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Beijing Academy of Artificial Intelligence 822

2014-42/1178/en_head.json.gz/18476

Vital Record About TAMHSC Masters in Health Administration students awarded fellowships May 31, 2013 by Rae Lynn Mitchell Master of Health Administration (M.H.A.) students at the Texas A&M Health Science Center School of Rural Public Health are encouraged to compete for Administrative Fellowships as part of their post-graduate experience. Students begin preparing for their fellowships during the second semester of their first year and continue through their final year. This fellowship opportunity allows students to work within an organization and experience real-world application of the skills they learned during their coursework. Here are the stories of three M.H.A. students who will be beginning their fellowships in the summer of 2013. Tyler Colton Tyler Colton will complete his fellowship with Vidant Medical Center (VMC) in Greenville, North Carolina. VMC is one of four medical centers in North Carolina and is the flagship hospital for Vidant Health, which is comprised of 10 hospitals spread throughout eastern North Carolina. It is a state-of-the-art 909-bed regional referral facility servicing 1.4 million people in 29 counties and is serviced by over 500 physicians and nearly 8,000 employees. During Tyler’s one-year fellowship, he will work with and observe senior leadership as they navigate a complex medical center. Tyler will also have the opportunity to contribute to the organization and gain valuable experience through a wide array of projects while working alongside two other fellows. Mai Hoang Mai Hoang will complete her fellowship at The University of Texas Medical Branch Health System (UTMB) in Galveston, Texas. UTMB is home to four schools, three institutes, the 320-bed John Sealy Hospital, and the 108-bed Texas Department of Criminal Justice Hospital. The health system operates 80 community-based clinics located in 51 locations on and off the island and became a member of the Texas Medical Center in 2010. The UTMB Health Administrative Fellowship Program will provide Mai with an opportunity to apply lessons from the classroom to real-life situations and allow her to explore operations through departmental rotations and projects. David Perez will complete his fellowship at the Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC). The MEDVAMC is a state-of-the-art facility with 357 acute care beds, a 40-bed Spinal Cord Injury Center, and a 141-bed Community Living Center. MEDVAMC serves as the primary health care provider for almost 130,000 veterans in southeast Texas, which also includes outpatient clinics in Beaumont, Conroe, Galveston, Houston, Lufkin, Richmond, and Texas City. During David’s fellowship he will work on projects that will provide a better understanding of the diverse facets of healthcare operations and management while rotating through multiple departments. David will be considered part of the leadership team and under the direction of the fellowship preceptor, which is the Medical Center Director. Administrative Fellowships, Public Health No Comment Subscribe Sign up for our bi-weekly newsletter Administrative Updates TagsAdministrative Fellowships Aging Awards Cancer Cancer Prevention CDC Chronic Disease CIADM Colonias Community Diabetes Ebola Education Global Health Health Tips Healthy Aging Infectious Disease Innovation Leadership Nutrition Obesity Pediatrics Public Health Preparedness Research Safety Scholarships Serving Texas South Texas Students Vaccinations Wielding Nature’s Sword: Researchers at Texas A&M discover new treatments against drug-resistant infections Since World War II, antibiotics have been our only defense against bacterial infection, but overuse and misuse have caused some bacteria to develop resistance to antibiotics. Now, researchers at Texas A&M Health Science Center have discovered an entirely new class of antimicrobials that have the potential to kill drug-resistant bacteria. South Texas teens get hands-on lesson about Ebola transmission High school students in South Texas learned first-hand about the transmission of Ebola this week during a simulated disease transmission lab facilitated by the Texas A&M Health Science Center Health Careers Program. College of Nursing Alumni receive DAISY Awards Two Texas A&M Health Science Center College of Nursing alumni recently received the honor of the DAISY Award for Extraordinary Nurses. The DAISY Award, which stands for diseases attacking 5 tricks for eating fewer treats on Halloween Halloween is the biggest holiday for candy producers, which can be a nightmare for parents. Nutritionist David Leal shares his top five tips to avoid eating too much sugar during Halloween. New drug boosts immune system to protect against world’s deadliest infectious diseases Researchers at the Texas A&M Health Science Center (TAMHSC) and the University of Texas MD Anderson Cancer Center have developed a new therapy to stimulate the body’s natural immune system, thereby providing effective protection against a wide range of life-threatening infectious diseases. Continue Reading → Colonias Bound: An expedition into preventative health care This month, the Texas A&M Health Science Center is teaming up with Texas A&M University Colonias Program and Texas A&M International University College of Nursing and heading to the Laredo Colonias to bring both resources and public education to those living in the Texas border communities. A&M Baylor College of Dentistry Rangel College of Pharmacy Facilities Work Request Photo ID & Access Request 1115 Medicaid Waiver Emergency Mgmt. State of Texas · Texas Homeland Security · Public Information Act · Risk, Fraud & Misconduct Hotline · Statewide Search · Equal Opportunity/Nondiscrimination · Texas Veterans Portal · Site Policies · · Webmaster · Site Policies · Web Accessibility

医学

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Your News Items UNL Announce Symposium to examine the genetic science behind addiction UNL will host the 61st annual Nebraska Symposium on Motivation on April 25 and 26. Many people use substances, but a relatively small percentage develop substance use disorders. Why this happens is an active area of research that will be explored April 25-26 at the 61st annual Nebraska Symposium on Motivation at UNL. The symposium’s theme this year is “Genes and the Motivation to Use Substances.” Six experts will present research findings on various topics on the motivation of substance use and addictive behavior. Scott Stoltenberg, assistant professor of psychology at UNL, is coordinating the symposium. He said the long-running symposium looks motivation’s role in human behavior and this year will delve into the incentives to use substances and the risks of developing a disorder. “There is no question that humans are motivated to use substances, such as alcohol, tobacco or marijuana,” Stoltenberg said. “Nearly all of us have used substances at some time in our lives and many of us use them regularly. Sizeable minorities of people develop a substance use disorder that is, at least in part, characterized by impaired control over use of the substance. “In other words, when people are motivated to quit using the substance they have trouble doing so,” he said. “Most of us don’t develop a substance use disorder and so the question arises: Are there underlying genetic differences between those that develop a problem with substances and those who don’t? The short answer is yes.” Stoltenberg said that in the past two decades, genetic research on substance use disorders has grown tremendously, providing evidence that genetic factors influence a person’s motivation to use substances and the risk for developing disorders. “There is no single gene that causes addiction, but there are many genes that have some influence, along with certain environments,” he said. “This symposium will examine what is currently known about the role that genes play in the motivation to use substances and the risk for developing a disorder.” The event is free and open to the public. While the presentations are scientific, Stoltenberg said the public could gain new insights into addiction. “There is a lot of curiosity about how genes might contribute to a person’s vulnerability to addiction,” he said. “Nearly everyone knows someone who has suffered with a substance use problem. I think the public will gain an appreciation for the amount of research that has been conducted in the area. We know a lot more about the causes of addiction than we did just a few years ago.” The symposium will be in the Nebraska Union, 14th and R streets. A full schedule, list of speakers and more information on the symposium – including how to register, which is suggested but not required – can be found at http://psychology.unl.edu/symposium/nebraska-symposium-motivation. The event also will be live-streamed at http://psychology.unl.edu/symposium/streaming. More details at: http://go.unl.edu/pgd Today@UNL Tue. April 23, 2013 Promotion, tenure celebration is todayUNL team’s discovery yields super-tough, strong nanofibersInstant messaging going mobile, system-wide, April 28Ross to host free showing of 'Trashed'Research office offers help session on NUgrant routingSymposium to examine the genetic science behind addictionLee to be awarded academic freedom honor Newsletters including this story Today@UNL | Team's discovery yields super tough nanofibers; Promotion, tenure celebration is today Your browser does not appear to support JavaScript, or you have turned JavaScript off. You may use unl.edu without enabling JavaScript, but certain functions may not be available. Lincoln, NE 68588 402-472-7211 © 2014 University of Nebraska–Lincoln · Lincoln, NE 68588 · 402-472-7211 · About UNL The University of Nebraska–Lincoln is an equal opportunity educator and employer. For current job openings, visit employment.unl.edu

医学

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News Opinion Lifestyle Showcase Sports Ads Classifieds Jobs Extras CU Notices Contact Us Health « Operation Fill the Trailer... New equipment aids Jersey Sh...» Battling ignorance Parents want to educate others about Tourette’s syndrome December 11, 2012 By ALYSSA MURPHY amurphy@sungazette.com , Save | HUNTERSVILLE - Ron Polcyn had hoped that since his two daughters had not inherited his Tourette's syndrome, his son, Austin, also would not develop it. Yet right around the age of 5 or 6, Austin started showing symptoms. Now at 13, he has tics, such as doing things with his hands, jumping and facial grimaces when he eats. While many people associate the syndrome with cursing uncontrollably, there actually are many types of tics people can experience. They also can change daily. "He could have one tic today and two tomorrow," Ron said. Then his tics could completely disappear and he could be in remission until five years down the line, it could come back. People with Tourette's syndrome often also have attention deficit hyperactivity disorder (ADHD) or obsessive compulsive disorder (OCD). When Ron gets stressed out, his OCD becomes more pronounced where he will repeatedly have to check something. "Eventually I say, 'That's the last time,' " he said. A third of the people with it stutter, something that Austin does, Ron said. A big trigger for Austin is stress. When he becomes overwhelmed, his tics become more pronounced. If he is having trouble with his homework and becomes too stressed about it, his parents encourage him to go upstairs to his bedroom to play the drums. Drumming is his outlet, something he does to relax. While not everyone with Tourette's syndrome plays drums, Ron said it is important for them to have outlets. "I know what he's going through," Ron said. "I was in martial arts. That was my escape. ... I don't know where I'd be if my father didn't get me involved with it." Like Austin, Ron inherited Tourette's from his father. Ron had done some drumming, which inspired him to buy a drum set for Austin at a "dollar" store. He did not have it long before it broke. He got another one, which also broke. When he became serious about drumming, his parents bought him a "nice drum set." "I surpassed my Dad a long time ago (in drumming)," Austin said. He drums every day he can. Recently, he started working with Mike Wrench, who brought to the area Drums and Disabilities, a national organization based on helping people with disabilities through drumming. Mostly however, Austin and his family have to deal with the misconceptions. "A lot of people think people with Tourette's are mentally handicapped," Ron said. Shannon, Austin's mother, worked with him and discovered he learned a different way. She had him take a test after reading a lesson silently. He failed. "The second test, he read out loud," Shannon said. "No mistakes." His parents called him an auditory learner, something they shared with his teachers so they would know how to help him. "A lot of people think he's stupid," Ron said. "He made the honor roll." Some people think Tourette's syndrome is contagious, which it isn't. Ron and Shannon want to make people more aware of facts about the syndrome. Ron said they begged his school for more than a year to educate the students about why Austin does what he does. They educated one grade and some of the students asked questions, but it didn't help the students in seventh, ninth, 10th, 11th and 12th grades. Ron said he wants to educate people in hopes of stopping bullying. Austin has been yelled at in school for acting out in ways that he can't help. "Teachers never understand," Shannon said. "Every kid has a right to a fair and proper education," Ron said. They tried starting a support group for anyone who has or anyone who knows someone who has or anyone who just want to learn more about Tourette's syndrome. If interested, call Ron at 435-5181. Save | Subscribe to Williamsport Sun-Gazette I am looking for:

医学

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WHO Director-General visits Madagascar, Mauritius and Kenya WHO/Pierre Formenty Dr Lee visits a bird sanctuary in Mauritius where experts are on the alert for the arrival of birds carrying the H5N1 virus. Dr LEE Jong-wook visited Madagascar, Mauritius and Kenya from 3–9 March 2006. Each of the three countries has a different set of health challenges. Malnutrition, malaria, and neglected diseases such as leprosy and plague are important issues in Madagascar — an island nation of 18 million people. In Mauritius — a middle-income country with 1.2 million people — chronic diseases such as heart disease, stroke and diabetes are responsible for the vast majority of deaths. In Kenya, curbing infectious diseases including HIV/AIDS, tuberculosis and malaria, and improving maternal health for its 34 million people are high on the health agenda. Dr Lee stressed one common health challenge to leaders in all three countries — to quickly tackle the highly pathogenic avian influenza virus H5N1 should it infect their wild or domestic birds, and to prepare for a potential human influenza pandemic. Travelogue: Madagascar, Mauritius and Kenya Related links Director-General's speech: launch of Preventing chronic diseases: a vital investment at the Mauritius Institute of Health Director-General's statement to a press conference, Mbagathi District Hospital, Nairobi, Kenya Madagascar country profile Mauritius country profile Kenya country profile Former Director-General: Dr LEE Jong-wook Director-General travelogues

医学

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Public Health Assessments & Health Consultations Back to Arizona Reports PETITIONED HEALTH CONSULTATION CHOULIC GRAVEL PIT (a/k/a BABOQUIVARI DISTRICT) TOHONO O'ODHAM NATION, PIMA COUNTY, ARIZONA In February 1994, the construction company, under the oversight of Tohono O'odham Nation representatives and its consultant, dug test trenches on the site. Trenches were dug in several areas for the purpose of locating former burial trenches and collecting soil samples. During the trenching activities, buried asphalt and chunks of what appeared to be lime were found. In addition, samplers encountered stained subsurface soils with a diesel fuel odor. Three of the five subsurface soil samples, collected at depths of three and eight feet, showed the presence of total petroleum hydrocarbons (TPH) at levels up to 14,700 parts per million (ppm). Although not applicable to tribal lands, the State of Arizona has established a cleanup standard of 100 ppm for TPH in soils. Subsequent sampling, at five and ten foot depths, yielded five of 39 samples with TPH levels exceeding the 100 ppm standard. The highest result from the second batch of soil samples was 2120 ppm TPH [4]. In the area surrounding the arroyo, 1140 acres drain into the pit which is 30 feet deep in some places. Based on the average annual runoff and capacity of the pit, consultants estimated that the pit can hold all of the annual runoff. Infiltration through the bottom of the pit appears to be high and, as a result, all of the runoff is expected to recharge the groundwater. Depth to groundwater is about 700 feet in this area. One estimate shows that any pollution existing in the pit could reach the groundwater in as soon as five years [6]. A drinking water well is located about one mile down gradient of the Choulic Gravel Pit [3]. For about six months of the year, during the rainy seasons, there is standing water in the arroyo [3]. The concern for cattle and wildlife drinking any pooled water in the contaminated area prompted the local water utility to sample the surface water at the site. The water utility reported that methylene chloride was found at 44 ppb and 12 ppb in the surface water samples [1]. The Maximum Contaminant Level (MCL) for methylene chloride in drinking water is 5 ppb. The area around the pit is now fenced and cattle and most wildlife have no access to the standing water. Under a cooperative agreement with the U.S. Environmental Protection Agency, the Tohono O'odham Nation plans to conduct an environmental investigation of the Choulic Gravel Pit [7]. The results of the environmental investigation will provide more information about the types and levels of contaminants associated with the site. This contaminant data can serve as the basis for a more definitive public health evaluation of the site. Page last reviewed: January 25, 2010 Page last updated: January 25, 2010

医学

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High Point Regional and Duke Medicine High Point Regional Health System Announces Relationship with Duke Medicine for Heart and Cancer Care HIGH POINT, N.C. – High Point Regional Health System and Duke Medicine have entered into a unique agreement to expand program development and operational support for oncology and cardiovascular patient care programs. The two health care leaders together will provide unparalleled research and clinical care expertise to the Triad and surrounding communities. The High Point/Duke relationship was formed to further enhance the nationally recognized cardiac and cancer programs at High Point Regional Health System and provide a new opportunity for further clinical development. “After exploring several opportunities for a clinical affiliation with medical centers around the state and region, we found Duke Medicine to be the right fit,” said Jeffrey S. Miller, president of High Point Regional Health System. “This means our patients benefit from the very best of both treatment facilities, close to home.” The new agreement will provide the hospital with access to the clinical, operational and clinical research expertise of Duke Medicine, which is known for cardiology and oncology clinical care and research programs considered among the best in the nation, to enhance the cardiology and oncology services it offers to the community. Duke will provide support for quality and patient safety systems and clinical program development. Utilizing Duke’s extensive clinical research programs in cardiology and oncology, hospital-based research programs will be developed and expanded offering area patients new and innovative treatment protocols through clinical trial opportunities. “Duke University Health System has a long history of supporting community hospitals in meeting the needs of their patients and improving the health of populations throughout North Carolina,” said William J. Fulkerson, Jr., MD, Executive Vice President of Duke University Health System.. “We look forward to strengthening our relationship with a quality organization like High Point Regional Health System and its dedicated leadership, medical staff and employees.” By entering into this relationship, High Point Regional Health System joins a network of Duke-affiliated hospitals and health systems in communities throughout North and South Carolina, Virginia, West Virginia, and Florida. A truly comprehensive facility, Carolina Regional Heart Center contains every component of heart care under one roof. Featuring a vast array of services focused on diagnosis, treatment, and education about cardiovascular disease, the center houses the cardiac catheterization lab, a medically directed fitness center, and the cardiac rehab program. “Our program has maintained a high level of quality that sets us apart from the competition,” said Zan Tyson, MD, medical director of the Carolina Regional Heart Center. “Duke joining our team will mean we have access to emerging technologies quicker which will benefit our patients.” “Patient care is a team sport – it does not depend on any one single person. The relationship of the best community oncology program in the Triad with the best oncology program in the State is an incredible match. Patients will be the real beneficiaries of the positive energy this relationship creates,” said Bernard Chinnasami, MD, medical director, Hayworth Cancer Center. Hayworth Cancer Center was the first cancer center in NC to offer all oncology services under one roof (radiation, outpatient chemotherapy, inpatient care, CT/PET scans, clinical research, and supportive care), maximizing convenience for patients and families. According to U.S. News & World Report, Hayworth Cancer Center at High Point Regional Hospital was ranked number one in the Triad for the 3rd consecutive year in 2011. About Duke Medicine A world-renowned academic health care system, Duke Medicine strives to improve health care locally and globally through innovative research, education, patient care, and outreach. As one of the nation’s preeminent health care providers, Duke Medicine serves patients from the Southeast, the United States, and far beyond, with a total of more than 61,000 inpatient stays and 1.8 million outpatient visits annually across the Duke University Health System. U.S. News & World Report consistently ranks Duke University Medical Center in the top 10 on its Honor Roll of “America’s Best Hospitals”—with a complete range of nationally ranked specialty services. About High Point Regional As part of a not-for-profit Health System governed by a volunteer, community-based board of trustees, High Point Regional offers a wide variety of inpatient and outpatient care. High Point Regional, the largest piece of the Health System, offers 384 private beds for medical and surgical patients and has its foundation in six primary service areas: Carolina Regional Heart Center, The Hayworth Cancer Center, The Neuroscience Center, The Women's Center, The Emergency Center and The Piedmont Joint Replacement Center. High Point Regional’s mission is to provide exceptional health services to the people of this region. For more information, visit www.HighPointRegional.com. For Immediate Release: January 19, 2012 Contact: Tracie Blackmon (336) 442-9064 High Point Regional Health System

医学

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← Diabetes Disaster Plan Vitamin E for Your Fatty Liver → Who the Empowered Health Seekers Are June 2nd, 2010 · No Comments The odds are that you haven’t yet fully empowered your search for good health. I know this about you because a couple of months ago HealthCentral surveyed 2,888 of its registered members who have one of eight chronic conditions, including diabetes, and who completed the study. And in this respect at least people with diabetes are just like the people with the other seven chronic conditions. HealthCentral CEO Christopher M. Schroeder and James E. Burroughs, associate professor of commerce at the University of Virginia, presented their findings at the DTC National Conference in Washington, D.C. earlier this month and shared them with me. After asking the people in the survey all sorts of standard psychological assessments, they found that about 30 percent of us take an active role in our health care plan. If you are in this group, one of your characteristics is that you are energized and engaged when you need to learn new tasks or master new subjects — you are what the survey calls a person with a need for cognition. If you are an empowered health seeker, the other characteristic you have is self-confidence — you have, in the formal terminology of the survey, high self-efficacy. You can click to view the study, “Understanding What Motivates the Empowered Patient,” here. Mr. Schroeder and Professor Burroughs prepared it in association with Ted Smith, Ph.D., HealthCentral’s executive vice president for research. My posts here at HealthCentral and your many comments are just one small corner of this huge health resource. HealthCentral is a collection of condition and wellness websites providing clinical information, tools, and mobile applications. Its sites provide a platform for more than 3,000 bloggers, 200 expert patients, and more than 12 million monthly visitors sharing real-life experiences about specific conditions. But those who are empowered are less than a third of of the registered members that HealthCentral surveyed. These are the people who ask for treatment and prepare for their doctor appointments. Then, half fall into the “traditional mainstream” category of people who have a low need for cognition and yet have high self-efficacy. Finally, 20 percent fall in the “traditional resistant” category with both a low need for cognition and low self-efficacy. These proportions surprised me. I had always though that most of you already took charge of your health care, working with your doctor as co-pilots or co-authors of your health treatment. But that’s just one of the survey’s surprises. For starters, I was surprised that nobody ever did a survey like this before. “Lots of people have been talking about this concept that people are taking greater and greater control of their lives and health,” Mr. Schroeder told me in an interview. “We all know anecdotally that this is true, but we weren’t able to find any hard research or data about what is driving the empowered patient — who these people are and why they do what they do and what influence they have. We discovered that this is the first all-out investigation of who the empowered patient is, why they do what they do, and what potential ramifications this will have on health care. That’s why we commissioned it.” This in turn presented even more surprises. Empowerment revolves much more around personality than education or income level. This not only surprised me but it also surprised Mr. Schroeder. “That is the biggest surprise that I had,” he told me. “I had a belief that empowered people would be people who had a little bit more time available for them, a little more resources. They might have had graduate degrees or at least more education and viewed themselves in this way. And our study showed unbelievably clearly that this has nothing to do with one’s demographic or where they come from or what education they have had or how much money they make.” They care a lot about what they are wrestling with or thinking about, Mr. Schroeder continued. They also strongly believe that they have a role to play in the outcome of things that they engage in and feel that they have almost an obligation — certainly a concern — that they not only empower themselves but also empower others. They try to influence other people to realize the benefits of stepping up and taking control of something that is as important to them as their health. The researchers were curious about how the empowered health seekers could motivate or influence others to empower themselves. The learned that a patronizing approach doesn’t cut it. Talking down to them backfires. But empowered health seekers can influence a good part of the 50 percent in the traditional mainstream category by appealing to their need for understanding and their desire to be addressed in a direct, straightforward manner. What sways them is common sense. But making a human connection is just as important as the logic. People in the second and third categories can learn to take control of their health not only from the experts but also from people who have been there and are trying to figure out how to live their lives on a day-to-day basis. “That’s my biggest take-away,” Mr. Schroeder says. The exciting thing is that these second and third groups of people — many of whom are already taking steps in the direction of the first group — get encouragement from the empowered health seekers, he says. “I would be willing to put down a significant bet that if we do the study again in two years you will see the empowered group grow rapidly as that central group gets more and more confident as part of the reality of what it means to take on their health. If other studies prove anything, it is that the more people are engaged, the more that people are helping each other, the outcomes are almost always better. Almost a third are already proactive, but well over half are stepping up on ways unimagined even a few years ago. And more and more are moving that way.” Empowered health seekers are at the forefront of change in how people can take control of their own health. The key phrase that Mr. Schroeder uses is that “people are helping each other.” You can made a difference not only in your own lives but also in the lives of many other people who have diabetes. This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles. Tags: diabetes, Diabetes Management, Diabetes Research, diabetes treatmentPosted in: Psychosocial Vitamin E for Your Fatty LiverThe Trouble with Naps Intensive Glucose Control WorksStudy: Healthy Fasting Reduces Risk of Heart Disease, DiabetesEmbrace Diabetes Support Groups for a Healthy LifestyleWhich Blood for Checking GlucoseMedical Marijuana for DiabetesIndigenous DiabetesMeeting the tiniBoy Lancet Inventor in KoreaTest Strips and Meters from South Korea

医学

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Should Your Herbalist Be Certified? Herbalists seek to define standards and who should impose them. http://www.motherearthliving.com/Health-and-Wellness/Should-your-herbalist-be-certified.aspx By Laurel Vukovic If you were searching for an herbalist, how would you go about finding one? “In a perfect world, every community would have an herbalist who everyone knew and trusted,” says Aviva Jill Romm, executive director of the American Herbalists Guild (AHG) and the guild’s director of education and certification. Not long ago, lay herbalists tended the well-being of their communities without concern of credentials or certification. An herbalist was judged solely by his or her skill as a healer. Yet today, our society is dominated by credentials, says Romm, and community herbalists can be hard to find. Brigitte Mars, a longtime Boulder, Colorado-based herbalist, author, and faculty member at the Rocky Mountain Center for Botanical Studies, agrees. “If I wanted to find an herbalist, I would contact the American Herbalists Guild for a referral to a qualified practitioner,” Mars says. But Rosemary Gladstar, founder of the California School of Herbal Studies and a well-known educator, writer, and activist in the herbal community, has a different point of view. “I would never choose a healer according to whether or not they had credentials. I’d find someone through word of mouth,” says Gladstar. Up to this point, there has been no certifying organization for U.S. herbalists, and no standards for the practice of herbalism. The AHG wants to change that and is actively working to establish educational guidelines and a process of both registration and certification for herbalists. This raises a red flag for some herbalists who believe that certification will be detrimental to the practice of herbal medicine. “I don’t think there’s anything that fires the herbal community up more than this controversy,” says Gladstar. “The decisions made about these issues will have a tremendous and far-reaching effect on the future of herbalism.” The AHG was founded in 1989 with the intention of developing a professional organization for herbalists specializing in medical herbalism. Its stated purpose was to unify practitioners and to serve the public by raising the standards of herbal medicine and ensuring the competency of herbalists. From the beginning, though, there has been dissension around the issue of certification. Although the final plans for registration and certification are still in the works, the AHG intends to make both available by the end of this year. Meanwhile, the controversy continues. “Many people are concerned about what certification implies,” says Roy Upton, vice president of the AHG and the legislative coordinator for the organization. “And some people have an inherent distrust of anything organized.” According to the AHG’s plan, the title of “registered herbalist” will replace (and be equivalent to) its present designation of “professional member.” Currently, professional members undergo a review process by a group of peers who evaluate their education, experience, and training. Applicants must also demonstrate a minimum of four years of experience in working with clients and submit three letters of reference from professional herbalists. “Certified clinical herbalist” is another title that registered herbalists or other health professionals such as naturopaths, physicians, nurses, Traditional Chinese Medical practitioners, or Ayurvedic practitioners may choose to pursue with the AHG. Applicants for this certification must pass a comprehensive exam that tests their knowledge of Western herbal medicine. “This is specifically for people who want certification in Western botanical medicine,” says Romm. “We’re not in any way saying that a certified herbalist is more skilled than a noncertified herbalist, or that one has to be an AHG member to be a competent practitioner. We simply want to provide a way for an herbal practitioner to demonstrate competency in this one particular form of botanical medicine.” Will the standards be biased? “My belief is that it’s the caring of the healer that’s most important, but no one’s going to be able to test for that.”—Stephen Buhner, herbalist Herbalists wary of certification maintain that the practice of herbalism is an art as well as a skill, and as such, it cannot and should not be regulated in any way. Despite the care taken by the AHG to make clear its policy of nondiscrimination, opponents are concerned that the AHG is proposing standards that will inevitably create prejudice against herbalists who are not certified. Stephen Buhner, herbalist, author, and a former lobbyist on licensure issues related to herbalism and alternative medicine, is strongly opposed to certification and the educational standards that the AHG is proposing. Buhner feels that the AHG is trying to institute a Western medical paradigm, but he doesn’t believe that a knowledge of Western medical science is fundamental to the practice of herbalism. “Human beings have used herbs for at least 60,000 years without a knowledge of biochemistry. The truth is that we don’t really know how and why herbs work,” he says. Buhner adds that some people have made the assumption that a knowledge of biochemistry is essential for someone to be a good healer. “My belief is that it’s the caring of the healer that’s most important, but no one’s going to be able to test for that,” he says. “I think it’s fine for people to practice who are interested in biochemistry and physiology, but I also want to make sure that people who aren’t interested in Western medical science will still be free to practice.” Christopher Hobbs, L.Ac., an herbalist, author, and educator, is in favor of certification but believes there are problems inherent in creating a test for certification. “If we adhere solely to the intellectual model of learning facts by rote, we automatically put some people, perhaps potentially good herbalists, at a disadvantage,” says Hobbs. “Just as some people are bright in the usual sense of intellectual prowess, some have a high ‘E.Q.,’ or emotional quotient. They are attuned to the more subtle, even esoteric clues that lead to insights that facilitate healing.” According to Romm, the guild has no intention of excluding anyone. “We are working hard to make sure that we are respectful of multiple routes of entry, study, and practice. At the same time, we want to establish a meaningful standard,” she says. “We are upholding a standard of excellence, not one of exclusion.” The certification exam proposed by the AHG is meant for those who are actively practicing herbal medicine. “It gives them a reference for where they are in their own set of skills and provides direction for areas they need to work on,” says Upton. “Our whole idea has been to increase our levels of professionalism, competency, and skill in what we do.” Gladstar believes the intentions of the guild are good but questions the paradigm they are adopting for certification. “They are emulating the model used by most of our modern world, and I don’t see that it’s worked very well,” Gladstar notes. “It’s a model that hasn’t benefited the healing community or the people choosing healers. No matter what the intentions of the guild are, once the AHG standards are in place, it will force people to either join the ranks or become renegades.” As one of the pioneers of the U.S. herbal renaissance that took place in the 1960s, Gladstar was instrumental in bringing herbalists together for gatherings at Oregon’s Breitenbush Hot Springs, where the seeds of the idea for forming a guild of herbalists were first planted. Yet she has resisted becoming a member. “I never joined AHG, although many of the people involved are among my closest friends,” she says. “My not joining is my way of making a statement that it’s not necessary to join an organization to practice as an herbalist. You can do this work and be effective without being sanctioned by an organization.” Romm concedes that certification doesn’t guarantee that someone will be a competent healer. “This is well demonstrated by our current medical system with its high numbers of [medically] caused injuries and deaths,” she says. “However, a credential does provide a guide for those seeking the care of an herbalist. Credentials offer some assurance that an herbalist has at least met a specific standard of education, knowledge, and experience.” Romm adds that the AHG gets calls daily from its members, health professionals, consumers, and regulatory agencies requesting information about certification or certified practitioners. “We have people calling who want to know how to obtain a recognizable credential in botanical medicine, and calls from people seeking credentialed practitioners,” she explains. “We are responding to their needs.” Some believe that certification will give herbalists more recognition by the current health-care system and that physicians, pharmacists, and hospital administrators want to see a traditional training and testing process akin to what they are accustomed to in the medical and pharmaceutical professions. “We need community herbalists who are free to practice without fear of retribution, and we need trained herbalists in hospitals who are able to integrate herbs with standardpractice medical care,” Hobbs argues. “This will allow many millions of people to have access to high-quality natural health care, herbal medicine, and wellness-oriented practitioners. The certification process is beneficial because it will impel us to take a deeper look into how herbal medicine can serve the people, how it can work best with the dominant medical disease-care system, and perhaps reorient us toward more emphasis on prevention of disease and true health care.” Opponents of certification fear it could lead to the same situation that occurred when the American Medical Association (AMA) rose to power and tried to suppress all other healing traditions. “Theoretically, eventually some state is going to pass a law regulating herbalists, and they may adopt the standards set forth by the AHG,” says Upton. “But we have a strong legislative position that we will oppose any legislation that would limit the practice of herbal medicine or the use of herbs to any one group, including certified herbalists.” First and foremost, Upton believes, herbal medicine has to remain medicine for the common people. “We can’t turn it into a hierarchy like the AMA that stifles all other types of health care. We believe that naturopaths, lay herbalists, traditional cueranderos, Native American herbalists, traditional Chinese herbalists, Ayurvedic herbalists—all should be allowed to practice.” The AHG position is that all practitioners are complementary to one other, Upton explains. “Everyone needs to know what their limitations are and needs to know when it’s appropriate to refer a patient to someone else.” “If there are going to be some controls set on the practice of herbalism, then let it come from herbalists and not from doctors or some other outside group.”—Aviva Romm, AHG executive director Regulations and restrictions Buhner, along with others who are opposed to certification, is concerned about what he sees as the next logical step following AHG certification: state regulation and restrictions on practice. “For herbalists to be free to work, each state would have to recognize their profession in some fashion. Usually, the state legislature in question would pass a law that says that only licensed, certified, or registered herbalists can practice. And the only way they will do this is if they are convinced there is the potential for harm, and that they need to enact legislation to protect consumers,” Buhner says. “We’re not moving in that direction,” counters Upton. “At some point, some group in a particular state might seek licensure of medical herbalists. But our key fundamental principle is that the guild will actively oppose any legislation that would suggest that a nonlicensed person could not practice herbalism.” Upton doesn’t think that herbalists will have to be licensed to be part of the current health-care system. He cites registered dietitians as an example of a professional group that has managed to avoid licensure by establishing standards for themselves. ‘We can do the same thing. With certification and registration, we don’t give up our power or autonomy. We decide on our own set of standards, and eventually, we will be recognized by the state,” he says. Gladstar believes that the AHG is listening to those who oppose certification, and she acknowledges that the AHG is continually trying to adapt what they are creating to take those concerns into consideration. “But I see them still trying to use the old health-care system model that is currently in place that isn’t working,” she says. “We don’t need to repeat the mistakes that have already been made. Instead, we need to look for new solutions. This is a big issue, and it’s important that people speak up about their feelings now because things are being put into place that won’t be able to be changed later.” Buhner favors using the same type of legislation for herbalists that has been enacted in Colorado and Washington to regulate the practice of psychotherapy, and a recent Minnesota law that grants freedom of practice to a wide variety of alternative health-care practitioners. In those states, the legislature says that anyone can set up a practice. But they do require that anyone who wants to practice has to be registered with the state (which is done by filing a form), and that everyone who practices has to have clients sign an informed consent statement. Informed consent means that a client is provided with a written statement disclosing the practitioner’s professional training and experience; standards of practice; expectations for both parties; fees and policies; and information as to how a client can file a grievance. Who will set the standards? The AHG already encourages its professional members to practice informed consent and full disclosure. “This means that I give a client a piece of paper that tells how I learned about herbs, what I believe I can do, what services I can provide, my expectations of them, and what they can expect from me. I make it clear that I am not a medical doctor and that my suggestions are not to take the place of their doctor’s advice,” explains Upton. The intent, he stresses, is to clarify the relationship between a practitioner and client and to avoid possible misunderstandings that can lead to legal action. “We definitely support informed consent and full disclosure, but to codify this would require a law—and then we change from being a self-certifying body to being certified by the government, and things can get scary,” Upton says. “The more we can keep the government out of the process, the better it will be for our profession.” The AHG is definitely interested in hearing what people have to say about certification and registration, Romm says. “If the consensus in the herbal community is not to have certification, that’s fine with me,” she says. Romm is currently working for certification because that’s what she hears the majority of people—professionals, students, and clients—want. The other primary reason is that establishing some kind of standards appears inevitable. “It’s a question of whether we do it for ourselves, or whether someone makes those decisions for us,” she says. “If there are going to be some controls set on the practice of herbalism, then let it come from herbalists and not from doctors, naturopaths, nurses, pharmacists, or some other outside group. One of the stated goals of the AHG is to increase communication and cooperation among herbalists. We heartily invite those who wish to participate in shaping the direction of herbalism to get involved. The future of herbal medicine in this country is in part, what we make of it. We have a terrific opportunity to work together to achieve planetary wellness.” For more information, contact the American Herbalists Guild, 1931 Gaddis Road, Canton, GA 30115; (770) 751-6021; www.americanherbalist.com.

医学

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PONY POSTAL CENTER REMEMBER WHEN ANTIQUES HAGERSTOWN AUCTIONS Recent Articles >> Good Health Reishi Mushroom Offers Hope for Living Healthier Longer1/13/2013Reishi Mushroom Offers Hope for Living Healthier Longer (NAPS)-When most people think about longevity, they don't usually think about the immune system. Without the ability to fight off infections and abnormal cells, however, they wouldn't live very long. This is where the reishi mushroom comes into play. It's been used for thousands of years and flourishes mainly on the trunks of plum trees. It's very scarce, however...out of 10,000 plum trees, perhaps two or three will have reishi growth. Today, there are over 5,000 studies documenting the health benefits of the six primary types of reishi-red, black, blue, white, yellow and purple. Traditionally, black and red reishi have been credited with the most significant health-enhancing effects. Black and Red Reishi Activate Immune Cells Reishi's immune-enhancing properties are probably the most notable. Reishi is used to fight immuno_senescence-the loss of immune function that comes with age. Aging adults produce fewer white blood cells-the immune cells responsible for fighting against bacteria, viruses and abnormal cells. According to Michael Smith, M.D., senior health science specialist with Life Extension in Fort Lauderdale, Fla., and host of Healthy Talk radio on WWNN-AM, reishi mushroom extract can increase production of white blood cells from your bone marrow. "Not only that, reishi helps to activate dendritic cells," says Dr. Smith. "These cells present bacterial and viral antigens like to antibody-producing cells called B cells. As a result, you're able to effectively fight infections before getting too sick. And if you do happen to get sick, you'll feel better faster with more antibodies on board." Intrinsic Antioxidants Reishi mushrooms are also believed to activate intrinsic antioxidants, helping to reduce oxidative stress, one of the leading theories of aging. Highly reactive oxygen compounds, generated from environmental toxins and normal cellular metabolism, bind to healthy cells and tissues, causing damage. Naturally occurring compounds in reishi can boost intrinsic anti_oxidants, sequestering the damaging oxygen compounds and preserving healthy cell and tissue function. In animal models, reishi was shown to increase the intrinsic antioxidant activity of plasma glutathione by 34 to 42 percent, liver catalase by 19 to 30 percent and liver glutathione by 9 percent. Boosting liver antioxidants, such as catalase and peroxidase, is considered an extremely important strategy for living longer, given the toxic environment. The EPA estimates that over 70,000 industrial chemicals are used in the U.S. "And if that's not enough to make you sick," says Dr. Smith, "government scientists estimate the average American has over 700 chemicals in his or her blood- stream at any given time." Living Healthier Longer A weak immune system and high levels of oxidative stress are counterproductive to living health_ier longer. For many, reishi mushroom extract offers real hope for reversing these two aging processes. The reishi mushroom extract complex delivers powerful compounds and represents the next generation of natural immune support. For more information about reishi mushroom extract, visit www.LEF.org/reishi or call 1-866-748-7542. Editor's Note: These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.

医学

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Search the Newsroom: Profile by Sanford launches in Sioux Falls Program offers research-based method for weight management (Sioux Falls, SD) – Sanford Health has introduced an integrated approach to weight management. Profile by Sanford was designed using a large body of clinical research to ensure a sustainable means to healthy weight loss. The Profile system utilizes meal-replacement products, nutritionally complete food and qualified health coaches. In addition to members consuming both Profile-produced and grocery-store food, coaches develop customized plans for their clients and offer advice on nutrition, exercise and behavior. A clinical and scientific advisory board comprised of 10 Sanford physicians and researchers oversaw the development of the Profile system. “Profile by Sanford is endorsed by our physicians and researchers and is rooted in scientific research,” said Rich Adcock, president of Sanford Frontiers, which developed the system. “Obesity is a national epidemic; Profile is our way of lending a hand in the fight.” According to the Centers for Disease Control and Prevention, more than 60 percent of the U.S. population is considered overweight or obese. In addition to face-to-face meetings, coaches are able to efficiently track members’ progress through the use of smart wireless technology. Each member is outfitted with wireless devices to measure progress, including tools to track body weight and measurement, blood pressure and step count and intensity (exercise). These devices automatically upload to a secure server, where members and coaches can monitor improvement on the web or mobile applications. Printed options are also available to members. “As a physician, I witness firsthand the health complications that accompany obesity,” said Michael Wilde, MD, who is part of the clinical and scientific advisory board. “The Profile system will not only help members lose weight but also develop habits for a healthier lifestyle.” Profile by Sanford is now open at 401 W 69th Street in Sioux Falls. Additional locations are planned for Sioux Falls and Fargo. To learn more, visit profileplan.net. Sanford Health is an integrated health system headquartered in the Dakotas and is now the largest, rural, not-for-profit health care system in the nation with locations in 126 communities in eight states. In addition, Sanford Health is in the process of developing international clinics in Ireland, Ghana, Israel and Mexico. Sanford Health includes 35 hospitals, 140 clinic locations and 1,200 physicians in 70 specialty areas of medicine. With more than 25,000 employees, Sanford Health is the largest employer in North and South Dakota. The system is experiencing dynamic growth and development in conjunction with Denny Sanford's nearly $700 million in gifts, the largest ever to a health care organization in America. These gifts are making possible the implementation of several initiatives including global children's clinics, multiple research centers and finding cures for type 1 diabetes and breast cancer. For more information, please visit sanfordhealth.org. Sanford Media Strategist – Sioux Falls Region (605) 366-2432 / timothy.gerszewski@sanfordhealth.org Follow me on Twitter @SanfordTimG

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LeadershipSt. Jude LeadershipALSAC LeadershipBoards of Directors and GovernorsExternal Advisory Boards Boards of Directors and GovernorsALSAC-St. Jude Children’s Research HospitalThe Board’s Role Governing the organizations by establishing broad policies and objectives Selecting, appointing, supporting, and reviewing the performance of the chief executive officers Insuring the availability of adequate financial resources Approving annual budgets and strategic planning Accounting for the ethics, compliance, and performance of the organizations ALSAC Board of Directors - Officers Richard (Rich) M. Unes, Chairman Paul J. Ayoub, First Vice Chair James B. Barkate, Second Vice Chair Fred R. Harris, Secretary St. Jude Board of Governors - Officers Terry Burman, Chairman Martha Perine Beard, First Vice Chair Camille Sarrouf Jr., Second Vice Chair Fred P. Gattas Jr., Secretary Ex-Officios James Downing, MD, President and Chief Executive Officer, St. Jude Children's Research Hospital Richard C. Shadyac, Jr., President and Chief Executive Officer, ALSAC Executive Administrator to the Board Helen B. Wood, Executive Administrator to the Board View a complete list of members of the ALSAC-St. Jude Boards of Directors and Governors Audit Committee - Its primary function is to assist the Board in fulfilling their oversight responsibilities by reviewing the financial information which will be provided to any governmental body or the public; the systems of internal controls and policies which management and the Board have established; and accounting, auditing, and financial processes; and the effectiveness of the Corporate Compliance Program to support the vision and mission statement of ALSAC and St. Jude Children's Research Hospital. Compensation Committee - The primary function is to assist the Boards of Directors and Governors in fulfilling their oversight responsibilities by articulating and implementing the compensation philosophy for executives at St. Jude and ALSAC. Conflict of Interest Committee - The primary function is to advise and assist St. Jude and ALSAC in maintaining high ethical standards and complying with applicable laws related to conflicts of interest and oversee conflict of interest issues of officers, directors, and certain covered employees. Oversee the financial affairs of ALSAC and St. Jude including: The development and implementation of sound fiscal policies and management practices, of ALSAC and St. Jude both individually and on a consolidated basis; and The annual and strategic/long-range budgeting process of ALSAC and St. Jude. Approve and monitor the annual budgeted revenues and expenses, operational and capital, of ALSAC and St. Jude as well as the financial strategic plans of ALSAC and St. Jude. Governance Committee - The primary function is to identify, evaluate and recommend best practices of governance that will enhance the effectiveness of the Board and assist the Board in developing, monitoring, and evaluating the Board’s governance policies and procedures. p> Investment Committee - The committee’s primary functions are the formulation, implementation and ongoing oversight of those coherent policies designed to best serve the long-term financial objectives of the institution. Legal and Compliance Committee - The Legal and Compliance Committee assists the Board in overseeing all material legal activities and the continuing compliance with all laws, regulations and rules affecting the conduct and operation of the organization’s affairs and operations in a manner that promotes the organization’s purpose and mission statement. This assistance shall include discussion with the appropriate staff at St. Jude Children’s Research Hospital/ALSAC and reporting same to the Board, where appropriate. Marketing Committee - Support efforts to ensure that marketing and outreach efforts at ALSAC and St. Jude are well integrated from both a strategic planning and implementation standpoint, and reflect one voice in reinforcing our brand positioning. Membership Committee - The purpose of the committee is to develop and administer a membership selection and evaluation process for initial appointment and subsequent reappointment to ensure that the Board will be comprised of a broad range of competencies, diversity and expertise to ensure its effectiveness. Nominating Committee - Reviews all board members of both ALSAC and St. Jude so that appropriate nominations are made by the committee for recommending officers to the Boards. Quality Assurance & Patient Care Committee - The committee performs due diligence for the Board of Governors to provide oversight of the performance of patient care by the clinical staff, and to serve as liaison to the Board for all issues that deal with the care of patients, and the safety of patients’ families and staff. The Quality Assurance & Patient Care Committee has a responsibility to report to the Board the quality of care rendered by all health care providers at the institution, and all programs to improve care. Strategic Planning Committee - Develops and leads a process by which the Board and Management of ALSAC and St. Jude arrive at a shared vision of what the institutions should be in 10-20 years, including broad operating and financial parameters, and to begin a process of which we plan for and achieve that shared vision.

