Monotherapy with major antihypertensive drug classes and risk of hospital admissions for mood disorders

Major depressive and bipolar disorders predispose to atherosclerosis, and there is accruing data from animal model, epidemiological, and genomic studies that commonly used antihypertensive drugs may have a role in the pathogenesis or course of mood disorders. In this study, we propose to determine whether antihypertensive drugs have an impact on mood disorders through the analysis of patients on monotherapy with different classes of antihypertensive drugs from a large hospital database of 525 046 patients with follow-up for 5 years. There were 144 066 eligible patients fulfilling the inclusion criteria: age 40 to 80 years old at time of antihypertensive prescription and medication exposure >90 days. The burden of comorbidity assessed by Charlson and Elixhauser scores showed an independent linear association with mood disorder diagnosis. The median time to hospital admission with mood disorder was 847 days for the 299 admissions (641 685 person-years of follow-up). Patients on angiotensin-converting enzyme inhibitors or angiotensin receptor blockers had the lowest risk for mood disorder admissions, and compared with this group, those on β-blockers (hazard ratio=2.11; [95% confidence interval, 1.12–3.98]; P=0.02) and calcium antagonists (2.28 [95% confidence interval, 1.13–4.58]; P=0.02) showed higher risk, whereas those on no antihypertensives (1.63 [95% confidence interval, 0.94–2.82]; P=0.08) and thiazide diuretics (1.56 [95% confidence interval, 0.65–3.73]; P=0.32) showed no significant difference. Overall, our exploratory findings suggest possible differential effects of antihypertensive medications on mood that merits further study: calcium antagonists and β-blockers may be associated with increased risk, whereas angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may be associated with a decreased risk of mood disorders

Development of Stresses in Cohesionless Poured Sand

The pressure distribution beneath a conical sandpile, created by pouring sand from a point source onto a rough rigid support, shows a pronounced minimum below the apex (`the dip'). Recent work of the authors has attempted to explain this phenomenon by invoking local rules for stress propagation that depend on the local geometry, and hence on the construction history, of the medium. We discuss the fundamental difference between such approaches, which lead to hyperbolic differential equations, and elastoplastic models, for which the equations are elliptic within any elastic zones present .... This displacement field appears to be either ill-defined, or defined relative to a reference state whose physical existence is in doubt. Insofar as their predictions depend on physical factors unknown and outside experimental control, such elastoplastic models predict that the observations should be intrinsically irreproducible .... Our hyperbolic models are based instead on a physical picture of the material, in which (a) the load is supported by a skeletal network of force chains ("stress paths") whose geometry depends on construction history; (b) this network is `fragile' or marginally stable, in a sense that we define. .... We point out that our hyperbolic models can nonetheless be reconciled with elastoplastic ideas by taking the limit of an extremely anisotropic yield condition.Comment: 25 pages, latex RS.tex with rspublic.sty, 7 figures in Rsfig.ps. Philosophical Transactions A, Royal Society, submitted 02/9

Play that Barber Shop Chord / music by Lewis F. Muir; words by Wm. Tracey

Cover: photo of singer Bert Williams in blackface (see 479); Publisher: J. Fred Helf Company (New York)https://egrove.olemiss.edu/sharris_c/1003/thumbnail.jp

Donating breastmilk: Regulated and unregulated practices: A review of the ethical issues

