Smoking Cessation And Outcome After Ischemic Stroke Or Tia

People who smoke cigarettes are 2-4 times more likely to have a stroke and 2-5 times more likely to have a myocardial infarction compared with people who do not smoke. On a population level, it is estimated that smoking accounts for 33% of all cardiovascular deaths. Fortunately, quitting smoking can rapidly normalize risk. After an MI, smoking cessation reduces the risk of recurrent coronary events to the level of a never-smoker\u27s after 3 years. While the benefits of smoking cessation in patients with cardiovascular disease are well-known, the benefits of smoking cessation after stroke have never been adequately examined and remain unquantified. In this research, we tested the hypothesis that smoking cessation after an ischemic stroke or transient ischemic attack (TIA) improves outcome, compared to continued smoking. We conducted a prospective observational cohort study of 1072 men and women who were current cigarette smokers at the time they were enrolled in the Insulin Resistance Intervention after Stroke (IRIS) trial. The IRIS trial was conducted during 2005-2015 to test the effectiveness of pioglitazone, compared with placebo, for prevention of stroke or MI among non-diabetic patients with a recent qualifying stroke or TIA; the main finding was that pioglitazone significantly reduced the risk of subsequent stroke or MI.5 A tobacco use history was obtained at baseline and updated during annual interviews. Cox regression models were used to estimate the differences in rates of stroke, MI, or death between quitters and continuing smokers after 4.8 years of IRIS participation. Pre-specified adjustment variables were age, sex, stroke [vs. TIA] as index event, prior history of stroke, history of hypertension, history of coronary artery disease, systolic blood pressure, diastolic blood pressure, and pioglitazone treatment. By the time of randomization, 450 (42%) patients had quit smoking. Among quitters, the 5-year risk of stroke, MI, or death was 15.7%, compared to 22.6% for patients who continued to smoke (adjusted hazard ratio, 0.66; 95% confidence interval, 0.48-0.90). Cessation of cigarette smoking after an ischemic stroke or TIA was associated with significant health benefits over 4.8 years in the IRIS trial cohort

Statistical Mechanics of Transport Processes in Active Fluids II: Equations of Hydrodynamics for Active Brownian Particles

We perform a coarse-graining analysis of the paradigmatic active matter model, Active Brownian Particles, yielding a continuum description in terms of balance laws for mass, linear and angular momentum, and energy. The derivation of the balance of linear momentum reveals that the active force manifests itself directly as a continuum-level body force proportional to an order parameter-like director field, which therefore requires its own evolution equation to complete the continuum description of the system. We derive this equation, demonstrating in the process that bulk currents may be sustained in homogeneous systems only in the presence of inter-particle aligning interactions. Further, we perform a second coarse-graining of the balance of linear momentum and derive the expression for active or swim pressure in the case of mechanical equilibrium.Comment: 9 pages, 3 appendices with derivation

Renal medullary Na-K-ATPase and hypoxic injury in perfused rat kidneys

Renal medullary Na-K-ATPase and hypoxic injury in perfused rat kidneys. We wished to see if chronic alterations in Na-K-ATPase activity in the medullary thick ascending limb would modify the susceptibility of its cells to the hypoxic injury produced by perfusion of the isolated kidney. Rats were fed a diet high (64%) or low (8%) in protein for three weeks. Renal medullary Na-K-ATPase was 75 ± 12 U/mg protein/hr (mean ± SE) in the high protein group and 44 ± 3 in rats given low protein. After 90 minutes of perfusion, the kidneys of rats fed a high protein diet showed almost all mTAL cells near the inner medulla with severe damage (93 ± 4.8%), whereas the same zone in perfused kidneys of rats on a low protein diet showed only 47 ± 7.7% injury. In a similar fashion, damage to mTAL cells seen in perfused kidneys was greatly augmented by compensatory renal hypertrophy produced by removal of the contralateral kidney two weeks earlier, and by a diet high in potassium given for two weeks, procedures which also increased the activity of medullary Na-K-ATPase. The results suggest that the level of transport work of medullary cells mediated by Na-K-ATPase is a determinant of the vulnerability of mTAL cells to hypoxic injury

