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Unhealthy alcohol use, smoking, and depressive symptoms are risk factors for cardiovascular disease (CVD). Little is known about their co-occurrence - termed a syndemic, defined as the synergistic effect of two or more conditions-on CVD risk in people with HIV (PWH). We used data from 5621 CVD-free participants (51% PWH) in the Veterans Aging Cohort Study-8, a prospective, observational study of veterans followed from 2002 to 2014 to assess the association between this syndemic and incident CVD by HIV status. Diagnostic codes identified cases of CVD (acute myocardial infarction, stroke, heart failure, peripheral artery disease, and coronary revascularization). Validated measures of alcohol use, smoking, and depressive symptoms were used. Baseline number of syndemic conditions was categorized (0, 1, ≥ 2 conditions). Multivariable Cox Proportional Hazards regressions estimated risk of the syndemic (≥ 2 conditions) on incident CVD by HIV-status. There were 1149 cases of incident CVD (52% PWH) during the follow-up (median 10.1 years). Of the total sample, 64% met our syndemic definition. The syndemic was associated with greater risk for incident CVD among PWH (Hazard Ratio [HR] 1.87 [1.47-2.38], p < 0.001) and HIV-negative veterans (HR 1.70 [1.35-2.13], p < 0.001), compared to HIV-negative with zero conditions. Among those with the syndemic, CVD risk was not statistically significantly higher among PWH vs. HIV-negative (HR 1.10 [0.89, 1.37], p = .38). Given the high prevalence of this syndemic combined with excess risk of CVD, these findings support linked-screening and treatment efforts.

We study four-point functions of scalars, conserved currents, and stress tensors in a conformal field theory, generated by a local contact term in the bulk dual description, in two different causal configurations. The first of these is the standard Regge configuration in which the chaos bound applies. The second is the `causally scattering configuration' in which the correlator develops a bulk point singularity. We find an expression for the coefficient of the bulk point singularity in terms of the bulk S matrix of the bulk dual metric, gauge fields and scalars, and use it to determine the Regge scaling of the correlator on the causally scattering sheet in terms of the Regge growth of this S matrix. We then demonstrate that the Regge scaling on this sheet is governed by the same power as in the standard Regge configuration, and so is constrained by the chaos bound, which turns out to be violated unless the bulk flat space S matrix grows no faster than $s^2$ in the Regge limit. It follows that in the context of the AdS/CFT correspondence, the chaos bound applied to the boundary field theory implies that the S matrices of the dual bulk scalars, gauge fields, and gravitons obey the Classical Regge Growth (CRG) conjecture., Comment: Added a section, new references, and clarifications

BackgroundInsomnia may be a risk factor for cardiovascular disease in HIV (HIV-CVD); however, mechanisms have yet to be elucidated.MethodsWe examined cross-sectional associations of insomnia symptoms with biological mechanisms of HIV-CVD (immune activation, systemic inflammation, and coagulation) among 1,542 people with HIV from the Veterans Aging Cohort Study (VACS) Biomarker Cohort. Past-month insomnia symptoms were assessed by the item, "Difficulty falling or staying asleep?," with the following response options: "I do not have this symptom" or "I have this symptom and…" "it doesn't bother me," "it bothers me a little," "it bothers me," "it bothers me a lot." Circulating levels of the monocyte activation marker soluble CD14 (sCD14), inflammatory marker interleukin-6 (IL-6), and coagulation marker D-dimer were determined from blood specimens. Demographic- and fully-adjusted (CVD risk factors, potential confounders, HIV-related factors) regression models were constructed, with log-transformed biomarker variables as the outcomes. We present the exponentiated regression coefficient (exp[b]) and its 95% confidence interval (CI).ResultsWe observed no significant associations between insomnia symptoms and sCD14 or IL-6. For D-dimer, veterans in the "Bothers a Lot" group had, on average, 17% higher D-dimer than veterans in the "No Difficulty Falling or Staying Asleep" group in the demographic-adjusted model (exp[b] = 1.17, 95%CI = 1.01-1.37, p = .04). This association was nonsignificant in the fully-adjusted model (exp[b] = 1.09, 95%CI = 0.94-1.26, p = .27).ConclusionWe observed little evidence of relationships between insomnia symptoms and markers of biological mechanisms of HIV-CVD. Other mechanisms may be responsible for the insomnia-CVD relationship in HIV; however, future studies with comprehensive assessments of insomnia symptoms are warranted.

