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\"Maryland-raised Cayce Kerr began his caddying career at the storied Congressional Country Club in 1986 and within a year had managed to work his way onto the PGA Tour, rubbing shoulders with the biggest names in the world of golf. Armed with quick wit and deep golf knowledge, he quickly established himself in the top echelon of his profession and never looked back, partnering with more than two dozen major champions and even working 30 Masters tournaments in a row from 1987 until 2016. In Walking with Greatness, Kerr reveals what really goes on inside and outside the ropes at the highest levels of golf. With a cast of characters including Ernie Els, Fred Couples, Vijay Singh, Fuzzy Zoeller, and Tiger Woods, this true insider's memoir pulls no punches in portraying life on the PGA Tour. Spanning indelible triumphs, improbable mishaps, and no shortage of hijinks, Kerr's adventures and observations will leave golf fans illuminated, entertained, and often literally laughing out loud\"-- Provided by publisher.

Journey back to the Mesozoic Era, when fearsome dinosaurs roamed the land, menacing pterosaurs patrolled the skies, and the seas were filled with awesome reptiles. Find out how these creatures lived, why they died out, and what their fossil traces tell us.

Estimates of the volume of the earliest crust based on zircon ages and radiogenic isotopes remain equivocal. Stable isotope systems, such as molybdenum, have the potential to provide further constraints but remain underused due to the lack of complementarity between mantle and crustal reservoirs. Here we present molybdenum isotope data for Archaean komatiites and Phanerozoic komatiites and picrites and demonstrate that their mantle sources all possess subchondritic signatures complementary to the superchondritic continental crust. These results confirm that the present-day degree of mantle depletion was achieved by 3.5 billion years ago and that Earth has been in a steady state with respect to molybdenum recycling. Mass balance modelling shows that this early mantle depletion requires the extraction of a far greater volume of mafic-dominated protocrust than previously thought, more than twice the volume of the continental crust today, implying rapid crustal growth and destruction in the first billion years of Earth’s history.

Combining authoritative, exciting text and bold images, The World War I Book explores the historical background of the war, its causes, all of the key events across the major theatres of conflict, and its aftermath. Using the original, graphic-led approach of the series, entries profile more than 90 of the key events during and surrounding the conflict -- from the growing tensions between Europe's major powers to the assassination of Archduke Franz Ferdinand, the German invasion of Belgium, the endless slaughter in the trenches, the American entry into the war, the Russian Revolution, the Armistice, and the creation of the League of Nations.

Most cardiovascular disease risk prediction equations in use today were derived from cohorts established last century and with participants at higher risk but less socioeconomically and ethnically diverse than patients they are now applied to. We recruited a nationally representative cohort in New Zealand to develop equations relevant to patients in contemporary primary care and compared the performance of these new equations to equations that are recommended in the USA. The PREDICT study automatically recruits participants in routine primary care when general practitioners in New Zealand use PREDICT software to assess their patients' risk profiles for cardiovascular disease, which are prospectively linked to national ICD-coded hospitalisation and mortality databases. The study population included male and female patients in primary care who had no prior cardiovascular disease, renal disease, or congestive heart failure. New equations predicting total cardiovascular disease risk were developed using Cox regression models, which included clinical predictors plus an area-based deprivation index and self-identified ethnicity. Calibration and discrimination performance of the equations were assessed and compared with 2013 American College of Cardiology/American Heart Association Pooled Cohort Equations (PCEs). The additional predictors included in new PREDICT equations were also appended to the PCEs to determine whether they were independent predictors in the equations from the USA. Outcome events were derived for 401 752 people aged 30–74 years at the time of their first PREDICT risk assessment between Aug 27, 2002, and Oct 12, 2015, representing about 90% of the eligible population. The mean follow-up was 4·2 years, and a third of participants were followed for 5 years or more. 15 386 (4%) people had cardiovascular disease events (1507 [10%] were fatal, and 8549 [56%] met the PCEs definition of hard atherosclerotic cardiovascular disease) during 1 685 521 person-years follow-up. The median 5-year risk of total cardiovascular disease events predicted by the new equations was 2·3% in women and 3·2% in men. Multivariable adjusted risk increased by about 10% per quintile of socioeconomic deprivation. Māori, Pacific, and Indian patients were at 13–48% higher risk of cardiovascular disease than Europeans, and Chinese or other Asians were at 25–33% lower risk of cardiovascular disease than Europeans. The PCEs overestimated of hard atherosclerotic cardiovascular disease by about 40% in men and by 60% in women, and the additional predictors in the new equations were also independent predictors in the PCEs. The new equations were significantly better than PCEs on all performance metrics. We constructed a large prospective cohort study representing typical patients in primary care in New Zealand who were recommended for cardiovascular disease risk assessment. Most patients are now at low risk of cardiovascular disease, which explains why the PCEs based mainly on old cohorts substantially overestimate risk. Although the PCEs and many other equations will need to be recalibrated to mitigate overtreatment of the healthy majority, they also need new predictors that include measures of socioeconomic deprivation and multiple ethnicities to identify vulnerable high-risk subpopulations that might otherwise be undertreated. Health Research Council of New Zealand, Heart Foundation of New Zealand, and Healthier Lives National Science Challenge.

