherence in the control group (Relative Risk (RR) 4.09, 95% CI 1.82 to 9.18; 62 participants randomised) at eight weeks. Pandey 2014 (34 participants randomised) assessed medication adherence through self-reported logs with 90% adherence in the intervention group compared to 70% in the control group at 12 months. Park 2014a (90 participants randomised) reported a greater increase of the medication adherence score in the control group, but also measured adherence with an event monitoring system for a number of medications with adherence levels ranging from 84.1% adherence to 86.2% in the intervention group and 79.7% to 85.7% in the control group at 30 days. Quilici 2013, reported reduced odds of non-adherence in the intervention group (Odds Ratio (OR) 0.43, 95% CI 0.22 to 0.86, 521 participants randomised) at 30 days. Fang 2016, reported that participants given SMS alone had reduced odds of being non-adherent compared to telephone reminders (OR 0.40 95% CI 0.18 to 0.63; 280 patients randomised). Kamal 2015 reported higher levels of adherence in the intervention arm (adjusted MD 0.54, 95% CI 0.22 to 0.85; 200 participants randomised). Khonsari 2015 was the only study to report fatal cardiovascular events and only reported two events, both in the control arm. No study reported on the other primary outcomes. No study reported repetitive thumb injury or road traffic crashes or other adverse events that were related to the intervention.Four authors replied to our questionnaire on SMS development. No study reported examining causes of non-adherence or provided SMS tailored to individual patient characteristics.The included studies were small, heterogeneous and included participants recruited directly after acute events. All studies were assessed as having high risk of bias across at least one domain. Most of the studies came from high-income countries, with two studies conducted in an upper middle-income country (China, Malaysia), and one study from a lower middle-income country (Pakistan). The quality of the evidence was found to be very low. There was no obvious conflicts of interest from authors, although only two declared their funding. AUTHORS' CONCLUSIONS: While the results of this systematic review are promising, there is insufficient evidence to draw conclusions on the effectiveness of text message-based interventions for adherence to medications for secondary prevention of CVD. Sufficiently powered, high-quality randomised trials are needed, particularly in low- and middle-income countries

Noncommunicable diseases and injuries in Latin America and the Caribbean: Time for action

The region is in a privileged position to quickly translate investment in health research into practice, argue Perel and colleagues

The Guadiaro-Baños contourite drifts (SW Mediterranean). A geotechnical approach to stability analysis

Two Quaternary plastered contourite drifts, with terraced and low-mounded morphologies, make up the continental slope and base-of-slope in the northwestern Alboran Sea, respectively, between the Guadiaro and Baños turbidite systems, close to the Strait of Gibraltar. Considering their significant lateral extent, the link between the contourite drift deposits and landslides may be particularly important for hazard assessment. The physical properties, composition and geometry of contourite drifts have been proposed as key factors in slope stability, although this relationship still needs to be better constrained. In this work, new in-situ geotechnical data (cone penetration tests; CPTu) has been combined with morphostratigraphic, sedimentological, and (laboratory) geotechnical properties to determine the stability of the Guadiaro-Baños drifts. For the depositional domains of both drifts, the resulting sedimentary and geotechnical model describes low-plasticity granular and silty sands on the erosive terraced domain that evolve seawards to silty and silty-clay deposits with a higher plasticity and uniform geomechanical properties. For the shallower coarse-grained contourite sediments, the cohesion (c') and internal friction angle (ϕ') values are 0–9 kPa and 46–30°, respectively, whereas for the distal fine contourites the undrained shear strength gradient (∇Su) is 2 kPa/m. These properties allow us to establish high factors of safety for all the scenarios considered, including seismic loading. Slope failure may be triggered in the unlikely event that there is seismic acceleration of PGA > 0.19, although no potential glide planes have been observed within the first 20 m below the seafloor. This suggests that the contourite drifts studied tend to resist failure better than others with similar sedimentary characteristics. The interplay of several processes is proposed to explain the enhanced undrained shear strength: 1) the geometry of the drifts, defined by an upper contouritic terrace and lower low-mounded shapes; 2) recurrent low-intensity earthquakes with insufficient energy to trigger landslides, favouring increased strength due to dynamic compaction; and 3) cyclic loading induced by solitons/internal waves acting on the sediment.En prens

Constraints from Inflation on Scalar-Tensor Gravity Theories

We show how observations of the perturbation spectra produced during inflation may be used to constrain the parameters of general scalar-tensor theories of gravity, which include both an inflaton and dilaton field. An interesting feature of these models is the possibility that the curvature perturbations on super-horizon scales may not be constant due to non-adiabatic perturbations of the two fields. Within a given model, the tilt and relative amplitude of the scalar and tensor perturbation spectra gives constraints on the parameters of the gravity theory, which may be comparable with those from primordial nucleosynthesis and post-Newtonian experiments.Comment: LaTeX (with RevTex) 19 pages, 8 uuencoded figures appended, also available on WWW via http://star.maps.susx.ac.uk/index.htm

Inhibitory effect against polymerase and ribonuclease activities of HIV-reverse transcriptase of the aqueous leaf extract of Terminalia triflora

Dichloromethane, methanol and aqueous extracts from the leaves of Terminalia triflora were investigated for their inhibitory effect on polymerase and ribonuclease activities of HIV reverse transcriptase.The most potent activity was found in the aqueous extract, which inhibited both polymerase and ribonuclease activities of the enzyme with an IC50 of 1.6 micro g/mL and 1.8 micro g/mL respectively. The antiinfective activity of the extract was demonstrated in HLT4LacZ-IIIB cell culture with an IC50 of 1.0 micro g/mL. The extract was submitted to a purification process by extractive and chromatographic methods. The activity remained in the hydrophillic fraction. Tannins present in this active purified fraction, as determined by TLC and HPLC methods, could account for the anti HIV-RT activity found in the aqueous extract

Las balsas agrícolas en Andalucía: una oportunidad para enlazar desarrollo y conservación en climas mediterráneos

Se presenta el resumen de un extenso y fructífero trabajo de levantamiento de información, investigación y gestión llevado a cabo durante los años 2003-2011 entre la Administración de medio ambiente andaluza, Universidades Públicas de Sevilla, Almería y Granada y propietarios de fincas privadas en Andalucía, para estudiar la importancia, el reservorio, la localización y potencial uso de las balsas agrícolas en esta Comunidad Autónoma. Los resultados del trabajo de campo asociado continúan ofreciendo resultados muy llamativos acerca de su biodiversidad asociada así como del extraordinario poder como canalizadores y reservorios para muchas especies asociadas a los humedales naturales que, en muchos casos, han visto disminuida su distribución y posibles zonas de asentamiento, cría, refugio, debido en parte a la actividad humana

STATIONARY SOLUTIONS IN BRANS-DICKE STOCHASTIC INFLATIONARY COSMOLOGY

In Brans-Dicke theory the Universe becomes divided after inflation into many exponentially large domains with different values of the effective gravitational constant. Such a process can be described by diffusion equations for the probability of finding a certain value of the inflaton and dilaton fields in a physical volume of the Universe. For a typical chaotic inflation potential, the solutions for the probability distribution never become stationary but grow forever towards larger values of the fields. We show here that a non-minimal conformal coupling of the inflaton to the curvature scalar, as well as radiative corrections to the effective potential, may provide a dynamical cutoff and generate stationary solutions. We also analyze the possibility of large nonperturbative jumps of the fluctuating inflaton scalar field, which was recently revealed in the context of the Einstein theory. We find that in the Brans--Dicke theory the amplitude of such jumps is strongly suppressed.Comment: 19 pages, LaTe