Beth Israel Deaconess Medical Center, Division of Podiatric Surgery
Boston, Massachusetts
The quality of the fits achieved were then based on 2 situations 1) the accuracy of the prediction for all 91 major yarn 2) the accuracy of the prediction for the 15 small variation yarns asthma treatment ladder generic ventolin 100 mcg fast delivery. Results and Analysis Using the mean fiE of the fit as a measure of how close the colour match is we find that the neural network model is the clear winner out of the 4 models considered as it is the only model that achieves an average fiE less than 1 will asthmatic bronchitis go away order 100mcg ventolin with amex. However asthmatic bronchitis home treatment buy ventolin 100mcg without prescription, figure (1) clearly indicates that this can only occur when the training data is in excess of approximately 50 yarns asthma bronchitis buy discount ventolin 100 mcg online, which may not be feasible in a manufacturing situation asthma treatment without steroids buy ventolin american express. For lower training set sizes the basic and enhanced Stearns Noechel models appear to be the best asthma symptoms worse in fall order ventolin pills in toronto, even if they still average greater than fiE =1 asthma symptoms 8 dpo buy ventolin from india. It is interesting to note that with increasing training set size there is little variation in the predictive power of the theoretical and empirical models asthma symptoms burning lungs discount ventolin 100mcg free shipping, possibly indicating that it is the fine functional dependence that they do not adapt to well. Figures (2a) and (2b) supports the conjecture that the theoretical and empirical models do not adapt significantly to an increased training set. Only the Neural Network model changes significantly, with a smaller percentage of the colour predictions falling above fiE =1. This is however unsurprising as the data over such small ranges is smooth and this was moreover a test of whether the models could fit a smooth curve. Figure 1: Changes in mean fiE of fit with increasing training set size for all models Figures 2a and 2b: Histogram of fiE for training sets of 10 yarns and 28 yarns 5. Conclusion Whilst a Neural Network model is the only method to consistently achieve predictions lower than fiE =1, for a small training (20 yarns or less) set it appears that either the basic Stearns-Noechel or the Phillips-Invernizzi enhanced Stearns-Noechel model is the closest predictor. In one of the research stages that has the aim of understanding the participation of color in the development of architectural project in its different phases, what was sought was a deeper understanding of the possible color relations use that could be analyzed under the prism of archetypal relations, in accordance with the conceptions of Carl G. Jung was not the only one to raise the question of color as an element characteristic of archetypal images, it being possible to find references to that in the writings of Plato, Dionysus Aeropagite, Frank H. The question is if these studies can be applied to architecture or not, and in what way. The paper presents a theoretical approach to the subject, aiming at establishing elements that can serve as tools in the development of the architectural project as to the achievement of its aims, as also in the teaching of architecture. Turner, Daniel How to cite: Turner, Daniel (2015) Impact of acute resistance exercise on glycaemia in individuals with type 1 diabetes. Any person downloading material is agreeing to abide by the terms of the repository licence: copies of full text items may be used or reproduced in any format or medium, without prior permission for personal research or study, educational or non-commercial purposes only. The copyright for any work remains with the original author unless otherwise specified. The full-text must not be sold in any format or medium without the formal permission of the copyright holder. Permission for multiple reproductions should be obtained from the original author. Authors are personally responsible for adhering to copyright and publisher restrictions when uploading content to the repository. Please link to the metadata record in the Swansea University repository, Cronfa (link given in the citation reference above. In the unlikely event that the author did not send a com plete manuscript and there are missing pages, these will be noted. In my younger years I was once told that I could achieve anything if I set my mind to it. Although such a thought is admittedly naive, it is a phrase that I still hold close to me. But the rollercoaster of emotions and countless matches burned has given me a sense of achievement that inspires me to continue to challenge what I consider my own limits. In all sincerity, the work presented herein would not have been possible without the following people whom I deeply thank: the participants thank you for all of your time and efforts. Without your commitment and dedication this research would not have been possible. Dr Richard Bracken ~ your passion for science and enthusiasm for success has been an inspiration to me. Your meticulousness to detail has been a welcome challenge and the backbone to my academic development. There are countless moments where you reignited my confidence to complete this body of work. I thank you for the opportunity to study for a doctorate and for being a great supervisor. Dr Steve Luzio I thank you for all of your efforts to get me to the finish line. You have helped make this work more enjoyable and have fostered my understanding of how to be a well-rounded scientist. Professor Steve Bain your clinical perspective has been an integral component in the design and interpretation of these investigations. Ben and Gareth without your assistance and patience I would still be lifting weights onto the Smith machine and running assays. To the staff of the Clinical Research Facility thank you greatly for your support throughout these studies. Holly firstly, I apologise for the countless early mornings and late nights working away in silence, in my own little world. Had you known the ins and outs of a PhD, I wonder whether you would have encouraged me into such an endeavour, but I know you had my ambitions at heart. For supporting me during every up and down, every night without sleep, and every day without a sunny sky, I cannot express how grateful I am to you. You have not only been a sprinkle of happiness and joy to each day but an inspiration to challenge myself and accomplish my goals. Reductions in resistance exercise-induced hyperglycaemia are associated with circulating interleukin-6 in type 1 diabetes. Resistance exercise intensity does not influence the magnitude of post-exercise hyperglycaemia in type 1 diabetes individuals. An algorithm that delivers an individualised rapid-acting insulin dose after morning resistance exercise counters post-exercise hyperglycaemia in type 1 diabetes patients. Efficacy of an individually determined rapid-acting insulin dose algorithm for improving post-resistance exercise glycemia in type 1 diabetes patients. Similar magnitude of post-exercise hyperglycaemia following moderate and low intensity resistance exercise in type 1 diabetes individuals. Resistance exercise induces increases in circulating interleukin-6 in type 1 diabetes individuals. Increasing the duration of an acute resistance exercise session tempers exerciseinduced hyperglycaemia in those with type 1 diabetes. However, the generation of effective strategies is complicated by the diverse relationship between different exercise characteristics and glycaemia. Insulin stimulates a net decrease in glycaemia by inhibiting glucose output from the liver and increasing peripheral 3 glucose uptake (12). While the liver can modulate glucose production in response to changing blood glucose levels independent of hormone and substrate delivery (13), the liver responds directly to the concentration of insulin within the portal vein; insulin exerts its effects by binding to hepatic insulin receptors and stimulating insulin-signaling pathways; hepatic glycogenolysis is inhibited by small increases in portal insulin concentration whereas large increases in insulin concentration occurs before inhibition of hepatic gluconeogenesis (14). Insulin augments the peripheral glucose uptake by binding to insulin receptors on extrahepatic insulin sensitive cells. At rest, a rise in blood glucose concentration triggers an increase in the secretory rate of insulin resulting in a net loss of glucose within the blood stream. Conversely, insulin secretion is repressed at a blood glucose concentration of ~4. The primary objective of this response is to invoke a disproportionate increase in the rate of endogenous glucose production relative to that of glucose uptake. Catecholamines promote an elevation in blood glucose levels by stimulating a transient increase in hepatic glucose output (22-27) as well as a reduction in the rate of glucose uptake (22), via binding to p-adrenoceptors. This increase in hepatic glucose production is initially accounted for by an increase in glycogenolysis, while gluconeogenesis seems to have a more progressive contribution (23). Catecholamineinduced inhibition of glucose