History of depression and survival after acute myocardial infarction

Objective: To compare survival in post-myocardial (MI) participants from the Enhancing Recovery In Coronary Heart Disease (ENRICHD) clinical trial with a first episode of major depression (MD) and those with recurrent MID, which is a risk factor for mortality after acute MI. Recent reports suggest that the level of risk may depend on whether the comorbid MD is a first or a recurrent episode. Methods: Survival was compared over a median of 29 months in 370 patients with an initial episode of MD, 550 with recurrent MD, and 408 who were free of depression. Results: After adjusting for an all-cause mortality risk score, initial Beck Depression Inventory score, and the use of selective serotonin reuptake inhibitor antidepressants, patients with a first episode of MD had poorer survival (18.4% all-cause mortality) than those with recurrent MD (11.8%) (hazard ratio (HR)=1.4; 95% Confidence Interval (CI)=1.0-2.0; p=.05). Both first depression (HR=3.1; 95% CI=1.6-6.1; p=.001) and recurrent MD (HR=2.2; 95% CI=1.1-4.4; p=.03) had significantly poorer survival than did the nondepressed patients (3.4%). A secondary analysis of deaths classified as probably due to a cardiovascular cause resulted in similar HRs, but the difference between depression groups was not significant. Conclusions: Both initial and recurrent episodes of MD predict shorter survival after acute MI, but initial MD episodes are more strongly predictive than recurrent episodes. Exploratory analyses suggest that this cannot be explained by more severe heart disease at index, poorer response to depression treatment, or a higher risk of cerebrovascular disease in patients with initial MD episodes

The selection of comparators for randomized controlled trials of health-related behavioral interventions: recommendations of an NIH expert panel

Objectives: To provide recommendations for the selection of comparators for randomized controlled trials of health-related behavioral interventions. Study Design and Setting: The National Institutes of Health Office of Behavioral and Social Science Research convened an expert panel to critically review the literature on control or comparison groups for behavioral trials and to develop strategies for improving comparator choices and for resolving controversies and disagreements about comparators. Results: The panel developed a Pragmatic Model for Comparator Selection in Health-Related Behavioral Trials. The model indicates that the optimal comparator is the one that best serves the primary purpose of the trial but that the optimal comparator's limitations and barriers to its use must also be taken into account. Conclusion: We developed best practice recommendations for the selection of comparators for health-related behavioral trials. Use of the Pragmatic Model for Comparator Selection in Health-Related Behavioral Trials can improve the comparator selection process and help resolve disagreements about comparator choices

How the U.S. can benefit from risk-based premiums combined with flood protection

Flood risk management in the USA is largely embedded in the National Flood Insurance Program (NFIP). Climate change and increasing exposure in flood plains pose a challenge to flood risk managers and make it vital to reduce risk in the future. The proposed reforms are steering the NFIP to risk-based premiums, but it is uncertain if the reforms will result in unaffordability and incentivize risk-reduction investments or how the NFIP is affected by large-scale adaptation efforts. Using an agent-based model approach for current and future scenarios, we demonstrate that risk-based premiums will yield a positive societal benefit (US$10 billion) because they will incentivize household risk-reduction investments. Moreover, our results show that proactive investment in large-scale adaptation measures complements a transition to risk-based premiums to yield a higher overall societal benefit (US$26 billion). We suggest that transitioning the NFIP to risk-based premiums can only be secured by additional investments in large-scale flood protection infrastructure

Climate proofing the National Flood Insurance Program

Reforms are required to maintain a healthy and robust flood insurance market under future climate conditions for the United States. Therefore, policymakers should implement premiums that reflect flood risk and incentivize household-level risk reduction, complemented with regional flood adaptation investments

Climate proofing the National Flood Insurance Program

Reforms are required to maintain a healthy and robust flood insurance market under future climate conditions for the United States. Therefore, policymakers should implement premiums that reflect flood risk and incentivize household-level risk reduction, complemented with regional flood adaptation investments

How the USA can benefit from risk-based premiums combined with flood protection

Flood risk management in the USA is largely embedded in the National Flood Insurance Program (NFIP). Climate change and increasing exposure in flood plains pose a challenge to flood risk managers and make it vital to reduce risk in the future. The proposed reforms are steering the NFIP to risk-based premiums, but it is uncertain if the reforms will result in unaffordability and incentivize risk-reduction investments or how the NFIP is affected by large-scale adaptation efforts. Using an agent-based model approach for current and future scenarios, we demonstrate that risk-based premiums will yield a positive societal benefit (US$10 billion) because they will incentivize household risk-reduction investments. Moreover, our results show that proactive investment in large-scale adaptation measures complements a transition to risk-based premiums to yield a higher overall societal benefit (US$26 billion). We suggest that transitioning the NFIP to risk-based premiums can only be secured by additional investments in large-scale flood protection infrastructure

Evidence for a highly deformed oblate O+O^+ state in 3674^{74}_{36}Kr

International audienc

Studies of isomeric states and limits of particle stability around N=Z=40 using fragmentation reactions

Fragmentation products from a 92Mo beam on a natural nickel target have been used to study structural properties of the very neutron deficient nuclei around N∼Z∼40. We present the first observation of isomeric decays in the Tz=1 systems 3674Kr, 3980 Y and 4184Nb. The isomer in 74Kr is interpreted as the hindered decay from an excited 0+ state, confirming the prediction of prolate/oblate shape coexistence in this nucleus. Transitions from states below an isomer in the N=Z nucleus 4386Tc have also been tentatively identified, making this the heaviest N=Z system for which decays from excited states have been observed. In addition, we have obtained the first conclusive evidence for the existence of the Tz = -1/2 isotopes 3977Y, 4079Zr and 4283Mo. The data for 3977Y is of particular interest in light of the reported instability in the lighter odd-Z, Tz = -1/2 systems 69Br and 73Rb