Does autonomic function link social position to coronary risk? The Whitehall II study.

BACKGROUND: Laboratory and clinical studies suggest that the autonomic nervous system responds to chronic behavioral and psychosocial stressors with adverse metabolic consequences and that this may explain the relation between low social position and high coronary risk. We sought to test this hypothesis in a healthy occupational cohort. METHODS AND RESULTS: This study comprised 2197 male civil servants 45 to 68 years of age in the Whitehall II study who were undergoing standardized assessments of social position (employment grade) and the psychosocial, behavioral, and metabolic risk factors for coronary disease previously found to be associated with low social position. Five-minute recordings of heart rate variability (HRV) were used to assess cardiac parasympathetic function (SD of N-N intervals and high-frequency power [0.15 to 0.40 Hz]) and the influence of sympathetic and parasympathetic function (low-frequency power [0.04 to 0.15 Hz]). Low employment grade was associated with low HRV (age-adjusted trend for each modality, P< or =0.02). Adverse behavioral factors (smoking, exercise, alcohol, and diet) and psychosocial factors (job control) showed age-adjusted associations with low HRV (P<0.03). The age-adjusted mean low-frequency power was 319 ms2 among those participants in the bottom tertile of job control compared with 379 ms2 in the other participants (P=0.004). HRV showed strong (P<0.001) linear associations with components of the metabolic syndrome (waist circumference, systolic blood pressure, HDL cholesterol, triglycerides, and fasting and 2-hour postload glucose). The social gradient in prevalence of metabolic syndrome was explained statistically by adjustment for low-frequency power, behavioral factors, and job control. CONCLUSIONS: Chronically impaired autonomic function may link social position to different components of coronary risk in the general population

Lithium, sodium and potassium enolate aggregates and monomers: syntheses and structures

\ua9 2024 The Royal Society of Chemistry. In this Article, we report the syntheses and comparative structural studies of lithium, sodium, and potassium anthracen-9-yl enolates, as their aggregates (Li, Na: hexamer; K: tetramer) and ligand-stabilized monomers (for Li and Na). The monomers add new members to the rare collection of group-1 metal monomeric enolates. Moreover, the series covers different group-1 metal cations (Li+, Na+ and K+) and aggregate sizes, allowing comparative structural studies to elucidate how the metal identity and aggregate size influence the enolate structure

A quantitative study of spin-flip co-tunneling transport in a quantum dot

We report detailed transport measurements in a quantum dot in a spin-flip co-tunneling regime, and a quantitative comparison of the data to microscopic theory. The quantum dot is fabricated by lateral gating of a GaAs/AlGaAs heterostructure, and the conductance is measured in the presence of an in-plane Zeeman field. We focus on the ratio of the nonlinear conductance values at bias voltages exceeding the Zeeman threshold, a regime that permits a spin flip on the dot, to those below the Zeeman threshold, when the spin flip on the dot is energetically forbidden. The data obtained in three different odd-occupation dot states show good quantitative agreement with the theory with no adjustable parameters. We also compare the theoretical results to the predictions of a phenomenological form used previously for the analysis of non-linear co-tunneling conductance, specifically the determination of the heterostructure g-factor, and find good agreement between the two.Comment: 5 pages, 5 figure

Structure of Lambda(1405) and chiral dynamics

We report on a recent theoretical work on the structure of the Lambda(1405) resonance within a chiral unitary approach, in which the resonance is dynamically generated in meson-baryon scattering. Studying the analytic structure of the scattering amplitude, we have found that there are two poles lying around energies of Lambda(1405) with different widths and couplings to the meson-baryon states. We discuss reactions to conform the double pole structure in experiment and elastic K^- p scattering at low energies.Comment: 4 pages, LaTeX, 2 eps figures. Talk given at 10th International Conference on the Structure of Baryons (Baryon 2004) at Palaiseau (France), 25-29 October 200

Type and timing of heralding in ST-elevation and non-ST-elevation myocardial infarction: an analysis of prospectively collected electronic healthcare records linked to the national registry of acute coronary syndromes.

AIMS: It is widely thought that ST-elevation myocardial infarction (STEMI) is more likely to occur without warning (i.e. an unanticipated event in a previously healthy person) than non-ST-elevation myocardial infarction (NSTEMI), but no large study has evaluated this using prospectively collected data. The aim of this study was to compare the evolution of atherosclerotic disease and cardiovascular risk between people going on to experience STEMI and NSTEMI. METHODS: We identified patients experiencing STEMI and NSTEMI in the national registry of myocardial infarction for England and Wales (Myocardial Ischaemia National Audit Project), for whom linked primary care records were available in the General Practice Research Database (as part of the CALIBER collaboration). We compared the prevalence and timing of atherosclerotic disease and major cardiovascular risk factors including smoking, hypertension, diabetes, and dyslipidaemia, between patients later experiencing STEMI to those experiencing NSTEMI. RESULTS: A total of 8174 myocardial infarction patients were included (3780 STEMI, 4394 NSTEMI). Myocardial infarction without heralding by previously diagnosed atherosclerotic disease occurred in 71% STEMI (95% CI 69-72%) and 50% NSTEMI patients (95% CI 48-51%). The proportions of myocardial infarctions with no prior atherosclerotic disease, major risk factors, or chest pain was 14% (95% CI 13-16%) in STEMI and 9% (95% CI 9-10%) in NSTEMI. The rate of heralding coronary diagnoses was particularly high in the 12 months before infarct; 4.1-times higher (95% CI 3.3-5.0) in STEMI and 3.6-times higher (95% CI 3.1-4.2) in NSTEMI compared to the rate in earlier years. CONCLUSIONS: Acute myocardial infarction occurring without prior diagnosed coronary, cerebrovascular, or peripheral arterial disease was common, especially for STEMI. However, there was a high prevalence of risk factors or symptoms in patients without previously diagnosed disease. Better understanding of the antecedents in the year before myocardial infarction is required

