Schizophrenia is associated with excess multiple physical-health comorbidities but low levels of recorded cardiovascular disease in primary care: cross-sectional study

<b>Objective</b> To assess the nature and extent of physical-health comorbidities in people with schizophrenia and related psychoses compared with controls. <p></p> <b>Design </b>Cross-sectional study. <p></p> <b>Setting </b>314 primary care practices in Scotland. <p></p> <b>Participants </b>9677 people with a primary care record of schizophrenia or a related psychosis and 1 414 701 controls. Main outcome measures Primary care records of 32 common chronic physical-health conditions and combinations of one, two and three or more physical-health comorbidities adjusted for age, gender and deprivation status. <p></p> <b>Results</b> Compared with controls, people with schizophrenia were significantly more likely to have one physical-health comorbidity (OR 1.21, 95% CI 1.16 to 1.27), two physical-health comorbidities (OR 1.37, 95% CI 1.29 to 1.44) and three or more physical-health comorbidities (OR 1.19, 95% CI 1.12 to 1.27). Rates were highest for viral hepatitis (OR 3.98, 95% CI 2.81 to 5.64), constipation (OR 3.24, 95% CI 3.00 to 4.49) and Parkinson's disease (OR 3.07, 95% CI 2.42 to 3.88) but people with schizophrenia had lower recorded rates of cardiovascular disease, including atrial fibrillation (OR 0.62, 95% CI 0.51 to 0.73), hypertension (OR 0.71, 95% CI 0.67 to 0.76), coronary heart disease (OR 0.75, 95% CI 0.61 to 0.71) and peripheral vascular disease (OR 0.83, 95% CI 0.71 to 0.97).<p></p> <b>Conclusions </b>People with schizophrenia have a wide range of comorbid and multiple physical-health conditions but are less likely than people without schizophrenia to have a primary care record of cardiovascular disease. This suggests a systematic under-recognition and undertreatment of cardiovascular disease in people with schizophrenia, which might contribute to substantial premature mortality observed within this patient group. <p></p&gt

A summer time series of particulate carbon in the air and snow at Summit, Greenland

Carbonaceous particulate matter is ubiquitous in the lower atmosphere, produced by natural and anthropogenic sources and transported to distant regions, including the pristine and climate-sensitive Greenland Ice Sheet. During the summer of 2006, ambient particulate carbonaceous compounds were characterized on the Greenland Ice Sheet, including the measurement of particulate organic (OC) and elemental (EC) carbon, particulate water-soluble organic carbon (WSOC), particulate absorption coefficient (σap), and particle size-resolved number concentration (PM0.1–1.0). Additionally, parallel ∼50-day time series of water-soluble organic carbon (WSOC), water-insoluble organic carbon (WIOC), and elemental carbon (EC) were quantified at time increments of 4–24 h in the surface snow. Measurement of atmospheric particulate carbon found WSOC (average of 52 ng m−3) to constitute a major fraction of particulate OC (average of 56 ng m−3), suggesting that atmospheric organic compounds reaching the Greenland Ice Sheet in summer are highly oxidized. Atmospheric EC (average of 7 ng m−3) was well-correlated with σap (r = 0.95) and the calculated mass-absorption cross-section (average of 24 m2 g−1) appears to be similar to that measured using identical techniques in an urban environment in the United States. Comparing surface snow to atmospheric particulate matter concentrations, it appears the snow has a much higher OC (WSOC+WIOC) to EC ratio (205:1) than air (10:1), suggesting that snow is additionally influenced by water-soluble gas-phase compounds. Finally, the higher-frequency (every 4–6 h) sampling of snow-phase WSOC revealed significant loss (40–54%) of related organic compounds in surface snow within 8 h of wet deposition

How to design and evaluate interventions to improve outcomes for patients with multimorbidity

Multimorbidity is a major challenge for patients and healthcare providers. The limited evidence of the effectiveness of interventions for people with multimorbidity means that there is a need for much more research and trials of potential interventions. Here we present a consensus view from a group of international researchers working to improve care for people with multimorbidity to guide future studies of interventions. We suggest that there is a need for careful consideration of whom to include, how to target interventions that address specific problems and that do not add to treatment burden, and selecting outcomes that matter both to patients and the healthcare system. Innovative design of these interventions will be necessary as many will be introduced in service settings and it will be important to ensure methodological rigour, relevance to service delivery, and generalizability across healthcare systems