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Home Page - Infectious Diseases Home > Online Library > Home Page - Infectious Diseases > Prevention of Infectious Diseases > Pets and Infectious Diseases Pets and infectious diseases Proper care of your pet may prevent him/her from becoming ill and infecting the household. Further, to prevent the spread of disease from your pet, take the following precautions: Keep your pet's immunizations current. See a veterinarian regularly with your pet for health checkups. Keep your pet's bedding and living area clean. Feed your pet a balanced diet and avoid having your pet eat raw foods or drink out of the toilet. Clean cat litter boxes every day. Pregnant women should avoid touching cat litter, because it may contain infectious diseases that cause birth defects, including toxoplasmosis. Wash your hands thoroughly after touching animals or cleaning up animal waste. Washing hands is especially important after handling reptiles, because reptiles may harbor a bacteria called salmonella. Salmonella can cause salmonellosis, which is characterized by up to a week of diarrhea, fever, and abdominal cramps. Most people who contract salmonella will have symptoms that last from four to seven days and will recover without treatment. Wild animals and infectious diseases Wild animals and insects can be carriers for some very serious diseases, including rabies, tetanus, Lyme disease, Rocky Mountain Spotted Fever, hantavirus, and the plague. Animal bites and scratches, even when they are minor, may become infected and spread bacteria to other parts of the body. Whether the bite is from a family pet or an animal in the wild, scratches and bites may carry disease. Cat scratches, for example, even from a kitten, may carry "cat scratch disease," a bacterial infection. Bites and/or scratches that break the skin are even more likely to become infected. Immediate care for animal bites Wash the wound with soap and water under pressure from a faucet, but do not scrub, as this bruises the tissue. If the bite or scratch is bleeding, apply pressure to it with a clean bandage or towel to stop the bleeding. Dry the wound and cover it with a sterile dressing, but do not use tape or butterfly bandages, as they can trap harmful bacteria in the wound. Call your physician or health care professional for guidance in reporting the attack and to determine whether additional treatment, such as antibiotics, a tetanus booster, or rabies vaccination is needed. If possible, locate the animal that inflicted the wound. Some animals need to be captured, confined, and observed for rabies. Do not try to capture the animal yourself; instead, contact the nearest animal warden or animal control office in your area. If the animal cannot be found, if the animal was a high-risk species (skunk or bat), or the animal attack was unprovoked, the victim may need a series of rabies shots. What is rabies? Rabies is a widespread, viral infection of warm-blooded animals. Caused by a virus in the Rhabdoviridae family, it attacks the nervous system and, once symptoms develop, is 100 percent fatal in animals. In North America, rabies occurs primarily in skunks, raccoons, foxes, and bats. In some areas, these wild animals infect domestic cats, dogs, and livestock. In the United States, cats are more likely than dogs to be rabid. Generally, rabies is rare in small rodents such as beavers, chipmunks, squirrels, rats, mice, or hamsters. Rabies is also rare in rabbits. In the mid-Atlantic states, where rabies is increasing in raccoons, woodchucks can be rabid. How does rabies occur? The rabies virus enters the body either through a cut, scratch, or through mucous membranes (such as the lining of the mouth and eyes), and travels to the central nervous system. Once the infection is established in the brain, the virus travels down the nerves from the brain and multiplies in different organs. The salivary glands and organs are most important in the spread of rabies from one animal to another. When an infected animal bites another animal, the rabies virus is transmitted through the infected animal's saliva. Scratches by claws of rabid animals are also dangerous because these animals lick their claws. What are the symptoms of rabies? The incubation period in humans from the time of exposure to the onset of illness can range anywhere from five days to more than a year, although the average incubation period is about two months. The following are the most common symptoms of rabies. However, each individual may experience symptoms differently. Symptoms may include: Intense thirst, but drinking will induce painful throat spasms Symptoms of rabies may resemble other medical conditions and problems. Always consult your physician for a diagnosis. Prevention of Infectious Diseases

医学

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Patients & FamiliesEducationResearchCommunity Referring PhysiciansFind a PhysicianDepartments & CentersAbout URMC LibrariesAlumniGiving URMC » Wilmot Cancer Center » Dialogue - Winter 2011 » Research Director's MessageCover Story: Grateful Cancer Survivor Makes Gift to Wilmot Cancer CenterResearchBreast CT Imaging System A Pain-Free Tool to Aid MammogramsMolecular Biologist Gets Wilmot Cancer Center’s Top Scientific HonorCommunityAccomplishmentsCalendarPast Issues (PDF)Wilmot Cancer Center NewsroomPublications Molecular Biologist Gets Wilmot Cancer Center’s Top Scientific Honor Davey Award presentation highlights 15th annual Scientific Symposium Dirk Bohmann, Ph.D. (left) receives his award from Jeffrey Davey. The award is named in memory of R. Bruce Davey, Jeffrey's father. Dirk Bohmann, Ph.D., an accomplished molecular biologist and geneticist, is the recipient of the 2010 Davey Memorial Award for outstanding cancer research. The award was presented during the James P. Wilmot Cancer Center’s 15th annual Scientific Symposium, which celebrates the leading-edge cancer research of University of Rochester Medical Center physicians and scientists. Bohmann’s research has focused on answering fundamental questions about cancer, aging and metabolic regulation using a tiny, yet fascinatingly complex organism – Drosophila – more commonly known as the fruit fly. Bohmann, is director of the Center for Genomics and Systems Biology and the Graduate Program for Genetics, Genomics and Development and a professor of Biomedical Genetics. He began his career looking at the extensive cell signaling processes that contribute to cancer in people. One of his early successes was the identification of a human proto oncogene known as c-jun that is now widely studied. He switched to Drosophila because they’re simpler and easier to study, yet rely on much of the exact same signaling to develop, grow and function as humans do. The hope is that studies in fruit flies will provide new insights and ideas that can help to solve complex questions about human cancer. Recently, scientists in his lab used the fruit fly’s metamorphosis from maggot to flying insect as a guide to identify a mechanism that may control tissue remodeling, a process that can be hijacked by cancers to transform functional tissues into malignant ones. His work, published in Developmental Cell, identifies a molecule that is critical for determining how cells invade and create new tissues. Similar tissue invasion processes that make cancer so deadly have proven very difficult for scientists to understand in enough depth to interrupt or stop the spread of cancer. Bohmann received his Ph.D. in biology from the University of Tübingen in 1986, worked as a post-doc at University of California at Berkeley, and was senior scientist at the European Molecular Biology Laboratory in Heidelberg before joining the University in 2001. The Davey Memorial Award for Outstanding Cancer Research was established in memory of R. Bruce Davey, who was treated for cancer before his death in 1996. His wife, Linda Wells Davey, and sons, Peter and Jeffrey, created their own significant way to join Rochester’s fight against cancer. Linda Wells Davey was a founding member of the Cancer Center Board, dedicated to advancing local research and care, and served as its first chair. The Daveys are true partners in the effort to promote community recognition of the Wilmot Cancer Center and the outstanding contributions each doctor, nurse, scientist and support staff member makes to improve cancer care and find cures. Wilmot Cancer Center Calendar of Events Hat Day Friday, April 1 4th annual Meaghan’s Run 5K Discovery Ball

医学

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All posts Weekly support group provides social network to seniors Every week for the past two years, a group of a dozen senior citizens has gathered at Weiss. They sip coffee and chat—initially about their weeks, but as the hour-long meetings progress, they delve into deeper issues. They discuss their dreams, fears, and the ups and downs of getting older. The group initially formed for seniors coping with chronic illness, but it has evolved into a support group for all seniors—chronically ill or not. “We got to know each other, and everyone had revealed so many personal, private, secret things that we became close friends,” said Susan*, one of the members of the current “Senior Care Support Group.” Two interns, students from the social work master’s program at Loyola University in Chicago, run the meetings. “It’s important because for a lot of older adults, their social circles begin to narrow as they age. This gives them a chance to connect anew with people,” said Caitrin Connolly, one of the interns. Her colleague Sha’rika Wilson agreed. “It gives them something to look forward to, something to do, and people to talk to.” They begin each weekly meeting by asking everyone to share one good thing and one challenging thing about their week. Often, tips come out of these discussions. For example, one week, a group member might share that he had a difficult time finding fresh vegetables within his budget, but another group member will know which grocery stores have the best deals. After everyone shares, they discuss one major question, different each week, such as: What is your dream or fantasy vacation? What is your therapy—self-soothing/relaxation techniques? “We always take home some information that’s useful to us. Whether it’s coping, buying something or going to a museum that’s free—little tips that make your life easier,” Susan said. The seniors appreciate being able to help each other and accept advice in return. Many have built solid friendships within the group, and go to eat or to museums together outside of the meetings. “A lot of people have really blossomed,” said Connolly. “Almost everyone in the group is single, divorced or widowed. It’s people who are really trying to branch out.” Group member Betty* has been part of the group for two years and said she comes back every week for the sense of camaraderie. “It’s an experience where you learn you’re not all alone,” she said. New members are welcome to join the group, which meets every Friday at 11 a.m. Contact the WISE Senior Center for more information, at (773) 564-5666. *Not her real name. Members in the support group requested anonymity because of the personal information discussed in the meetings. Recent Posts

医学

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HomeAbout UsNews & MediaIn the NewsAwards/RecognitionBest Place to Work News & MediaIn the NewsAwards/RecognitionIn the CommunityEventsMaking a DifferenceSupporting Winchester HospitalPublicationsAnnual ReportContact UsPhone DirectoryJoin Our Mailing ListEvents CalendarMedical Staff OfficeOur HistoryHospital AuxilariesWinton ClubFriends of Winchester HospitalHospital LeadershipBoard of DirectorsSenior Management TeamVendor InformationCode of Business Conduct Winchester Hospital Named No. 9 Best Place to Work Winchester Hospital has been named No. 9 on Boston Business Journal’s 2013 Best Places to Work in Massachusetts list in the large company category for excellence in employee satisfaction, working conditions and company culture. Winchester Hospital has been recognized in all 12 years of the program’s existence, twice with the No. 1 ranking. This year, more than 400 companies qualified for consideration. Companies were evaluated on the results of satisfaction surveys, which included questions about work environment, work-life balance, job satisfaction, advancement opportunities, management, and compensation and benefits. The survey project was launched by Boston Business Journal in conjunction with market research firm Quantum Workplace of Omaha, Neb. “To be considered one of the best places to work in Massachusetts is truly an honor," said Kevin Smith, president and chief executive officer of Winchester Hospital. "Our entire team goes above and beyond every day in support of our patients and each other. That's what makes Winchester Hospital a great place to work." “Companies on our list can be justifiably proud of creating a high level of workplace satisfaction during an economy where traditional rewards like big raises and bonuses aren't as easy to give,” said Chris McIntosh, publisher of the Boston Business Journal. “In good times and in bad, our results validate how the creation of the right corporate culture can create powerful business advantages. Employees are proud to work for companies that are about more than just business.” Winchester Hospital, along with 59 other winners in three categories – small (20-100 employees), midsize (101-500 employees) and large (more than 500 employees) – are profiled in Boston Business Journal’s special June 13 supplement. About Winchester Hospital Winchester Hospital is the first hospital in Massachusetts to earn Magnet recognition, the American Nurses Association’s highest honor for nursing excellence, three times. As the northwest suburban Boston area’s leading provider of comprehensive health care services, the 229-bed facility provides care in general, bariatric and vascular surgery, orthopedics, pediatrics, cardiology, pulmonary medicine, oncology, gastroenterology, rehabilitation, radiation oncology, pain management, obstetrics/gynecology and a Level IIB Special Care Nursery. Winchester Hospital has clinical affiliations with several nationally recognized hospitals in the region, including Boston Children’s Hospital, Tufts Medical Center and Beth Israel Deaconess Medical Center. To learn more, visit www.winchesterhospital.org.

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Search the NIDA Archives Evaluation of the National Youth Anti-Drug Media Campaign - Executive Summary The number one goal of The National Drug Control Strategy is to "Educate and enable America’s youth to reject illegal drugs as well as alcohol and tobacco." Objectives in support of that goal include "Pursue a vigorous advertising and public communications program dealing with the dangers of drug, alcohol, and tobacco use by youth." Under the Treasury-Postal Appropriations Act of 1998, Congress approved funding (P.L. 105-61) for "a national media campaign to reduce and prevent drug use among young Americans." Pursuant to this act, the Office of National Drug Control Policy (ONDCP) launched the National Youth Anti-Drug Media Campaign (the Media Campaign). This program has progressed through three phases of increasing complexity and intensity. Phases I and II are not discussed in this report. ONDCP has other reports available that evaluate those phases. This report focuses on Phase III, which began in September 1999 and is planned to run at least until 2003. An evaluation of Phase III is being conducted under contract to the National Institute on Drug Abuse (NIDA) by Westat and its subcontractor, the Annenberg School for Communication at the University of Pennsylvania. Funding of the evaluation is provided by ONDCP from the appropriation for the Media Campaign itself. This is the first semi-annual report of the Westat and Annenberg evaluation of Phase III of the Media Campaign. This report by Westat and Annenberg provides four types of information: A brief description of the Media Campaign’s activities to date; A review of the logic and approach of the evaluation; Statistics on the level of exposure to messages achieved by the Media Campaign in the first 9 months of Phase III; and A description of baseline behaviors, beliefs, attitudes, and intentions of both parents and youth. These descriptions focus on the outcomes that will be monitored over time for possible changes that might be brought about by the Media Campaign. This report from the Westat and Annenberg evaluation presents a first round of measurement. It includes early estimates of exposure to the Media Campaign, and it identifies anti-drug beliefs and drug use behaviors that will be watched over time both for movement and for their association with exposure. It thus sets the stage for the evaluation. This report contains no findings about the effectiveness of the Media Campaign. Such findings after only 9 months of operation of Phase III of the Media Campaign would be premature. This reflects both substantive and technical concerns. From the substantive perspective, effects are expected to be achieved and measurable after a longer period of Media Campaign operations. From the technical perspective, there would be little confidence in inferences from a simple cross-sectional analysis, without even accompanying evidence for change over time in outcomes. The first report on tentative analyses of effects will be issued after the next wave of data collection in March 2001. At that time, there will be some evidence presented about changes, if any, in outcome measures like the cognitive variables of interest such as beliefs about the consequences of marijuana use at least once or twice in a lifetime. This evidence about change will be complemented by evidence about association of exposure with the outcome measures. However, it is possible that Media Campaign-produced change will take longer to achieve and/or to detect. Indeed, conclusive evidence will take several years to accumulate and analyze. The final report is scheduled for March 2004. At that time, the sample youth and their parents will have been studied for 3 to 4 years. Background on the Media Campaign The Media Campaign has three goals: Educate and enable America's youth to reject illegal drugs; Prevent youth from initiating use of drugs, especially marijuana and inhalants; and Convince occasional users of these and other drugs to stop using drugs. The Media Campaign targets paid advertising at youth aged 9 to 11, 12 to 13, and 14 to 18, parents of youth in these age ranges, and other influential adults. Phase III advertising is being disseminated through a full range of media or "channels" following a Communications Strategy developed by ONDCP. Phase III also includes components other than advertising. There are partnerships with the media, entertainment and sports industries, as well as civic, professional, and community groups. These other components, which are being coordinated by a public relations firm, include encouraging entertainment programs with anti-drug themes, coverage of the anti-drug campaign in the news media, community activities, corporate co-sponsorship, and special interactive media programming. ONDCP runs the Media Campaign in collaboration with the following groups:<

医学

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Reference > Anatomy of the Human Body > X. The Organs of the Senses and the Common Integument > 1d. 2. The Middle Ear or Tympanic Cavity 1d. 2. The Middle Ear or Tympanic Cavity (Cavum Tympani; Drum; Tympanum)The middle ear or tympanic cavity is an irregular, laterally compressed space within the temporal bone. It is filled with air, which is conveyed to it from the nasal part of the pharynx through the auditory tube. It contains a chain of movable bones, which connect its lateral to its medial wall, and serve to convey the vibrations communicated to the tympanic membrane across the cavity to the internal ear. 1 The tympanic cavity consists of two parts: the tympanic cavity proper, opposite the tympanic membrane, and the attic or epitympanic recess, above the level of the membrane; the latter contains the upper half of the malleus and the greater part of the incus. Including the attic, the vertical and antero-posterior diameters of the cavity are each about 15 mm. The transverse diameter measures about 6 mm. above and 4 mm. below; opposite the center of the tympanic membrane it is only about 2 mm. The tympanic cavity is bounded laterally by the tympanic membrane; medially, by the lateral wall of the internal ear; it communicates, behind, with the tympanic antrum and through it with the mastoid air cells, and in front with the auditory tube (Fig. 907). 2 The Tegmental Wall or Roof (paries tegmentalis) is formed by a thin plate of bone, the tegmen tympani, which separates the cranial and tympanic cavities. It is situated on the anterior surface of the petrous portion of the temporal bone close to its angle of junction with the squama temporalis; it is prolonged backward so as to roof in the tympanic antrum, and forward to cover in the semicanal for the Tensor tympani muscle. Its lateral edge corresponds with the remains of the petrosquamous suture. 3 The Jugular Wall or Floor (paries jugularis) is narrow, and consists of a thin plate of bone (fundus tympani) which separates the tympanic cavity from the jugular fossa. It presents, near the labyrinthic wall, a small aperture for the passage of the tympanic branch of the glossopharyngeal nerve. 4 The iter chordæ anterius (canal of Huguier) is placed at the medial end of the petrotympanic fissure; through it the chorda tympani nerve leaves the tympanic cavity. 8 The Tympanic Membrane (membrana tympani) (Figs. 909, 910) separates the tympanic cavity from the bottom of the external acoustic meatus. It is a thin, semitransparent membrane, nearly oval in form, somewhat broader above than below, and directed very obliquely downward and inward so as to form an angle of about fifty-five degrees with the floor of the meatus. Its longest diameter is downward and forward, and measures from 9 to 10 mm.; its shortest diameter measures from 8 to 9 mm. The greater part of its circumference is thickened, and forms a fibrocartilaginous ring which is fixed in the tympanic sulcus at the inner end of the meatus. This sulcus is deficient superiorly at the notch of Rivinus, and from the ends of this notch two bands, the anterior and posterior malleolar folds, are prolonged to the lateral process of the malleus. The small, somewhat triangular part of the membrane situated above these folds is lax and thin, and is named the pars flaccida; in it a small orifice is sometimes seen. The manubrium of the malleus is firmly attached to the medial surface of the membrane as far as its center, which it draws toward the tympanic cavity; the lateral surface of the membrane is thus concave, and the most depressed part of this concavity is named the umbo. 9 of the membrane. Branched or dendritic fibers, as pointed out by Grüber, are also present especially in the posterior half of the membrane. 10 Vessels and Nerves.—The arteries of the tympanic membrane are derived from the deep auricular branch of the internal maxillary, which ramifies beneath the cutaneous stratum; and from the stylomastoid branch of the posterior auricular, and tympanic branch of the internal maxillary, which are distributed on the mucous surface. The superficial veins open into the external jugular; those on the deep surface drain partly into the transverse sinus and veins of the dura mater, and partly into a plexus on the auditory tube. The membrane receives its chief nerve supply from the auriculotemporal branch of the mandibular; the auricular branch of the vagus, and the tympanic branch of the glossopharyngeal also supply it. 150 11 external, or mucous, derived from the mucous lining of the tympanic cavity; an internal, from the lining membrane of the cochlea; and an intermediate, or fibrous layer. 14 The promontory (promontorium) is a rounded hollow prominence, formed by the projection outward of the first turn of the cochlea; it is placed between the fenestræ, and is furrowed on its surface by small grooves, for the lodgement of branches of the tympanic plexus. A minute spicule of bone frequently connects the promontory to the pyramidal eminence. 15 The prominence of the facial canal (prominentia canalis facialis; prominence of aqueduct of Fallopius) indicates the position of the bony canal in which the facial nerve is contained; this canal traverses the labyrinthic wall of the tympanic cavity above the fenestra vestibuli, and behind that opening curves nearly vertically downward along the mastoid wall. 16 The mastoid or posterior wall (paries mastoidea) is wider above than below, and presents for examination the entrance to the tympanic antrum, the pyramidal eminence, and the fossa incudis. 17 The entrance to the antrum is a large irregular aperture, which leads backward from the epitympanic recess into a considerable air space, named the tympanic or mastoid antrum (see page 142). The antrum communicates behind and below with the mastoid air cells, which vary considerably in number, size, and form; the antrum and mastoid air cells are lined by mucous membrane, continuous with that lining the tympanic cavity. On the medial wall of the entrance to the antrum is a rounded eminence, situated above and behind the prominence of the facial canal; it corresponds with the position of the ampullated ends of the superior and lateral semicircular canals. 18 The pyramidal eminence (eminentia pyramidalis; pyramid) is situated immediately behind the fenestra vestibuli, and in front of the vertical portion of the facial canal; it is hollow, and contains the Stapedius muscle; its summit projects forward toward the fenestra vestibuli, and is pierced by a small aperture which transmits the tendon of the muscle. The cavity in the pyramidal eminence is prolonged downward and backward in front of the facial canal, and communicates with it by a minute aperture which transmits a twig from the facial nerve to the Stapedius muscle. 19 The fossa incudis is a small depression in the lower and back part of the epitympanic recess; it lodges the short crus of the incus. 20 The Carotid or Anterior Wall (paries carotica) is wider above than below; it corresponds with the carotid canal, from which it is separated by a thin plate of bone perforated by the tympanic branch of the internal carotid artery, and by the deep petrosal nerve which connects the sympathetic plexus on the internal carotid artery with the tympanic plexus on the promontory. At the upper part of the anterior wall are the orifice of the semicanal for the Tensor tympani muscle and the tympanic orifice of the auditory tube, separated from each other by a thin horizontal plate of bone, the septum canalis musculotubarii. These canals run from the tympanic cavity forward and downward to the retiring angle between the squama and the petrous portion of the temporal bone. 21 The semicanal for the Tensor tympani (semicanalis m. tensoris tympani) is the superior and the smaller of the two; it is cylindrical and lies beneath the tegmen tympani. It extends on to the labyrinthic wall of the tympanic cavity and ends immediately above the fenestra vestibuli. 22 The septum canalis musculotubarii (processus cochleariformis) passes backward below this semicanal, forming its lateral wall and floor; it expands above the anterior end of the fenestra vestibuli and terminates there by curving laterally so as to form a pulley over which the tendon of the muscle passes. 23 The auditory tube (tuba auditiva; Eustachian tube) is the channel through which the tympanic cavity communicates with the nasal part of the pharynx. Its length is about 36 mm., and its direction is downward, forward, and medialward, forming an angle of about 45 degrees with the sagittal plane and one of from 30 to 40 degrees with the horizontal plane. It is formed partly of bone, partly of cartilage and fibrous tissue (Figs. 819, 915). 24 The osseous portion (pars osseo tubæ auditivæ) is about 12 mm. in length. It begins in the carotid wall of the tympanic cavity, below the septum canalis musculotubarii, and, gradually narrowing, ends at the angle of junction of the squama and the petrous portion of the temporal bone, its extremity presenting a jagged margin which serves for the attachment of the cartilaginous portion. 25 by the Salpingopharyngeus and Dilatator tubæ. The latter arises from the hook of the cartilage and from the membranous part of the tube, and blends below with the Tensor veli palatini. 26 Note 150. American Journal of Anatomy, 1908, viii. [back]

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Surgery vs Radiation Patient and Surgeon Experiences Clinical Evidence HomeGlobalTerms Terms of Use Intuitive Surgical, Inc. ("Intuitive") maintains this Web site as a service to the Internet community. This Web site has been designed to provide general information about Intuitive and its products. These pages are not intended to provide medical advice, nor do they provide instruction on the appropriate use of products produced or supplied by Intuitive, its affiliates, related companies, or its licensors or joint venture partners. The interviews and quotations on this web site from patients, surgeons and administrators describe individual experiences with the da Vinci® Surgical System. As you read, please remember that the experience is specific to the individual. While clinical studies support the effectiveness of robotic-assisted minimally invasive surgery, results cannot be guaranteed, as surgery is procedure- and patient-specific. 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California health reform Ned Spurgeon (Utah and visiting distinguished chair at McGeorge this semester) has done a really nice piece on California health reform. It's been posted by Elizabeth Ann Weeks (Kansas) on the Jurisdynamics blog page. posted by tommayo, 3:11 PM Living with an incurable genetic disease The N.Y. Times ran a remarkable story last Sunday describing the life changes that occur when a person chooses to learn whether she has the genetic condition -- Huntington's Disease (or HD) -- that killed her grandfather and afflicts her cousin. Is it a good idea to find out, or is it an invitation for sorrow, stigmatization, and loss of insurability? The issues are explored sensitively and in detail in this article, which I didn't see last Sunday as I prepared for and gave a talk to The Institute for the Humanities at Salado on, of all things, medical privacy and the uses to which genetic information may be put. Thanks to college classmate Rick Goggans, M.D., for pointing this one out to me!Links to HD resources (provided by The Times):Huntington’s Disease Society of AmericaHereditary Disease FoundationHuntington’s Disease Advocacy Center posted by tommayo, 10:10 AM Fen-phen lawyers defrauded plaintiffs, court rules Physicians, other health care professionals, hospitals, and other health-care entities take their lumps here with some regularity, so it is perhaps only fitting that I should note this story from yesterday's N.Y. Times:W. L. Carter knew there was something fishy going on when he went to his lawyers’ office a few years ago to pick up his settlement check for the heart damage he had sustained from taking the diet drug combination fen-phen. The check was, for starters, much smaller than he had expected. And his own lawyers threatened to retaliate against him if he ever told anyone, including his family, how much he had been paid. “You will be fined $100,000, you will go to jail and you will be sued,” Mr. Carter recalled them saying.Mr. Carter was right to have been suspicious. The lawyers defrauded their clients, a state judge has ruled in a civil case, when they settled fen-phen lawsuits on behalf of 440 of them for $200 million but kept the bulk of the money for themselves. Legal experts said the fraud might be one of the biggest and most brazen in legal history. This week, several clients testified before a federal grand jury that has begun to investigate potential criminal wrongdoing arising from the settlement.“It enrages me,” said Sonja Pickett, a retail manager, who testified Thursday before the grand jury. “They robbed us.”. . . The basic facts are not in dispute. When the clients sued the drug maker, they agreed to pay the lawyers 30 percent to 33 percent of any money that was recovered, plus expenses. In this case, that would have left the 440 clients to divide perhaps $135 million. But the clients received only $74 million. An additional $20 million went to a questionable “charitable fund.” The rest — $106 million — went to lawyers. Though amounts of the individual settlements remain sealed, court papers suggest they were from $100,000 to $5 million. On average, plaintiffs received less than 40 percent of what the settlement agreement specified, instead of the roughly 70 percent to which they were entitled. Had the lawyers merely taken what they were contractually entitled to, they would have become very rich men, said Tracy Curtis, a mortgage loan officer who is also suing her former lawyers. “They could have taken the high road,” Ms. Curtis said. “They would have made plenty of money.”There's more, and it's all ugly. Shameful. posted by tommayo, 9:56 AM Federal bill prohibiting genetic discrimination analyzed by Congressional Budget Office H.R. 493 (the "Genetic Information Nondiscrimination Act of 2007") would broadly prohibit genetic discrimination by employers (including states and their political subdivisions), unions, employment agencies, and insurers. It has 221 co-sponsors, which is more than enough (assuming they all vote for the bill in the form in which it hits the floor and after amendments, if any) to pass in the House. Here's the Congressional Research Service's summary of the bill:Amends the Employee Retirement Income Security Act of 1974 (ERISA) and the Public Health Service Act to expand the prohibition against discrimination by group health plans and health insurance issuers in the group and individual markets on the basis of genetic information or services to prohibit: (1) enrollment and premium discrimination based on information about a request for or receipt of genetic services; and (2) requiring genetic testing. Sets forth penalties for violations.Amends title XVIII (Medicare) of the Social Security Act to prohibit issuers of Medicare supplemental policies from discriminating on the basis of genetic information.Extends medical privacy and confidentiality rules to the disclosure of genetic information.Makes it an unlawful employment practice for an employer, employment agency, labor organization, or training program to discriminate against an individual or deprive such individual of employment opportunities because of genetic information. Prohibits the collection and disclosure of genetic information, with certain exceptions.Establishes a Genetic Nondiscrimination Study Commission to review the developing science of genetics and advise Congress on the advisability of providing for a disparate impact cause of action under this Act.For a more detailed discussion of the bill, go to H. Rept. 11-28 (Part I), March 5, 2007. Also, a number of states already have similar laws on their books. The National Conference of State Legislatures has a handy list of such laws (last updated Nov. 2006 (employment) and June 2005 (insurance)).Yesterday, the CBO published its cost estimate for H.R. 493. Over 10 years, the federal treasury would be out about $2 million (because premiums for some of the new insureds would be tax-deductible) and the CBO estimates increased outlays of about $2 million (assuming appropriations are approved) for the Departments of Labor, Treasury, and HHS. There will be additional state and private-sector mandates in connection with the anti-discrimination law, but CBO figures the cost will be low for the states and below the threshold in the Unfunded Mandates Reform Act for the private-sector actors.If there's a surprise in any of this, it might be in the estimated number of citizens expected to benefit from this law: 600. Is there any chance this is a typo? posted by tommayo, 7:46 AM From CMS today (see new COP in Friday's Federal Register (I'll supply the link when it's available tomorrow)):NEW MEDICARE HOSPITAL CONDITIONS OFPARTICIPATION FOR TRANSPLANT CENTERSThe Centers for Medicare & Medicaid Services (CMS) issued a final rule today setting forth the requirements that transplant centers must meet to participate in the Medicare program that moves Medicare covered transplant programs toward an outcome-focused system.This final rule will move Medicare-covered transplant programs toward an outcome-focused system that reflects the clinical experience, resources and commitment of the transplant program. The rule contains comprehensive conditions of participation for transplant programs serving Medicare beneficiaries.It will ensure effective oversight of transplant centers by advancing coordination between CMS, State survey agencies, the Health Resources and Services Administration, the Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients.“This is a major milestone in our efforts to make sure that people needing transplants get the best possible care, while giving transplant centers and physicians comprehensive and reliable guidance,” said Leslie V. Norwalk, CMS acting administrator. “This rule both improves the current transplant outcome measure requirements and strengthens the protection of the health and safety of patients and living donors.”In recent decades, remarkable strides in transplantation technology and pharmacology have turned organ transplantation into a mainstream treatment for many patients in end stage organ failure. CMS issued coverage decisions related to heart transplants in 1987, liver transplants in 1991, lung transplants in 1995, and intestine transplants in 2001 and updated in 2006. Kidney transplant centers have been regulated in the Code of Federal Regulations since 1976. This rule will consolidate all transplant center requirements into one regulation.All transplant centers that continue to participate in Medicare, including kidney transplant centers, are required to submit a request for initial approval. Once approved by Medicare, transplant centers are eligible for re-approval every 3 years.Transplant centers with current Medicare approval, that have applied for initial approval within 180 days from the effective date of the final rule may continue to provide transplant services and receive payment from Medicare until CMS makes a decision on the transplant center’s request for approval.The final rule went on public display today at the Office of the Federal Register for publication on Friday, March 23, 2007. IRS releases "Good Governance Practices" for charitable organizations I meant to post this earlier, but the posts have been few and far between this month, and Davis & Tremaine beat me to the punch, so I have to give them credit for this one: The IRS has announced the release of a staff discussion draft of "Good Governance Practices for 501(c)(3) Organizations." Major sections of the draft include these topics: Mission Statement, Code of Ethics, Due Diligence, Duty of Loyalty, Transparency, Fundraising Policy, Financial Audits, Compensation Practices, Document Retention Policy. It's about three (3) pages long and its content shouldn't surprise anyone with a passing familiarity with the law of exempt orgs.The IRS seems to be saying that adoption of these good governance practices is not a criterion for obtaining or retaining exempt status, but that an organization that departs to a significant degree from them is more likely to engage in practices that put its exempt status in jeopardy. Interestingly, if somewhat bizarrely, the Service inserted a comment about board size into its introduction that doesn't appear -- either implicitly or explicitly -- in the Good Governance Practices themselves. It's the trite-but-true "Goldilocks" principle that boards that are too small have difficulty representing "a public interest" and boards that are too large "may be less attentive to oversight duties." Presumably boards that are "just right" are more likely to see that their duties are carried out in a manner that promotes, in the case of exempt hospitals, community benefits. GAO testimony on DOD/VA care problems for injured soldiers, vets GAO released the text of its testimony today before the Subcommittee on National Security and Foreign Affairs of the House Committee on Oversight and Government Reform. The witness list and links to testimony and related documents are here. What is fairly clearly emerging is a sense that the problems with outpatient care at Walter Reed Army Hospital -- described in a series of articles in The Washington Post last week -- are the tip of the iceberg. That's the gist of an article by Anne Hull and Dana Priest in today's Post.It may be true, as Paul Krugman writes in today's op-ed (paid TimesSelect subscription required) in the N.Y. Times, that the worst of the worst in terms of quality care (or the lack thereof) is in the military hospitals, which are separate and distinct from the VA. And the VA may still be the exemplar of quality that it's been touted to be for the past 10 years (although that's not what I hear from the medical students who rotate through the VA hospital here, and that's not the message from vets in today's Post article by Hull and Priest). But the testimony of the GAO witness documents some of the ways that the care in the VA system breaks down when a patient is handed off from the military's hospital system to the VA's. posted by tommayo, 12:35 PM To be middle-class and uninsured Robert Pear has an interesting front-page article today in the N.Y. Times ("Without Health Benefits, a Good Life Turns Fragile") on the growing phenomenon of employees and independent contractors whose arrangements don't include health insurance. The main focus is about a 50-year-old real-estate agent with Century 21, Vicki Readling, who makes about $60,000 but can't afford a health-insurance policy that is priced -- on account of her pre-existing diagnosis of cancer -- at $27,000:[T]he uninsured are not necessarily the poor, the unemployed and the undocumented. Solidly middle-class people like Ms. Readling are one of the fastest growing subgroups. And that is one reason, according to a recent New York Times/CBS News poll, that the problems of the uninsured have jumped to the top of the domestic political agenda in Washington and on the campaign trail. Today, more than one-third of the uninsured — 17 million of the nearly 47 million — have family incomes of $40,000 or more, according to the Employee Benefit Research Institute, a nonpartisan organization. More than two-thirds of the uninsured are in households with at least one full-time worker. The article offers a good illustration of the problems encountered by the uninsured.To save money, Ms. Readling said, she defers visits to the doctor and stretches out her cancer medication, which costs her about $300 a month. She takes the tiny pills three or four times a week, rather than seven days a week as prescribed.“I really try to stay away from the doctor because I am so scared of what everything will cost,” said Ms. Readling, who is divorced and has twin 18-year-old sons. Before every doctor’s visit and test, she asks, “How much are you going to charge me?” She says she tries to arrange “the best deals I can.” But in many cases, the price is still unaffordable, and “I have to do without.”Undertreatment and general mismanagement of chronic conditions will, in the long run, result in more expense, not less, but if short-term cash flow makes the cost of care prohibitively expensive, where's the safety net for patients like Ms. Readling? It doesn't exist. Health care law (including public health law, medical ethics, and life sciences), with digressions into constitutional law, poetry, and other things that matter Kaiser: health policy AHLA CDC Pub. Health News Healthcare Organizational Ethics AP health stories Name: tommayo Location: Dallas, Texas [1] Director, Cary M. Maguire Center for Ethics and Public Responsibility (SMU); [2] Associate Professor, SMU/Dedman School of Law; [3] Adjunct Associate Professor, Internal Medicine, UT-Southwestern Medical School; [4] Of Counsel, Haynes and Boone, LLP

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Celebrating 20 years of enhancing the lives of women affected by breast cancer 20 Lives, 20 Ways 20th Anniversary Luncheon WAR attends national breast cancer advocacy conference Patient Navigator appointed to prestigious research committee GOPiNK hosts successful fundraiser Chappaqua's "A Cure in Our Lifetime" supports Patient Navigation Women At Risk's breast cancer research, support, and education programs depend on the generosity of donors like you. To make a donation in honor of Women At Risk's 20th Anniversary year, please contact Eric Dubinsky at edubinksy@ womenatrisknyc.org or (212) 305-4486. First, we'd like to thank everyone who came out to support WAR at our 20th Anniversary Luncheon on May 9th. It was a great success, and we couldn't have done it without the generosity of all of our supporters. In the past few months, Women At Risk has also been busy advancing breast cancer advocacy, furthering research initiatives, and much more! Read on for the latest news... WAR Luncheon celebrates 20 years of research, education, and support On May 9, 2011, hundreds of Women At Risk supporters gathered at the Waldorf=Astoria to celebrate WAR's incredible work over the past 20 years. The Luncheon honored Jeffrey Kalinsky, President & CEO of Jeffrey New York & Atlanta and the EVP of Designer Merchandising at Nordstrom, for his tremendous commitment to the fight against breast cancer. Dr. Katherine Crew, WAR's Co-Medical Director, spoke about the importance of research, followed by the two guest speakers: Lynn Sherr, author and former ABC News Correspondent and The Honorable Carolyn B. Maloney of the 14th Congressional District. Their remarks were both thought-provoking and inspirational, speaking to the importance of living our lives to the fullest and keeping the spotlight on issues impacting women. We look forward to expanding Women At Risk's programs to fight breast cancer and support those affected by the disease in the coming decades. To celebrate our 20th Anniversary, WAR is profiling 20 individuals whose lives have been touched in some way by the many programs we have offered over the past two decades. If you, or someone you know, has been impacted by Women At Risk's work and would like to be potentially featured in this series, please send your story to Lisa Held at lisaelaineh@gmail.com. We'd love to hear from you! 4. Dr. Francisco Espinel, the 2009-2010 "Alan & Susan Fuirst Women At Risk Breast Surgery Fellow." 5. Yuka Hasegawa, an artist and fashion designer from Kyoto, Japan who was helped by WAR after her breast cancer diagnosis in 2009. Women At Risk attends the National Breast Cancer Coalition's Annual Training & Advocacy Conference This year, a group of nine Women At Risk staff members, patients, and volunteers attended the NBCC Advocacy Conference on April 30th-May 3rd, 2011 in Washington, D.C.. The four-day conference was packed with interesting speakers, panel discussions, plenary sessions, workshops, and information. The focus this year was on the Breast Cancer Deadline 2020 and how we can “change the conversation” to end breast cancer. Read about the details of the conference and the advocates' day of lobbying on Capitol Hill. You can also apply for a scholarship to attend the San Antonio Breast Cancer Symposium this December as a patient advocate. WAR's Patient Navigator chosen for prestigious breast cancer research committee Women At Risk is proud to announce that Nancy Singleton, our Patient Navigator, has been named the "Breast Cancer Committee Patient Advocate" at SWOG, one of the largest cancer clinical trials cooperative groups in the United States. Funded by research grants from the National Cancer Institute, the Group conducts clinical trials to prevent and treat cancer in adults, and to improve the quality of life for cancer survivors. The Group’s network includes more than 4,000 physicians who practice at more than 500 institutions, including 19 NCI-designated cancer centers. Roughly 5,000 patients and healthy participants are enrolled each year in SWOG studies, and approximately 30,000 are involved annually in ongoing clinical trials. During the last 25 years more than 170,000 patients have directly benefited from the Group’s trials, while millions more have received improved care through new standards of treatment or prevention developed by the Group. As the Patient Advocate on the Breast Cancer Committee, Nancy will be responsible for representing the perspective of those affected by cancer at the group's biannual meetings and will also review research protocols. Congratulations, Nancy! GOPiNK hosts Pink and White Party On Saturday, May 14th, GOPiNK, Women At Risk's Junior Committee, hosted a "Pink and White Party"at Bloomingdale's in White Plains, where high school girls and boys modeled the latest pink and white trends in front of an audience of more than 300 people. Allie Farber and Erica Baevsky, the founders of GOPiNK, organized the event with the help of a committee of 60 teenagers from schools throughout Westchester. The event raised $40,000 to support Women At Risk's breast cancer initiatives. WAR would like to thank the GOPiNK girls for their incredible hard work, and congratulate them on another successful event! Chappaqua's "A Cure in Our Lifetime" raises funds to support WAR's Patient Navigation program On Friday, May 13th, Chappaqua's "A Cure in Our Lifetime" held their 14th Annual Spring Breakfast Benefit at the Trump National Golf Club in Westchester. One of the most influential individuals in breast cancer research and treatment today, Dr. Larry Norton, was the guest speaker. The event raised funds for several prestigious cancer centers and breast cancer programs, one of which was WAR's Patient Navigation program. WAR would like to thank Chappaqua's "A Cure in Our Lifetime" for their continued support of this critical program, which provides resources, navigation, and support to newly-diagnosed breast cancer patients at Columbia University Medical Center/NewYork-Presbyterian Hospital. Women At Risk is the breast cancer program of NewYork-Presbyterian Hospital/Columbia University Medical Center whose mission is to enhance the lives of women at high risk for and with breast cancer through research, education and support. For more information, visit us at www.womenatrisknyc.org or www.womenatriskblog.com.

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News from Ministry Saint Joseph's Hospital in Marshfield, WI Ministry names new vice president Vanessa L. Freitag, PharmD, RPh, has been named vice president, clinical services for the Ministry Health Care Western Region which includes Ministry Saint Joseph’s Hospital (MSJH) in Marshfield and Ministry Our Lady of Victory Hospital (MOLV) in Stanley. In this new position she will be jointly accountable for the overall senior leadership at MOLVH and for a number of clinical services within Ministry Saint Joseph’s Hospital in Marshfield. She will start her new position on June 1. Freitag is currently the director of pharmacy for Ministry Saint Joseph’s Hospital, a position she has held since 2007. In addition to her pharmacy responsibilities, she has been active in a leadership role with Ministry Health Care, and currently serves on a number of committees, including the Ministry Health Care Quality Council and the Ministry Saint Joseph’s Hospital Coordinating Council. On the state level, she is a member of the Pharmacy Society of Wisconsin Hospital Advisory Board. Brian Kief, Western Region CEO, says, “Since joining Ministry and Saint Joseph’s seven years ago, Vanessa has exhibited broad based leadership skills in a variety of capacities. She is an engaging leader, who reaches out to all stakeholders to create success. She maintains high standards and expectations while also having a caring approach that ensures team understanding and participation.” Vanessa adds, “I believe in the values and am committed to Ministry Health Care and the Catholic Health Care model of service. I see this new opportunity as a way to continue to grow and contribute to the Mission of our organization, supporting access to strong rural health care. I have gotten to know leaders at Ministry Our Lady of Victory through my work in the pharmacy integration between the two organizations and am very excited about this leadership opportunity and working with this team.” Freitag earned her doctor of pharmacy and bachelor of science in pharmacy from the University of Minnesota College of Pharmacy in Minneapolis. She will replace current hospital president, Cynthia Eichman, who is retiring at the end of June. Eichman joined MOLVH in 1995 as a part of the hospital’s affiliation with Ministry Health Care. Ministry Saint Joseph's Hospital Considering a Health Care Career Email Greetings Gifts from Ministry Saint Joseph's Hospital

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NAMI Albuquerque Watch in its entirety at : http://www.mindsontheedge.org/watch/ Moderator Frank Sesno Do you have a family member suffering from bipolar disorder, schizophrenia, or other serious mental illness? "The one-hour television program zeros in on wrenching and confounding situations that are playing out every day in homes and hospital ERs, on city streets and school campuses, in courtrooms and in jails, as Americans struggle with the challenges of severe mental illness. Produced for PBS by the Fred Friendly Seminars using their signature format of a hypothetical scenario, the program considers the case of a college student who develops mental illness while at school. Her professor knows something is wrong, but is unsure how to approach her and whether it is even legal to contact her parents. Upset and confused when they see their daughter, her parents do not know where to turn and are shocked to discover how limited their options are when they try to seek medical help. The program also explores the circumstances of an adult who has coped with his mental illness until his mother dies, and then he is left without critical support. As his mental health unravels, and he is unable to get treatment or maintain his home, he is arrested for a minor crime and absorbed into the criminal justice system. For him it is the beginning of a merry-go-round of homelessness and jail that has become all too common for many individuals who are living with schizophrenia, bipolar disorder and other severe mental illnesses. Moderator Frank Sesno, unfolds this story and asks the program panelists to put themselves in the shoes of these hypothetical characters and talk about what they would do if faced with this situation. The distinguished panel includes U.S. Supreme Court Justice Stephen Breyer, Nobel Prize winning neurologist Eric Kandel, along with attorneys, doctors, legislators and other experts in the field. Several of the panelists have personal, as well as professional experience, in living with mental illness."

医学

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Entries : Tuberculosis Municipal Tuberculosis Sanitarium, 1941 Tuberculosis is an infectious disease of the lungs and other organs. Once considered incurable, the disease caused its victims to slowly waste away, which was why it was called “consumption.” With a mortality rate of approximately 18 per 10,000 people, tuberculosis was a leading cause of death within the city of Chicago at the turn of the twentieth century. Early attempts at controlling tuberculosis in Chicago focused on home sanitation, public health education, and isolation of the patient. Private hospitals took a few tuberculosis patients, but public facilities to care for consumptives were not available. In order to raise public awareness, the Visiting Nurses Association and physician Theodore Sachs spearheaded an antituberculosis movement in the early 1900s. This eventually resulted in the passage of state legislation, the Glackin Tuberculosis Law, in 1909, giving the city of Chicago the ability to raise funds for the treatment and control of tuberculosis through a special property tax. In 1915, the Chicago Municipal Tuberculosis Sanitarium opened and remained in operation until the 1970s. Mortality rates from tuberculosis declined slowly in Chicago in the early twentieth century with disparities in mortality rates due especially to race. As a result of overcrowding and poverty, African American and immigrant communities were hardest hit. While mortality rates for whites were decreasing, racially restrictive hospital admittance and public health policies led to an increase in mortality for the black community. Finally, midcentury drug therapies effectively controlled tuberculosis. Tuberculosis remained under control in Chicago until the 1980s, when the spread of AIDS created a community of individuals susceptible to the disease. Susan Vieweg Bonner, Thomas Neville. Medicine in Chicago 1850–1950. 1957. McBride, David. From T.B. to AIDS: Epidemics among Urban Blacks. 1991. Rothman, Sheila. Living in the Shadow of Death. 1995.

