This book is a sociological study of a societal grouping that has the popular title 'middle class'. It argues that it is more precise to describe the middle classes as dominant groupings, and the ...book draws upon a wide range of characters from such groupings. In a detailed analysis of cultural practices, those making an appearance include omnivores, carnivores, herbivores, the middle-brow, traditional culture vultures, middle class plunderers, the urban arts eclectic and the English gentleman. There is a particular focus on those expressing the 'silver disposition'; predominantly affluent, middle-aged and white, with a taste for conspicuous consumption and established cultural forms. The book brings together a range of disparate sources on the middle classes and offers a sustained engagement with the concept of 'culture'. It illustrates the extent to which social groups utilize the various assets at their disposal and seek to maintain the legitimacy of their cultural practices. The findings emphasise the continuing link between class and taste. Culture and the Middle Classes will be of interest to those working in the fields of class and culture across a range of disciplines, including sociology, cultural studies, social theory, media studies and cultural anthropology.
Hydrostatic pore water pressure revisited Stewart, Simon A.; Albertz, Markus
Basin research,
February 2023, 2023-02-00, 20230201, Letnik:
35, Številka:
1
Journal Article
Recenzirano
Hydrostatic or “normal” pressure can be easily visualized as a water column with pressure given by ρgh and any departures classified as abnormal pressure. This is the basis for commonly used ...hydrostatic pressure depth trends in sedimentary basins that are constructed on assumptions of constant gradients and are datumed at mean sea level or ground level. But the straightforward water column concept does not upscale in a simple way to sedimentary basins where the zones of interest are several thousands of metres below the land or sea surface. Sedimentary basins are heterogeneous, including stacked, confined reservoirs and variations in pore water composition. It is possible to construct pressure‐depth profiles that honour the geology and hydrostratigraphy of a basin and these give different hydrostatic baselines from simple constant gradients hung from familiar local datums such as ground level. Key steps are using a reservoir‐specific datums such as the water table or potentiometric surface relevant to that unit, then building a pressure‐depth trend that represents the pore fluid salinity variation and density profile throughout the reservoir unit. At a given depth, this version of hydrostatic may predict pressures several hundred psi different from a single density gradient hung from a datum local to the well, and exhibit a notched profile reflecting the geological and hydrological stratigraphy. This construct redefines normal and abnormal pore fluid pressures in sedimentary basins. The impacts of this alternative approach to sedimentary basin hydrostatics, even if data are limited and pressure profiles have to be framed probabilistically, extend to many aspects of studying and interacting with fluid systems in sedimentary basins including basin modelling, petroleum systems analysis, well planning and well operations.
Hydrostatic (normal) pressure gradients are over‐simplified in most geoscience applications. Potentiometric surfaces are appropriate datums for confined reservoirs and non‐linear gradients are required where salinity varies with depth. Vertical wells through stacked reservoirs are expected to encounter hydrostatic pore pressure profiles that are notched according to hydrostratigraphy.
Abstract
Background
We aimed to address the paucity of information describing the treatable burden of disease associated with severe aortic stenosis (AS) within Australia’s ageing population.
Methods
...A contemporary model of the population prevalence of symptomatic, severe AS and treatment pathways in Europe and North America was applied to the 2019 Australian population aged ≥ 55 years (7 million people) on an age-specific basis. Applying Australian-specific data, these estimates were used to further calculate the total number of associated deaths and incident cases of severe AS per annum.