Particulate and water-soluble carbon measured in recent snow at Summit, Greenland

Water-soluble organic carbon (WSOC), waterinsoluble particulate organic carbon (WIOC), and particulate elemental carbon (EC) were measured simultaneously for the first time on the Greenland Ice Sheet in surface snow and in a 3-meter snow pit. Snow pit concentrations reveal that, on average, WSOC makes up the majority (89%) of carbonaceous species, followed by WIOC (10%) and EC (1%). The enhancement of OC relative to EC (ratio 99:1) in Greenland snow suggests that, along with atmospheric particulate matter, gaseous organics contribute to snow-phase OC. Comparison of summer surface snow concentrations in 2006 with past summer snow pit layers (2002 – 2005) found a significant depletion in WSOC (20 – 82%) and WIOC (46 – 65%) relative to EC for 3 of the 4 years. The apparent substantial loss of WSOC and WIOC in aged snow suggests that post-depositional processes, such as photochemical reactions, need to be considered in linking ice core records of organics to atmospheric concentrations. Citation: Hagler, G. S. W., M. H. Bergin, E. A. Smith, J. E. Dibb, C. Anderson, and E. J. Steig (2007), Particulate and water-soluble carbon measured in recent snow at Summit, Greenland, Geophys. Res. Lett., 34, L16505, doi:10.1029/2007GL030110

Maximizing Dividends without Bankruptcy

Consider the classical compound Poisson model of risk theory, in which dividends are paid to the shareholders according to a barrier strategy. Let b* be the level of the barrier that maximizes the expectation of the discounted dividends until ruin. This paper is inspired by Dickson and Waters (2004). They point out that the shareholders should be liable to cover the deficit at ruin. Thus, they consider b0 , the level of the barrier that maximizes the expectation of the difference between the discounted dividends until ruin and the discounted deficit at ruin. In this paper, b* and b0 are compared, when the claim amount distribution is exponential or a combination of exponential

Geophysical Exploration of Vesta

Dawn’s year-long stay at Vesta allows comprehensive mapping of the shape, topography, geology, mineralogy, elemental abundances, and gravity field using it’s three instruments and highprecision spacecraft navigation. In the current Low Altitude Mapping Orbit (LAMO), tracking data is being acquired to develop a gravity field expected to be accurate to degree and order ~20 [1, 2]. Multi-angle imaging in the Survey and High Altitude Mapping Orbit (HAMO) has provided adequate stereo coverage to develop a shape model accurate to ~10 m at 100 m horizontal spatial resolution. Accurate mass determination combined with the shape yields a more precise value of bulk density, albeit with some uncertainty resulting from the unmeasured seasonally-dark north polar region. The shape and gravity of Vesta can be used to infer the interior density structure and investigate the nature of the crust, informing models for Vesta’s formation and evolution

Rooting out ultraweak photon emission a-mung bean sprouts

It is well known that life has evolved to use and generate light, for instance, photosynthesis, vision and bioluminescence. What is less well known is that during normal metabolism, it can generate 1–100 photons s−1 cm–2 known as ultra-weak photon emission (UPE), biophoton emission or biological autoluminescence. The highest generation of these metabolic photons seem to occur during oxidative stress due to the generation and decay of reactive oxygen species (ROS), and their interaction with other components of the cell. To study this further, we have configured a sensitive detection system to study photon emission in germinating mung beans. Here we investigated growing mung beans over 7 days at a constant temperature of 21 ± 1 °C in a light tight box, using dual top and bottom opposing photomultiplier tubes. Over this time period we showed that in total, mung beans grown from seeds generated an average of 5 ± 1 counts s−1 above background. As the new bean stems grew, they showed a gradual linear increase in emission of up to 30 ± 1 counts s−1, in agreement with previous literature. In addition to this “steady-state” emission we also observe delayed luminescence and drought-stress response emission previously observed in other species. Finally, we also observe episodic increased emission events of between 2 and 15 counts s−1 for durations of around 3 h detected underneath the sample, and assign these to the growing of secondary roots. We then induce secondary root formation using aqueous solutions of growth hormones hydrogen peroxide (H2O2, 167 µM) or 3-indole acetic acid (IAA, 0.5 µM) for watering. Both hormones show prolonged increase in emission above steady-state, over days 3–5 with at least 3 times the number of secondary roots formed compared with water alone. We also observed a significant peak increase in photon emission (474 and 1738 cps vs. 28 and 55 cps for water alone) for the H2O2 which we attribute to direct ROS reaction emission as confirmed by measurement on dead plants. Altogether we have expanded upon and demonstrated an instrument and biological system for reliably producing and measuring intrinsic metabolic photons, first observed 100 years ago by Alexander Gurwitsch

