Case-control study of stroke and the quality of hypertension control in north west England

Objective: To examine the risk of stroke in relation to quality of hypertension control in routine general practice across an entire health district. Design: Population based matched case-control study. Setting: East Lancashire Health District with a participating population of 388,821 aged < or = 80. Subjects: Cases were patients under 80 with their first stroke identified from a population based stroke register between 1 July 1994 and 30 June 1995. For each case two controls matched with the case for age and sex were selected from the same practice register. Hypertension was defined as systolic blood pressure > or = 160 mm Hg or diastolic blood pressure > or = 95 mm Hg, or both, on at least two occasions within any three month period or any history of treatment with antihypertensive drugs. Main outcome measures: Prevalence of hypertension and quality of control of hypertension assessed by using the mean blood pressure recorded before stroke) and odds ratios of stroke (derived from conditional logistic regression). Results: Records of 267 cases and 534 controls were examined; 61% and 42% of these subjects respectively were hypertensive. Compared with non-hypertensive subjects hypertensive patients receiving treatment whose average pre-event systolic blood pressure was controlled to or = 160 mm Hg) or untreated had progressively raised odds ratios of 1.6, 2.2, 3.2, and 3.5 respectively. Results for diastolic pressure were similar; both were independent of initial pressures before treatment. Around 21% of strokes were thus attributable to inadequate control with treatment, or 46 first events yearly per 100,000 population aged 40-79. Conclusions: Risk of stroke was clearly related to quality of control of blood pressure with treatment. In routine practice consistent control of blood pressure to below 150/90 mm Hg seems to be required for optimal stroke prevention

Off-Shell Rho-Omega Mixing Through Quark Loops With Non-Perturbative Meson Vertex And Quark Mass Functions

The momemtum dependence of the off-shell $\rho$-$\omega$ mixing amplitude is calculated through a two-quark loop diagram, using non-perturbative meson-quark vertex functions for the $\rho$ and $\omega$ mesons, as well as non-perturbative quark propagators. Both these quantities are generated self-consistently through an interlinked BSE-cum-SDE approach with a 3D support for the BSE kernel with two basic constants which are pre- checked against a wide cross section of both meson and baryon spectra within a common structural framework for their respective 3D BSE's. With this pre-calibration, the on-shell strength works out at -2.434$\delta(m_q^2)$ in units of the change in "constituent mass squared", which is consistent with the $e^+e^-$ to $\pi^+\pi^-$ data for a u-d mass difference of ~4 MeV ,while the relative off-shell strength (0.99 $\pm$ 0.01) lies midway between quark-loop and QCD-SR results. We also calculate the photon-mediated $\rho$-$\omega$ propagator whose off-shell structure has an additional pole at $q^2$=0. The implications of these results vis-a-vis related investigations are discussed.Comment: 12 Pages, latex file, NTUTH-94-0

Beings in their own right? Exploring Children and young people's sibling and twin relationships in the Minority World

This paper examines the contributions that the sociological study of sibship and twinship in the Minority World can make to childhood studies. It argues that, in providing one forum within which to explore children and young people's social relationships, we can add to our understanding of children and young people's interdependence and develop a more nuanced understanding of agency. As emergent subjects, children, young people and adults are in a process of ‘becoming’. However, this does not mean that they can ‘become’ anything they choose to. The notion of negotiated interdependence (Punch 2002) is useful in helping us to grasp the contingent nature of children and young people's agency

Lessons from Mycobacterium avium complex-associated pneumonitis: a case report

ABSTRACT: INTRODUCTION: Mycobacterium avium complex (MAC) is an increasingly recognized cause of pulmonary disease in immunocompetent individuals. An acute form of MAC lung disease, MAC-associated pneumonitis, has generally been associated with the use of hot tubs. There is controversy in the literature about whether MAC-associated pneumonitis is a classic hypersensitivity pneumonitis or is a direct manifestation of mycobacterial infection. CASE PRESENTATION: We report the second case in the literature of MAC-associated pneumonitis not related to the use of hot tubs. The source of MAC in a 52-year-old immunocompetent patient was an intrapulmonary cyst containing numerous acid-fast bacilli. The patient developed disseminated miliary nodules throughout both lung fields. Histological examination of resected lung tissue revealed well-formed, acid-fast negative granulomas composed predominantly of CD4+ T-cells and CD68+ histiocytes. The granulomas were strongly positive for tumor necrosis factor-alpha, a pro-inflammatory cytokine. CONCLUSION: The attempt to classify MAC-associated pneumonitis as either a classic hypersensitivity pneumonitis or a direct manifestation of mycobacterial infection is not particularly useful. Our case demonstrates that MAC-associated pneumonitis is characterized by a vigorous T-helper 1-like, pro-inflammatory, immune response to pulmonary mycobacterial infection. The immunopathology provides a rationale for clinical studies of anti-MAC therapy with the addition of anti-inflammatory agents (for example, corticosteroids) to hasten the resolution of infection and symptoms

Maintained physical activity and physiotherapy in the management of distal upper limb pain – a protocol for a randomised controlled trial (the arm pain trial)

