Use of Coronary Computed Tomographic Angiography to guide management of patients with coronary disease

Background In a prospective, multicenter, randomized controlled trial, 4,146 patients were randomized to receive standard care or standard care plus coronary computed tomography angiography (CCTA). Objectives The purpose of this study was to explore the consequences of CCTA-assisted diagnosis on invasive coronary angiography, preventive treatments, and clinical outcomes. Methods In post hoc analyses, we assessed changes in invasive coronary angiography, preventive treatments, and clinical outcomes using national electronic health records. Results Despite similar overall rates (409 vs. 401; p = 0.451), invasive angiography was less likely to demonstrate normal coronary arteries (20 vs. 56; hazard ratios [HRs]: 0.39 [95% confidence interval (CI): 0.23 to 0.68]; p < 0.001) but more likely to show obstructive coronary artery disease (283 vs. 230; HR: 1.29 [95% CI: 1.08 to 1.55]; p = 0.005) in those allocated to CCTA. More preventive therapies (283 vs. 74; HR: 4.03 [95% CI: 3.12 to 5.20]; p < 0.001) were initiated after CCTA, with each drug commencing at a median of 48 to 52 days after clinic attendance. From the median time for preventive therapy initiation (50 days), fatal and nonfatal myocardial infarction was halved in patients allocated to CCTA compared with those assigned to standard care (17 vs. 34; HR: 0.50 [95% CI: 0.28 to 0.88]; p = 0.020). Cumulative 6-month costs were slightly higher with CCTA: difference $462 (95$303 to $621). Conclusions In patients with suspected angina due to coronary heart disease, CCTA leads to more appropriate use of invasive angiography and alterations in preventive therapies that were associated with a halving of fatal and non-fatal myocardial infarction. (Scottish COmputed Tomography of the HEART Trial [SCOT-HEART]; NCT01149590

Determinants of the maternal 25-hydroxyvitamin D response to vitamin D supplementation during pregnancy

Context: Current approaches to antenatal vitamin D supplementation do not account for interindividual differences in 25-hydroxyvitamin D (25(OH)D) response.Objective: We assessed which maternal and environmental characteristics were associated with 25(OH)D after supplementation with cholecalciferol.Design: Within-randomization-group analysis of participants in the Maternal Vitamin D Osteoporosis Study trial of vitamin D supplementation in pregnancy.Setting: Hospital antenatal clinics.Participants: A total of 829 pregnant women (422 placebo, 407 cholecalciferol). At 14 and 34 weeks of gestation, maternal anthropometry, health, and lifestyle were assessed and 25(OH)D measured. Compliance was determined using pill counts at 19 and 34 weeks.Interventions: 1000 IU/d of cholecalciferol or matched placebo from 14 weeks of gestation until delivery.Main Outcome Measure: 25(OH)D at 34 weeks, measured in a single batch (Diasorin Liaison).Results: 25(OH)D at 34 weeks of gestation was higher in the women randomized to vitamin D (mean [SD], 67.7 [21.3] nmol/L) compared with placebo (43.1 [22.5] nmol/L; P &lt; .001). In women randomized to cholecalciferol, higher pregnancy weight gain from 14 to 34 weeks of gestation (kg) (? = ?0.81 [95% confidence interval ?1.39, ?0.22]), lower compliance with study medication (%) (? = ?0.28 [?0.072, ?0.48]), lower early pregnancy 25(OH)D (nmol/L) (? = 0.28 [0.16, 0.40]), and delivery in the winter vs the summer (? = ?10.5 [?6.4, ?14.6]) were independently associated with lower 25(OH)D at 34 weeks of gestation.Conclusions: Women who gained more weight during pregnancy had lower 25(OH)D in early pregnancy and delivered in winter achieved a lower 25(OH)D in late pregnancy when supplemented with 1000 IU/d cholecalciferol. Future studies should aim to determine appropriate doses to enable consistent repletion of 25(OH)D during pregnancy.<br/

Constraints on ultra-high energy neutrinos from optically thick astrophysical accelerators

The Z-burst mechanism invoked to explain ultra-high energy cosmic rays is severely constrained by measurements of the cosmic gamma-ray background by EGRET. We discuss the case of optically thick sources and show that jets and hot spots of active galaxies cannot provide the optical depth required to suppress the photon flux. Other extragalactic accelerators (AGN cores and sites of gamma ray bursts), if they are optically thick, could be tested by future measurements of the secondary neutrino flux.Comment: 9 pages, 1 figure; v2: 10 pages, references added; experimental data on neutrino fluxes updated significantly; to be published in Astropart.Phy

The Lake Baikal neutrino experiment

We rewiew the present status of the Baikal Neutrino Project and present the results of a search for high energy neutrinos with the detector intermediate stage NT-96.Comment: 3 pages, 2 figures, to appear in the Proceedings of Sixth International Workshop on Topics in Astroparticle and Underground Physics (TAUP99), September 6-10, 1999, Pais, Franc

Does antenatal cholecalciferol supplementation affect the mode or timing of delivery? Post hoc analyses of the MAVIDOS randomized controlled trial

