The incidence of TIA in the United States is estimated to be 200,000-500,000 per year, with a prevalence of 5 million individuals, but is likely underreported.2 Stroke is preceded by TIA in 12-30% of patients and is the 5th leading cause of death in the US, contributing significantly to long term disability.2,3 Strokes occur more commonly in men than women, but women experience more severe morbidity.2,3 Stroke prevalence increases with age and occurs more frequently in black and Hispanic populations.3 It should also be noted that 90% of strokes worldwide occur in the setting of potentially modifiable risk factors which presents an incredible opportunity for early intervention, especially following TIA.2TIA: Emergency Department Evaluation and Disposition — http://www.emdocs.net/tia-emergency-department-evaluation-and-disposition/?utm_source=feedly&utm_medium=rss&utm_campaign=tia-emergency-department-evaluation-and-disposition
From zero in 1993 to $1.728 trillion in 2021: this is the predatory financialization of higher education which has enriched lenders, Wall Street and the Higher Education CartelAmerica Is a Moral Cesspool, and Student Loans Prove It — https://charleshughsmith.blogspot.com/2021/07/america-is-moral-cesspool-and-student.html
Way back in the Dark Ages I borrowed a total of $8000.00 and worked summers and during the school years to pay for my college education. It took me ten years of payments at $69.72 a month to pay the loan off. I promised myself no matter the hardship my own children would not borrow money for their undergraduate degrees (medical school different story). There were reasons why I drove a 2006 Ford Taurus for 15 effing years.
One of the joys of aging is you get to a point where you say what you want to say and the hell with everyone else. Charles Hugh Smith is one of us who possess critical thinking skills and will always tell it like it is. Check out his blog.
And this is a perfect time to remind all of my readers that the opinions expressed in this and my other blog are mine alone and do not represent the views of any corporate entity that I may or may not be involved with either in the present or past.
I should play more and work less. https://garyskitchen.net/2021/07/24/stress-reduction/ I’m starting to become more cynical than usual.
I’ve finished looking at the newspaper. Afterwards, I started browsing my RSS feed and for some inexplicable reason I read an article on whole bowel irrigation at https://emcrit.org/toxhound/the-purge/.
Memo to My Life Underwriting Colleagues:
Retire before you get to this point in your career. Reading articles like this will not facilitate advancement in your chosen profession. Get out. Get a life.
So far not a SARS-CoV-2 symptom of infection nor a reported vaccine side effect.
#2 Remember naloxone, glucose, and thiamine (NGT)
Original: Consider or give naloxone, glucose and thiamine
The number of patients presenting with opioid intoxication is growing, and the gentle reversal of patients without severe respiratory depression with naloxone is in the art of medicine – consider starting with 0.4mg and titrate to effect.
In contrast to empiric administration of glucose in the altered or ill patient, rapid assessment of glucose level with point-of-care testing is recommended.
Thiamine deficiency may be less prevalent than previously thought in intoxicated patients, but we now know that giving 100mg of IV thiamine can benefit other malnourished patients, including those with calorie-malnourishment from cancer, gastric bypass, hyperemesis gravidarum, and eating disorders. Personally, I use the ‘T’ of ‘NGT’ to remind myself not to miss alcohol withdrawal.Ten Commandments of Emergency Medicine Revisited — https://journalfeed.org/article-a-day/2021/ten-commandments-of-em-revisited
Why does this matter? I hear you thinking we underwrite life insurance, we’re not doctors. So true. But if we think like doctors we will get better at what we do by recognizing the subtleties buried within the medical charts we read. Here’s what my eyes/brain picked up.
The bold in the excerpt above are mine to illustrate how the mind of a mortality risk expert works. In Emergency Department records pay attention to the initial treatments provided which in some cases hints to a serious condition impacting mortality. Naloxone and opioids are obvious. But would you have associated the administration of IV thiamine to malnutrition or alcohol withdrawal? I thought so.