医学

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Health System > Continuing Medical Education > UC Davis nursing school hopes to improve care ... Point of Care Learning CME California Subscribe to the latest RSS news feeds. NEWS | March 14, 2014 UC Davis nursing school hopes to improve care for cancer patients with social network Several chemotherapy patients at the UC Davis Comprehensive Cancer Center will be invited to use tablets with a unique social networking tool as part of their treatment plan. Researchers at the Betty Irene Moore School of Nursing at UC Davis hope to prove that mobile health technology improves the care experience for patients as well as the quality of care while also reducing cost. Researchers at the Betty Irene Moore School of Nursing at UC Davis hope to prove that mobile health technology improves the care experience for patients as well as the quality of care while also reducing cost. The project is part of a two-year, $199,854 grant from the McKesson Foundation and its national Mobilizing for Health Initiative. Research on mobile health technology in cancer care is new, said Jill Joseph, the associate dean for research at the nursing school. Other cancer-related mobile applications are available, but are limited to education and awareness and don’t provide disease management tools or real-time communication.“We have ample evidence that cancer patients often receive fragmented care, experience significant distress, and may needlessly require care in emergency departments or inpatient settings, particularly during chemotherapy,” Joseph said. “Little research and development has focused on providing novel technologies to support cancer care coordination.”Participating patients will use a tablet device, such as a Google Nexus or iPad, to connect to their unique and private Personal Health Network that includes a nurse coordinator — who manages the their care — along with family, caregivers, clinicians and other desired partners. These people can connect with one another through real-time messaging, video and audio components as well as schedule appointments, assign tasks, store and track information and more.A nurse coordinator is assigned to support each chemotherapy patient who uses the mobile application. This coordinator monitors the patient’s care plan, triages issues and communicates with caregivers. Unlike electronic health records and other information systems common in hospitals, the social networking platform allows patients, their families and caregivers to not only access information but communicate with another and make decisions about care and health management.“This is a new tool designed with the patient and family at the center of care,” said Katherine Kim, a recent doctoral graduate of the UC Davis nursing school who is now a visiting faculty member and project director.For example, a chemotherapy patient might message her nurse coordinator that she’s not doing well that day, and feels nauseous and anxious. The nurse can then communicate with the patient to further assess the situation, communicate with other caregivers, and work with the patient to address the issues or take other steps such as reschedule appointments or review current medications.Developed by private technology partner Tiatros, the social networking platform is different from other social media sites, like Facebook and LinkedIn, because it is designed to compy with health privacy laws and operates securely. Researchers will test that design as part of the study.“I’m excited about bringing nursing research into the Cancer Center. I’m especially excited for our patients to have an opportunity to be part of this project,” said Kerri Stuart, a nurse manager at the Cancer Center. “Learning you have cancer is overwhelming and the thought of chemotherapy is often terrifying. This is a tool that empowers patients and provides access to information when they need it, not just when the clinic is open.”Research team members will interview patients after they have used the program for six months to determine how their health, the delivery of care and their need for emergency or inpatient care was affected. The team includes nursing faculty from the School of Nursing as well as oncology nurses, social workers, and physicians from the UC Davis Comprehensive Cancer Center.The study is the first funded project resulting from the development of the UC Davis Collaborative Cancer Care Research Group, a multidisciplinary team of experts who hope to develop technology-enabled solutions that improve the quality, accessibility and affordability of cancer care.Visit the school’s website at http://nursing.ucdavis.edu for more information.Founded in 1943, the McKesson Foundation is dedicated to improving the health of patients through improved health-care quality, personal health management and lower costs. The foundation’s current focus area is cancer, with a specific emphasis on organizations that provide direct services to low-income cancer patients in the U.S. The Mobilizing for Health Initiative, or mHealth Initiative, was designed to build the evidence base for what works and what doesn’t work in the rapidly expanding field of mHealth.About the UC Davis Comprehensive Cancer Center UC Davis Comprehensive Cancer Center is the only National Cancer Institute comprehensive-designated center serving the Central Valley and inland Northern California, a region of more than 6 million people. Its top specialists provide compassionate, comprehensive care for more than 9,000 adults and children every year, and offer patients access to more than 150 clinical trials at any given time. Its innovative research program includes more than 280 scientists at UC Davis and Lawrence Livermore National Laboratory. The unique partnership, the first between a major cancer center and national laboratory, has resulted in the discovery of new tools to diagnose and treat cancer. Through the Cancer Care Network, UC Davis is collaborating with a number of hospitals and clinical centers throughout the Central Valley and Northern California regions to offer the latest cancer-care services. For more information, visit http://cancer.ucdavis.edu.About the Betty Irene Moore School of Nursing at UC Davis The Betty Irene Moore School of Nursing at UC Davis was established in March 2009 through a $100 million commitment from the Gordon and Betty Moore Foundation, the nation's largest grant for nursing education. The vision of the Betty Irene Moore School of Nursing is to transform health care through nursing education and research. The school’s first programs, doctoral and master’s degrees, opened in fall 2010. Master’s degree programs for nurse practitioners and physician assistants, with a focus on preparing primary-care providers for rural and underserved communities, opened in summer 2013. The Betty Irene Moore School of Nursing is part of UC Davis Health System, an integrated, academic health system encompassing the UC Davis School of Medicine, UC Davis Medical Center and the UC Davis Medical Group. For more information, visit http://nursing.ucdavis.edu. Continuing Medical Education | 4610 X Street, Suite 2301, Center for Health and Technology Building | Sacramento, CA 95817 | Main Phone: (916) 734-5390 | Toll Free: (866) CME-4EDU FAX (916) 734-0776

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How Rosetta@home helps cure cancer, AIDS, Alzheimer's, and more This page attempts to explain the basic science behind Rosetta@home, and in doing so, explain how Rosetta@home can help lead to cures for human diseases. What are proteins? What do proteins do? How are proteins related to disease? What role does protein structure play in treating disease? What does Rosetta@home do on my computer? Proteins are the workhorses in every cell of every living thing. Your body is made up of trillions of cells, of all different kinds: muscle cells, brain cells, blood cells, and more. Inside those cells, proteins are allowing your body to do what it does: break down food to power your muscles, send signals through your brain that control the body, and transport nutrients though your blood. Proteins come in thousands of different varieties, but they all have a lot in common. For instance, they're made of the same stuff: every protein consists of a long chain of joined-together amino acids. Amino acids are small molecules made up of atoms of carbon, oxygen, nitrogen, sulfur, and hydrogen. To make a protein, the amino acids are joined in an unbranched chain, like a line of people holding hands. Just as the line of people has their legs and feet "hanging" off the chain, each amino acid has a small group of atoms (called a sidechain) sticking off the chain that connects them to each other (the mainchain or backbone). Every amino acid contributes the same "arms" to the mainchain, but unlike a line of people, the sidechains ("legs") of amino acids are quite different from each other. In fact, there are 20 different kinds of amino acids, which differ from one another based on what atoms are in their sidechains. The 20 amino acids have names like alanine, tryptophan, glutamine, and leucine. Another thing proteins all have in common is that they don't like to stay stretched out in a straight line. The protein folds up to make a compact blob, but as it does, it keeps some amino acids near the center of the blob, and others outside; and it keeps some pairs of amino acids close together and others far apart. Every kind of protein folds up into a very specific shape -- the same shape every time. Most proteins do this all by themselves, although some need extra help to fold into the right shape. It turns out that the identity of a protein is simply determined by which amino acids are in it, and what order they're in. Amazingly, a particular chain of amino acids always folds in exactly the same way -- whatever way results in the lowest overall energy. That means that to make two identical proteins with exactly the same shape and properties, all the body has to do is make two chains with the same amino acids in the same order. That's important, because there are thousands of identical copies of some proteins in every cell in your body! Cells are always making new copies of proteins and breaking down old ones to be recycled. The blueprints for making proteins are genes, which are encoded in your DNA. There are small differences in DNA that make one person different from another. This means that one person's proteins may be slightly different than another's. It also means that half of your proteins come from the genes you inherited from your mother (and are like her proteins), and the rest come from your father (and are like his). Sometimes this is called the Central Dogma of molecular biology: every gene in your DNA gets translated into a protein in your body. Proteins are involved in almost all of the processes going on inside your body: they break down food to power your muscles, send signals through your brain that control the body, and transport nutrients though your blood. Many proteins act as enzymes, meaning they catalyze (speed up) chemical reactions that wouldn't take place otherwise. But other proteins power muscle contractions, or act as chemical messages inside the body, or hundreds of other things. Here's a small sample of what proteins do: starts the process of breaking down starch from food into forms the body can use. Alcohol dehydrogenase transforms alcohol from beer/wine/liquor into a non-toxic form that the body uses for food. carries oxygen in our blood. forms a scab to protect cuts as they heal. gives structure and support to our skin, tendons, and even bones. Actin is one of the major proteins in our muscles. helps regulate the growth of children into adults. Potassium channels help send signals through the brain and other nerve cells. regulates the amount of sugar in the blood and is used to treat diabetes. Proteins are present in all living things, even plants, bacteria, and viruses. Some organisms have proteins that give them their special characteristics: is a collection of proteins in plants that captures sunlight for photosynthesis. Luciferase catalyzes the chemical reaction that makes fireflies glow. Hemagglutinin helps the influenza virus invade our cells. With all the things proteins do to keep our bodies functioning and healthy, they can be involved in disease in many different ways. Below, we list three diseases that represent different ways that proteins can be involved in disease. HIV / AIDS: The HIV virus is made up largely of proteins, and once inside a cell it creates other proteins to help itself reproduce. HIV-1 protease and reverse transcriptase are two proteins made by the HIV virus that help it infect the body and replicate itself. HIV-1 protease cuts the "polyprotein" made by the replicating virus into the functional pieces it needs. Reverse transcriptase converts HIV's genes from RNA into a form its host understands, DNA. Both proteins are critical for the virus to replicate inside the body, and both are targetted by anti-HIV drugs. This is an example of a disease producing proteins that do not occur naturally in the body to help it attack our cells. Cancer is very different from HIV in that it's usually our own proteins to blame, instead of proteins from an outside invader. Cancer arises from the uncontrolled growth of cells in some part of our bodies, such as the lung, breast, or skin. Ordinarily, there are systems of proteins that limit cell growth, but they may be damaged by things like UV rays from the sun or chemicals from cigarette smoke. But other proteins, like p53 tumor suppressor, normally recognize the damage and stop the cell from becoming cancerous -- unless they too are damaged. In fact, damage to the gene for p53 occurs in about half of human cancers (together with damage to various other genes). Alzheimer's: In some ways, Alzheimer's is the disease most directly caused by proteins. A protein called amyloid-beta precursor protein is a normal part of healthy, functioning nerve cells in the brain. But to do its job, it gets cut into two pieces, leaving behind a little scrap from the middle -- amyloid-beta peptide. Many copies of this peptide (short protein segment) can come together to form clumps of protein in the brain. Although many things about Alzheimer's are still not understood, it is thought that these clumps of protein are a major part of the disease. Proteins are very small, too small to see, even with a microscope. However, using special x-rays or very powerful magnets, scientists have been able to figure out the structures of some proteins -- what they would look like if we could see them. A complete structure defines the three-dimensional position of every atom in the protein. In order for a protein to function normally, it must usually bind to and interact with at least one chemical compound or other protein. The site of interaction is called the protein's binding site (or active site, for enzymes that carry out chemical reactions). The interaction depends on a nearly perfect fit between the shape of the binding site and the thing it binds to, like a key fitting into a lock. Solving the structure of a protein allows us to see the exact shape and position of its binding site(s). Most drugs do their work by targetting the binding or active site of a particular protein. For example, the anti-cancer drug tamoxifen fits into the binding site of estrogen receptor. Without the drug, estrogen will bind to estrogen receptor, which can contribute to the uncontrolled growth of cancer cells. With the drug in place, estrogen can't get in, and so the cancer's growth is slowed down. Tradionally, drugs have been discovered by what amounts to trial and error. But if a specific protein is known to be involved in a disease, and if the structure of that protein is known, then chemists can try to design a drug to bind to the protein. If it works, the new drug will bind to the target protein and keep it from doing whatever it does. For example, two proteins from the HIV virus, HIV-1 protease and reverse transcriptase, have been targetted this way. Unfortunately, this is still a time-consuming process and success is not guaranteed. However, many people believe that knowing protein structures will play an increasingly important role in the future of drug discovery. Of course, drug design isn't the only role for protein structure in treating disease: the structure of a protein helps explain what it does and how it does it. That can give insight into how particular processes work in the body, and how they go wrong in disease. This kind of basic understanding can contribute to the treatment of a disease apart from any specific drug. The computer program Rosetta works on several kinds of calculations, but they all relate to protein structure. A large number of computers are needed because the calculations take a long time, and many different possibilities must be explored in order to discover the right answers. For more information, Dr. David Baker's Rosetta@home Journal is a great source of timely information about what new projects are being run on Rosetta@home, and how they relate to important biomedical problems. You can also see the Active WorkUnits Log, which has up-to-date information about what Rosetta@home is working on right now, but descriptions may be terse and/or technical. Design of therapeutic proteins: Since proteins are part of so many diseases, they can also be part of the cure. The Baker lab is using Rosetta@home to design brand new proteins that could help prevent or treat important diseases. For example, Rosetta is being used to redesign parts of the HIV virus' coat so they can be administered as an effective vaccine. We are also working on antagonists for androgen receptor (a protein involved in prostate cancer) and on novel endonucleases (protein enzymes that cut DNA) for gene therapy approaches to treating a variety of hereditary diseases. See Disease Related Research for more details. Protein structure prediction: As described above, knowing the structure of a protein is key to understanding how it works and to targetting it with drugs. Rosetta attempts to predict the structure of a protein computationally, as opposed to determining it experimentally. This problem, often called "the protein folding problem", is regarded as one of the hardest problems in biology today. A computational solution is desirable because experimental methods generally take months to years of time and cost hundreds of thousands of dollars per protein. (And human beings have tens of thousands of different proteins -- not to mention all the proteins in other organisms.) Some of the structure predictions on Rosetta@home are for proteins whose structure is truly not known. The resulting models are used to address some specific biological question, such as a disease mechanism. Other predictions are tests where we already know the answer, aimed to improve Rosetta itself. A specific case of this is the CASP competition, where teams of researchers around the globe try to predict the structures of proteins where the answer was recently determined experimentally but is not yet public knowledge. Rosetta is consistently among the best performers in CASP. Protein-protein docking: Docking problems focus on predicting how two things bind to each other -- in this case, how two proteins bind to each other. Knowing which parts of the proteins interact and their relative orientations in space helps explain the functions of those proteins. It also suggests ways to create drugs that would disrupt the interaction, if the interaction is part of a disease. (For instance, HIV proteins that bind to cell surface proteins so that the virus can infect the cell.) In some cases, the structures of the two proteins by themselves are already known, but in other cases we must first predict them (see above). To improve Rosetta's performance on protein-protein docking, the Baker lab also competes in CAPRI. As in the CASP competition, in CAPRI researchers try to predict protein-protein interactions that have recently been determined but are not yet public knowledge. Drug docking and design (coming soon): Rosetta can also be used to dock drug-like molecules with proteins to see how they might bind to each other. By trying many potential drugs from a large library of molecules, we may be able to discover a drug that binds to a protein of interest. On the other hand, if a drug is already known to target that protein, then by predicting how it binds to the protein we can predict ways of improving the drug. (These calculations are not currently running on Rosetta at home, but we expect that they will be soon.) Please direct questions and comments about this page to iwd@u.washington.edu.

医学

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Vegetables in Childhood May Benefit Breast Health FRIDAY, April 11, 2014 (HealthDay News) -- Girls who ate the most fruits and vegetables rich in carotenoids were less likely to get benign breast disease, a new study suggests. Carotenoids are a group of pigments that typically produce an orange, red or dark green color. They are believed to have antioxidant properties that may guard against disease. Benign breast disease describes a variety of noncancerous conditions of the breast; some forms raise the risk of breast cancer. "There have been a number of studies about carotenoids and breast cancer," said lead researcher Caroline Boeke, a postdoctoral fellow at Channing Division of Network Medicine at Brigham and Women's Hospital and Harvard School of Public Health, in Boston. While the studies have produced mixed results, she said, overall they suggest a protective effect of the carotenoids. So her team decided to analyze the intake of these vegetables by girls enrolled in an ongoing study that began in 1996. For her study, Boeke and her colleagues looked at food reports from 1996 through 1998 and then evaluated reports in 2005, 2007 and 2010 from girls who got a diagnosis of benign breast disease from a doctor after having a biopsy. In all, Boeke studied nearly 6,600 girls, and 122 reported a diagnosis of benign breast disease. When she looked at carotenoid intake, she found high intakes were protective. "The odds of benign breast disease in those who consumed the most beta carotene were about half that of those who consumed the least," she said. Girls in the highest intake group ate two to three servings of carotenoid-rich foods weekly, she said. The study is published in the May issue of Pediatrics. "It's an observational study, so we can't say for sure the carotenoids cause the lower risk," Boeke noted. "We can only say there's an association." She did take into account other factors that might affect the risk of benign breast disease, such as alcohol intake, physical activity, family history and body mass index (a measure of body fat using height and weight). Why might the fruits and vegetables help? It's not known for sure, but Boeke said it may be due partly to their antioxidant properties. Carotenoids absorb harmful substances known as free radicals which can harm cells. The s

医学

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| | MENTAL HEALTH SCREENING NAMI calls on Congress to reject campaigns of misinformation on mental health screening and to oppose anti-screening legislation, both of which promise to drive up stigma and prey on fear. Many NAMI families know first-hand the unfortunate and sometimes-tragic consequences of failing to have a child diagnosed early and watching the child lose critical developmental years to an untreated mental illness. There are also families who are grateful that their child was diagnosed early and has benefited from appropriate treatment and intervention. President Bush’s New Freedom Commission on Mental Health report (2003) calls for early mental health screening, assessment and referral to services as common practice in our nation. Approximately 10% of children and adolescents in our nation live with a mental illness that causes serious impairment, yet only 20% of youth with mental illnesses receive treatment and services. America cannot afford to continue to fail our youth with mental illnesses that require treatment. Fact vs. Fiction About Mental Health Screening Screening is voluntary and requires parental consent. The TeenScreen program featured in the New Freedom Commission report requires parental consent before a youth may be screened and is a voluntary program. This program also requires the youth’s assent for the mental health screening. Anti-psychiatry groups claim that the New Freedom Commission report calls for “mandatory screening, without parental consent.” That is simply not true. Screening does not diagnose youth; it only identifies those that require a more complete mental health evaluation. Screening does not result in a child being medicated. Medications may only be prescribed by a medical doctor. Ultimately, parents must decide about the appropriate treatment approach for their child and no one is suggesting otherwise. Mental health screening opponents claim that it will lead to the “labeling” and “drugging” of children. The truth is that screening is limited to identifying youth that require a further evaluation. A child can only be diagnosed by a trained mental health or medical professional who also should discuss treatment options with the family. Suicide represents a public health crisis and tragically claims about 3,000 young lives every year in our nation. About 90% of those who commit suicide have a mental illness (U.S. Surgeon General, 1999). Screening promises to help reduce youth suicide. Opponents of screening claim that it does not help reduce suicide. In fact, studies of the Columbia University TeenScreen program show that screening is an accurate predictor of mental health concerns and identifies youth who may later become suicidal. Clearly, by making the mental health of children a national priority, we will reduce youth suicide. Mental disorders in children and adolescents lead to other tragic consequences, especially when they go undiagnosed and untreated: -Youth with mental illnesses have the highest school dropout and failure rates and lowest academic achievement of any disability group; -65% of boys and 75% of girls in juvenile detention have one or more psychiatric disorders. Opponents of screening simply fail to address the research that shows the gross under-identification of youth with mental disorders and the often tragic consequences that follow. Representative Ron Paul of Texas has introduced legislation, the Parental Consent Act of 2005 (HR 181) that would prohibit the use of federal funds for mental health screening. NAMI strongly opposes H.R. 181 and urges Congressional members to oppose the bill and any similar measures. The bill would stifle efforts to support state and local programs designed to identify youth struggling with mental illnesses and initiatives designed to help reduce the existing youth suicide crisis in this country. The Congressional Research Service (CRS) issued a memorandum on mental health screening on December 15, 2004 that also serves to set the record straight on mental health screening. The memo also references the House and Senate appropriations report language that specifically addresses mental health screening. The House report noted that “SAMHSA is overseeing a very promising pilot study utilizing evidence-based screening techniques and tools to screen and identify teenagers who are at risk.” The Senate report also recognized the pilot study involving the TeenScreen program. Screening cannot be viewed in isolation. NAMI calls on federal, state and local leaders to build a comprehensive mental health system of care for the millions of children who require mental health treatment and services. Children with mental illnesses and their families deserve nothing less. For more information please contact: Darcy Gruttadaro, Director of the Child and Adolescent Action Center at 703-516-7965or darcy@nami.org

医学

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Scientists tweak immune cells to fight cancer Researchers at the University of Georgia are developing a new treatment technique that uses nanoparticles to reprogram immune cells so they are able to recognize and attack cancer. The findings were published recently in the early online edition of ACS Nano. The human body operates under a constant state of martial law. Chief among the enforcers charged with maintaining order is the immune system, a complex network that seeks out and destroys the hordes of invading bacteria and viruses that threaten the organic society as it goes about its work. The immune system is good at its job, but it's not perfect. Most cancerous cells, for example, are able to avoid detection by the immune system because they so closely resemble normal cells, leaving the cancerous cells free to multiply and grow into life-threatening tumors while the body's only protectors remain unaware. Shanta Dhar and her colleagues are giving the immune system a boost through their research. "What we are working on is specifically geared toward breast cancer," said Dhar, the study's co-author and an assistant professor of chemistry in the UGA Franklin College of Arts and Sciences. "Our paper reports for the first time that we can stimulate the immune system against breast cancer cells using mitochondria-targeted nanoparticles and light using a novel pathway." In their experiments, Dhar and her colleagues exposed cancer cells in a petri dish to specially designed nanoparticles 1,000 times finer than the width of a human hair. The nanoparticles invade the cell and penetrate the mitochondria-the organelles responsible for producing the energy a cell needs to grow and replicate. They then activated the nanoparticles inside the cancer cells by exposing them to a tissue-penetrating long wavelength laser light. Once activated, the nanoparticles disrupt the cancer cell's normal processes, eventually leading to its death. The dead cancer cells were collected and exposed to dendritic cells, one of the core components of the human immune system. What the researchers saw was remarkable. "We are able to potentially overcome some of the traditional drawbacks to today's dendritic cell immunotherapy," said Sean Marrache, a graduate student in Dhar's lab. "By targeting nanoparticles to the mitochondria of cancer cells and exposing dendritic cells to these activated cancer cells, we found that the dendritic cells produced a high concentration of chemical signals that they normally don't produce, and these signals have traditionally been integral to producing effective immune stimulation." Dhar added that the "dendritic cells recognized the cancer as something foreign and began to produce high levels of interferon-gamma, which alerts the rest of the immune system to a foreign presence and signals it to attack. We basically used the cancer against itself." She cautions that the results are preliminary, and the approach works only with certain forms of breast cancer. But if researchers can refine the process, this technology may one day serve as the foundation for a new cancer vaccine used to both prevent and treat disease. "We particularly hope this technique could help patients with advanced metastatic disease that has spread to other parts of the body," said Dhar, who also is a member of the UGA Nanoscale Science and Engineering Center, Cancer Center and Center for Drug Discovery. If the process were to become a treatment, doctors could biopsy a tumor from the patient and kill the cancerous cells with nanoparticles. They could then produce activated dendritic cells in bulk quantities in the lab under controlled conditions before the cells were injected into the patient. Once in the bloodstream, the newly activated cells would alert the immune system to the cancer's presence and destroy it. "These are the things we can now do with nanotechnology," Dhar said. "If we can refine the process further, we may be able to use similar techniques against other forms of cancer as well." Besides Dhar and Marrache, other UGA researchers on the project were Smanla Tundup and Donald A. Harn. The work was supported by a startup grant from the National Institutes of Health (P30 GM 092378) to UGA, by the UGA Office of the Vice President for Research to Dhar and by a grant from the National Institutes of Health (NIH AI056484) to Harn. Nanoscale Science and Engineering Center: Full version of study: Franklin College of Arts and Sciences Chemistry, Department of Previously

医学

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Conditions InDepth: Viral Upper Respiratory Infections (Colds and Influenza) Viral upper respiratory infections come in every degree of severity and cause symptoms in the ears, sinuses, throat, and nose. This report will cover two of the most common respiratory infections: the common cold and influenza (the flu). The Upper Respiratory Tract In the United States the broad category of viral respiratory illness is responsible for many school and work absenteeisms. Influenza travels around the globe in yearly winter epidemics of varying magnitude. Major epidemics occur every 10-15 years and may kill upwards of 40,000 people or more in the United States. Most of the deaths occur in the elderly and those weakened by chronic illnesses, such as heart and respiratory diseases. The common cold is characterized by nasal congestion, a runny nose, sneezing, and perhaps a sore throat, headache, and malaise (not feeling well). A fever is unusual. Symptoms resolve on their own usually within 1-2 weeks. There are at least 200 known rhinoviruses responsible for the symptoms of a common cold. Some of these may also affect the lower respiratory tract and cause other conditions. Other viruses, such as respiratory syncytial virus can cause severe pneumonia in infants. Influenza is a very specific illness caused by influenza viruses. It has a characteristic seasonal cycle that peaks in the winter. It also has typical symptoms, although they vary greatly in severity among cases. It may feel similar to a common cold, but it usually causes a high fever (102°F-104°F), significant malaise, and a dry cough along with a runny nose, headache, muscle ache, and sore throat. Influenza viruses are divided into three groups: A, B, and C. Influenza A is the cause of the worst epidemics. This is because it changes its identity often, so that a person’s previously developed immunity may not recognize the new variation. International organizations like the World Health Organization (WHO) Epidemic and Pandemic Alert and Response (CSR) team are constantly searching the world for new variations of influenza viruses. Each year they attempt to identify the strains most likely to cause epidemics and make recommendations for developing vaccines against them. What are the risk factors for colds and influenza?What are the symptoms of colds and influenza?How are colds and influenza diagnosed?What are the treatments for colds and influenza?Are there screening tests for colds and influenza?How can I reduce my risk of colds and influenza?What questions should I ask my doctor?Where can I get more information about colds and influenza? National Center for Infectious Diseases. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/ncidod World Health Organization website. Available at: http://www.who.int/en

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BIO Statement on Compassionate Use Biotech companies have an ethical obligation to develop safe and effective drugs and biologics and make them available to all patients as quickly as possible. March 18, 2014 Recommend Biotech Leader Provides Testimony on Bioethical Issues in International Clinical Trials Ensuring Patient Safety and Continued Innovation Must Stand As Focus Of Follow-On Biologics Debate Points to Consider: Benefit-Risk FAST Act Would Provide Patients with Accelerated Access to Innovative Therapies Over the last several months there has been increased media coverage of “compassionate use” cases – or the treatment of seriously ill patients with experimental drugs or biologics outside of the traditional clinical trial process, when other treatments are not working. These cases are always difficult and painful for everyone involved - the patients, their families, and the companies working to find cures and gain FDA approval of their products as quickly as possible. While BIO does not comment on individual companies or their decision-making in regards to compassionate use, as the trade association representing the industry, we can comment on the issue of early access to experimental products that have not yet received FDA approval. Biotech companies have an ethical obligation to develop safe and effective drugs and biologics and make them available to all patients as quickly as possible. There are instances when patients may request access to drugs and biologics prior to their approval. These requests typically come from seriously ill patients or their families who believe an experimental product could save or prolong their lives. In such cases, companies often have to address the challenge of equitable distribution of limited drug supply to a large number of patients in need. These decisions are particularly difficult and heart-wrenching when we know the personal stories of the individual patients. Today’s social media campaigns can make certain individual stories more visible than others, which makes the fair distribution of experimental drugs even more challenging. People at biotech companies therefore often must make emotionally difficult decisions when trying to balance an individual's early access to a drug still in clinical trials against the company’s obligation to develop drugs for larger groups of patients and ensure these products gain regulatory approval as quickly as possible. In some cases, such early access programs could create a conflict between these two principles. In addition, even when compassionate use programs are in place, difficult decisions sometimes still must be made about which patients will get access to the limited amounts of the drug. These are issues of great concern to people in biotechnology companies, to regulators, and to patients and their families. All of the people concerned with public health, as well as the health of their own loved ones, want to ensure that safe and effective medicines are available as quickly as possible to people in need. The scientists and researchers in biotech companies have dedicated their lives to helping others by conducting years of research to find cures for disease. Yet they know that even very promising early results do not mean that the experimental drug will help all patients in need or ultimately be approved as safe and effective; indeed the opposite may be true, and this is why further testing is always required. It also is essential for companies to consider whether the development and administration of a compassionate use program will be able to serve fairly all the patients potentially in need, and whether such a program will draw the attention of key company personnel and other resources away from the crucial task of getting the drug approved for a wider population. We recognize that the complex balancing of factors related to compassionate use programs can at times create situations that appear on one hand as deeply unfair to a single patient or family facing the unthinkable and holding out hope for a miracle. Yet the reality facing companies presented with these situations is whether individualized decisions could delay FDA approval of a drug or therapy for use in a larger number of suffering patients. BIO believes that these complex and difficult decisions require thoughtful involvement of the people working in biotech companies, regulators, and representatives of patients and their families. While the case of each individual patient may be moving and compelling, very difficult decisions must be often made to ensure fair and optimal use of limited resources, in order to achieve full evaluation of a drug’s safety and effectiveness as quickly as possible. Because of the importance of this issue to BIO members and the patients we serve, our Board Bioethics Committee reviewed the topic in depth and issued "Points to Consider" in April 2010 to help members analyze the many ethical challenges raised by early access programs. This document is available here: http://www.bio.org/sites/default/files/20100416.pdf. The Board Bioethics Committee will continue to work on developing a better path forward for all parties involved in such difficult and emotional cases. Hide Related Contenet: Show Hide Date: Show Hide Add This: Show Printer-friendly version

医学

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CTPA Responds to Report on Cosmetics Blocking Androgens in Male Fetuses Sep 2, 2008 | Contact Author | By: Katie Schaefer Title: CTPA Responds to Report on Cosmetics Blocking Androgens in Male Fetuses The Cosmetic, Toiletry and Perfumery Association (CTPA) has responded to reports questioning the safety of perfumes and scented body lotion for unborn males. The CTPA states,"Safety is the number one priority for the cosmetics industry. As required by law, every single cosmetic and perfumery product is assessed for safety by qualified professionals before being placed on the market. Products must be and are safe for such use. Safety assessments take account of the fact that any cosmetic or perfume may be used by pregnant women at any time and that consumers will be exposed to complex mixtures of ingredients. Both the immediate and long-term consequences of use of the ingredients are taken into account." The statement in in response to reports by the newswires Scotland on Sunday and the Daily Telegraph and Daily Mail claiming that pregnant women should avoid perfume, scented body creams and cosmetics. The report was based on research by Professor Richard Sharpe, the principal investigator in the Medical Research Council's human reproductive sciences unit. The reports claim that the reproductive systems of fetuses may be damaged by chemicals in personal care products used by their mothers. Sharpe's research reportedly discovered the chemicals to block the delivery of androgens in the fetuses, resulting in infertility problems or cancer later in life. Sharpe's research was conducted on rats. According to the CTPA, feeding large doses of substances may produce adverse effects in experimental animals like rats, but low levels of exposure in normal cosmetics use are without any such adverse effects when applied topically to humans. CTPA stresses that cosmetics and perfumery products are safe for use during pregnancy. Sharpe has added on the Sense about Science Web site that his research was taken out of context. He maintains that his research is not cosmetic related and that the chemicals tested are common environmental chemicals. Sharpe will be presenting his research at the Simpson Symposia in Edinburgh, UK today. Close

医学

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News Digital Imaging Advancing Care at School of Dentistry Clinical instructor, Dr. Erika Benavides and third-year dental student Brandon Shoukri use digital imaging to access patient radiographs and a dental model as they discuss a comprehensive treatment plan. Ann Arbor, MI — October 2, 2013 — Digital imaging is making significant inroads at the University of Michigan School of Dentistry. New digital imaging equipment was recently installed in 22 clinics throughout the School to enhance the quality of care patients receive as well as prepare students in dental, dental hygiene, and graduate programs for the digital environment they will experience after graduation. The latest efforts build upon the successful use of digital technology in the Dr. Roy Roberts Preclinical Laboratory as well as the digital impression system available in dental student clinics. For 10 years, clinical instructors have been using digital technology to demonstrate dental procedures that first- and second-year dental students watch on a monitor at each of 110 workstations. Students apply that knowledge and develop their clinical skills on models of the oral cavity (typodonts), plastic teeth, and mannequin heads prior to treating patients in the School’s clinics. More recently, students have been taking digital impressions and replacing traditional stone models with highly accurate and durable stereolithography models. Benefits Cited The new digital imaging equipment now being used includes intraoral X-ray units, sensors and phosphorous plates, as well as panoramic, panoramic-cephalogram, and cone beam computed tomography machines that provide excellent visualization of the teeth and bony structures of the head. The radiographic images “will appear on a monitor in seven seconds or less,” said Roger Gillie, director of Application Services in Dental Informatics. Students and clinical faculty can zoom in on a digital image, highlight details and share radiographs. For example, residents in the oral surgery clinic, he said, “will be able to see radiographs taken in the emergency or predoctoral clinics before the patient is taken to that clinic for evaluation and treatment.” Electronic enhancements allow for greater review of image details and notes can be added as reminders of areas to watch in the future. Light boxes that have been used for many years to view film X-rays have been removed in the radiology clinic. However, in four clinics where predoctoral students treat patients under the supervision of clinical faculty, light boxes will remain since it will take about a year to scan tens of thousands of film radiographs to digital format. Dr. Stephen Stefanac, associate dean for Patient Services, said, “the quality of the digital X-ray images is exceptional and should help us to detect problems in patients earlier. Also important,” he added, “is that students can now show detailed images to their patients to help them understand the treatment options that are available.” Extensive Rollout Preparation The digital imaging initiative involved extensive collaboration among clinicians, radiologists, and staff in Patient Services, Radiology, Dental Informatics and others throughout the School, according to Dr. Erika Benavides, clinical assistant professor and oral and maxillofacial radiologist. She led the clinical digital imaging team. “It was a giant research project,” Benavides said with a smile. “We reviewed a considerable amount of information from many different hardware vendors and, because the equipment had different capabilities, evaluated each system using objective criteria.” Also critical was choosing the digital imaging software to use. “The software is the foundation that allows us to capture and store the images using the different radiology equipment, and allows clinicians and students to share the images throughout the School or even across campus,” she said. “Our clinician users were actively involved in evaluating the software, so their input was essential in making a final decision.” As Benavides talked to faculty and students, Gillie led a team of 12 people who “looked under the hood” to assess the digital technology being considered and evaluate its effectiveness. “The images had to be shared among 22 clinics at the School and three others at U-M Hospital where the School of Dentistry also has a clinic. The technology also had to be robust and user friendly for students, dental clinical faculty, students in graduate dental programs, and in research. Every area was important,” he said. The Paper to Digital Transition As the new school year began, Terri Stilwell, radiology clinic instructor, trained small groups of dental, dental hygiene, and graduate students how to use the new equipment. “The students are adapting to the changes very well and are excited to use the new technology,” she said. “They’re tech savvy and amazed at how easy it is to use.” The transition to digital imaging has also led to a change in vocabulary. As she trained one group of predoctoral students, Stilwell caught herself saying “film X-rays” and quickly corrected that. “It’s hard to break an old habit, especially when one has used a phrase like ‘film X-rays’ for so many years,” she said with a smile. Let’s use ‘digital images’ instead.” After January 1, 2014, the School will no longer create a paper record for new patients. “We will then digitize portions of 30,000 existing records,” Stefanac said. “When the paper records are in digital form and combined with new digital images, our students will have easier access to all their patient information.” Eventually, digital images will be accessible on Apple and Android mobile devices. All information will be encrypted to comply with all protected health information standards. Collaboration Across U-M “It was a great team effort. People from many disciplines came together to make this happen,” Benavides said. “Our faculty members were excited to learn about the capabilities of the new digital equipment and how to use it. Dental students were also enthused because they use technology extensively.” Gillie lauded the help received from the School’s Technology Services group, U-M’s Information Technology Communications (ITCOM) unit and the Medical School’s radiology department. “Working together we installed 80 imaging stations that allow us to take, store and manage digital images that are available on more than 1,000 computers,” he said. “Digital imaging is an excellent example of how the School of Dentistry is using technology to enhance the educational experience of students and the care provided to their patients.”

医学

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Division of Health Sciences Home Administration Events News News Stories Search News Articles News Staff For News Media Main Campus News Contact Us About Attack on America: Shock, horror and prayers for healing follow attacks Though terrorists hit New York, Washington, D.C., and Pennsylvania, the pain reached PCMH and the Brody School of Medicine The American flag at the Brody Building flies at half-staff following the Sept. 11 terrorist attacks. Photo by Cliff Hollis GREENVILLE, N.C. (Oct. 4, 2001) — The prayers spoken, the song sung, Dr. Larry Austin looked across the crowded Pitt County Memorial Hospital auditorium. "We are strong," said Austin, director of pastoral services at PCMH. "We will survive this. We are in pain, but that's OK." Thus ended a special service to remember those killed in the Sept. 11 terrorist attacks in Washington D.C., New York City and Pennsylvania, though many of the crowd of approximately 200 lingered to talk and share. Earlier, a number of people had spent part of their lunch hour in the auditorium of the Brody Medical Sciences Building reflecting and praying. The medical community was slowly getting back into a routine, though getting back to the same normal that existed before 8:45 a.m. Sept. 11, when an airliner carrying 92 people crashed into the north tower of the World Trade Center, might not be possible. "This is one of those days when we will all remember where we were," Jim Ross, PCMH president said. Two airliners had plowed into the twin towers of the World Trade Center, a third had slammed into the Pentagon, and a fourth had crashed in Pennsylvania, perhaps on its way to the Capitol or the White House. Around the hospital, people were gathered around televisions or listening to radios. Executives were wondering what might happen next, how far the disasters might reach. As events unfolded, special measures the hospital took included increasing the police presence around the perimeter of the campus, making sure that doors that were supposed to be locked were locked and making sure that supplies were at adequate levels, especially in light of air traffic being grounded. Chaplains with the pastoral services department also made themselves available to those wishing to speak with them about the attacks. "We are trying to do all the things necessary to support your staff and families and all the people in this building," Dave McRae, PCMH and UHS chief executive officer told managers during a called meeting hours after the attacks. "This is a time of crisis. This is in essence a declaration of war on this country and our very way of life and our freedoms." McRae added that the UHS family will remain strong and continue its mission in the face of the attacks. "In the meantime, we have work to do," he said. "We can't shut down and go home. We have people to take care of." The attacks also disturbed and angered local Muslim leaders. President Bush has named Saudi exile Osama bin Laden, a Muslim, as a top suspect in orchestrating the attacks. "[The terrorists] should be considered as individuals, and no ethnic group should be involved," said Dr. M. Saeed Dar, a professor of pharmacology at the Brody School of Medicine at East Carolina University. "It is bad as a human being to do that. It is worse as a Muslim. Taking one human life is like taking (all) humanity. No human being has a right to do something like that." Dar, a native of Pakistan, said most Muslims in his homeland and elsewhere are moderates who do not condone terrorism. "We're shocked. We've never seen anything like this in the world," Dar said. He added that local Muslims were joining relief efforts by donating blood and contributing money. Dr. Mareen Long, a 1995 ECU medical graduate and surgery resident in Fairfax, Va., was at a conference in Washington, D.C., when the attacks occurred. She said a physician from New York City was speaking when a clock fell from the wall at 8:27 a.m., prompting the speaker to say, "That's not a good omen." An hour later, after an airliner had struck the Pentagon, the conference center was evacuated, and Long joined the thousands of Washingtonians walking the streets. "Walking over the Key Bridge, you could see the black smoke coming out of the Pentagon," she said. "It was like a mass exodus out of Washington. "A lot of people are in a daze," she continued. "For two days, I had trouble concentrating. The biggest thing, I really felt helpless. It's been really stressful." Meanwhile, at ECU more than 2,200 students and others lined up to donate blood Sept. 11 and 12. Only about 950 made it through the line, with 757 units being collected. Also, the Student Government Association began a drive to raise $18,000, or approximately $1 from each student, to assist in relief efforts. The SGA also held a candlelight vigil Sept. 13 at Joyner Library. The ECU Student Union Cultural Awareness Committee offered free admission to a Sept. 13 program at Wright Auditorium titled, "Sacred Music, Sacred Dance for World Healing." The university also held a memorial service Sept. 12 in Wright Auditorium to honor victims of the terrorist attacks, canceling noon classes so students and faculty could attend. Sept. 14, ECU staff, faculty and students gathered at the Cupola to stop and reflect on the tragic events of this week. At PCMH, Linda Baker was one of three operating room staff members who hung red, white and blue bows over doorways outside and inside the O.R. area. "We're just being patriotic, showing that we're in support," Baker said. Over in the pre-op room, six staff members wore shirts bearing the American flag. In the medical intensive care unit, 9-year-old Brianna Peaden, daughter of Ron and Neva Peaden, a nurse and respiratory therapist, respectively, had written a message on a dry-erase board to PCMH employees, urging them to pray for those who lost loved ones or were hurt in the attacks. "This was a hard day for all of you," Brianna wrote. Next to her message, internal medicine resident Dr. Chirag Patel responded. "I wish we adults could make this world a better place for beautiful, caring kids like you," he wrote. "There are a lot of people in the hospital who are affected," Patel said later. "I feel bad for the youth who have to deal with it. They shouldn't have to see it. This is a scarring event." "I was out just yesterday, and people were snickering, looking," he said. "I guess that's to be expected, but I didn't do it (hijack the airliners)." Though the medical center and individual health care professionals were prepared to go to Washington and New York to help, sadly their services weren't needed. So complete was the devastation that few survivors remained to need medical attention. On a more positive note, the huge numbers of people who donated blood boosted low supplies to more than adequate levels. With that in mind, officials of PCMH and the American Red Cross have decided to keep the hospital's previously scheduled blood drive on Nov. 7 rather than moving it up. "There will still be a need in the future," said Will Moore of ViQuest, who coordinates blood drives at PCMH. Medical students follow coverage of the attacks on their laptops during a Sept. 12 class. Photo by Cliff Hollis | 252-744-2481 Division of Health Sciences 600 Moye Blvd | Greenville, NC 27834

医学

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Home > Living With Cancer > Treatment Choices Charting the Best Course 10 ways to make better decisions about cancer care For assistance in learning more about cancer treatments and accompanying risks, call the Patient Education Resource Center at 734-647-8626. Talking with doctors about cancer and cancer treatments can feel like learning a new language. People facing cancer diagnoses often need help to understand their treatment options -- and the risks and benefits of each choice "People are making life-and-death decisions that may affect their survival and they need to know what they're getting themselves into. Cancer treatments and tests can be serious. Patients need to know what kind of side effects they might experience as a result of the treatment they undergo," says Angela Fagerlin, Ph.D., associate professor of internal medicine at the University of Michigan Medical School and a U-M Comprehensive Cancer Center researcher. Fagerlin and colleagues recently published a commentary in the Journal of the National Cancer Institute that outlines 10 things health care professionals can do to improve the way they communicate information about treatment risks to patients. Here, they explain how patients can tap into these same best practices to become fluent in the language of cancer care and better understand their options. 1. Insist on plain language. If you don't understand something your doctor says, ask him or her to explain it better. "Doctors don't know when patients don't understand them. They want patients to stop them and ask questions," Fagerlin says. 2. Focus on the absolute risk. The most important statistic to consider is the chance that something will happen to you. "It"s important that patients and doctors know how to communicate these numbers, and patients need to have the courage to ask their doctor to present it so they can understand," Fagerlin says. Sometimes, the effect of cancer treatments is described using language like "this drug will cut your risk in half." But, such relative-risk statements don't tell you anything about how likely this is. Research has shown that using relative risk makes both patients and doctors more likely to favor a treatment because they believe it to be more beneficial than it actually may be. If, instead, your doctor told you that "the drug will lower your risk of cancer from 4% to 2%," now you know that most people won't get cancer regardless. And it will give you the exact benefit you would get from taking the drug. Fagerlin suggests asking doctors for this absolute-risk information for a truer picture. 3. Visualize your risk. Instead of just thinking about risk numbers, try drawing out 100 boxes and coloring in one box for each percentage point of risk. So, if your risk of a side effect is 10%, you would color in 10 boxes. This kind of visual representation, called a pictograph, can help people understand the meaning behind the numbers. Ask your doctor to draw it out for you or do it yourself. 4. Consider risk as a frequency rather than as percentages. What does it mean to say 60%t of men who have a radical prostatectomy will experience impotence? Imagine a roomful of 100 people: 60 of them will have this side effect and 40 will not. Thinking of risk in terms of groups of people can help make statistics easier to understand. 5. Focus on the additional risk. You may be told the risk of a certain side effect occurring is 7%. But if you didn't take the drug, is there a chance you'd still experience that? Ask what the additional or incremental risk of a treatment is. "You want to make sure the risk number you're being presented is the risk due to the treatment and not a risk you would face no matter what," Fagerlin says. 6. The order of information matters. Studies have shown that the last thing you hear is most likely to stick. When making a treatment decision, don't forget to consider all of the information and statistics you've learned. 7. Write it down. You may be presented with a lot of information. At the end of the discussion, ask your doctor if a written summary of the risks and benefits is available. Or ask your doctor to help you summarize all the information in writing. 8. Don't get hung up on averages. Some studies have found that learning the average risk of a disease does not help patients make good decisions about what's best for them. Your risk is what matters -- not anyone else's. Focus on the information that applies specifically to you. 9. Less may be more. Don't get overwhelmed by too much information. In some cases, there may be many different treatment options, but only a few may be relevant to you. Ask your doctor to narrow it down and only discuss with you the options and facts most relevant for you. 10. Consider your risk over time. Your risk may change over time. "What seems like a small risk over the next year or two may look a lot larger when considered over your lifetime," says study author Brian Zikmund-Fisher, Ph.D., assistant professor of health behavior and health education at the U-M School of Public Health. If you're told the five-year risk of your cancer returning after a certain treatment, ask what the 10-year or 20-year risk is. In some cases, this data might not be available, but always be aware of the time frame involved. Making Decisions and Charting the Best Course Resources from the U-M Comprehensive Cancer Center: Patient Education Resource Center at U-M Comprehensive Cancer Center The web is teeming with resources for patients who would like to take control of their health care. A good place to start your research is with the University of Michigan Comprehensive Cancer Center's Patient Education Center. Our librarian, Alexandra Sarkozy, can help you find the right information for you. Also, visit the PERC to receive a Patient Tool Kit to help you stay organized. Learning to Choose: How to make the right medical decisions for you Thrive profiles one family's path to choosing medical care at the University of Michigan Comprehensive Cancer Center. The story discusses research at the U-M Center for Behavioral and Decision Sciences and Medicine that seeks to help people make the best choices for their care. Patients key to advancing cancer treatment through clinical trials Thrive talks with Maha Hussain, M.D., associate director of clinical research at the U-M Comprehensive Cancer Center, about why some patients choose to participate in research studies as part of their cancer treatment plan. Association of Cancer Online Resources (ACOR) Find an online support group. Center for Advancing Health Foundation for Informed Medical Decision Making Visit this website to read experts' reviews of news stories about medicine and science. Journal of Participatory Medicine Prepared Patient Forum Jessie Gruman's tweets on health headlines ePatients: How They Can Help Us Heal Healthcare Read the document at the core of the e-patient movement. Thrive Issue: Winter, 2012

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Tuberculosis looks set to defy concerted efforts to treat it successfully with powerful drugs, turning the clock back to the 1930s, warn the editors of the journal Thorax in a special themed issue to mark World TB day on March 24. TB often lies dormant with no symptoms, but in a proportion of cases, becomes active, predominantly attacking the lungs. But it can also affect the bones and nervous system, and if left untreated can be fatal. The infection is developing increasing resistance around the world to the powerful drugs currently used to treat it. During the 1930s, dedicated sanitaria and invasive surgery were commonly prescribed for those with the infection — usually caused by Mycobacterium tuberculosis, which the editors describe as “the most successful human pathogen of all time". “Whatever we may have once optimistically thought, TB remains with death, taxes and political chicanery as being inevitable, unavoidable and deeply unpleasant,” write the joint editors, Andy Bush and Ian Pavord. “It shows every sign of weathering the storm and superb randomised controlled trials, to emerge in ever-increasingly drug-resistant forms, potentially turning the clock back to the 1930s. This edition of Thorax, coinciding with world TB day, is themed to recognise the ongoing sinister successes of Mycobacterium tuberculosis, unarguably the most successful human pathogen of all time.” The issue contains international research papers, looking at a broad range of issues, from the risk of TB after seroconversion to HIV infection, to the impact of ethnicity on the pattern of disease. Highlights include: The ability of new single step and cost effective tests to eradicate the need for chest x-ray screens for newly arrived immigrants to the UK, who account for 70% of TB reported infections in the UK http://press.psprings.co.uk/thx/february/thx201542.pdf The vulnerability of patients with diabetes to more severe TB infection and a higher probability of unsuccessful treatment http://press.psprings.co.uk/thx/february/thx201756.pdf A 16-fold increase in non-tuberculous mycobacterial (NTM) infection among patients with chronic obstructive pulmonary disease (COPD) treated with steroids: 1 in 3 people with NTM die within 3 years of contracting the infection http://press.psprings.co.uk/thx/february/thx201772.pdf The ability of childhood BCG vaccination against latent TB to last for decades afterwards, resolving some of the doubts about its long term impact http://press.psprings.co.uk/thx/february/thx202208.pdf The cost effectiveness of automatically treating young children in close contact with an infected adult, without testing them, in a bid to curb the spread of the infection. http://press.psprings.co.uk/thx/february/thx200933.pdf Plus editors’ comments and overview of the themed issue: http://press.psprings.co.uk/thx/february/thx203268.pdf To top

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November 9, 2010 CONTACT: Marc Kaplan 215-662-2560 marc.kaplan@uphs.upenn.edu This release is available online at http://www.uphs.upenn.edu/news/News_Releases/2010/11/caplan-biomedical-ethics-prize/ Leading Biomedical Ethics Prize Presented to Penn’s Arthur L. Caplan, Ph.D. PHILADELPHIA – Arthur L. Caplan, Ph.D., the Emmanuel and Robert Hart Director of the Center for Bioethics and the Sydney D Caplan Professor of Bioethics at the University of Pennsylvania has been selected to receive the Patricia Price Browne Prize in Biomedical Ethics, administered by the University of Oklahoma College of Medicine. The $10,000 prize, given every two years, was established to honor the Oklahoma City community leader Patricia Price Browne, by selecting an individual who “demonstrates the highest standards in the medical or professional ethics fields.” Dr. Caplan is among the nation’s pre-eminent scholars and commentators in the field of biomedical ethics, having authored or edited twenty-nine books and over 500 papers in refereed journals. His most recent book is the Penn Guide to Bioethics (Springer, 2009). “Dr. Caplan has provided a consistently high level of research and analysis relating to the ethical quandaries posed by today’s relentless advances of medical science and technology,” said Terrence Stull, MD. Chairman, Department of Pediatrics, University of Oklahoma Health Sciences Center on behalf of the selection committee. “On the biomedical hot-button topics that generate sensational headlines, Dr. Caplan provides a reasoned, measured, and wise perspective that the public can rely upon.” Dr. Caplan has served on a number of national and international committees including as the Chair, National Cancer Institute Biobanking Ethics Working Group; the Chair of the Advisory Committee to the United Nations on Human Cloning; the Chair of the Advisory Committee to the Department of Health and Human Services on Blood Safety and Availability; a member of the Presidential Advisory Committee on Gulf War Illnesses; the special advisory committee to the International Olympic Committee on genetics and gene therapy; and most recently was the Co-Director of the Joint Council of Europe/United Nations Study on Trafficking in Organs and Body Parts. Caplan writes a regular column on bioethics for MSNBC.com. He is a frequent guest and commentator on various media outlets. ### Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $4.3 billion enterprise. The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 17 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $392 million awarded in the 2013 fiscal year. The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania -- recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report; Penn Presbyterian Medical Center; Chester County Hospital; Penn Wissahickon Hospice; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Chestnut Hill Hospital and Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine. Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2013, Penn Medicine provided $814 million to benefit our community.

