Patterns of cannabis use and prospective associations with health issues among young males.

BACKGROUND AND AIMS: To test prospective associations between cannabis disorder symptoms/frequency of cannabis use and health issues and to investigate stability versus transience in cannabis use trajectories. DESIGN: Two waves of data collection from the longitudinal Cohort Study on Substance Use Risk Factors (C-SURF). SETTING: A representative sample of young Swiss men in their early 20s from the general population. PARTICIPANTS: A total of 5084 young men (mean age 19.98 ± 1.19 years at time 1). MEASUREMENTS: Cannabis use (life-time use, frequency of use, cannabis disorder symptoms) and self-reported measures of health issues (depression, mental/physical health, health consequences) were assessed. Significant changes in cannabis use were tested using t-test/Wilcoxon's rank test for paired data. Cross-lagged panel models provided evidence regarding longitudinal associations between cannabis use and health issues. FINDINGS: Most of the participants (84.5%) remained in the same use category and cannabis use kept to similar levels at times 1 and 2 (P = 0.114 and P = 0.755; average of 15 ± 2.8 months between times 1 and 2). Cross-lagged panel models showed that cannabis disorder symptoms predicted later health issues (e.g. depression, β = 0.087, P < 0.001; health consequences, β = 0.045, P < 0.05). The reverse paths from health issues to cannabis disorder symptoms and the cross-lagged panel model between frequency of cannabis use and health issues were non-significant. CONCLUSIONS: Patterns of cannabis use showed substantial continuity among young Swiss men in their early 20s. The number of symptoms of cannabis use disorder, rather than the frequency of cannabis use, is a clinically important measure of cannabis use among young Swiss men.

In vivo measurements of atrial repolarization alternans based on standard pacemaker technology

It has been shown that repolarization alternans, a beat-to-beat alternation in action potential duration, enhances dispersion of repolarization above a critical heart rate and promotes susceptibility to ventricular arrhythmias. It is unknown whether repolarization alternans is measurable in the atria using standard pacemakers and whether it plays a role in promoting atrial fibrillation. In this work, atrial repolarization alternans amplitude and periodicity are studied in a sheep model of pacing-induced atrial fibrillation. Two pacemakers, each with one right atrial and ventricular lead, were implanted in 4 male sheep after ablation of the atrioventricular junction. The first one was used to deliver rapid pacing for measurements of right atrial repolarization alternans and the second one to record a unipolar electrogram. Atrial repolarization alternans appeared rate-dependent and its amplitude increased as a function of pacing rate. Repolarization alternans was intermittent but no periodicity was detected. An increase of repolarization alternans preceding episodes of non-sustained atrial fibrillation suggests that repolarization alternans is a promising parameter for assessment of atrial fibrillation susceptibility.

Maxine Hong Kingston as Counterculture Writer

This article examines Maxine Hong Kingston's work against the backdrop of the 1960s Berkeley counterculture, arguing that her books are informed by its values and aesthetics far more than has previously been recognized.

Viral genotype-specific role of PNPLA3, PPARG, MTTP, and IL28B in hepatitis C virus-associated steatosis.

BACKGROUND & AIMS: Steatosis is a prominent feature of hepatitis C, especially in patients infected with genotype 3. The analysis of genetic polymorphisms influencing steatosis in chronic hepatitis C has been limited by the studies' small sample size, and important single nucleotide polymorphisms (SNPs), such as those in the patatin-like phospholipase family 3 protein (PNPLA3), were never evaluated. METHODS: We analyzed the role of SNPs, from 19 systematically selected candidate genes, on steatosis in 626 Caucasian hepatitis C virus (HCV) infected patients. SNPs were extracted from a genome-wide association-generated dataset. Associations of alleles with the presence and/or different severity of steatosis were evaluated by univariate and multivariate logistic regression, accounting for all relevant covariates. RESULTS: The risk of steatosis was increased by carriage of I148M in PNPLA3, but only in patients with HCV genotypes non-3 (odds ratio [OR]=1.9, 95% confidence interval [CI]=1.6-2.3, p<0.001) and similar, albeit weaker associations were found for SNPs in peroxisome proliferator-activated receptor-γ (PPARG) and interleukin-28B (IL28B). Carriage of a SNP in the microsomal triglyceride transfer protein (MTTP) increased the risk of steatosis, but only in patients with HCV genotype 3 (rs1800803, OR=3.4, 95% CI=2.4-4.9, p=0.001). CONCLUSIONS: The rs738409 SNP in PNPLA3 is associated with an increased risk of steatosis in patients infected with HCV genotypes non-3. Host genes affect steatosis depending on the infecting HCV genotype, suggesting their interaction with viral factors.