disposal is thought to occur via reductions in insulinmediated glucose extraction (28; 29) and/or through a build-up of gIucose-6phosphate that inhibits hexokinase activity. High physiological levels of catecholamines have been shown to inhibit the secretion of insulin (30), while at the same time their increased appearance has been shown to augment the release of glucagon (31) and growth hormone (32). Notably, there is difficulty in inferring from systemic blood sampling the contribution of glucagon to alterations in circulatory glucose since prior to its appearance within the systemic circulation, glucagon is extracted by the liver following its release into the portal vein (33). Cortisol acts synergistically with both glucagon and adrenaline to increase blood glucose levels (34), but cortisol has also been shown to independently increase blood glucose concentrations within approximately 1 hour (35; 36) to 3 hours (37) of infusion, through augmenting glucose production and decreasing glucose 5 utilisation. Similarly, elevated growth hormone levels are associated with increased rates of hepatic glucose production (38) and attenuated rates of glucose utilisation (38-40). Studies demonstrate that growth hormone has insulin-antagonistic effects (39; 41; 42), by attenuating the glucoregulatory effects of insulin i. Studies suggest that the cause of acute growth hormone related insulin resistance is attributed to downstream reductions in glycogen synthase activity (39; 43). The increased availability of these metabolites contributes to hepatic glucose production via their conversion to glucose, thereby preserving liver glycogen stores (38; 49). With a continued loss of circulatory glucose, the intensity of the counterregulatory hormone response (particularly sympathoadrenal activity) increases, resulting in inhibition of peripheral glucose uptake, shunting of blood flow to central organs. Hyperglycaemia typically occurs during times of mild insulin deficiency or complete absence of portal and systemic insulin, when there is insufficient restraint of both hepatic glucose production and stimulation of glucose uptake, which favours a net increase in circulating glucose levels. Increased levels of blood glucose coupled with hypoinsulinaemia can result in glucosuria and hypovolaemia which can manifest as symptoms of increased thirst and polydipsia, polyuria and nocturia, blurred vision and drowsiness (52). The magnitude (or severity) of hypoinsulinaemic-hyperglycaemia is exacerbated by an increase in counterregulatory hormones. Insulin deficiency and raised counterregulatory hormone levels stimulates the production of ketones bodies (p6 hydroxybutyrate, acetoacetate and acetone), as a by-product of elevated rates of hepatic beta-oxidation (53). L"1) increases blood acidity and lowers residual bicarbonate levels with resulting metabolic acidosis and ketonaemia (53), which is clinically deemed as ketoacidosis. Ketoacidosis manifests symptoms of nausea, vomiting, hypotension, tachycardia, and psychological stress (52). L"1 without ketonaemia, and it is only essential to avoid exercise if fasting glucose levels are > 13. The frequent occurrence of hyperglycaemia promotes the generation of microvascular and macrovascular complications (52; 58), which are primarily associated with the formation of advanced glycation end-products that accumulate in proportion to the magnitude of hyperglycaemia and time of exposure. Thus for the purpose of this thesis, hyperglycaemia was defined as a blood glucose reading of > 9. However, a single blood glucose concentration cannot define hypoglycaemia in diabetes. This is because glycaemic thresholds for symptoms and neuroendocrine responses to hypoglycaemia are lowered after recent antecedent hypoglycaemia (6062) and raised in individuals with poorly control diabetes (63). With varying degrees of hypoglycaemia manifests neurogenic (autonomic) symptoms including tremor, palpitations, anxiety/arousal, sweating, hunger and paresthesia, which are also a function of the individuals perception of the sympathetic response associated with hypoglycaemia (65; 66). Brain glucose deprivation per se evokes neuroglycopenic 7 symptoms including cognitive impairments, behavioural changes and psychomotor abnormalities. Circulatory insulin levels can be considered excessive when they inhibit hepatic glucose production to an extent that results in a greater increment in glucose uptake than production leading to net decrease in blood glucose. The glucagon response to lowered blood glucose is progressively lost over time (69), potentially due to impairments in (3-a cell signalling with a resulting loss of a-cell function (70). Failure in these defences necessitates the third response; the sympathoadrenal and sympathetic neural response resulting in increased catecholamine secretion (19). With this reduced awareness to hypoglycaemia comes a loss of the behavioural defense to hypoglycaemia, i. Notably, even when the glucagon and adrenaline responses are intact, excessive insulin can blunt hepatic glucose production and increase glucose uptake resulting in hypoglycaemia. Consequently, the main defense against hypoglycaemia is early recognition of symptoms in order to increase energy consumption and prevent a further decline in blood glucose levels. However, the normalisation of glycaemia through the administration of exogenous insulin (also known as insulin therapy; section 1. The study specifically demonstrated that a 1% fall in HbAlc resulted in a statistically significant decrease in microvascular complications (77). Furthermore, lowering daily carbohydrate intake with a compensatory increase in fat and protein intake resulted in a > 1% reduction in HbAlc over a 12 month period (89). The primary aim of insulin therapy is to mimic the natural secretory pattern of endogenous insulin of healthy individuals without diabetes (as depicted in Figure 1. There exists background insulin secretion upon which is superimposed by secretory bursts in response to meal-time feeding. As such, there are multiple types of exogenous insulin that differ pharmacokinetically in absorption rate, duration of action and time of peak action (Table 1. Regular soluble (short acting) insulin is used as a bolus injection (20-30 minutes before meals) alongside intermediate acting insulin in a twice-daily regimen or a basal analogue given once daily. Alternatives to short acting insulin are rapid acting insulin analogues, which are typically administered before meals (and in some cases, soon after) in combination with longer acting insulin. This form of insulin is taken once daily in the evening or morning, usually in combination with rapid acting insulin. Long acting insulins are similar to basal insulin analogues in that they are designed to exert an effect over 24 hours. However, converse to basal insulin analogues, long acting insulins have a dose accumulative effect that can increase the likelihood of hypoglycaemia. The onset, peak effect and duration of action vary as a function of many peripheral factors, all of which affect the speed and consistency of absorption. For instance, age, fat mass, dose 11 of injection, site and depth of injection (subcutaneous vs. Pharmacokinetics Insulin Type Onset of Peak of Period of Reference action (h) action (h) action (h) Rapid acting analogue: aspart, 0. This approach has been shown to positively effect glycaemic control, reflected in lowered HbAlc after one-quarter year (101). Refinement of the bolus insulin dosage occurs with regular testing of postprandial glucose at ~2-hours after the meal against pre-prandial glucose concentrations. While correctional doses of insulin can be effective at restoring euglycaemia, the timing of injection and dose need to be considered carefully. For example, approximately 50% of the previously injected bolus insulin analogue can have an affect on glucose metabolism for 2 hours after injection, and 20% of the dose remains within the circulation at ~4-hours after injection (90). While there are permutations in calculation of the correctional dose (98; 99), these algorithms are fundamentally used to estimate what magnitude of fall in blood glucose concentration will occur per unit of insulin. For example, a strategy should be aligned to not only the anticipated glycaemic response to a task. Thus, the derivation of an optimal glucose management strategy is to tailor the adjustment of insulin and diet to each individual as a function of the change in blood glucose evoked by the environment/situation; in turn, the strategy is validated and individualised. Exercise training programs should (102) recognise and accommodate comorbidities and complications. Muscle-strengthening activities should involve major muscle groups on > 2 days a week. Also, moderate intensity circuit, interval or free weights, with progression in number of repetitions in relation to physical ability. As such, exercise guidelines have been developed with specific reference to exercise modality, intensity, duration, volume and frequency of training (Table 1. Along with regular performance of aerobic oriented activities (or submaximal exercise), it is evident from these guidelines (in Table 1. Reduction in daily insulin requirements could be