The Beatitudes Are for Today

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Survival with Treated and Well-Controlled Blood Pressure: Findings from a Prospective Cohort Study.

AIM: To compare survival and incident cardiovascular disease between normotensive, untreated hypertensive, treated and poorly-controlled hypertensive and treated and well-controlled hypertensive adults. METHODS AND RESULTS: Data from the British Regional Heart Study (men) and British Women's Heart and Health Study (women) were used (N = 6476). Blood pressure and treatment were assessed at baseline (1998-2001) when participants were aged 60-79 years and participants were followed up for a median of 8 years. Date and cause of death were obtained from death certificates and non-fatal cardiovascular disease events were obtained from repeat detailed medical record reviews. Of the whole cohort 52% of women and 49% of men had untreated hypertension and a further 22% and 18%, respectively, had poorly treated hypertension. Just 3% of women and 4% of men had treated and well controlled hypertension and 23% and 29%, respectively, were normotensive. Compared to normotensive individuals, incident cardiovascular disease (fatal and non-fatal) was increased in those with poorly-controlled hypertension (Hazard Ratio (HR): 1.88; 95%CI: 1.53, 2.30), those with untreated hypertension (HR 1.46; 95%CI 1.22, 1.75) and those who were well-controlled hypertension (HR 1.38; 95%CI 0.94, 2.03). Adjustment for baseline differences in mean blood pressure between the groups resulted in attenuation of the increased risk in the poorly-controlled (1.52 (1.18, 1.97) and untreated groups (1.21 (0.97, 1.52), but did not change the association in the well-controlled group. All-cause mortality was also increased in all three hypertension groups but estimates were imprecise with wide confidence intervals. CONCLUSIONS: Half of women and men aged 60-79 in Britain had untreated hypertension and only a very small proportion of those with diagnosed and treated hypertension were well controlled. Those with hypertension, irrespective of whether this was treated and controlled or not, were at greater risk of future cardiovascular disease than those who are normotensive

Waist-to-height ratio and cardiometabolic risk factors in adolescence: findings from a prospective birth cohort

What is already known about this subject In adults, associations between body mass index (BMI), waist-to-height ratio (WHtR) and cardiometabolic outcomes are similar. In children and adolescents, results from cross-sectional studies examining the associations between BMI z scores, WHtR and cardiometabolic outcomes are conflicting and there is a paucity of prospective data.<p></p> What this study adds This is the first study to demonstrate the prospective association between WHtR in childhood and cardiometabolic outcomes in adolescent boys. WHtR is a simple calculation that can be used to identify children and adolescents for cardiometabolic risk without the need for reference growth charts. The WHtR cut-point of ≥0.5 was highly specific in identifying cardiometabolic risk co-occurrence but has poor sensitivity.<p></p> Objective To examine the associations between body mass index (BMI) and waist-to-height ratio (WHtR) measured in childhood and adolescence and cardiometabolic risk factors in adolescence.<p></p> Methods Secondary data analysis of the Avon Longitudinal Study of Parents and Children, a population based cohort. Data from 2858 adolescents aged 15.5 (standard deviation 0.4) years and 2710 of these participants as children aged 7–9 years were used in this analysis. Outcome measures were cardiometabolic risk factors, including triglycerides, low density lipoprotein cholesterol, high density lipoprotein cholesterol, insulin, glucose and blood pressure at 15 years of age.<p></p> Results Both BMI and WHtR measured at ages 7–9 years and at age 15 years were associated with cardiometabolic risk factors in adolescents. A WHtR ≥0.5 at 7–9 years increased the odds by 4.6 [95% confidence interval 2.6 to 8.1] for males and 1.6 [0.7 to 3.9] for females of having three or more cardiometabolic risk factors in adolescence. Cross-sectional analysis indicated that adolescents who had a WHtR ≥0.5, the odds ratio of having three or more cardiometabolic risk factors was 6.8 [4.4 to 10.6] for males and 3.8 [2.3 to 6.3] for females. The WHtR cut-point was highly specific in identifying cardiometabolic risk co-occurrence in male children and adolescents as well as female children (90 to 95%), but had poor sensitivity (17 to 53%). Similar associations were observed when BMI was used to define excess adiposity.<p></p> Conclusions WHtR is a simple alternative to age and sex adjusted BMI for assessing cardiometabolic risk in adolescents

Intrahepatic Cholestasis of Pregnancy with Severe Elevation of Bile Acids in the Setting of Acute Hepatitis C Infection