Factor structure of early smoking experiences and associations with smoking behavior: valence or sensitivity model?

The Early Smoking Experience (ESE) questionnaire is the most widely used questionnaire to assess initial subjective experiences of cigarette smoking. However, its factor structure is not clearly defined and can be perceived from two main standpoints: valence, or positive and negative experiences, and sensitivity to nicotine. This article explores the ESE's factor structure and determines which standpoint was more relevant. It compares two groups of young Swiss men (German- and French-speaking). We examined baseline data on 3,368 tobacco users from a representative sample in the ongoing Cohort Study on Substance Use Risk Factors (C-SURF). ESE, continued tobacco use, weekly smoking and nicotine dependence were assessed. Exploratory structural equation modeling (ESEM) and structural equation modeling (SEM) were performed. ESEM clearly distinguished positive experiences from negative experiences, but negative experiences were divided in experiences related to dizziness and experiences related to irritations. SEM underlined the reinforcing effects of positive experiences, but also of experiences related to dizziness on nicotine dependence and weekly smoking. The best ESE structure for predictive accuracy of experiences on smoking behavior was a compromise between the valence and sensitivity standpoints, which showed clinical relevance.

Association between nonmedical prescription drug use and health status among young swiss men.

PURPOSE: To examine the relationship between the nonmedical prescription drug use (NMPDU) of six drug classes and health. METHODS: Data on young adults males (mean age, 19.96 years) from the baseline and follow-up of the Cohort Study on Substance Use Risk Factors (C-SURF) were used (n = 4,958). Two sets of logistic regression models were fitted to examine the associations between NMPDU of opioid analgesics, sedatives or sleeping pills, anxiolytics, antidepressants, beta blockers and stimulants, and health status (assessed using the Medical Outcomes Study 12-Item Short Form Survey Instrument [SF-12 v2]). We first computed odds ratios between NMPDU at baseline and poor mental and physical health at follow-up, adjusting for poor mental or physical health at baseline. We then computed odds ratios between poor mental and physical health at baseline and NMPDU at follow-up, adjusting for NMPDU at baseline. RESULTS: Three key findings regarding mental health were (1) there was a reciprocal risk between poor mental health and sedatives and anxiolytics; (2) poor mental health increased NMPDU of opioid analgesics and antidepressants but not vice versa; and (3) there were no associations with stimulants. Three key findings regarding physical health were (1) poor physical health increased the risk of NMPDU of anxiolytics; (2) the only reciprocal risk was between physical health and NMPDU of opioid analgesics; and (3) there were no associations with stimulants. CONCLUSION: These results, among the first ever on reciprocal effects between NMPDU and mental and physical health status, give unique information concerning the adverse effects of NMPDU on health and vice versa. The study shows that NMPDU is not only a sign of self-medication but may induce health problems.

A Further Evaluation of Concrete Bridge Deck Surfacing in Iowa, MLR-79-1, 1979

The Iowa Department of Transportation has overlaid 446 bridge decks with low slump dense concrete from 1964 through October 1978. The overall performance of these decks has been satisfactory. Nineteen bridges that were resurfaced with either low slump dense concrete (LSDC) or latex-modified concrete were analyzed for chloride content, electrical corrosion potential, delaminations or debonding, and deck surface condition. The resurfacing ages of these bridges range from 5 to 13 years. None of the bridges showed any evidence of surface distress and the chloride penetration into the resurfacing concrete is relatively low. There are delaminations in the original decks below the resurfacing on the majority of bridges examined. The delaminations are concluded to be caused by either (A) reinforcing steel corrosion, (B) not removing all delaminated concrete prior to placing the resurfacing concrete, or (C) creating an incipient fracture in the top surf ace of the original deck through the use of scarification equipment. The active corrosion of the reinforcing steel is predominately in the gutter line on the majority of bridges evaluated. Recommendations for future deck repairs include removal of concrete to the top layer of reinforcing steel in areas where an electrical corrosion potential of -0.35V or more is detected, providing more positive methods of locating delaminated concrete, and treating the curb and gutter line to reduce the potential damage from salt water.