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HomeThis is the archived site - Click here for the new site An unvaccinated child has died from a preventable disease Swift Written by Phil Plait This story is so sad, and what makes it worse is that it was preventable. The Centers for Disease Control has put out an alert: in Minnesota in 2008, there were five confirmed cases of Haemophilus influenzae type b (or Hib) among children younger than five years old. Of these five cases, three of the children were unvaccinated, one had started the series of vaccines but did not complete the series due to shortages, and the fifth -- who had been fully vaccinated -- had an immune deficiency. Five cases may not sound like a lot... until you learn that one of the unvaccinated children died. This was a baby, just a seven-month-old infant. I can barely type that sentence out; my heart is aching so. I can only imagine what the parents are feeling. I literally have nightmares about such things. There are several things to note about this incidence of Hib: 1) It's the largest number of cases in one year since 1992 in Minnesota, when 10 cases were reported. In the intervening years, between 0 and 4 cases were reported per year (1994 saw four cases, the average is about 2). These are small number statistics, so 5 cases may just be a normal statistical fluctuation. But the stakes are very, very high here. 2) We do not know why three of the five children were unvaccinated. It may be due to the antivax crowd, or it may be due to any number of other factors; the report doesn't say (however, see (5) below) 3) Out of three unvaccinated children, one died. The historical rate of death from Hib, once infected, is about 1 in 20, so this is something of a fluke. But 1 in 20 is still way, way too high... and of the ones who do survive the infection, 1 in 5 will suffer deafness, blindness, or severe, permanent brain damage. Russian roulette has better odds than 1 in 5; do you want to play that with your baby? If that sounds harsh, good. We're dealing with babies' lives here. The best thing you can do is make sure they don't get the disease in the first place. 4) Getting a vaccine does not guarantee not getting the disease. We don't know how many babies were vaccinated, and how many weren't that didn't get the disease. But with 1 in 20 odds, I know which way I fall. 5) There is a shortage of Hib vaccines right now, and it's expected to last for a few more months. However, according to the CDC report, there are adequate supplies to have infants inoculated and complete the primary three-dose infant series. Data were reviewed for 25,699 children born between November 1, 2007 and March 31, 2008... Among children aged 7 months, 3-dose primary Hib series coverage was 46.5%, which is lower than the age-appropriate coverage for children who had received pneumococcal conjugate or diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccination. In contrast, data from the 2007 National Immunization Survey, conducted prior to the shortage, showed that Hib vaccination coverage among children in Minnesota aged 19 months to 35 months was high and did not differ from the national average, suggesting that coverage has declined as a result of the shortage. So there has been a decline in coverage due to the shortage, with roughly half the children in the survey being vaccinated. Putting this all together is difficult, with so many unknowns. But to belabor the obvious, we do know one thing: of the three unvaccinated children who got Hib, one died. The doctors from the CDC add this editorial comment: Before development of Hib conjugate vaccines, Hib was the most common cause of bacterial meningitis in children aged <5 years. Since implementation of the Hib conjugate vaccine immunization program in the United States in the early 1990s, the incidence of Hib disease has declined from a peak of 41 cases per 100,000 children aged <5 years in 1987 to approximately 0.11 cases per 100,000 in 2007. In other words, the infection rate among infants dropped by a factor of nearly 400 after the Hib vaccination was developed. This recent increase may reflect a loss of herd immunity, meaning too many kids are not getting vaccinated. Folks. Please. Vaccinate your children. The science is in, the tests have been done, the results are solid: vaccinations do not cause autism. What vaccines do is save the lives of thousands of children who would otherwise be suffering the effects of preventable diseases... and one of these effects can be death. Save your kids' lives. Take them to a doctor and get his or her advice on this. And if they recommend vaccinations, then do it. My thanks to Dr. Joe Albietz for providing me with some of the numbers in this article.

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Home About Us COEH at a Glance COEH Activities & Events COEH Chronology COEH Movie Links What is COEH? Global Health & Environment Occupational & Environmental Epidemiology Occupational & Environmental Medicine Occupational & Environmental Health Nursing Financial Support Llewellyn COEH Student Award M. Donald Whorton Writing Award STEER Program NIOSH Traineeships (FAQs) Links for students SPH Job Site Education Overview Global Heath & Environment Occupational & Environmental Health Nursing Continuing Professional Education Financial Support NIOSH Traineeships FAQ Service & Outreach Continuing Professional Education Labor & Community Education COEH Bridges Newsletter Faculty Websites Recently Funded Projects Administrators Contact Us Links for students SPH Job Site Home For Students & Alumni Alumni Pete Estacio COEH Alumnus Uses Medical Training to Fight Bio-terrorism March 2002 On September 11, physician Pedro Luis (Pete) Estacio, staff scientist at the Lawrence Livermore National Laboratory (LLNL), was in New York attending a conference on terrorism with many leaders of the anti-terrorism community of New York City. Following the attacks on the World Trade Center, Estacio went first to the ad hoc command center and then joined a search and rescue team that was using special radar equipment developed at LLNL to hunt for survivors. Tragically, there were none. "I was struck by the extent of the devastation and the realization that the people who did that would have done more if they could," Estacio recalls. "They would have used the most destructive means they could to harm as many people as possible without a second thought. It was sobering to realize that there are people who would deliberately cause such harm to innocent people." As part of the chemical and biological national security program at LLNL, Estacio helps to develop detection methods and response capacity for bio-terrorism. Since the attacks of September and the early days of the anthrax crisis, Estacio has worked practically non-stop responding to national crises. A member of the California Disaster Medical Action Team (DMAT), he has gone to New York, Washington, and Florida to help monitor potential anthrax exposure risks and to help state laboratories develop new detection methods, improve sampling efficiency, and validate assays. "I became profoundly interested in this area several years ago when I was asked to consult," he said. "The more I learned, the more worried I became about the safety and welfare of my children and my neighbors, and the more I wanted to be involved in addressing the problems." Estacio brings a unique combination of education and experience to protecting the nation's health and welfare. With a doctorate in chemistry from UC San Diego, an M.D. degree from Albert Einstein College of Medicine in New York, a master's degree in public health from UC Berkeley, and years of clinical practice in COEH's Occupational and Environmental Medicine Program at UC San Francisco, he considers combating biological, chemical, and nuclear terrorism to be "a natural offshoot" of problems he has had to address over the years. People who want to do harm can use materials that are commonly found in the work setting, like chlorine gas, he said, noting that occupational and environmental medicine deals with chemical, biological, and radiation exposure as well as with epidemiology, which is critical to surveillance. Two other graduates of COEH's Occupational and Environmental Medicine Program play key roles at LLNL in fighting bio-terrorism and responding to national disasters: Medical Director James Seward and clinical physician Steven Burastero, who oversees the medical needs of the crisis teams. Lack of Preparedness Estacio believes the biggest threat to our nation is our lack of preparedness. "The infrastructure is not well tuned enough," he said, adding that we should consider chemical, biological, and radiological detection to be just as important—and as normal in everyday life—as fire alarms. "There will be false alarms," he said, calling the occasional false alarm the price we pay for safety. "If that's intolerable, then we'll never be ready," he said. "Ongoing surveillance and response planning is critical to protect ourselves, our loved ones, and our community." Another challenge is improving coordination among government agencies. "It will be next year before we really see if the people who have been put in charge to coordinate all of these 40 to 50 agencies really have any effect. I think they won't, unless they have some kind of financial clout," he said. Public Health Pay-off Estacio sees his role as helping to bring a strong scientific foundation to the nation's ability to combat biological threats. He is optimistic that the work being done all over the country to respond to bio-terrorism will "significantly advance public health, not just our response to bio-agent threats but also to natural occurrences like outbreaks of infectious disease." He hopes to work with COEH faculty members to "do more solid science" in addressing vital questions such as how to make personal protective equipment more safe for biological exposures. "You don't have to work with nasty bugs to prove the principles and advance public health in this important area," he said. PHOTO: Pedro Luis Estacio Contact COEH Send web questions and comments to coeh@berkeley.edu © , The Regents of the University of California. All rights reserved.

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7:00 pm 3 Steps to Incredible Health! with Joel Fuhrman, M.D. 3 STEPS TO INCREDIBLE HEALTH! with Joel Fuhrman, MD is a sixty-minute pledge program that directly addresses the crisis of obesity and chronic disease plaguing America. Over 65% of Americans are overweight or obese - and that number is growing just like our waistlines! Dr. Joel Fuhrman's revolutionary health plan is not about will power, it is about knowledge. 3 STEPS TO INCREDIBLE HEALTH! offers a healthy, effective, and scientifically proven plan for shedding weight quickly and reclaiming the vitality and good health we all deserve. D 9:00 pm Burt Wolf: Travels & Traditions "Assisi, Italy" The town of Assisi, in the center of Italy was built on a hill that has been inhabited for about 4,000 years, and for almost as long it has been a religious center. They say that the stones that were used to build Assisi have absorbed the prayers of the millions of pilgrims that have come there over the centuries. And now, it is believed that the stones radiate a sense of peace and quiet that has a spiritual effect on visitors. D "Dinner Party Special" Jacques develops his own version of Tibetan flatbread, which is cooked in a frying pan. Next, Jacques fixes risotto with broccoli stems.G 10:00 pm America's Test Kitchen from Cook's Illustrated "Mediterranean Specials" NULL "Rustic Yet Refined" NULL "West Turkey" Rick visits the ancient sites of Ephesus and Aphrodisias, meanders up the Meander River, eats Turkish pizza and discovers a blend of ancient and modern cultures.G <<Previous Month

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Share New CEO Takes Reigns at Savannah's Memorial Health (June 5, 2009) - This week, Phillip S. Schaengold, J.D., MBA, FACHE, began work as the new president and CEO of Memorial Health. Schaengold is a veteran healthcare executive with more than 25 years of senior leadership experience, primarily at academic medical centers and safety-net hospitals similar to Memorial University Medical Center. "I've already met many of the Team Members at Memorial Health. I can tell that these are hard-working people who are committed to providing the very best and safest medical care every day. I'm honored to be part of this organization and this community," said Schaengold. Schaengold and his wife, Melanie, moved to Savannah from Syracuse, N.Y., where he was CEO of University Hospital, an academic medical center affiliated with the State University of New York Upstate Medical University. Memorial Health has been under the leadership of an interim CEO since spring 2008, when the Board of Directors voted to hire a new leader. Schaengold was chosen following an extensive nationwide search. He holds a Bachelor of Science in Pharmacy degree, a Master of Business Administration degree from the University of Cincinnati, and a Juris Doctor from the Salmon P. Chase College of Law at Northern Kentucky University. Schaengold is also a Fellow in the American College of Healthcare Executives. Memorial University Medical Center is a two-state healthcare organization serving a 35-county area in southeast Georgia and southern South Carolina. The system includes its flagship hospital, a 530-bed academic medical center; Memorial primary

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< Go BackGlaucoma Drug May Help Reverse Obesity-Related Vision LossTUESDAY, April 22, 2014 (HealthDay News) -- A drug used to treat glaucoma eye disease can also help people with vision loss linked to obesity, a new study reveals.Researchers examined the effectiveness of the inexpensive drug, called acetazolamide (Diamox), in women and men with the condition known as "idiopathic intracranial hypertension." According to the researchers, the disorder primarily affects overweight women of reproductive age, and 5 percent to 10 percent of women with it suffer disabling vision loss.This study included 161 women and four men with idiopathic intracranial hypertension and mild vision loss. The investigators found that adding acetazolamide to a weight-loss plan featuring calorie reduction, lowered salt intake and exercise boosted vision improvement in these patients.Specifically, the vision of those who took the drug improved twice as much after six months compared to those who took an inactive placebo, according to the U.S. National Eye Institute-funded study published April 22 in the Journal of the American Medical Association."Our results show that acetazolamide can help preserve and actually restore vision for women with [idiopathic intracranial hypertension] when combined with a moderate but comprehensive dietary and lifestyle modification plan," Dr. Michael Wall, a professor of neurology and ophthalmology at the University of Iowa in Iowa City, said in a National Eye Institute (NEI) news release.Doctors need more guidance in treating this condition, another expert noted."The vision problems associated with this condition can be extremely debilitating, at significant cost to patients and the health care system. Yet there are no established treatment guidelines. We made it a priority to develop an evidence-based treatment for helping patients keep their vision," Eleanor Schron, director of clinical applications at NEI, said in the news release.Idiopathic intracranial hypertension occurs when increased pressure within the fluid-filled spaces inside and around the brain causes swelling and damage to the optic nerve, according to the news release. Common symptoms include headache and eye problems such as blind spots, poor side vision, double vision and temporary spells of blindness.Acetazolamide reduces fluid production in the brain and is often used as an additional treatment -- along with weight loss -- for people with idiopathic intracranial hypertension. However, there has been little evidence that the drug is effective in such cases.About 100,000 Americans have idiopathic intracranial hypertension, according to the news release, and that number is rising due to the nation's obesity epidemic.More informationJohns Hopkins Medicine has more about idiopathic intracranial hypertension.SOURCE: U.S. National Eye Institute, news release, April 22, 2014

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PURPOSE AND HEALTH ISSUES The purpose of this health consultation is to examine the potential for adverse health effects to residents living in the vicinity of the Smith Road Municipal Solid Waste Landfill (MSWL) in Homerville, Georgia. The discussion of these health effects will be limited to those which may result from exposure to contaminants released from this particular source. This document specifically examines any potential routes of exposure that have existed in the past, that may currently exist, and that may exist in the future. The discussion of exposure issues focuses on any impacts that releases from the landfill may have on private wells in the areas surrounding the site. Because this is a public health document, it does not address issues of liability, remediation alternatives, future land use, and other issues that are decided by state or federal environmental agencies unless the issue affects public health. Ultimately, this document provides conclusions on the public health issues which are relevant to this site and recommendations to protect the health of the residents who live in the area. The Georgia Division of Public Health (GDPH) was asked by the Georgia Department of Natural Resources, Environmental Protection Division (EPD), to conduct a health consultation on the MSWL in Homerville, Georgia. The cooperation between EPD and GDPH was initiated through a memorandum of agreement for GDPH to address public health hazards at any Georgia sites where EPD is concerned about environmental contamination releases from a site that they regulate. EPD is concerned about possible adverse health effects caused by past, present, and future exposures to environmental contamination from the landfill. The Clinch County MSWL is located approximately 2.3 miles north-northwest of the city of Homerville, Georgia. The landfill is located adjacent to Woodyard Creek on relatively flat land. A number of residences are in the surrounding areas south and southeast of the landfill. The landfill was opened in 1983 for disposal of municipal solid waste on land which was leased by Clinch County. As part of an agreement with EPD for irrigation and promotion of on-site contaminant volatilization, 17 trenches, each four feet deep by 30 feet wide, were dug, along with a perimeter ditch that extended below the water table. In June of 1990, Clinch County purchased the property on which the landfill is located. In June 1991, a groundwater monitoring plan was prepared and sent to EPD for approval. The plan called for establishment of 13 downgradient wells and 2 up-gradient wells. The monitoring plan was approved by EPD in February 1992. The wells were installed in May 1992, and sampling began in July 1992. These on-site wells contained very high levels of several volative organic chemicals (VOCs) when sampled in July 1992. In January 1994, the landfill was closed, and EPD ordered Clinch County to begin an assessment monitoring program at the landfill. In July 1997, Mr. Steve White of EPD's Hazardous Waste Management Branch conducted a site investigation on site and off site at the landfill. In April 1998, GDPH conducted a site visit and an interview with Mr. John Strickland, Clinch County Commissioner. Over the years, most of the trenches had been filled by topsoil runoff. In the areas where the perimeter ditch was still in place, a great deal of standing water was found. There did not appear to be any on-site activity, but access to the site is unrestricted.

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NAMA backs petition for corn masa flour fortification by Josh Sosland WASHINGTON — The North American Millers’ Association has written the Food and Drug Administration in support of a petition to allow the fortification of corn masa flour with folic acid. The letter from Mary Waters, president of NAMA, to Judith Rabaglia with F.D.A.’s Office of Food Additive Safety, was written in support of a petition by the Spina Bifida Association and five other petitioners to allow the fortification. Ms. Waters noted Hispanic women are 20% more likely to have a child with a neural tube defect than non-Hispanic women. “While the reasons for the disparity are not fully understood, Hispanic women have been found to have a lower intake of folic acid overall compared to non-Hispanic women,” Ms. Waters said. Since 1998, fortification of enriched cereals grains and pasta has been mandatory while corn masa flour has lacked federal regulatory approval for the addition of folic acid. Over this period, the rate of neural tube birth defects has fallen about one third. But Hispanics today have the highest rate when compared to other race or ethnic groups. “Fortifying corn masa flour with folic acid is a simple and highly effective step in protecting the health of Hispanic children in the U.S. and the North American Millers’ Association strongly supports this public health effort,” Ms. Waters said.

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Healthcare Bridging the Cultural & Language Barrier Professional ethnic and demographic nursing associations within our region celebrate diversity while helping bridge language and cultural barriers for patients. How do these groups work to foster the best of their cultures, help their communities, and bridge cultural and language barriers to health care for minority and immigrant populations? Business Life contacted several for their perspective: Rosine Der-Tavitian, RN, MSN, MPH Clinical Placement Coordinator, Dept. of Nursing, CSUN President, Armenian American Nurses Association Rosine Der-Tavitian, RN, MSN, MPH is the current president of the Armenian American Nurses Association (AANA). She has worked at trauma hospitals, city colleges and universities for more than 25 years, and is a board certified Clinical Nurse Specialist. She leads 97 active members of the ANAA in the Western region. “AANA is a professional organization of Armenian nurses from Los Angeles who are dedicated to serving the Armenian community, both in Armenia and the Diaspora. We conduct monthly meetings with educational dinner lectures. The lectures provide approved Continuing Education units,” says Der-Tavitian. “AANA has been very active in the Armenian community by bridging language barriers. We provide healthcare community education locally and globally. This is done in collaboration with the Armenian American Medical Society, Local Armenian Cultural organizations, the Glendale Unified School District, and the LA County Public Health Department, to name a few. Every year in November we do health screenings at the Glendale Health Festival. “Currently, our biggest challenge is preparing for the first international nursing conference to be held in Hollywood July 3, 2013. This requires added commitment from our members, most of whom work full time and take care of their families. We know we will overcome the challenge because we believe that education is the door to success for a healthy society.” For more information, visit AANA at www. armeniannurse.org/home.html. Joyce Spalding, MSN, RN, CDE Cedars-Sinai Medical Center President Council of Black Nurses, Los Angeles, Inc. The Council of Black Nurses, Los Angeles, Inc. (CBN, LA) was the first chartered Chapter of the National Black Nurses Association (NBNA). CBN, LA’s mission and goals are aligned with NBNA’s: to provide a forum for collective action by black nurses to investigate, define and advocate for the health care needs of African Americans; and to implement strategies that ensure access to health care, equal to, or above health care standards of the larger society. CBN, LA is celebrating 41 years as an organization, and currently represents more than 70 LVNs, RNs and nursing students in the Los Angeles area. Joyce Spalding, MSN, RN, CDE is the 15th president of CBN, LA and works at Cedars-Sinai Medical Center as the Outpatient Diabetes Educator. Spalding, on the activities and goals of the local chapter: “CBN, LA currently serves its members by providing continuing education units, providing a forum for networking, scholarships and mentoring. Members of CBN, LA reach out to our community by providing health care screenings, giving lectures on health topics, partnering with other organizations and attending NBNA day on Capitol Hill to speak to representatives about the health disparities in our community. Our main challenges include recruitment of nurses and educating the community we serve on the Affordable Care Act.” For more information, visit CBN, LA online at www.cbnlosangeles.org. Diane Sanchez, RN, PHN, MSN/MPH, CNS Assistant Nursing Director President, National Association of Hispanic Nurses, Los Angeles Chapter Reaching out to the Hispanic community in Southern California, the Los Angeles Chapter of the National Association of Hispanic Nurses (NAHN LA) has more than 200 members. The active chapter produces newsletters, maintains a website, and sends email blasts to keep members up to date on local activities, events and job opportunities. The chapter also provides networking opportunities and a mentorship program for generic nursing students and RNs returning to school for advanced degrees. “Latino communities have many barriers which inhibit access to medical care,” says Sanchez. “Knowing the language, culture and belief system assists our members in closing those barriers by being an advocate at the bedside, in the community, and in the legislative arena. Many of our members work in underserved areas of Los Angeles where the majority of our Hispanics live. “In California, there are 7.1 million uninsured people, with Hispanics having the highest rate of uninsured – at 30.1 percent. Hispanic nurses comprise only four percent of all registered nurses in California. With the Affordable Care Act looming, a more diverse workforce is needed in relation to the Hispanic population. We need to ensure that hospitals, clinics, and public health programs reflect the faces of their patients, customers and stakeholders.” For more information, visit NAHN LA at www.lanahn.com. Mindy C. Ofiana, MSN, RN Assistant Administrator for Operations, Kaiser Permanente LA Medical Center President, Philippine Nurses Association Southern California, Inc. It is the 50th anniversary of the Philippine Nurses Association of Southern California, Inc. (PNASC, Inc.) and Mindy Ofiana, current President, reflected: “History can be defined as a study of events from the past leading up to the present time. And the study of history focuses on not just chronological events but also the impact and influence those events continued to have throughout time. PNASC, Inc. took this journey of history from its humble beginnings in 1961 to what it has now become. We are 50 years of age, more than 500 members strong, and growing. PNASC, Inc. is one of the 43 Chapters of our mother organization, Philippine Nurses Association of America, with approximately 5000 members. “We facilitate the creation of a community of Filipino-American nurses who work together to promote and protect the profession by upholding the positive image and welfare of our constituents, promoting professional excellence, and contributing to positive outcomes for healthcare and society at the local, national and global level. Our members benefit from educational programs at discounted rates, networking opportunities with other professional and community organizations, linkages for advancement and diversification in nursing practice, education and research, awards and scholarship grants to qualified candidates, and social media access. PNASC, Inc. does share variety of challenges that impact our dynamics and performance. In many ways, the age old question, ‘What's in it for me?’, continues to be our stumbling block. We need to challenge members’ motivation and commitment, distinguish ourselves from other professional organizations, and balance members' multiple priorities.” For more information, visit PNASC, Inc. online at www.thepnasc.org.

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HomeVOICE CENTER HOMEPatient EducationVoice Disorders Johns Hopkins Voice Center VOICE CENTER HOME Voice Screenings Care of Your Voice Vocal Warm-Ups Vocal Self-Screening Reflux Changes to the Larynx Tips for Professional Voice Users Research and Resources on the Larynx Video / Image Library National Referral Database The Relationship Between Your Medical Health and Your Voice The cause of a voice disorder may be attributable to a wide range of structural, medical, neurological, or behavioral conditions. Complete evaluation by an otolaryngologist and a speech-language pathologist is highly recommended. Voice Disorders - View Brochure Inflammatory Conditions Acute Non-Specific LaryngitisThe term "laryngitis" refers to an inflammation of the vocal folds and larynx, and may cause hoarseness, lowered pitch, or even voice loss. Acute non-specific laryngitis may be associated with viral infections, acid reflux, exposure to pollutants in the atmosphere, exposure to tobacco or drugs, or a period of vocal fold irritation such as shouting. TreatmentTreatment is usually antibiotic or steroidal; occasionally voice therapy is recommended if appropriate. Chronic Non-Specific LaryngitisChronic non-specific laryngitis refers to long-term inflammation of the vocal folds, and may be characterized by persistent hoarseness and vocal fatigue. Vocal overuse and misuse is a leading cause of chronic laryngitis. Additional causes include smoking, dehydration including the use of dehydrating medications, acid reflux disease, abusive use of mouth washes containing alcohol, or the repeated vomiting often associated with bulimia. TreatmentVaries depending on the cause.(The Voice and Its Disorders , Greene & Mathieson, 5th edition, Whurr Publishing, 1989). Voice Disorders Related to Vocal Overuse and Misuse Vocal Fold NodulesVocal fold nodules are the most common benign vocal fold lesions, and are sometimes referred to as "singers nodes." They are usually bilateral and occur at the junction of the anterior 1/3 and posterior 2/3 of the vocal folds. They may vary significantly in size. Nodules may be acute or chronic; chronic, or "mature" nodules are similar to calluses within the vocal fold tissue. Vocal characteristics include hoarseness, breathiness, and lowered pitch.TreatmentVoice therapy is often the first step in resolving nodules; treatment is usually 4 - 8 weeks. Results may vary depending on how long the nodules have been present and patient compliance with the therapy program. Surgical removal may be appropriate in some cases. Vocal Fold PolypsA vocal fold polyp is a fluid-filled lesion that may occur unilaterally or bilaterally. They may vary in size and will often be classified as either "sessile" (close to the tissue, like a blister) or pedunculated" (attached to a slim stalk). They are most commonly thought to be caused by vocal abuse or trauma, cigarette smoking, or vocal fold hemorrhage, but the exact cause is unknown. Vocal characteristics often include hoarseness, breathiness, diplophonia (audible perception of two distinct pitches), and stridor (noisy breathing).TreatmentA vocal fold polyp usually does not respond to voice therapy; however, your physician may recommend voice therapy to clear the surgical field (reduce swelling and irritation). Surgical removal will most likely be recommended. Vocal Fold Cysts Vocal fold cysts are fluid-filled growths that may be congenital or acquired. They may appear on only one or both of the vocal folds. Vocal quality consistent with a vocal cord cyst may include hoarseness, breathiness, and voice and pitch breaks.TreatmentVocal fold cysts generally do not respond to voice therapy, and surgical removal will most likely be recommended depending on the severity of the vocal problem; however, your physician may recommend voice therapy pre-surgically to clear the surgical field (reduce swelling and irritation) or post-surgically to address any residual hoarseness. Reinke's Edema Reinke's Edema occurs when the membranous portion of the vocal folds become filled with fluid. It may be unilateral or bilateral, and when it becomes very severe, it is often referred to as Polypoid Degeneration. Risk factors include long-term smoking and chronic vocal overuse or misuse. Vocal characteristics consistent with Reinke's Edema include significantly lowered pitch and severe hoarseness.TreatmentReinke's edema does not generally improve with voice therapy, and surgical removal is often recommended. Pre- or post-surgical voice therapy may be recommended by your physician. Muscle Tension DysphoniaMuscle Tension Dysphonia (MTD) is a general term to describe excessive and unnecessary tension of laryngeal muscles during voicing. MTD is often referred to by many different names, including hyperfunction, functional dysphonia, ventricular or false vocal fold compression, etc. MTD is often thought to be a compensatory mechanism in the presence of an underlying laryngeal pathology. Symptoms often include a sensation of excessive laryngeal tension and strain, vocal fatigue, and hoarseness.TreatmentThe definitive treatment for muscle tension dysphonia is voice therapy with a speech-language pathologist. Specific vocal exercises will be prescribed to decrease excessive muscular tension with voicing. Voice Disorders Related to Nervous System Disturbance Vocal Fold Paresis/ ParalysisVocal fold paresis (weakness) or paralysis (complete absence of movement) may result from a viral infection, cerebral vascular accident (stroke), trauma to the head, recurrent laryngeal nerve damage following surgery to the head, neck, or chest region, or may be idiopathic (cause unknown). A tumor may also cause immobility of the vocal fold(s). Vocal characteristics consistent with vocal fold paresis/ paralysis include breathiness, hoarseness, diplophonia (audible perception of two distinct pitches), decreased pitch range, and an inability to increase loudness.TreatmentTreatment will vary depending on the cause of the paresis/ paralysis, but voice therapy and surgery are two common treatment options. Prior to any surgical recommendations, many physicians may request a procedure called a laryngeal electromyography to assess the nerve activity and recovery potential of the larynx. Spasmodic DysphoniaSpasmodic dysphonia refers to group of disorders characterized by involuntary spasms of the vocal folds. The two most recognized forms are described as either adductor spasmodic dysphonia (increased closing of the vocal folds) or abductor spasmodic dysphonia (increased opening of the vocal folds). The exact cause of spasmodic dysphonia is unknown, but it is thought to have a neurological origin. Other neurological symptoms will sometimes be present, including tremor, facial ticks/ jerks, or other uncontrollable movements. Vocal characteristics include a strained/ strangled voice, or in the case of adductor spasmodic dysphonia, a breathy voice, often with pitch breaks. Symptoms often disappear in whispered or sung speech.TreatmentSpasmodic dysphonia has been known to be resistant to treatment. A popular treatment in the case of adductor spasmodic dysphonia are Botox injections. Botox, or botulinum toxin, is injected into certain laryngeal muscles to relax the muscles and decrease spasms. Voice therapy will not "cure" spasmodic dysphonia but is often recommended to educate the patient and to instruct the patient in compensatory strategies. Voice Disorders Related to Disease or Trauma HemorrhageA hemorrhage of the vocal fold occurs when a blood vessel ruptures and bleeds into the submucosal layer of the vocal fold. A hemorrhage is usually unilateral, but can occur bilaterally, and is usually the result of a single episode of traumatic voice use. It may also result from a combination of overuse of the voice and taking anticoagulants (e.g., aspirin) or persistent usage of steroidal inhalants. Vocal characteristics include hoarseness, loss of pitch range, and vocal fatigue.TreatmentVoice therapy is often recommended to address vocal health and hygiene and to instruct the patient in vocal facilitation techniques targeted at reducing swelling. VarixA varix is described as a long, defined blood vessel on the surface of the vocal fold, and is often seen in conjunction with a hemorrhagic episode. It is thought to be caused by vocal overuse or misuse and is usually the result of a single traumatic episode. Vocal quality may be hoarse.TreatmentVoice therapy may be recommended depending on the vocal symptoms present. GranulomaGranulomas are vascular lesions that are most often the result of laryngopharyngeal reflux (acid reflux into the larynx), laryngeal intubation during surgery, or voice misuse. Because granulomas often occur on the vocal process of the arytenoid cartilage and not on the actual vocal fold, vocal quality may not be affected; however, vocal symptoms may include hoarseness, breathiness, reduced pitch range, and vocal fatigue.TreatmentIn cases where the granuloma is felt to be related to laryngopharyngeal reflux, anti-reflux medications are usually prescribed. Surgical removal may be necessary. Voice therapy is often recommended. PapillomaPapillomas are wart-like lesions thought to be caused by viruses. Lesions can invade deep into vocal fold tissue, causing severe hoarseness and breathiness, and in some cases, respiratory problems. Papillomas can occur throughout the larynx and upper airway.TreatmentBecause papillomas have a tendency to spread rapidly, surgical treatment is almost always recommended. Papillomas also have a tendency to recur, and often multiple surgical excisions are required. Voice therapy may be recommended to assist patients after surgery and to encourage optimal vocal quality. Contact UlcersA contact ulcer is a small lesion that typically develops on the medial portion of the vocal folds. The ulcer may be unilateral or bilateral. Contact ulcers are most often caused by vocal overuse and misuse, acid reflux into the larynx (laryngopharyngeal reflux), smoking, and excessive alcohol consumption. Vocal symptoms are often hoarseness, breathiness, lowered pitch, and decreased pitch range.TreatmentAs contact ulcers are often caused by laryngopharyngeal reflux, anti-reflux medication and diet and lifestyle modifications are typically recommended. Voice therapy is also often recommended to address vocal hygiene and behaviors. CarcinomaCancer may affect the oral, pharyngeal (throat), or laryngeal cavities. Most laryngeal cancers are of the squamous cell type, and are most often the result of chronic irritation due to cigarette smoke. Laryngeal cancer can be life-threatening, and can also cause devastating changes in voicing, breathing, and swallowing. TreatmentDepending on the nature and severity of the cancer, treatment options include surgery, radiation, chemotherapy, or a combination of these therapies. The Geriatric Voice Presbylarynx Normal aging of the larynx can result in loss of vocal fold tone and elasticity, resulting in hoarseness, breathiness, decreased loudness, and pitch instability. The hallmark appearance of presbylarynx is the appearance of "bowed" vocal folds secondary to vocal fold atrophy (muscle wasting). TreatmentVoice therapy is often recommended to increase strength/ tone of laryngeal muscles, improve vocal fold closure, and improve overall vocal quality. In severe cases, an injection of a substance into the vocal folds may improve closure and quality. Johns Hopkins Voice Center | Greater Baltimore Medical Center6569 North Charles Street, Physicians Pavilion West, Suite 402, Baltimore, MD 21204443-849-2087 | Barbara Messing | Webmaster Services

医学

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Obama calls for changes to mental health care; Texoma providers react By: Morgan Downing Email Posted: Wed 10:38 PM, Jan 16, 2013 / Article SHERMAN, TX -- As part of his gun control proposal, President Obama also announced his plan to improve the country's mental health care. Local mental health care providers say lack of funding, large demand and lack of public education are just a few of the problems with our country's mental health care. President Obama announced ten different executive actions he is planning to take to improve mental health care. Locally, medical professionals say this is a step in the right direction. "If there's even one life that can be saved, then we've got an obligation to try," President Obama said. Mister Obama is calling on Congress for more funding. He wants $50 million to train 5,000 mental health professionals to work with young people in communities and schools. $15 million to train teachers and other adults to detect and respond to mental illness in children and adolescents. And another $40 million to help school districts and other community institutions make sure young people get help they need. "Having teachers, especially, who would know about all mental health issues that could identify when a child or adolescent is having trouble and what symptoms to look for would be very helpful," Sylvia Cave said. Sylvia Cave is the Director for Mental Health Services at Texoma Community Center. She says less than one percent of mental health patients are violent. But right now, her agency doesn't have the resources to treat the patients who are most likely to become violent. "Funding for those services at your state and federal level have done nothing but decrease over the years," Sue Daley said. Texas Health Presbyterian WNJ Behavioral Health Services Director, Sue Daley, says funding isn't the only problem.Since HIPAA was enacted, many healthcare providers are unsure about when they can report violent behaviors to law enforcement. Now, the President says he'll clarify those regulations. "I was happy to read that Obama is going to re-approve the "duty to warn" clause and encourage health care providers to report when they have patients that are a homicide risk, " she said. Daley says the President's proposed changes to the broken system are a step in the right direction, especially when it comes to preventing gun violence and keeping our community safe. "I think mental health issues are just part of being human and it's amazing to me that we've ignored that important part of ourselves for that long," she said. President Obama will issue a presidential memorandum directing the CDC to research the causes and prevention of gun violence, and he said he will finalize regulations on equal insurance coverage for mental health.

医学

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Cumbrian hospitals staff must work Queen's Jubilee for no extra pay By Pamela McGowan Health reporter Last updated at 10:15, Saturday, 21 April 2012 While street parties get underway across the county to celebrate the Queen’s Diamond Jubilee many Cumbrian health staff will find themselves having to work – and for no extra pay. North Cumbria’s hospitals are treating the extra public holiday on Tuesday, June 5 as a normal working day. It stresses that those who are already rostered to work at the Cumberland Infirmary in Carlisle or West Cumberland Hospital in Whitehaven will get an extra day of holiday to take in lieu – however they will not get additional pay for working a public holiday. A North Cumbria University Hospitals NHS Trust spokeswoman said: “I can confirm that, as with the Royal wedding last year, the Trust is offering staff an additional day’s leave. Tuesday June 5 will be treated as a normal working day in order to meet the needs of the service – in line with other NHS organisations in Cumbria.” The Cumbria Partnership NHS Foundation Trust, which runs community and mental health services across the county, will be operating a public holiday service – but again, those who do have to work won’t get extra pay. “The trust will be operating the services we would normally operate on a public holiday. “For staff who are rostered to work on the June 5, payment and conditions of service will be those which would apply on a normal Tuesday, with a day off in lieu. All other staff will be given a day’s annual leave,” said a spokeswoman. Many health trusts across England are taking a similar stance, as was the case during the extra public holiday for last year’s Royal Wedding. This has prompted the trade union Unite to call on the Queen herself to intervene. It says that although the Government has declared June 5 a public holiday, many NHS employers in England will be regarding it as a normal working day with staff not being paid additional rates. Unite, the largest union in the country, added that the Diamond Jubilee was taking place against a backdrop of more than one million NHS employees taking serious pay cuts, being forced to pay more for their pensions and receive less on retirement. In a letter to the Queen, Unite’s head of health, Rachael Maskell said: “I am asking if you could make an intervention to ensure that hard-working NHS staff in England will be afforded the opportunity, with the rest of the nation, to celebrate Your Majesty’s Diamond Jubilee. “And for those that have to provide cover to ensure patient safety and wellbeing of the sick receive the nationally-agreed public holiday terms and conditions.” First published at 08:58, Saturday, 21 April 2012 working for nhs on a bank holiday is both pleasure and pain Posted by nhs staff on People should stop whinging and be just be thankful that they have a job. They're getting a day off in lieu, what more do they want? Posted by Nikki on