Breastmilk is the optimal source of nutrition for babies although there are a range of situations in which breastfeeding is difficult, including prematurity. Human milk is donated in the UK in both regulated and unregulated ways. A network of human milk banks receive and distribute donor milk, primarily to premature and sick infants, supported by NICE guidance (NICE, 2010) and the UK Association for Milk Banking (UKAMB). Variations in the geographical spread and funding of the banks mean that women who want to donate or receive breastmilk are not always able to do so. Discourse around the ethics of the provision and use of human milk in this way often emphasises issues of risk and safety.There are also ways in which breastmilk is donated informally, often using the terminology of ‘sharing’, usually to full-term infants. Some women feed each other’s babies via friendship groups whilst others contact each other using online (often international) networks specifically set up for the purpose of peer-to-peer human milk sharing. Health bodies in a number of countries (although not in the UK) have issued warnings against obtaining breastmilk in this way, focussing again on ‘danger’ and ‘risk’ and drawing on limited research evidence (Keim et al, 2013; Stuebe et al., 2014, cited in Palmquist and Doehler, 2014). In the UK the issues were raised in a recent BMJ editorial (Steele et al, 2015). Other researchers have compared the risk of sharing breastmilk with the (known) risks of formula feeding (Gribble and Hausman, 2012).These topics have been the subject of a range of academic papers as well as online discussions, raising questions about the ethical issues and obligations in both regulated and unregulated practices of milk donation. These include the nature of donation and whether donors and recipients are viewed differently according to the mode of donation (milk bank vs. milk sharing; donating vs. selling) and the situation of the recipient. Is the ethics of ‘giving’ a body product different when the product is human milk rather than blood or organs? Is this an area which should remain unregulated, as a private practice, or should it be more widely or formally considered? In addition there are a range of Issues relating to the perception of human milk – as both ‘white/liquid gold’ and ‘matter out of place’ (Douglas, 1966) – which draw on ideas of cultural unease about women’s bodily fluids. Milk for use in milk banks is depersonalised but there is unease about sharing intimate bodily fluids with known/unknown others. The focus here is on informal milk sharing – why and how it happens (the lived experience of donors and recipients) and how both donation and risk are framed and accounted for. What is known is mostly from the US and Australia; women who use websites for milk sharing talk about ‘informed choice’. Where they examine all the available evidence, share information about milk collection and storage and gather knowledge about the donor (e.g. is the donor breastfeeding her own baby?). Health professionals and non-professionals working with pregnant and lactating women may be asked for advice and need to consider these issues. My conclusion is that breastmilk donation differs from other forms of donation in important ways; donating and sharing breastmilk has increased in prevalence and possibilities but the scale and scope of informal milk sharing in the UK is unknown. Many opportunities to donate and receive breastmilk have arisen in grassroots woman-to-woman ways (in a similar way to other forms of parenting and breastfeeding support). Ideas of risk frame the ‘official’ reaction to sharing breastmilk via the internet (but not in the UK) and little is known about how individual women understand and make sense of these risks

Play That Barber Shop Chord / music by Lewis F. Muir; words by Wm. Tracy

Key of C. Cover: a photo of a man in a black suit; Publisher: J. Fred Helf Company (New York)https://egrove.olemiss.edu/sharris_c/1014/thumbnail.jp

On representations of super coalgebras

The general structure of the representation theory of a $Z_2$-graded coalgebra is discussed. The result contains the structure of Fourier analysis on compact supergroups and quantisations thereof as a special case. The general linear supergroups serve as an explicit illustration and the simplest example is carried out in detail.Comment: 18 pages, LaTeX, KCL-TH-94-

Advances in Ambulatory Oxygen workshop and Longterm Oxygen therapy in real-life practice.

The practical workshop presented recent advances in the field of ambulatory oxygen (AO), with experts discussing identification of patients who would benefit from AO, as well as current trials to measure specific benefits of AO in chronic patients. In particular, AO prescription in clinical practice and developments in pulsed-dose delivery of AO as a more efficient method of oxygen delivery were extensively discussed. After audience questions, the attendees had the opportunity to handle the AO systems on display in order to gain greater insight into their functionality and wearability, which should assist them in providing the most appropriate device for each patient. The symposium addressed considerations required when prescribing long-term oxygen therapy (LTOT). Dr Kampelmacher reviewed current indications for LTOT, emphasising the importance of accurate assessment of patients for LTOT, optimisation of oxygen dose, and patient education. Dr Vivodtzev discussed the evidence for LTOT in patients with exercise-induced desaturation, the role of portable oxygen concentrators, and the optimisation necessary to benefit from their use. The symposium concluded with a health economic study presented by Dr Little, demonstrating the cost benefits of a reform of the Scottish healthcare oxygen supply service

The Effect of Condensed Tannins in Lotus spp. on the Lesser Migratory Grasshopper

Hatchling grasshoppers (Melanoplus sanguinipes Fab.) fed one accession of field grown big trefoil (Lotus uliginosis Schkuhr) containing a tannin content of 56 mg. g-1 FW, had a significantly lower mean weight than hatchlings fed field grown Lotus species and accessions with lower tannin content. Adult female grasshoppers fed L. uliginosis foliage with 32.3 mg.g-1 FW tannin also ate more feed and had a 2-fold higher gut trypsin and chymotrypsin activity than adults fed low tannin L. corniculatus foliage (0.13 mg.g-1 FW tannin). In more controlled experiments, growth at 20o C or 30o C was used to increase tannin in rooted cuttings of L. uliginosis to concentrations ranging from 7 to 195 mg.g-1 FW. Hatchling weight decreased as a function of dietary tannin concentration when fed these clones. Both hatchling weight and survival were affected when hatchlings were fed pelleted wheat seedlings supplemented with purified L. uliginosis tannin preparations