Punk Archaeology

Punk Archaeology is a irreverent and relevant movement in archaeology, and these papers provide a comprehensive anti-manifesto

Association of Socioeconomic Status with One-Year Readmission and Mortality among Patients with Acute Myocardial Infarction

Background: Mortality and morbidity are known to be negatively associated with socioeconomic status (SES). This research aims to investigate the magnitude of this association at the individual level: household income (a proxy for the SES) and cardiovascular disease (CVD). CVD accounts for almost one-third of deaths in the world and one-fourth of deaths in the United States. Given the size of CVD incidence and its severity, we examined how it occurs across various levels of SES. Methods: The zip-code based median household income data in the U.S. Census Bureau were matched to CVD patients from the Myocardial Infarction Data Acquisition System (MIDAS), a rich database that comprises cardiovascular admissions to acute care hospitals in New Jersey. Logistic Regression and Cox Proportional Hazards models were applied to study the relationship between income and three cardiovascular clinical outcomes: readmission for acute myocardial infarction (AMI readmission), cardiovascular death (CV death), and all-cause death among patients with a first admission for AMI, while controlling for covariates available in the database, including demographic factors, insurance types, and comorbidities. Results: The main results indicate that patients at the lowest income level had higher risk for AMI readmission and CV death, but not for all-cause death. Ceteris paribus, the chance of one-year AMI readmission increases with lower income levels according to the Logistic Regression outcomes. Conclusions: Our findings may help better allocate limited resources to where they are in greater need, so the costly and deadly incidence of heart disease can be reduced

Diffusion MRI Tractography of the Developing Human Fetal Heart

Objective: Human myocardium has a complex and anisotropic 3D fiber pattern. It remains unknown, however, when in fetal life this anisotropic pattern develops and whether the human heart is structurally fully mature at birth. We aimed here to use diffusion tensor MRI (DTI) tractography to characterize the evolution of fiber architecture in the developing human fetal heart. Methods: Human fetal hearts (n = 5) between 10–19 weeks of gestation were studied. The heart from a 6-day old neonate and an adult human heart served as controls. The degree of myocardial anisotropy was measured by calculating the fractional anisotropy (FA) index. In addition, fiber tracts were created by numerically integrating the primary eigenvector field in the heart into coherent streamlines. Results: At 10–14 weeks the fetal hearts were highly isotropic and few tracts could be resolved. Between 14–19 weeks the anisotropy seen in the adult heart began to develop. Coherent fiber tracts were well resolved by 19 weeks. The 19-week myocardium, however, remained weakly anisotropic with a low FA and no discernable sheet structure. Conclusions: The human fetal heart remains highly isotropic until 14–19 weeks, at which time cardiomyocytes self-align into coherent tracts. This process lags 2–3 months behind the onset of cardiac contraction, which may be a prerequisite for cardiomyocyte maturation and alignment. No evidence of a connective tissue scaffold guiding this process could be identified by DTI. Maturation of the heart’s sheet structure occurs late in gestation and evolves further after birth

Use of advanced statistical techniques to predict all-cause mortality in the Systolic Blood Pressure Intervention Trial

Background: The Systolic Blood Pressure Intervention Trial (SPRINT) was conducted in patients with hypertension and additional risk for cardiovascular disease who were randomized to the intensive blood pressure group targeting systolic blood pressure (SBP) less than 120 mm Hg and to the standard group where the target was less than 140 mm Hg. Analyses were done in the matched group of participants with the same gender, same age (±2 years) and same SBP (±3 mm Hg) at three months of treatment regardless of initial randomization to intensive or standard group (shaded area in Figure 1). Methods and results: During 3.26 years of follow-up, intensive group participants had 14.8 mm Hg lower SBP and received on average one more (2.8 vs. 1.8) blood pressure lowering medications. This was associated with lower all-cause mortality in the intensive treatment group (hazard ratio, 0.73; 95% CI, 0.60 to 0.90, p = 0.003). The effect on SBP was achieved at 3 months and remained unchanged thereafter. This paper addresses two questions with respect to all-cause mortality in SPRINT in the matched set. 1) What is the effect of receiving more than one drug on all-cause mortality. Conditional logistic regression for all-cause mortality with respect to number of drugs indicated that during the 3.26 years of follow-up persons who received more than one drug were more likely to die (coefficient = 0.5039, OR = 1.6552, p = 0.0322) than patients who received one drug. 2) Was there a U curve relationship between on treatment SBP and all-cause mortality? A U curve fitting a quadratic equation (parabola) of SBP and all-cause death was observed. This was seen in the patients randomized to the standard target group in unadjusted analyses as well as in analyses adjusted for demographics or all covariates (p \u3c 0.001 for all). The U curves in the combined group and the intensive treatment group were less pronounced. Conclusion: SPRINT participants who were matched for gender, age, and SBP at 3 months, and received more than one drug had higher all-cause mortality during the 3.26 years of follow-up. Those who were randomized to standard treatment target had a U curve relationship between SBP at three months and all-cause mortality. The U curves in the combined group and the intensive treatment group were less pronounced