Results
Based on an overall point prevalence of 1.48 % among those aged ≥ 55 years, we estimate that a minimum of 97,000 Australians are living with severe AS. With a 2-fold increased risk of mortality without undergoing aortic valve replacement (AVR), more than half of these individuals (∼56,000) will die within 5-years. From a clinical management perspective, among those with concurrent symptoms (68.3 %, 66,500 95 % CI 59,000–74,000 cases) more than half (58.4 %, 38,800 95 % CI 35,700 − 42,000 cases) would be potentially considered for surgical AVR (SAVR) - comprising 2,400, 5,400 and 31,000 cases assessed as high-, medium- or low peri-operative mortality risk, respectively. A further 17,000/27,700 (41.6 % 95 % CI 11,600 − 22,600) of such individuals would be potentially considered to a transthoracic AVR (TAVR). During the subsequent 5-year period (2020–2024), each year, we estimate an additional 9,300 Australians aged ≥ 60 years will subsequently develop severe AS (6,300 of whom will experience concurrent symptoms). Of these symptomatic cases, an estimated 3,700 and 1,600 cases/annum, will be potentially suitable for SAVR and TAVR, respectively.
Conclusions
These data suggest there is likely to be a substantive burden of individuals living with severe AS in Australia. Many of these cases may not have been diagnosed and/or received appropriate treatment (based on the evidence-based application of SAVR and TAVR) to reduce their high-risk of subsequent mortality.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Case fatality associated with a first coronary event is often underestimated when only those who survive to reach a hospital are considered. Few studies have examined long-term trends in case ...fatality associated with a major coronary event that occurs out of the hospital.
Record linkage documented all case subjects 35 to 84 years of age in Sweden during 1991 to 2006 with a first major coronary event (out-of-hospital coronary death or hospitalization for acute myocardial infarction). Of the 384 597 cases identified, 111 319 (28.9%) died out of the hospital, and another 36 552 (9.5%) died in the hospital or within 28 days of hospitalization. From 1991 to 2006, out-of hospital deaths as a proportion of all major coronary events declined from 30.5% to 25.6% (adjusted mean annual decrease 2.2%, 95% confidence interval 2.1% to 2.4%), however, with a larger decline in 28-day case fatality in hospitalized cases (adjusted mean annual decrease 5.8%, 95% confidence interval 5.5% to 6.0%). As a result of the faster decline in in-hospital deaths, the relative contribution of out-of-hospital deaths to overall case fatality increased, particularly among younger individuals (eg, among those 35 to 54 years of age, no more than 10.8% of all deaths occurred in hospitalized cases during 2003-2006). Although female sex (odds ratio 0.85, 95% confidence interval 0.83 to 0.87) and older age (odds ratio 0.972, 95% confidence interval 0.971 to 0.974 per year) were associated with lower risk for initial out-of-hospital death, each successive calendar year was associated with increased risk (odds ratio 1.041, 95% confidence interval 1.038 to 1.044).
The great majority of all fatal coronary events occur outside the hospital, and this proportion is increasing, particularly among younger individuals.
Abstract Background Atrial fibrillation (AF) represents an increasing public health challenge with profound social and economic implications. Methods A comprehensive synthesis and review of the AF ...literature was performed. Overall, key findings from 182 studies were used to describe the indicative scope and impact of AF from an individual to population perspective. Results There are many pathways to AF including advancing age, cardiovascular disease and increased levels of obesity/metabolic disorders. The reported population prevalence of AF ranges from 2.3%–3.4% and historical trends reflect increased AF incidence. Estimated life-time risk of AF is around 1 in 4. Primary care contacts reflect whole population trends: AF-related case-presentations increase from less than 0.5% in those aged 40 years or less to 6–12% for those aged 85 years or more. Globally, AF-related hospitalisations (primary or secondary diagnosis) showed an upward trend (from ~ 35 to over 100 admissions/10,000 persons) during 1996 to 2006. The estimated cost of AF is greater than 1% of health care expenditure and rising with hospitalisations the largest contributor. For affected individuals, quality of life indices are poor and AF confers an independent 1.5 to 2.0-fold probability of death in the longer-term. AF is also closely linked to ischaemic stroke (3- to 5-fold risk), chronic heart failure (up to 50% develop AF) and acute coronary syndromes (up to 25% develop AF) with consistently worse outcomes reported with concurrent AF. Future projections predict at least a doubling of AF cases by 2050. Summary AF represents an evolving, global epidemic providing considerable challenges to minimise its impact from an individual to whole society perspective.