医学

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You are here: Parliament home page > Parliamentary business > Publications and Records > Lords Publications > Lords Hansard > Lords Hansard Previous Sessions Lord Adonis: My Lords, the better the support that is available to children in care, both to prevent them going into care in the first place and to tackle issues such as the poor standard of education which children in care experience at present, the more likely we are to keep them out of the custody system—a measure which I am sure the right reverend Prelate supports. A whole section of the Green Paper, which 17 Oct 2006 : Column 648 was published last week, concerns how we better support children in care who end up in custody and are very liable to reoffend but who do not get the provision that they need when they leave custody. We hope that those measures will also improve that situation. Baroness Walmsley: My Lords, the Green Paper published last week contained the very welcome measure that young people can choose to remain in foster care until the age of 21, or even later if they are in further or higher education. Has the Minister any idea of the number of young people choosing to do that? Will he assure the House that, when the relevant figures are collected in future, the figure relating to those children will be recorded separately so that we can genuinely see any increase or decrease in the number of children in the lower age groups taken into care? Lord Adonis: My Lords, as the noble Baroness will be aware, for two years now children coming up to16 have had the option to remain in care. Better support arrangements are in place to enable them to do so. A substantial and rising proportion have chosen to do so. I believe that we will monitor the number in the older age ranges who choose to stay in care. I shall let the noble Baroness know how we propose to do that. Baroness Morris of Bolton: My Lords, the most alarming fact about children in care is that they are 66 times more likely to have their own children taken into care, creating a generational vicious circle. There are massive variations in the number of children taken into care across the country. What action has been taken, other than publishing the Green Paper, to address that? Lord Adonis: My Lords, when we discussed the Green Paper last week, the noble Baroness pointed out, for example, the work that Kent County Council has done to better support children in care. We are doing a great deal to promote best practice between local authorities in this area, which is a prime local authority responsibility. I accept that there is more that we need to do in future, and we will seek to do it. Baroness Greengross asked Her Majesty’s Government: Whether, in accepting the decision of the National Institute for Health and Clinical Excellence to deny Aricept to people with early stage Alzheimer’s disease, they have taken into account the full cost of the decision. The Minister of State, Department of Health (Lord Warner): My Lords, the National Institute for Health and Clinical Excellence has done a very thorough 17 Oct 2006 : Column 649 job on this difficult appraisal. It would be entirely inappropriate for the Government to second-guess NICE’s conclusions, though I know that many people will find them disappointing. The final appraisal guidance will be published next month alongside a clinical guideline on dementia, to make clear what care and support should be provided to people at all stages of Alzheimer’s disease. Baroness Greengross: My Lords, I thank the Minister for that helpful reply. I agree that NICE plays a very important role in assessing the benefits of particular drugs and the direct costs of providing them through the NHS. But does he not agree that it is the Government’s job to set those costs against their own priorities, for example prevention of disease and early intervention, and to take into account the costs of alternative medications that are often needed and the huge cost to families, whose lives are turned upside down when Alzheimer’s strikes? Above all, there are the costs to the national economy of carers being forced out of the labour market, often on to state benefits for the rest of their life. Will the Minister agree to take all those costs into account and tell your Lordships’ House whether these drugs, at £2.50 a day, are really not cost-effective? Lord Warner: My Lords, we set up NICE with cross-party support, and it has achieved a huge international reputation. It needs to be able to carry out its difficult work free from political interference. If Ministers were to overrule NICE, it would set a dangerous and undesirable precedent. The findings of the appraisal do not in any way suggest that the drugs concerned should not be used for moderate to severe Alzheimer’s disease, except Ebixa, a new drug that was not recommended for the treatment of moderate to severe stages. The three existing drugs continue to be recommended for moderate to severe Alzheimer’s, and the patients currently receiving all four drugs, whether routinely or as part of a clinical trial, may continue to do so until it is considered appropriate to stop. This is not a wholesale removal of those drugs from the treatment of Alzheimer’s disease. Lord Forsyth of Drumlean: My Lords, does the Minister not accept that the health service once had a principle that people should be able to get the care they need regardless of ability to pay? No one is disputing that Aricept is not effective in the early stages of treatment of Alzheimer’s. What is happening is that only those who can afford to buy the drugs will get the treatment. That cannot be right, and the Minister cannot hide behind his responsibilities as a Minister to ensure that the health service does what it is supposed to do and remains true to its central principles. Lord Warner: My Lords, it is this Government who have adhered firmly to the principle that the NHS provides free care at the point of clinical need. If I may say so to the noble Lord, it is his Governments who from time to time have wavered on that principle, so I do not feel inclined to accept lectures on this issue 17 Oct 2006 : Column 650 from him. This Government set up NICE so that we could have a transparent, careful appraisal of the cost-effectiveness of these drugs. I thought that that had been supported by the Conservative Party. When the going gets tough, when there is an uncomfortable decision, we should support NICE, not resile from that support. Lord Walton of Detchant: My Lords, does the Minister accept that many neurologists and psychiatrists have been disappointed, as he is aware, at NICE’s recent guidance, not least because it is a matter of extremely difficult clinical judgment to tell when early Alzheimer’s disease becomes moderately severe, when the drugs may be prescribed under the NICE guidelines, and when it is advanced, when according to the guidance the drugs may not be prescribed? It is crucial that the guidance to be produced next month should be carefully examined, because the medical profession is concerned about its effects in this situation. Lord Warner: My Lords, the noble Lord is right that this is a complex issue. That is why NICE will produce the clinical guideline next month, following consultation with a wide range of clinicians of different opinions. Baroness Pitkeathley: My Lords, does my noble friend appreciate that the families of people with Alzheimer’s disease are hungry for any kind of support? That is why there is so much emphasis on these drugs, although everyone accepts they are not effective in every case. Can the Minister give us more details about the kind of support that he mentioned in his Answer, which is to be offered to patients and families? Lord Warner: My Lords, my noble friend is right. I do not deny that we appreciate that the NICE guidance for people with Alzheimer’s disease is terribly important to their carers and clinicians. I cannot anticipate the precise terms of NICE’s clinical guideline, but it is intended to help clinicians, the public and carers to understand the best ways to meet the need for care and support, alongside drug regimes, for people who unfortunately suffer from Alzheimer’s disease. Lord Addington: My Lords, does the Minister not agree that we have this familiar debate every time a new type of drug or service comes up? Do the Government agree that, whatever NICE is doing, its way of explaining it to the public and politicians is failing? Can the Government give a guarantee that everyone will be brought on board in producing the new regulations, including the Plain English Campaign? Lord Warner: My Lords, I do not accept that NICE has failed to communicate its ideas properly and appropriately. It has been extremely transparent at all stages of its process in putting information on its website and into the public arena. It sends regular briefing on its work to all Members of both Houses. 17 Oct 2006 : Column 651 It has been one of the most conscientious bodies in explaining its decisions. I repeat: it has acknowledged that the three existing drugs, Aricept, Exelon and Reminyl, are recommended for the treatment of moderate to severe Alzheimer’s disease. It has not recommended that those drugs are not made available to those with that level of the disease. Education and Inspections Bill Report received. Clause 1 [Duties in relation to high standards and the fulfilment of potential]: Lord Judd moved Amendment No. 1: Page 1, line 5, after “Duty” insert “to secure the right to education and” The noble Lord said: My Lords, I shall speak also to Amendment No. 2 and strongly support Amendment No. 7, standing in the name of the noble Baroness, Lady Walmsley. In one sense, the purpose of the amendment is to emulate the example of legislators north of the Border in Scotland. They have seen fit to put on the face of their legislation, as the cornerstone of everything they want to achieve, the principle of the right of every child to education. I should declare an interest at this point, because I am a half-Scot and sometimes my English half wishes that we had the courage of Scots conviction. With the greatest possible respect to the Minister, I believe that he should again look at this point before he finally makes up his mind. The Minister listens very carefully to arguments—he is almost exemplary in how this should be done—and he is extremely courteous and thorough in following up points. We approached and discussed this issue in Committee, and I deeply appreciate the full letter that he has sent to me about the concerns behind my amendment. I am sure that it was no fault of the department, but I am afraid that the Minister’s letter did not reach me in time to have meetings with his officials before this discussion. However, because I take his letter seriously, I should like to examine some of the points that he makes in it. The Minister emphasises that the right to education is guaranteed by Article 2 of the first protocol to the European Convention on Human Rights and, for children, by Article 28 of the European Convention on the Rights of the Child. The right to education, he argues, is provided by the European convention and is already part of national law by virtue of the Human Rights Act 1998. We recognised that when we argued our case in Committee. I do not believe that anyone could be a more committed internationalist than I am. I am glad that the conventions say what they do and I am proud of the part that Britain played in leading the cause in making those conventions. However, internationalist though I am and seriously though I take the conventions, 17 Oct 2006 : Column 652 at a time when we are determined to make a success of our education system—the Minister is second to no one in that respect—and when we are also debating other dimensions, such as the importance of emphasising what it is to be British, what makes the British character and what is important about Britain, I believe it is important that we do not approach education simply by saying, “Ah, we now have commitments under certain international conventions and the right is established under those conventions”. We must make it clear that in our own approach within the United Kingdom to these matters we take the right to education of every child as absolutely central to everything that we do. For that reason, I believe that the Scots were right and I wish that we would follow their example. The Minister argued that, because the objective is spelt out in the Human Rights Act 1998, the amendment would confuse the issue as it would not be clear whether the Human Rights Act or this Bill prevailed. I do not think that there is any problem in that respect. As I understand it, it is absolutely clear that ultimately the European Convention on Human Rights prevails in all aspects of legislation and activity in this country. My noble friend also goes on to emphasise the importance of the judgment by the noble and learned Lord, Lord Bingham, in the Ali case, when he upheld what has been described as the fourfold foundation for this right. The Minister very kindly spells out again in his letter to me what the fourfold commitment amounts to. The first element is the duty of parents under Section 7 of the Education Act 1996 to cause their children to receive efficient and suitable full-time education, either by regular attendance at school or otherwise. That is a great objective and a great principle. But what happens if the parents do not share that commitment or do not fulfil it? The second element is the Secretary of State's duty under Section 10 of the Education Act 1996 to promote the education of the people of England and Wales. Again, that is absolutely salutary. That is great, but that is not an objective that automatically becomes fulfilled. To promote the importance of it is not actually ensuring that it happens. The third element is that local education authorities are required by Section 13 of that Act to secure that efficient education is available to meet the needs of the population of their areas. Such education being available is not ensuring that every child enjoys it. The fourth element is that maintained schools themselves have a responsibility to ensure that their governing bodies conduct the schools with a view to promoting high standards of educational achievement at the schools. Again, that is excellent but it does not ensure that every child is able to enjoy that provision. On Report, we are proposing, in a slightly different form, that, because of the residual overall responsibility of local education authorities, it should be made quite clear that those authorities have a responsibility to secure the right to education for every child. We then go on to demonstrate how that should be done. Part 1 of the Bill talks about the responsibilities of local education authorities. For local education authorities in England it is about promoting high standards, 17 Oct 2006 : Column 653 ensuring fair access to educational opportunity and promoting the fulfilment by every child concerned of its educational potential. Those are all absolutely first-class principles—none of us would question them—but not one of them ensures that that right is being enjoyed. With great respect to my noble friend, we spell out in the amendment the fact that local educational authorities have a responsibility to secure the rights spelt out in the convention—we are not now insisting that it is established as a right in the introduction to the Bill, but we want to establish the right that the Government themselves argue is established in the convention. I know that the noble Baroness, Lady Walmsley, with all her experience and all her usual commitment and analytical power, will put forward a powerful argument to this set of amendments. A mistake that all of us in Parliament sometimes make is to think that the battle has been won when we have introduced legislation. We have seldom won the battle; at best, we have usually created opportunities. What wins the battle is winning the hearts, minds, commitment and understanding of the widest possible cross-section of people to the principles that we are trying to achieve by education and by enthusing the population as a whole with an objective that is worth while achieving. I ask my noble friend to say that a responsibility and a right are spelt out in international conventions, but we, for a host of convoluted reasons, do not think it is appropriate to spell out that right in the Bill as the cornerstone and presentation of all else we are doing. I think that is sad. With the greatest possible respect to all concerned, I think it is institutional Whitehall getting caught up in the niceties and missing an opportunity to take the nation forward. In his letter to me, the Minister emphasised—and he was generous to do it so strongly—that if there are doubts about legal problems that might be opened up by such a declaration, one can look at Scotland where no single parent has tried to introduce any complaint or criticism on the grounds of that declaratory principle in the Bill. That is very significant. He says: “As regards the risks of changing the meaning of the existing right to education”— which he has gone into in some detail in his letter— “the Scottish Executive took the view that the declaratory benefits were worth the risk of legal challenge. This is not a view that, on serious reflection, we share”. I beg the Minister to indicate in his reply that he and his officials will go away and think about this. I am a very open-minded sort of chap, and if he can come back to the House—or indicate that he is prepared to do so—with some wording that gets this principle flying as a standard at the head of all we are trying to do on education and, with the legal advice that has so far been holding him back from endorsing our amendment, expresses in a watertight way what we enthusiastically propose, I shall be greatly encouraged. I beg to move. Baroness Walmsley: My Lords, I support the noble Lord, Lord Judd, on Amendments Nos. 1 and 2, to which I have put my name, and I shall speak also to Amendment No. 7, which is tabled in my name and that of my noble friend Lady Sharp. The Bill gives a clear duty to the LEA to identify those children who 17 Oct 2006 : Column 654 are not receiving an education. That is a very important matter, not just in terms of the education of those children, but in terms of their safety and protection. Children who do not come in front of teachers and other professionals every day may escape attention when they show signs of abuse and mistreatment. That is what happened to Victoria Climbié. However, the Bill misses the opportunity to make clear who is responsible, not just for identifying these children, but for making sure that they receive a suitable education. That is a pity, because the Bill is an ideal vehicle for so doing. I am a great believer in clarity in the law and in making it easily understandable and, in particular, accessible to the citizens of this country, not just to clever lawyers. In Committee, and in his letter to the noble Lord, Lord Judd, the Minister made clear that several bits of law added together do what the noble Lord and I seek to do today. He referred to several pieces of statute in different Acts of Parliament and a case-law judgment by the noble and learned Lord, Lord Bingham, in which those are all listed. Other clauses lay out the sanctions that the LEA and the courts can use against parents who do not send their child to school or provide a suitable education at home. I do not think that is good enough. In the Bill, we have an ideal vehicle of statute to make the law clear, as was done in Scotland. We would not need to rely on case law. People would not need to go into a lawyer's office and have him take down several Acts of Parliament in order to explain what the child’s rights were. We would not be just talking about sanctions against the parents, but making it clear that it is the duty of the legal authority either to ensure that the child has a place in a suitable school—that can be very problematic these days where children cannot even get a place in their first six choices of school—and actually attends the school, or to satisfy itself that the alternatives are in place for a home education. Frankly, I do not mind if this involves a certain amount of repetition. British law is no stranger to repetition. That is why some people call for a total review of our laws, a codification and clarification. I understand that this may take a very long time and result in a vast reduction in the size of legal libraries, let alone legal bank balances. However, it is not a bad idea. I do not seek to do anything so ambitious today, but I am loath to let pass an opportunity to make the rights of children to receive an education absolutely clear, and to make clear on whom the duty lies to fulfil that right. The noble Lord, Lord Judd, mentioned the rights of children enshrined in a number of international human rights conventions, but it is UK law that gives effect to the rights of children enshrined in those conventions. Let us not lose an opportunity to emphasise our commitment to children's rights as enshrined in those conventions by not clarifying the law in this way today.

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Anthrax Vaccine: Controversy over Safety and Efficacy Vaccination News Home Page http://www.immed.org/publications/gulf_war_illness/anthrax3-18-00.html Antimicrobics and Infectious Disease Newsletter (Elsevier Science) 2000; 18(1):1 -6 Garth L. Nicolson, Meryl Nass and Nancy L. Nicolson The Institute for Molecular Medicine, Huntington Beach, CA 92649 and Parkview Hospital, Brunswick, ME 04011 In 1999 2.4 million U.S. Armed Forces personnel, including more than one million reserve and National Guard members, were ordered to receive anthrax vaccine over a period of several years. This was justified to counter an increasing threat from hostile countries and possibly terrorist groups that now or in the future will likely possess the capability of fielding weaponized anthrax spores as a Biological Weapon (BW). This decision has resulted in courts-martial and disciplinary hearings among U.S. Armed Forces personnel who have refused the anthrax vaccine on safety grounds. Are these individuals overreacting to misperceived risks from the anthrax vaccine that the military considers safe, or are there real safety concerns that should be considered? Bacillus anthracis as a BW Agent Bacillus anthracis is a relatively common spore-forming soil bacterium found rarely in the U.S. but more commonly in some areas of the world as an endogenous infectious agent. Bacillus anthracis infection can cause death within six days of exposure to a lethal dose, usually by inhalation of spores. To be effective as a BW agent a microorganism must be highly infectious, very pathogenic and stable in the air and environment for the period of time needed for dissemination and infection of large numbers of people. Spore-forming bacteria like Bacillus anthracis are ideal for this purpose. Spores are relatively inactive metabolically and are much more resistant to sunlight, heat, dryness and chemicals than the replicating microorganism. ‘Weaponized’ versions of anthrax spores are more pathogenic and survive better than spores from native strains of Bacillus anthracis. It is estimated that as few as 50,000 weaponized anthrax spores can kill a human after inhalation and fewer can kill small primates. Although weaponized anthrax spores are probably the most easily manufactured BW weapon, they are only one of dozens of lethal and incapacitating (causing nonlethal sicknesses) BW agents that have been produced in large quantities suitable for BW deployment and tactical use. Bacillus anthracis is also one of the few BW agents for which a vaccine exists that is capable of preventing some (but not all) lethal infections. Although dozens of additional microbial candidates for BW have been produced in various quantities by several countries, such as bacteria (Clostridium botulinum, Brucella melitensis, Yersinia pestis, Clostridium perfringens, Bacillus cereus, Francisella tularensis, Coxiella burnetii, among others), toxins (ricin, aflatoxin, Clostridium botulinum toxin, Staphylococcal enterotoxin B toxin, tricothecene mycotoxins, etc.), viruses (Ebola, West Nile fever, Marburg, small pox, etc.) and miscellaneous BW (rickettsias, mycoplasmas, fungi, etc.), weaponized Bacillus anthracis is considered one of the greatest threats because of the ease of its production, storage and dissemination (spores) as a lethal BW agent. There are basically three methods to counter anthrax BW: active immunization, passive immunization and prophylactic antibiotics. Antibiotics have to be administered shortly before or after exposure, otherwise they won’t be effective, and they cannot prevent a lethal infection once the Bacillus anthracis has produced signs of illness. Passive immunoprophylaxis requires quantities of immune sera or monoclonal antibodies not currently available, and their administration in a monitored, hospital setting. Active immunity using vaccines on the other hand can be administered years before exposure as long as immunity is maintained. Thus vaccines can be effective as long as there is enough immunity to neutralize the Bacillus anthracis before it starts rapidly replicating en masse from its inactive spore form and producing lethal toxins. From a practical standpoint, only antibiotics and vaccines can protect the large numbers of people who could be exposed in a BW attack, and antibiotics are more effective when the BW agent(s) and its(their) antibiotic sensitivity are identified so the appropriate antibiotic(s) can be used. Are anthrax vaccines then a reliable method of protecting against Bacillus anthracis BW? Not necessarily. Although vaccines can protect against accidental exposure of relatively small doses of anthrax spores that infect skin wounds, such as encountered occasionally in meat processing, it remains unproven whether anthrax vaccines will actually protect against a lethal aerosol dose of inhaled anthrax spores of the weaponized variety that are used as BW agents. This is especially true if mixtures of BW agents are used instead of single BW agents. The Anthrax Vaccine: Safety Concerns The anthrax vaccine in use remains unproven in its ability to stop a lethal dose of weaponized Bacillus anthracis spores, and there are questions about its safety. According to the U.S. Army Medical Research Institute for Infectious Disease (USAMRIID) at Fort Detrick, MD, the anthrax vaccine used by the military was determined to be safe, and adverse reactions were found to occur only at the rate of one per 50,000 doses (less than 0.002%). This has now been revised to a rate of 0.02-0.2% or higher. Moreover, in recent testimony by one of us [M.N.] to the National Academy of Sciences the safety of the anthrax vaccine and the rates of adverse reactions were questioned. Using Dover AFB as an example, the rate of chronic health problems after receiving the anthrax vaccine may be as high as 7%. The difference is that the official rates are for acute reactions only. The Department of Defense (DoD) claims that the rate for vaccine chronic reactions is zero. A major part of the problem in assessing vaccine safety is in how vaccine adverse effects are reported. Many people who suffer from adverse anthrax vaccine effects are reluctant to step forward to seek medical care, because they have seen their colleagues' concerns dismissed as due to depression or stress. They also fear that they could lose their ability to perform their duties, as a number of the pilots and airmen at Dover AFB are now on DNIF (duties not including flying) status because of undiagnosed illnesses that began after they received their anthrax vaccinations. Lt. Colonel Randy Randolf, director of the U.S. Army’s vaccination program, counters that all vaccines, the anthrax vaccine included, can produce adverse effects, such as soreness, redness, itching, swelling, and lumps at the injection site. He has stated that about 30% of men and 60% of women report these local reactions, but they usually last only a short time. Lt. Col. Randolf further describes that beyond the injection site, from 5% up to 35% of people have noticed muscle aches, joint aches, headaches, rash, chills, fever, nausea, loss of appetite, malaise, or related symptoms. It is commonly thought that these symptoms go away after a few days, and apparently there have been no completed studies of the long-term side effects of anthrax vaccine using active surveillance. Although the DoD began such a study at Tripler Army Medical Center, Honolulu in September, 1998, they have yet to release any preliminary data on long-term problems that developed after anthrax vaccination. The difference between what military and civilian physicians conclude about adverse reactions and the anthrax vaccine seems to be based on whether you accept that vaccines can cause chronic illnesses beyond the initial reporting period of vaccine adverse effects. The high incidence of unusual chronic health problems at Dover AFB include systemic signs and symptoms, such as vomiting, diarrhea, polyarthralgias, fever, splenic tenderness, cognitive problems, polymyalgias, weakness and numbness, and these problems can occur well after the usual reporting period for vaccine adverse effects. Patients with preexisting autoimmune illnesses such as rheumatoid arthritis, lupus, multiple sclerosis, among others, are probably more likely to suffer a serious adverse reaction, as are those with neurologic disease, such as those who had polio in childhood. Stevens Johnson Syndrome, a severe allergic reaction in which there is loss of epidermis (skin) and the lining of the GI tract, was found in some patients as well as more classic allergic signs and symptoms. Even more serious, many anthrax vaccine recipients report seizures with complete loss of consciousness. Respiratory distress and a variety of pulmonary illnesses have also been reported. Because these types of reactions have rarely been identified with other vaccines and because few of those reporting illness have been subjected to an exhaustive medical evaluation, including sophisticated immunological testing, the mechanisms by which anthrax vaccine may be causing illnesses have not been elucidated. Furthermore, the entire stockpile of anthrax vaccine is owned by the DoD, and none has yet been made available for thorough, independent testing. The Anthrax Vaccine: Source One of the most difficult problems in dealing with anthrax vaccine safety is obtaining specific information on the anthrax vaccine and how it was determined to be safe. Most military vaccines in the U.S. are from ‘sole-source’ manufacturers. In the case of FDA-approved vaccines, a number of strict production and safety requirements must be fulfilled, and evidence for effectiveness in humans must be presented to the FDA before approval for production and sale is granted. However, in the case of the anthrax vaccine there seem to be missing elements in this safety net. The sole producer of the anthrax vaccine was originally Michigan Biologic Products, Inc., a state-owned corporation that obtained U.S. Government approval for the anthrax vaccine at a time when FDA approval was not required. The anthrax vaccine was approved by the Bureau of Biologics at NIH in 1970, two years before efficacy data and approval were required by the FDA. In the case of the anthrax vaccine, long-term safety data were not supplied with the license application, and none has yet been supplied to the FDA. As it turns out, the Bacillus anthracis vaccine now being produced may be different or the procedure for vaccine preparation modified from the original vaccine approved by NIH. The usual requirement is that any new product or modification in preparation must be examined and approved by the FDA, but the FDA has apparently not examined or approved every modification made to the current vaccine for anthrax. The original license and the facility producing the anthrax vaccine was owned by Michigan Biologic Products, Inc. of the Michigan State Department of Health. The new owner of both is a company called Bioport, Inc., owned by a group of investors lead by Admiral William Crowe, Jr., former head of the Joint Chiefs of Staff, DoD, and Faud El-Hibri, a German citizen of Lebanese descent who has since obtained American citizenship. The facility was sold to Admiral Crowe’s investor group after the DoD decided to vaccinate all of its servicemen and servicewomen against anthrax. Recently Bioport ran into financial problems and negotiated a series of changes in its DoD contract that increases by three-fold the per dose price of the anthrax vaccine supplied to the military. This and other problems have resulted in a congressional investigation into the financial relationship between DoD and the new owners of Bioport, which may constitute a conflict of interest. The Anthrax Vaccine: Safety Problems with the anthrax vaccine have raised questions about previous vaccine programs. The former commander of the USAMRIID, Dr. Phillip Russell, admitted in an infectious disease journal (Infectious Disease Clinics of North America, 1990) that unlicensed anthrax vaccines were used on Armed Forces personnel before the Gulf War. There is, of course, no record of safety available for unlicensed vaccines. In fact, there were no published studies of safety or efficacy for the current anthrax vaccine until very recently, well after the decision was made to vaccinate. A recent brief publication from the USAMRIID in JAMA provides some safety information about the anthrax vaccine, but it refers to previously unpublished data that are not available for evaluation. The normal procedure for post-marketing vaccine evaluation requires that the FDA must review adverse vaccine reactions collected through the Vaccine Adverse Event Reporting System (VAERS). Adverse events are usually recorded independently by a FDA-approved contractor. The contractor then sends its data to the FDA, and the FDA assembles a committee that then evaluates adverse events for the likelihood that the vaccine might have caused them, and it can recommend further study. However, in the case of the anthrax vaccine, military physicians were instructed that only certain adverse effects could be vaccine reactions, such as classic immediate allergic reactions, and others, such as joint pain, cognitive disturbances, etc. could not be due to the vaccine. Physicians treating these patients had no access to published data on anthrax vaccine side effects, and there is no entry for anthrax vaccine in the Physicians Desk Reference (PDR). The package insert for the vaccine is based on data collected from an earlier anthrax vaccine, and it does not list the range of possible reactions that could occur. Thus until recently none of the long-term chronic effects of the vaccine were even reported by medical providers. In the case of the anthrax vaccine, only reactions that resulted in hospitalization or immediate loss of 24 hours of duty time were reported to a military clearing-house for vaccine reactions. This has changed recently, and it appears now that other adverse vaccine effects will be entered in the medical records of patients, but whether they are always reported to the FDA remains questionable. We feel strongly that traditional and accepted means of FDA vaccine evaluation must be implemented for military vaccines, just as they are required for commercial vaccines. Only then can the safety of the anthrax vaccine be evaluated. The anthrax vaccine should be treated just like any other commercial vaccine and not given special waivers or treatment in the evaluation process. Only then will the public be satisfied that the current anthrax vaccine is safe. The Anthrax Vaccine: Quality For years Michigan Biologic Products Inc. had been warned by the FDA of intent to revoke their license to produce vaccines because of violations in the production and testing of their vaccines. As recently as 1997, MBPI received formal written notification from the FDA that they had not complied with FDA-mandated requirements. However, since MBPI was the only manufacturer of anthrax vaccine, they were given a waiver and allowed to remain open, pending FDA compliance. During this time vaccine lots were distributed to the military. In 1998 some of these vaccine lots were retested, and only 6 out of 31 lots passed initial supplemental testing. Most of the retested vaccine lots had expired or had been redated for an additional 3-year period once or even twice. This is obviously unacceptable. The question has been raised whether expired or failed vaccine lots were used for vaccinating military personnel during the Gulf War. Since supplemental testing on anthrax vaccines used in the Gulf War was not undertaken, and some of these lots apparently also had previously expired and had been redated, some personnel could have received out-of-date vaccines, or worse, contaminated vaccines. Information is not available on whether U.S. Forces received contaminated vaccines (no such testing has been made public), but the British Gulf War veterans report that several vaccine lots from the Gulf War were reported to be contaminated with “unknown microorganisms.” Thus some of the health problems associated with the anthrax vaccine could be related to possible vaccine contamination. Vaccines and the Gulf War Before military personnel were deployed to the Persian Gulf Theater of Operations, they had to pass physical examinations and be fit for active duty. After passing their physical exams, they received several types of vaccinations, mostly with commercially available vaccines. In the Persian Gulf area this was usually done by administering as many as two dozen vaccine doses over a period of a few days, even if the vaccines were normally required to be given over a course of several months to over a year. In contrast to previous wars, service personnel were not allowed to keep a record of these vaccinations, and according to the DoD the shot records of hundreds of thousands of deployed personnel have since disappeared. Some health personnel administering the vaccines were also warned that they would be courts-martialed if they kept any record of vaccines given to military personnel. According to nurses that took part in the vaccination program, many soldiers became sick after the vaccines were given, but few were allowed to report the adverse effects of the vaccines, unless they were hospitalized. Most had to return to active duty, even if they suffered adverse effects directly attributable to the vaccines. The records of these adverse effects are for the most part also missing. The problem with administering multiple vaccines all at once is that this can result in immune-depression and leave individuals susceptible to opportunistic infections, such as the types that the vaccines were supposed to protect against. To be effective, the vaccines used in the Gulf War should have been given in several steps, the initial vaccination followed by several boosters given over months to over a year to maximize immunity. If given all at once, these vaccines are more likely to cause adverse reactions and produce diminished immunity; thus they may be useless in protecting an individual, and they may even make the vaccinated person more susceptible to opportunistic infections due to immune-suppression. Gulf War Illnesses and Vaccines Between 100,000-200,000 veterans of the Persian Gulf War in 1991 now have Gulf War Illnesses (GWI), which are characterized by complex, multi-organ chronic signs and symptoms. These include chronic fatigue, headaches cognitive problems, nausea, gastrointestinal problems, vomiting, diarrhea, polyarthralgias, fever, splenic tenderness, polymyalgias, among other signs and symptoms. Often these patients show the appearance of rheumatic and other autoimmune signs and symptoms. The signs and symptoms of GWI overlap with Chronic Fatigue Syndrome (CFS) or Myalgic Encephalomyelitis (ME), and often they meet the criteria for the diagnosis of CFS/ME or Fibromyalgia syndrome (FMS) where the distinguishing feature is the presence of chronic fatigue and widespread muscle pain and tenderness. Often included in this complex clinical picture are increased sensitivities to various environmental agents and enhanced allergic responses. There are other clinical problems in these patients, including impaired cardiac function, increases in spontaneous abortions and other chronic signs. The signs and symptoms reported by many anthrax vaccine recipients also overlap with GWI. In some cases GWI has spread to immediate family members. Although incomplete, a 1994 report by investigators of a U.S. Senate committee found after contacting approximately 1,200 GWI families that ~77% of spouses and ~65% of children born after the war developed the chronic signs and symptoms of GWI. Although officially denied by the U.S. DoD and British Ministry of Defence, this indicates that at least a subset of GWI patients have an illness that is being passed to spouses and children. Since some of the GWI patients have an illness that is transmissible to family members and perhaps others as well, these GWI cases cannot be explained solely on the basis of chemical or radiological exposures, or the even more unlikely cause of battlefield stress leading to Post Traumatic Stress Disorder. Although stress can induce some illness, the General Accounting Office (GAO), the investigational arm of the U.S. Congress, after studying government and civilian data on GWI, concluded that the link between stress and GWI was not established. Of course, stress can exacerbate chronic illness but most military personnel indicated to us that the Gulf War was not a particularly stressful war, and they strongly doubted that stress was the origin of their illnesses. However, in the absence of physical or laboratory tests that could identify possible origins of GWI, many physicians accepted that stress was the cause of GWI or that it was caused by combinations of chemical exposure and stress. A recent psychiatric study indicates that patients with GWI do not fit the classical picture of stress related illness. If stress is added to multiple vaccines given at once, plus chemical and other toxic exposures encountered during the Gulf War, then immune suppression and opportunistic infections could be a likely outcome in at least a subset of the military personnel that subsequently came down with GWI. This would also explain in some cases the apparent transmission of illness to immediate family members and the occurrence of GWI in some vaccinated forces that were not deployed. Vaccine Contamination and Gulf War Illnesses Testing of commercial vaccine lots demonstrates that contamination can and does occur. A common vaccine contaminant is Mycoplasma species of the class Mollicutes, small cell wall-deficient bacteria lacking many of the genes involved in macromolecular and lipid synthesis. Although not widely appreciated for their ability to cause disease, mycoplasmas have been implicated in a variety of chronic illnesses, including CFS/ME, FMS, Rheumatoid Arthritis and GWI. When we examined thousands of GWI patients for evidence of blood mycoplasmal infections, we found evidence of mycoplasmas in about one-half of GWI cases, and in particular, one species of mycoplasma, Mycoplasma fermentans, was found at high incidence. M. fermentans has been examined over the last decade or so by the Armed Forces Institute of Pathology for its role in causing a progressive, non-HIV AIDS-like fatal disease that has many of the hallmarks of GWI. Mycoplasmas like M. fermentans could be involved in the transmission of GWI to immediate family members. When symptomatic family members of veterans with GWI were tested for the presence of mycoplasmal infections in their blood, they were found to have the same species of mycoplasma as found in the sick veteran family member. In addition, most of these patients responded to the appropriate antibiotics and eventually recovered, albeit slowly, from their illness, similar to what we have seen in CFS/ME, FMS and Rheumatoid Arthritis patients with mycoplasmal infections. When recovered patients were retested for mycoplasmal blood infections, they were no longer positive for Mycoplasma species in their blood samples. This suggests that mycoplasmal infections could be causing at least some if not most of the signs and symptoms of GWI found in these patients, and these infections can be passed to family members who then develop similar illnesses. What remains to be determined is whether the vaccines used in the Gulf War were the source of the mycoplasmas found in veterans’ blood. A study reporting the presence of antibodies to an unlicensed vaccine adjuvant in over 90% of the GWI patients evaluated has just been published. This strongly suggests that experimental vaccines were used in the Gulf War. Experimental vaccines are unapproved vaccines without available safety and efficacy data. Although listed as our number one possible source of the infections found in GWI patients, vaccines are not the only possible source of microorganisms from the Gulf War. In our sworn testimony to the U.S. Congress [G.L.N., N.L.N.] we stated that there were several potential sources of chronic biological agents in the Gulf War. The Iraqis were known to have extensive stockpiles of BW agents and the potential to deliver these weapons offensively, at short range in modified Italian-made biological sprayers that deliver BW agents onto the sand to create exclusionary zones or 'biological minefields' and at long range in modified SCUD-B (SS-1) missiles with 'airburst' warheads or sprayers carried by aircraft. Many of the storage and factory facilities where BW agents were stored were destroyed immediately up to, during and after the Desert Storm ground offensive, releasing plumes containing these agents high in the atmosphere where they could be carried downwind ('blow-back' exposures) to our lines. These and other possible mechanisms of potential exposure must be carefully examined as well as the possible role of mycoplasmas and other chronic infections in GWI patients. War, Terrorism and BW Attacks If BW agents are ever deployed in war or terrorist attacks, many times the lethal (human) dose could be encountered in an aerosolized BW and chemical mixture that is designed to inhibit and overwhelm the body’s defensive abilities. These mixtures, called ‘Russian Doll Cocktails,’ contain microorganisms plus immune inhibitors and other chemicals to impede the immune system’s ability to contain the infection by blocking pulmonary defenses. The pulmonary immune system, particularly the pulmonary macrophage, is the first level of defense against inhaled foreign microorganisms and its suppression could result in systemic infection. BW use on the battlefield of the future will likely involve multiple BW agents, not just one or even a few agents. Countries like Iraq operate under ‘Soviet War Doctrine,’ a battle strategy that stresses combinations of conventional and unconventional weapons. Thus combinations of multiple BW, CW (Chemical Warfare) or even NW (Nuclear Warfare) agents may be used together to heighten BW virulence and confuse the diagnosis and treatment of casualties. The rationale is to overwhelm a medical corps’ ability to effectively manage large numbers of casualties with unknown or incomplete diagnoses. Iraqi Field Manuals found during the Gulf War described this strategy in detail. Unfortunately, BW can be developed and produced at a fraction of the cost of other weapons of mass destruction, making it likely that future terrorists will choose BW agents over other weapons for terrorist attacks. The U.S. military’s strategy of defense against BW agents is prior immunization using multiple vaccines. Unfortunately, this can only be successful if the exact BW agents likely to be encountered are known in great detail and for some time in advance of exposure. For example, the vaccine against Bacillus anthracis requires a rather lengthy immunization protocol, administering multiple vaccine and booster doses over more than a year. If multiple vaccines were to be administered, then they would have to be administered at different times to prevent immune suppression or excessive stimulation. Obviously, this strategy requires advance knowledge of the threat and careful long-term preparation against the threat. To prepare for any new threat that arises will require some time, possibly years or over a decade. Recent reports have appeared indicating that the Russians have developed anthrax strains for which it is claimed protective vaccines do not exist. What is the evidence that our ‘multivalent’ Bacillus anthracis vaccine will protect against all known anthrax strains? Protection against BW Attacks Other strategies besides the vaccine approach to BW defense are available. During the Gulf War the French forces elected not to use vaccines as a primary defense against Iraqi BW and not to use anti-nerve agents as a defense against Iraqi Chemical Warfare agents. Instead, they used prophylactic antibiotics to counter Iraqi BW agents, and they depended on protective suits to counter Iraqi chemicals. Interestingly, the French Armed Forces were the only nation in the Coalition Forces that did not report any cases of GWI, nor were there any illnesses reported in the immediate families of French Gulf War veterans. What assurances do we have that future vaccines will be free of microbial contamination that could cause disease? Obviously, the purity and safety of vaccines depend on their ability to remain free of contamination by microorganisms. FDA-mandated vaccine preparation methods are generally considered adequate to prevent this possibility, but unless each ‘batch’ or lot of vaccine is routinely tested for possible contamination, including animal testing, this remains a possibility that must be carefully examined, not uncritically dismissed by untrained bureaucrats as a remote hypothetical possibility. If prophylactic antibiotic or antiviral agents are used for BW defense, can these be defeated? Yes, BW agents can be modified or ‘constructed’ that have integrated into their genomes antibiotic- or antiviral-resistance genes. Similar to the ‘engineering’ of more lethal BW agents to circumvent known vaccines, such microorganisms can be ‘engineered’ to resist specific antibiotic or antiviral agents. Interestingly, certain U.S. units were issued antibiotics like ciprofloxacin and doxycycline just before the ground offensive in the Gulf War. These antibiotics would be expected to be effective in preventing infections of at least two of the agents identified in veterans with Gulf War Illness (Mycoplasma fermentans and Brucella spp.). Examination of the numbers, deployments and types of casualties and their diagnoses in the units administered antibiotics before and during the Gulf War could tell us if the French approach to BW defense was more or less effective than our approach of administering multiple vaccines to prevent BW casualties. Anthrax Vaccine Package Insert (available at http://www.Bioportcorp.com/anthraxIns.htm) Asa PB, Cao Y, Garry RF: Antibodies to Squalene in Gulf War Syndrome. Exp Mol Pathol 68(1):55-64, 2000. Brachman PS and Friedlander AM: Anthrax. In: Plotkin SA and Mortimer EA (eds), Vaccines, 2nd Ed., WB Saunders, Philadephia, P. 729-740, 1994. Brachman PS, Gold H, Plotkin SA, et al.: Field evaluation of a human anthrax vaccine. Am J Pub Health 52:632-645, 1962. Code of Federal Regulations: (available at http://www.access.gpo.gov/nara/cfr/cfr-retrieve.html#page1) Ellenberg S, Chen R: The complicated task of monitoring vaccine safety. Pub Health Rep 112:10-20, 1997. FDA Inspection Reports: Bioport, November 1999 and MBPI, February 1998 (available at htpp://www.anthraxvaccine.org). Friedlander AM, Pittman PR, Parker GW: Anthrax vaccine: evidence for safety and efficacy against inhalational anthrax. JAMA 282:2104-2106, 1999. Geissler E (Ed): Biological and Toxin Weapons Today. Oxford University Press, Oxford, 1986. Inglesby TV, Jahrling PB, Friedland AM, et al.: Anthrax as a Biological Weapon: medical and public health management. JAMA 281:1735-1745, 1999. Istock CA: Bad medicine. Bull Atom Sci Nov/Dec:21-23, 1998. Lange G, Tiersky L, DeLuca J, et al.: Psychiatric diagnoses in Gulf War veterans with fatiguing illness. Psychiat Res 89:39-48, 1999. Lo S-C, Wear DJ, Shih W-K, et al.: Fatal systemic infections of nonhuman primates by Mycoplasma fermentans (incognitus strain). Clin Infect Dis 17(Suppl 1):S283-S288, 1993. McDade JE, Franz D: Bioterrorism as a public health threat. Emerg Infect Dis 4:403-404, 1988. Nass, M: Will anthrax vaccine help prevent biological warfare? Def Systems Intern :37-39, 1998. Nass, M: Anthrax vaccine. Model of a response to the biologic warfare treat. Inf Dis Clin North Amer 13:187-208, 1999. Nicolson GL: Considerations when undergoing treatment for chronic infections found in Chronic Fatigue Syndrome, Fibromyalgia Syndrome and Gulf War Illnesses. (Part 1). Antibiotics Recommended when indicated for treatment of Gulf War Illness/ CFIDS/FMS (Part 2). Intern J Med 1:115-117, 123-128, 1998. Nicolson GL, Nasralla M, Haier J, Nicolson NL: Diagnosis and treatment of chronic mycoplasmal infections in fibromyalgia and chronic fatigue syndromes: Relationship to Gulf War Illness. Biomed Therapy 16:266-271, 1998. Nicolson GL, Nasralla MY, Haier J, et al.: Mycoplasmal infections in chronic illnesses: Fibromyalgia and Chronic Fatigue Syndromes, Gulf War Illness, HIV-AIDS and Rheumatoid Arthritis. Med Sentinal 4:172-176, 1999. Nicolson GL, Nasralla M, Haier J, Nicolson NL: Gulf War Illnesses: Role of chemical, radiological and biological exposures. In: War and Health, H. Tapanainen, ed., Zed Press, Helinsiki, in press, 2000. Nicolson GL, Nicolson NL: Chronic fatigue illness and Operation Desert Storm. J Occup Environ Med 38:14-16, 1996. Nicolson GL, Nicolson NL: Diagnosis and treatment of mycoplasmal infections in Persian Gulf War Illness-CFIDS patients. Int J Occup Med Immunol Tox 5:69-78, 1996. Nicolson GL, Nicolson NL: The eight myths of Operation Desert Storm and Gulf War Syndrome. Med Confl Surviv 13:140-146, 1997. Nicolson GL, Nicolson NL: Gulf War Illnesses: complex medical, scientific and political paradox. Med Confl Surviv 14:156-165, 1998. Pomerantnsev AP, Startsin NA, Mockov YV, et al.: Expression of cereolysin AB genes in Bacillus anthracis vaccine strain ensures protection against experimental hemolytic anthrax infection. Vaccine 15:1846-1850, 1997. Roth JA: Mechanistic bases for adverse vaccine reactions and vaccine failures. Adv Vet Med 41:681-700, 1999. Takefuji ET and Russell PK: Military immunizations: past, present and future prospects. Inf Dis North Amer 4:156-170, 1990. Thornton D: A survey of mycoplasma detection in veterinary vaccines. Vaccine 4:237-240, 1986. U.S. Congress, Senate Committee on Banking, Housing and Urban Affairs, U. S. chemical and biological warfare-related dual use exports to Iraq and their possible impact on the health consequences of the Persian Gulf War, 103rd Congress, 2nd Session, Report May 25, 1994. U.S. Congress, Senate Committee on Veterans’ Affairs, Is military research hazardous to veterans’ health? 103rd Congress, 2nd Session, Report December 8, 1994. U.S. General Accounting Office, Gulf War Illnesses: improved monitoring of clinical progress and reexamination of research emphasis are needed. Report GAO/SNIAD-97-163, 1997. ALL INFORMATION, DATA, AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR LEGAL ADVICE. THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH YOUR HEALTH CARE PROVIDER. BioMedSearch.com Tweet "A foolish faith in authority is the worst enemy of truth." -- Albert Einstein, letter to a friend, 1901 "I know of no safe depository of the ultimate powers of the society but the people themselves, and if we think them not enlightened enough to exercise control with a wholesome discretion, the remedy is not to take it from them, but to inform their discretion by education." -- Thomas Jefferson, letter to William C. Jarvis, September 28, 1820 “A sacred cow will not protect the herd.” -- Sandy Gottstein "What's the point of vaccination if it doesn't protect you from the unvaccinated?" -- Sandy Gottstein "Who gets to decide what the greater good is and how many will be sacrificed to it?"

医学

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American Recovery and Reinvestment Act of 2009: Independent Living Recovery Funds The American Recovery and Reinvestment Act of 2009 (ARRA) appropriates significant new funding for the Independent Living (IL) programs authorized under Title VII, Chapter 1, Part B and Part C, and Chapter 2 of the Rehabilitation Act of 1973, as amended (Rehabilitation Act). The IL programs support services to individuals with significant disabilities and older individuals who are blind to maximize their leadership, empowerment, independence, and productivity, and to promote the integration and full inclusion of individuals with disabilities into the mainstream of American society. The ARRA funds provide an unprecedented opportunity to implement innovative strategies to improve and expand IL services for individuals with significant disabilities and older individuals who are blind. Under the ARRA, $140 million in recovery funds are provided under three authorities: State IL Services Program (State IL Grants): $18,200,000 IL Services for Older Individuals Who Are Blind Program (OIB): $34,300,000 Centers for Independent Living Program (CIL): $87,500,000 Information about each State's formula allocation under the State IL Grants and OIB programs is available at: http://www.ed.gov/about/overview/budget/statetables/index.html This website also provides information about the State Fiscal Stabilization Fund (SFSF) under the ARRA, which is separate from the IL ARRA funds described in this fact sheet. This document focuses on the State IL Grants Program and the OIB Program. The Department will provide separate guidance regarding the CIL program authorized under Title VII, Chapter 1, Part C of the Rehabilitation Act. Overview of ARRA Principles: The overall goals of the ARRA are to stimulate the economy in the short term and invest in education and other essential public services to ensure the long-term economic health of our nation. The success of the part of the ARRA that provides support for programs under the Rehabilitation Act will depend on the shared commitment and responsibility of all involved in supporting improved outcomes for young people and adults with disabilities. Collectively, we must advance ARRA's short-term economic goals by investing quickly, and we must support ARRA's long-term economic goals by investing wisely, using these funds to strengthen IL programs, drive reforms, and improve results for people with disabilities. Principles guiding the distribution and use of ARRA funds that are particularly relevant to the State IL Grants and OIB programs include: Spend funds quickly to save and create jobs. ARRA funds will be distributed quickly to states and other entities in order to avert layoffs and create jobs. They in turn are urged to move rapidly to develop plans for using funds, consistent with ARRA's reporting and accountability requirements, and to begin spending funds promptly to help drive the nation's economic recovery. Ensure transparency, reporting, and accountability. To prevent fraud and abuse, support the most effective uses of ARRA funds, and accurately measure and track results, recipients must publicly report on how funds are used. Due to the unprecedented scope and importance of this investment, ARRA funds are subject to additional and more rigorous reporting requirements than normally apply to grant recipients. Invest one-time ARRA funds thoughtfully to minimize the "funding cliff." ARRA represents a historic infusion of funds that is expected to be temporary. For the State IL Grants and OIB programs, these funds are available for obligation until September 30, 2011. These funds should be invested in ways that do not result in unsustainable continuing commitments after the funding expires. Awarding IL ARRA Funds The Department awarded the ARRA funds available under the State IL Grants and OIB programs on April 1, 2009. These awards are in addition to the regular FY 2009 awards for these programs, and together, these awards will constitute a state's total FY 2009 allocation for the State IL Grants and OIB programs. States are eligible to receive ARRA funds under these programs based on their approved State Plan for Independent Living (SPIL) and OIB applications and the provision of the certification required by section 1607 of the ARRA. The assurances in a state's SPIL and OIB application, as well as the requirements of the ARRA, will apply to the use of ARRA funds. Amendments to a state's SPIL are not required for the receipt and expenditure of the ARRA funds, as long as those expenditures are consistent with the FY 2009 SPIL. However, as required by the IL program regulations and the Education Department General Administrative Regulations (EDGAR), a state will be required to amend its SPIL where necessary to reflect significant and relevant changes to the SPIL's information or assurances, its administration or operation, or the organization, policies or operations of the State agency that received the grant, if the change materially affects the information or assurances in the plan. If required by the program regulations and EDGAR, amendments should be initiated expeditiously in accordance with the procedures for amendments outlined in the Rehabilitation Act and applicable regulations. The Department encourages Designated State Units and Statewide Independent Living Councils to begin efforts to reach agreement on how the State IL Grants ARRA funds will be spent. The Department has reserved funds from the $140 million appropriated for all three IL programs under the ARRA for the required set-aside under section 21(b) of the Rehabilitation Act for capacity building activities of minority entities and Indian tribes. Uses of IL ARRA Funds All ARRA funds for State IL Grants and OIB programs under the Rehabilitation Act must be used consistently with the current statutory and regulatory requirements for those programs, as well as applicable requirements in the General Education Provisions Act (GEPA) and EDGAR. Grantees under the State IL Grants and OIB programs should consider how they can use the additional funds to improve and expand IL services; serve additional consumers, especially populations that are unserved or underserved in the state; increase the capacity of IL service providers to provide IL services; and maximize employment opportunities and economic benefits to individuals with significant disabilities consistent with the goals and objectives established by individual consumers. The ARRA State IL Grants and OIB funds constitute a large one-time increase that offers a unique opportunity to improve IL outcomes. Generally, funds should be used for short-term investments with the potential for long-term benefits, rather than for commitments that the State may not be able to sustain once ARRA funds are expended. Some examples of possible uses include: Designing or identifying and providing services that may be extended at low cost beyond 2012 to additional individuals who wish to transition from nursing homes to their communities; Creating more efficient and effective ways of increasing IL services to students with disabilities transitioning from school to employment and independent living; Building long-term capacity by improving the technological core of the program, including, but not limited to, purchasing equipment, improving connections, and obtaining software in order to better serve consumers; Training current staff in effective ways of providing assistive technology to consumers; Expanding information and referral and advocacy services to address the needs of consumers who were laid off and may need assistance replacing services or assistive technology previously provided through an employer; and Providing professional development opportunities that have both short-term and long-term benefits to service provider staff. Fiscal Issues In accordance with the goals of the ARRA, the funds for the State IL Grants and OIB programs should be obligated expeditiously and with appropriate accountability. The ARRA funds received by the State IL Grants and OIB programs will remain available for obligation by grantees until September 30, 2011, which includes one year of carry over in accordance with section 19 of the Rehabilitation Act. Under the Rehabilitation Act and the ARRA, the Department may not waive the matching requirements for the ARRA funds awarded to states under the State IL Grants program or the OIB program. States must provide the requisite non-federal share for all funds received for these two programs in FY 2009, which includes the FY 2009 appropriation and the IL ARRA funds, by September 30, 2010. A state may not count State Fiscal Stabilization or IL ARRA funds as non-federal funds for purposes of meeting the matching requirements for the State IL Grants and OIB programs. Accountability Principles As with all federal funds, states are responsible for ensuring that the ARRA State IL Grants and OIB funds are used prudently and in accordance with the law. ARRA requires that recipients of funds made available under that Act separately account for, and report on how those funds are spent. Further information on reporting instructions will be provided shortly online at www.FederalReporting.gov. The President and the Secretary are committed to ensuring that ARRA funds are spent with an unprecedented level of transparency and accountability. ARRA State IL Grants and OIB program expenditures will be reported on the Recovery.gov Web site. The Department will provide updates as additional information becomes available regarding the details of the ARRA State IL Grants and OIB program funds. The Department will also provide further information on the government-wide data collection and reporting requirements as this information becomes available. If you have any questions or concerns, please email them to RSARecoveryActComments@ed.gov. Printable view

医学

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info@genetic-healthcare.com FAQ HOME E-GENETIC LIBRARY EVENT & NEWS ROOM 100 Diseases Susceptibility (Inherited) Gene Test Prediction of Major Diseases Prevention of Health Complications Personalization of Healthcare Management Innate Talent & Behavioral Gene (DNA) Test How Much Do You Really Know About Your Child? Genetic Healthcare Group is in the forefront of Genetics Testing . Research results of modern medical science indicate that most diseases are determined by various factors and genetic constitution. Though the Human Genome Project has been successfully completed, work has been ongoing in exploring the next steps in the Human Genome. The completion of the human genome sequence, increases the knowledge of DNA sequence differences between individuals. This, together with the rapidly advancing technology for reading DNA sequences have further led to significant progress in identifying genes underlying common, genetically complex diseases ("susceptibility genes"). By January 2009, more than 500 new susceptibility genes for these diseases have been systematically mapped to the genome and, in many cases; the underlying genes have been identified. The human genome was discovered by renowned scientists in the middle of the last century and has now become the revolution to the world of healthcare and medical industry. The completion of the Human Genome (DNA) Project which was fully completed early this century was a joint effort between the United States, United Kingdom, China, Germany, France and Japan. Working towards the goal of providing a better and quality personalized lifestyle for everyone, Genetic Healthcare was being established with the support of renowned scientists from all over the world. Genetic Healthcare provides high accuracy Diseases Susceptibility Gene (DNA) Test with the use of State-of-the-Art technologies and applications. offers comprehensive DNA Mapping (Test) to determine your child's inborn talents, traits, and their natural abilities. The DNA Test for Child Innate Talent is 100% scientific that identifies the genes which reveals critical information about your Child's IQ, Emotional Controls, Focus, Memory, Athletic Abilities, and many more. EVERY CHILD IS GIFTED !!! It is the combination of different strengths and weaknesses within their traits that decides the different talents of your child. It is also the different talents that decides their future prospects and careers. About Genetic Healthcare Group is in the forefront of entrepreneurial genomics. Subscribe Newsletter Subscribe to our newsletter and stay up to date with the latest news and deals! Contact Us Malaysia: +60 (3) 6211 9021 Email: info@genetic-healthcare.com Stay Connected 2013 © Genetic Healthcare Group. ALL Rights Reserved.