Intrahepatic cholestasis of pregnancy (ICP) is a complication of pregnancy resulting in elevation of serum bile acid levels. ICP is often associated with underlying liver disease, including hepatitis C. Bile acids in relationship to the acute infection of hepatitis C virus have not yet been delineated in the literature. A 26-year-old gravida 4 para 2103 with dichorionic, diamniotic twin gestation and history of intravenous drug abuse developed ICP in the setting of acute hepatitis C infection. In addition to clinical symptoms of pruritus and right upper quadrant pain, she developed severe elevation in bile acids, 239 micromol/L, and transaminitis aspartate aminotransferase 1033 U/L, and alanine aminotransferase 448 U/L. She received ursodeoxycholic acid and antenatal testing was performed. Patient delivered vaginally at 33-week gestation following preterm rupture of membranes. Neonates were admitted to NICU and had uncomplicated neonatal courses. In the setting of ICP with significant transaminitis and severe elevation of bile acids, consideration of acute viral hepatitis is important, especially considering the worsening opioid epidemic and concurrent increase in intravenous drug use in the United States. Further study is needed regarding the acute form of HCV infection and its effect on ICP and associated bile acids

Intrahepatic Cholestasis of Pregnancy with Severe Elevation of Bile Acids in the Setting of Acute Hepatitis C Infection

Intrahepatic cholestasis of pregnancy (ICP) is a complication of pregnancy resulting in elevation of serum bile acid levels. ICP is often associated with underlying liver disease, including hepatitis C. Bile acids in relationship to the acute infection of hepatitis C virus have not yet been delineated in the literature. A 26-year-old gravida 4 para 2103 with dichorionic, diamniotic twin gestation and history of intravenous drug abuse developed ICP in the setting of acute hepatitis C infection. In addition to clinical symptoms of pruritus and right upper quadrant pain, she developed severe elevation in bile acids, 239 micromol/L, and transaminitis aspartate aminotransferase 1033 U/L, and alanine aminotransferase 448 U/L. She received ursodeoxycholic acid and antenatal testing was performed. Patient delivered vaginally at 33-week gestation following preterm rupture of membranes. Neonates were admitted to NICU and had uncomplicated neonatal courses. In the setting of ICP with significant transaminitis and severe elevation of bile acids, consideration of acute viral hepatitis is important, especially considering the worsening opioid epidemic and concurrent increase in intravenous drug use in the United States. Further study is needed regarding the acute form of HCV infection and its effect on ICP and associated bile acids

Trends in Project Management 1966 – 2015

This study charts the trends and changing emphases in project management in the last 50 years. A quantitative, positivistic study, using frequency analysis and 116,202 records from online databases, this paper uses a priori categories to search for project management keywords in the period 1966 to 2015. The key findings were that the categories of project management methods, project success and stakeholder management were likely to see an increase as the topics for publications but that the remaining 13 categories were expected to feature in fewer publications in alignment with the reduction in project management publications generally. The paper provides data on citations in project management publications and lists the 30 most cited authors in project management. It is intended that this paper will be of benefit to those studying project management, to academics who work in this sphere and to others interested in this subject area

Temporal Variability of Cetaceans near Halifax, Nova Scotia

Annual and seasonal trends in sightings of coastal cetaceans near Halifax, Nova Scotia, were studied using observations from whale watching and dedicated research vessels from late spring to early fall of 1996 to 2005. Four species of cetaceans routinely used the area during the summer: White-beaked and Atlantic White-sided dolphins (Lagenorhynchus albirostris and L. acutus), Harbour Porpoises (Phocoena phocoena), and Minke Whales (Balaenoptera acutorostrata). The dolphin species were temporally separated, with White-beaked Dolphins being common earlier in the summer than White-sided Dolphins. White-sided Dolphins were unusually abundant in 1997, and were found in larger groups (mean = 46.5 ± 46.19 sd) than Whitebeaked Dolphins (mean = 9.1 ± 5.19 SD). The area also appears to be an important habitat for dolphin calves and juveniles of both species. Fin Whales (B. physalus) were commonly observed in relatively large groups in 1997, but were uncommon or absent in other years. Humpback Whales (Megaptera novaeangliae), Blue Whales (B. musculus) and North Atlantic Right Whales (Eubalaena glacialis) were uncommon in the area, although Humpback Whales were sighted frequently in 1997. Increased numbers of White-sided Dolphins, Fin and Humpback whales in 1997 may be explained by increased prey abundance and decreased sea-surface temperatures