explained by an improvement in insulin sensitivity (132); for instance, improvements in insulin sensitivity have been demonstrated in response to aerobic exercise training (132-134) alongside a reduction in bolus (not basal) insulin dosage (132). But these results contradict more recent findings, in which no improvements in glucose tolerance were observed at 24,48 and 72-hours post-exercise (140). Conversely, after acute performance of one to three sets of 8-10 exercises (upper and lower body) at 65-85% (~10 repetitions per set), individuals without diabetes demonstrate increases in insulin sensitivity at 24-hours after exercise (141-143). Aside from possible limitations presented by differences in the methods used to assess insulin sensitivity between these studies. It is difficult to determine why regular exercise has contrasting effects on glycaemic control, but factors such as reductions in insulin dosage or increases in dietary intake could negate an improvement in glycaemic control (albeit a reduction in insulin requirements could be considered as favourable) (133). From a different perspective, acute glycaemic instability could be a factor in attenuated exercise performance. Thus glycaemic imbalances during exercise may restrict energy provision to the muscles. Furthermore, during moderate intensity exercise, where glucose was infused to maintain hyperglycaemic levels (8 mmol. Interestingly, it was later found by the same group that these responses were not related to an insulin-mediated inhibition on hepatic glucose production (172). Furthermore, when compared to euglycaemia, exercising under hyperglycaemia was without effect on peak power output or other physiological endpoints such as lactate, heart rate, or respiratory exchange ratio (177), and reductions in insulin dose to reduce the likelihood of hypoglycaemia did not influence aerobic capacity during cycling compared to the usual insulin dose (178). Notably, hyperglycaemia per se may increase the susceptibility to dehydration and acidosis, which could reduce exercise tolerance. In this study, it was unclear why there was an association between HbAlc and exercise performance, but as discussed previously, individuals with poor glycaemic control might be more susceptible to diabetes-related complications. Screening for complications and/or reductions in functional capacity is important to the safe and effective prescription of exercise (where health benefits are maximised), given that attenuated physical capacity could cause additional stress and ultimately reduce exercise tolerance and/or adherence. As such, a fundamental aspect of developing a strategy to improve exercise-induced glycaemic fluctuations is knowledge of glycaemic imbalances caused not only by different exercise modalities but also of the relationship between subtle adjustments in exercise characteristics and blood glucose. Advice on how to appropriately adjust insulin 24 therapy and diet so that exercise can be performed safely is important to optimal management of blood glucose.
Diseases
Diffuse leiomyomatosis with Alport syndrome
Hepatitis
Alpha-thalassemia
Methylmalonic acidemia
Fox Fordyce disease
18p deletion syndrome
Familial ALS
Inhalant abuse, aromatic hydrocarbons
Constitutional growth delay
They are located at the telomeres of river buffalo chromosomes 3p asthma treatment videos purchase generic ventolin, 4p asthma symptoms lump in throat purchase generic ventolin on line, 6 asthma 6 month old ventolin 100mcg otc, 21 asthma symptoms 7dpo order ventolin australia, 23 asthma mayo clinic buy 100 mcg ventolin fast delivery, and 24 (Iannuzzi et al asthma when to go to the hospital generic ventolin 100mcg amex. Thus mild asthma definition 100mcg ventolin amex, no crosses between these two species (and subspecies) are possible and their different karyotypes also support their classification in two separate genera asthma questions and answers order ventolin online pills. In the Sulawesi (Indonesia) island is present another (and endangered) Asiatic buffalo species: the Bubalus depressicornis (2n=46). It is divided in two subspecies: Bubalus depressicornis depressicornis (Lowland Anoa) and Bubalus depressicornis quarlesi (Mountain Anoa). This species is the smallest buffalo in the world, ranging between 70 (Mountain Anoa) to 100 cm (Lowland Anoa) of tall. The karyotype of this species is very close to that of river buffalo (Bubalus bubalis). Indeed, four of the six biarmed chromosome pairs in Anoa are similar to those present in river buffalo (1;27, 2;23, 8;19, 5;28), whereas the other two biarmed chromosomes were originated by centric fusion translocations of cattle homoeologous chromosomes (11;20 and 17;15) (Gallagher et al. This is, at the moment, the main autosome mutation which changed (even partially) the chromosome arms (and gene content and order) in the autosome of bovids. At the same time, complex chromosome rearrangements occurred to differentiate sex chromosomes among bovids, in particular the X-chromosome. Indeed, the X-chromosomes of bovids can be mainly fitted in three different types: submetacentric in cattle, acrocentric in buffaloes and acrocentric with visible p-arms in sheep and goat. Caprinae X-chromosome differentiated from bovinae X by at least four chromosome transpositions involving four chromosome regions (Iannuzzi et al. Also the Y-chromosome differs in size (different content of heterochromatin) and shape (different position of the centromere) among domestic bovids It is submetacentric in cattle, acrocentric in 373 buffaloes (Figures 1-2), acrocentric with small p-arms in zebu (Bos indicus, 2n=60) and a very small metacentric in sheep and goat (Di Meo et al. Clinical cytogenetics A standard karyotype of river buffalo using six banding techniques and G and R banded ideograms has been established by an international scientific Committee coordinated by Iannuzzi (1994). A comparison between this river buffalo standard karyotype, based also on specific chromosome river buffalo genetic markers (Iannuzzi et al. River buffalo karyotypes were also obtained at the high resolution banding (Iannuzzi, 1994), thus allowing a detailed description of Q-, Gand R-banding patterns of this important species. This standard karyotype and the six banded standard karyotypes available have been the point of reference when analyzing the karyotypes of animals in searching of chromosome abnormalities. Although the buffalo is a very important species in the world, few studies have been undertaken to ascertain the presence of chromosome abnormalities in the buffalo populations, especially in females with reproductive problems (females which do not show sign of oestrus or do not remain pregnant in fertile age even when bulls are present in the herd). Cytogenetic analyses in Italian river buffalo females with reproductive problems revealed that about 20% of them were found carriers of sex chromosome abnormalities (Iannuzzi et al, 2000a, 2001a, 2004, 2005; Di Meo et al. Sex chromosome abnormalities They are the most common chromosome abnormalities found so far in river buffalo. Five females 2n=49,X have been found so far in buffalo carrying this abnormality: three in India (Yadav et al. In humans this syndrome induces taller stature in most cases and ovarian dysfunctions in a reduced number of women. Influence of the duration of in vitro maturation and gamete co-incubation on the efficiency of in vitro embryo development in Italian Mediterranean Buffalo (Bubalus bubalis). Effect of type of cryoprotectant on morphology and development competence of in vitro-matured buffalo (Bubalus Bubalis) oocytes subjected to slow freezing or vitrification. In vitro maturation and fertilization of riverine buffalo follicular oocytes in media supplemented with oestrus buffalo serum and hormones. Somatic cell cloning in buffalo (Bubalus bubalis): effects of interspecies cytoplasmic recipients and activation procedures. Nuclear transfer of buffalo fetal fibroblasts and oviductal cells into enucleated bovine oocytes and their subsequent development. Oocytes retrevial and histological studies of follicular population in buffalo ovaries. In vitro embryo production in buffalo (Bubalus bubalis) using sexed sperm and oocytes from ovum pick up. Birth of twins after in vitro fertilization with flow-cytometric sorted buffalo (Bubalus bubalis) sperm. The bull is incapable of gaining intromission while maintains libido and the ability to achieve erection. They are more effective if they are equipped with some device for marking the mounted cows, like a chain ball marker (Fig. The marker consists of a paint reservoir with a steel ball valve, similar to a ball-point pen. Comparison of pregnancy rates with two estrus synchronization protocols in Italian Mediterranean Buffalo cows. Influence of the month on the reliability of estrus detection by pedometer in buffalo species (Bubalus bubalis). Ovarian hypoplasia in the left ovary; the right ovary shows longitudinal layers on Figure 5. This is a rare condition usually associated to the arrest development of the paramesonephric ducts. Clinical analysis of reproductive failure among female buffaloes under village management in Andra Pradesh. Ocorrencia de alteracoes do ovario, tuba uterina e utero, em bufalos abatidos