Abstract
Nearshore (littoral) habitats of clear lakes with high water quality are increasingly experiencing unexplained proliferations of filamentous algae that grow on submerged surfaces. These ...filamentous algal blooms (FABs) are sometimes associated with nutrient pollution in groundwater, but complex changes in climate, nutrient transport, lake hydrodynamics, and food web structure may also facilitate this emerging threat to clear lakes. A coordinated effort among members of the public, managers, and scientists is needed to document the occurrence of FABs, to standardize methods for measuring their severity, to adapt existing data collection networks to include nearshore habitats, and to mitigate and reverse this profound structural change in lake ecosystems. Current models of lake eutrophication do not explain this littoral greening. However, a cohesive response to it is essential for protecting some of the world's most valued lakes and the flora, fauna, and ecosystem services they sustain.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Summary Background The Heart of Soweto Study aims to increase our understanding of the characteristics and burden imposed by heart disease in an urban African community in probable epidemiological ...transition. We aimed to investigate the clinical range of disorders related to cardiovascular disease in patients presenting for the first time to a tertiary-care centre. Methods From Jan 1 to Dec 31, 2006, we recorded data for 4162 patients with confirmed cases of cardiovascular disease (1593 newly diagnosed and 2569 previously diagnosed and under treatment) who attended the cardiology unit at the Chris Hani Baragwanath Hospital in Soweto, South Africa. We developed a prospectively designed registry and gathered detailed clinical data relating to the presentation, investigations, and treatment of all 1593 patients with newly diagnosed cardiovascular disease. Findings Most patients were black Africans (n=1359 85%), and the study population contained more women (n=939 59%) than men. Women were slightly younger than were men (mean 53 SD 16 years vs 55 15 years; p=0·031), with 399 (25%) patients younger than 40 years. Heart failure was the most common primary diagnosis (704 cases, 44% of total). Moderate to severe systolic dysfunction was evident in 415 (53%) of 844 identified cases of heart failure, 577 (68%) of which were attributable to dilated cardiomyopathy or hypertensive heart disease, or both. Black Africans were more likely to be diagnosed with heart failure than were the rest of the cohort (739 54% vs 105 45%; odds ratio OR 1·46, 95% CI 1·11–1·94; p=0·009) but were less likely to be diagnosed with coronary artery disease (77 6% vs 88 38%; OR 0·10, 0·07–0·14; p<0·0001). Prevalence of cardiovascular risk factors was very high, with 897 (56%) patients diagnosed with hypertension (190 44% of whom were also obese). Only 209 (13%) patients had no identifiable risk factors, whereas 933 (59%) had several risk factors. Interpretation We noted many threats to the present and future cardiac health of Soweto, including a high prevalence of modifiable risk factors for atherosclerotic disease and a combination of infectious and non-communicable forms of heart disease, with late clinical presentations. Overall, our findings provide strong evidence that epidemiological transition in Soweto, South Africa has broadened the complexity and spectrum of heart disease in this community. This registry will enable continued monitoring of the range of heart disease.
Aims
We investigated the sex‐based risk of mortality across the spectrum of left ventricular ejection fraction (LVEF) in a large cohort of patients in Australia.