Kinetics of atrial repolarization alternans in a free-behaving ovine model.

Kinetics of Atrial Repolarization Alternans. INTRODUCTION: Repolarization alternans (Re-ALT), a beat-to-beat alternation in action potential repolarization, promotes dispersion of repolarization, wavebreaks, and reentry. Recently, Re-ALT has been shown to play an important role in the transition from rapid pacing to atrial fibrillation (AF) in humans. The detailed kinetics of atrial Re-ALT, however, has not been reported so far. We developed a chronic free-behaving ovine pacing model to study the kinetics of atrial Re-ALT as a function of pacing rate. METHODS: Thirteen sheep were chronically implanted with 2 pacemakers for the recording of broadband right atrial unipolar electrograms and delivery of rapid pacing protocols. Beat-to-beat differences in the atrial T-wave apex amplitude as a measure of Re-ALT and activation time were analyzed at incremental pacing rates until the effective refractory period (ERP) defined as stable 2:1 capture. RESULTS: Atrial Re-ALT appeared intermittently but without periodicity, and increased in amplitude as a function of pacing rate until ERP. Intermittent 2:1 atrial capture was observed at pacing cycle lengths 40 ms above ERP, and increased in duration as a function of pacing rate. Episodes of rapid pacing-induced AF were rare, and were preceded by Re-ALT or complex oscillations of atrial repolarization, but without intermittent capture. CONCLUSION: We show in vivo that atrial Re-ALT developed and increased in magnitude with rate until stable 2:1 capture. In rare instances where capture failure did not occur, Re-ALT and complex oscillations of repolarization surged and preceded AF initiation. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1003-1012, September 2012).

Post-exercise parasympathetic reactivation and sensibility to hypoxia

Introduction Exposure to hypoxia leads to several reactions of the organism, which try to compensate the reduced oxygen level in the blood. Acute response is characterized by an increase in pulmonary ventilation (Hypoxia Ventilatory Response, HVR) and in cardiac output (cardiac response to hypoxia). Heart rate (HR) at rest and during exercise is higher at high altitude than at sea level, whereas HRmax is lower. These cardiac adaptations are partially explained by an increased sympathetic stimulation associated with a reduced parasympathetic tone (12). The precise mechanisms of HRmax decline in acute hypoxia are however still to be identified, although several hypothesis have been suggested, such as a direct effect of hypoxia on the electrophysiological properties, an influence of skeletal maximal VO2 or a modulation of the autonomic nervous system (8). Some authors have reported that endurance trained athletes present an increased sensitivity to hypoxia shown by a large reduction in VO2max and an important decrease in arterial saturation. (9,11, 13) A hypoxia test can assess the sensibility of chemoreceptors to the reduction of oxygen by calculating hypoxic ventilatory and cardiac responses, knowing that low sensibility is correlated with poor acclimatization. Two parameters results from the differences in ventilation (and heart rate) divided by the difference in the arterial oxygen saturation between normoxia and hypoxia (18). Objective The hypothesis tested by this study is that parasympathetic reactivation after moderate effort in hypoxic condition can be used as a marker of individual sensibility to hypoxia. Parasympathetic reactivation is a marker of vagal tone that predict endurance capacity and aerobic fitness (2,7). Methods Subjects This study uses data obtained from two groups of athletes participating into two larger studies about adaptation to hypoxia. One group is composed of elite athletes (Swiss ski mountaineering team), the other one of mid-level athletes (ski mountaineering amateurs). The particularity of this target population is that they often train at high altitude, and therefore could show a better response to hypoxia than athleltes of other disciplines. Protocol The athletes performed a submaximal exercise (6min run at 9 km/h, flat) followed by 10 min of seated rest either in an hypoxic chamber (simulated altitude of 3000m) or in normoxic conditions. During the resting phase parasympathetic reactivation was assessed by beat-to-beat HR measurements.A test of tolerance to altitude was also performed. Analysis Parasympathetic reactivation, assessed by the calculation of the root mean square of successive differences in the R-R intervals (RMSSD)(4), is compared to individual responses at altitude, in order to appreciate the correlation between the two phenomena.