So read and research widely. You’ll always find little jewels to improve your skills and to impress your friends with. Or in my case to make Dr. Lee think his old man knows more than he actually does.
Subsequent research discovered that this age-related U-shape in job satisfaction is part of a much broader phenomenon. A similar midlife nadir is detectable in measures of people’s overall life satisfaction and has been found in more than 50 countries. On average, life satisfaction is high when people are young, then starts to decline in the early 30s, bottoming out between the mid-40s and mid-50s before increasing again to levels as high as during young adulthood. And this U-curve occurs across the entire socio-economic spectrum, hitting senior-level executives as well as blue-collar workers and stay-at-home parents. It affects childless couples as well as single people or parents of four. In short, a mid-career crisis does not discriminate.Why So Many of Us Experience a Midlife Crisis Harvard Business Review Hannes Schwandt — https://getpocket.com/explore/item/why-so-many-of-us-experience-a-midlife-crisis?utm_source=pocket-newtab
This post originally appeared on Harvard Business Review and was published April 20, 2015. A link popped up on my browser webpage.
U shaped curves are everywhere.
In some cases, food companies can obscure their involvement through the use of what are known as “front groups,” third-party organizations disguised by innocuous-seeming names. (Until recently, for example, Coca-Cola funded a front group called the “Global Energy Balance Network” that conducted research on obesity.) Sacks and his team included front groups in their definition of industry involvement.
“It’s sometimes quite difficult to see when you’re looking at who’s funding a study, if [they] are related to the food industry,” he said. “So when we would see a paper funded by some random-sounding group, the challenge was actually digging in, going on their website and seeing who’s funding them. Because the food industry often tries to hide that.”In the most popular nutrition journals, 1 in 7 articles have food industry involvement — https://thecounter.org/food-industry-involvement-nutrition-journals-studies/
At least 10 peer-reviewed studies about pasta published since 2008 were either funded directly by Barilla or, like the one published this month, were carried out by scientists who have had financial ties to the company, which reported sales of 3.4 billion euros ($4.2 billion) in 2016. For two years, Barilla has publicized some of these studies, plus others favorable to its product, on its website with taglines like “Eat Smart Be Smart…With Pasta” and “More Evidence Pasta Is Good For You.” And the company hired the large public relations firm Edelman to push the latest study’s findings to journalists.Those Studies About Pasta Being Good For You? Some Are Paid For By Barilla. — https://www.buzzfeednews.com/article/stephaniemlee/pasta-barilla-science-funding#.dmmzapNdG
I just love writing obvious click bait headlines.
Ashton Glover Gatewood, 31, a member of the Choctaw Nation and descendent of both the Chickasaw and Cherokee Nations, has long lamented the glaring lack of Native American physicians. So she decided to become one.
Gatewood is a student in the inaugural class of the first tribally affiliated medical school in the United States, the Oklahoma State University (OSU) College of Osteopathic Medicine at the Cherokee Nation. The school opened this fall on Cherokee land in Tahlequah, the capital of the Cherokee Nation’s 14-county reservation in the rolling hills of rural Oklahoma, about an hour east of Tulsa.
First-of-Its-Kind Med School Makes History — https://www.medscape.com/viewarticle/941187?src=rss#vp_1
I’ll have to ask Project #1 on my Project List if he will be teaching any classes at the new medical school.
This article provides an overview of the clinical evidence on the poorer clinical outcomes of COVID-19 infection in patients with diabetes versus patients without diabetes, including in specific patient populations, such as children, pregnant women, and racial and ethnic minorities.COVID-19 and Diabetes: A Collision and Collusion of Two Diseases — Diabetes 2020 Oct; dbi200032. https://doi.org/10.2337/dbi20-0032
In the article above the researchers reviewed nearly 90 studies.
