Time trends in survival and readmission following coronary artery bypass grafting in Scotland, 1981-96: retrospective observational study

Improvements in coronary revascularisation techniques and an increase in the use of percutaneous interventions1 have led to a rise in the number of coronary artery bypass grafting operations in older patients with more severe cardiac disease and worse comorbidity and who have previously undergone revascularisation procedures. 2 3 Advances in surgical and anaesthetic techniques have prevented a worsening risk profile from being translated into an increase in perioperative deaths. 2 3 The aim of our study was to examine time trends in major outcomes up to two years after coronary artery bypass grafting

Short-term and long-term outcomes in 133 429 emergency patients admitted with angina or myocardial infarction in Scotland, 1990-2000: population-based cohort study

Objective: To analyse short- and long-term outcomes and prognostic factors in a large population-based cohort of unselected patients with a first emergency admission for suspected acute coronary syndrome between 1990 and 2000 in Scotland. Methods: All first emergency admissions for acute myocardial infarction (AMI) and all first emergency admissions for angina (the proxy for unstable angina) between 1990 and 2000 in Scotland (population 5.1 million) were identified. Survival to five years was examined by Cox multivariate modelling to examine the independent prognostic effects of diagnosis, age, sex, year of admission, socioeconomic deprivation and co-morbidity. Results: In Scotland between 1990 and 2000, 133 429 individual patients had a first emergency admission for suspected acute coronary syndrome: 96 026 with AMI and 37 403 with angina. After exclusion of deaths within 30 days, crude five-year case fatality was similarly poor for patients with angina and those with AMI (23.9% v 21.6% in men and 23.5% v 26.0% in women). The longer-term risk of a subsequent fatal or non-fatal event in the five years after first hospital admission was high: 54% in men after AMI (53% in women) and 56% after angina (49% in women). Event rates increased threefold with increasing age and 20–60% with different co-morbidities, but were 11–34% lower in women. Conclusions: Longer-term case fatality was similarly high in patients with angina and in survivors of AMI, about 5% a year. Furthermore, half the patients experienced a fatal or non-fatal event within five years. These data may strengthen the case for aggressive secondary prevention in all patients presenting with acute coronary syndrome

Heat Capacity in Magnetic and Electric Fields Near the Ferroelectric Transition in Tri-Glycine Sulfate

Specific-heat measurements are reported near the Curie temperature ($T_C$~= 320 K) on tri-glycine sulfate. Measurements were made on crystals whose surfaces were either non-grounded or short-circuited, and were carried out in magnetic fields up to 9 T and electric fields up to 220 V/cm. In non-grounded crystals we find that the shape of the specific-heat anomaly near $T_C$ is thermally broadened. However, the anomaly changes to the characteristic sharp $\lambda$-shape expected for a continuous transition with the application of either a magnetic field or an electric field. In crystals whose surfaces were short-circuited with gold, the characteristic $\lambda$-shape appeared in the absence of an external field. This effect enabled a determination of the critical exponents above and below $T_C$, and may be understood on the basis that the surface charge originating from the pyroelectric coefficient, $dP/dT$, behaves as if shorted by external magnetic or electric fields.Comment: 4 Pages, 4 Figures. To Appear in Applied Physics Letters_ January 200

Prevalence of vitamin D deficiency in Pakistan and implications for the future

Background and aims: Vitamin D deficiency (25-hydroxyvitamin D - VitDD) affects over one billion people worldwide. VitDD results in progression of osteoporosis as well as other conditions. Previous studies have shown high rates of VitDD in Pakistan despite appreciable levels of sunshine. However, none have assessed VitDD across all age groups, genders, incomes and locations to guide future strategies. Methods: Questionnaire and blood sampling among 4830 randomly selected citizens. Results: High levels of VitDD among all age groups, genders, income levels and locations. 53.5% had VitDD, 31.2% had insufficient Vitamin D and only 15.3% normal Vitamin D. Conclusion: High rates of VitDD in Pakistan despite high levels of sunshine and previous Food Acts asking for food fortification with Vitamin D. Public health strategies are needed to address high VitDD rates, including food fortification, i.e. nurture, alongside increasing exposure to sunlight, i.e. nature. This will involve all key stakeholder groups

Linear Stochastic Models of Nonlinear Dynamical Systems

We investigate in this work the validity of linear stochastic models for nonlinear dynamical systems. We exploit as our basic tool a previously proposed Rayleigh-Ritz approximation for the effective action of nonlinear dynamical systems started from random initial conditions. The present paper discusses only the case where the PDF-Ansatz employed in the variational calculation is ``Markovian'', i.e. is determined completely by the present values of the moment-averages. In this case we show that the Rayleigh-Ritz effective action of the complete set of moment-functions that are employed in the closure has a quadratic part which is always formally an Onsager-Machlup action. Thus, subject to satisfaction of the requisite realizability conditions on the noise covariance, a linear Langevin model will exist which reproduces exactly the joint 2-time correlations of the moment-functions. We compare our method with the closely related formalism of principal oscillation patterns (POP), which, in the approach of C. Penland, is a method to derive such a linear Langevin model empirically from time-series data for the moment-functions. The predictive capability of the POP analysis, compared with the Rayleigh-Ritz result, is limited to the regime of small fluctuations around the most probable future pattern. Finally, we shall discuss a thermodynamics of statistical moments which should hold for all dynamical systems with stable invariant probability measures and which follows within the Rayleigh-Ritz formalism.Comment: 36 pages, 5 figures, seceq.sty for sequential numbering of equations by sectio

How well do activity monitors estimate energy expenditure? A systematic review and meta-analysis

Objective: To determine the accuracy of wrist and arm-worn activity monitors’ estimates of energy expenditure (EE). Data sources: SportDISCUS (EBSCOHost), PubMed, MEDLINE (Ovid), PsycINFO (EBSCOHost), Embase (Ovid) and CINAHL (EBSCOHost). Design: A random effects meta-analysis was performed to evaluate the difference in EE estimates between activity monitors and criterion measurements. Moderator analyses were conducted to determine the benefit of additional sensors and to compare the accuracy of devices used for research purposes with commercially available devices. Eligibility criteria: We included studies validating EE estimates from wrist-worn or arm-worn activity monitors against criterion measures (indirect calorimetry, room calorimeters and doubly labelled water) in healthy adult populations. Results: 60 studies (104 effect sizes) were included in the meta-analysis. Devices showed variable accuracy depending on activity type. Large and significant heterogeneity was observed for many devices (I2 >75%). Combining heart rate or heat sensing technology with accelerometry decreased the error in most activity types. Research-grade devices were statistically more accurate for comparisons of total EE but less accurate than commercial devices during ambulatory activity and sedentary tasks. Conclusions: EE estimates from wrist and arm-worn devices differ in accuracy depending on activity type. Addition of physiological sensors improves estimates of EE, and research-grade devices are superior for total EE. These data highlight the need to improve estimates of EE from wearable devices, and one way this can be achieved is with the addition of heart rate to accelerometry. PROSPEROregistration number: CRD42018085016

Numerical Evolution of axisymmetric vacuum spacetimes: a code based on the Galerkin method

We present the first numerical code based on the Galerkin and Collocation methods to integrate the field equations of the Bondi problem. The Galerkin method like all spectral methods provide high accuracy with moderate computational effort. Several numerical tests were performed to verify the issues of convergence, stability and accuracy with promising results. This code opens up several possibilities of applications in more general scenarios for studying the evolution of spacetimes with gravitational waves.Comment: 11 pages, 6 figures. To appear in Classical and Quantum Gravit