The angiographic and pathologic findings are described in three patients who died less than 24 h after failed percutaneous transluminal coronary angioplasty. In two of the three patients, coronary angiography performed before angioplasty disclosed apparently focal lesions in the left anterior descending and right coronary arteries. In these two patients quantitative angiographic analysis disclosed a minimal lumen cross-sectional area of 1.82 and 0.47 mm2, respectively, at the sites of apparently focal stenoses before angioplasty; corresponding percent lumen area narrowing measured 84% and 91%, respectively, by quantitative angiography at these two sites. In the third patient, coronary angioplasty was undertaken when the patient developed spontaneous occlusion of the right coronary artery several hours after diagnostic angiography. Retrospective quantitative angiographic analysis of the right coronary artery revealed a minimal lumen cross-sectional area of 1.14 mm2, with 85% lumen area narrowing at the site of subsequent total occlusion and angioplasty. In each of these three patients, necropsy examination disclosed that the distribution of coronary narrowing in the artery treated by angioplasty was in fact not focal; rather, in each of these three patients, the artery treated by angioplasty, as well as the extramural coronary arteries not treated by angioplasty, were severely narrowed by diffusely distributed atherosclerotic plaque. The angiographic and necropsy findings in these three patients document that coronary narrowing that remains occult by virtue of diffuse distribution may complicate evaluation of patients being considered for coronary angioplasty.

Climate change poses serious threats to public health and is exacerbating health inequities. Policy changes are essential to mitigate climate change impacts on human and planetary health. The purpose was to describe recommendations by the Policy and Advocacy Subgroup of the Society of Behavioral Medicine (SBM) Climate Change, Behavior Change and Health Presidential Working Group (PWG). The Policy and Advocacy subgroup was comprised of experts in public health, climate policy, and health behavior change, who worked together to identify priorities and develop recommendations. We worked under the premise that building political will for climate policy action is the most urgent goal, and we recommended promotion of citizen advocacy for this purpose. Because citizen advocacy is a set of behaviors, SBM members can use behavioral science to identify and scale up interventions, working collaboratively with communities targeted for marginalization. Recommendations for SBM included establishing an organizational home for climate and health work, providing training and resources, engaging in climate advocacy as an organization, and networking with other organizations. Recommendations for a proposed SBM Climate and Health Committee, Council, or Special Interest Group included developing trainings and resources, seeking opportunities for networking and collaborations, and identifying a research agenda. Individual behavior changes are insufficient to address climate change; policy actions are needed. SBM and similar organizations can support their members to work in developing, evaluating, and scaling up advocacy interventions for action on climate policy to magnify the power of the health and medical sectors to protect planetary and human health.

There is considerably greater variation in metabolic rates between men than between women, in terms of basal, activity and total (daily) energy expenditure (EE). One possible explanation is that EE is associated with male sexual characteristics (which are known to vary more than other traits) such as musculature and athletic capacity. Such traits might be predicted to be most prominent during periods of adolescence and young adulthood, when sexual behaviour develops and peaks. We tested this hypothesis on a large dataset by comparing the amount of male variation and female variation in total EE, activity EE and basal EE, at different life stages, along with several morphological traits: height, fat free mass and fat mass. Total EE, and to some degree also activity EE, exhibit considerable greater male variation (GMV) in young adults, and then a decreasing GMV in progressively older individuals. Arguably, basal EE, and also morphometrics, do not exhibit this pattern. These findings suggest that single male sexual characteristics may not exhibit peak GMV in young adulthood, however total and perhaps also activity EE, associated with many morphological and physiological traits combined, do exhibit GMV most prominently during the reproductive life stages.