Prevalence of antiplatelet therapy in patients with diabetes

OBJECTIVE: To determine the prevalence of, and patient characteristics associated with, antiplatelet therapy in a cohort of primary care patients with Type 1 or Type2 diabetes. METHODS: Subjects participating in a randomized trial of a decision support system were interviewed at home and medication usage verified by a research assistant. Eligibility for antiplatelet therapy was determined by American Diabetes Association criteria and clinical contraindications. The association between antiplatelet use and patient characteristics was examined using bivariate and multivariate logistic regression. RESULTS: The mean age of subjects was 64 years (range 31–93). The prevalence of antiplatelet use was 54% overall; 45% for subjects without known CVD vs. 78% for those with CVD; 46% for women vs. 63% for men; and 45% for younger subjects (age< 65) vs. 62% for senior citizens. After controlling for race/ethnicity, income, education, marital status, insurance status and prescription coverage, the following were associated with the use of antiplatelet therapy: presence of known CVD (OR 3.4 [2.2, 5.1]), male sex (OR 2.0 [1.4, 2.8]), and age > = 65 (OR 1.9 [1.3, 2.7]). The prevalence of antiplatelet therapy for younger women without CVD was 32.8% compared to a prevalence of 90.3% for older men with CVD. CONCLUSION: Despite clinical practice guidelines recommending antiplatelet therapy for patients with diabetes, there are still many eligible patients not receiving this beneficial therapy, particularly patients under 65, women, and patients without known CVD. Effective methods to increase antiplatelet use should be considered at the national, community, practice and provider level

Concentration-dependent Effects of D-Methylphenidate on Frontal Cortex and Spinal Cord Networks in vitro

Spontaneously active frontal cortex and spinal cord networks grown on microelectrode arrays were used to study effects of D-methylphenidate. These central nervous system tissues have relatively low concentrations of dopaminergic and noradrenergic neurons compared to the richly populated loci, yet exhibit similar neurophysiological responses to methylphenidate. The spontaneous spike activity of both tissues was inhibited in a concentration-dependent manner by serial additions of 1-500 µM methylphenidate. Methylphenidate is non-toxic as spike inhibition was recovered following washes. The average concentrations for 50% spike rate inhibition (IC50 ± SD) were 118 ± 52 (n= 6) and 57 ± 43 (n = 11) for frontal cortex and spinal cord networks, respectively. A 3 hour exposure of a network to 1 mM methylphenidate was nontoxic. The effective concentrations described in this study are within the therapeutic dosage range. Therefore, the platform may be used for further investigations of drug mechanisms

Hamster oocyte membrane potential and ion permeability vary with preantral cumulus cell attachment and developmental stage

BACKGROUND: In vitro maturation of mammalian oocytes is an area of great interest due to its potential application in the treatment of infertility. The morphological and physiological changes that occur during oocyte development are poorly understood, and further studies are needed investigating the physiological changes associated with oocyte maturation. In this study we evaluated the membrane potential and the sodium/potassium permeability ratio of oocytes acutely isolated, and cumulus-oocyte complexes in metaphase II and preantral follicle stages. RESULTS: Intracellular electrical recordings revealed that cumulus-enclosed oocytes have a membrane potential significantly more negative at the preantral follicle stage than at metaphase II stage (-38.4 versus -19.7 mV, p < 0.0005). The membrane potential of the cumulus-free oocytes was not different between the preantral and metaphase II stages. The membrane potential of the cumulus cells forming preantral stage follicles was shown to be significantly different from that of the oocyte within the follicle (-28.6 versus -38.4 mV, p < 0.05). The sodium/potassium permeability measured in cumulus-enclosed oocytes at the preantral stage equaled a mean value of 0.33. The ratio was significantly lower when measured in oocytes denuded of cumulus cells or cumulus-enclosed metaphase II oocytes, 0.76, 0.79, 0.77 respectively (p < 0.001). CONCLUSIONS: These data show a change in the membrane potential and Na(+)/K(+) permeability ratio during ooycte development from the preantral stage oocyte to the metaphase II stage. We have also demonstrated a change in the preantral oocyte membrane potential when surrounding cumulus cells are removed; either due to membrane changes or loss of cumulus cells

Forced and unforced variability of twentieth century North American droughts and pluvials

Research on the forcing of drought and pluvial events over North America is dominated by general circulation model experiments that often have operational limitations (e.g., computational expense, ability to simulate relevant processes, etc). We use a statistically based modeling approach to investigate sea surface temperature (SST) forcing of the twentieth century pluvial (1905-1917) and drought (1932-1939, 1948-1957, 1998-2002) events. A principal component (PC) analysis of Palmer Drought Severity Index (PDSI) from the North American Drought Atlas separates the drought variability into five leading modes accounting for 62% of the underlying variance. Over the full period spanning these events (1900-2005), the first three PCs significantly correlate with SSTs in the equatorial Pacific (PC 1), North Pacific (PC 2), and North Atlantic (PC 3), with spatial patterns (as defined by the empirical orthogonal functions) consistent with our understanding of North American drought responses to SST forcing. We use a large ensemble statistical modeling approach to determine how successfully we can reproduce these drought/pluvial events using these three modes of variability. Using Pacific forcing only (PCs 1-2), we are able to reproduce the 1948-1957 drought and 1905-1917 pluvial above a 95% random noise threshold in over 90% of the ensemble members; the addition of Atlantic forcing (PCs 1-2-3) provides only marginal improvement. For the 1998-2002 drought, Pacific forcing reproduces the drought above noise in over 65% of the ensemble members, with the addition of Atlantic forcing increasing the number passing to over 80%. The severity of the drought, however, is underestimated in the ensemble median, suggesting this drought intensity can only be achieved through internal variability or other processes. Pacific only forcing does a poor job of reproducing the 1932-1939 drought pattern in the ensemble median, and less than one third of ensemble members exceed the noise threshold (28%). Inclusion of Atlantic forcing improves the ensemble median drought pattern and nearly doubles the number of ensemble members passing the noise threshold (52%). Even with the inclusion of Atlantic forcing, the intensity of the simulated 1932-1939 drought is muted, and the drought itself extends too far into the southwest and southern Great Plains. To an even greater extent than the 1998-2002 drought, these results suggest much of the variance in the 1932-1939 drought is dependent on processes other than SST forcing. This study highlights the importance of internal noise and non SST processes for hydroclimatic variability over North America, complementing existing research using general circulation models