Background Observational studies relating maternal 25-hydroxyvitamin D status to timing and mode of delivery have reported inconsistent results. We assessed the effect of antenatal cholecalciferol supplementation on the incidence of preterm birth, delivery mode and post-partum haemorrhage (PPH). Methods MAVIDOS was a randomized, double-blind, placebo-controlled trial of 1000 IU/day cholecalciferol from 14 weeks’ gestation until delivery. Gestational age, mode of delivery [categorized as spontaneous vaginal delivery (SVD), instrumental (including forceps and vacuum extraction) or Caesarean section] and PPH (>500 ml estimated blood loss) were determined from medical records. Results A total of 965 women participated in the study until delivery. Gestation at birth and incidence of preterm birth (cholecalciferol 5.7%, placebo 4.5%, P = 0.43) were similar between the two treatment groups. SVD (versus instrumental or Caesarean delivery) was more likely in women randomized to cholecalciferol [Relative Risk (RR) 1.13, 95% confidence interval (CI) 1.02,1.25] due to lower instrumental (RR 0.68, 95%CI 0.51,0.91) but similar risk of Caesarean delivery (RR 0.94, 95%CI 0.74,1.19). PPH was less common in women randomized to cholecalciferol [32.1% compared with placebo (38.1%, P = 0.054) overall], but similar when stratified by delivery mode. Conclusions Antenatal cholecalciferol supplementation did not alter timing of birth or prevalence of preterm birth but demonstrated a possible effect on the likelihood of SVD

Pregnancy vitamin D supplementation and childhood bone mass at age 4 years : findings from the Maternal Vitamin D Osteoporosis Study (MAVIDOS) randomized controlled trial

In the Maternal Vitamin D Osteoporosis Study (MAVIDOS) randomized trial, vitamin D supplementation in pregnancy did not lead to greater neonatal bone mass across the trial as a whole, but, in a prespecified secondary analysis by season of birth, led to greater neonatal bone mass among winter-born babies. Demonstrating persistence of this effect into childhood would increase confidence in a long-term benefit of this intervention. We investigated whether antenatal vitamin D supplementation increases offspring bone mineralization in early childhood in a prespecified, single-center follow-up of a double-blinded, multicenter, randomized controlled clinical trial based in the UK (MAVIDOS). A total of 1123 women in early pregnancy with a baseline 25-hydroxyvitamin D level 25–100 nmol/L from three research centers (2008–2014) were randomized to 1000 IU/d cholecalciferol or matched placebo from 14 weeks of gestation to delivery. Offspring born at the Southampton, UK research center were assessed at age 4 years (2013–2018). Anthropometry and dual-energy X-ray absorptiometry (DXA) were performed (yielding whole body less head [WBLH] bone mineral content [BMC], areal bone mineral density [aBMD], bone area [BA], and body composition). Of 723 children, 564 (78.0%) children attended the 4-year visit, 452 of whom had a useable DXA. Maternal vitamin D supplementation led to greater WBLH aBMD in the children compared with placebo (mean [95% confidence interval {CI}]: supplemented group: 0.477 (95% CI, 0.472–0.481) g/cm2; placebo group: 0.470 (95% CI, 0.466–0.475) g/cm2, p = 0.048). Associations were consistent for BMC and lean mass, and in age- and sex-adjusted models. Effects were observed across the whole cohort irrespective of season of birth. Maternal-child interactions were observed, with a greater effect size among children with low milk intake and low levels of physical activity. Child weight, height, and body mass index (BMI) were similar by maternal randomization group. These findings suggest a sustained beneficial effect of maternal vitamin D supplementation in pregnancy on offspring aBMD at age 4 years, but will require replication in other trials

Kinetic investigations into the effect of inoculum to substrate ratio on batch anaerobic digestion of simulated food waste

This anaerobic digestion (AD) study investigated the effect of inoculum to substrate ratio (ISR 4.00 to 0.25) on viability of methanogenesis using simulated food waste as substrate. Given the complexity of the AD process, this study considered the interdependency of AD parameters and their effect on biogas production, as the digestion progressed. Maximum methane production was between ISR 2.00 (139 ± 10 ml CH 4/g VS added) and 1.00 (152 ± 12 ml CH 4/g VS added); further decreases in ISR were found to result in system acidification. Under acidogenic conditions (ISR≤0.5) pH and the volatile fatty acid (VFA) profile were found to be strongly dependent on the ISR. In contrast to ISR 0.25, ISR 0.50 showed reverse beta oxidation, which resulted in increased concentrations of medium chain VFAs over the digestion period. Maximum total VFA (TVFA) concentrations that the system could survive with reversible acidification (ISR 1.00) was found to be 17.52 ± 0.02 g/l, whereas the maximum TVFA production was found to be 29.25 ± 0.73 g/l for ISR 0.50. Uniquely, this study also reports up to 55% anaerobic degradation of lignin in acidified reactors with ISR 0.25, which based on existing literature, points towards the involvement of specific bacterial strains