Methods and results
Quantified levels ...of LVEF from 237 046 women (48.1%) and 256 109 men undergoing first‐time, routine echocardiography (2000–2019) were linked to 119 232 deaths (median 5.6 years of follow‐up). Overall, 17.6% of men vs. 8.3% of women had an LVEF <50%. An LVEF <40% was associated with the highest crude cardiovascular‐related and all‐cause mortality at 5 years (∼20–30% and ∼ 40–50%, respectively). Thereafter, actual cardiovascular‐related and all‐cause mortality at 5 years in both sexes steeply improved to a nadir LVEF of 65.0–69.9% (reference group). Below this LVEF level, the adjusted hazard ratio (HR) for cardiovascular‐related mortality for a LVEF of 55.0–59.9% was 1.36 95% confidence interval (CI) 1.16–1.59; P < 0.001 in women and 1.21 (95% CI 1.05–1.39; P = 0.008) in men. In women, an LVEF of 60.0–64.9% was also associated with a HR 1.33 (95% CI 1.16–1.52; P < 0.001) for cardiovascular‐related mortality. These associations were most striking in women and men aged <65 years and were replicated in those with suspected heart failure (32 403 cases aged 65.2 ± 16.1 years, 57.0% women). For pre‐existing heart failure (33 738 cases aged 67.6 ± 16.9 years, 46.5% women), the specific threshold of increased mortality was at and below 50.0–54.9%.
Conclusions
Among patients investigated for suspected or established cardiovascular disease, we found clinically relevant sex‐based differences in the distribution and mortality associated with an LVEF <65.0–69.9%. Specifically, they suggest a greater risk of mortality at higher LVEF levels among women.
The observed associated risk of between left ventricular ejection fraction (LVEF, on a continuous/unit‐level basis) and probability of all‐cause mortality is presented as smoothed spline curves (age‐adjusted) for women and men separately. Shaded areas represent the 95% confidence interval (CI). Box inserts show the fully adjusted risk (hazard ratio plus 95% CI) of cardiovascular (CV)‐related mortality with a LVEF 65.0–69.9% as the reference group.
Objectives The goal of this study was to make a head-to-head comparison of 2 common forms of multidisciplinary chronic heart failure (CHF) management. Background Although direct patient contact ...appears to be best in delivering CHF management overall, the precise form to optimize health outcomes is less clear. Methods This prospective, multicenter randomized controlled trial with blinded endpoint adjudication comprised 280 hospitalized CHF patients (73% male, age 71 ± 14 years, and 73% with left ventricular ejection fraction ≤45%) randomized to home-based intervention (HBI) or specialized CHF clinic–based intervention (CBI). The primary endpoint was all-cause, unplanned hospitalization or death during 12- to 18-month follow-up. Secondary endpoints included type/duration of hospitalization and healthcare costs. Results The primary endpoint occurred in 102 of 143 (71%) HBI versus 104 of 137 (76%) CBI patients (adjusted hazard ratio HR: 0.97 95% confidence interval (CI): 0.73 to 1.30, p = 0.861): 96 (67.1%) HBI versus 95 (69.3%) CBI patients had an unplanned hospitalization (p = 0.887), and 31 (21.7%) versus 38 (27.7%) died (p = 0.252). The median duration of each unplanned hospitalization was significantly less in the HBI group (4.0 interquartile range (IQR): 2.0 to 7.0 days vs. 6.0 IQR: 3.5 to 13 days; p = 0.004). Overall, 75% of all hospitalization was attributable to 64 (22.9%) patients, of whom 43 (67%) were CBI patients (adjusted odds ratio: 2.55 95% CI: 1.37 to 4.73, p = 0.003). HBI was associated with significantly fewer days of all-cause hospitalization (−35%; p = 0.003) and from cardiovascular causes (−37%; p = 0.025) but not for CHF (−24%; p = 0.218). Consequently, healthcare costs ($AU3.93 vs. $AU5.53 million) were significantly less for the HBI group (median: $AU34 IQR: 13 to 81 per day vs. $AU52 17 to 140 per day; p = 0.030). Conclusions HBI was not superior to CBI in reducing all-cause death or hospitalization. However, HBI was associated with significantly lower healthcare costs, attributable to fewer days of hospitalization. (Which Heart failure Intervention is most Cost-effective & consumer friendly in reducing Hospital care WHICH?; ACTRN12607000069459 )
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