em matadouro, no Estado do Para. Faculdade de Medicina Veterinaria e Zootecnia, Universidade Estadual Paulista, Botucatu, Tese de Doutorado. Parametros da eficiencia reprodutiva em bubalinos criados extensivamente em area de varzea: Alteracoes reprodutivas. Prevalencia das alteracoes clinicas e patologicas do sistema genital de bufalas, na regiao do Baixo Amazonas, Estado do Para. Eficiencia Reprodutiva do Rebanho Bubalino na Fazenda Agropecuaria Motogeral, Itaubal, Amapa. The study is also intended to feed directly into current policy debates about the nature of authority in Islam. Scope of Work Nigeria has traditionally had a large number of traditional authorities and rulers who have played an important role in community coherence and traditional justice systems, especially in the North and Middle Belt of the country. During the colonial era, the positions of existing authorities were recognised, and new chiefs were created to harmonise the system. Although this system has persisted until the present day, the rise of alternative poles of power, in particular the local and state governments, has tended to undermine the powers of such individuals or councils. They are also able to take pre-emptive action through their familiarity with the different sections of the community, where the government has been observed to be reactive. Some traditional rulers work extremely hard with little official recognition of their efforts. In much of the south (with a few important exceptions), their posts are little more than ceremonial. The Hausa Emirates in the north retain significant authority and influence, but the role of traditional leaders in that region is relatively well documented and understood. This study will therefore focus mainly on the Northern and Central Zones (the North and the Middle Belt), where there have been significant violent conflicts in recent years. The northern region is generally much better documented than the Middle Belt, but nonetheless, the researchers believe there are new developments which affect our previous understanding of the role of traditional rulers. This is now seen in some quarters as a policy failure, and the President had invited some of them to a national conference to look into the part they should play in a revised Constitution. This choice of traditionally respected individuals is an example of recognition of the impotence of government officials in these situations and the corresponding importance of respected individuals. Greater information on this topic should thus feed directly into high-level policy debates within Nigeria and also illuminate the nature of Islamic authority systems across the wider region. The Constitution review exercise has been stalled but the debate is far from being over. Conduct a literature review on the origins, distribution and current legal and political status of traditional rulers in North-Central Nigeria; 2. Review the origin and evolution of the power of traditional rulers, both within a framework of Islamic law and the Nigerian legal system; 3. Design and carry out a survey of traditional rulers in areas where their power is still functional but largely undocumented. For the reasons given above, the main focus of the work will be the North Central zone of the country. The survey should interview a wide range of stakeholders, including the rulers themselves, palace officials, local politicians, security officials, and subjects of the rulers. Are there case studies, with a particular focus on their role in prevention or mediation of conflictfi Survey work in Nigeria has been conducted by two Nigerian researchers, with training and other technical inputs provided by U. The survey is based on a sample of emirates and chiefdoms in all of the states in the study area. We have sampled as many of the large and nationally important emirates and chiefdoms as possible together with a selection of the smaller ones. Within each of these traditional units semi-structured interviews have been conducted with office holders and other key informants at different levels of the hierarchy, from the emir or paramount chief down to village and ward heads and including ordinary men and women. Two pilot case studies were undertaken at the beginning of the fieldwork in Nigeria and detailed training notes and guidance prepared on this basis. The objective of this study is to document the current and historical role of traditional rulers in the prevention and mediation of conflict in northern Nigeria, with a focus on North-Central Nigeria. A current review the status and role of traditional rulers and their role of peacemaking and conflict resolution is long overdue. Most of the well-regarded monographs on chieftaincy institutions in Nigeria date from the 1960s while more recent literature has an immediate political agenda and can only be used with considerable care. Recent concerns about the role of Islam in worldwide political instability need to be considered for their relevance to Nigeria. Traditional rulers have traditionally had an important role in conflict resolution, but should this be replaced by institutions more in keeping with a modernising statefi The report is based on a series of interviews both with traditional rulers and local officials around Northern Nigeria during 2005-6. This resulted in a large number of case studies of individual conflicts and the role of traditional rulers in their resolution or lack of it. The case studies show that the current situation of traditional rulers is very ambiguous. While they command considerable traditional allegiance in certain areas, their non-elected status makes them a target for local politicians and other critics. Some are impressively hard working in the promotion of their region and the representation of the interests of the people they serve, others are corrupt and have been summarily ejected for factional behaviour or financial misdemeanours. During political periods some have been dismissed simply for supporting the wrong party, which contributes to the insecurity of their position. Government is content to make use of their services in peace-making and reconciliation, but is unwilling to give them the political and administrative support required to make chieftaincy institutions function adequately. A particular trend from the 1990s onwards has been the widespread upgrading and creation of chieftaincies either to reinforce ethnic agendas or to reward wealthy political donors. The sheer numbers of recently created chiefs inevitably contributes to the dilution of the authority of traditional chiefs as well as reducing the extent of their domains. While it is certainly true that Islamic theology is used in the promulgation of chiefly status in the northern Emirates, in reality, rulers stand or fall by their behaviour. Combined with the unchecked flow of arms into the country, this could be the beginning of a worrying future trend. Traditional rulers have proven much less effective in dealing with confrontations within Islam. A characteristic asymmetry of the situation in Nigeria, is that intra-Islamic strife is common, whereas violence between Christian groups is rare. The tenor of numerous interviews as well as the pronouncements of politicians is that traditional rulers enjoy continuing and indeed increased support in many regions of the North. In an ideal world, as Nigeria moved towards a representative democracy, the authority of such rulers would wither away and their role iii the Role of Traditional Rulers in Conflict Prevention and Mediation in Nigeria: Final Report become essentially ceremonial. Traditional rulers are often much more responsive to the travails of individuals and have a much stronger investment in the broader harmony of the community. As of 2006, the Nigerian constitution has no provision for traditional rulers and legally they continue under the dispensation of the 1979 constitution, which is an unrealistic representation of their actual role. Remuneration needs to move on from fixed percentage systems, which make no distinction between effective and ineffective incumbents, to allocations by responsibility and results. The process of creation and upgrading of traditional rulers should be in the hands of the Federal Government. While it remains with the States, it will be in the service of highly ephemeral interests and will simply lead to a multiplicity of overlapping interests without any benefit to the communities in question. This is not to say that communities should not have the right to establish whatever ceremonial posts they consider appropriate, but these should not be integrated with the authority system. Although traditional rulers are often made use of in conflict resolution processes this is entirely ad hoc and informal as well as reactive. At least some traditional rulers are well aware of underlying problems that can result in trouble and if state and local governments were more able to make use of their knowledge as well as investing in their presence earlier, such meetings could be more effective. For international donors concerned about the situation in Nigeria and willing to provide assistance, for example, to conflict resolution, traditional rulers present something of a problem. They can