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The goals of the present study were to examine the associations between depressive symptoms, sleep problems and the risk of developing heart disease in a Canadian community sample.
Baseline data were from the CARTaGENE study, a community health survey of adults aged 40–69 years in Quebec, Canada. Incidence of heart disease was examined in N = 33 455 participants by linking survey data with administrative health insurance data. Incident heart disease was identified using the World Health Organization's International Classification of Diseases, 9th or 10th edition (ICD-9 and ICD-10) diagnostic codes for heart disease. Sleep problems were assessed with diagnostic codes for sleep disorders within the 2 years preceding the baseline assessment. Average sleep duration was assessed by self-report. Depressive symptoms were assessed with the nine-item Patient Health Questionnaire.
In total, 2448 (7.3%) participants developed heart disease over an average follow-up period of 4.6 years. Compared to those without depressive symptoms and with no sleep disorders, those with elevated depressive symptoms and a sleep disorder (HR = 2.60, 95% CI 1.83–3.69), those with depressive symptoms alone (HR = 1.40, 95% CI 1.25–1.57) and those with sleep disorders alone (HR = 1.33, 95% CI 1.03–1.73) were more likely to develop heart disease. Test of additive interaction suggested a synergistic interaction between depressive symptoms and sleep disorders (synergy index = 2.17 [95% CI 1.01–4.64]). When sleep duration was considered, those with long sleep duration and elevated depressive symptoms were more likely to develop heart disease than those with long sleep alone (HR = 1.77, 95% CI 1.37–2.28; and HR = 1.16, 95% CI 0.99–1.36, respectively).
Depression and diagnosed sleep disorders or long sleep duration are independent risk factors for heart disease and are associated with a stronger risk of heart disease when occurring together.
Soft X-ray, vacuum ultraviolet diagnostics of high temperature, high density plasmas are used to determine the temporal, spatial, spectral and total fluence of radiation emitted from plasmas. Some of the radiation diagnostics used to characterize these plasmas are: metallic photocathodes with thin anodes; Ross filter - PIN detector combination; time-resolved pinhole cameras; metallic calorimeter; bent crystal and grazing incidence spectrographs; and differentially pumped, windowless, Samson-type ionization chambers.
Photoelectric diodes with aluminum photocathod.es have been calibrated in the energy range from 0.1 keV to 1 keV with a multielement Henke X-ray tube system using regenerative monochromatic filters. The calibration is performed at six energies: (1) Be - (0.109 keV) , (2) C - Kα (0.277 keV), (3) Ti – Lα1, 2 (0.452 keV) , (4) Fe – Lα1, 2 (0.705 keV), (5) Cu – Lα1, 2 (0.930 keV), and (6) Al – Kαl, 2 (1.487 keV). Several different 99.9%, (1000 series) aluminum foils were calibrated for use as cathodes. In addition, the average energy per electron ion pair, W, has been measured for methane at these same energies.
An x-ray source is described that can have high brilliance, monochromaticity and spatial coherence. This source filters, by successive diffraction, spontaneous x-ray radiation produced by electron impact in a Bonse-Hart monolithic crystal monochromater. A germanium single crystal was grooved to form a monolithic monochromater and subsequently was fitted with a filament. Field emitted electrons from the filament impact on the crystal side walls. Thus, the passive Bonse-Hart monochromater is converted into an active x-ray source. The detailed diffraction geometry within the cavity, in the limit of kinematic diffraction theory, is described and compared to the experimentally observed radiation pattern. Since this radiation source achieves its monochromaticity and spatial coherence by filtering it is highly inefficient. However, the diffraction process is highly efficient when the radiation is in the proper geometric direction to satisfy Bragg's law. Thus, the stationary radiation source can have a high brilliance although the input of electrical energy could be well in excess of a rotating anode x-ray tube.
Major depressive disorder (MDD) is a leading cause of disease burden worldwide, with lifetime prevalence in the United States of 17%. Here we present the results of the first prospective, large-scale, patient- and rater-blind, randomized controlled trial evaluating the clinical importance of achieving congruence between combinatorial pharmacogenomic (PGx) testing and medication selection for MDD.
1,167 outpatients diagnosed with MDD and an inadequate response to ≥1 psychotropic medications were enrolled and randomized 1:1 to a Treatment as Usual (TAU) arm or PGx-guided care arm. Combinatorial PGx testing categorized medications in three groups based on the level of gene-drug interactions: use as directed, use with caution, or use with increased caution and more frequent monitoring. Patient assessments were performed at weeks 0 (baseline), 4, 8, 12 and 24. Patients, site raters, and central raters were blinded in both arms until after week 8. In the guided-care arm, physicians had access to the combinatorial PGx test result to guide medication selection. Primary outcomes utilized the Hamilton Depression Rating Scale (HAM-D17) and included symptom improvement (percent change in HAM-D17 from baseline), response (50% decrease in HAM-D17 from baseline), and remission (HAM-D17<7) at the fully blinded week 8 time point. The durability of patient outcomes was assessed at week 24. Medications were considered congruent with PGx test results if they were in the ‘use as directed’ or ‘use with caution’ report categories while medications in the ‘use with increased caution and more frequent monitoring’ were considered incongruent. Patients who started on incongruent medications were analyzed separately according to whether they changed to congruent medications by week8.