Metrical strength and contradiction in turkish Makam music

In this paper we investigate how note onsets in Turkish Makam music compositions are distributed, and in how far this distribution supports or contradicts the metrical structure of the pieces, the usul. We use MIDI data to derive the distributions in the form of onset histograms, and comparethem with metrical weights that are applied to describe the usul in theory. We compute correlation and syncopation values to estimate the degrees of support and contradiction, respectively. While the concept of syncopation is rarelymentioned in the context of this music, we can gain interesting insight into the structure of a piece using such a measure.We show that metrical contradiction is systematically applied in some metrical structures. We will compare thedifferences between Western music and Turkish Makam music regarding metrical support and contradiction. Such a study can help avoiding pitfalls in later attempts to perform audio processing tasks such as beat tracking or rhythmic similarity measurements.

Particulate matter exposure in cars is associated with cardiovascular effects in healthy young men

Exposure to fine airborne particulate matter (PM(2.5)) is associated with cardiovascular events and mortality in older and cardiac patients. Potential physiologic effects of in-vehicle, roadside, and ambient PM(2.5) were investigated in young, healthy, nonsmoking, male North Carolina Highway Patrol troopers. Nine troopers (age 23 to 30) were monitored on 4 successive days while working a 3 P.M. to midnight shift. Each patrol car was equipped with air-quality monitors. Blood was drawn 14 hours after each shift, and ambulatory monitors recorded the electrocardiogram throughout the shift and until the next morning. Data were analyzed using mixed models. In-vehicle PM(2.5) (average of 24 microg/m(3)) was associated with decreased lymphocytes (-11% per 10 microg/m(3)) and increased red blood cell indices (1% mean corpuscular volume), neutrophils (6%), C-reactive protein (32%), von Willebrand factor (12%), next-morning heart beat cycle length (6%), next-morning heart rate variability parameters, and ectopic beats throughout the recording (20%). Controlling for potential confounders had little impact on the effect estimates. The associations of these health endpoints with ambient and roadside PM(2.5) were smaller and less significant. The observations in these healthy young men suggest that in-vehicle exposure to PM(2.5) may cause pathophysiologic changes that involve inflammation, coagulation, and cardiac rhythm.

Mise en place percutanée de filtres dans la veine cave inférieure en prévention de l'embolie pulmonaire : recommandations

Recommandations conçues dans le cadre d'un Groupe de travail coordonée par Lucia Mazzolai du Service d'angiologie. Membres du Groupe de travail: Angelillo-Scherrer Anne (Service d'hématologie), Burnier Michel ( Service de néphrologie), Demartines Nicolas (Service de chirurgie viscérale), Duchosal Michel (Service d'hématologie), Farron Alain (Service d'orthopédie), Hohlfeld Patrick (Département de gynéco-obstétrique), Hugli Olivier (Service des urgences), Jichlinski Patrice (Service d'urologie), Jolliet Philippe (Service de médecine intensive), Kern Christian (Service d'anesthésiologie), Levivier Marc (Service de neurochirurgie), Leyvraz Serge (Service d'oncologie), Meuli Reto (Service de radiodiagnostic et radiologie interventionnelle), Nicod Laurent (Service de pneumologie), Qanadli Salah (Service de radiodiagnostic et radiologie interventionnelle), Ris Hans-Beat (Service de chirurgie thoracique et vasculaire), Ruchat Patrick (Service de chirurgie cardiovasculaire), Vial Yvan (Service de gynécologie obstétrique), Vogt Pierre (Service de cardiologie), Von Segesser Ludwig (Service de chirurgie cardiovasculaire), Waeber Gerard (Service de médecine interne), Yersin Bertrand (Service des urgences)

