Cardiovascular diseases in older patients with osteoporotic hip fracture: prevalence, disturbances in mineral and bone metabolism, and bidirectional links

BACKGROUND Considerable controversy exists regarding the contribution of mineral/bone metabolism abnormalities to the association between cardiovascular diseases (CVDs) and osteoporotic fractures. AIMS AND METHODS To determine the relationships between mineral/bone metabolism biomarkers and CVD in 746 older patients with hip fracture, clinical data were recorded and serum concentrations of parathyroid hormone (PTH), 25-hydroxyvitamin D, calcium, phosphate, magnesium, troponin I, parameters of bone turnover, and renal, liver, and thyroid functions were measured. RESULTS CVDs were diagnosed in 472 (63.3%) patients. Vitamin D deficiency was similarly prevalent in patients with (78.0%) and without (82.1%) CVD. The CVD group had significantly higher mean PTH concentrations (7.6 vs 6.0 pmol/L, P 6.8 pmol/L, 43.0% vs 23.3%, P 7.5 nmol/μmol, 87.9% vs 74.8%, P < 0.001). In multivariate regression analysis, SHPT (odds ratio [OR] 2.6, P = 0.007) and high DPD/Cr (OR 2.8, P = 0.016) were independent indictors of CVD. Compared to those with both PTH and DPD/Cr in the normal range, multivariate-adjusted ORs for the presence of CVD were 17.3 (P = 0.004) in subjects with SHPT and 9.7 (P < 0.001) in patients with high DPD/Cr. CVD was an independent predicator of SHPT (OR 2.8, P = 0.007) and excess DPD/Cr (OR 2.5, P = 0.031). CVD was predictive of postoperative myocardial injury, while SHPT was also an independent predictor of prolonged hospital stay and in-hospital death. CONCLUSION SHPT and excess bone resorption are independent pathophysiological mediators underlying the bidirectional associations between CVD and hip fracture, and therefore are important diagnostic and therapeutic targets

A hafted halberd excavated at Trecastell, Powys: from undercurrent to uptake – the emergence and contextualisation of halberds in Wales and North-west Europe

Excavations at Trecastell, Powys, south Wales, in 2007 yielded a copper halberd complete with its haft-grip. This has major implications for the mode of hafting halberds, but the discovery has also prompted a reconsideration of insular halberds in their north-west European context. Understanding the relationships between different types of halberd and different regional groups continues to be hampered by the dearth of good dating evidence, but the creation of better classifications for British and Irish weapons and new radiocarbon dates on two examples, one being Trecastell, have allowed a new developmental scheme to be advanced.The emergence of metal-headed halberds is considered more generally. While it is acknowledged that halberd-like implements pre-existed in other materials in some parts of Europe, it is argued that the appearance of metal-headed halberds depended on the transmission of a particular set of metallurgical and related skills. A new model for the vigorous uptake of halberds on a regional basis helps explain the patchiness and anachronism of halberd hotspots.The Trecastell halberd adds to one of the significant concentrations of the weapon type in Britain and prompts a more general review of the earliest metalwork from Wales and the Marches. For the Chalcolithic, halberds are instrumental in identifying a major contrast in depositional behaviour; this contrast dissolves at the beginning of the Early Bronze Age when a ‘new deposition ground’ is established. The former is attributed to the existence of a regional group across much of the region for whom the halberd served as a cultural icon, while the latter may relate to the demise of this enshrined value for the halberd.</jats:p

Modeling Ice Shelf/Ocean Interaction in Antarctica: A Review

The most rapid loss of ice from the Antarctic Ice Sheet is observed where ice streams flow into the ocean and begin to float, forming the great Antarctic ice shelves that surround much of the continent. Because these ice shelves are floating, their thinning does not greatly influence sea level. However, they also buttress the ice streams draining the ice sheet, and so ice shelf changes do significantly influence sea level by altering the discharge of grounded ice. Currently, the most significant loss of mass from the ice shelves is from melting at the base (although iceberg calving is a close second). Accessing the ocean beneath ice shelves is extremely difficult, so numerical models are invaluable for understanding the processes governing basal melting. This paper describes the different ways in which ice shelf/ocean interactions are modeled and discusses emerging directions that will enhance understanding of how the ice shelves are melting now and how this might change in the future

Effects of alteplase for acute stroke according to criteria defining the European Union and United States marketing authorizations: individual-patient-data meta-analysis of randomized trials

