Impact of cyclooxygenase inhibitors in the Women's Health Initiative hormone trials: secondary analysis of a randomized trial.

OBJECTIVES: We evaluated the hypothesis that cyclooxygenase (COX) inhibitor use might have counteracted a beneficial effect of postmenopausal hormone therapy, and account for the absence of cardioprotection in the Women's Health Initiative hormone trials. Estrogen increases COX expression, and inhibitors of COX such as nonsteroidal anti-inflammatory agents appear to increase coronary risk, raising the possibility of a clinically important interaction in the trials. DESIGN: The hormone trials were randomized, double-blind, and placebo-controlled. Use of nonsteroidal anti-inflammatory drugs was assessed at baseline and at years 1, 3, and 6. SETTING: The Women's Health Initiative hormone trials were conducted at 40 clinical sites in the United States. PARTICIPANTS: The trials enrolled 27,347 postmenopausal women, aged 50-79 y. INTERVENTIONS: We randomized 16,608 women with intact uterus to conjugated estrogens 0.625 mg with medroxyprogesterone acetate 2.5 mg daily or to placebo, and 10,739 women with prior hysterectomy to conjugated estrogens 0.625 mg daily or placebo. OUTCOME MEASURES: Myocardial infarction, coronary death, and coronary revascularization were ascertained during 5.6 y of follow-up in the estrogen plus progestin trial and 6.8 y of follow-up in the estrogen alone trial. RESULTS: Hazard ratios with 95% confidence intervals were calculated from Cox proportional hazard models stratified by COX inhibitor use. The hazard ratio for myocardial infarction/coronary death with estrogen plus progestin was 1.13 (95% confidence interval 0.68-1.89) among non-users of COX inhibitors, and 1.35 (95% confidence interval 0.86-2.10) among continuous users. The hazard ratio with estrogen alone was 0.92 (95% confidence interval 0.57-1.48) among non-users of COX inhibitors, and 1.08 (95% confidence interval 0.69-1.70) among continuous users. In a second analytic approach, hazard ratios were calculated from Cox models that included hormone trial assignment as well as a time-dependent covariate for medication use, and an interaction term. No significant interaction was identified. CONCLUSIONS: Use of COX inhibitors did not significantly affect the Women's Health Initiative hormone trial results

Effects of Soundscape Complexity on Urban Noise Annoyance Ratings: A Large-Scale Online Listening Experiment

Noise annoyance has been often reported as one of the main adverse effects of noise exposure on human health, and there is consensus that it relates to several factors going beyond the mere energy content of the signal. Research has historically focused on a limited set of sound sources (e.g., transport and industrial noise); only more recently is attention being given to more holistic aspects of urban acoustic environments and the role they play in the noise annoyance perceptual construct. This is the main approach promoted in soundscape studies, looking at both wanted and unwanted sounds. In this study, three specific aspects were investigated, namely: (1) the effect of different sound sources combinations, (2) the number of sound sources present in the soundscape, and (3) the presence of individual sound source, on noise annoyance perception. For this purpose, a large-scale online experiment was carried out with 1.2k+ participants, using 2.8k+ audio recordings of complex urban acoustic environments to investigate how they would influence the perceived noise annoyance. Results showed that: (1) the combinations of different sound sources were not important, compared, instead, to the number of sound sources identified in the soundscape recording (regardless of sound sources type); (2) the annoyance ratings expressed a minimum when any two clearly distinguishable sound sources were present in a given urban soundscape; and (3) the presence (either in isolation or combination) of traffic-related sound sources increases noise annoyance, while the presence (either in isolation or combination) of nature-related sound sources decreases noise annoyance

High-fat meal effect on LDL, HDL, and VLDL particle size and number in the Genetics of Lipid-Lowering drugs and diet network (GOLDN): an interventional study

<p>Abstract</p> <p>Background</p> <p>Postprandial lipemia (PPL) is likely a risk factor for cardiovascular disease but these changes have not been well described and characterized in a large cohort. We assessed acute changes in the size and concentration of total and subclasses of LDL, HDL, and VLDL particles in response to a high-fat meal. Participants (n = 1048) from the Genetics of Lipid-Lowering Drugs and Diet Network (GOLDN) Study who ingested a high-fat meal were included in this analysis. Lipids were measured at 0 hr (fasting), 3.5 hr, and 6 hr after a standardized fat meal. Particle size distributions were determined using nuclear magnetic resonance spectroscopy. Analyses were stratified by baseline triglycerides (normal vs. elevated) and gender. The effect of PPL on changes in lipoprotein subclasses was assessed using repeated measures ANOVA.</p> <p>Results</p> <p>Postprandially, LDL-C, HDL-C, VLDL-C, and triglycerides increased regardless of baseline triglyceride status, with the largest increases in VLDL-C and TG; however, those with elevated triglycerides demonstrated larger magnitude of response. Total LDL particle number decreased over the 6-hour time interval, mostly from a decrease in the number of small LDL particles. Similarly, total VLDL particle number decreased due to reductions in medium and small VLDL particles. Large VLDL particles and chylomicrons demonstrated the largest increase in concentration. HDL particles demonstrated minimal overall changes in total particle number.</p> <p>Conclusions</p> <p>We have characterized the changes in LDL and VLDL particle number, and their subclass patterns following a high-fat meal.</p