Generation and nonlinear evolution of shore-oblique/transverse sand bars

The coupling between topography, waves and currents in the surf zone may selforganize to produce the formation of shore-transverse or shore-oblique sand bars on an otherwise alongshore uniform beach. In the absence of shore-parallel bars, this has been shown by previous studies of linear stability analysis, but is now extended to the finite-amplitude regime. To this end, a nonlinear model coupling wave transformation and breaking, a shallow-water equations solver, sediment transport and bed updating is developed. The sediment flux consists of a stirring factor multiplied by the depthaveraged current plus a downslope correction. It is found that the cross-shore profile of the ratio of stirring factor to water depth together with the wave incidence angle primarily determine the shape and the type of bars, either transverse or oblique to the shore. In the latter case, they can open an acute angle against the current (upcurrent oriented) or with the current (down-current oriented). At the initial stages of development, both the intensity of the instability which is responsible for the formation of the bars and the damping due to downslope transport grow at a similar rate with bar amplitude, the former being somewhat stronger. As bars keep on growing, their finite-amplitude shape either enhances downslope transport or weakens the instability mechanism so that an equilibrium between both opposing tendencies occurs, leading to a final saturated amplitude. The overall shape of the saturated bars in plan view is similar to that of the small-amplitude ones. However, the final spacings may be up to a factor of 2 larger and final celerities can also be about a factor of 2 smaller or larger. In the case of alongshore migrating bars, the asymmetry of the longshore sections, the lee being steeper than the stoss, is well reproduced. Complex dynamics with merging and splitting of individual bars sometimes occur. Finally, in the case of shore-normal incidence the rip currents in the troughs between the bars are jet-like while the onshore return flow is wider and weaker as is observed in nature.

Self-organization mechanisms for the formation on nearshore crescentic and transverse sand bars

The formation and development of transverse and crescentic sand bars in the coastal marine environment has been investigated by means of a nonlinear numerical model based on the shallow-water equations and on a simpli ed sediment transport parameterization. By assuming normally approaching waves and a saturated surf zone, rhythmic patterns develop from a planar slope where random perturbations of small amplitude have been superimposed. Two types of bedforms appear: one is a crescentic bar pattern centred around the breakpoint and the other, herein modelled for the rst time, is a transverse bar pattern. The feedback mechanism related to the formation and development of the patterns can be explained by coupling the water and sediment conservation equations. Basically, the waves stir up the sediment and keep it in suspension with a certain cross-shore distribution of depth-averaged concentration. Then, a current flowing with (against) the gradient of sediment concentration produces erosion (deposition). It is shown that inside the surf zone, these currents may occur due to the wave refraction and to the redistribution of wave breaking produced by the growing bedforms. Numerical simulations have been performed in order to understand the sensitivity of the pattern formation to the parameterization and to relate the hydro-morphodynamic input conditions to which of the patterns develops. It is suggested that crescentic bar growth would be favoured by high-energy conditions and ne sediment while transverse bars would grow for milder waves and coarser sediment. In intermediate conditions mixed patterns may occur.

What determines the wavelength of self-organized shoreline sand waves?

Shoreline undulations extending into the bathymetric contours with a length scale larger than that of the rhythmic surf zone bars are referred to as shoreline sand waves. Many observed undulations along sandy coasts display a wavelength in the order 1-7 km. Several models that are based on the hypothesis that sand waves emerge from a morphodynamic instability in case of very oblique wave incidence predict this range of wavelengths. Here we investigate the physical reasons for the wavelength selection and the main parametric trends of the wavelength in case of sand waves arising from such instability. It is shown that the existence of a minimum wavelength depends on an interplay between three factors affecting littoral drift: (A) the angle of wave fronts relative to local shoreline, which tends to cause maximum transport at the downdrift flank of the sand wave, (B) the refractive energy spreading which tends to cause maximum transport at the updrift flank and (C) wave focusing (de-focusing) by the capes (bays), which tends to cause maximum transport at the crest or slightly downdrift of it. Processes A and C cause decay of the sand waves while process B causes their growth. For low incidence angles, B is very weak so that a rectilinear shoreline is stable. For large angles and long sand waves, B is dominant and causes the growth of sand waves. For large angles and short sand waves C is dominant and the sand waves decay. Thus, wavelength selection depends on process C, which essentially depends on shoreline curvature. The growth rate of very long sand waves is weak because the alongshore gradients in sediment transport decrease with the wavelength. This is why there is an optimum or dominant wavelength. It is found that sand wave wavelength scales with λ0/β where λ0 is the water wave wavelength in deep water and β is the mean bed slope from shore to the wave base.