医学

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Applying | Calendars | Contact | News & Events Teaching & Research Giving to Vet Med Veterinary Medical Diagnostic Laboratory (VMDL) CVM Employment Zalk Veterinary Medical Library CVM Course Materials MyZou ACLAM Honors CVM’s Franklin with Comparative Medicine Scientist Award Dr. Sue VandeWoude, professor of Comparative Medicine at Colorado State University, presents Dr. Craig Franklin with the ACLAM Comparative Medicine Scientist Award. The American College of Laboratory Animal Medicine (ACLAM) has awarded MU College of Veterinary Medicine Professor Craig Franklin its Comparative Medicine Scientist Award for 2014. In addition to his position as professor within the Department of Veterinary Pathology, Franklin, DVM, PhD, is the director of the MU Mutant Mouse Regional Resource Center, a position he has held since 2011. He has also served as director of Comparative Medicine Program since 1998 and head of the Veterinary Research Scholars Program since 2005. The Comparative Medicine Scientist Award is the ACLAM’s highest honor for scientific achievement in comparative medicine. Judging is based on outstanding contributions to the field through research publications, reviews, book chapters and lectures over a period of time between five and 20 years. The award criteria states that recipients must have had a significant impact on the field of animal-based biomedical research. Franklin earned a bachelor’s degree in agriculture from the University of Missouri in 1984. He went on to complete his doctor of veterinary medicine in 1987, a master’s in laboratory animal medicine in 1990, and a PhD in pathology in 1992, all from the University of Missouri. He also undertook a residency in laboratory animal medicine from 1988-1991. Franklin began his professional career at MU in 1987 as a research associate. After completing his residency and PhD, he was appointed as an assistant professor in 1992 and an associate professor in 1999. He became a professor in 2011. Dr. Gregory Boivin, a professor in the Department of Pathology and Orthopaedic Surgery and director of Laboratory Animal Resources at Wright State University in Dayton, Ohio, nominated Franklin for the award. In his letter to the nomination committee, Boivin noted that Franklin’s research has been continuously funded through the National Institutes of Health or industry partners for 15 years. That research has resulted in the publication of more than 90 articles, most related to infectious diseases in laboratory animals. He also noted that Franklin’s mark on the field extends to the more than 60 post-DVM graduate students he has trained who have also gone on to careers in laboratory animal medicine. In letters supporting his nomination, other colleagues commended Franklin’s mentorship of graduate students and noted that he also encourages veterinary students to explore careers in research through his involvement in the Veterinary Research Scholars Program. Franklin received the award during the ACLAM’s annual forum held earlier this month in Coeur d’Alene, Idaho. Return to News and Events home College of Veterinary Medicine W-203 Veterinary Medicine Building E-mail: cvmwebmaster@missouri.edu ©2005 Curators of the University of Missouri DMCA and other copyright information. an equal opportunity/ADA institution

医学

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Education » Daily Health News Health Information Daily Health News Migraine Sufferers Show More Brain Changes Than Others: Study 2012-Nov-13 :: TUESDAY, Nov. 13 (HealthDay News) -- Women who suffer from migraines are more likely to have brain lesions than those who don't get the debilitating headaches, but new MRI research shows that the severity of those lesions does not correlate with greater memory or thinking problems."We found a higher volume of brain changes among women with migraines, but no evidence of a strong relationship between the attack rate or other related factors with the degree of lesions," said study author Dr. Mark Kruit, a neuroradiologist at Leiden University Medical Center in the Netherlands. The brain changes, also called "white matter hyperintensities," are believed to be caused by episodes of low oxygen to the cells, called ischemia. The lesions are associated with higher risk of atherosclerotic disease, ischemic stroke and cognitive decline, according to the researchers. "From a broad perspective, we should probably understand migraines as a problem related to coronary artery disease," Kruit said. "The white matter hyperintensities are likely of ischemic origin, but we need further studies." The study was published Nov. 14 in the Journal of the American Medical Association. About 12 percent of people in the United States get migraines, which are recurring attacks of moderate to severe throbbing or pulsing head pain, according to the U.S. National Library of Medicine. They are three times more common in women than in men.As for why women are more prone to migraines than men, Kruit explained that previous studies implicate the female hormone estrogen.The researchers developed this study to follow up on work published in 2004, Kruit said. "[That study] had a scary message: that females with migraines had more brain damage, and the researchers had no clue why they were seeing brain lesions," he explained. "They said that people with higher migraine attack frequency had more lesions, suggesting causation."The researchers wanted to determine whether women or men who had migraines had a higher incidence of brain changes nine years after having an initial MRI. Tapping 286 people from the Netherlands who had participated in the previous study, the scientists gave MRIs to people with migraines and to those without the headaches, accounting for age, gender, hypertension, diabetes and educational level.The participants in the migraine group had an average age of 57 years old, and 71 percent were women. Those in the control groups were an average of 55 years old, and 69 percent were women.The researchers found that 77 percent of the women with migraines and 60 percent of the control group showed progression of white matter hyperintensities. The women with migraines, however, did not have significantly higher progression of other brain changes, as measured by MRI.What are these white matter hyperintensities?Dr. Deborah Friedman, professor of neurology and ophthalmology at the University of Texas South Western Medical Center in Dallas, explained in an editorial accompanying the research: "They're most likely ischemic changes related to migraines, but it's unlikely these itty bitty spots will grow or become a problem." "Nerve cells get excited and fire more than usual, and then they fire less; it starts at the back of the brain and moves forward," Friedman said. "It could be ischemia. Not everyone with migraines gets them." But Friedman is optimistic. "I wanted to headline the editorial 'Don't Panic,'" she said. "The MRI is not the whole story. We need to treat people with migraines like anyone, looking at the whole picture."Friedman said physicians should work with migraine sufferers to help them reduce the classic risk factors of cardiovascular disease: obesity, high blood pressure, smoking, high cholesterol and lack of exercise.It's possible, Friedman said, that some migraine sufferers may be at increased genetic risk for white matter disease, including stroke, transient ischemic attacks and cognitive changes. "But there's no evidence that preventing migraines will decrease the risk of cardiovascular disease," she said. More informationTo learn more about migraines, visit the U.S. National Institute of Neurological Disorders and Stroke. 2012Copyright © 2012 HealthDay. All rights reserved. Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition. Emergency ServicesLearn more about our Emergency Services.

医学

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Connecticut school shooter and Asperger's syndrome Phyllis L. Smith Asinyanbi Investigators believe Adam Lanza—now infamous for killing his mother, 26 students and faculty at Sandy Hook Elementary School and then himself—had Asperger's syndrome, a type of high-functioning autism. According to experts, there is no link between Asperger's syndrome, also known as Asperger's Disorder, and mass murder. Asperger's, like other forms of autism, is a developmental disorder. It differs from classic autism because those with Asperger’s have on-time language development and average or above-average intelligence, whereas 75 percent of those with classic autism have varying degrees of intellectual disabilities, formerly known as mental retardation. Autism is a neurobiological disorder—not a mental disorder—in which the brain functions differently from typical individuals, specifically affecting communication, both verbal and non-verbal, as well as speech. Adam Lanza is described as a gifted genius who excelled academically, but also as a socially awkward, quiet, anxiety-ridden teenager who was unable to make good eye contact or connect with his peers. Poor eye contact is common in individuals who suffer from an autism spectrum disorder, as are social deficits. An individual who is afflicted with Asperger’s can also have diagnoses, such as depression, anxiety, obsessive-compulsive disorder, bipolar and myriad other mental health issues—just as a non-Asperger’s person can. Adam Lanza's brother, Randy, reported to officials that Adam was autistic and had a personality disorder. Children who have an ASD and high intelligence, often falling into the cognitively gifted range, with IQs ranging from 130 to immeasurable, still have special needs. It is difficult to imagine a gifted child as having special needs, but giftedness in itself is an anomaly, and gifted children must be nurtured to reach their full potential. Twice exceptional (2E) children are those who are gifted but also have a special need or challenge. Schools, even in the best districts, are often ill equipped to provide the proper support for 2E autistic children, and ABC News reported that Adam’s mother, Nancy Lanza, pulled her son out of high school and homeschooled him because she was not satisfied with the district's plans for him. An Individualized Education Plan, known as an IEP, is often provided for students who are known to have a disability. However, the resources to carry out IEP mandates, such as paraprofessional support, are often unavailable due to lack of funding. The New York Daily News reported that Adam Lanza had a condition that caused him not to feel physical pain while playing baseball when he was younger. This condition is known as sensory processing disorder or sensory integration dysfunction, and is common in individuals on the autism spectrum. SPD can best be described as over-sensitivity or under-sensitivity to tactile experiences, including touch. In Adam Lanza's case, it was extreme. However, these symptoms often diminish as a child gets older. Like other types of autism, Asperger’s is treatable but not medically curable. It is often referred to as mild autism or high-functioning autism. Treatment methods may include medication for anxiety or associated sleep disorders, along with behavioral therapy and social skills groups. Occupational therapy is often employed to help individuals with Asperger’s cope with SPD. The earlier that behavioral therapy begins, the more beneficial it is to an autistic child. It is unclear whether Adam Lanza was diagnosed in early childhood or received standard treatment and therapies. Asperger’s is often not diagnosed until later, because unlike classic autism, children with Asperger’s can speak, often have advanced vocabularies and function well, or at least adequately, in school. The average age at diagnosis is eight, and misdiagnoses often occur. It takes a skilled, experienced clinician to accurately diagnose Asperger’s. Children with Asperger’s are often teased, bullied and physically assaulted due to social deficits, immature demeanor and repetitive behaviors. They are often described by peers as weird, strange and odd. Reportedly, bullying was not a problem for Adam Lanza, and those in the community were aware that he had issues and chose to allow him to be himself. His struggles appeared to be internal ones. Per the Autism Society of America, 1 percent of children in the United States between the ages of 3 and 17 have autism, with boys affected five times as often as girls. More research is needed on prevention and treatment. Although Adam Lanza may have had Asperger’s syndrome, those who have an Asperger’s diagnosis have no more potential for mass murder than typical persons. The author has served as an expert witness in a disability case on Asperger's syndrome. References: http://www.autism-society.org/about-autism/facts-and-statistics.html http://www.allvoices.com/contributed-news/13617517-adam-lanza-portrait-of-connecticut-school-shooter-emerges Following is resource information on Asperger's Syndrome: Asperger's and Girls, By Tony Atwood, Temple Grandin, Teresa Bolick and Catherine Faherty Asperger's Syndrome: A Guide for Parents and Professionals, By Tony Atwood Asperger's Syndrome and Homeschooling, By Phyllis L. Smith Asinyanbi Hitchhiking Through Asperger's Syndrome, By Lisa Pyles How to Help Your Child Who Has Asperger's Syndrome, By Phyllis L. Smith Asinyanbi Look Me in the Eye: My Life with Aspergers, By John Elder Robison Tony Atwood’s website, Information from a world-renowned expert on Asperger's Allvoices.com

医学

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HomeResearchPostgraduateClinical Research TrainingMembersContact Us The Centre for Clinical Brain Sciences (CCBS) was established in 2004. It is a multidisciplinary translational "centre without walls" combining basic and applied research to study the causes, consequences and treatment of major brain disorders. Our major disease targets, that straddle the disciplines of Neurology and Psychiatry, include: bipolar disorders, brain cancer, multiple sclerosis, motor neurone disease, prion disease, schizophrenia, stroke and epilepsy. Events & Announcements Exercise After Stroke Pathway wins NHS Lothian Best Innovation prize The Exercise after Stroke (EAS) pathway in Edinburgh runs in partnership with Edinburgh Leisure and culminates in an in-reach project at the acute stroke unit at the Royal Infirmary of Edinburgh. The pathway has already achieved the same number of referrals into EAS in six months that are normally received in one year and, more importantly, has already doubled the normal annual numbers taking up exercise in the community with Edinburgh Leisure in just six months. This suggests a four-fold increase in the take up of EAS pathway projected to 12 months, bringing all the evidence-based benefits of increased physical fitness to those individuals. One half of those seen in the ward by a stroke specialist fitness instructor were still exercising in the community three months after the acute intervention. This is a great improvement over previous performance. The pathway was presented by Mark Smith, Consultant Physiotherapist, at the NHS Lothian Allied Health Professionals Conference at Dynamic Earth on 8th September 2014, and won the prize for the "Best Innovation", which was presented by Mr Brian Houston, Chair, NHS Lothian. This work has been funded by the Edinburgh and Lothians Health Foundation and has involved multiple key stakeholders. Conference attendees were also interested in how an in-reach modelmight be replicated with other patient groups such as in orthopaedics or older people's services. The team is looking at ongoing funding opportunities and considering a submission to the Scottish Stroke Improvement Plan Fund as a mechanism for delivering such an in-reach model for stroke in other health boards in Scotland. £2M for FOCUS: a multicentre randomised trial to establish the effect of Fluoxetine (Prozac) in stroke Stroke is the major cause of adult disability in the UK, and new treatments are needed to reduce the long-term physical and emotional problems faced by stroke survivors. Selective serotonin reuptake inhibitors (SSRI) are a class of drug that have been used to treat mood disorders for many years. Several small trials have suggested that they might also promote brain recovery when given routinely early after stroke, even in patients without mood disorders. The FOCUS trial (Fluoxetine or Control under Supervision), which is led by Prof Gillian Mead and Prof Martin Dennis of CCBS, aims to find out whether fluoxetine, a type of SSRI, started at 2-15 days after stroke, and continued for 6 months, improves recovery at 6 months, and whether any benefits persist to 12 months. The start-up phase of FOCUS, funded by the Stroke Association, has demonstrated that a UK multicentre trial is feasible. The FOCUS investigators (G Mead, M Dennis, A House, J Forbes, M MacLeod, S Lewis, G Hankey, M Hackett, C Anderson, D Morales, F Sullivan) have now been awarded £2,088,149 from NIHR Health Technology Assessment over 4.5 years, for the main phase of the trial, which will recruit from up to 120 UK centres and complete recruitment of at least 3000 patients. If Fluoxetine is effective, this simple treatment would be widely applicable throughout the world. Parallel trials based on the design of FOCUS are being run in Sweden (EFFECTS) led by Erik Lundstrom and Veronica Murray; and Australia (AFFINITY) led by Graeme Hankey and Maree Hackett. The three teams are collaborating closely: e.g., the Data Monitoring Committees of the three trials will share safety data, and when each trial has published its results, the data will be pooled. For further information, please see www.focustrial.org.uk Urine test for CJD developed An international team including researchers from CCBS has published research suggesting that people carrying variant Creutzfeldt-Jakob disease (CJD) could be identified from a urine test. Variant CJD - which is linked to bovine spongiform encephalophathy (BSE) in cattle - is caused by infectious proteins called prions. Using a new, high-powered technique, the researchers discovered that patients with variant CJD had traces of prions in their urine. The technique, called protein misfolding cyclic amplification (PMCA), was developed at The University of Texas Medical School at Houston. It amplifies minute quantities of abnormal prion protein, enabling highly sensitive detection. "This is the first time that we have been able to detect prions in the urine of patients with variant CJD. It opens the door to the development of a screening tool for people infected with CJD who do not show any symptoms, which is of particular concern in the UK for securing the safety of our blood supply." Professor James Ironside, National CJD Research & Surveillance Unit, University of Edinburgh. The disease remains very rare - 229 people have died from variant CJD since it was first identified almost 20 years ago, of which 177 were from the UK. However, it has been estimated that as many as one in 2000 people in the UK could be carrying infectious prions without showing any symptoms. The findings are published in the New England Journal of Medicine: Prions in the Urine of Patients with Variant Creutzfeldt–Jakob Disease. Moda F, Gambetti P, Notari S, Concha-Marambio L, Catania M, Park K-W, Maderna E, Suardi S, Haïk S, Brandel J-P, Ironside J, Knight R, Tagliavini F, and Soto C. N Engl J Med 2014; 371:530-539August 7, 2014DOI: 10.1056/NEJMoa1404401. "This could lead to the development of commercial technology for diagnosis as well as to determine the safety of donated blood and urinary products" Claudio Soto, Professor of Neurology, The University of Texas Medical School at Houston. Dementia experts join forces in global bid to tackle disease Dementia experts are forming the world's largest research group in the field to tackle the condition. They hope to improve the detection, treatment and ultimately prevention of dementia by looking at the disease in the context of the whole body and not only the brain. Investigator teams from eight UK universities Å including the University of Edinburgh Å are joining forces with industry experts from pharmaceutical and biotech companies to form the UK Dementia Platform (UKDP). The team will study data from two million volunteers aged 50 and over who have taken part in existing research projects such as UK Biobank, a long term national health study. Participants in these studies have generously provided a wealth of medical and lifestyle data which experts will examine alongside ongoing genetic studies, brain imaging and tests of mental skills. Researchers hope to gain a better understanding of who is at risk of developing dementia, possible triggers for the disease, and what might speed or slow its progress. The aim is to identify biological changes and shifts in thinking abilities that are linked to the condition. It is hoped that this could lead to earlier detection and improved monitoring of dementia and will help design better ways of testing new treatments. Looking at the links between development of dementia and other factors Å such as diet or illness Å could also unearth targets for new treatments or new uses for existing drugs. Data from the project will be made available to scientists around the world in a bid to accelerate progress in dementia research and encourage innovation. The collaboration - which is being led by the Medical Research Council - was announced on 20th June 2014 by Prime Minister David Cameron in a speech at a summit of world health and finance leaders in London. Four of the 14 research leaders who will steer the project are from the University of Edinburgh including scientists from the Centre for Cognitive Ageing and Cognitive Epidemiology, the Alzheimer Scotland Dementia Research Centre, Centre for Clinical Brain Sciences and The Roslin Institute. Professor Ian Deary, Director of the Centre for Cognitive Ageing and Cognitive Epidemiology, said: "We are delighted that the University has the opportunity to take a leading role in such an important programme of research. Looking at dementia in the context of the whole body is one that we have already taken in our cognitive ageing studies in Edinburgh, and one that we hope will yield significant breakthroughs in this larger setting." Professor Cathie Sudlow of the Centre for Clinical Brain Sciences, who is also Chief Scientist at UK Biobank, said: "This initiative has the potential to make a significant global impact in the battle against dementia." Neuroresearchers Fund Awards Professor Gillian Mead (CCBS) has co-authored a new guideline on physical activity and exercise recommendations for stroke survivors. The guideline discusses the really important issue of inactivity after stroke, and what we can do about it. It has beenCongratulations to two CCBS researchers who have been awarded Neuroresearcher funds. The aim of this fund is to assist in the establishment of new collaborations, bring new techniques to Edinburgh to benefit the community, and enable attendance at high profile techniques-based workshops. The CCBS awardees were: Mark Hughes, who was awarded £870 towards a visit to Charlottesville, USA to learn a new technique (trans-cranial magnetic resonance-guided focused ultrasound) as a potential new surgical approach to treating conditions such as Parkinson's. Lynsey Hall, who was awarded £500 towards the costs of attending the Wellcome Trust Advanced Course in Genetic Analysis of Multifactorial Diseases in Cambridge in July. We would also like to offer our congratulations to the other six winners. Physical Activity and Exercise Recommendations for Stroke Survivors Professor Gillian Mead (CCBS) has co-authored a new guideline on physical activity and exercise recommendations for stroke survivors. The guideline discusses the really important issue of inactivity after stroke, and what we can do about it. It has been published in Stroke, doi: 10.1161/STR.0000000000000022. Causes of depression in spotlight with £4.7m funding boost People suffering from clinical depression, and those at risk from the condition, could benefit from a major medical research initiative that is being led by Prof Andrew McIntosh (Psychiatry, CCBS). The Stratifying Resilience and Depression Longitudinally (STRADL) project has been awarded £4.7million from the Wellcome Trust to study the condition in new ways in the hope of developing better treatments. In addition to CCBS researchers from Psychiatry, the project involves the Centre for Cognitive Ageing and Cognitive Epidemiology (CCACE), the Institute for Genetics and Molecular Medicine (IGMM) and brain imaging facilities in Edinburgh and at the University of Aberdeen. Over the next five years, the scientists will study groups of people who have known depression risk factors. These include family history of low mood, diseases like heart disease and diabetes and early life problems such as low birth weight or childhood psychological trauma. Researchers will then use memory, reasoning and mental speed tests as well as brain imaging to find out whether specific subgroups of patients correspond to specific disorders. Prof McIntosh said: "For many people, the symptom of low mood is the most understandable of reactions to loss or stress, yet we remain ignorant of its causes and mechanisms. This means that progress in discovering new and more effective treatments is slow. This Wellcome Trust grant will enable us to make significant progress with this common and disabling condition." Prestigious Award for CCBS Researcher Dr Jon Stone Congratulations to Dr Jon Stone on being awarded the Jean Hunter Prize for Nervous Diseases by the Royal College of Physicians of London for his work on Functional Disorders. Former awardees include Dame Kay Davies, Prof Doug Tunrbull, Prof John Newsom Davies, Dame Pam Shaw and Sir Simon Wessely, so Jon is in magnificent company! Jon will be presented with his award on 27th May. Read Jon Stones profile on the Clinical Neurosiceneces Website Launch of the world's biggest study of cognitive function A third of a million adults in the UK are to be invited to take part in the world's biggest study of cognitive function. The trial aims to predict which factors may increase the risk of developing dementia. All the participants will be part of UK Biobank, and previously gave DNA samples and lifestyle information. They will be asked to do a series of memory and reasoning tests online. Professor Cathie Sudlow (CCBS) is Chief Scientist of UK Biobank. Cathie described the project on radio and TV news bulletins on Friday 2nd May. Coverage on the BBC Radio 4 Today programme (1hr 34min in) [available until 8th May 2014] UK Biobank Stroke recovery chances step up with exercise Regular exercise can speed recovery for stroke survivors and may reduce their risk of having another stroke. Professor Gillian Mead (CCBS) has been researching the benefits of exercise on stroke recovery for more than 10 years. She will be speaking about her research at a public event on Tues 15th April as part of the Edinburgh International Science Festival. Prof Mead's findings reveal that a structured physical training plan - including aerobic, strength and balance training - can help stroke survivors to become more mobile, improve their balance and reduce their disability. She is currently investigating whether breaking up long periods of sitting or lying - so-called 'sedentary' behaviour - with short periods of movement might help to bring down the risk of having another stroke. Professor Mead said: "We're working with fitness experts to determine the best 'exercise prescription' for stroke survivors. It's also important that we understand more about the factors that put patients off from taking part in exercise programs, and how we can motivate them to take advantage of the benefits." See coverage on the BBC news website: http://www.bbc.co.uk/news/uk-scotland-edinburgh-east-fife-27023739 Congratulations to Katie McGoohan Congratulations to Katie McGoohan (Masters of Nursing in Clinical Research student at the University of Edinburgh), who has been awarded a prestigious Stroke Association Postgraduate Fellowship for nurses to do a PhD. Katie will be co-supervised by Rustam Al-Shahi Salman (CCBS) and Sheila Rodgers (Nursing Studies). Her clinical research project will be based with the Stroke Research Group and will focus on the participants in LINCHPIN, a clinico-radio-pathological case control study of the causes of intracerebral haemorrhage. This study is part of the Research to Understand Cerebral Haemorrhage (RUSH) programme that is led by Prof Al-Shahi Salman. Can the damaged brain repair itself? Siddharthan Chandran's TED talk now online The talk that CCBS Director Siddharthan Chandran gave at TEDGlobal last year is now available to view online at here... In this short talk, Siddharthan explores how it might be possible to heal damage from degenerative disorders such as MS and motor neurone disease (ALS). Video overview of the Human Brain Project featuring Prof Seth Grant The Human Brain Project (HBP) is the world's largest neuroscience project (https://www.humanbrainproject.eu/en_GB) aiming to generate data, infrastructure and resources for the research community, develop new clinical tools and train students. The University of Edinburgh is highly involved in the project with CCBS Professor Seth Grant, one of the architects of the HBP, leading the work on the molecular and cellular programs. The HBP also includes Prof Siddharthan Chandran and computational scientist Prof Douglas Armstrong (Informatics). A video has been developed providing an overview of the project with Seth making an appearance halfway through. Watch it here: http://ec.europa.eu/programmes/horizon2020/en/news/human-brain-project-video-presenting-flagship-project. Featured Publication 1 Statistical analysis plan for the third International Stroke Trial (IST-3); part of a 'thread' of reports of the trial. Sandercock P, Lindley R, Wardlaw J, Whiteley W, Murray G; ST-3 collaborative group. Int J Stroke. 2012 Apr;7(3):186-7. doi: 10.1111/j.1747-4949.2012.00782.x. More Info..... Recognition of mental incapacity when consenting patients with intracranial tumours for surgery: how well are we doing? Kerrigan S, Dengu F, Erridge S, Grant R, Whittle IR. Br J Neurosurg. 2012 Feb;26(1):28-31. Epub 2011 Aug 4. Mutant induced pluripotent stem cell lines recapitulate aspects of TDP-43 proteinopathies and reveal cell-specific vulnerability. Bilican B, Serio A, Barmada SJ, Lumi Nishimura A, Sullivan GJ, Carrasco M, Phatnani HP, Puddifoot CA, Story D, Fletcher J, Park I-H, Friedman BA, Daley GQ, Wyllie DJA, Hardingham GE, Wilmut I, Finkbeiner S, Maniatis T, Shaw CE and Chandran S. PNAS 2012; published ahead of print March 26, 2012, doi:10.1073/pnas.1202922109/ More Info..... Featured Publication 4 Effects of a mis-sense DISC1 variant on brain activation in two cohorts at high risk of bipolar disorder or schizophrenia. Whalley HC, Sussmann JE,Johnstone M, Romaniuk L, Redpath H, Chakirova G, Mukherjee P, Hall J,Johnstone EC, Lawrie SM, McIntosh AM. Am J Med Genet B Neuropsychiatr Genet.2012 Apr;159B(3):343-53. doi:10.1002/ajmg.b.32035. Epub 2012 Feb 15. Untreated clinical course of cerebral cavernous malformations: a prospective, population-based cohort study. Salman RA, Hall JM, Horne MA,Moultrie F, Josephson CB, Bhattacharya JJ, Counsell CE, Murray GD,Papanastassiou V, Ritchie V, Roberts RC, Sellar RJ, Warlow CP; for the Scottish Audit of Intracranial Vascular Malformations (SAIVMs) Collaborators. Lancet Neurol. 2012 Mar;11(3):217-224. Epub 2012 Jan 31. (hover over a publication to pause the scrolling list) The University of Edinburgh is a charitable body, registered in Scotland, with registration number SC005336.

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Patient Care Research Education and Training Give Careers About City of Hope Tara Branham: Leukemia Survivor Tara Branham: I have leukemia. Other than that, I'm fine. Like so many other young women, Tara Branham arrived in Los Angeles with dreams of becoming an actress — but her life soon changed in ways she'd never imagined. Within three months of beginning classes at the American Academy of Dramatic Arts, the 29-year-old Michigan native began feeling tired. Really tired. To her shock, her physician diagnosed her with acute myelogenic leukemia, a cancer involving white blood cells. When Branham learned that a hematopoietic cell transplant offered her the best chance for survival, a relative and oncologist recommended City of Hope. Branham was admitted to City of Hope for a transplant shortly after her 30th birthday. Her brother, Cheyne, one of two siblings who was a match for her tissue type, donated his bone marrow to give her a chance at life. It worked. While her transplant was a success, Branham acknowledges residual physical challenges that she says have simply served to strengthen her spirit. Yes, she said, she lost her hair. She has had one hip replaced, and walking for an extended time is tough. The dream Branham once had to become a commercially successful actress no longer holds the same enchantment. Her life is different, but the changes, she insists, have brought their own reward. She lives with greater awareness and compassion and has discovered a new creative force within her, becoming a prolific writer. She once believed she would never again venture onto a stage as an actress, but she has written a one-woman show and is looking forward to performing it. In a nod to the optimism and often-repeated words of her City of Hope physician, Anthony Stein, M.D., she titled the work, "Other Than That, I'm Fine." It is her story of illness, challenges, recovery and discovery. It is a story about life. "It isn't a miracle that I survived," Branham said. "The miracle is that there are people on earth who want others to live through this — that there are scientific minds that are driven to do that."

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Electoral medicine By Richard E. Ralston web posted October 29, 2012 The authority to restore free choice in medicine is gradually being taken out of our hands. Congress and President Barack Obama are determined--without requisite legislation, no less--to have unelected boards and agencies dictate the medical care we are permitted to receive. Our only hope is that a few choices are still available in the voting booth. The Independent Payment Advisory Board (IPAB) authorized by Obamacare has been given a dedicated source of income not appropriated by Congress--which, therefore, cannot cut it off. The board’s decisions to deny Medicare payment for any procedures or treatments may not be subjected to judicial or congressional review. And, amazingly, Obamacare requires that any proposal to repeal the creation of IPAB or amend its powers in a future Senate or House of Representatives must be ruled "out of order" by the presiding office. Why elect lawmakers who are not allowed to change law? But then, we live in an era when the president thinks he can make a "recess appointment" to the U.S. Supreme Court if the Senate breaks for lunch. Why bother with a Congress that cannot change law or confirm appointments? For everyone on Medicare, any decision by IPAB to disallow payment for their treatment will leave them with no alternatives. Under current law, no physician who accepts Medicare patients is allowed to receive payment directly from patients for anything not covered by Medicare. For younger patients, no insurance company will long pay for procedures not sanctioned by IPAB. Millions of daily decisions about the treatment of 300 million people, in a rapidly changing technological environment, with regular new advances in drugs and procedures in complex combination with each other, will be subject to the decisions of one government board. But many politicians adore IPAB, because, as President Obama likes to say, "it is more fair," and they think medical care must be based upon the redistribution of wealth. The result: equal medicine for all--and equal misery for all. Is that "fair"? An additional burden for those with or without insurance will result from a new tax on medical equipment manufacturers. Although their development costs are often so high that there might not be any profit for years, Obamacare's new tax circumvents that difficulty by taxing manufacturers on all revenue from the sale of equipment, whether it is profitable or not. That will discourage new investment and add costs to all those who need the equipment to diagnose or treat their illness. For Obamacare, higher costs and less treatment means more "fairness." With our attention on the choices that Obamacare has eliminated, the Food and Drug Administration is rapidly expanding its role by direct interference in the practice of medicine. Countless thousands of patients have died while waiting for access to drugs and devices that were eventually approved by the FDA. Now thousands more will die while waiting for FDA approval of each use of stem cell, venous catheter or other therapies. Individual physicians and surgeons are constrained against following their judgment of the best treatment for their patients, but the authority of a vast bureaucracy is carefully preserved. It is a tragedy that our medical choices are limited to the choices in a voting booth. But those votes are vitally important if that is all we have left. Richard E. Ralston is the executive director of Americans for Free Choice in Medicine, Newport Beach, California. Copyright © 2012 Americans for Free Choice in Medicine. All rights reserved. Send a link to this story

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Washington ACEP’s Historic Fight Over Medicaid Cuts by Mark Plaster, MD, JD with Steven Anderson, MD on April 3, 2012 Print E-mail Reprint Tweet Expansion of the Medicaid rolls under the Affordable Care Act has caused more than one state to look at ways to cut healthcare spending. In Washington State, the result has been a clash between physician groups and state health agencies that could to be a sign of battles to come. According to Dr. Steven Anderson, an emergency physician from the Washington State ACEP chapter, trouble began in Washington when the Health Care Authority (HCA) was charged with cutting $72 million from a budget already suffering from a $1.5 billion shortfall. The budget proviso stated that the HCA – the state agency in charge of Medicaid expenditures – was to make the cuts in cooperation with “the Collaborative Group,” a collection of organizations comprised of the Washington State Medical Association (WSMA), Washington State Hospital Association (WSHA), the Washington chapter of the American College of Emergency Physicians (WA ACEP), the American Academy of Pediatrics, and the American College of Physicians. Enter Steven Anderson, who has been spearheading Washington ACEP’s efforts in what quickly turned from collaboration to conflict. Instead of seeking consensus, the HCA acted over the objections of the Collaborative Group, publishing a list of 700+ diagnostic codes that would not be paid for more than 3 times per year. The HCA list was significantly expanded from what the medical community considered truly non-emergency because that list would have only saved $10 million/year. (See inset for covered “Emergency Conditions” and patients exempted from the limitations.) Further, the HCA planned to use the “Billings Formula” to retrospectively identify those claims that were ‘non-emergent’ and would be denied payment. “It was absolutely in violation of the ‘prudent layperson’ standard which came out of the Healthcare Affordability Act in 1996,” said Dr. Anderson. This plan was to be implemented Oct 1, 2011 and run through June 30, 2012. Since EMTALA still applied to EDs, with the standard for mandated treatment being what the prudent layperson deemed to be an emergency, the Group concluded that the HCA was effectively expanding an already massive unfunded mandate for emergency care, the cost of which would be born by the poor and those that provided care, mostly the latter. WSMA, WSHA, and WA ACEP responded by proposing a robust notification and tracking system after each “unnecessary” visit, without denying payment. It was estimated to save the state $15-25 million per year. This plan, however, was rejected by the HCA. The Group responded by filing a suit to enjoin the implementation of the HCA plan, which was initially successful. However, even this temporary action to restrain the law cost over $300,000 in legal fees. On Christmas Eve, 2011, the HCA changed their tactics by changing the rules of the game. They announced that the previous “rule” was no longer that. Rather, it was simply a “budget management process,” fluid in nature, with no hard list of what was to be denied. As such, the HCA’s decisions were not subject to the courts injunction. To make matters worse, the HCA decided to forego the 3 visit rule and simply deny payment for ALL “non-emergent visits”. By doing this, the HCA effectively took the process underground, with no medical oversight, no access to input, no limits to decision, no communication of list of accepted or denied services, and no further collaboration with the “Collaborative Group”. The plan that was announced Jan 27, 2012, was – according to the HCA – no longer about “bottom dollar savings” but about “quality, best practices, and utilization review,” optimizing state tools for case management of ‘frequent flyers’, and tracking “medically unnecessary uses of the ED.” The Collaborative Group responded with a detailed plan of their own to accomplish the goals outlined by the HCA. However, three days later, this plan was rejected by the HCA. At the time of this writing, the Collaborative Group has turned it’s efforts to lobbying the Governor and the legislature to step in and impose the “prudent layperson” standard into any payment scheme that the HCA applies to emergency care. The Prudent Layperson Exception According to a document promulgated by the AMA “as an educational and advocacy tool for use by physicians” the Affordable Care Act states that “All emergency screening and treatment services (as defined by the prudent layperson standard) provided by physicians and hospitals to patients must be covered without regard to prior authorization or the treating physicians’ or other health care provider’s contractual relationship with the payer.” As such, the Collaborative Group anticipated that the federal government might intervene on behalf of the medical community and their patients to enforce this standard on state Medicaid programs. However, the legal position of the HCA and subsequently the federal government was that a closer evaluation of the law suggests that the prudent layperson standard only applies to insurance groups and not to Medicaid. Was this an intentional oversight on the part of the legislators drafting the law or just a semantic manipulation by crafty government lawyers? No one is saying. “We anticipated that someone from CMS would step in and get involved,” said Dr. Anderson. But so far the response from the Administration has been “disappointing.” A Reasonable Goal Considering that the CDC has determined that 8% of emergency department visits were non-emergent, the Collaborative Group set an 8% reduction in expenditures as a more reasonable cost cutting goal. (Even a superficial analysis of this logic would show that the Collaborative Group was being generous in their estimates. The majority of costs of an emergency department fall on the sickest, obviously emergent patients.) The Collaborative Group focused their attention on reducing the cost of frequent fliers by aggressive case management. Patients who over-utilize the ED were assigned to case managers with their names appearing on widely circulated lists. One health system alone found that patients who had been seen 10 times or more in an ED were responsible for 30,000 annual visits to the system. At an average visit cost of $331, these frequent fliers accounted for $9.9 million dollars a year in cost to the system. As all emergency physicians know, one of the drivers of over-utilization of the ED is opioid prescription abuse. With the implementation of a statewide opioid prescription monitoring program they were able to see gradual declines in utilization of up to 10 percent. Maintaining this rate of decrease would result in savings of $25 million per year. Targeting unnecessary return visits to the ED and to other providers by simply providing better home-going instructions, the Group felt that they could reduce follow ups and returns by 20%, thus saving $4.2 million per year. Next, the Collaborative Group turned it’s attention on drug costs to the system. They found that while state and federal law prohibited the adoption of a mandatory statewide formulary, by working with other physicians from every specialty, they felt that they could adopt a voluntary formulary that would take advantage of some of the market-based reduced cost pharmaceuticals such as the $4 Walmart formulary. By publishing a statewide quarterly report to all physicians that included data on generic fill rates, opioid prescribing habits and ED utilization rates, the Group felt that an 8% reduction in costs, $4-8 million, was achievable. Summing up all of the achievable goals, the Group determined that a reasonable goal was $48.2 million. They felt that such a plan would improve care while not imposing arbitrary limits. Nevertheless, the HCA rejected this plan in favor of deeper cost cutting. Where It Stands in Washington At the time of this writing, WA ACEP had received a very positive hearing from the legislative committee responsible for putting their plan forward. “We’ve been in the courts,” said Dr. Anderson, “we’ve worked with . . . the HCA, but clearly where we’ve made our inroads is going to the legislator, going to the governor’s office and really presenting our plan.” However, more action has been taken between writing and printing. Follow here on www.epmonthly.com or on Twitter @epmonthly for real-time updates on this situation. Washington State’s budget issues – and the proposals to solve them – are not unique to Washington. Sixteen states have followed the progress of Washington in anticipation of using this method of shrinking their Medicaid budget. So unless your state has a significant budget surplus, even if your state is not one of the 16, the expansion of the Medicaid rolls nationwide as a result of the Affordable Care Act will put a strain on state budgets. This will likely cause legislators to look to you to make up the difference. In other words, what happened in Washington is likely to happen everywhere. So get ready. Lessons Learned in Washington Strategy Session with Dr. Steven Anderson 1. Protect the prudent layperson protection that exists in the Health Care Affordability Act, because if Medicaid is successful with this, every private insurer in the country is going to look at it. 2. Provide alternative plans, don’t just come to the table with, “we don’t like what you’re saying.” 3. Advocacy is your best alternative to litigation. The old axiom that “you can’t fight City Hall” is true. Go over the bureaucrats heads and go straight to top executives and legislators that you can reach. It may be sad to admit that medicine has become political. But given that, play the game to win. 4. Rally your troops and your allies. Every emergency physician is going to be effected, so everyone should be involved. Raise the necessary money. Make friends and allies with other specialists, and speak with one voice. Comments # illegal taking of services — Myles Riner Steve, in your legal wrangling with Washington State, have WA ACEP's legal advisors looked into whether the EMTALA mandate to provide medical screening to all ED patients (and the Fed's and State's enforcement of this mandate), in combination with refusal to pay for even medical screening (let alone treatment) for certain patients whose diagnosis, as a result of this screening, meets WA State's criteria for non-payment, constitutes illegal theft of emergency physician services by the government? If so, is government service mandate without government payment deemed to be a cause of action worthy of pursuit if the State decides to implement this non-payment scheme, or CMS decides to allow other states to do the same?

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Contact: Vanessa Pavinato media@esmo.org Study reveals magnitude of variation in gene expression measurements within breast cancers 5th IMPAKT Breast Cancer Conference Lugano-CH, Brussels- BE, 2 May 2013 -- An important new study has revealed the clearest picture yet of precisely how much measurement variation influences gene expression profiles of breast cancer. The results show, for the first time, which gene expression measurements may benefit from pooling of biopsies from a single tumour, researchers said at the 5th IMPAKT Breast Cancer Conference in Brussels, Belgium. These findings represent an important step toward allowing doctors to more precisely tailor an individual's treatment to a detailed analysis of their tumour's gene expression. Over recent years, scientists have identified many genes, and groups of genes, that can provide crucial information about how an individual patient's cancer will respond to treatment with different drugs. But a number of hurdles need to be cleared before tests to measure the expression of these genes can be used in clinical situations. One important challenge is the fact that many different cell types can be present within a single tumour (known as intratumoural heterogeneity), each with different patterns of gene expression and potentially different sensitivity to drugs. "Performing these tests with a single biopsy may or may not accurately represent that cancer, depending on intratumoural heterogeneity," explains lead author Dr Rosanna Lau from the University of Texas MD Anderson Cancer Center, US. A further complication is that some of the variation between test results can arise from technical variations in the testing process, and not by real differences between samples (analytical variance). To differentiate between these sources of variation in breast cancer, Dr Lau and colleagues performed DNA microarray analysis on three biopsies each from 51 breast cancers. "Our results indicate that analytical variance, resulting from technical aspects of the assay, can be dramatically reduced by standard data processing methods such as normalizing and scaling," Dr Lau says. "Pre-analytical sources of variance, such as tissue preservation method and ischemia mostly did not affect gene measurements." The dominant source of variance between biopsies from the same tumour was due to intratumoural heterogeneity, Dr Lau's group found. However, the extent of that variation depended on the particular gene or groups of genes being studied. "Some genes, such as ESR1 and HER2, are very consistently expressed across the tissue, thus gene expression measurements display little variation between biopsies. However, other genes such as MKI67, which is known to be highly variable, is expressed less consistently, and therefore can produce vastly different results depending on the area of the tumour that is sampled," Dr Lau says. For the first time, Dr Lau's group also showed how combining samples of two or three biopsies from a single breast tumour could effectively overcome this variation for selected genes. "Differences between tumours are much greater than variability within a tumour or a test. Our current study shows that we can get a comprehensive picture of the genes being expressed in the tumour by sampling multiple areas of the tumour and pooling the samples together. This increases the precision of the assay and allows us to make more reliable predictions related to the disease. The trade-off is that intratumoural heterogeneity is also averaged to a single, more consistent measurement." This study is an excellent example of how researchers are rising to the challenges of tumour heterogeneity, comments Prof Charles Swanton, Chair in Personalised Cancer Medicine at the UCL Cancer Institute in London and from the Cancer Research UK London Research Institute, member of the ESMO Translational Research Working Group, who was not involved in the study. "Developing accurate biomarkers that are not subject to real tumour sampling bias is of critical importance. This intricate study will likely be a gold standard by which other studies in this area are measured. Such in-depth analyses will ultimately be essential in the biomarker qualification process," he said. "The study also emphasises the need to limit the potential for tissue processing or assay technologies to lead to spurious measurements through well-defined standardised operating procedures," Prof Swanton said. ###

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Press Releases About HarrisonNews & MediaSupport HarrisonQuality & SafetyeCafeContact UsMyChartInternal Systems Press Release Archive Press Releases Franciscan Health System Welcomes Harrison Medical Center - 8/7/2013 Organizations will bring enhanced healthcare to Kitsap and Olympic peninsulas Harrison Medical Center in Bremerton is now affiliated with Tacoma-based Franciscan Health System and becomes the seventh hospital associated with the Franciscan organization. Harrison’s affiliation with Franciscan offers opportunities to expand services; improve the delivery and quality of care; and broaden access to services for individuals, employers, and communities in the South Puget Sound and on the Kitsap and Olympic peninsulas.The Harrison-Franciscan affiliation was announced in October 2012, and became official August 7, 2013 after reviews by state and federal regulatory agencies were finalized. This agreement will allow Harrison Medical Center to continue to operate as a secular (non-religious) nonprofit community medical center. This affiliation with Franciscan makes Harrison a part of one of the largest integrated health systems in Washington. Franciscan includes St. Joseph Medical Center, Tacoma; St. Francis Hospital, Federal Way; St. Elizabeth Hospital, Enumclaw; St. Anthony Hospital, Gig Harbor; St. Clare Hospital, Lakewood; Highline Medical Center; Burien and the Franciscan Medical Group network of primary-care and specialty-care clinics. Franciscan has been ranked among the Top 100 Integrated Health Networks in the nation annually since 2004.The affiliation will enable physicians and employees at Harrison and Franciscan to collaborate and innovate in order to improve the delivery of efficient and effective inpatient, outpatient and in-home care across a broad geographic region. “We can enhance the services we offer and build on the economies of scale that a larger organization can provide,” said Harrison Medical Center President and Chief Executive Officer Scott Bosch. “In light of upcoming national reforms, this partnership helps ensure we keep our enduring promise of exceptional health care to the residents of the Kitsap and Olympic peninsulas and North Mason County, now and for generations to come.” “This is a historic day for Franciscan, Harrison and the community,” said Franciscan Health System Chief Executive Officer Joe Wilczek. “Both organizations have long traditions of providing health care to everyone, regardless of their ability to pay. Our shared mission and values, including our shared commitment to excellence and exceptional health care, will allow us to work together to better serve residents throughout the region.”Harrison Medical Center has evolved from a small community hospital into a regional medical center serving patients from Kitsap, North Mason, Clallam and Jefferson counties. Its services include 24-hour emergency and trauma care, cardiac care, cancer care, inpatient medical and surgical care, imaging services, outpatient surgery, pediatrics, orthopaedics and a sleep center. It has a medical staff of more than 400 physicians representing 40 medical specialties. The joining together of Harrison with Franciscan will occur over time as staff from both organizations collaborate to provide high quality care and share best practices and resources. The organizations also envision expanding access to an array of services-- from primary to specialized care--on a scale neither could achieve on its own.As part of the affiliation, a state-of-the-art electronic health records system will connect Harrison facilities and physicians with each other as well as with Franciscan hospitals, clinics and providers. Franciscan selected the Epic clinical information technology platform for its system-wide electronic health record that went live this June, and which will be integrated at Harrison in 2014. The system features a “patient portal” so patients can securely and confidentially communicate with their physicians, request prescription refills, set up appointments and receive test results. Franciscan Health System includes St. Joseph Medical Center, Tacoma; St. Francis Hospital, Federal Way; St. Clare Hospital, Lakewood; St. Elizabeth Hospital, Enumclaw; St. Anthony Hospital, Gig Harbor; Highline Medical Center, Burien; Harrison Medical Center and Harrison HealthPartners, Kitsap and Olympic peninsulas; Franciscan Hospice House, University Place; Franciscan Medical Group clinics and providers, Pierce, King and Kitsap counties; and the Franciscan Foundation. Franciscan is part of Catholic Health Initiatives (CHI), a national nonprofit health system with headquarters in Englewood, Colo. Currently, CHI ranks as the nation’s third-largest faith-based health system, with annual operating revenues of $10.7 billion and approximately 78,500 employees. In fiscal year 2012, CHI provided more than $715 million in charity care and community benefit, including services for the poor, free clinics, education and research. For more information visit us at www.fhshealth.org Copyright © 2007-2014 Harrison Medical Center. All rights reserved.

