Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

From Smart Agriculture to Smart Economy: Case of Vijayawada City Region

Smart City, as this chapter proves, is the one that adapts to its dynamic structural changes in the economy within a shortest possible time without causing pitfalls. Vijayawada–Guntur–Mangalagiri–Tenali (VGTM) area, which has been identified as the capital region of the newly created state of Andhra Pradesh with its capital Amaravati in Guntur District, is fast adjusting to this structural change and plans to bring in technology to boost its economic dynamism. From that of a ‘rice bowl’, the region is transforming itself into a major service sector region, servicing not only the region, but is emerging as a major node in the eastern coast

Third Year of Survey Data Shows Continuing Benefits of Medicaid Expansions for Low-Income Childless Adults in the U.S.

BACKGROUND: The Affordable Care Act (ACA) of 2010 incentivized states to expand eligibility for their Medicaid programs. Many did so in 2014, and there has been great interest in understanding the effects of these expansions on access to health care, health care utilization, and population health. OBJECTIVE: To estimate the longer-term (three-year) impact of Medicaid expansions on insurance coverage, access to care, preventive care, self-assessed health, and risky health behaviors. DESIGN: A difference-in-differences model, exploiting variation across states and over time in Medicaid expansion, was estimated using data from the Behavioral Risk Factor Surveillance System (BRFSS) for 2010-2016. PARTICIPANTS: Low-income childless adults aged 19-64 years in the BRFSS. MAIN MEASURES: Outcomes included insurance coverage, access to care, several forms of preventive care (e.g., routine checkups, flu shots, HIV tests, dental visits, and cancer screening), risky health behaviors (e.g., smoking, alcohol abuse, obesity), and self-assessed health. KEY RESULTS: The previously documented benefits of Medicaid expansions on insurance coverage, access to care, preventive care, and self-assessed health have persisted 3 years after expansion. There was no detectable effect on risky health behaviors. CONCLUSIONS: The Affordable Care Act was motivated in part by a desire to increase health insurance coverage, improve access to care, and increase use of preventive care. The Medicaid expansions facilitated by the ACA are helping to achieve those objectives, and the benefits have persisted 3 years after expansion

Changes in Insurance Coverage Among Cancer Patients Under the Affordable Care Act

The Affordable Care Act (ACA) has reduced the number of uninsured persons in the United States to a historic low. Debate continues about potential changes to the law that could affect coverage for millions, particularly those with preexisting conditions. Meanwhile, cancer is the leading cause of death among Americans aged 19 to 64 years. Treatment is often unaffordable for uninsured patients, and some studies suggest that expanding insurance coverage could improve cancer-related outcomes. Our objective was to quantify changes in health insurance coverage under the ACA among patients newly diagnosed with cancer

Effect of Medicaid Expansions of 2014 on Overall and Early-Stage Cancer Diagnoses

Objectives. To determine whether the 2014 Medicaid expansions facilitated by the Affordable Care Act affected overall and early-stage cancer diagnosis for nonelderly adults. Methods. We used Surveillance, Epidemiology, and End Results Cancer Registry data from 2010 through 2014 to estimate a difference-in-differences model of cancer diagnosis rates, both overall and by stage, comparing changes in county-level diagnosis rates in US states that expanded Medicaid in 2014 with those that did not expand Medicaid. Results. Among the 611 counties in this study, Medicaid expansion was associated with an increase in overall cancer diagnoses of 13.8 per 100 000 population (95% confidence interval [CI] = 0.7, 26.9), or 3.4%. Medicaid expansion was also associated with an increase in early-stage diagnoses of 15.4 per 100 000 population (95% CI = 5.4, 25.3), or 6.4%. There was no detectable impact on late-stage diagnoses. Conclusions. In their first year, the 2014 Medicaid expansions were associated with an increase in cancer diagnosis, particularly at the early stage, in the working-age population. Public Health Implications. Expanding public health insurance may be an avenue for improving cancer detection, which is associated with improved patient outcomes, including reduced mortality

Gains in health insurance coverage explain variation in Democratic vote share in the 2008-2016 presidential elections.

In the last decade, health care reform has dominated U.S. public policy and political discourse. Double-digit rate increases in premiums in the Health Insurance Marketplaces established by the Affordable Care Act (ACA) in 2018 make this an ongoing issue that could affect future elections. A seminal event that changed the course of policy and politics around health care reform is the 2016 presidential election. The results of the 2016 presidential election departed considerably from polling forecasts. Given the prominence of the Affordable Care Act in the election, we test whether changes in health insurance coverage at the county-level correlate with changes in party vote share in the presidential elections from 2008 through 2016. We find that a one-percentage-point increase in county health insurance coverage was associated with a 0.25-percentage-point increase in the vote share for the Democratic presidential candidate. We further find that these gains on the part of the Democratic candidate came almost fully at the expense of the Republican (as opposed to third-party) presidential candidates. We also estimate models separately for states that did and did not expand Medicaid and find no differential effect of insurance gains on Democratic vote share for states that expanded Medicaid compared to those that did not. Our results are consistent with the hypothesis that outcomes in health insurance markets played a role in the outcome of the 2016 presidential election. The decisions made by the current administration, and how those decisions affect health insurance coverage and costs, may be important factors in future elections as well

Short-axis versus long-axis approach for ultrasound-guided vascular access: An updated systematic review and meta-analysis of randomised controlled trials

Background and Aims: There are two approaches for ultrasound (US)-guided vessel cannulation: the short axis (SA) approach and the long axis (LA) approach. However, it remains to be seen which approach is better. Therefore, we performed the present updated systematic review and meta-analysis to assess the effectiveness and safety of US-guided vascular cannulation between the SA and LA techniques. Methods: We performed a comprehensive electronic database search in PubMed, Embase, Cochrane Library and Web of Science for the relevant studies from inception to June 2022. Randomised controlled trials comparing the SA approach and the LA approach for US-guided vascular access were incorporated in this updated meta-analysis. The first-attempt success rate was the primary outcome. The secondary outcomes were the overall success rate, cannulation time, number of attempts and the incidence of complications. The statistical analysis was conducted using RevMan software (version 5.4; the Nordic Cochrane Centre, the Cochrane Collaboration, Copenhagen, Denmark). The Cochrane risk of bias tool was used to evaluate each study's potential risk for bias. Results: In total, 16 studies consisting of 1885 participants were incorporated in this updated meta-analysis. No statistically significant difference was found between the SA and LA vascular access techniques for first-pass success rate (risk ratio = 1.07, 95% confidence interval: 0.94–1.22). The overall cannulation success rate, complication rate, average cannulation time and average number of attempts were not significantly different between the SA and LA groups. Conclusion: This updated meta-analysis demonstrated that the SA and LA approaches of US-guided vessel cannulation are similar regarding first-pass success, overall cannulation success rate, total complication rate, cannulation time and the number of attempts

Recent trends in caries diagnosis

To create opportunity for a preventive approach to the management of caries, it is important to keep abreast of developments in diagnostic systems. It is apparent that conventional methods for the detection of dental canes do not fulfill the criteria for an ideal canes detection method. These methods rely on subjective interpretation and are insensitive to early canes detection. To overcome these shortcomings, researchers are developing advanced techniques. These not only detect mineral loss but also quantify it