At week 8, symptom improvement for individuals in the guided-care arm was not significantly different than TAU (27.2% versus 24.4%, p=0.11). However, individuals in the guided-care arm were more likely than those in TAU to achieve remission (15% versus 10%; p<0.01) and response (26% versus 20%; p=0.01). Remission rates, response rates, and symptom reductions continued to improve in the guided-treatment arm until the 24week time point. Congruent prescribing increased to 91% in the guided-care arm by week 8. Among patients who were taking one or more incongruent medication at baseline, those who changed to congruent medications by week 8 demonstrated significantly greater symptom improvement (p<0.01), response (p=0.04), and remission rates (p<0.01) compared to those who persisted on incongruent medications.
Combinatorial PGx testing improves short- and long-term response and remission rates for MDD compared to standard of care. In addition, prescribing congruency with PGx-guided medication recommendations is important for achieving symptom improvement, response, and remission for MDD patients.
Funding Acknowledgements: This study was supported by Assurex Health, Inc.
I. De Pater, University of California, Berkeley Berkeley, California, USA,
D. P. Hamilton, University of Maryland College Park, Maryland, USA,
M. R. Showalter, SETI Institute Mountain View, California, USA,
H. B. Throop, Planetary Science Institute Tucson, Arizona, USA,
J. A. Burns, Cornell University Ithaca, New York, USA
We examine whether the dark, orbitally-leading hemisphere of Saturn's satellite Iapetus might be coated by debris from low-albedo Phoebe, which orbits retrograde well exterior to Iapetus. Using simplified analytical models along with more complete numerical integrations, we follow the paths of various-sized particles launched gently off Phoebe following collisions with interplanetary and interstellar meteoroids. Micron grains can quickly reach Iapetus since (due to solar radiation) they trace elliptical orbits; larger grains may only hit after their more-circular orbits collapse due to Poynting-Robertson drag; few very large and very small Phoebe grains strike Iapetus. Despite some inconsistencies with observations, we conclude that Phoebe may possibly be the agent that has darkened Iapetus.
In this chapter we will review how the principles of mechanics can be used to address scientific questions relating to equine performance and disease.
Performance can be defined in terms of fundamental qualities or at an applied level. Energetic efficiency, speed, acceleration, endurance capacity, stability, and manoeuvrability, are recognised as fundamental selection pressures in the evolution of terrestrial locomotion. These contribute individually or in combination to performance in a particular sport. Whereas the capacity to achieve the highest value of the outcome measure for a particular sport might be used as an overall measure of performance however, it is more useful for the purpose of scientific investigation to consider performance in terms of more fundamental quantities. The overall aim is generally to relate locomotor form (morphology), function (movement), and environmental factors to fundamental measures of performance.
Size (indicated by body mass) has an important effect on the form of the locomotor systems of terrestrial animals.
Previous studies have examined associations of cardiometabolic factors with depression and cognition separately.
To determine if depressive symptoms mediate the association between cardiometabolic factors and cognitive decline in two community studies.
Data for the analyses were drawn from the Rotterdam Study, the Netherlands (n = 2940) and the Whitehall II study, UK (n = 4469).
Mediation analyses suggested a direct association between cardiometabolic factors and cognitive decline and an indirect association through depression: poorer cardiometabolic status at time 1 was associated with a higher level of depressive symptoms at time 2 (standardised regression coefficient 0.07 and 0.06, respectively), which, in turn, was associated with greater cognitive decline between time 2 and time 3 (standardised regression coefficient of −0.15 and −0.41, respectively).
Evidence from two independent cohort studies suggest an association between cardiometabolic dysregulation and cognitive decline and that depressive symptoms tend to precede this decline.
There is growing interest in linking vitamin D deficiency with autism spectrum disorders (ASDs). The association between vitamin D deficiency during gestation, a critical period in neurodevelopment, and ASD is not well understood.
To determine the association between gestational vitamin D status and ASD.
Based on a birth cohort (n=4334), we examined the association between 25-hydroxyvitamin D (25OHD), assessed from both maternal mid-gestation sera and neonatal sera, and ASD (defined by clinical records; n=68 cases).
Individuals in the 25OHD-deficient group at mid-gestation had more than twofold increased risk of ASD (odds ratio (OR)=2.42, 95% confidence interval (CI) 1.09 to 5.07, P=0.03) compared with the sufficient group. The findings persisted in analyses including children of European ethnicity only.
Mid-gestational vitamin D deficiency was associated with an increased risk of ASD. Because gestational vitamin D deficiency is readily preventable with safe, inexpensive and readily available supplementation, this risk factor warrants closer scrutiny.