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Featured in the August, 2014 Scleroderma, Vasculitis & Myositis eNewsletter John DeSilvestri Scleroderma, Vasculitis & Myositis Center of Excellence All the world�s a stage,And all the men and women merely players:They have their exits and their entrances;And one man in his time plays many parts.-William Shakespeare Living with chronic diseases such as scleroderma, myositis and vasculitis can have a drastic effect on mood. Depression, anxiety, fear, and anger are all normal reactions to the grief caused by sudden change in our personal health and in the way we live. It can be difficult to express feelings of loss and physical change in a way of living that was once taken for granted. Creative expression as a form of healing is a process that has been wildly accepted by many cultures throughout history. One of way to help patients in expressing themselves can be through drama therapy. The roots of drama therapy go back as far as the ancient Greeks where theatre was a part of life, a festival for the gods and an opportunity to express social impacts of life and change. Aspects of the theatre have routinely come into play in therapy including role play, an exercise in which two people express themselves by pretending to be, for example, a mother and daughter discussing the day. Drama therapy goes a step further and allows the patient to express their emotions by not just pretending to be the characters, but actually �being� the characters and separating themselves from the actions using their emotions to drive the action. At a glance, drama therapy is similar to the Stanislavski method of acting (a method still used by actors today) wherein actors draw believable performances by focusing on an emotional memory which they then focus internally to portray a character�s emotions on stage. This method was founded by Constantin Stanislavski, a russian actor, director and administrator of The Moscow Art Theater in the early 1900s. Forms of Drama Therapy There are several forms of drama therapy, Role play: which explores life experiences through the creation of an imaginary environment Using objects and materials: using the objects as a cypher to deal with problematic feelings or experiences. Wearing masks and costumes: Depicts the self and self-image Using play, storytelling, and fable: Searches for problems within events of issues Creating �ritual�: Acknowledging changes of life milestones Acting in progressive stages: Developing new ways to connect to one�s self and to others. Allowing yourself to fall into a role through drama therapy as an actor can help you leave your inhibitions behind. By giving yourself �permission,� to feel your emotions, you find new ways of approaching problems, coming up with solutions, and sharing with the group without fear of consequences. The most important thing in drama therapy is to remember to never give up. Put yourself out there and learn from your experiences. For more information on drama therapy and how it may benefit you, a simple search for drama therapy programs in your area will set you in the right direction. *Remember to consult your physician before attempting any form of therapy on your own. In the meantime, see more theater! Allow yourself to get lost in the stories and the actions taking place on the stage. Bring a friend and follow up your experience with a discussion with what you just saw. And as always, be sure to support your local arts organizations. Posted: 8/1/2014 The Theory and Practice of Expressive Art Therapy: Drama Therapy, By Fang-Ian Chen The Connection Between Art, Healing, and public Health By: Heather L. Stuckey, DEd and Jeremy Nobel, MD, MPH The North American Drama Therapy Association NYU Drama Therapy Program About John DeSilvestriJohn is an Actor, Producer, and Voice-Over Artist. He has appeared on stage in New York and regionally, as well as television and video games. He holds a BA in dramatic arts from the University of Hartford and an MBA from Fordham University School of Business. John is also an alumnus of the O�Neill National Theater Institute and studied in Russia at the Moscow Art Theatre. In addition to performing, John also assisted the producers for the Tony Award Winning �Peter and the Starcatcher� on Broadway and has co-produced with off-Broadway companies such as FullStop Collective and The Active Theater. Other Related Resources Scleroderma, Vasculitis & Myositis eNewsletters

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Myth #6 Countries With National Health Insurance Make Health Care Available On The Basis Of Need Rather Than Ability To Pay. By John C. Goodman and Gerald L. Musgrave, published on Sept. 1, 1992 Most people in Britain, Canada and other countries that ration health care believe that the wealthy, the powerful and the sophisticated move to the head of the rationing lines. Because government officials have little interest in verifying this fact, few formal studies exist. There is considerable evidence, however, that in the face of health care rationing those who can pay find other ways to obtain health care. In response to severe rationing by waiting, both Britain and New Zealand have a growing market in private health insurance – where citizens willingly pay for coverage for private surgery, although they are theoretically entitled to "free" surgery in public hospitals. As a result, the privately insured pay for health care twice – through taxes and through insurance premiums. In Britain, the number of people with private health insurance policies has more than doubled in the last ten years, currently totaling about 10 percent of the population with about one in every five elective surgeries performed in the private sector. In New Zealand, one-third of the population is covered by private health insurance, and private hospitals now perform 25 percent of all surgical procedures. Since Canada does not allow private health insurance, if Canadians go to the less than 1 percent of the private physicians or less than 5 percent of private hospitals, they must pay the full bill out-of-pocket. [63] An exception is thesmall number of outpatient surgery clinics operated by entrepreneurial physicians. Government will pay the surgeon's fee but not other costs. Canadians who receive cataract surgery on an outpatient basis, for example, must pay from $900 to $1,200 out of pocket.[64] In addition, Canadian citizens are increasingly entering the United States to get health care they cannot get at home. In some cases, the Canadian province pays the bill. In other cases, patients spend their own money. [65] In either event, patients must bear the costs of travel. For example: About 100 Canadian heart patients go to the Cleveland clinic each year because they cannot get timely treatment in their own country. A volunteer organization, "Heartbeat Windsor," arranges for Ontario heart patients to get treatment at Detroit hospitals (which accept the Ontario rate as payment in full), and Alberta has indicated it will accept a similar arrangement. Because there is only one lithotripter in all of Ontario, many lithotripsy patients cross the border; at Buffalo General Hospital in New York, for example, half of the lithotripsy patients are Canadians. Because of the inadequate facilities in Canada, about half of the in vitro fertilization patients at the University of Washington Medical Center are Canadians, paying $5,000 out of pocket for each procedure. In general, the Ontario government will pay 75 percent of the standard U.S. hospital charges and the same physician's fee it would have paid had the service been provided in Ontario. Apparently many American hospitals and physicians believe they can make a profit at those rates. U.S. drug dependency centers are actually marketing their services to Canadian citizens. Although the number of Canadian patients who cross the border is small, it is growing: In 1990, the Ontario Health Insurance Plan paid about $214 million to U.S. doctors and hospitals – up 45 percent over the previous year. Of that amount, 40 percent went to Florida, 9 percent to New York, 5 percent to Michigan and Minnesota and 4 percent to California. IntroductionMyth #1Myth #2Myth #3Myth #4Myth #5Myth #6Myth #7Myth #8Myth #9Myth #10Myth #11Myth #12Myth #13Myth #14Myth #15Myth #16Myth #17Myth #18Myth #19Myth #20ConclusionEndnotesAbout the Authors John C. Goodman Progressive Environmentalism: A Pro-Human, Pro-Science, Pro-Free Enterprise Agenda for Change

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India: Good Endings, Good Beginnings! Sponsored by Focus Reports 123456Next � (PHOTO CREDIT: KOEN LIEKENS) 'Paradigm shift:' the two words that best describe what the Indian pharmaceutical industry has experienced in the last 40-plus years. Numerous developments have drastically altered the healthcare and pharmaceutical environment in the world's seventh-largest and second-most populous country. Within an industry that traditionally moves at a slow pace, the rapidly changing playing field has required both Indian pharmaceutical companies, as well as multinational corporations (MNCs), to adjust their strategies accordingly. Provided that India's $12 billion market will keep growing at the same rate, its total domestic market size is set to reach between $49 billion and $74 billion by 2020, according to a recent PricewaterhouseCoopers (PwC) estimate. With a consistently higher growth rate than most other countries, India is expected to soon earn a place in the world's top 10 largest pharma markets. India GDP Growth rate % (PPP) While the country's astounding GDP growth has recently enabled Finance Minister Pranab Mukherjee to lay out an increase of 20% in health allocations in 2011-2012, India's public expenditure on healthcare as a proportion of GDP still stands at a worrying low of around 1%. Policymakers are aware of the issue, but a country the size of India has many challenges to tackle. How, then, to step away from a model where 80% of health expenditures are out-of-pocket payments? "The role of the insurance providers is obviously the answer to many issues India faces today," says Sujay Shetty, pharma and life sciences leader at PwC India. "This is the single most important thing that should happen in India, and is bound to lift up the broader markets, as well as certain specialist therapies which would otherwise be unaffordable." Tapan Ray, Director General of OPPI Government has already taken a number of measures to ensure affordable medicine in the country, and 74 drugs and formulations have been under price control by the National Pharmaceutical Pricing Authority since 1995. These downward price pressures explain the high penetration of bioequivalent versions of innovator drugs (branded generics occupy roughly 90% of the market according to industry experts), as well as the fact that a market massive in volume has remained low in value. Whether differential pricing is the solution to enhance uptake depends to a great extent on the therapeutic portfolio and strategic course companies embark upon. A 1970 law that recognized patents on processes, rather than products, meant the start of a booming domestic generic industry in India. However, having joined the World Trade Organization (WTO) in 1995, Indian policymakers were obliged to harmonize local legislation with the global-standard Trade Related Intellectual Property Rights (TRIPS) agreement, resulting in the adoption of product patent law from 2005 onwards. "The previous paradigm was one of replication, where Indian manufacturers were replicating and marketing products at a fraction of their international price," recalls Tapan Ray, director general of the Organization of Pharmaceutical Producers of India (OPPI), India's premier association of the largest research-based international pharmaceutical companies in India. While it has been a practice that gave India a pool of some of the most brilliant process chemists in the world, Ray believes that further progress within the country's economy and pharma industry will be driven, to a large degree, by innovation. 123456Next � Articles by Sponsored by Focus Reports Country Report: Czech Republic Country Report: Turkey Country Report: Mexico Country Report: Thailand Country Report: Spain

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1 Mar 2006 : Column 320 Mr. Deputy Speaker (Sir Alan Haselhurst): We now come to the second debate on an Opposition motion. I must inform the House that I have selected the amendment in the name of the Prime Minister, and once again placed a 10-minute limit on speeches by Back-Bench Members. Mr. John Baron (Billericay) (Con): I beg to move, That this House recognises that there have been improvements in the provision of cancer care due to the extra investment in the NHS and the hard work and dedication of NHS staff; but notes that a different approach is now needed to raise standards of treatment throughout the entire patient pathway to the best levels achieved in other European countries; believes that more should be done to end the postcode lottery in drugs and treatments; wishes to see more done to raise awareness of the risk factors and symptoms of cancer; further believes that cancer is increasingly a long-term condition and that there should now be a greater recognition of the importance of quality of life issues; and calls on the Government to give the National Institute of Health and Clinical Excellence a much stronger role in establishing holistic standards and entitlements to care covering the entire patient pathway. No one can doubt the significance of cancer to many millions of people in this country. The disease remains one of the biggest killers in the UK, accounting for approximately a quarter of all deaths and claiming more than 150,000 lives a year. More than one person in three will be diagnosed with cancer at some point in their lives, and there is likely to be a significant increase in the number of new cases over the next few years, partly due to our ageing population structure. Given its importance, I hope that this debate about the future of cancer services can be constructive. I, for one, recognise that improvements have taken place under this Government, but I shall also highlight the fact that there are still failings in the system, in the hope that they will be recognised and put right. The Government's amendment runs the risk of appearing somewhat complacent. It is full of self-congratulation, and mainly looks back at the past. Putting that to one side, however, I accept that it would be churlish not to accept that the Government have made extra funding available and that improvements have been made. It is not often that a shadow Minister quotes good figures on the Government's behalf, but one example of those improvements is that, whereas only 42 per cent. of patients diagnosed with colon cancer in the first half of the 1990s survived for five years, that figure had risen to 50 per cent. by the start of the present decade. Naturally, Opposition Members congratulate staff in the NHS and the voluntary sector on their hard work and dedication to patient care, which have helped to bring about the improvements in outcomes. Those improvements are welcome, but they are not exceptional when compared with the long-term trends that date back to the 1980s. Dr. Howard Stoate (Dartford) (Lab): Will the hon. Gentleman give way? Mr. Baron: I intend to make some progress, but I assure the hon. Gentleman that I will give way in a little while. According to figures produced by Cancer Research UK, mortality rates fell by 11 per cent. between 1988 and 1997, and by 6.5 per cent. in the first six years after Labour came to power. I hope that the Secretary of State will not copy the Prime Minister's trick of using the mortality figures since 1997 as proof of the effectiveness of the Government's cancer strategies. There has been no marked improvement in the overall trend going back to the 1980s, despite the extra funding. The Government use more selective figures in their amendment, but even they cannot disprove our case. Although there has been a 14 per cent. fall in mortality figures since 1996, the total death rate for people under 75 years of age also fell by 14 per cent. in the final nine years of the previous Conservative Administration. The Opposition recognise that there have been improvements in outcomes, but they have not outstripped comparable improvements in continental survival rates. According to last year's report from the Karolinska institute, the UK still lags behind other European countries when it comes to survival rates over periods of one year and five years. In fact, Britain has one of the worst survival rates in all of western Europe: whereas 81 per cent. of cancer patients in France survive for one year, the equivalent UK figure is only 67 per cent. Even Albania and Lithuania have better one-year and five-year survival rates than we do. Estimates suggest that more than 20,000 lives a year could be saved each year if the NHS met the best European standards of care. Meanwhile, the outcomes gap between rich and poor people in the UK is also unacceptable and getting wider. A recent report from the Public Accounts Committee highlighted persistent and unacceptable variations in outcomes, depending on where patients lived. Breast cancer death rates are 20 per cent. higher in some northern regions than they are in other areas, mainly in the south of the country. Those are unfortunate facts, but whether cancer services are equipped to meet the fresh challenges that we face is also open to question. For example, more cancer patients are now living longer, which means that, increasingly, the disease must be regarded as a long-term condition. The emphasis of policy in the future must shift from getting patients into the early stages of treatment as quickly as possible, important though that is, to ensuring that later stages of care, information and emotional support are widely available. To achieve that, several failings need to be addressed. Dr. Stoate : I am grateful to the hon. Gentleman for acknowledging that services are improving. Does he agree that the most difficult time for any patient with a possible cancer diagnosis is the early stages of waiting for a diagnosis? Will he therefore join me in congratulating the NHS on reaching the target of ensuring that almost every patient whom a GP suspects may have cancer is seen within two weeks by an NHS specialist? The initial tests can be done quickly to reduce the awful burden of anxiety faced by someone in that position. Mr. Baron: I take the hon. Gentleman's point, but he refers to early referrals. The problem is that far too 1 Mar 2006 : Column 322 many women are diagnosed with cancer after being referred on a routine, non-urgent basis. It could be argued that the two-week target has distorted clinical priorities. Breakthrough Breast Cancer has made that case many times. Mrs. Iris Robinson (Strangford) (DUP): My mother was diagnosed with breast cancer and had a mastectomy, and I had quite a scare last September. Does the hon. Gentleman agree that the Government must take steps to ensure the correct analysis of mammograms? Radiographers have got that wrong in the past, but patients need to be assured that they receive the correct results. Does he also agree that herceptin should be given to the women who need it, and that we should not have a postcode lottery? Mr. Baron: I completely agree with the hon. Lady and I will come to those points later in my speech. Mr. Sadiq Khan (Tooting) (Lab): The hon. Gentleman compared the UK with European countries with better success rates, but does he agree that we have seen improvements over the past eight years? In 1997, Labour was the first major political party to mention the word "cancer" in a manifesto. In 1997, we had a Green Paper that set a target on death rates for 13 years' time and, in 1999, for the first time, a directorate was set up to deal with cancer. Again for the first time, in 2000, we had a 10-year plan to fight cancer. Is it not the decades of neglect that have led to the problems that the hon. Gentleman mentions? Mr. Baron: I suggest to the hon. Gentleman that there is no point just talking about cancer—we want action, and we are trying to look forward in this debate. As I said earlier, there have been no marked improvements in mortality rates, despite all the money that has gone into the NHS. The Government can produce as many papers as they like, but what we need are improvements on the ground. Bob Spink (Castle Point) (Con): My hon. Friend is right to talk about the need for action. Does he agree that long-term survival rates could be greatly improved if everybody had proper access to the most appropriate and up-to-date medicines, without postcode prescribing? For instance, for high grade malignant brain tumours, we need to ensure that sufferers have access to temozolomide and gliadel implants. Mr. Baron: I agree with my hon. Friend and I shall address the issue of the postcode lottery shortly. One reason why the Government's additional funding for cancer services has not produced a marked improvement in the longer term mortality trend is that the two-week and one-month targets, to which the hon. Member for Dartford (Dr. Stoate) referred, have focused attention and resources on the front end of the patient pathway, to the detriment of the other end. The later stages of cancer care have been neglected as a result. The Government's targets may have been successful in getting more people into the system more quickly, but staff shortages have created bottlenecks further down the line. Radiotherapy offers an example. The importance of radiotherapy is that more than half of all cancer patients will undergo it at some stage of their treatment, yet in January a report in the British Medical Journal observed that pressures on cancer units across the UK have led to longer waits for radiotherapy patients and may be reducing chances of survival. High staff vacancy rates are causing real concern. In evidence to the pay review body, the Society of Radiographers noted that vacancy rates for therapeutic radiographers in England stood at 17 per cent. There is a particular shortfall of experienced, specialist radiographers. The Government may have increased student numbers, but new graduates do not possess the skills needed to fill that type of vacancy. According to the society, the current high number of vacancies and Government targets have made managers reluctant to release existing staff for further training opportunities, so it does not look as though the situation is getting better. As a result, waiting times for radiotherapy have lengthened since 1997. According to figures collected by the Royal College of Radiologists, radiotherapy waiting times in 2005 were worse than those documented in 1998; for example, whereas in 1998, 32 per cent. of patients in need of radical radiotherapy waited longer than the recommended maximum of four weeks, by 2005 the figure had grown to 53 per cent. More than half of all patients receiving curative radiotherapy now wait longer than the recommended maximum of four weeks. For their part, despite a recent assurance at Health questions that hidden waits would be measured, the Government have insisted that no official monitoring of radiotherapy waiting times will take place. That is a great shame. I put it to the Secretary of State: how can the Government hope to resolve the serious problems in radiotherapy if they have no official idea of the extent of the problems because they are unwilling to collect the statistics? Although I wrote to the Secretary of State about the issue after our exchange at Health questions in January, I am still waiting for a response. Radiotherapy is not alone, however. There are similar problems for other treatments. According to the Dr. Foster organisation, there has actually been an upward trend in waiting times for surgery for the 10 most prevalent cancers since 2001. Meanwhile, according to research cited in a report by the cancer capacity coalition, a number of clinical directors expected rising demand for chemotherapy to lead to longer waiting times over the next five years. Things must change. The Opposition believe that one solution to the problems would be to move away from targets, which distort clinical priorities by focusing resources on the front end of the patient pathway, and to instruct NICE to draw up standards and entitlements for patients covering the entire pathway—a point to which my hon. Friend the Member for Castle Point (Bob Spink) referred. In other words, we should shift entirely the emphasis for cancer care from politicians dictating targets for patients to patients having entitlements to standards of care decided by medical professionals; the entire journey should be covered, including the later stages of treatment such as radiotherapy. Such an approach directly recognises the 1 Mar 2006 : Column 324 fact that there is no use in getting more people on to the patient pathway sooner if we do not ensure their access to all stages of life-saving treatment.

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Search Health Information Costly Breast Cancer Screenings May Not Help Seniors: Study To determine benefit, more older women should be included in clinical trials, expert says By Kathleen DohenyHealthDay Reporter MONDAY, Jan. 7 (HealthDay News) -- Medicare spends more than $1 billion each year for breast cancer screenings such as mammography, according to a new study. However, all that expenditure may not help produce better results for older women, said Dr. Cary Gross, an associate professor of internal medicine at Yale University School of Medicine. He also directs the Yale Cancer Outcomes, Public Policy, and Effectiveness Research Center. In the new study, Gross and his colleagues identified more than 137,000 women, aged 66 to 100, who had no history of breast cancer. Gross looked at the costs to fee-for-service Medicare for breast cancer screening during 2006-2007. The study authors also looked at costs of screening in different regions. Women living in areas with higher screening costs were as much as 78 percent more likely to be diagnosed with early-stage or in-situ breast cancer as women in regions spending less. However, regardless of how much was spent on screening, it didn't make a difference in diagnosing late-stage cancers, the investigators found. This suggests "overdiagnosis" of breast cancers in the regions spending the most on screening, Gross said. This means a cancer that was diagnosed may not have been problematic during a woman's lifetime. However, other experts argue that it's difficult to determine which cancers will become a threat to health. The study is published online Jan. 7 in JAMA Internal Medicine. The variation in screening costs by regions, Gross said, is driven by newer and more expensive screening technologies such as digital mammography and computer-aided detection. The costs varied greatly by region of the country, from $42 to $107 per person. In older women, he said, research is lacking about whether the newer technologies produce better health outcomes. The overall screening costs of a billion dollars annually are higher than previous researchers have found, Gross noted. He takes issue with Medicare's reimbursement strategy, which the study authors pointed out, "support rapid adoption of newer modalities [methods], frequently without adequate data to support their use." "Our study is largely directed at policymakers," Gross said. For older women, he explained, the take-home message is this: "Getting more expensive tests for breast cancer does not necessarily produce a better outcome." And he added, "Our study highlights the insanity of a system that pays substantially more for a new technology without any evidence that it is beneficial in the older population." The co-author of an editorial accompanying the study, Dr. Jeanne Mandelblatt, a professor of medicine and associate director of population sciences at the Georgetown Lombardi Comprehensive Cancer Center in Washington, D.C., said that the new study "is a call to action to get more research." The findings, Mandelblatt said, raise the possibility that newer technology may not always be better for all women. Research on the breast cancer screening technologies in older women is lacking "because older women have not been included in sufficient numbers" in research studies, she said. "One important message for older women is they need to get involved in research studies, they need to advocate for research studies," Mandelblatt said. Another expert, Judith Malmgren, takes issue with the findings and the emphasis on late-stage cancer detection. "By focusing only on stage 4, you are not evaluating the overall effectiveness of screening," said Malmgren, an affiliate faculty member with the department of epidemiology at the University of Washington School of Public Health, who has written about breast cancer screening. "The purpose of mammography screening is to find early stage cancers," Malmgren said. To learn more about breast cancer, visit the U.S. National Cancer Institute. SOURCES: Cary Gross, M.D., associate professor of internal medicine, Yale School of Medicine, and director, Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, Conn.; Jeanne S. Mandelblatt, M.D., M.P.H., professor of medicine and associate director for population sciences, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, D.C.; Judith Malmgren, Ph.D., affiliate faculty, University of Washington School of Public Health, Seattle; Jan. 7, 2013, JAMA Internal Medicine, online

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Giving to UC Davis Health System Health System > Giving > Betty Irene Moore School of Nursing doctoral student ... All Leading Initiatives Comprehensive Cancer Center and Programs Children’s Hospital and Programs Informatics and Telehealth Stem Cell and Transplantation Student Scholarships and Support Emergency, Trauma and Surgical Services All Ways to Give Gifts of Stock, Real Estate, Other Why Support UC Davis? Your Giving Matters Health System Leadership Community Benefit Report (PDF) Health System Strategic Plan Newsroom & Publications Health System Advisers & Friends Learn more about UC Davis Health System’s major awards and honors UC Davis Health System Annual Report (PDF) The campaign for UC Davis Major gifts Memorial and tribute gifts Gifts of stock, real estate, etc. Events Employee giving NEWS | February 29, 2012 Betty Irene Moore School of Nursing doctoral student wins health information technology scholarship Katherine Kim, a Betty Irene Moore School of Nursing at UC Davis doctoral student, was awarded the Healthcare Information and Management Systems Society 2011 Northern California Chapter scholarship for academic excellence. The society annually awards eight scholarships at its national conference to student members who possess the potential to be future leaders in the health-care information and management-systems industry.Student Katherine Kim"I am so honored and excited to receive this scholarship," Kim said. "As part of the award I had the opportunity to go to the national conference and be introduced to leaders in the field. This is the type of invaluable experience that can help open doors at a national level."The Healthcare Information and Management Systems Society is focused on providing global leadership for the optimal use of information technology and management systems for the improvement of health care.Kim, one of the 33 inaugural-class students at the School of Nursing, juggles a full-time class schedule, teaches at San Francisco State University and leads the Interprofessional Health Informatics Special Interest Group. The student group, which she co-founded, was created to provide professional development opportunities. The group's goal is to stay on the cutting edge of informatics--the use of electronic resources, devices and methods to enhance the acquisition, storage, retrieval and use of information in health--and to be aware of ever-changing new technologies that can be used to improve health care and systems.She is excited about the future of nurses as leaders in health informatics. Nurses, as the primary health-care providers who acquire and manage health information, are in the best position to think of new ways technology can solve problems in health care, Kim said. Education in human-computer interaction and how technology may be better applied prepares the future workforce, she continued.Kim plans to use the scholarship award to prepare her dissertation, which focuses on the development of a tool to assess how technology can be matched to individuals to improve their health. Kim says she hopes to increase people's capacity for self-management and enhance their interactions with health-care providers."As a researcher and university faculty member, I will be able to conduct applied research that leverages the field of health informatics to design, develop, implement and evaluate interventions that place consumers in control of their health and support a partnership among people and their health-care providers," Kim said.Kim was the only Californian awarded a scholarship at the Healthcare Information and Management Systems Society award banquet Feb. 23 during their annual conference in Las Vegas. More than 35,000 members attended the four-day conference. To learn more about the Healthcare Information and Management Systems Society visit www.himss.org. About the Betty Irene Moore School of Nursing at UC Davis For 100 years, UC Davis has engaged in teaching, research and public service that matters to California and to transform the world. The Betty Irene Moore School of Nursing at UC Davis was established in March 2009, UC Davis' first major initiative to address society's most pressing health-care problems in its second century of service. The school was launched through a $100 million commitment from the Gordon and Betty Moore Foundation, the nation's largest grant for nursing education. The vision of the Betty Irene Moore School of Nursing is to transform health care through nursing education and research. Through nursing leadership, the school will discover knowledge to advance health, improve quality of care and health outcomes, and inform health policy. The school's first programs, a doctoral and a master's degree program, opened in fall 2010. Additional students and programs will be phased in over the next decade. The Betty Irene Moore School of Nursing is part of the UC Davis Health System, an integrated, academic health system encompassing UC Davis School of Medicine, the 645-bed-acute-care hospital and clinical services of UC Davis Medical Center and the 800-member physician group known as the UC Davis Medical Group. For more information, visit nursing.ucdavis.edu. Giving | UC Davis Health System | 4900 Broadway, Suite 1150 | Sacramento, CA 95820 | Phone: 916-734-9400 | FAX: 916-451-2637

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Seismic Rescue Medicine By Pascal J. Goldschmidt, M.D. The catastrophic earthquake that ravaged the already fragile Haitian capital of Port-au-Prince on January 12 unleashed an unprecedented humanitarian crisis. The devastation was beyond belief, the suffering horrific. Yet the brave people of Haiti were stoic in rescuing their neighbors and friends, the injured and the homeless, triggering an impassioned humanitarian response from around the world that showed Haiti will never be forgotten, nor forsaken. Led by Barth Green, M.D., chairman of neurological surgery, an army of our doctors, nurses, and staff would be joined by more than 2,700 medical volunteers from the U.S. and beyond, who staffed the most advanced ground zero hospital in the hemisphere’s poorest nation. In a 25,000-square-foot tent facility erected by a team led by Ron Bogue, assistant vice president for facilities and services, we collectively treated close to 30,000 patients, saving countless lives. I will never forget the night of January 17, when I landed in Port-au-Prince with one of the first hospital shifts. I was joining our team in Haiti to assess the needs and develop with Barth and other UM leaders a strategy for our long-term relief effort. We were immediately immersed in the formidable rescue, caring for hundreds of injured Haitians who were brought to two cargo tents at the non-functioning airport. In an improvised emergency room, our volunteers performed life-saving procedures on patients whose survival hung by a thread. One young man, Junior Clermond, had a crushed leg and was suffering from rhabdomyolysis. In need of dialysis, which was unavailable, the 19-year-old would surely die. With a plastic carpet, we lifted him onto a plane bound for Miami, where he would receive the treatment that saved his life. As he bravely awaited takeoff, he asked me to speak to his mother, who stayed quietly behind. The dead, dying, and injured were everywhere. I was, to say the least, overwhelmed, as probably everybody else was. But our teams in Port-au-Prince and Miami worked beautifully together to ensure that volunteers, supplies, and other necessary equipment were dispatched like clockwork. The next morning, a 13-year-old girl needed plastic surgery for her chest. A falling rock had sheared off her flesh and rib. Enrique “Iky” Ginzburg, M.D., professor of surgery, and I took her to the Israeli Army Field Hospital, the only one with a plastic surgery service. Our driver, his hand locked on the horn, drove the makeshift ambulance at 70 miles per hour through roads jammed with people, bicycles, cars, and trucks, all trying to navigate a world of chaos. Somehow we made it with our young patient, who said not one word nor shed a single tear. Our Israeli friends traded her for a patient for whom only we were prepared to care. I could not help but think that if all our fellow humans would always interact in such a kind, collaborative way, the world would be a better place. Haitian patient Junior Clermond, center, is assisted by a care team including, from left, Dean Pascal J. Goldschmidt, M.D., Enrique Ginzburg, M.D., professor of surgery, and Daniel Pust, M.D., critical care fellow. The Miller School relief effort was extraordinary—from top-notch trauma care by the UM/Jackson team of doctors and nurses to the can-do spirit of our orthopaedic surgeons, anesthesiologists, pediatricians, OB/GYNs, epidemiologists, dermatologists, neurologists, ophthalmologists, and physical therapists, who pitched in every way they could, even taking orphans under their wing; from the expansion of our pre-earthquake programs in comprehensive health care for underserved Haitians to the introduction of telemedicine to transmit real-time images of patients for consultations with experts in Miami; from the prosthetic limbs and physical therapy provided to hundreds of new amputees to the distribution of hundreds of eyeglasses and the establishment of an eyeglass library by the Bascom Palmer Eye Institute. Of course, little of this would have been possible without the caring generosity of Stuart Miller, Alonzo Mourning, Eric Feder, Carnival Cruise Lines, the students of Ransom Everglades School, and all the others who collectively contributed $5.8 million, donated their planes, pilots, personnel, and considerable energy or pharmaceuticals, supplies, and equipment to help us help our neighbors in their greatest time of need. The UM Global Institute for Community Health and Development has since passed the baton for day-to-day operations of our field hospital to our partner in Haiti, Project Medishare, which is leading the effort to establish a desperately needed national trauma, critical care, and rehabilitation network in the nation, as well as the educational components to support them. Slowly but surely, Haiti is rebuilding. Tim Dixon, Ph.D., professor of marine geology and geophysics, whose team helped us understand the risks as we sent people to Haiti, and other University specialists later convened world experts committed to reconstructing the nation with earthquake-resistant buildings. As we look back, we have learned so much from this tragedy. Our psychology/ psychiatry teams are helping Haitians surmount their loss and pain in reconstructing a nation that, as it did when it became the first independent state in Latin America, can look toward a future of hope and promise. I am so proud to review what the Miller School did as a team, thanks in no small measure to the wonderful relationship Barth has with the Haitian people, who did all they could to facilitate our mission. To those who delivered God’s work in Haiti, to those who stayed here to support the relief effort and continue to serve our patients, advance our research, and provide outstanding education, and to those who opened their hearts and their checkbooks, I thank you from the bottom of my heart. There is no better team in the world.

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Home > Health Information > Diseases & Conditions > Guillain-Barré Syndrome Guillain-Barré Syndrome (GBS) Guillain-Barré syndrome is a disorder in which the body's immune system attacks part of the peripheral nervous system. The first symptoms of this disorder include varying degrees of weakness or tingling sensations in the legs. In many instances, the weakness and abnormal sensations spread to the arms and upper body. These symptoms can increase in intensity until the muscles cannot be used at all and the patient is almost totally paralyzed. In these cases, the disorder is life-threatening and is considered a medical emergency. The patient is often put on a respirator to assist with breathing. Most patients, however, recover from even the most severe cases of Guillain-Barré syndrome, although some continue to have some degree of weakness. Guillain-Barré syndrome is rare. Usually Guillain-Barré occurs a few days or weeks after the patient has had symptoms of a respiratory or gastrointestinal viral infection. Occasionally, surgery or vaccinations will trigger the syndrome. The disorder can develop over the course of hours or days, or it may take up to 3 to 4 weeks. No one yet knows why Guillain-Barré strikes some people and not others or what sets the disease in motion. What scientists do know is that the body's immune system begins to attack the body itself, causing what is known as an autoimmune disease. Guillain-Barré is called a syndrome rather than a disease because it is not clear that a specific disease-causing agent is involved. Facts and InformationFact Sheet: Guillain-Barré Syndrome (GBS)CDCGeneral Questions and Answers on Guillain-Barré syndrome (GBS)CDCGBS Fact SheetNIHSurveillanceGBS Surveillance ProjectResourcesDivision of Communicable Disease ControlCalifornia Emerging Infections ProgramNational Institutes of Health Last modified on: 11/4/2009 9:39 AM

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NATIONAL LONGITUDINAL SURVEY OF YOUTH Return to Data Center NLS Web Investigator NLSY79 Errata NLSYA Errata NLS Questionnaires NLSY79 (2008) Questions and Frequencies NLSYA (2006) Questions and Frequencies National Longitudinal Surveys Website NLS FAQs BLS Help Center ANES/NLS Partnership The Center for Human Resource Research (CHRR) at the Ohio State University has been conducting longitudinal surveys with nationally representative panels of adults and children since the 1960s. CHRR is funded by the U.S. Bureau of Labor Statistics, the National Institute of Child Health and Human Development, and other federal agencies. The National Longitudinal Survey of Youth was conducted annually from 1979 through 1994 at which time it became a biennially survey. It's primary focus is labor force behavior. ANES was invited to include questions on two CHRR surveys: The National Longitudinal Survey of Youth (known as the NLSY79) and the Children of the NLSY (CNLSY) Young Adult component. Data collection for these surveys has been done by the National Opinion Research Center (NORC) at the University of Chicago. The interviews have each been quite lengthy and multifaceted, documenting a breathtaking range of aspects of the respondents� lives, including: labor force experiences, education and training experiences, standardized aptitude and achievement test scores, high school academic performance, time use, alcohol and substance use, participation in and income from various delinquent and criminal activities, fertility and more. You must register for access to the NLS data and documentation. Data can only be downloaded from the NLS Web Investigator. ANES questions on these NLSY surveys include party affilition, voter registration, voter participation, attitudinal questions about the political system and political experiences. Any opinions, findings and conclusions or recommendations expressed in these materials are those of the authors and do not necessarily reflect the views of the ANES or its funding organizations. Questions about the NLSY materials should be directed to the Bureau of Labor Statistics rather than to ANES. This page contains live references (or pointers) to information created and maintained by other organizations. Please note that the ANES does not control and cannot guarantee the relevance, timeliness, or accuracy of these outside materials.

医学

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| March 01, 2010 HHS Report on CHIPRA's First Year Highlights Gains in Coverage for Children Enrollment of children in Medicaid and the Children's Health Insurance Program (CHIP) increased by 2.6 million during federal fiscal year 2009. Over the course of the year, these programs served nearly 40 million children, according to a report released in February by the Department of Health and Human Services (HHS) exactly one year after President Obama signed the Children's Health Insurance Program Reauthorization Act (CHIPRA). Despite these gains, it is estimated that five million of the nation's 7.3 million uninsured children are eligible for Medicaid or CHIP but are not yet enrolled. Features of CHIPRA designed to boost enrollment include a new Express Lane Eligibility (ELE) option that allows state Medicaid and CHIP agencies to borrow and rely on eligibility findings from other need-based programs, such as Head Start and the National School Lunch Program, and to use information from other databases, such as tax records, to identify eligible children for outreach efforts. In 2009 three states (New Jersey, Alabama, and Louisiana) received approval to use the ELE option in their Medicaid programs. Many more states have expressed interest in the option for both Medicaid and CHIP, and the approvals that are expected in 2010 will help to identify and enroll a large number of uninsured children. Officials in states that receive 2010 approval for the ELE option may find guidance in a new issue brief from the Kaiser Foundation's Commission on Medicaid and the Uninsured. The brief provides an overview of eight key decisions that a state will face in designing an ELE initiative. Early decisions involve how to determine which state agencies can and should be tapped as appropriate sources of data for identifying eligible children and determining their eligibility and then how to structure a collaboration with these agencies that imposes the least burden on them and that falls within their allowable activities. In addition, technology plays a key role in simplifying the data-sharing and enrollment processes, and states must decide which electronic systems to implement or upgrade and whether they can use specific federal matching or incentive funds that support such improvements. The 11-page brief, Building an Express Lane Eligibility Initiative: A Roadmap of Key Decisions for States, is available on the Kaiser Web site at www.kff.org/medicaid/8043.cfm. The HHS report describes another CHIPRA feature designed to boost enrollment—performance bonuses for states that meet established targets. These bonus payments help to offset the costs of expanding coverage to previously uninsured children. In December 2009 HHS Secretary Kathleen Sebelius awarded bonuses totaling nearly $73 million to nine states. This was a strong showing, the HHS report notes, because of the "aggressive" 2009 enrollment targets established by CHIPRA and because states had less than a year to meet these goals. Thus it is likely that even more states will qualify for bonus payments in 2010. Enrollment of the lowest-income uninsured children is a key goal of CHIPRA, and the 2009 gains were greatest in this group. Of the 2.6 million newly covered children, 2.2 million were enrolled in "regular" Medicaid, as opposed to CHIP-funded Medicaid expansions or separate CHIP programs. States' ability to enroll more children during a year of record budget shortfalls is largely attributable to increased federal matching payments to state Medicaid programs that were made available through the American Recovery and Reinvestment Act, which was signed into law less than two weeks after CHIPRA. Medicaid and CHIP are important sources of coverage for children from all racial and ethnic groups. However, the programs play an especially critical role for African-American and Hispanic children, who are more likely than white children to be from low-income families. Children from minority groups experience well-documented disparities in access to health care, and a recent data analysis conducted by the Kaiser Family Foundation examined whether Medicaid is helping to reduce them. Disparities were no more likely among children enrolled in Medicaid than among privately insured children on the four indicators examined: has a usual source of care, made at least one past-year ambulatory medical visit, experienced a problem getting needed care, and had a problem seeing a specialist. Insurance coverage—both private and public—improved access for African-American and Hispanic children but generally did not significantly narrow disparities in access. The 14-page Kaiser report, Racial/Ethnic Disparities in Access to Care Among Children: How Does Medicaid Do in Closing the Gaps?, examines data for more than 15,000 children from the 2003 and 2004 Medical Expenditure Panel Survey. It is available at www.kff.org/minorityhealth/upload/8031.pdf. In releasing the report on achievements under CHIPRA, HHS Secretary Sebelius announced "The Secretary's Challenge: Connecting Kids to Coverage," a five-year campaign that calls on government officials at all levels, representatives of community organizations, faith leaders, and concerned individuals to find and enroll the five million children who are eligible but remain uncovered. The 20-page HHS report, CHIPRA One Year Later: Connecting Kids to Coverage, is available at www.insurekidsnow.gov. Recipient(s) will receive an email with a link (good for 72 hours) to 'HHS Report on CHIPRA's First Year Highlights Gains in Coverage for Children' 's Psychiatric Services: 'HHS Report on CHIPRA's First Year Highlights Gains in Coverage for Children' HHS Report on CHIPRA's First Year Highlights Gains in Coverage for Children. Psychiatric Services. 2010 Mar;61(3):330-330. Download citation file: RIS (Zotero) EndNote BibTex Medlars ProCite RefWorks Reference Manager Copyright © American Psychiatric Association. All rights reserved.

医学

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Vol 6, No 3 (2014) > Yamaguchi Effects of Social Capital on General Health Status Ayano Yamaguchi This paper discusses the concept of social capital as a potential factor in understanding the controversial relationship between income inequality and individual health status, arguing a positive, important role for social capital. Most of the health research literature focuses on individual health status and reveals that social capital increases individual health. However, the difficulty in measuring social capital, together with what may be the nearly impossible task of attributing causality, should relegate the concept to a more theoretical role in health research. Nonetheless, social capital receives academic attention as a potentially important factor in health research. This paper finds that the mixed results of empirical research on income inequality and health status remain a problem in the context of defining a stable relationship between socioeconomic status and health status. Clearly, further research is needed to elaborate on the income inequality and health relationship. In addition, focused, rigorous examination of social capital in a health context is needed before health researchers can comfortably introduce it as a concept of influence or significance.