Type 2 diabetes (T2D) is defined by a single metabolite, glucose, but is increasingly recognized as a highly heterogeneous disease, including individuals with varying clinical characteristics, disease progression, drug response, and risk of complications. Identification of subtypes with differing risk profiles and disease etiologies at diagnosis could open up avenues for personalized medicine and allow clinical resources to be focused to the patients who would be most likely to develop diabetic complications, thereby both improving patient health and reducing costs for the health sector. More homogeneous populations also offer increased power in experimental, genetic, and clinical studies. Clinical parameters are easily available and reflect relevant disease pathways, including the effects of both genetic and environmental exposures. We used six clinical parameters (GAD autoantibodies, age at diabetes onset, HbA1c, BMI, and measures of insulin resistance and insulin secretion) to cluster adult-onset diabetes patients into five subtypes. These subtypes have been robustly reproduced in several populations and associated with different risks of complications, comorbidities, genetics, and response to treatment. Importantly, the group with severe insulin-deficient diabetes (SIDD) had increased risk of retinopathy and neuropathy, whereas the severe insulin-resistant diabetes (SIRD) group had the highest risk for diabetic kidney disease (DKD) and fatty liver, emphasizing the importance of insulin resistance for DKD and hepatosteatosis in T2D. In conclusion, we believe that subclassification using these highly relevant parameters could provide a framework for personalized medicine in diabetes.Subtypes of Type 2 Diabetes Determined From Clinical Parameters — Diabetes 2020 Oct; 69(10): 2086-2093. https://doi.org/10.2337/dbi20-0001
Not just potential for personalized medicine in the treatment of diabetes but perhaps a framework for better risk stratification and selection in life insurance.
Intakes of Folate, Vitamin B6, and Vitamin B12 in Relation to Diabetes Incidence Among American Young Adults: A 30-Year Follow-up Study
RESULTS During 30 years (mean 20.5 ± 8.9) of follow-up, 655 incident cases of diabetes occurred. Intake of folate, but not vitamin B6 or vitamin B12, was inversely associated with diabetes incidence after adjustment for potential confounders. Compared with the lowest quintile of total folate intake, the multivariable-adjusted hazard ratios (95% CI) in quintiles 2–5 were 0.85 (0.67–1.08), 0.78 (0.60–1.02), 0.82 (0.62–1.09), and 0.70 (0.51–0.97; Ptrend = 0.02). Higher folate intake was also associated with lower plasma homocysteine (Ptrend < 0.01) and insulin (Ptrend < 0.01). Among supplement users, folate intake was inversely associated with serum C-reactive protein levels (Ptrend < 0.01).
CONCLUSIONS Intake of folate in young adulthood was inversely associated with diabetes incidence in midlife among Americans. The observed association may be partially explained by mechanisms related to homocysteine level, insulin sensitivity, and systemic inflammation.Intakes of Folate, Vitamin B6, and Vitamin B12 in Relation to Diabetes Incidence Among American Young Adults: A 30-Year Follow-up Study — Diabetes Care 2020 Oct; 43(10): 2426-2434. https://doi.org/10.2337/dc20-0828
Folate is a B vitamin that occurs naturally in foods such as green leafy vegetables, citrus fruit, and beans. So eat your greens and beans. Taking a supplement can’t hurt either. My multivitamin has plenty of folate.
Higher education committed suicide with its dual racketeering model. First was the college loan racket, in which schools colluded with the federal government to jam too many “customers” through the pipeline who didn’t belong there, and who buried themselves under a lifetime debt obligation they could never escape. The second was the intellectual racket of creating sham fields of study that contaminated all the other “humanities” with poisonous bullshit theory, and eventually even invaded the STEM disciplines. Covid-19 screwed the pooch on all that, scotching the four-year party-hearty in-residence part of the deal. For now, who needs an online class in Contemporary Sexual Transgression ($2000-a-credit) when you can just click on Porn-hub for free? Hundreds of colleges and universities will be going out of business in the years ahead.James Howard Kunstler — https://kunstler.com/clusterfuck-nation/things-going-by/#more-‘