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The association between depression after myocardial infarction and increased risk of mortality and cardiac morbidity may be due to cardiac disease severity.
To combine original data from studies on the association between post-infarction depression and prognosis into one database, and to investigate to what extent such depression predicts prognosis independently of disease severity.
An individual patient data meta-analysis of studies was conducted using multilevel, multivariable Cox regression analyses.
Sixteen studies participated, creating a database of 10 175 post-infarction cases. Hazard ratios for post-infarction depression were 1.32 (95% CI 1.26–1.38, P<0.001) for all-cause mortality and 1.19 (95% CI 1.14–1.24, P<0.001) for cardiovascular events. Hazard ratios adjusted for disease severity were attenuated by 28% and 25% respectively.
The association between depression following myocardial infarction and prognosis is attenuated after adjustment for cardiac disease severity. Still, depression remains independently associated with prognosis, with a 22% increased risk of all-cause mortality and a 13% increased risk of cardiovascular events per standard deviation in depression z-score.
The paper describes results of experiments of a converging spherical shock wave reflected from a spherical wall. In order to visualize the motion and the flow field behind the shock waves, an aspheric lens-shaped transparent test section made of acrylic PMMA (polymethyl methacrylate) with an inner spherical cavity was designed and constructed. This test section made optical flow visualization with collimated object beams possible. Spherical shock waves were produced at the centre of the spherical cavity by explosion of silver azide pellets ranging from 1.0 to 10.0 mg with corresponding energies of 1.9 to 19 J. The charges were ignited by irradiation of a pulsed Nd:YAG laser beam. Pressures were also measured at two points with pressure transducers mounted flush at the inner wall of the test section. The pellet was simultaneously ignited on two sides or was shaped to produce a uniform diverging spherical shock wave. This spherically diverging shock wave was reflected from the spherical inner wall of the test section to form a converging spherical shock wave. We visualized the shock-wave motion by using double exposure holographic interferometry and time-resolved high-speed video recording. The sequence of diverging and converging spherical shock-wave propagations and their interaction with gaseous explosion products were observed. The convergence, acceleration and stability of the imploding shock wave in the test section were studied.
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