Summary:Hospital records of 120 patients undergoing aortic valve replacement were retrospectively reviewed for risk factors associated with early aortic valve replacement, Patients were separated into four groups (rheumatic, congcnital bicuspid. degenerative, and miscellaneous) based upon the morphologic etiology of aortic stenosis. Multiplc regression analysis was performed using age at surgcry as the dependent variable. lndependent variables for the study were race, gender, systemic hypertension, total triglyceride level, total serum cholesterol level, tobacco smoking history, diabetes mellitus, and angiographic coroiiary artery disease. In the rheumatic valve group only showed a statistically significant risk effect whereas in the congenital bicuspid valve group i u w , g n idcv.? and tri,qIycwicle.s were statistically correlated with age at surgcry. In the degenerative valve group ,qencIcr and .snioAiri,q were found to be statistically significant risk factors. The establishment of aortic stenosis risk factors might be an indication for clinical trials of risk factor modification i n patients with aortic stenosis.

A family history of premature cardiovascular disease and male gender were found to have strong, independent associations with having a snow-shoveling-related ACS. A history of chronic stable angina trended toward an association.

Summary Conservation of freshwater unionid mussels presents unique challenges due to their distinctive life cycle, cryptic occurrence and imperilled status. Relevant ecological information is urgently needed to guide their management and conservation. We adopted a modelling approach, which is a novel application to freshwater mussels to enhance inference on rare species, by borrowing data among species in a hierarchical framework to conduct the most comprehensive occurrence analysis for freshwater mussels to date. We incorporated imperfect detection to more accurately examine effects of biotic and abiotic factors at multiple scales on the occurrence of 14 mussel species and the entire assemblage of the Tar River Basin of North Carolina, U.S.A. The single assemblage estimate of detection probability for all species was 0.42 (95% CI, 0.36–0.47) with no species‐ or site‐specific detection effects identified. We empirically observed 15 mussel species in the basin but estimated total species richness at 21 (95% CI, 16–24) when accounting for imperfect detection. Mean occurrence probability among species ranged from 0.04 (95% CI, 0.01–0.16) for Alasmidonta undulata, an undescribed Lampsilis sp., and Strophitus undulatus to 0.67 (95% CI, 0.42–0.86) for Elliptio icterina. Median occurrence probability among sites was <0.30 for all species with the exception of E. icterina. Site occurrence probability generally related to mussel conservation status, with reduced occurrence for endangered and threatened species. Catchment‐scale abiotic variables (stream power, agricultural land use) and species traits (brood time, host specificity, tribe) influenced the occurrence of mussel assemblages more than reach‐ or microhabitat‐scale features. Our findings reflect the complexity of mussel ecology and indicate that habitat restoration alone may not be adequate for mussel conservation. Catchment‐scale management can benefit an entire assemblage, but species‐specific strategies may be necessary for successful conservation. The hierarchical multispecies modelling approach revealed findings that could not be elucidated by other means, and the approach may be applied more broadly to other river basins and regions. Accurate measures of assemblage dynamics, such as occurrence and species richness, are required to create management plans for effective conservation.