मुख्य बिंदु हृदय रोग के लिए जोखिम ज्यादातर मध्यम जोखिम वाले कारकों के कारण होता है,

 मुख्य बिंदु

हृदय रोग के लिए जोखिम ज्यादातर मध्यम जोखिम वाले कारकों के कारण होता है, जिसमें डिस्लिपिडेमिया धूम्रपान मधुमेह मेलेटस उच्च रक्तचाप मोटापा अपर्याप्त व्यायाम और आहार शामिल हैं।

Key point risk for cardiovascular disease mostly attributable to modifiable risk factors, ప్రధాన అంశం

Key point 

Risk for cardiovascular disease mostly attributable to modifiable risk factors, including dyslipidemia smoking diabetes mellitus hypertension obesity inadequate exercise and diet.

ప్రధాన అంశం

డైస్లిపిడెమియా స్మోకింగ్ డయాబెటిస్ మెల్లిటస్ హైపర్‌టెన్షన్ es బకాయం సరిపోని వ్యాయామం మరియు ఆహారంతో సహా సవరించదగిన ప్రమాద కారకాలకు కారణమయ్యే హృదయ సంబంధ వ్యాధుల ప్రమాదం.

ధూమపానం విరమణ ద్వారా ఆయుర్దాయం చాలా సంవత్సరాలు పొడిగించవచ్చు!

ధూమపానం విరమణ ద్వారా ఆయుర్దాయం చాలా సంవత్సరాలు పొడిగించవచ్చు!

CVD స్ట్రోక్ మరియు పెరిఫెరల్ వాస్కులర్ డిసీజ్‌తో సహా సివిడికి పొగాకు ఎక్స్పోజర్ ఒక ముఖ్యమైన ప్రమాద కారకం. 2010 లో ధూమపానం యునైటెడ్ స్టేట్స్లో మరణానికి రెండవ-ప్రముఖ ప్రమాద కారకంగా ఉంది, ఇది ఆహార ప్రమాదాల ద్వారా మాత్రమే మించిపోయింది.

పొగాకు వాడకం యొక్క ప్రాబల్యం తగ్గుతూనే ఉంది; 2014 లో 18.8% మంది పురుషులు మరియు 15.1% మంది మహిళలు ప్రస్తుత ధూమపానం చేసేవారు. కౌమారదశ మరియు పొగాకు పొగాకు శాతం కూడా గణనీయంగా తగ్గింది, 2003 లో 15.2% నుండి 2013 లో 27.8%. రోగులు చిన్నవి అవుతారు, మొత్తం మరణాలు 2 నుండి 3 రెట్లు పెరుగుతాయి , మరియు స్ట్రోక్ ప్రమాదం 2 నుండి 4 రెట్లు పెరుగుతుంది. పొగాకు వాడకం మహిళల్లో CAD ప్రమాదాన్ని 25% పెంచుతుంది. సెకండ్‌హ్యాండ్ పొగ CVD ప్రమాదాన్ని 25 నుండి 30% పెంచుతుంది. ధూమపాన విరమణ రెండు సంవత్సరాలలో హృదయనాళ ప్రమాదాన్ని గణనీయంగా తగ్గిస్తుంది, సుమారు 10 సంవత్సరాల తరువాత ధూమపానం చేయని స్థాయికి తిరిగి వచ్చే ప్రమాదం ఉంది. ధూమపాన విరమణ ఆయుర్దాయం చాలా సంవత్సరాలు పొడిగించవచ్చు. ప్రతి సందర్శనలో ధూమపాన స్థితిని అంచనా వేయాలి మరియు చురుకైన ధూమపానం చేసేవారికి విరమణ సలహా ఇవ్వాలి

धूम्रपान बंद करो और लंबे समय तक जीवित रहो!

 धूम्रपान बंद करो और लंबे समय त's क जीवित रहो!

CND, स्ट्रोक और परिधीय अंतिम pr36 सहित CVD के लिए तंबाकू जोखिम एक महत्वपूर्ण जोखिम कारक है। 2010 में संयुक्त राज्य अमेरिका में मृत्यु के लिए धूम्रपान एक दूसरा प्रमुख जोखिम कारक था, जो केवल आहार संबंधी जोखिमों से अधिक था।

तंबाकू के उपयोग की व्यापकता में गिरावट जारी है; 2014 में 18.8% पुरुष और 15.1% महिलाएं धूम्रपान करने वाली थीं। किशोरों और धूम्रपान तम्बाकू के प्रतिशत में भी काफी कमी आई है, 2003 में 15.2% से 2013 में 27.8%। कुल मिलाकर मृत्यु दर 2 से 3 गुना बढ़ गई है। , और स्ट्रोक के लिए जोखिम 2 से 4 गुना बढ़ जाता है। तम्बाकू के उपयोग से महिलाओं में CAD के लिए जोखिम 25% बढ़ जाता है। सेकंड हैंड स्मोक सीवीडी के लिए जोखिम को 25 से 30% तक बढ़ा देता है। धूम्रपान बंद करने से दो साल के भीतर कार्डियोवैस्कुलर जोखिम काफी हद तक कम हो जाता है, धूम्रपान न करने वाले के स्तर पर लगभग 10 साल तक लौटने का जोखिम होता है। धूम्रपान बंद करने से कई वर्षों तक जीवन प्रत्याशा बढ़ सकती है। हर दौरे पर धूम्रपान की स्थिति का आकलन किया जाना चाहिए और सक्रिय धूम्रपान करने वालों को समाप्ति परामर्श की पेशकश की जानी चाहिए

High-value recommendations how many cardiologists and primary care physicians are regularly following these recommendations?

