Do changes in traditional coronary heart disease risk factors over time explain the association between socio-economic status and coronary heart disease?

<p>Abstract</p> <p>Background</p> <p>Socioeconomic status (SES) predicts coronary heart disease independently of the traditional risk factors included in the Framingham risk score. However, it is unknown whether <it>changes </it>in Framingham risk score variables over time explain the association between SES and coronary heart disease. We examined this question given its relevance to risk assessment in clinical decision making.</p> <p>Methods</p> <p>The Atherosclerosis Risk in Communities study data (initiated in 1987 with 10-years follow-up of 15,495 adults aged 45-64 years in four Southern and Mid-Western communities) were used. SES was assessed at baseline, dichotomized as low SES (defined as low education and/or low income) or not. The time dependent variables - smoking, total and high density lipoprotein cholesterol, systolic blood pressure and use of blood pressure lowering medication - were assessed every three years. Ten-year incidence of coronary heart disease was based on EKG and cardiac enzyme criteria, or adjudicated death certificate data. Cox survival analyses examined the contribution of SES to heart disease risk independent of baseline Framingham risk score, without and with further adjustment for the time dependent variables.</p> <p>Results</p> <p>Adjusting for baseline Framingham risk score, low SES was associated with an increased coronary heart disease risk (hazard ratio [HR] = 1.53; 95% Confidence Interval [CI], 1.27 to1.85). After further adjustment for the time dependent variables, the SES effect remained significant (HR = 1.44; 95% CI, 1.19 to1.74).</p> <p>Conclusion</p> <p>Using Framingham Risk Score alone under estimated the coronary heart disease risk in low SES persons. This bias was not eliminated by subsequent changes in Framingham risk score variables.</p

Twenty-three unsolved problems in hydrology (UPH) – a community perspective

This paper is the outcome of a community initiative to identify major unsolved scientific problems in hydrology motivated by a need for stronger harmonisation of research efforts. The procedure involved a public consultation through on-line media, followed by two workshops through which a large number of potential science questions were collated, prioritised, and synthesised. In spite of the diversity of the participants (230 scientists in total), the process revealed much about community priorities and the state of our science: a preference for continuity in research questions rather than radical departures or redirections from past and current work. Questions remain focussed on process-based understanding of hydrological variability and causality at all space and time scales. Increased attention to environmental change drives a new emphasis on understanding how change propagates across interfaces within the hydrological system and across disciplinary boundaries. In particular, the expansion of the human footprint raises a new set of questions related to human interactions with nature and water cycle feedbacks in the context of complex water management problems. We hope that this reflection and synthesis of the 23 unsolved problems in hydrology will help guide research efforts for some years to come

Experiences Working with Stakeholders and Surprises of the Way to Achieving Water Security

Abstract: As important as understanding the physical, biological and geomorphological processes affecting runoff, so are the economic, social and political aspects and impacts affecting how we manage this runoff. The planning, design and operation of infrastructure aimed at managing runoff typically involves people. We engineers and scientists are taught that our purpose in life is to meet the needs of society, and that is people. For us in this conference this translates to how best can we satisfy the needs of all those impacted by what we as a profession do to insure adequate and reliable quantities and qualities of this runoff at affordable costs. This proves difficult when people can’t agree on what it is they want, and when, and how. This talk will identify, discuss, and compare some major on-going case studies that suggest that the more we work to address the social impacts of what we do, the more it costs, the longer it takes, and that whatever decisions are made, they will surely be addressed again, and again, on into the future. If this is true, how do we best practice what we are taught, or what some of us teach, today

Daniel Peter Loucks and Jery Russell Stedinger discuss the history of systems analysis in CEE

The Civil and Environmental Engineering Oral History Project at Cornell University1_8buiufe

Engineering: Cornell Quarterly, Vol.16, No.3 (Winter 1981-82): The Advance of Computer Graphics

IN THIS ISSUE: How Computer Graphics Works and What It Can Do /2 (Professor Donald P. Greenberg, director of Cornell's Program of Computer Graphics and of the College of Engineering's Computer-Aided Design Instructional Facility (CADIF), explains an important and rapidly developing technology.) ... Computer Graphics for Students: A Fun Way to Learn Faster and Better /15 (With the enthusiastic endorsement of faculty members and students, CADIF is established at the College of Engineering.) ... In the Vanguard of Structural Engineering /23 (Three Cornell professors of structural engineering??n F. Abel, Anthony R. Ingraffea, and William McGuire??lore the potential of computer graphics in their discipline and describe Cornell research in this area.) ... CAD/CAM: Industrial Takeover by Designing Computers /37 (John C. Dill, manager of the computer-graphics instructional facility (CADIF) at the College, draws on his industrial experience with the technology to assess the impact of computer-aided design and manufacture.) ... Friendly Computers With Color Pictures: New Tool for Resource and Environmental Planning /46 (Cornell professor Daniel P. Loucks and his associates Peter N. French and Marshall R. Taylor discuss the significance of computer graphics in their field of research.) ... Editorial /5