Background: The recommended maximum age and time window for intravenous alteplase treatment of acute ischemic stroke differs between the Europe Union and United States. Aims: We compared the effects of alteplase in cohorts defined by the current Europe Union or United States marketing approval labels, and by hypothetical revisions of the labels that would remove the Europe Union upper age limit or extend the United States treatment time window to 4.5 h. Methods: We assessed outcomes in an individual-patient-data meta-analysis of eight randomized trials of intravenous alteplase (0.9 mg/kg) versus control for acute ischemic stroke. Outcomes included: excellent outcome (modified Rankin score 0–1) at 3–6 months, the distribution of modified Rankin score, symptomatic intracerebral hemorrhage, and 90-day mortality. Results: Alteplase increased the odds of modified Rankin score 0–1 among 2449/6136 (40%) patients who met the current European Union label and 3491 (57%) patients who met the age-revised label (odds ratio 1.42, 95% CI 1.21−1.68 and 1.43, 1.23−1.65, respectively), but not in those outside the age-revised label (1.06, 0.90−1.26). By 90 days, there was no increased mortality in the current and age-revised cohorts (hazard ratios 0.98, 95% CI 0.76−1.25 and 1.01, 0.86–1.19, respectively) but mortality remained higher outside the age-revised label (1.19, 0.99–1.42). Similarly, alteplase increased the odds of modified Rankin score 0-1 among 1174/6136 (19%) patients who met the current US approval and 3326 (54%) who met a 4.5-h revised approval (odds ratio 1.55, 1.19−2.01 and 1.37, 1.17−1.59, respectively), but not for those outside the 4.5-h revised approval (1.14, 0.97−1.34). By 90 days, no increased mortality remained for the current and 4.5-h revised label cohorts (hazard ratios 0.99, 0.77−1.26 and 1.02, 0.87–1.20, respectively) but mortality remained higher outside the 4.5-h revised approval (1.17, 0.98–1.41). Conclusions: An age-revised European Union label or 4.5-h-revised United States label would each increase the number of patients deriving net benefit from alteplase by 90 days after acute ischemic stroke, without excess mortality

Mothers after gestational diabetes in Australia Diabetes Prevention Program (MAGDA-DPP) post-natal intervention: study protocol for a randomized controlled trial

Background:Gestational diabetes mellitus (GDM) is defined as glucose intolerance with its onset or first recognition during pregnancy. Post-GDM women have a life-time risk exceeding 70% of developing type 2 diabetes mellitus (T2DM). Lifestyle modifications reduce the incidence of T2DM by up to 58% for high-risk individuals.Methods/Design:The Mothers After Gestational Diabetes in Australia Diabetes Prevention Program (MAGDA-DPP) is a randomized controlled trial aiming to assess the effectiveness of a structured diabetes prevention intervention for post-GDM women. This trial has an intervention group participating in a diabetes prevention program (DPP), and a control group receiving usual care from their general practitioners during the same time period. The 12-month intervention comprises an individual session followed by five group sessions at two-week intervals, and two follow-up telephone calls. A total of 574 women will be recruited, with 287 in each arm. The women will undergo blood tests, anthropometric measurements, and self-reported health status, diet, physical activity, quality of life, depression, risk perception and healthcare service usage, at baseline and 12 months. At completion, primary outcome (changes in diabetes risk) and secondary outcome (changes in psychosocial and quality of life measurements and in cardiovascular disease risk factors) will be assessed in both groups.Discussion:This study aims to show whether MAGDA-DPP leads to a reduction in diabetes risk for post-GDM women. The characteristics that predict intervention completion and improvement in clinical and behavioral measures will be useful for further development of DPPs for this population.</span

Antenna-coupled TES bolometers used in BICEP2, Keck array, and SPIDER

We have developed antenna-coupled transition-edge sensor (TES) bolometers for a wide range of cosmic microwave background (CMB) polarimetry experiments, including BICEP2, Keck Array, and the balloon borne SPIDER. These detectors have reached maturity and this paper reports on their design principles, overall performance, and key challenges associated with design and production. Our detector arrays repeatedly produce spectral bands with 20%-30% bandwidth at 95, 150, or 220~GHz. The integrated antenna arrays synthesize symmetric co-aligned beams with controlled side-lobe levels. Cross-polarized response on boresight is typically ~0.5%, consistent with cross-talk in our multiplexed readout system. End-to-end optical efficiencies in our cameras are routinely 35% or higher, with per detector sensitivities of NET~300 uKrts. Thanks to the scalability of this design, we have deployed 2560 detectors as 1280 matched pairs in Keck Array with a combined instantaneous sensitivity of ~9 uKrts, as measured directly from CMB maps in the 2013 season. Similar arrays have recently flown in the SPIDER instrument, and development of this technology is ongoing.Comment: 16 pgs, 20 fig