Protective action of glycine in cisplatin nephrotoxicity

Protective action of glycine in cisplatin nephrotoxicity. Because glycine is cytoprotective for kidney cells in vitro, we investigated its possible action in vivo to protect rats against cisplatin nephrotoxicity, a well-established experimental model of renal tubular injury. Glycine was infused at a dose of 1mmol per 100g body weight per hour for 75 minutes, starting 15 minutes before cisplatin, 5mg per kg, was injected intravenously. Plasma concentration of glycine rose to 3.5mmol per liter at the time cisplatin was injected. These rats were compared with cisplatin-treated animals treated with L-alanine or with isotonic saline. After five days plasma creatinine of saline-treated rats given cisplatin had risen threefold to 2.6 ± 1.5mg per 100ml (mean ± SD), as creatinine clearance fell to 25% of baseline (0.14 ± 0.05ml/min/100g). Morphological evaluation disclosed extensive damage involving all S3 segments in the outer medulla as well as the medullary rays of the cortex. In contrast, in rats treated with glycine, plasma creatinine rose only to 1.2 ± 0.2mg/100ml and creatinine clearance was maintained at 75% of baseline (0.35 ± 0.05ml/min/100g). Glycine also attenuated the weight loss, polyuria, increased fractional excretion of sodium and potassium, decreased urinary osmolality, and renal glycosuria observed in control, saline-treated rats after cisplatin, while substantially decreasing the percentage of S3 tubules with evident morphological injury. Renal platinum content was unaffected by glycine. The administration of L-alanine or the delayed infusion of glycine, starting one hour after cisplatin was given, did not prevent cisplatin toxicity. Thus, high plasma concentrations of glycine achieved during a brief period of time when cisplatin is administered, markedly attenuate cisplatin nephrotoxicity

Mortality and Access to Care among Adults after State Medicaid Expansions

Background: Several states have expanded Medicaid eligibility for adults in the past decade, and the Affordable Care Act allows states to expand Medicaid dramatically in 2014. Yet the effect of such changes on adults’ health remains unclear. We examined whether Medicaid expansions were associated with changes in mortality and other health related measures.Methods:We compared three states that substantially expanded adult Medicaid eligibility since 2000 (New York, Maine, and Arizona) with neighboring states without expansions. The sample consisted of adults between the ages of 20 and 64 years who were observed 5 years before and after the expansions, from 1997 through 2007. The primary outcome was all-cause county-level mortality among 68,012 year- and countyspecific observations in the Compressed Mortality File of the Centers for Disease Control and Prevention. Secondary outcomes were rates of insurance coverage, delayed care because of costs, and self-reported health among 169,124 persons in the Current Population Survey and 192,148 persons in the Behavioral Risk Factor Surveillance System.Results Medicaid expansions were associated with a significant reduction in adjusted allcause mortality (by 19.6 deaths per 100,000 adults, for a relative reduction of 6.1%;P=0.001). Mortality reductions were greatest among older adults, nonwhites, and residents of poorer counties. Expansions increased Medicaid coverage (by 2.2 percentage points, for a relative increase of 24.7%; P=0.01), decreased rates of uninsurance (by 3.2 percentage points, for a relative reduction of 14.7%; P<0.001), decreased rates of delayed care because of costs (by 2.9 percentage points, for a relative reduction of 21.3%; P=0.002), and increased rates of self-reported healthstatus of “excellent” or “very good” (by 2.2 percentage points, for a relative increase of 3.4%; P=0.04). Conclusions State Medicaid expansions to cover low-income adults were significantly associated with reduced mortality as well as improved coverage, access to care, and selfreported health

Effects of Autism Spectrum Disorder Insurance Mandates on the Treated Prevalence of Autism Spectrum Disorder

Key Findings: State mandates requiring commercial health plans to cover services for children with autism spectrum disorder increased the number of children diagnosed with the disorder. However, diagnosis rates remain much lower than community estimates, suggesting that many commercially insured children with ASD remain undiagnosed or are insured through public plans

Understanding and Evaluating Quality of Life for Individuals with Intellectual Disabilities: A Northwestern Vermont Population Study

Introduction There are 7-8 million individuals with intellectual or developmental disabilities living in the US. • 91,795 of this population lives in Vermont • Historically marginalized and isolated community • Socioeconomic, health-related, and emotional burden • Public health-related disparity Champlain Community Services (CCS): non-profit service provider and coordinator for 86 persons with intellectual disabilities in Northwestern Vermont Objectives: • Develop and apply measures to better understand and evaluate quality of life in the population CCS serves. • Recommend improvement to CCS data collection and evaluation methods. • Provide a basis for future recommendations to CCS services that are aligned to the needs of consumers.https://scholarworks.uvm.edu/comphp_gallery/1275/thumbnail.jp