clearly be effective, and yet they are unelected and sometimes side with factional interests. Moreover, some of their actions clearly take place outside any usual framework of human rights, no matter how much they have local support. Many of the examples of traditional leaders and conflict resolution given here suggest reactive strategies. Once a violent confrontation has occurred, officials contact whoever they consider has the gravitas to call and preside over peace talks. There appears to be an astonishing lack of political will to resolve even rather obvious problems such as the Sayawa desire for their own District Head (Case Study 4) even though it should be clear that this one will continue to generate friction. It is principally District Heads, Village Heads and occasionally lower level chiefs who are most active in developing regular meetings and discussions to try and defuse potential areas of friction between communities and who are therefore most worthwhile considering for support. Emirs and other First Class Chiefs are too entangled in the web of local politics and too beholden to the Federal and State Governments to pay any pro-active role in conflict reduction. They often sit on peace committees, but they are unlikely ever to take any position that will threaten their own status. These recommendations could be summarised in another way as providing more informed appreciation of the situation on the ground in respect of traditional rulers and supporting those both politically and financially who appear to be making a difference. As the report shows, the existing subventions to traditional rulers are of limited value in terms of the demands on them. Relatively small amounts of funding could support activities such as peacemaking committees, familiarisation visits, printing of documents relative to agreements reached and the like. Since the 1970s, much of the particular colour of events has been shaded by the impact of oil revenues, exported principally from the Niger Delta and offshore rigs. Since 1999, Nigerian has been under democratic rule, with an elected President, House of Assembly, Senate and a Federal system characterised by States and Local Governments. This is specified in a constitution dating from 1999, which was to have been revised in 2005-6, but presently stands unaltered. Even those with older roots, such as the Shehus of Borno and the larger Northern Emirates, have found the nature of their authority significantly reconstructed in recent times. Despite predictions in the 1960s that this type of traditional ruler would disappear, they have persisted and flourished in Nigeria. Hypotheses abound to explain this, but clearly the problematic issue of trust in officially constituted authority in Nigeria play a part. A recent review of the situation in other countries of West Africa (Perrot & Fauvelle-Aymar 2003) has found that there has also been a resurgence in the prestige of chiefs in neighbouring countries as well. From the point of view of the colonial authorities, supporting traditional governance was a convenient and cheap method of both maintaining order and collecting tax with limited resources. At the same time, the colonial authorities were anxious to create an orderly system, where they perceived chaos. In other countries, national governments were unwilling to share power with bodies whose exact remit was unspecified, whose administrative boundaries were debated but who could mobilise ethnic populations rapidly in time of crises. Moreover, many African countries were in the first instance led by individuals trained in Britain in the 1940s and 1950s and had often absorbed quasi-socialist ideas before being thrust into authority. There were thus also ideological reasons for attempting to eliminate traditional rulers. Tanzania, for example, passed a 2 law eliminating the authority of traditional leaders in 1963 (Miller 1968).
She was fiown to Lagos asthma symptoms medication 100 mcg ventolin with amex, Nigeria asthma symptoms phlegm proven ventolin 100 mcg, where she lay for four days in an isolation shed asthma symptoms in children under 2 ventolin 100 mcg fast delivery, and then to New York attended by a missionary nurse asthma symptoms rapid heart beat buy 100 mcg ventolin with visa. Pinneo were carried to the Rockefeller Foundation Arbovirus Laboratory at Yale for study asthmatic bronchitis yogurt buy ventolin in united states online. Even so asthma symptoms blood pressure 100 mcg ventolin free shipping, the patient recovered strength slowly asthma symptoms vs cold symptoms cheap 100mcg ventolin with amex, became fever-free and was discharged from the hospital on the 3rd of May asthma triggers definition 100mcg ventolin with mastercard. Jordi Cassals of the Yale University Arbovirus Research Laboratory, who was working with specimens from Ms. Because he had developed symptoms like those of the other three patients, he was admitted to the Columbia University Presbyterian Hospital. Other tests confirmed that all four patients had been infected with Lassa fever virus. By November, work began on the live virus isolated from patients and passaged in mouse brains. On the day after Thanksgiving, he entered a local hospital and died from Lassa fever before blood from an immune donor (such as Dr. The Yale Arbovirus Laboratory decided not to perform any more experiments with live Lassa fever virus. Most are suspected of having malaria, an extremely common disease in that area also accompanied by fever, or of having a bacterial or viral infection. Invariably, their contact with the virus has been as short as five or as long as twenty-one days earlier. After an additional week of progressively worsening sore throat, diarrhea, and cough, pain surges through the chest and abdomen. Frequently red lesions erupt inside the mouth; the patients become anxious and appear deathly ill as their faces swell and their eyes redden. Blood leaks from small blood vessels, called capillaries, and from needle punctures made during hospital care. As internal bleeding worsens, the patients become delirious or confused, and many convulse before dying. Lassa fever virus is constantly present in portions of West Africa, particularly in Guinea, Liberia, Sierra Leone, and Nigeria. An estimated 100,000 to 300,000 residents incur these infections each year with approximately 5,000 to 10,000 deaths. For about 80 percent of those infected with the virus, the disease is mild, although the remaining 20 percent suffer severe involvement of multiple bodily systems that, during epidemics, can reach a 50 percent or more level of fatality. Additionally, 15 to 20 percent of patients hospitalized for Lassa fever die from the illness. The death rate is extraordinarily high for women in the third trimester of pregnancy, and close to 95 percent of fetuses die in utero when the mothers have been infected. Of those who recover, deafness frequently follows, occurring in approximately one-third of the subjects. Estimates are that fewer than 10 percent of African patients with Lassa fever appear at medical care stations; the vast majority stay in their homes or in the bush. Those who do come to medical clinics or hospitals, once they begin to bleed, have the potential to infect nurses, orderlies, and physicians through blood contamination because their blood contains high levels of infectious virus. The death rate among hospital workers varies from outbreak to outbreak; the worst reported is about 60 percent and the least 10 percent. As the infection spreads, attending personnel and families of the patients sicken and die. Despite its virulence, Lassa fever has yielded but few of its secrets to those studying tissues from the victims. Little has been found to help in understanding the pathogenesis, or cause, of the disease (1). Although the liver is the most consistent site of disease, only a modest number of liver cells are destroyed, probably accounting for the absence of jaundice in these patients. Damage to the spleen is common, as is the loss of white blood cells such as T lymphocytes and macrophages in that organ. But many areas of the body become swollen, and, occasionally, T cells and other Lassa Fever 211 lymphocytes infiltrate a variety of tissues. The reservoir for Lassa fever virus is rodents, which can retain a longterm, persistent infection with the virus. Secretions of urine or feces from infected rodents then contaminate humans who come into contact with them. The rodent-to-human transmission is augmented by human-tohuman transmission, which spreads the viruses via contaminated blood, excreta, or saliva. Sadly, the African custom of nursing patients in homes and hospitals where relatives sleep in close quarters with the infected patient helps to spread the disease during both the incubation period and acute infection. Home nursing care nearly always involves direct contact with infected or dead persons through mucosal surfaces, skin abrasions, and contaminated needles/syringes/blood supply. After the virus enters its host, a fourto twelve-day incubation period passes, then the symptoms of disease suddenly begin. Usually, a fiu-like syndrome of fever, chills, and malaise with muscle and headaches is followed by abdominal pain, nausea, and vomiting. The terminal