Effect of β blockers on mortality after myocardial infarction in adults with COPD: Population based cohort study of UK electronic healthcare records

Objectives: To investigate whether the use and timing of prescription of β blockers in patients with chronic obstructive pulmonary disease (COPD) having a first myocardial infarction was associated with survival and to identify factors related to their use. Design: Population based cohort study in England. Setting: UK national registry of myocardial infarction (Myocardial Ischaemia National Audit Project (MINAP)) linked to the General Practice Research Database (GPRD), 2003-11. Participants: Patients with COPD with a first myocardial infarction in 1 January 2003 to 31 December 2008 as recorded in MINAP, who had no previous evidence of myocardial infarction in their GPRD or MINAP record. Data were provided by the Cardiovascular Disease Research using Linked Bespoke studies and Electronic Health Records (CALIBER) group at University College London. Main outcome measure: Cox proportional hazards ratio for mortality after myocardial infarction in patients with COPD in those prescribed β blockers or not, corrected for covariates including age, sex, smoking status, drugs, comorbidities, type of myocardial infarction, and severity of infarct. Results: Among 1063 patients with COPD, treatment with β blockers started during the hospital admission for myocardial infarction was associated with substantial survival benefits (fully adjusted hazard ratio 0.50, 95% confidence interval 0.36 to 0.69; P<0.001; median follow-up time 2.9 years). Patients already taking a β blocker before their myocardial infarction also had a survival benefit (0.59, 0.44 to 0.79; P<0.001). Similar results were obtained with propensity scores as an alternative method to adjust for differences between those prescribed and not prescribed β blockers. With follow-up started from date of discharge from hospital, the effect size was slightly attenuated but there was a similar protective effect of treatment with β blockers started during hospital admission for myocardial infarction (0.64, 0.44 to 0.94; P=0.02). Conclusions: The use of β blockers started either at the time of hospital admission for myocardial infarction or before a myocardial infarction is associated with improved survival after myocardial infarction in patients with COPD. Registration: NCT01335672

Predicting mortality after acute coronary syndromes in people with chronic obstructive pulmonary disease

Objective To assess the accuracy of Global Registry of Acute Coronary Events (GRACE) scores in predicting mortality at 6 months for people with chronic obstructive pulmonary disease (COPD) and to investigate how it might be improved. Methods Data were obtained on 481 849 patients with acute coronary syndrome admitted to UK hospitals between January 2003 and June 2013 from the Myocardial Ischaemia National Audit Project (MINAP) database. We compared risk of death between patients with COPD and those without COPD at 6 months, adjusting for predicted risk of death. We then assessed whether several modifications improved the accuracy of the GRACE score for people with COPD. Results The risk of death after adjusting for GRACE score predicted that risk of death was higher for patients with COPD than that for other patients (RR 1.29, 95% CI 1.28 to 1.33). Adding smoking into the GRACE score model did not improve accuracy for patients with COPD. Either adding COPD into the model (relative risk (RR) 1.00, 0.94 to 1.02) or multiplying the GRACE score by 1.3 resulted in better performance (RR 0.99, 0.96 to 1.01). Conclusions GRACE scores underestimate risk of death for people with COPD. A more accurate prediction of risk of death can be obtained by adding COPD into the GRACE score equation, or by multiplying the GRACE score predicted risk of death by 1.3 for people with COPD. This means that one third of patients with COPD currently classified as low risk should be classified as moderate risk, and could be considered for more aggressive early treatment after non-ST-segment elevation myocardial infarction or unstable angina

Increasing Vegetable Intakes: An Updated Systematic Review of Published Interventions

Vegetable consumption is important for a variety of health reasons, yet intakes are typically lower than recommended. Interventions to improve fruit and vegetable consumption are available, but these interventions are typically more successful for fruit consumption, while vegetable intakes remain low. This chapter details the interventions currently available that focus specifically on improving vegetable intakes. A systematic review of the published literature was conducted in 2015, and this has been updated for this chapter. Databases - PubMed, PsychInfo and Medline were searched over all years of records until January 2017 using pre-specified terms. Our searches identified 119 studies, detailing 206 interventions. Interventions aimed to use or change hedonic factors, such as taste, liking and familiarity (n=103), use or change environmental factors (n=54), use or change cognitive factors (n=28), or a combination of strategies (n=21). Increased vegetable acceptance, selection and/or consumption were reported to some degree in 186 (90%) interventions. Greatest success appears to be achieved in interventions that improve education, change the environment or use multiple approaches, but long-term success and cost-effectiveness are rarely considered. A focus on long-term benefits and sustained behaviour change is required

Non perturbative chiral approach to s-wave \bar{K}N interactions

The s-wave meson-nucleon interaction in the $S = -1$ sector is studied by means of coupled-channel Lippmann Schwinger equations, using the lowest order chiral Lagrangian and a cut off to regularize the loop integrals. The method reproduces succesfully the $\Lambda (1405)$ resonance and the $K^- p \to K^- p, \bar{K}^0 n, \pi^0 \Lambda, \pi^0 \Sigma, \pi^+ \Sigma^-, \pi^- \Sigma^+$ cross sections at low energies. The inclusion of the $\eta \Lambda, \eta \Sigma^0$ channels in the coupled system is found very important and allows a solution in terms of only the lowest order Lagrangian.Comment: 34 pages, 11 figures, uses epsf.sty, submitted to Nucl.Phys.