Physical activity is prospectively associated with adolescent nonalcoholic fatty liver disease

Objectives: The aim of the present study was to assess whether objectively measured physical activity at mean ages 12 and 14 years are prospectively associated with ultrasound scan liver fat and stiffness (alanine aminotransferase, aspartate aminotransferase [AST], and [gamma]-glutamyl transferase [GGT]) assessed at mean age 17.8 years. Methods: Participants were from the Avon Longitudinal Study of Parents and Children. Total physical activity (counts per minute) and minutes of moderate to vigorous physical activity (MVPA) were measured using ActiGraph accelerometers at mean ages 12 and 14 years. Results: Greater total physical activity and MVPA at ages 12 and 14 years were associated with lower odds of liver fat and lower GGT levels at mean age 17.8 years, such as per 15-minute increase in daily MVPA at age 12 years, the confounder adjusted odds ratio of liver fat was 0.47 (95% confidence interval [CI] 0.27–0.84). Associations attenuated after additional adjustment for fat mass as a potential confounder (eg, per 15-minute increase in daily MVPA at age 12 years, the odds ratio of liver fat attenuated to 0.65 [95% CI 0.35–1.21]) or a potential mediator (eg, per 15-minute increase in daily MVPA at age 12 years the odds ratio of liver fat attenuated to 0.59 [95% CI 0.32–1.09]). Results did not further attenuate after additional adjustment for insulin resistance. There was some evidence that greater total physical activity and MVPA at age 12 years were associated with the higher AST levels. Conclusions: Adolescents who were more active in childhood have lower odds of fatty liver and lower GGT levels. These findings are likely to be, at least in part, explained by adiposity

Weight trajectories through infancy and childhood and risk of non-alcoholic fatty liver disease in adolescence: the ALSPAC study

Background and Aims: Adiposity is a key risk factor for NAFLD. Few studies have examined prospective associations of infant and childhood adiposity with subsequent NAFLD risk. We examined associations of weight-for-height trajectories from birth to age 10 with liver outcomes in adolescence, and assessed the extent to which associations are mediated through fat mass at the time of outcome assessment.<p></p> Methods: Individual trajectories of weight and height were estimated for participants in the Avon Longitudinal Study of Parents and Children using random-effects linear-spline models. Associations of birthweight (adjusted for birth length) and weight change (adjusted for length/height change) from 0–3 months, 3 months–1 y, 1–3 y, 3–7 y, and 7–10 y with ultrasound scan (USS) determined liver fat and stiffness, and serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT) at mean age 17.8 y were assessed with linear and logistic regressions. Mediation by concurrent fat mass was assessed with adjustment for fat mass at mean age 17.8 y.<p></p> Results: Birth weight was positively associated with liver stiffness and negatively with ALT and AST. Weight change from birth to 1 y was not associated with outcomes. Weight change from 1–3 y, 3–7 y, and 7–10 y was consistently positively associated with USS and blood-based liver outcomes. Adjusting for fat mass at mean age 17.8 y attenuated associations toward the null, suggesting associations are largely mediated by concurrent body fatness.<p></p> Conclusions: Greater rates of weight-for-height change between 1 y and 10 y are consistently associated with adverse liver outcomes in adolescence. These associations are largely mediated through concurrent fatness

The born again (VLTP) scenario revisited: The mass of the remnants and implications for V4334 Sgr

We present 1-D numerical simulations of the very late thermal pulse (VLTP) scenario for a wide range of remnant masses. We show that by taking into account the different possible remnant masses, the observed evolution of V4334 Sgr (a.k.a. Sakurai's Object) can be reproduced within the standard 1D-MLT stellar evolutionary models without the inclusion of any $ad-hoc$ reduced mixing efficiency. Our simulations hint at a consistent picture with present observations of V4334 Sgr. From energetics, and within the standard MLT approach, we show that low mass remnants \hbox{($M\lesssim0.6$\msun)} are expected to behave markedly different than higher mass remnants \hbox{($M\gtrsim0.6$\msun)} in the sense that the latter are not expected to expand significantly as a result of the violent H-burning that takes place during the VLTP. We also assess the discrepancy in the born again times obtained by different authors by comparing the energy that can be liberated by H-burning during the VLTP event.Comment: Submitted to MNRAS. In includes an appendix regarding the treatment of reduced convective motions within the Mixing Length Theor