Describes a case of Takotsubo syndrome (TS) (also known as apical ballooning syndrome) in which the pattern of regional wall motion and the associated electrocardiogram (ECG) changes differed between the first and the recurrent admission. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.

aim: Computed tomography coronary angiography (CTCA) is a sensitive tool for the diagnosis of atherosclerotic coronary artery disease (CAD). The study aim was to determine whether the finding of coronary atheroma on CTCA was associated with the subsequent use of statin therapy. methods: Patients with chest pain who underwent CTCA in 2020–2021 were identified from the Aotearoa New Zealand All Cardiology Services Quality Improvement (ANZACS-QI) cardiac computed tomography (CT) registry at Middlemore Hospital, Auckland, New Zealand. Patients were categorised into three groups: no atheroma, atheroma with non-obstructive CAD and atheroma with obstructive CAD. results: There were 548 patients with acute chest pain and 746 with stable chest pain. Of those with acute chest pain, no atheroma, non-obstructive and obstructive CAD was documented in 37.2%, 38% and 24.8%, respectively. In patients with obstructive CAD, statin dispensing was 52.9% pre-admission, 92.6% early post-CTCA and 87.5% at 1 year. In those with non-obstructive CAD, statin dispensing was 45.7% pre-admission, 67.8% early post-CTCA and 59.6% at 1 year. In those without atheroma, statins were dispensed in 23.5% at pre-admission and in 28.9% at 1 year. In the stable chest pain cohort, patterns of statin dispensing post-CTCA were similar to those in the acute chest pain cohort. On multivariate regression the presence of atheroma both with/without obstructive CAD was associated with higher levels of statin dispensing. conclusion: The finding of atheroma with obstructive CAD on CTCA is associated with appropriate increases in statin use. There are opportunities to optimise care by greater statin utilisation in non-obstructive CAD and down-titration in those without atheroma.

Despite dramatic declines in coronary heart disease (CHD) incidence in Aotearoa New Zealand over more than 50 years, the burden of CHD is still inequitable, particularly for Māori and Pacific peoples. We studied recent trends in first hospitalisations for acute coronary syndromes (ACS) by ethnicity. All first ACS hospitalisations (2005-2019) were identified from national administrative datasets. Population denominators were constructed using multiple linked national data sources. Trends in rates of incident ACS and incidence rate ratios (IRRs) were analysed for younger (20-59 years) and older (60-84 years) patients. The ACS cohort (n=69,161) comprised 74.7% European, 14.2% Māori, 6.1% Pacific peoples, 2.8% Indian and 2.2% non-Indian Asian peoples. For younger patients, annual ACS incidence initially decreased in all ethnic groups but plateaued between 2013 and 2015 for Māori, non-Indian Asians and Europeans; the decline was minimal for Pacific peoples across the time period. In older patients ACS incidence initially fell for all groups, but plateaued for Māori from 2015, and slowed after 2014 for Europeans. IRRs, compared with Europeans, increased between 2005 and 2019 for younger Māori (IRR 1.5 to 2.25, p=0.017) and Pacific peoples (IRR 1.25 to 1.5, p<0.001), and for older Māori (IRR 1.35 to 1.6, p=0.006) and Pacific peoples (IRR 1.0 to 1.6, p<0.001). Rates of decline in ACS incidence have stalled or slowed for most younger ethnic groups, and for older Māori and Europeans. The differential rate of change between ethnic groups has resulted in increasing inequity for Māori and Pacific peoples across the age range.

ObjectiveThe medium-term outcome and cause of death in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) is not well characterised. The aim of this study was to compare mortality and rates of recurrent events in post myocardial infarction (MI) patients with obstructive coronary artery disease (CAD) and in patients with MINOCA compared with an age and sex-matched cohort without cardiovascular disease (CVD).MethodsWe performed a national cohort study of consecutive patients undergoing coronary angiography for MI during 2 years between 2013 and 2015 from the All New Zealand Acute Coronary Syndrome—Quality Improvement (ANZACS QI) registry. MI patient registry data were linked anonymously to national hospitalisation and mortality records. Age and sex matched patients without known CVD formed the comparison group.ResultsOf the 8305 patients with MI, 897 (10.8%) were classified as MINOCA. Compared with those without known CVD, the adjusted HRs for the primary outcome (all-cause death or recurrent non-fatal MI) were 7.81 (95% CI 6.64 to 9.19, p<0.0001) in those with obstructive CAD and 4.64 (95% CI 3.54 to 6.10, p<0.0001) in those with MINOCA. Kaplan-Meier all-cause mortality at 2 years was 7.9% for those with obstructive CAD, with nearly half being CVD deaths (3.6% CVD deaths and 4.5% non-CVD deaths, respectively). In contrast, MINOCA all-cause mortality was 4.9% with non-CVD death (4.5%) predominating.ConclusionsMINOCA is common and has an adverse outcome rate approximately half than that of those with obstructive CAD. The predominant contributor to mortality is non-CVD death. The rate of events in MINOCA is significantly greater than the population without CVD.