Impact of cyclooxygenase inhibitors in the Women\u27s Health Initiative hormone trials: secondary analysis of a randomized trial

OBJECTIVES: We evaluated the hypothesis that cyclooxygenase (COX) inhibitor use might have counteracted a beneficial effect of postmenopausal hormone therapy, and account for the absence of cardioprotection in the Women\u27s Health Initiative hormone trials. Estrogen increases COX expression, and inhibitors of COX such as nonsteroidal anti-inflammatory agents appear to increase coronary risk, raising the possibility of a clinically important interaction in the trials. DESIGN: The hormone trials were randomized, double-blind, and placebo-controlled. Use of nonsteroidal anti-inflammatory drugs was assessed at baseline and at years 1, 3, and 6. SETTING: The Women\u27s Health Initiative hormone trials were conducted at 40 clinical sites in the United States. PARTICIPANTS: The trials enrolled 27,347 postmenopausal women, aged 50-79 y. INTERVENTIONS: We randomized 16,608 women with intact uterus to conjugated estrogens 0.625 mg with medroxyprogesterone acetate 2.5 mg daily or to placebo, and 10,739 women with prior hysterectomy to conjugated estrogens 0.625 mg daily or placebo. OUTCOME MEASURES: Myocardial infarction, coronary death, and coronary revascularization were ascertained during 5.6 y of follow-up in the estrogen plus progestin trial and 6.8 y of follow-up in the estrogen alone trial. RESULTS: Hazard ratios with 95% confidence intervals were calculated from Cox proportional hazard models stratified by COX inhibitor use. The hazard ratio for myocardial infarction/coronary death with estrogen plus progestin was 1.13 (95% confidence interval 0.68-1.89) among non-users of COX inhibitors, and 1.35 (95% confidence interval 0.86-2.10) among continuous users. The hazard ratio with estrogen alone was 0.92 (95% confidence interval 0.57-1.48) among non-users of COX inhibitors, and 1.08 (95% confidence interval 0.69-1.70) among continuous users. In a second analytic approach, hazard ratios were calculated from Cox models that included hormone trial assignment as well as a time-dependent covariate for medication use, and an interaction term. No significant interaction was identified. CONCLUSIONS: Use of COX inhibitors did not significantly affect the Women\u27s Health Initiative hormone trial results

Resumming the large-N approximation for time evolving quantum systems

In this paper we discuss two methods of resumming the leading and next to leading order in 1/N diagrams for the quartic O(N) model. These two approaches have the property that they preserve both boundedness and positivity for expectation values of operators in our numerical simulations. These approximations can be understood either in terms of a truncation to the infinitely coupled Schwinger-Dyson hierarchy of equations, or by choosing a particular two-particle irreducible vacuum energy graph in the effective action of the Cornwall-Jackiw-Tomboulis formalism. We confine our discussion to the case of quantum mechanics where the Lagrangian is $L(x,\dot{x}) = (1/2) \sum_{i=1}^{N} \dot{x}_i^2 - (g/8N) [ \sum_{i=1}^{N} x_i^2 - r_0^2 ]^{2}$. The key to these approximations is to treat both the $x$ propagator and the $x^2$ propagator on similar footing which leads to a theory whose graphs have the same topology as QED with the $x^2$ propagator playing the role of the photon. The bare vertex approximation is obtained by replacing the exact vertex function by the bare one in the exact Schwinger-Dyson equations for the one and two point functions. The second approximation, which we call the dynamic Debye screening approximation, makes the further approximation of replacing the exact $x^2$ propagator by its value at leading order in the 1/N expansion. These two approximations are compared with exact numerical simulations for the quantum roll problem. The bare vertex approximation captures the physics at large and modest $N$ better than the dynamic Debye screening approximation.Comment: 30 pages, 12 figures. The color version of a few figures are separately liste

Universal WBC reduction

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75583/1/j.1537-2995.2000.40060751.x.pd