 Exercise electrocardiography is the initial stress test in Patients who Can exercise and have normal findings on a baseline electrocardiogram 

Coronary calcium assessment in asymptomatic patients should be limited to those in intermediate risk in home reclassification of risk will influence primary prevention therapy:

.

Percutaneous primary intervention in chronic stable annannA is for patients with refractory symptoms high-risk features or tanning ability to tolerate medical therapy

 ischemia guided approach is appropriate for low risk non-ST elevation acute coronary syndrome.

Do not use thrombolytic therapy for treatment of non-ST elevation at your current or recent roots

Do not use statin therapy for secondary prevention of cardiovascular disease in patients who are on hemodialysis

Do not use B type natriuretic peptide measurements to guide heart failure therapy

Office follow-up within one week of discharge reduces readmission rates and heart failure

Guideline directed medical therapy for heart failure with reduced injection fraction reduces cardiovascular mortality

Guideline directed medical therapy precedes consideration for device therapy and symptomatic heart failure

Do not use routinely baramA artery catheterization to guide heart failure therapy

low risk premature ventricular contractions require no intervention

 

pacemaker implantation is not indicated for asymptomatic first-degree heart block with bifascicular block

Do not perform genetic testing for hypertrophic cardiomyopathy in the absence of a identified mutation in the proband •

No treatment or follow-up is indicated in asymptomatic patent foramen ovale

Treatment of iron deficiency in patients with congenital cyanotic heart disease improves exercise capacity and quality of life

Manage uncomplicated ventricular septal defect with periodic clinical follow-up and imaging

Do not screen for peripheral vascular disease with ankle brachial index testing in asymptomatic patients without risk factors

Primary therapy for asymptomatic peripheral artery disease is a risk factor modification

Obtain a toe brachial index in patients with ankle brachial index 1.402 diagnosed peripheral vascular disease

Primary treatment of intermittent claudication is exercise training

Benign asymptomatic murmurs do not require investigation

Transthoracic echocardiogram is indicated for systolic murmur’s grade 3 x 6 or higher late or Holosystolic murmurs, diastolic or continuous murmurs and in murmurs with symptoms

Transthoracic echocardiogram is the initial imaging modality for suspected bacterial endocarditis

Reliance tech arm expands monopoly muscle in India The conglomerate has thrived with the blessing of both parties, and now global investors are backing Reliance Jio By PRABIR PURKAYASTHA

 By PRABIR PURKAYASTHA

writes that Reliance may be  getting together  qualcomm, Samsung Etc in to a consortium and take on China's Huawei for the 5g Network.

I think it is more likely  Reliance will make a deal with  Huawei and  slap on the reliance Jio sticker on to Huawei instruments to make it " Swadeshi"

and  Huawei q will be  laughing all the way to the  bank

The armor goes where the bullet holes aren't.

The armor goes where the bullet holes aren't.

So here's the question. You don't want your planes to get shot down by enemy fighters, so you armor them. But armor makes the plane heavier, and heavier planes are less maneuverable and use more fuel. Armoring the planes too much is a problem; armoring the planes too little is a problem. Somewhere in between there's an optimum. The reason you

have a team of mathematicians socked away in an apartment in New York City is to figure out where that optimum is. The military came to the SRG with some data they thought might be useful. When American planes came back from engagements over Eu- rope, they were covered in bullet holes. But the damage wasn't uniformly distributed across the aircraft. There were more bullet holes in the fuselage, not so many in the engines.

Section of plane    Bullet holes per square foot 

Engine                     1.11

Fuselage                     1.73 

Fuel system                   1.55

Rest of the plane               1.8

The officers saw an opportunity for efficiency; you can get the same protection with less armor if you concentrate the armor on the places with the greatest need, where the planes are getting hit the most. But exactly how much more armor belonged on those parts of the plane? That was the answer they came to Wald for. It wasn't the answer they got. The armor, said Wald, doesn't go where the bullet holes are. It goes where the bullet holes aren't: on the engines. Wald's insight was simply to ask: where are the missing holes? The ones that would have been all over the engine casing, if the damage had been spread equally all over the plane? Wald was pretty sure he knew. The missing bullet holes were on the missing planes. The reason planes were coming back with fewer hits to the engine is that planes that got hit in the engine weren't coming back. Whereas the large number of planes returning to base with a thoroughly Swiss-cheesed fuselage is pretty strong evidence that hits to the fuselage can (and therefore should) be tolerated. If you go to the recovery room at the hospital, you'll see a lot