stage adds poor coagulation, increased vascular permeability, hemorrhage, and neurologic symptoms. Those progressing to death have extremely large amounts of virus in their blood but little evidence of a functional (innate or adoptive) immune response. Most of our understanding of the pathogenesis (disease causation) of Lassa fever virus is by analogy with lymphocytic choriomeningitis virus, the prototype Old World arenavirus. Like Lassa fever virus, lymphocytic choriomeningitis virus utilizes a molecule called alpha-dystroglycan as its receptor for attachment on and entry into cells (5). Dendritic cells are the players of the immune system that are essential for initiating the innate and adoptive immune response. Among various cell populations that constitute the immune system, dendritic cells express the greatest amounts of the viral receptor alpha-dystroglycan on their surfaces (6,7). That is, greater than 99 percent of the total amount of alphadystroglycan found in the immune system is on dendritic cells with less than 1 percent on T and B lymphocytes. As carefully worked out and well established during intensive research, we know that those strains of lymphocytic choriomeningitis virus that bind at the highest affinity (most tightly) to alpha-dystroglycan preferentially infect dendritic cells and alter their ability to initiate effective and efficient immune responses (6,8). The consequence of suppressing such innate and adoptive antiviral immune responses is that the viruses are free to replicate unchecked. Identification of the virions is useful for diagnosis because of the variation in size (polymorphism) and electron-dense ribosomes within virions. The electron photomicrographs here are of lymphocytic choriomeningitis virus, a member of the arenavirus family that looks identical to Lassa fever virus. These related viruses are distinguishable on the basis of chemical, nucleic acid, and immunologic assays. This failure, coupled with the elevated virus titers that result from unchecked replication, lead the host to succumb from overwhelming infection. By contrast, those Lassa fever virus-infected individuals who mount adequate immune responses most often survive the infection. When he returned to his home in Chicago, he became sick and was admitted to the hospital for a fever of unknown origin. The specific cause of his illness was not diagnosed or understood during the short remainder of his life. Fortunately, the infection did not spread among the other hospital patients, the medical and technical staff, his friends, or family. Currently, a very modest amount of research is under way in the West African countries where Lassa fever virus is endemic. Monitoring of the disease is underreported, so understanding of its epidemiology and spread is limited. Yet, the introduction of Lassa fever from Africa into Europe, the United States, and other densely populated countries remains a continuing concern. The classification of Lassa fever virus as a highly dangerous biowarfare (terrorist) weapon also calls for more vigorous research in this area of virology. The responsible strain of this virus, called Ebola Zaire, surfaced again a year later in southern Zaire, but only one person died. The virus then lay quiescent until 1995, when it erupted to cause another epidemic in Southern Zaire. There, the Ebola virus is known to have infected 316 persons, and in its wake over 244, or 77 percent, died. But certainly the numbers were greater, since no one could count individuals infected and dying in the bush. Most of those infected were young adults, on average about thirty-seven years old, although the range was from two to seventy-one years of age. The army sealed off roads and prevented anyone from leaving, a situation reminiscent of the yellow fever panic along the Mississippi River in Memphis 117 years earlier and of the barricades around parts of New York City seventy-nine years earlier during the outbreak of poliomyelitis. Similarly, the Ebola virus began to move toward the city of Kinshasa, about 250 miles away from Kikwit, despite the blockades. Like the Ebola outbreak in 1976 in 214 Ebola 215 villages along the Ebola River, 500 miles to the North of Kikwit, when nine of every ten residents who became infected died, the Ebola virus again made its mark along the Kinshasa Highway. At the beginning of May 1995, a large number of patients with hemorrhagic fever entered the hospital in Kikwit, Zaire. In short order, the patients hospitalized for treatment, their families accompanying them, and many nurses and doctors who treated these patients died of severe hemorrhages. Ebola was suspected by local physicians who had observed similar cases nineteen years earlier (2). As reported in the weekly magazine Newsweek (5): When a 36-year-old lab technician known as Kinfumu checked into the general hospital in Kikwit, Zaire, last month, complaining of diarrhea and a fever, anyone could have mistaken his illness for the dysentery that was plaguing the city. Terrified health officials in Kikwit sent an urgent message to the World Health Organization. The Geneva-based group summoned expert help from around the globe: a team of experienced virus hunters composed of tropical-medicine specialists, virologists and other researchers. They grabbed their lab equipment and their bubble suits and clambered aboard transport planes headed for Kikwit. Except for a handful of patients too sick to run away, the hospital was almost abandoned when the experts arrived. The quarantine was mostly a hollow announcement; it had been years since there was a functioning government in Zaire. The international doctors sent people with bullhorns through the streets pleading with residents to stay home. But they could not be tested there for diagnosis of Ebola because that institute no longer had the appropriate containment laboratory for such studies. In Belgium, as elsewhere including the United States, short-term political considerations had reduced funding for surveillance as well as research into infectious diseases. The samples then traveled from Antwerp to the Communicable Disease Center in Atlanta, Georgia, where tests proved that most of the patients were infected with Ebola virus. At that time, public health officials sought travelers to Europe or other countries who had been in the Kikwit region during the time of the outbreak and who might be incubating the Ebola agent. The quarantine lasted until blood samples could be obtained and analyzed to show that they were not carriers of the Ebola virus. Undoubtedly, the reports of 280 cases of Ebola in Kikwit and its surrounding areas were gross underestimations of the true tragedy that had occurred. First, the stigma of disease prevents many victims from coming into the city, so they die in their rural villages. Second, an epidemic is frequently underreported or denied because of the fear that prospective tourists would cancel their visits. Zaire, like other African countries, depends on tourist travel for a major portion of its budget. Nevertheless, teams of international scientists arrived and searched for plants, animals, or insects in which the virus might reside when not ravaging humans. They failed to turn up leads until 2007, twelve years after outbreak in Kikwik, when the fruit bat was implicated as a reservoir (1). Ebola virus can spread either through the air or by exposure to contaminated blood of infected humans. Relatives and family, who usually accompany African patients to the hospital and stay with them to administer nursing care, as well as medical and technical staff, are at high risk of contamination by coming into contact with blood or breathing infectious particles from these patients. The clinical course of Ebola virus infection is that of a severe hemorrhagic fever (2,3). During an initial incubation period, usually six to ten days (ranging from two to twenty-one days), the virus replicates in infected individuals. An abrupt onset of fever, frontal headache, weakness, muscle pain, slow heart rate, reddening of the eyes (conjunctivitis), and abdominal pain follow. Lethargy and lack of facial expression are common, with eyes having a sunken look. A rash then appears, and death usually follows six to nine days after the symptoms start. For those few who survive, convalescence usually takes two to five weeks and is marked by profound exhaustion and weight loss. Spontaneous abortions are common consequences of this infection, and infants born of mothers dying of the infection become fatally infected. The terminal state consists of coagulation disorders, disseminated intravascular coagulation, increased vascular permeability, hemorrhage from mucosal surfaces, and death (2,3). Because the disease process moves with such rapidity and devastation, systematic study of pathophysiologic changes has been difficult. There is no treatment for Ebola virus infection except rest, 218 Viruses, Plagues, and History nourishment, and fiuids. The only antiviral drug with potential benefits, ribavirin, has not been tested enough to evaluate its effectiveness. However, since administering (passive transfer) antibodies to ill patients is not effective, it is questionable whether antibodies play a protective role. Within the immune