&lt;b&gt;Background&lt;/b&gt;&lt;p&gt;&lt;/p&gt; Distal upper limb pain (pain affecting the elbow, forearm, wrist, or hand) can be non-specific, or can arise from specific musculoskeletal disorders. It is clinically important and costly, the best approach to clinical management is unclear. Physiotherapy is the standard treatment and, while awaiting treatment, advice is often given to rest and avoid strenuous activities, but there is no evidence base to support these strategies. This paper describes the protocol of a randomised controlled trial to determine, among patients awaiting physiotherapy for distal arm pain, (a) whether advice to remain active and maintain usual activities results in a long-term reduction in arm pain and disability, compared with advice to rest; and (b) whether immediate physiotherapy results in a long-term reduction in arm pain and disability, compared with physiotherapy delivered after a seven week waiting list period.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Methods/Design&lt;/b&gt;&lt;p&gt;&lt;/p&gt; Between January 2012 and January 2014, new referrals to 14 out-patient physiotherapy departments were screened for potential eligibility. Eligible and consenting patients were randomly allocated to one of the following three groups in equal numbers: 1) advice to remain active, 2) advice to rest, 3) immediate physiotherapy. Patients were and followed up at 6, 13, and 26 weeks post-randomisation by self-complete postal questionnaire and, at six weeks, patients who had not received physiotherapy were offered it at this time. The primary outcome is the proportion of patients free of disability at 26 weeks, as determined by the modified DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire.&lt;p&gt;&lt;/p&gt; We hypothesise (a) that advice to maintain usual activities while awaiting physiotherapy will be superior than advice to rest the arm; and (b) that fast-track physiotherapy will be superior to normal (waiting list) physiotherapy. These hypotheses will be examined using an intention-to-treat analysis.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Discussion&lt;/b&gt;&lt;p&gt;&lt;/p&gt; Results from this trial will contribute to the evidence base underpinning the clinical management of patients with distal upper limb pain, and in particular, will provide guidance on whether they should be advised to rest the arm or remain active within the limits imposed by their symptoms

Temperature and Density Effects on the Nucleon Mass Splitting

The finite temperature and finite density dependence of the neutron-proton mass difference is analysed in a purely hadronic framework where the $\rho-\omega$ mixing is crucial for this isospin symmetry breakdown. The problem is handled within Thermo Field Dynamics. The present results, consistent with partial chiral and charge symmetry restoration, improve the experimental data fit for the energy difference between mirror nuclei.Comment: 17 pages, revtex fil

The Off Shell ρ\rho-ω\omega Mixing in the QCD Sum Rules

The $q^2$ dependence of the $\rho-\omega$ mixing amplitude is analyzed with the use of the QCD sum rules and the dispersion relation. Going off shell the mixing decreases, changes sign at $q^2 \simeq 0.4 m_{\rho}^2 > 0$ and is negative in the space like region. Implications of this result to the isospin breaking part of the nuclear force are discussed.Comment: 26 pages + 11 figures (PostScript

Electromagnetic Form Factors of the SU(3) Octet Baryons in the semibosonized SU(3) Nambu-Jona-Lasinio Model

The electromagnetic form factors of the SU(3) octet baryons are investigated in the semibosonized SU(3) Nambu--Jona-Lasinio model (chiral quark-soliton model). The rotational $1/N_c$ and strange quark mass corrections in linear order are taken into account. The electromagnetic charge radii of the nucleon and magnetic moments are also evaluated. It turns out that the model is in a remarkable good agreement with the experimental data.Comment: RevTex is used. 37 pages. The final version to appear in Phys. Rev. D. 13 figures are include

Growing up beside you: a relational sociology of early childhood

This article will begin by outlining influential attempts by historians and sociologists to develop a more adequate theoretical understanding of past and contemporary childhoods, focusing on the major problems that stem from the pivotal role that ‘developmentalism’ plays in their arguments. I will argue that sociologists can overcome some of their deepest fears about the role of developmental psychology by developing a relational approach that integrates the biological and social aspects of children’s development. In the development of a relational sociology of early childhood we need to make important connections with closely related disciplines, but at the same time draw on and integrate research findings from relevant areas within the social and natural sciences. An alternative perspective drawn from the writings of Norbert Elias will be put forward and illustrated by discussing some of the key concepts that Elias and Vygotsky used to explain the language development of young children

Sport coaches' experiences of athlete injury : the development and regulation of guilt

This study sought to examine coaches’ stories of guilt in the specific context of athlete injury. Using narrative interviews with a diverse group of ten coaches, guilt was found to be a commonly experienced emotion that the participants also sought to regulate. The coaches’ experiences of the embodiment and management of guilt is primarily, although not exclusively, interrogated using the mainstream psychological theorising of Kubany and Watson (2003). The article concludes by connecting the coaches’ experiences of guilt with critiques of the prevailing deontological approach used to define what it means to be a ‘good’ sport coach. Here we suggest that dominant perspectives in coach education may be instrumental in entrenching coaches’ experience of guilt