Spatial clustering of mental disorders and associated characteristics of the neighbourhood context in Malmö, Sweden, in 2001

Study objective: Previous research provides preliminary evidence of spatial variations of mental disorders and associations between neighbourhood social context and mental health. This study expands past literature by (1) using spatial techniques, rather than multilevel models, to compare the spatial distributions of two groups of mental disorders (that is, disorders due to psychoactive substance use, and neurotic, stress related, and somatoform disorders); and (2) investigating the independent impact of contextual deprivation and neighbourhood social disorganisation on mental health, while assessing both the magnitude and the spatial scale of these effects. Design: Using different spatial techniques, the study investigated mental disorders due to psychoactive substance use, and neurotic disorders. Participants: All 89 285 persons aged 40–69 years residing in Malmö, Sweden, in 2001, geolocated to their place of residence. Main results: The spatial scan statistic identified a large cluster of increased prevalence in a similar location for the two mental disorders in the northern part of Malmö. However, hierarchical geostatistical models showed that the two groups of disorders exhibited a different spatial distribution, in terms of both magnitude and spatial scale. Mental disorders due to substance consumption showed larger neighbourhood variations, and varied in space on a larger scale, than neurotic disorders. After adjustment for individual factors, the risk of substance related disorders increased with neighbourhood deprivation and neighbourhood social disorganisation. The risk of neurotic disorders only increased with contextual deprivation. Measuring contextual factors across continuous space, it was found that these associations operated on a local scale. Conclusions: Taking space into account in the analyses permitted deeper insight into the contextual determinants of mental disorders

Higgs ultraviolet softening

We analyze the leading effective operators which induce a quartic momentum dependence in the Higgs propagator, for a linear and for a non-linear realization of electroweak symmetry breaking. Their specific study is relevant for the understanding of the ultraviolet sensitivity to new physics. Two methods of analysis are applied, trading the Lagrangian coupling by: i) a "ghost" scalar, after the Lee-Wick procedure; ii) other effective operators via the equations of motion. The two paths are shown to lead to the same effective Lagrangian at first order in the operator coefficients. It follows a modification of the Higgs potential and of the fermionic couplings in the linear realization, while in the non-linear one anomalous quartic gauge couplings, Higgs-gauge couplings and gauge-fermion interactions are induced in addition. Finally, all LHC Higgs and other data presently available are used to constrain the operator coefficients; the future impact of $pp\to\text{4 leptons}$ data via off-shell Higgs exchange and of vector boson fusion data is considered as well. For completeness, a summary of pure-gauge and gauge-Higgs signals exclusive to non-linear dynamics at leading-order is included.Comment: 31 pages, 3 figures, 7 table

Disentangling a dynamical Higgs

The pattern of deviations from Standard Model predictions and couplings is different for theories of new physics based on a non-linear realization of the $SU(2)_L\times U(1)_Y$ gauge symmetry breaking and those assuming a linear realization. We clarify this issue in a model-independent way via its effective Lagrangian formulation in the presence of a light Higgs particle, up to first order in the expansions: dimension-six operators for the linear expansion and four derivatives for the non-linear one. Complete sets of pure gauge and gauge-Higgs operators are considered, implementing the renormalization procedure and deriving the Feynman rules for the non-linear expansion. We establish the theoretical relation and the differences in physics impact between the two expansions. Promising discriminating signals include the decorrelation in the non-linear case of signals correlated in the linear one: some pure gauge versus gauge-Higgs couplings and also between couplings with the same number of Higgs legs. Furthermore, anomalous signals expected at first order in the non-linear realization may appear only at higher orders of the linear one, and vice versa. We analyze in detail the impact of both type of discriminating signals on LHC physics.Comment: Version published in JHE

Myocarditis evolving in cardiomyopathy: When genetics and offending causes work together

Myocarditis is an infectious-inflammatory disease often superimposed to individual genetic background which could favour or inhibit its progression into a chronic heart muscle disorder (most often dilated cardiomyopathy, rarely arrhythmogenic, or right-sided cardiomyopathy). Post-myocarditis cardiomyopathy is likely caused by a complex interaction between the viral infection and an individual predisposition. Some viruses are able to highlight a clinical phenotype replicating a model similar to the genetically determined conditions, while other can affect the resolution or the progressive remodelling of the left ventricle after the infectious process. The identification of specific individual genetic backgrounds, or genes favouring the progression of the disease, are important future research goals for precision medicine aiming at a specific and individualized treatment for patients affected with myocarditis

Understanding the effects of a decentralized budget on physicians' compliance with guidelines for statin prescription – a multilevel methodological approach

<p>Abstract</p> <p>Background</p> <p>Official guidelines that promote evidence-based and cost-effective prescribing are of main relevance for obvious reasons. However, to what extent these guidelines are followed and their conditioning factors at different levels of the health care system are still insufficiently known.</p> <p>In January 2004, a decentralized drug budget was implemented in the county of Scania, Sweden. Focusing on lipid-lowering drugs (i.e., statins), we evaluated the effect of this intervention across a 25-month period. We expected that increased local economic responsibility would promote prescribing of recommended statins.</p> <p>Methods</p> <p>We performed two separate multilevel regression analyses; on 110 827 individual prescriptions issued at 136 <it>publicly</it>-administered health care centres (HCCs) nested within 14 administrative areas (HCAs), and on 72 012 individual prescriptions issued by 115 <it>privately</it>-administered HCCs. Temporal trends in the prevalence of prescription of recommended statins were investigated by random slope analysis. Differences (i.e., variance) between HCCs and between HCAs were expressed by median odds ratio (MOR).</p> <p>Results</p> <p>After the implementation of the decentralized drug budget, adherence to guidelines increased continuously. At the end of the observation period, however, practice variation remained high. Prescription of recommended statins presented a high degree of clustering within both publicly (i.e., MOR_HCC= 2.18 and MOR_HCA= 1.31 respectively) and privately administered facilities (MOR_HCC= 3.47).</p> <p>Conclusion</p> <p>A decentralized drug budget seems to promote adherence to guidelines for statin prescription. However, the high practice differences at the end of the observation period may reflect inefficient therapeutic traditions, and indicates that rational statin prescription could be further improved.</p

Self-pulsing effect in chaotic scattering

We study the quantum and classical scattering of Hamiltonian systems whose chaotic saddle is described by binary or ternary horseshoes. We are interested in parameters of the system for which a stable island, associated with the inner fundamental periodic orbit of the system exists and is large, but chaos around this island is well developed. In this situation, in classical systems, decay from the interaction region is algebraic, while in quantum systems it is exponential due to tunneling. In both cases, the most surprising effect is a periodic response to an incoming wave packet. The period of this self-pulsing effect or scattering echoes coincides with the mean period, by which the scattering trajectories rotate around the stable orbit. This period of rotation is directly related to the development stage of the underlying horseshoe. Therefore the predicted echoes will provide experimental access to topological information. We numerically test these results in kicked one dimensional models and in open billiards.Comment: Submitted to New Journal of Physics. Two movies (not included) and full-resolution figures are available at http://www.cicc.unam.mx/~mejia