system, infection settles in dendritic cells, monocytes, and macrophages. At present, researchers who seek to understand how the Ebola/Marburg group of viruses infect and destroy tissues focus on the involvement of endothelial blood vessels, the coagulation system, and the suppression of T and B cell antiviral immune responses, likely a consequence of dendritic cell infection. The Ebola virus bears an enclosing coat of glycoprotein that is thought to increase viral replication and even kill (cause apoptosis of) several types of cells where the virus replicates. As to the source of this virus, the fruit bat (1,7) was recently identified as its first-known nonhuman vector. A total of sixty cases with forty-five deaths (fatality rate 75 percent) occurred in Gabon between mid-July 1996 and January 1997. As recently as August 2007, reports from the southeastern Congo documented 217 people who were affiicted with the virus, of whom 103 have died (fatality rate of 47 percent). The infection caused by airborne Ebola virus was from cynomologous monkeys brought from the Philippines (6). Of the 161 monkeys imported, more than half died over a two-and-a-halfmonth period. Luckily, and for unknown reasons, the virus failed to spread to other humans, even though the airborne route of transmission was available. Ebola virus is classified as a filovirus (filo, Latin for worm) because its structure seen under the electron microscope resembles that of a worm (1). Another member of this group of viruses is called Marburg, for the city of Marburg, Germany, where the virus caused an outbreak of infection. In Marburg and unaware that monkeys carried Marburg virus, technicians and researchers used such monkeys as a source of tissue culture materials in their laboratories. At the initial outbreak in 1967, thirty-one persons came down with an acute illness and fever, and seven of them died before the virus was identified. Recent Outbreaks Ebola 2007 Uganda 149 25 Ebola 2007 Congo 249 74 Marburg 2007 Uganda 1 100 near symbiotic relationship with the monkeys it infects so does not harm them. But when man as an interloper comes into contact with fiuids from an infected monkey, potentially fatal disease follows. Of over 5,000 blood samples collected from individuals in central Africa, nearly a quarter (25 percent) tested positive for prior infection with Ebola. Whether the fruit bat is the only natural reservoir for such viruses, how Ebola is transmitted, and where it lurks, all remain unknown. These human responses to Ebola are reminiscent of events in the past associated with outbreaks of yellow fever and polio. The fear and fascination attached to Ebola infection come from our ignorance of how to treat, prevent, or contain the disease, and our helplessness in its wake.
This supports the idea that bacteria may be responsible for sarcoidosis in some individuals with the disease asthma vs bronchiolitis order discount ventolin on-line. This fnding emphasizes the importance of taking8 an occupational history when sarcoidosis is suspected asthma treatment differences generic ventolin 100 mcg mastercard. Prevalence estimates in the United States range from less than 1 to 40 cases per 100 asthma wiki discount ventolin online american express,000 population asthma symptoms no wheezing order ventolin in united states online. However asthma symptoms pubmed buy online ventolin, both gender and ethnicity may impact disease risk; the age-adjusted annual incidence rate is higher for Blacks (35 qge031 asthma buy genuine ventolin online. Sarcoidosis usually is not disabling and most people with the disease can live normal lives asthma treatment for adults order ventolin 100 mcg visa. In the majority of cases asthma symptoms yellow mucus cheap ventolin 100mcg with visa, the condition appears temporarily and disappears on its own without treatment. In cases where the lumps do not heal and disappear, the tissues tend to remain infamed and become scarred. About 20 percent to 30 percent of people with sarcoidosis are left with some permanent lung damage. African Americans are more likely to have involvement of the skin other than skin infammation, and eye, liver, bone marrow and lymph involvement outside the chest region. Women are more likely to have neurologic and eye involvement and skin infammation; men are more likely to have elevated calcium levels. Diagnostic tests for sarcoidosis include chest x-rays, pulmonary function tests and special blood tests. Although no treatment has been shown to be clearly effective on a prolonged basis, when the disease progresses, or there are signifcant symptoms, including critical organ involvement (such as the eyes, brain and heart), health care providers will ordinarily prescribe corticosteroids. Some patients with sarcoidosis are unable to tolerate corticosteroids and other treatment options due to side effects, or have diseases unresponsive to these agents. Lung transplantation can be considered as the treatment of last resort for intractable sarcoidosis unresponsive to immunotherapy. Since sarcoidosis tends to occur more frequently in certain ethnic groups and may occur in families, much research is taking place to fnd the genetic basis for these predispositions. Genomewide scans on both German and African-American families have produced candidate genes on chromosomes 6 and 5, respectively. These cells are associated with sarcoid infammation and offer a potential treatment approach. Regulatory T cells have been found to be abnormal in some sarcoidosis patients and may be contributing to the disease. Nine out of 10 patients receiving Infiximab were reviewed and reported symptomatic improvement with therapy; all 10 demonstrated evidence of improvement. It also was recommended that patients receiving the drug should be screened for latent tuberculosis and lymphoproliferative disorders. The American Lung Association has supported prominent researchers who have greatly contributed to the understanding of sarcoidosis. One researcher has been instrumental in helping scientists better understand the mechanisms underlying sarcoidosis and how it affects different populations, especially African Americans. His research group is searching for the specifc genes that cause sarcoidosis by using genetic linkage and association analysis. Other genetic factors that predispose people to the progressive disease are being investigated. Thousands of advocates have joined with the American Lung Association to tell Congress that more needs to be done to fght sarcoidosis. In 1994, the Centers for Disease Control and Prevention initiated a national Back to Sleep education campaign to encourage parents, healthcare providers and the public to make sure all infants sleep on their backs or sides. As of 2000, approximately 20 percent of United States infants continued to sleep face down. I Infants were monitored and arousals during the night were defned as either incomplete waking or complete waking. Sudden infant death syndrome is the third-ranking cause of death for infants under one year of age. Infant Mortality Statistics from the 2002 Period Linked Birth/Infant Death Data Set. National Vital Statistics Reports: Infant Mortality Statistics from the 2003 Period Linked Birth/Infant Death Data Set. Infant Mortality Statistics from the 2004 Period Linked Birth/Infant Death Data Set. Male infants already have far fewer serotonin binding neurons, multiplying the effect of abnormal neurotransmitter signaling. Over 438,000 Americans die from diseases directly related to cigarette smoking each year. About half of all regular cigarette smokers 2 will eventually be killed by their addiction. The earlier someone 3 quits smoking, the longer their life expectancy will become. In addition to the staggering death toll, tobacco use also causes serious, chronic diseases that impact upon quality of life. Additionally, smoking is responsible for approximately 80 percent and 90 percent of lung cancer deaths in women and men, respectively. Smoking is also a major risk factor for coronary heart disease, stroke and lower respiratory tract infections. It causes cancer in other parts of the body, including the esophagus, oral cavity and bladder, and has been linked to a variety of other conditions and disorders. Smoking both increases the risk of developing such diseases (depending on the exposure level) and can worsen conditions that are already present. Exposure to cigarette smoke, for example, greatly raises the risk of lung disease for workers exposed to coal, silica and grain or cotton dusts. Smoking enhances the effects of hazardous materials that may be found in the workplace and plays a major role in occupation-associated lung cancer. For example, nonsmoking asbestos workers are fve times more likely to develop lung cancer than nonsmokers not exposed to asbestos. However, if an asbestos worker is also a smoker, the risk factor jumps to 50 times or higher. Please view the Trends in Tobacco Use report, which includes statistics and information on consumption and quitting, as well as related morbidity and mortality, at. The annual9 prevalence of smoking declined 40 percent between 1965 and 1990, but the decrease has slowed since then. Figure 1: Estimated Percentage of Adults Who Were Current Smokers by