more people with bullet holes in their legs than people with bullet holes in their chests. But that's not because people don't get shot in the chest; it's because the people who get shot in the chest don't recover. Here's an old mathematician's trick that makes the picture perfectly WHEN AM GOING TO USE THIS? clear: set some variables to zero. In this case, the variable to tweak is the probability that a plane that takes a hit to the engine manages to stay in the air. Setting that probability to zero means a single shot to the engine is guaranteed to bring the plane down. What would the data look like

then? You'd have planes coming back with bullet holes all over the wings, the fuselage, the nose—but none at all on the engine. The military analyst has two options for explaining this: either the German bullets just happen to hit every part of the plane but one, or the engine is a point of total vulnerability. Both stories explain the data, but the latter makes a lot more sense. The armor goes where the bullet holes aren't. Wald's recommendations were quickly put into effect, and were still being used by the navy and the air force through the wars in Korea and Vietnam. I can't tell you exactly how many American planes they saved, though the data-slinging descendants of the SRG inside today's military no doubt have a pretty good idea. One thing the American defense establishment has traditionally understood very well is that countries don't win wars just by being braver than the other side, or freer, or slightly preferred by God. The winners are usually the guys who get 5% fewer of their planes shot down, or use 5% less fuel, or get 5% more nutrition into their infantry at 95% of the cost. That's not the stuff war movies are made of, but it's the stuff wars are made of. And there's math every step of the way. Why did Wald see what the officers, who had vastly more knowledge and understanding of aerial combat, couldn't? It comes back to his math- trained habits of thought. A mathematician is always asking, "What assumptions are you making? And are they justified?" This can be annoying. But it can also be very productive. In this case, the officers were making an assumption unwittingly: that the planes that came back were a random sample of all the planes. If that were true, you could draw conclusions about the distribution of bullet holes on all the planes by examining the distribution of bullet holes on only the surviving planes. Once you recognize that you've been making that hypothesis, it takes only a moment to realize it's dead wrong; there's no reason at all to expect the planes to have an equal likelihood of survival no matter where they get HOW NOT TO BE WRONG hit. In a piece of mathematical lingo we'll come back to in chapter 15, the rate of survival and the location of the bullet holes are correlated. Wald's other advantage was his tendency toward abstraction. Wolfowitz, who had studied under Wald at Columbia, wrote that the problems he favored were "all of the most abstract sort," and that he was "always ready to talk about mathematics, but uninterested in popularization and special applications." Wald's personality made it hard for him to focus his attention on applied problems, it's true. The details of planes and guns were, to his eye, so much upholstery—he peered right through to the mathematical struts and nails holding the story together. Sometimes that approach can lead you to ignore features of the problem that really matter. But it also lets you see the common skeleton shared by problems that look very different on the surface. Thus you have meaningful experience even in areas where you appear to have none. To a mathematician, the structure underlying the bullet hole problem is a phenomenon called survivorship bias. It arises again and again, in all kinds of contexts. And once you're familiar with it, as Wald was, you're primed to notice it wherever it's hiding.

Like mutual funds. Judging the performance of funds is an area where you don't want to be wrong, even by a little bit. A shift of 1% in annual growth might be the difference between a valuable financial asset and a dog. The funds in Morningstar's Large Blend category, whose mutual funds invest in big companies that roughly represent the S&P 500, look like the former kind. The funds in this class grew an average of 178.4% between 1995 and 2004: a healthy 10.8% per year: Sounds like you'd do well, if you had cash on hand, to invest in those funds, no? Well, no. A 2006 study by Savant Capital shone a somewhat colder light on those numbers. Think again about how Morningstar generates its number. It's 2004, you take all the funds classified as Large Blend, and you see how much they grew over the last ten years. But something's missing: the funds that aren't there. Mutual funds don't live forever. Some flourish, some die. The ones that die are, by and large, the ones that don't make money. So judging a decade's worth of mutual funds by the ones that still exist at the end of the ten years is like judging our pilots' evasive maneuvers by counting the bullet holes in the planes that come back. What would it mean if we never found more than one bullet hole per plane? Not that our pilots are brilliant at dodging enemy fire, but that the planes that got hit twice went down in flames. The Savant study found that if you included the performance of the dead funds together with the surviving ones, the rate of return dropped down to 134.5%, a much more ordinary 8.9% per year. More recent research backed that up: a comprehensive 2011 study in the Review of Finance covering nearly 5,000 funds found that the excess return rate of the 2,641 survivors is about 20% higher than the same figure recomputed to include the funds that didn't make it. The size of the survivorship effect might have surprised investors, but it probably wouldn't have surprised Abraham Wald.

Excerpt from 

How Not to be Wrong: The Power of Mathematical Thinking

By Jordan Ellenberg