219 research outputs found

    Endothelin-1 Predicts Hemodynamically Assessed Pulmonary Arterial Hypertension in HIV Infection.

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    BackgroundHIV infection is an independent risk factor for PAH, but the underlying pathogenesis remains unclear. ET-1 is a robust vasoconstrictor and key mediator of pulmonary vascular homeostasis. Higher levels of ET-1 predict disease severity and mortality in other forms of PAH, and endothelin receptor antagonists are central to treatment, including in HIV-associated PAH. The direct relationship between ET-1 and PAH in HIV-infected individuals is not well described.MethodsWe measured ET-1 and estimated pulmonary artery systolic pressure (PASP) with transthoracic echocardiography (TTE) in 106 HIV-infected individuals. Participants with a PASP ≥ 30 mmHg (n = 65) underwent right heart catheterization (RHC) to definitively diagnose PAH. We conducted multivariable analysis to identify factors associated with PAH.ResultsAmong 106 HIV-infected participants, 80% were male, the median age was 52 years and 77% were on antiretroviral therapy. ET-1 was significantly associated with higher values of PASP [14% per 0.1 pg/mL increase in ET-1, p = 0.05] and PASP ≥ 30 mmHg [PR (prevalence ratio) = 1.24, p = 0.012] on TTE after multivariable adjustment for PAH risk factors. Similarly, among the 65 individuals who underwent RHC, ET-1 was significantly associated with higher values of mean pulmonary artery pressure and PAH (34%, p = 0.003 and PR = 2.43, p = 0.032, respectively) in the multivariable analyses.ConclusionsHigher levels of ET-1 are independently associated with HIV-associated PAH as hemodynamically assessed by RHC. Our findings suggest that excessive ET-1 production in the setting of HIV infection impairs pulmonary endothelial function and contributes to the development of PAH

    Discovery of the Onset of Rapid Accretion by a Dormant Massive Black Hole

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    Massive black holes are believed to reside at the centres of most galaxies. They can be- come detectable by accretion of matter, either continuously from a large gas reservoir or impulsively from the tidal disruption of a passing star, and conversion of the gravitational energy of the infalling matter to light. Continuous accretion drives Active Galactic Nuclei (AGN), which are known to be variable but have never been observed to turn on or off. Tidal disruption of stars by dormant massive black holes has been inferred indirectly but the on- set of a tidal disruption event has never been observed. Here we report the first discovery of the onset of a relativistic accretion-powered jet in the new extragalactic transient, Swift J164449.3+573451. The behaviour of this new source differs from both theoretical models of tidal disruption events and observations of the jet-dominated AGN known as blazars. These differences may stem from transient effects associated with the onset of a powerful jet. Such an event in the massive black hole at the centre of our Milky Way galaxy could strongly ionize the upper atmosphere of the Earth, if beamed towards us.Comment: Submitted to Nature. 4 pages, 3 figures (main paper). 26 pages, 13 figures (supplementary information

    Changes in physical health among participants in a multidisciplinary health programme for long-term unemployed persons

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    Background. The relationship between poor health and unemployment is well established. Health promotion among unemployed persons may improve their health. The aims of this study were to investigate characteristics of non-participants and drop-outs in a multidisciplinary health promotion programme for long-term unemployed persons with health complaints, to evaluate changes in physical health among participants, and to investigate determinants of improvement in physical health. Methods. A longitudinal, non-controlled design was used. The programme consisted of two weekly exercise sessions and one weekly cognitive session during 12 weeks. The main outcome measures were body mass index, blood pressure, cardiorespiratory fitness, abd

    Nothing Lasts Forever: Environmental Discourses on the Collapse of Past Societies

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    The study of the collapse of past societies raises many questions for the theory and practice of archaeology. Interest in collapse extends as well into the natural sciences and environmental and sustainability policy. Despite a range of approaches to collapse, the predominant paradigm is environmental collapse, which I argue obscures recognition of the dynamic role of social processes that lie at the heart of human communities. These environmental discourses, together with confusion over terminology and the concepts of collapse, have created widespread aporia about collapse and resulted in the creation of mixed messages about complex historical and social processes

    Forecasting the duration of volcanic eruptions: an empirical probabilistic model

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    The ability to forecast future volcanic eruption durations would greatly benefit emergency response planning prior to and during a volcanic crises. This paper introduces a probabilistic model to forecast the duration of future and on-going eruptions. The model fits theoretical distributions to observed duration data and relies on past eruptions being a good indicator of future activity. A dataset of historical Mt. Etna flank eruptions is presented and used to demonstrate the model. The data has been compiled through critical examination of existing literature along with careful consideration of uncertainties on reported eruption start and end dates between the years 1300 AD and 2010 and data following 1600 is considered to be reliable and free of reporting biases. The distribution of eruption durations between the years 1600 and 1670 is found to be statistically different from that following 1670 and represents the culminating phase of a century-scale cycle. The forecasting model is run on two datasets ofMt. Etna flank eruption durations; 1600-2010 and 1670-2010. Each dataset is modelled using a log-logistic distribution with parameter values found by maximum likelihood estimation. Survivor function statistics are applied to the model distributions to forecast (a) the probability of an eruption exceeding a given duration, (b) the probability of an eruption that has already lasted a particular number of days exceeding a given total duration and (c) the duration with a given probability of being exceeded. Results show that excluding the 1600-1670 data has little effect of the forecasting model result, especially where short durations are involved. By assigning the terms ‘likely’ and ‘unlikely’ to probabilities of 66 % and 33 %, respectively the forecasting model is used on the 1600-2010 dataset to indicate that a future flank eruption on Mt. Etna would be likely to exceed 20 days (± 7 days) but unlikely to exceed 68 days (± 29 days). This model can easily be adapted for use on other highly active, well-documented volcanoes or for different duration data such as the duration of explosive episodes or the duration of repose periods between eruptions
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