Year and Sex, U. In 2006, adults with less than a high school diploma had the highest prevalence of smoking (26. Every day, approximately 4,000 children between 12 and 17 years of age smoke their frst cigarette; an estimated 1,300 of them will become regular smokers. Figure 2 shows the percent of high school students (9th through 12th grade) who reported having smoked one or more cigarettes in the previous 30 days. Another survey which provides data on individual grade levels reported that in 2006, 21. Among high school students in 2005, the most prevalent forms of tobacco used were cigarettes (23. Bidi use (skinny, favored cigarettes) by 12th graders decreased to less than 2 percent in 2007, while kretek use (clove cigarettes) by 12th graders did not change from 2006. These numbers are troubling considering that exposure to pro-tobacco marketing and media more than doubles the chances (2. Researchers found that teens who were exposed to the greatest amount of smoking in movies were 2. One study found that daily television viewing was related to earlier smoking initiation. For each hour of additional television viewed per day, the average teen began smoking 60 days earlier. The risk of dying from a heart attack is 60 percent higher for smokers than nonsmokers 65 years of age or older. It consistently ranks among the top 10 most common chronic health conditions and causes of daily activity limitation. Figure 4: Estimated Percentage of Adults Who Were Current Smokers by Year and Sex, U. Note: * Reported smoking cigarettes on one or more of the 30 days preceding the survey. Smoking by expectant mothers leads to low birth-weight babies, a risk factor for infant death. Nicotine from smoking may restrict blood fow in the umbilical cord and uterus, decreasing oxygen to the developing fetus. Abnormal lung function in babies is a result of maternal smoking during pregnancy. These mothers also have about twice the risk of experiencing complications during pregnancy. Recent studies have suggested that children of smokers are twice as likely to develop asthma as the children of nonsmokers, and that even apparently healthy babies born to women who smoked during pregnancy have abnormally narrowed airways, which may predispose them to asthma and other respiratory disorders. The chance of developing asthma increased to 35 percent if the mother smoked more than 10 cigarettes a day while pregnant. American Indian/Alaska Native women had the highest rate of smoking during pregnancy (17. The smoking rate for Hispanic and Asian/Pacifc Islander mothers was substantially lower (2. Neonatal health-care costs attributable to maternal smoking in the United States have been estimated at $366 million per year, or $740 per maternal smoker. A study in 2007 comparing mostly African American and mostly White communities found 2. Additionally, studies have found that the numbers of tobacco advertisements are higher in magazines targeted toward African Americans than in magazines targeted at the general population. For the many diverse groups with high percentages of heavy smokers, these risks are even greater. As of 2006, the prevalence of current smoking is highest among American Indians/Alaska Natives (26. The smoking rate among Asians is substantially lower than that of other races due to the low rate of smoking among women in this group. Within the last few years, smoking rates have been comparable between Blacks 136 This trend traditionally has been reversed in women, with White women having higher smoking rates than Black women, though in 2006 the two rates were similar (19. A 2004 study found that adolescents who reported same-sex attraction or activity were 2. Scientifc evidence indicates that there is no risk-free level of exposure to secondhand smoke. Secondhand smoke causes approximately 3,400 lung cancer deaths and between 22,700 to 69,600 heart disease deaths in nonsmoking adults in the United States each year, along with magnifying hundreds of thousands of asthma cases and lower respiratory tract infections. One study found that both the average number of cigarettes smoked per day by a spouse and the number of years of secondhand smoke exposure were associated with an increased risk of a heart attack. In addition, the report suggested that breast and cervical cancer risk also may be infuenced by exposure to secondhand smoke. In homes where parents smoke outside, the levels are still seven times higher than in households of nonsmoking parents. Middle ear infections are the most common cause of childhood operations and childhood hearing loss. Cigar smoking has been strongly associated with an increased risk of lung, oral cavity, larynx and esophageal cancers, as cigars contain many of the same cancer-causing and toxic ingredients as cigarettes. The year 2006 was the ffth straight year in which adults who quit smoking outnumbered adults who were still smoking. Since 1965, the proportion of former smokers has increased dramatically; in 2006, there were 88 percent more former smok138 People who quit smoking before 35 years of age have a life expectancy similar to that of never-smokers. Smokers who quit at younger ages gained the most years of life, but even those who quit much later in life gained some benefts. After one year, the women who quit smoking had twice the improvement in lung function compared to men who quit. When an older person quits smoking, circulation improves immediately and the lungs begin to repair damage. In one year, the added risk of heart disease is cut almost in half, and risk of a stroke, lung disease and cancer decrease. In addition, most obstacles brought up by older adults for not quitting are based on incorrect information, such as the potential health risks from cessation aids like nicotine replacement therapy. Department of Health encourages all patients trying to quit to use an effective medication in addition to non-medical treatment options. In addition, combining a self-administered form of nicotine replacement (gum) with the patch is more effective than using just one type alone. A health care provider can help patients decide which products are best suited for them. Although most former smokers preferred quitting cold turkey, this method has the lowest success rate. It is in the economic interest of employers to provide this additional coverage as male and female employees who smoke incur, on average, $15,800 and $17,500 more in lifetime medical expenses and are absent from work an average of four and two days more each year, respectively, than nonsmokers. In 2004, tobacco use was estimated to cost the United States $193 billion, including $97 billion in lost productivity and $96 billion in direct health care expenditures. Figure 5 displays the economic costs of selected lung diseases compared to tobacco-related diseases in 2007. Some of these costs may overlap as the health effects of tobacco use may manifest as lung diseases. Recent studies have shown that school-based smoking cessation programs may be an effective way to help teenagers quit smoking. Since adolescents who smoke are likely to become habitual smokers, targeting high schools with cessation programs and raising awareness about the negative health effects of smoking may help counter this trend. One study of 495 never-smokers over 65 years of age reported that those with high lifetime exposure (more than 30 years) to secondhand smoke were about 30 percent more likely to develop dementia over a six-year period than those reporting no lifetime secondhand smoke exposure. Differences were not seen in lung cancer mortality risk, most likely because lung cancer develops over a period of time far longer than the three-year follow-up used in the study. One study found that never-smokers with non-small cell lung cancer (although never-smokers represent only a small percentage of those with the disease), had a better prognosis than smokers with the disease, including fve-year survival rate (64% versus 56%). As the amount and duration of smoking increased, fve-year survival rates decreased. Those who had smoked the most (40 pack-years) had a fve-year survival rate of only 35 percent. This provides a way to measure how much a person has smoked over a long period of time. The American Lung Association is committed to the elimination of tobacco use in future generations. To that end, the American Lung Association offers programs to help smokers quit and advocates for policy change at the federal, state and local level. The Lung Association offers two smoking cessation programs: Freedom From Smoking, a comprehensive program for adults, and Not On Tobacco (N-O-T), a non-punitive program for high school-aged smokers. The Freedom From Smoking program consists of eight group sessions, during which participants develop a personalized plan to quit smoking. Not On Tobacco (N-O-T) was developed by the American Lung Association in collaboration with researchers at West Virginia University to help teenagers quit smoking. This 10-session program offers support and instruction on topics such as understanding reasons for smoking, nicotine addiction and withdrawal, accessing and maintaining social support, coping with stress and preventing relapses.
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