Background People living with HIV have higher sudden cardiac death (SCD) rates compared with the general population. Whether HIV infection is an independent SCD risk factor is unclear. Methods and Results This study evaluated participants from the Veterans Aging Cohort Study, an observational, longitudinal cohort of veterans with and without HIV infection matched 1:2 on age, sex, race/ethnicity, and clinical site. Baseline for this study was a participant's first clinical visit on or after April 1, 2003. Participants were followed through December 31, 2014. Using Cox proportional hazards regression, we assessed whether HIV infection, CD4 cell counts, and/or HIV viral load were associated with World Health Organization (WHO)-defined SCD risk. Among 144 336 participants (30% people living with HIV), the mean (SD) baseline age was 50.0 years (10.6 years), 97% were men, and 47% were of Black race. During follow-up (median, 9.0 years), 3035 SCDs occurred. HIV infection was associated with increased SCD risk (hazard ratio [HR], 1.14; 95% CI, 1.04-1.25), adjusting for possible confounders. In analyses with time-varying CD4 and HIV viral load, people living with HIV with CD4 counts <200 cells/mm3 (HR, 1.57; 95% CI, 1.28-1.92) or viral load >500 copies/mL (HR, 1.70; 95% CI, 1.46-1.98) had increased SCD risk versus veterans without HIV. In contrast, people living with HIV who had CD4 cell counts >500 cells/mm3 (HR, 1.03; 95% CI, 0.90-1.18) or HIV viral load <500 copies/mL (HR, 0.97; 95% CI, 0.87-1.09) were not at increased SCD risk. Conclusions HIV infection is associated with increased risk of WHO-defined SCD among those with elevated HIV viral load or low CD4 cell counts.

The dissociation and ionization of hydrogen, during the formation of giant planets via core accretion, reduces the effective adiabatic index $\gamma$ of the gas and could trigger dynamical instability. We generalize the analysis of Chandrasekhar, who determined that the threshold for instability of a self-gravitating hydrostatic body lies at $\gamma=4/3$, to account for the presence of a planetary core, which we model as an incompressible fluid. We show that the dominant effect of the core is to stabilize the envelope to radial perturbations, in some cases completely (i.e. for all $\gamma > 1$). When instability is possible, unstable planetary configurations occupy a strip of $\gamma$ values whose upper boundary falls below $\gamma=4/3$. Fiducial evolutionary tracks of giant planets forming through core accretion appear unlikely to cross the dynamical instability strip that we define.

This paper studied the faint, diffuse extended X-ray emission associated with the radio lobes and the hot gas in the intracluster medium (ICM) environment for a sample of radio galaxies. We used shallow ($\sim 10$ ks) archival Chandra observations for 60 radio galaxies (7 FR I and 53 FR II) with $0.0222 \le z \le 1.785$ selected from the 298 extragalactic radio sources identified in the 3CR catalog. We used Bayesian statistics to look for any asymmetry in the extended X-ray emission between regions that contain the radio lobes and regions that contain the hot gas in the ICM. In the Chandra broadband ($0.5 - 7.0$ keV), which has the highest detected X-ray flux and the highest signal-to-noise ratio, we found that the non-thermal X-ray emission from the radio lobes dominates the thermal X-ray emission from the environment for $\sim 77\%$ of the sources in our sample. We also found that the relative amount of on-jet axis non-thermal emission from the radio lobes tends to increase with redshift compared to the off-jet axis thermal emission from the environment. This suggests that the dominant X-ray mechanism for the non-thermal X-ray emission in the radio lobes is due to the inverse Compton upscattering of cosmic microwave background (CMB) seed photons by relativistic electrons in the radio lobes, a process for which the observed flux is roughly redshift independent due to the increasing CMB energy density with increasing redshift., Comment: 19 pages, 18 figures