The normal ranges of cardiovascular parameters measured using the ultrasonic cardiac output monitor

The ultrasonic cardiac output monitor (USCOM) is a noninvasive transcutaneous continuous wave Doppler method for assessing hemodynamics. There are no published reference ranges for normal values in adults (aged 18– 60 years) for this device. This study aimed to (1) measure cardiovascular indices using USCOM in healthy adults aged 18–60 years; (2) combine these data with those for healthy children (aged 0–12), adolescents (aged 12–18), and the elderly (aged over 60) from our previously published studies in order to present normal ranges for all ages, and (3) establish normal ranges of USCOM-derived variables according to both weight and age. This was a population- based cross-sectional observational study of healthy Chinese subjects aged 0.5–89 years in Hong Kong. USCOM scans were performed on all subjects, to produce measurements including stroke volume, cardiac output, and systemic vascular resistance. Data from previously published studies (children, adolescents, and the elderly) were included. Normal ranges were defined as lying between the 2.5th and 97.5th percentiles. A total of 2218 subjects were studied (mean age = 16.4, range = 0.5–89; 52% male). From previous studies, 1197 children (aged 0–12, 55% male), 590 adolescents (aged 12–18, 49% male), and 77 elderly (aged 60–89, 55% male) were included. New data were collected from 354 adults aged 18–60 (47% male). Normal ranges are presented according to age and weight. We present comprehensive normal ranges for hemodynamic parameters obtained with USCOM in healthy subjects of all ages from infancy to the elderly

Selection of mosquito life-histories: a hidden weapon against malaria?

Background: There has recently been a substantial decline in malaria incidence in much of Africa. While the decline can clearly be linked to increasing coverage of mosquito vector control interventions and effective drug treatment in most settings, the ubiquity of reduction raises the possibility that additional ecological and associated evolutionary changes may be reinforcing the effectiveness of current vector control strategies in previously unanticipated ways. Presentation of hypothesis: Here it is hypothesized that the increasing coverage of insecticide-treated bed nets and other vector control methods may be driving selection for a shift in mosquito life history that reduces their ability to transmit malaria parasites. Specifically it is hypothesized that by substantially increasing the extrinsic rate of mortality experienced in vector populations, these interventions are creating a fitness incentive for mosquitoes to re-allocate their resources towards greater short-term reproduction at the expense of longer-term survival. As malaria transmission is fundamentally dependent on mosquito survival, a life history shift in this direction would greatly benefit control. Testing the hypothesis: At present, direct evaluation of this hypothesis within natural vector populations presents several logistical and methodological challenges. In the meantime, many insights can be gained from research previously conducted on wild Drosophila populations. Long-term selection experiments on these organisms suggest that increasing extrinsic mortality by a magnitude similar to that anticipated from the up-scaling of vector control measures generated an increase in their intrinsic mortality rate. Although this increase was small, a change of similar magnitude in Anopheles vector populations would be predicted to reduce malaria transmission by 80%. Implications of hypothesis: The hypothesis presented here provides a reminder that evolutionary processes induced by interventions against disease vectors may not always act to neutralize intervention effectiveness. In the search for new intervention strategies, consideration should be given to both the potential disadvantages and advantages of evolutionary processes resulting from their implementation, and attempts made to exploit those with greatest potential to enhance control