Correcting calf girth discriminates the incidence of falling but not bone mass by broadband ultrasound attenuation in elderly female subjects.

Calf circumference has been cited as an independent risk factor for hip fracture. Correcting this measured girth for subcutaneous adipose tissue or fluid accumulation provides a more valid estimate of lean tissue, but has not been reported in elderly populations. Two hundred eighty-eight randomly selected female volunteers, aged ≥ 70 years, were assessed by quantitative ultrasound (QUS) and clinical risk factors as part of a larger screening study for hip fracture risk. This involved measuring broadband ultrasound attenuation (BUA) and administering a structured risk factor questionnaire that included estimated daily skeletal loading (time standing or walking). Body mass index (BMI) was estimated using current body mass and height at age 25 years. Calf girth was measured using a standard anthropometric tape, the medial calf skinfold (a vertical fold at the point of maximum calf girth) was measured, and corrected calf girth (CCG) was calculated by subtracting the skinfold (in centimeters) multiplied by π from calf girth. Subjects were aged 76.9 ± 5.0 years, had BMIs of 24.3 ± 3.9 kg/m2, and spent an average of 5.5 ± 2.0 h on their feet each day. Age, current body mass, BMI calf girth, and CCG all correlated with BUA (p 0.05). Dividing the sample into tertiles by these correlates of BUA and predicting BUA using stepwise regression revealed different predictors for each tertile. Of the total sample, 93 had fallen in the last 12 months, whereas 195 had not. Independent t-tests showed these groups to be similar in age, BMI, and calf girth (p > 0.05), but fallers spent less time on their feet each day, and had smaller CCG (p < 0.05). This suggests that larger calf muscles may be protective against falling—possibly as a result of enhanced stability or greater neuromuscular control

The association of cognitive and somatic depressive symptoms with depression recognition and outcomes after myocardial infarction

BACKGROUND: Among patients with acute myocardial infarction (AMI), depression is both common and under-recognized. The association of different manifestations of depression, somatic and cognitive, with depression recognition and long-term prognosis is poorly understood. METHODS AND RESULTS: Depression was confirmed in 481 AMI patients enrolled from 21 sites during their index hospitalization with a Patient Health Questionnaire (PHQ-9) score ≥10. Within the PHQ-9, separate somatic and cognitive symptom scores were derived and the independent association between these domains and the clinical recognition of depression, as documented in the medical records, was evaluated. In a separate multisite AMI registry of 2,347 patients, the association between somatic and cognitive depressive symptoms and 4-year all-cause mortality and 1-year all-cause rehospitalization was evaluated. Depression was clinically recognized in 29% (n=140) of patients. Cognitive depressive symptoms (Relative Risk [RR] per Standard Deviation [SD] increase=1.14; 95% confidence interval [CI] 1.03–1.26; p=0.01) were independently associated with depression recognition, while the association for somatic symptoms and recognition (RR=1.04; 95% CI 0.87–1.26; p=0.66) was not significant. However, unadjusted Cox regression analyses found that only somatic depressive symptoms were associated with 4-year mortality (Hazard Ratio [HR] per SD increase=1.22; 95% confidence interval [CI] 1.08–1.39) or 1-year rehospitalization (HR=1.22; 95%CI 1.11–1.33) while cognitive manifestations were not (HR for mortality=1.01; 95%CI 0.89–1.14; HR for rehospitalization=1.01; 95%CI 0.93–1.11). After multivariable adjustment, the association between somatic symptoms and rehospitalization persisted (HR=1.16; 95% CI:1.06–1.27; p=0.01) but was attenuated for mortality (HR=1.07; 95% CI:0.94–1.21; p=0.30). CONCLUSIONS: Depression after AMI was recognized in fewer than 1 in 3 patients. Although cognitive symptoms were associated with recognition of depression, somatic symptoms were associated with long-term outcomes. Comprehensive screening and treatment of both somatic and cognitive symptoms may be necessary to optimize depression recognition and treatment in AMI patients

Greenberger-Horne-Zeilinger nonlocality for continuous variable systems

As a development of our previous work, this paper is concerned with the Greenberger-Horne-Zeilinger (GHZ) nonlocality for continuous variable cases. The discussion is based on the introduction of a pseudospin operator, which has the same algebra as the Pauli operator, for each of the $N$ modes of a light field. Then the Bell-CHSH (Clauser, Horne, Shimony and Holt) inequality is presented for the $N$ modes, each of which has a continuous degree of freedom. Following Mermin's argument, it is demonstrated that for $N$-mode parity-entangled GHZ states (in an infinite-dimensional Hilbert space) of the light field, the contradictions between quantum mechanics and local realism grow exponentially with $N$, similarly to the usual $N$-spin cases.Comment: RevTEX; comments are welcomed; new version with minor change

Dynamic generation of maximally entangled photon multiplets by adiabatic passage

The adiabatic passage scheme for quantum state synthesis, in which atomic Zeeman coherences are mapped to photon states in an optical cavity, is extended to the general case of two degenerate cavity modes with orthogonal polarization. Analytical calculations of the dressed-state structure and Monte Carlo wave-function simulations of the system dynamics show that, for a suitably chosen cavity detuning, it is possible to generate states of photon multiplets that are maximally entangled in polarization. These states display nonclassical correlations of the type described by Greenberger, Horne, and Zeilinger (GHZ). An experimental scheme to realize a GHZ measurement using coincidence detection of the photons escaping from the cavity is proposed. The correlations are found to originate in the dynamics of the adiabatic passage and persist even if cavity decay and GHZ state synthesis compete on the same time scale. Beyond entangled field states, it is also possible to generate entanglement between photons and the atom by using a different atomic transition and initial Zeeman state.Comment: 22 pages (RevTeX), including 23 postscript figures. To be published in Physical Review