Search for nucleon decays with EXO-200

A search for instability of nucleons bound in $^{136}$Xe nuclei is reported with 223 kg$\cdot$yr exposure of $^{136}$Xe in the EXO-200 experiment. Lifetime limits of 3.3$\times 10^{23}$ and 1.9$\times 10^{23}$ yrs are established for nucleon decay to $^{133}$Sb and $^{133}$Te, respectively. These are the most stringent to date, exceeding the prior decay limits by a factor of 9 and 7, respectively

Search for lepton-number violating processes in B+ -> h- l+ l+ decays

We have searched for the lepton-number violating processes B+ -> h- l+ l+ with h- = K-/pi- and l+ = e+/mu+, using a sample of 471+/-3 million BBbar events collected with the BaBar detector at the PEP-II e+e- collider at the SLAC National Accelerator Laboratory. We find no evidence for these decays and place 90% confidence level upper limits on their branching fractions Br(B+ -> pi- e+ e+) K- e+ e+) pi- mu+ mu+) K- mu+ mu+) < 6.7 x 10^{-8}.Comment: 8 pages, 4 postscript figures, submitted to Phys. Rev. D. R

IODP Expedition 328: Early Results of Cascadia Subduction Zone ACORK Observatory

Integrated Ocean Drilling Program (IODP) Expedition 328 was devoted to the installation of an "Advanced CORK" (Circulation Obviation Retrofit Kit) in the Cascadia subduction zone accretionary prism to observe the physical state and properties of the formation as they are influenced by long-term and episodic deformation and by gas hydrate accumulation. Pressures are monitored at four levels on the outside of a standard 10 3/4-inch casing string, two above and two below the base of the gas-hydrate stability zone at 230 mbsf (m below seafloor). The casing was sealed at the bottom, leaving the inside open down to 302 mbsf for installation of a tilt meter, seismometer, and thermistor cable (scheduled for 2013). The initial data, recovered in July 2011, document an initially smooth recovery from the drilling perturbation followed by what may be a sequence of hole-collapse events. Pressure at the deepest screen is roughly 40 kPa above hydrostatic; higher pressures (80 kPa) are observed at the two screens close to the level of hydrate stability. Tidal variations at the deepest screen are in phase with ocean tides, and define a loading efficiency of 0.6, which is reasonable in light of the consolidation state of the for-mation (porosity ~0.5). Tidal signals near the level of gas hydrate stability display large phase lags, probably as a consequence of hydraulic diffusion stimulated by the large contrast in interstitial fluid compressibility at the gas-hydrate boundary. The degree of isolation among the screens, the anticipated good coupling, and the estimated strain-to-pressure conversion efficiency (~5 kPa μstrain&lt;sup&gt;&amp;minus;1&lt;/sup&gt;) indicate that this installation will serve well to host a variety of hydrologic, seismic, and geodynamic experiments. &lt;br&gt;&lt;br&gt; doi:&lt;a href="http://dx.doi.org/10.2204/iodp.sd.13.02.2011" target="_blank"&gt;10.2204/iodp.sd.13.02.2011&lt;/a&gt;</jats:p

Origin and Evolution of Saturn's Ring System

The origin and long-term evolution of Saturn's rings is still an unsolved problem in modern planetary science. In this chapter we review the current state of our knowledge on this long-standing question for the main rings (A, Cassini Division, B, C), the F Ring, and the diffuse rings (E and G). During the Voyager era, models of evolutionary processes affecting the rings on long time scales (erosion, viscous spreading, accretion, ballistic transport, etc.) had suggested that Saturn's rings are not older than 100 My. In addition, Saturn's large system of diffuse rings has been thought to be the result of material loss from one or more of Saturn's satellites. In the Cassini era, high spatial and spectral resolution data have allowed progress to be made on some of these questions. Discoveries such as the ''propellers'' in the A ring, the shape of ring-embedded moonlets, the clumps in the F Ring, and Enceladus' plume provide new constraints on evolutionary processes in Saturn's rings. At the same time, advances in numerical simulations over the last 20 years have opened the way to realistic models of the rings's fine scale structure, and progress in our understanding of the formation of the Solar System provides a better-defined historical context in which to understand ring formation. All these elements have important implications for the origin and long-term evolution of Saturn's rings. They strengthen the idea that Saturn's rings are very dynamical and rapidly evolving, while new arguments suggest that the rings could be older than previously believed, provided that they are regularly renewed. Key evolutionary processes, timescales and possible scenarios for the rings's origin are reviewed in the light of tComment: Chapter 17 of the book ''Saturn After Cassini-Huygens'' Saturn from Cassini-Huygens, Dougherty, M.K.; Esposito, L.W.; Krimigis, S.M. (Ed.) (2009) 537-57