医学

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Phytopharm PLC (PYM.L) Hit by Failure of Parkinson's Drug 2/19/2013 7:57:52 AM 18 February 2013 -- Phytopharm plc (PYM: London Stock Exchange) (“Phytopharm”, the “Group” or the “Company”) today announces the results of the Phase II, randomised, double blind, placebo controlled, dose-ranging trial of Cogane™ in unmedicated patients with early-stage Parkinson’s disease (“CONFIDENT-PD”). Analysis of the headline results indicated that Cogane™ had no beneficial effects on patients’ symptoms measured by the primary or secondary endpoints in the study. Study details Over four hundred subjects with early-stage Parkinson’s disease were randomly allocated to receive either Cogane™ 60 mg, 120 mg or 180 mg, or placebo, which was taken orally, once daily for up to 28 weeks. Measurements were taken during the study to determine the efficacy, safety and tolerability of each dose of Cogane™ compared with placebo and also the systemic exposure to Cogane™. The prospectively defined primary endpoint in this study was the change in the combined UPDRS II/III (an assessment of activities of daily living and motor symptoms) score from baseline to end-of-treatment for each dose of Cogane™ vs. placebo. A number of secondary efficacy outcome measures were also explored. No statistically significant effects or trends towards improvement were seen in any of these endpoints. Analysis of the results indicates that the study was well conducted and gave a clear, albeit negative result. Review of the safety data confirmed that Cogane™ administered orally once daily for up to 28 weeks was well tolerated. The full results of the study will be published in an appropriate scientific forum in due course. Professor C Warren Olanow, Professor of Neurology and Neuroscience at Mount Sinai Medical School and Co-chief Investigator for the study commented: “This is disappointing news for the Parkinson disease community. Trophic factors that enhance and restore function to remaining nerve cells is an extremely promising approach for the treatment of neurodegenerative disorders such as Parkinson’s disease. Cogane™ offered the potential of providing trophic effects throughout the brain with an oral medication that was relatively safe and well tolerated. The company is to be congratulated for carrying out this important study in such a high quality manner. Sadly, the results are negative. Nonetheless, the search for more effective therapies for the millions of patients who suffer from Parkinson’s disease must continue.” Commenting on these results, Tim Sharpington, CEO said: “We are naturally disappointed with the outcome of this study of Cogane™ in patients with Parkinson’s disease. Cogane™ had demonstrated encouraging efficacy in a wide range of industry standard pre-clinical models but this promise has not translated into clinically meaningful efficacy in this study. I would like to thank the investigators who conducted the trial, our collaborators and especially the patients who participated in the study, along with the Parkinson’s disease community and all our stakeholders who have supported the development of Cogane™. During the coming weeks we will further analyse these results with our scientific advisors to better understand whether to continue the development of Cogane™ and Myogane™. In addition, a review of other strategic options for the Company will be initiated by the Board and shareholders will be kept informed of progress. No further R&D expenditure will be committed whilst this review is taking place.” Enquiries Phytopharm plc Tim Sharpington, CEO Roger Hickling, R & D Director U.K. Investor Relations FTI Consulting Limited Ben Atwell John Dineen About Phytopharm Phytopharm plc (“Phytopharm”) is a development stage pharmaceutical Group developing novel treatments targeting diseases with high levels of unmet need, with the objective of developing products to key value inflection points before seeking late-stage development and/or commercial partners, as appropriate. Phytopharm operates as a virtual Group ensuring the majority of our financial resources are focussed on the development our pharmaceutical pipeline. We utilise a network of external scientific and clinical experts to help guide our development programmes with our experienced pharmaceutical managers overseeing operations. Given the disappointing results from the CONFIDENT-PD clinical trial reported today and the importance of Cogane™ to Phytopharm’s development pipeline, the Company’s future business strategy is under review. As at 31 January 2013 the Group had unaudited net cash and cash equivalents (including money market investments) of approximately £5.5 million. Phytopharm shares are included on the Premium Segment of the official list of the UKLA and are traded on the London Stock Exchange main market (Symbol: PYM). Further information on Phytopharm is available from the Company’s website www.phytopharm.com Parkinson’s disease Parkinson's disease (“PD”) is a movement disorder affecting 1 in 100 people over 60 years of age and is characterised by muscle rigidity, tremor and a slowing of physical movement (bradykinesia) and, in extreme cases, a loss of physical movement (akinesia). The primary symptoms are the result of altered signalling in an area of the brain, the striatum, responsible for the control of movement. This is caused by degeneration of dopaminergic neurones that project from the substantia nigra to the striatum, leading to insufficient formation and action of dopamine. Parkinson’s disease is therefore termed a neurodegenerative disease. The disease is relatively slow in its onset, with the appearance and worsening of symptoms reflecting the progressive loss of dopaminergic neurones. There is increasing awareness within the field, of the non-motor symptoms of PD (e.g. cognitive impairment, depression and anxiety, sleep difficulties, anosmia, constipation, speech problems), which have a major impact on patients and their families/carers. Most patients with PD have only a slightly reduced lifespan, although quality of life during the advanced staged of the disease is often poor especially for those patients with dementia. Patients often become severely disabled as symptoms cannot be adequately controlled by current drug therapies, which may also be associated with severe side effects. Cogane™ in Parkinson's disease Cogane™ has previously been shown to demonstrate neuroprotective and neurorestorative properties in a number of industry-standard preclinical models of Parkinson’s disease and other neurodegenerative diseases conducted at independent laboratories. It has been formulated as a once-daily oral medication which was shown to be well tolerated and have good bio-availability in Phase I clinical studies. CONFIDENT-PD The CONFIDENT-PD trial was a multi-national, Phase II, double blind, placebo controlled, dose ranging clinical trial which compared the efficacy, safety and tolerability of three doses of Cogane™ with placebo, when administered for 28 weeks to unmedicated patients with early-stage Parkinson’s disease. Importantly, this trial assessed the ability of Cogane™ to affect both the motor and non-motor symptoms of Parkinson’s disease. In this trial, over 400 patients were randomised across more than 90 sites in North America and Europe. The primary efficacy endpoint of the CONFIDENT-PD clinical trial was the change from baseline to end-of-treatment on the Unified Parkinson’s disease rating scale (“UPDRS”), Parts II and III combined. The UPDRS is a well-established and widely-used tool used to assess patients’ PD symptoms. UPDRS Part II is an assessment of the impact of PD on activities of daily living (“ADL”), which include routine tasks such as doing up buttons and shoe laces. UPDRS Part III is an assessment of patients’ motor symptoms (e.g., gait, bradykinesia, postural stability, tremor). Secondary endpoints The scales for outcomes in Parkinson's disease-cognition tool (“SCOPA-COG”) is an assessment designed specifically to assess the impact of PD on cognitive function by measuring performance on a number of tasks relying on memory, learning ability, level of attention, executive decision-making and visuo-spatial function. The non-motor symptom scale (“NMSS”) is a rating scale used to assess a broad spectrum of important non-motor features associated with PD. The Parkinson’s disease 39 instrument (“PDQ-39”) is a quality-of-life (“QoL”) questionnaire which generates a profile of scores, providing a subjective indication of the effect of PD on patients’ QoL The Beck depression inventory, 2nd revision (“BDI-II”) is a questionnaire for assessing depression. The Epworth Sleep Scale (“ESS”) is a well-established questionnaire used to assess the level of excessive daytime sleepiness. Forward looking statements Certain information included in these statements is forward-looking and involves risk and uncertainties that could cause results to differ materially from those expressed or implied by the forward-looking statements. Forward looking statements include, without limitation, projections relating to results of operations and financial conditions, market estimates, the Group’s plans and objectives for future operations, including future revenues, financial plans and expected expenditures and divestments. All forward-looking statements in this report are based on information known to the Group on the date of this release. The Group undertakes no obligation to publicly update or revise any forward looking statement, whether as a result of new information, future events or otherwise. It is not reasonably possible to itemise all of the many factors and specific events that could cause the Group’s forward looking statements to be incorrect or that could otherwise have a material adverse effect on the future operations or results of the Group. Phytopharm PLC (PYM.L)'s Cogane(TM) - US FDA Grant Orphan Drug Status for Treatment of ALS Genmab A/S (GEN.CO) Rises as Danske Sees FDA Breakthrough Phytopharm PLC (PYM.L) Interim Results for the Six Months Ended 31 March 2011 Oncolytics Biotech Inc. (ONC.TO) Shares Soar on Reolysin Trial Success Phytopharm PLC (PYM.L) Announces Commencement of Phase II Study of Cogane(TM) in Patients with Parkinson's Disease Luye Pharma Group Ltd. Completes US Phase II Trial of Cardiovascular TCM Phytopharm PLC (PYM.L) Preliminary Results for theYear Ended 30 September 2010 Medtronic, Inc. (MDT)'s Brain Device Improves Early-Stage Parkinson's Phytopharm PLC (PYM.L) Interim Management Statement Blood-Based Biomarkers May Lead to Earlier Diagnosis of Parkinson's Disease, Van Andel Institute Study Read Article at • BioSpace.com • Phytopharm PLC • Clinical - Phase II • Clinical - Phase II (World)

医学

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Home Newsroom Publications Expanding the Search Paths of Progress Spring/Summer 2014 Expanding the Search Can casting a wider net for cancer genes improve patient care?by Richard Saltus "I am pretty optimistic," says Colin Steele, who volunteered for exome sequencing. "Give me something, and I'll try it." Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC) is an environment where doctors and laboratory scientists often rub shoulders. A chance encounter can spark a new research collaboration, another way of looking at a thorny problem, or a different approach to treating a patient whose options have narrowed. A case in point: In late 2012, thoracic oncologist David Barbie, MD, had run out of treatment options for Colin Steele, a 61-year-old patient from North Andover, Mass. Steele was being treated for male breast cancer when he was also diagnosed with an aggressive lung cancer. Despite several rounds of chemotherapy, the lung tumors were spreading and colonies of cancer had reached his brain. The two cancers had occurred simultaneously, but nothing in Steele's family background or genetic testing revealed an unusual risk. Moreover, tests of his lung tumors didn't reveal any of the known DNA mutations that often drive such cancers and which sometimes can be attacked with molecularly targeted drugs. "I kept thinking there must be something more," recalls Barbie, of the Lowe Center for Thoracic Oncology at DF/BWCC. Later, while attending a scientific talk, Barbie heard Nikhil Wagle, MD, a researcher with the Susan F. Smith Center for Women's Cancers at Dana-Farber, describing an ambitious new research project called CanSeq (pronounced "can seek"). In CanSeq, Wagle and other researchers are evaluating an advanced technology called whole-exome sequencing, which conducts a wide sweep for cancer genes in tumors. It's a joint project involving Dana-Farber, the Broad Institute of MIT and Harvard, and Brigham and Women's Hospital. Nikhil Wagle, MD (left), and Levi Garraway, MD, Phd, who co-leads CanSeq, discuss ways to speed the process. Overall, CanSeq "is about studying and developing best practices around the whole process of returning complex tumor and germline genomic information to oncologists and their patients," explains Levi Garraway, MD, PhD, of Dana-Farber, who heads the project with Pasi Jänne, MD, PhD, a DF/BWCC thoracic oncologist and researcher. Testing tumors for the presence of known cancer mutations is standard practice for many patients coming to DF/BWCC. Depending on the type of cancer, a sample of tumor tissue may be tested for a number of specific mutations, which may vary from patient to patient. The tumor's mutational profile can guide physicians in choosing designer drugs – a practice known as "precision" or "personalized" cancer care. In addition, all consenting patients have their tumor's DNA scanned by Profile, a research program that compiles mutations and other abnormalities found in cancers treated at DF/BWCC and Dana-Farber/Boston Children's Cancer and Blood Disorders Center. Scientists search the samples for a list of known mutations in tumor tissue, and they also sequence – that is, read out the entire genetic script of – 305 genes that have been linked to cancer. Whole-exome sequencing goes further. Unlike "targeted sequencing," the whole-exome method scans all 20,000 genes contained in the human genome. It's a monumental task, but whole-exome sequencing takes a shortcut by reading only the exons in each gene. Exons are the segments of DNA code that contain the recipes for cell proteins, the large molecules that build and operate the body. In all, the human genome contains some 180,000 exons. Collectively, these exons are called the "exome," which contains about 30 million letters of genetic code. Most mutations and alterations that cause cancer are likely to be found in DNA in the exons of genes: Thus, sequencing the exome should capture the vast majority of cancer-related DNA changes. The goal of the four-year study is to sequence the exomes of 200 patients with advanced lung cancer and 200 with advanced colon cancer. "CanSeq sets up a mechanism so we can understand how having this very comprehensive picture of a tumor can have an impact on patients," says Garraway. "Is it a good thing? Does it help, and if so, a lot, or not so much?" Hunting for Genetic Suspects Thoracic oncologist Pasi Jänne, MD, PhD, is co-leader of the four-year CanSeq project. If standard testing is like hunting for crime suspects at specific addresses, whole-exome sequencing can be thought of as unleashing a massive door-to-door search of an entire city. It can scoop up known wrongdoers, but also flush out thousands of others not previously identified. Whole-exome sequencing is mainly being applied in research settings, but many believe it is the next step in realizing the ambitious goals of precision cancer care. "Some of these genes we know nothing about – they're not mutated commonly enough," says Garraway. "But they may be relevant. For example, when a doctor says, 'I have a patient with nothing else to try,' whole-exome sequencing may find a mutation that could lead to a trial of a drug for this patient." Wagle's talk about CanSeq prompted a new approach to treating Colin Steele's relentless cancer. After the presentation, Barbie described the case and asked whether whole-exome sequencing might unearth mutations in the cancer that could guide treatment. Wagle thought it might. In December 2012, Steele became one of the first patients to undergo whole-exome sequencing through the CanSeq program. After he agreed to join the study, researchers extracted and sequenced DNA from cancerous tissue removed during his lung surgery. They also sequenced his "germline" DNA – the normal genome he was born with – from a blood sample. "To identify the mutations driving the cancer, we need to see the patient's normal DNA sequence and subtract it from the tumor DNA, leaving it with changes that are relevant to the cancer," explains Stacy Gray, MD, AM, a Dana-Farber oncologist and investigator in CanSeq. Sequencing the Exome of a TumorA cancer cell's genome comprises DNA blueprints for the body's proteins. Only a tiny fraction of the DNA, a collection of exons called the exome, is used in making proteins. Exome sequencing focuses on this DNA because it's thought to contain most of the cancer-causing genetic changes. Genes also contain large regions called introns that don't carry the code for proteins. Automated DNA sequencing instruments at the Broad deciphered the genetic code of the exons in Steele's cancer within a matter of weeks, generating a gigantic amount of data. "The actual sequencing is easier than interpreting all these pieces of data – you are going to find things that you don't know what they do, whether they are a bad actor or not," explains Jänne. Raw sequencing data is pumped through two analytic "pipelines" that highlight DNA alterations that might be clinically relevant. That genomic information is then parsed by a team of physician-scientists who study the DNA variants and rank them in terms of their potential value for guiding treatment. A major goal of CanSeq is to create the most efficient infrastructure for the process. "We've learned it's incredibly hard to interpret the data and report back with a turnaround time that's rapid enough to be clinically useful," Garraway says. In Steele's case, the results validated his physician's hunch and offered a glimmer of hope. It revealed at least three mutations missed by standard tests: a rare mutation in a gene called KRAS; a mutation in the ATM gene; and a deleted tumor-suppressor gene, LKB1. Mutant KRAS, which drives cells into cancerous growth, is found in many lung cancers. But standard tests available at the time hadn't spotted the mutation in Steele's tumor, because it occurred at a different position on the gene. "This particular KRAS mutation was only reported a few years ago, in colorectal cancer," Barbie says. "We know it drives the cancer and predicts that it will be resistant to chemotherapy." However, the discovery opened up experimental treatment options for Steele that hadn't existed prior to the sequencing. Barbie discussed the case with a colleague, Leena Gandhi, MD, PhD, in DF/BWCC's thoracic oncology program, who was leading a clinical trial of a drug known as a CDK4 inhibitor that had achieved responses in some patients with KRAS mutations. Steele enrolled in the trial. "Overall, I'm pretty optimistic," he said recently. "Give me something to try and I'll try it." In early December 2012, Steele underwent the first of four cycles of treatment with the experimental drug. Over the next months, scans showed the cancer's growth had slowed and some small tumors apparently halted. "It wasn't a home run," says Barbie, "but it stabilized his disease and caused some shrinkage, which hadn't happened with all his previous chemotherapy. We think the CDK4 inhibitor has damaged his tumor." After four cycles, the drug was stopped because of worsening side effects. But in 2013, Steele started another trial targeting the ATM mutation in his tumor's DNA. The new drug, veliparib, combines a PARP inhibitor and a CDK4 inhibitor. "The scans keep saying there's slow growth, and I've survived two and a half years with this lung cancer," says Steel. "I'm feeling pretty good, and I'm thankful for that." His case is an example of how whole-exome sequencing adds a new dimension to the search for cancer genes, potentially giving patients new treatment options. With this technology nearing clinical use, research like CanSeq is helping shape how exome sequencing can define a model for integrating it into cancer care. How Should We Use Whole-Exome Data? In addition to finding tumor genes, whole-exome sequencing may spot red flags in a patient's DNA, signaling an increased risk of diseases and conditions that have nothing to do with cancer. These byproducts of exome analysis are known as "incidental findings." How this information should be handled has stirred debate and ethical discussion across the oncology field. "This is something that is entirely new to cancer care," says Stacy Gray, MD, AM, medical oncologist with the CanSeq project at Dana-Farber. She is co-leader of a project that investigates the ethical, legal, and social implications of exome sequencing technology. Exome sequencing differs from current tumor profiling in that it also scans the patient's normal, inherited DNA. So, for example, a lung cancer patient's DNA might reveal she has an elevated risk of heart disease, or even sudden death, or that she carries a mutation that predisposes her to another cancer. Depending on the condition, a preventive or early treatment might save a life. If no treatment is available, or the severity of the risk is uncertain, some would argue the knowledge is more of a burden to the patient than a benefit. Gray explains that CanSeq's consent process is designed to ensure that patients understand the potential outcomes of exome sequencing. It allows them to state preferences about which results they wish to receive. Some patients may want to learn any and all DNA results, no matter how uncertain or distressing. Others might shun any findings not relevant to their cancer. But, do doctors have a duty to override these preferences for the patient's good? Are patients obligated to share with family members test results that could affect their relatives? What if the patient dies before information on a familial risk becomes available? The American College of Medical Genetics now lists 56 gene mutations it recommends as conditions that should be reported to doctors and patients. Among them: mutations causing hereditary breast and ovarian cancer, Li-Fraumeni familial cancer syndrome, Marfan syndrome, retinoblastoma, and certain heart disease risks. Some argue that such a stance threatens patient autonomy. CanSeq researchers "have thought this through," says Gray. A clause in the consent form allows researchers to inform a patient of a finding that is "immediately actionable and would be clinically beneficial," she says. "These findings may be returned to patients on a case-by-case basis if withholding them might result in patient harm." Patients will not be alone in dealing with these issues. CanSeq oncologists will refer patients with incidental findings to genetic counselors and other appropriate specialists for follow-up. Learn about our genetic research. Paths of Progress Spring/Summer 2014 Table of Contents Email Dana-Farber Blog Insight features the latest in cancer care and research news from Dana-Farber. Dana-Farber eNewsletter Stay current on the latest news about Dana-Farber and the Jimmy Fund by signing up for Spotlight, our email newsletter. View the current issueSubscribe now Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215 | Call us toll-free:

医学

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For more information, please call us at Content Forms DMS Assets Nursing Jobs at Lenox Hill Hospital Lenox Hill Healthplex Phone Listings Online Health Resources Find any physician affiliated with Lenox Hill Hospital. Search Medical Staff Awards & AccoladesAmerica's Best Hospitals 2014-15U.S. News and World ReportRead more Stay in TouchThere are many ways you can keep up on the latest health tips, news and events from Lenox Hill Hospital.Watch our videosConnect with usFollow UsRead our E-MagazineReceive our E-Newsletters Vascular SurgeryPhone: (212) 434-3420The Vascular Surgery Team at Lenox Hill Heart and Vascular Institute is a leading center within New York City treating all aspects of both arterial and venous problems. Our commitment to the patient is to offer the best clinical care for any vascular problem. Our practice is unique because of the multidisciplinary approach that is taken in evaluating vascular problems. At Lenox Hill, our vascular surgeons, interventional cardiologists and interventional radiologists work side-by-side and often together in the same operative/radiological suite, which allows us to offer the best and most current treatment. This team approach allows us to provide a level of care that is often not possible for any one clinical specialist, whether the procedure is minimally invasive or traditional open surgery. The vascular surgeons at Lenox Hill Heart and Vascular Institute are some of the country's most experienced in both traditional surgical techniques and minimally invasive endovascular surgery. We are a center that trains physicians and surgeons from throughout country in the newest techniques for treating thoracic and abdominal aortic aneurysms, as well as carotid artery disease.In addition to arterial disease, we are leaders in treating venous disease, including varicose veins. Laser and thermal ablation techniques are routinely performed for large and small venous varices. In keeping with our use of cutting-edge technology, we performed the first thermal ablation treatment for incompetent perforators in New York City in 2005.Lenox Hill Hospital encourages an environment that is patient driven. When providing care, the patient and family are our highest priorities. About Us | Our Services | For Patients & Visitors | Education & Training | How You Can Help | Contact Us | Privacy Policy/Terms | Directions | Site Map © Lenox Hill Hospital 2014. All rights reserved. 100 East 77th Street, New York, NY 10075 (212) 434-2000. For billing inquiries, please visit our website at www.nslij.com/resolve

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Printed from www.mcc.gov. Search: AboutMCC ExecutiveProfiles OrganizationChart Reports &Notifications SpeakersBureau Blog Values SelectionCriteria Programs &Activities Countries &Country Tools Press &Public Affairs Business &Procurements Poverty Reduction Blog Tag: Immunization A tough road to build a healthy nation Posted on January 28, 2014 by Dr. Ruhul Amin, Chief of Party, USAID-MCC Immunization Protects Children Project It was a lovely, bright morning as I walked beside the broad, blue river that passes through the district town of Viqueque in Timor-Leste. Kids were heading to school in their colorful uniforms, shouting "Bondia!” (“Good morning!”) to me. It made me smile to see them going to school to make their lives and their young country better. At the same time, I worried about the many challenges they face in a country with one of the world’s poorest populations. Timor-Leste is just 11 years old. Its health and development indicators, including immunization coverage, are among the worst in Asia. About 23 percent of 1-year-old children did not receive any immunizations, and the country has experienced several outbreaks of vaccine-preventable diseases in recent years. For example, more than 800 people contracted measles—and eight people died—during a nationwide outbreak in 2011. As I walked to the district health center in Viqueque where the staff of the immunization project that I lead helps the Ministry of Health to improve immunization services, I wondered if the school kids in the group were fully immunized. Some of the diseases that we treat successfully through immunization in the United States can be deadly in Timor-Leste. Timor-Leste’s $10.5 million Threshold Program focuses on anti-corruption initiatives and immunization. Under the $2.6 million immunization component, MCC is helping address the country’s low immunization rates by working with USAID and the Timorese Ministry of Health to increase coverage of the measles vaccine and the third dose of the diphtheria-tetanus-pertussis (DTP3) vaccine. The project targets seven of the country's 13 districts, focusing on areas where more than 75 percent of under-immunized Timorese children under 5 years of age live. The program provides technical assistance to the Ministry to improve the effectiveness, quality and accessibility of immunization services. This involves training staff, developing and applying new tools, providing staff and transport assistance, and coordinating community engagement activities, better reporting, mentoring, and supervision. Project implementers have been working hard to reach hard-to-reach communities by whatever means necessary—on foot, on horseback, by boat, and once by U.S. Navy helicopters. In Timor-Leste, families often lack the basics, including proper nutrition, clean water and sanitation and fundamental health services. Delivering health services is one of the biggest challenges that the Ministry of Health faces. The average walking distance from a household to the nearest health facility is more than an hour, and during the wet season even short distances become impassable. Although health services from public health facilities are free, parents still lose a day’s wages on transport costs. Most parents follow traditional beliefs and practices and do not seek care from a health facility except for the most serious problems. The immunization program has already produced some impressive results. DPT3 coverage in Baucau, the country’s second largest city, increased from 74 percent when the program began in January 2011 to 100 percent by June 2013. The program’s success goes beyond Baucau. The Ministry of Health reports a significant increase in immunization coverage in Timor-Leste. DTP3 coverage nationwide increased from 67 percent in 2011 to 78 percent in 2013. The districts that are the focus of the MCC-funded program saw immunization coverage reach 84 percent. Challenges remain in providing adequate immunization coverage throughout the country. Essential drugs and immunizations are sometimes out of stock. Deliveries of fuel for cold-chain refrigerators are delayed. Vehicles sometimes don't have enough fuel to travel to remote communities. But the Government of Timor-Leste has been working diligently to overcome these obstacles, and I'm happy that I am part of the effort to provide all Timorese a healthier future. africa agriculture benin burkina faso businesses cape verde ceo community services compact completed consultants contractors country ownership donors economic growth education el salvador food security foreign aid gender Categories Europe, Asia and the Pacific Property Rights and Land Policy CONTACT MCC OPEN GOV’T

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SCAA Keep It Beating Emergency University: CPR/AED training for success, part 2 Blended training has been well documented to be a superior method for learning. When applied to life supporting actions and developing the confidence to act at the time of a cardiac arrest, it has been especially beneficial. What also differentiates EU's programs from the many other available emergency care training curricula is not only its convenient, interactive, self-paced and multi-sensorial online training modules, but also the instructor-led, uniquely personal and individually validated hands-on skills practice classes. Interaction and validation from EU's qualified instructors are an essential component of the emergency responder’s learning and motivation.More Help out the SCAA by going shopping on Aug. 24 For only $5 you can receive 25 percent off regular merchandise and 10 percent off of electronics Macy's shopping pass. The proceeds from the $5 sales go to the SCAA. This is the perfect excuse to go shopping while helping the SCAA at the same time! To purchase a pass, please follow the "Read More" link or go to our website and click on the "Macy's Shop For a Cause" icon at the top of the home page. We hope to see you there shopping! More Don't worry, be healthy People with cheerful temperaments are significantly less likely to suffer a coronary event such as a heart attack or sudden cardiac death, new Johns Hopkins research suggests. Previous research has shown that depressed and anxious people are more likely to have heart attacks and to die from them than those whose dispositions are sunnier. But the Johns Hopkins researchers say their study shows that a general sense of well-being — feeling cheerful, relaxed, energetic and satisfied with life — actually reduces the chances of a heart attack.More Un-extraordinary measures: Stats show CPR often falls flat Since it was introduced to American physicians in 1960, cardiopulmonary resuscitation has become a staple of emergency medicine. Between 2011 and 2012, more than 14 million people in 60 countries were trained in CPR administration, according to the American Heart Association. But recent studies suggest that the number of lives saved by CPR isn't as many as your favorite TV police drama would have you believe.More 15 Alabama schools honored as 'Heart-Safe Schools' Children's of Alabama via AL.com In an effort to ensure that Alabama schools are well-equipped with and trained to use automated external defibrillators, Alabama LifeStart has awarded 15 schools the title of "Heart-Safe School." The recipient schools were honored for having incorporated AED training into their student health or physical education curriculum.More Houston mayor wants to improve the lack of CPR training in low-income areas KHOU-TV Shirley King has been the secretary at her church for more than 20 years. She's also a retired nurse, who's tried to teach some of her neighbors how to perform CPR. "I think the big thing is just the fear factor," King said. "Not knowing what's going to happen, not knowing how to do it and what's going to happen to you." A team of experts from Rice University has seen those same tendencies in low-income minority areas all throughout Houston. Most of those areas have higher numbers of heart attacks and fewer people either willing or able to administer CPR.More Survivor's story: Dawn Botwen-Hauver "Ironically, I remember feeling the best I had in a long time on the morning of that fateful day," writes 41 year-old wife and mother of two, Dawn Botwen-Hauver, of Hollywood, Fla. On Feb. 11, 2009, Dawn received a phone call from her son's school, alerting her that her five-year-old son wasn't feeling well. Little did she know how his illness would end up saving her life that very same day.More Cardiac arrest at 29,000 feet Prem Raghu's lucky numbers might as well be his flight and seat: American Airlines' No. 1006; seat 24D. That's where the 67-year-old retired custodian was about 2 p.m. April 3, when he suffered cardiac arrest at 29,000 feet. Ominous as that sounds, it was the right place at the right time given that he was surrounded, far and away, by the right company. More Delta employees save colleague after heart attack WXIA-TV David Morrison, 50, had to rely on his colleagues at Delta Air Lines to help him piece together what happened the day he suffered a heart attack. He was sitting at his desk in Delta's finance department on the morning on Feb. 13, when he suddenly slumped over and fell to the ground. Right away, everyone who worked around him found a way to help.More CPR directed over the phone by dispatcher helped save a toddler's life WTLV-TV A Flagler County, Fla., sheriff's communications specialist helped a grandmother save her grandchild's life. After walking away to answer a phone call, a grandmother found her 3-year-old grandchild not breathing after being pulled from the pool by another child, according to a Flagler County Sheriff's Office press release.More 5-year-old boy reunites with rescuers who saved him from cardiac arrest KNBC-TV A 5-year-old boy was recently reunited with his rescuers, three months after he went into cardiac arrest on his school playground. Elijah Watkins, along with his parents, were recognized by the Los Angeles Fire Department and once again met the paramedics and 911 caller who saved his life.More Mental health scars common after cardiac arrest Reuters via Chicago Tribune A quarter of cardiac arrest survivors suffer long-term psychological problems such as anxiety, post-traumatic stress disorder and depression, a new review of research estimates. This additional stress on recovering patients is under-diagnosed, researchers say, and doctors have few standard methods for identifying who is at risk.More Inappropriate shock rates driven lower with 'smart' programming: Very good news in ICD therapy Implantable cardioverter-defibrillator (ICD) therapy for the treatment of sudden cardiac death has undergone major improvements in the past year. This is welcome news for both patients and caregivers. A late-breaking clinical trial from EUROPACE 2013 delivers good news about ICD therapy.More Looking for stories about real people and experiences? Take a look at the SCAA's Human Interest News and please let us know if you have any stories you'd like to share by contacting info@suddencardiacarrest.org.More SCAA chapter donates AED The SCAA Western Pennsylvania Chapter, led by Cheryl Rickens, donated an AED to St. Wendelin Roman Catholic Church in Butler, Pa.More Heart failure: Mobbing James Gandolfini "James Gandolfini, beloved for portraying flawed mob boss Tony Soprano, was 51 when cardiac arrest ended his life," writes Tracey Conway, Emmy-winning actress and writer. "I was 38 when sudden cardiac arrest stopped my own heart from functioning for almost twenty minutes. Unlike Mr. Gandolfini, I was resuscitated. My heart, and I, beat the odds."More

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Dave Richard Op-Ed: DHHS Crisis Solutions Column: DHHS Crisis Solutions Initiative by Dave Richard http://www.gastongazette.com/opinion/columns/column-mental-health-1.245717?page=0 It's a Saturday in the middle of the busy holiday shopping season. A disheveled man is disrupting traffic in a popular shopping center, preaching loudly and scaring customers. A police officer responds to calls from merchants, but without any local options for crisis treatment services, he takes the man off to jail on a trespassing charge and hopes the jail nurses will be able to get him some help. A hundred miles away, a woman who has been clean for months relapses after losing her job. She is alone, depressed and frightened. After several weeks of drinking, she returns to crack cocaine. She knows she needs help, but without a car or money to pay a cab, she calls 911. Late one night in a quiet suburb, a teenager threatens suicide. Not knowing what else to do, her parents call their family doctor, who suggests they go to the nearest emergency department. They wait in a crowded treatment area for most of the night until someone can help them ease this young woman's mental health crisis. In many North Carolina communities, the only place for people in mental health crisis is the local ED or jail. Those needing inpatient hospitalization may have to wait there for hours, even days, for an appropriate place to begin treatment. The only available bed may be hours away; the only transportation, the back of a sheriff's car. As I travel around the state, I talk with family members, advocates and mental health care professionals worried about the alarming state of crisis services in North Carolina. Currently, hospitals and law enforcement are carrying most of the burden associated with crisis episodes because too many communities lack the appropriate resources to help people and their families during mental health crises. They tell me the system is not working. Earlier this month, Gov. Pat McCrory and Department of Health and Human Services Secretary Aldona Wos announced a new initiative to improve mental health and substance abuse crisis services in North Carolina. The Governor and Secretary Wos have invited mental health care professionals, hospital administrators, members of law enforcement, and patient advocates to join them on December 9 for the first meeting of the Crisis Solutions Initiative Coalition. The primary goal of the Crisis Solutions Initiative is to address the tremendous strain on the current mental health and substance abuse crisis system. High levels of emergency department usage, extended wait times in emergency departments, increased incidence of mental illness in jails and prisons - all of these contribute to higher costs - and just as important, they don't get the job done. Previous attempts at change have taken a wholesale transformation approach: Throw everything out and start over. This administration's approach is more pragmatic: we'll look to see what's working well and expand it. Instead of "reform," this will be a practical plan that focuses on long-term solutions. We want to look at evidence-based best practices that are working and use them to build a system that addresses the whole person and provides the right care at the right time. We have a number of pilot programs that are showing great promise, and this solution-oriented group also will explore new options that include funding and policy changes. One of the first steps will be to reduce the strain on hospital emergency departments: reduce the number of people in crisis who use them, reduce the wait times for those who must use them, and reduce the number of people readmitted within 30 days of a previous visit. Key to the success of the Mental Health Crisis Solutions Initiative will revolve around bringing the right people together and understanding the entire crisis continuum. The governor and his administration are committed to the effort, and the people of this state have everything to gain from its success. Richard is director of North Carolina's DHHS Division of Mental Health, Developmental Disabilities and Substance Abuse Services ### Jobs at NC DHHS | Disclaimer | Accessibility | Contact the Webmaster Updated: December 9, 2013

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Preview of the October 2014 Issue The church as health clinic Congregations pitch in to help fill the gaps in medical care. by Cary Estes She was the type of person who often slips through the cracks of society: no insurance, more than $10,000 in medical bills, and blood pressure that had soared into stroke range. She could not afford to be treated, but without treatment she could not continue working as a housekeeper—which meant that she wouldn’t be able to earn the money to pay for treatment. The woman desperately needed a helping hand in order to find a healing hand. And she managed to receive that assistance from Lois Bazhaw, a nurse who belongs to Faith Presbyterian Church in Greensboro, North Carolina. The woman had come to Faith Presbyterian for the church’s food pantry, and while there explained her situation to Bazhaw. Continue reading A Christian take on the Affordable Care Act Presbyterians navigate a thorny debate to find out how God’s children can best get access to healthcare. by Chris Herlinger Charles Freeman juggles seminary and chemo. Without his student insurance, he says, he never would have made the visit to the doctor that resulted in the consultation that resulted in the colonoscopy that revealed his cancer. Freeman, who has since graduated, now has insurance thanks to the Affordable Care Act. Deborah Wade feigns that she is no expert on the Affordable Care Act (ACA) or the US healthcare system. But within minutes, she is speaking as a savvy, empathetic, and passionate observer of both—their limits, problems, and possibilities. Before the ACA was enacted, she says, the healthcare system “seemed too often to be a money-making machine for doctors, clinics, and hospitals,” undergirded by costly tests, drugs, and operations. “It was a way to make money rather than a system for helping people improve their health.” A member of Anchorage Presbyterian Church near Louisville, Wade works as a program coordinator for innovation and community engagement at the University of Louisville School of Dentistry. Before that, she worked as a manager of outpatient HIV/AIDS medical clinics in Alabama and Kentucky, and that gave Wade something close to a front-row seat for some of the last quarter century’s spirited debates on the US healthcare system. “It’s not perfect, but at least something got done,” Wade said of the ACA, also known, often critically, as Obamacare. Still, she feels the country is far from achieving what would help provide optimal care—a patient-centered approach. Continue reading How making space for God can reduce stress by Joanie Friend “And can any of you by worrying add a single hour to your span of life?”—Luke 12:25 Sitting across from Carol (whose name has been changed for privacy), I notice her shift nervously in her chair. As the faith community nurse at Bradley Hills Presbyterian Church in Bethesda, Maryland, I already know some of her story. A middle-aged woman, she should be in the prime of her life. Instead, she seems tired and beaten down. Her father, who is 89, is in the beginning stages of dementia. Her mother, who died recently, had been chronically ill. A registered nurse, Carol has felt an acute need to help care for them both. To make matters worse, her husband has a serious heart condition, and she’s caring also for her young adult children, one of whom is engaged to be married. All the time she’s spent caring for multiple generations of family has led to missed workdays and lost jobs, leaving Carol and her family with lots of debt and little money. I listen as Carol, shaking, recounts source after source of stress. She is one of many who now comprise the “sandwich generation”—working adults caring simultaneously for children (many of whom are young adults returning home after college) and parents or even grandparents. As life expectancy extends and adult children can’t find adequate work, the sandwich generation is growing, bringing with it unprecedented stress. Continue reading One in Mission ‘Strengthening the body of Christ’ Collaborative approach helps mission coworkers bring healing to Madagascar. by Linda Valentine Elizabeth Turk was raised in what is now the Democratic Republic of the Congo, which sensitized her to the major health threats that affect the people of Africa. Now a nurse with a master’s degree in public health, she has served since 1996 with her husband, Dan, as a mission coworker in Madagascar. There she shares the fruits of her training—coupled with her unshakable faith—to help bring hope and healing to a country in crisis. The Malagasy people still suffer amid the unstable political conditions and abject poverty that became much worse after a coup toppled the country’s government in 2009. “Sometimes all we’ve done is sit and cry with people, or sit and pray,” says Elizabeth. “Sometimes that’s really what we’re called by God to do, not just to produce results.” Continue reading HIV/AIDS: a persisting stigma by Susan Barnett In 1981, a pivotal medical event occurred. A mysterious disease appeared and was given the name HIV, or Human Immunodeficiency Virus. Like polio and Ebola, HIV evoked fear, and we feared those who had it. In 1981, we did not know a lot about HIV. But now we do. HIV is the virus that may lead to AIDS, or Acquired Immunodeficiency Syndrome. Not having an immune system makes it easier to get sick and harder to fight illnesses. Not all of the 1 million people in the United States who have HIV will develop AIDS. Depending on when diagnosis and treatment occurs, those with HIV/AIDS can live fairly normal lives, have children, work, and worship. Yet in spite of medical advances and community education efforts, discrimination or stigma remains attached to those living with HIV/AIDS. For the most part, this discrimination stems from lack of knowledge of HIV and how it is contracted. Continue reading The second half of life in an age-anxious church Focusing on the short term shortchanges all of us. by Rachel M. Srubas Shortly before I turned 50 earlier this year, I dreamed I heard an authoritative voice announcing the death of someone important. “And now,” the announcer intoned, “Year Two has begun.” I woke up and thought, well, that was pretty transparent. Recently I’d been reading about what psychologist Carl Jung calls “the two halves of life.” In the first half of life, people tend to emphasize accomplishing, building, striving, competing, and problem solving, often while feeling as if something is missing. The second half of life can involve a shift toward deeper listening and reflecting, humbler wisdom, bolder compassion, and greater personal fulfillment. My dream had just confirmed what my mirror was already telling me. The second half of my life was officially under way. Continue reading 1001 New Worshiping Communities ‘People with a heart’ Host congregation and a 1001 health insurance grant provide help after tragedy. by Paul Seebeck As Elbis Hernandez can attest, the kindness of a congregation, backed by the resources of a national church, can transform lives. “It’s one of the reasons I’m still alive,” he says. In July 2012 Hernandez received devastating news: his youngest son, 17-year-old Job Hernandez, had been killed when a car going the wrong way on an interstate near Raleigh, North Carolina, plowed into a minivan that Job was riding in. The minivan driver, Job’s 21-year-old brother, Natanael Hernandez, was seriously injured. The car driver died. Her blood-alcohol level was three times above the legal limit. The news knocked Elbis Hernandez into a downward spiral of grief. But that’s when Milner Memorial Presbyterian Church in Raleigh stepped in. Continue reading Fear in the land of imagination A sermon about Exodus, Ferguson, and children refugees from Central America By Patrick David Heery, editor Two weeks ago, on August 24, 2014, I preached the following sermon at my home church in Cincinnati, Ohio. You can listen to the sermon here. It was important that I preach this sermon. It was important that I preach it in Cincinnati. Because years ago, when I was in the 11th grade, a white police officer shot yet another young unarmed African American man in the back. The shooting ripped the city apart, revealing deep ruptures that had been with the city for a very long time. The subsequent work to bring about justice and healing—and the real failure of that work—is what propelled me into ministry. It was in my anger, grief, and disillusionment in the political process that I heard God's call. And so here I was returning to Cincinnati to preach a guest sermon scheduled more than six months before I had ever heard of Ferguson, and I knew what the subject had to be. Continue reading New! Guide for Young Adult Ministry This special issue is a must-read for everyone who wants to better understand young adults and engage them in worship, education, and service. Pre-order your 2014 Advent Calendar Decluttering for Christmas, the new Advent Calendar from Presbyterians Today, is now available for pre-order! Pre-order your 2015 Lenten Devotional Presbyterian Today’s 2015 Lenten Devotional—Draw Near—contains Scripture readings, meditations, prayers, and reflection questions for each day of the Lenten season. Pre-order now. Welcome to the Presbyterian Church! NEW THIRD EDITION. Presbyterians Today’s special issue and guidebook — “Welcome to the Presbyterian Church!” — is a wonderful introduction and overview of all things Presbyterian. What Presbyterians Believe 2 Volume 2 of Presbyterians Today’s new special issue and guidebook—What Presbyterians Believe 2—brings you even more of our most popular articles all about Presbyterian beliefs, worship, and practice. Presbyterians Today Magazine Ministries

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Migrant sensitive health system: The challenging factor in public health - President CCPSL By Anuradha KODAGODA Public health professionals are not only to deal with people. They have to be seen as advocates to change the mindsets of the entrepreneurs who are especially in the food industry. Dr. Susie Perera Therefore we believe we have to come strongly as advocates to the public health to influence this existing environment, said the new President of the College of Community Physicians of Sri Lanka (CCPSL) Dr. Susie Perera. She was addressing the audience after being inducted as the new president of CCPSL in the presence of Minister of Health Maithripala Sirisena last week. Dr. Susie revealed the global challenge for migrant sensitive health system, is the most challenging factor in public health in today's world. "The College of Community Physicians of Sri Lanka (CCPSL) probably deals with the public health of the country. Public health is the branch of preventing and promoting medicine. The CCPSL delivers its service mainly through Medical Officer of Health (MOH) in each and every local government division of the country. Through over 300 MOHs which are active around the country, so far we have successfully facilitated the public by promoting and preventing medicines for the sanitation, immunisation, maternity health, child health, and communicable diseases and for many other public health needs. Investment on health has brought about a good level of maternal and child health care resulting in low maternal and infant mortality rates, high immunisation coverages, resulting in the control and virtual elimination status of some of the vaccine preventable diseases and also other diseases like leprosy, malaria and also we are considered as a low prevalent country for TB."With that today we could largely control so many diseases and as a country we are in a satisfactory level in public health," said Dr. Perera. The CCPSL originated as the 'Society of Medical Officers of Health' in 1927 and was the second professional body in the medical sciences in Sri Lanka following the establishment of the Ceylon Medical Association (CMA) branch of the British Medicine Association (BMA) in 1887. The association was subsequently established as a college with the incorporation by an Act of Parliament in 1995 with the primary objective of fostering public health in the country. Health Minister Maithripala Sirisena and the community health physicians listening to the presentation of Dr. Susie Perera "However, unlike earlier days, today the public health has grown. The inputs and public health specialists' involvement is much more compared to early days. Therefore, today the public health is expanded into programs such as non-communicable diseases, mental health and cancer. Even though cancer patients are being treated by oncologists, as public health physicians we have a huge responsibility in educating the general public in terms of promoting the idea of preventing cancer," Dr. Susie said. "Together with the former president of CCPSL Dr. Vinya S. Ariyaratne, we made a strategic plan for the next five years for the public health of the country. Through this we have a wider possibility in approaching the general public for their community health problems. We are seriously working to change the current public understanding of a community physician which is another clinician where people can only get medicines for their day-to-day needs. But a community physician means much more to the community. His ultimate responsibility is to prevent the communities from diseases rather than curing. It is not an easy task to achieve considering the current lifestyle of the people. Today we are facing a huge risk of non-communicable diseases where it is mainly due to the false food habits. It is not simply tackled by only medicine. That is where we see huge importance of preventing and promotion. "Public health professionals are not only to deal with people. They have to be seen as advocates to change the mindsets of the entrepreneurs who are especially in the food industry. Because as we think it is not possible to change the food culture by only advising the consumers, but traders also have to have the same understanding of these important factors to eliminate these non-communicable diseases which are spreading like a virus nowadays. Therefore we believe we have to come strongly as advocates to the public health to influence this existing environment," "Therefore in the near future we hope to come up with new ideas of promoting healthy food habits among the public and we hope to hold a health festival with the message of 'Super 8' which we hope to announce for the general public," Dr Susie said. "In 1951 the World Health Assembly adopted the International Sanitary Regulations which in 1969 were revised and renamed as The International Health Regulations (IHR). Its main purpose was to reduce the risk of international spread of diseases of global public health importance. Whilst IHR are to contain spread of disease across borders, Migration Health has emerged as a specialised field of health sciences that addresses the individual health concerns of migrants as well as public health issues related to the migration process of people. On-the-job training conducted for public health field staff Therefore the subject of Migration health has two major concerns being that of preserving or improving the public health of countries as well as the health of migrants' per-se. "Today, more than ever, people are on the move be it within the country or to and from a country, whether it is for a short duration like a couple of days or several years. The world today has a 7 billion population. It is estimated that at a given time 1 billion of the world population are migrants."The recently concluded population census in Sri Lanka revealed that we have a population of 202,775,971. These were the citizens residing in the country on the day of the censes. In addition, 1.9 million of our population is currently employed overseas and a smaller percentage leaves the country as students. Overall, a little more than 10 percent of Sri Lankans are employed overseas. "There are also people who stay away from their homes for a longer period but are moving internally. Again it is for work purposes and there is also a large student population. These different types of migrants make a significant contribution to the Sri Lankan Economy. "However, it remains that many developed countries are concerned mainly with who is coming into their country. They are challenged with containment or reducing disease burdens. Often border protection or immigration control is seen to be linked with health interventions that range from assessing health certificates for immunisation on specific diseases like yellow fever or comprehensive health assessments such as those undergone for work purposes. In fact, for some countries where their migrant population forms a considerable percentage of their overall population it becomes a critical challenge. "Sri Lanka faces a similar situation and our economy is heavily dependent on outbound, inbound and internal migration. "Therefore, there is a definite need to standardise and improve pre-departure health assessment. The review of bilateral agreements and also the study on returned migrants revealed that the Health protection is inadequately addressed in host countries - 27.8 percentage of those who returned stated the reason as being sick and 18.8 percentage who were hospitalised had to pay back the hospitalisation charges to their employer. Also 60.5 percentage stated that they did not inform their employer if not well due to fear of being dismissed," Dr. Susie said. EMAIL | PRINTABLE VIEW | FEEDBACK

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Expansion of mental services called for Published January 29. 2013 10:00AMUpdated January 29. 2013 11:44PM Hartford — Her 7-year-old son was one of the “runners” at Sandy Hook Elementary School and has nightmares. Her middle child, age 11, is doing remarkably well. It is her oldest child who worries Jennifer Maksel of Newtown the most. “I am reaching out as a mother with a son who is increasingly getting more and more withdrawn,” Maksel said.Her oldest child, who is 12½ years old, has the emotional level of a 9-year-old, is frequently violent at home and is not responding to social skills programs at school, she said.When she asked school officials what else could be done, she was told, “We don’t have the resources in your area,” Maksel said. Tired of fighting with the school system, insurance companies and hospitals, Maksel said, “I just think that I just need help. I don’t know what else to say.”Help is what state legislators said they hope to provide after they gather information from the mental health services working group, which met Tuesday in the Legislative Office Building. Numerous mental health experts discussed the need for more mental health services in schools and for better private insurance coverage and the pros and cons of “outpatient commitment.” Many members of the public with mental illnesses said they did not want outpatient commitment — people being forced to receive mental health services. They would rather have Connecticut’s recovery-oriented care system enhanced.“I am here today to respectfully request that you take a position against proposed legislation that would limit the rights of youth or young adults to choose at what point and where they access mental health treatment,” said Michaela Fissel of Windsor.Fissel said she struggled during her entire adolescence with untreated bipolar disorder.If it were available, she said, “I am confident the outpatient commitment would have been the solution that my family would have sought.”She spent six months as a young adult on a medication treatment plan that left her completely unresponsive, she said. Fissel said she couldn’t take it anymore and overdosed on the prescribed medication.“Is that what you are trying to seek?” she asked legislators.The mental health system would benefit more from recovery-oriented care, such as peer support, she said. Peer support might come from someone else living in the community with a mental illness.The psychiatrist-in-chief for The Institute of Living in Hartford, Harold Schwartz, said he highly recommends that the legislature adopt involuntary outpatient treatment.“Chronic schizophrenia and certain other chronic and severe mental illnesses are often marked by denial of illness,” he said. For many people hospitalization becomes a revolving door and people might become estranged from family and friends, become homeless or be arrested, he said.An outpatient commitment program would affect a very small percentage of patients with severe psychiatric illnesses, he said. The “take-home message” is that when done correctly outpatient commitment is a part of the solution, he said.He doubted this kind of bill would affect the people with mental illness who spoke at Tuesday's public hearing, Schwartz said.Where the public and experts agreed was in increasing access to mental health services. School-based health centers were suggested as a possible solution.This program is currently in 20 communities and 80 schools, said Jesse White-Frese, executive director of the Connecticut Association of School Based Health Centers. The centers allow mental health clinicians to screen individuals for mental health issues and provide direct support or referrals for youths dealing with issues such as peer conflict, ideas of suicide, trauma or substance abuse, White-Frese said.Nelba Marquez-Greene, the mother of 6-year-old Newtown victim Ana Marquez-Greene, also asked that access to mental health services in Connecticut be improved. Her sister, Taina Amaro, read Marquez-Greene’s testimony.“My prayer is that she (Ana) will be survived by a state and a country that will use this tragedy as an impetus for change,” Amaro read.Mental illness first needs to be de-stigmatized, then the state needs to identify the gaps in the current mental health system and, finally, new family-strengthening programs need to be created, Amaro said.Jeremy Richman, father of Newtown victim Avielle Rose Richman, 6, said he and Avielle’s mother, Jennifer Hensel, have created the Avielle Foundation to determine why the tragedy had occurred.The objectives would be to determine the mental underpinnings that lead to violent behavior, to understand the biological and environmental factors associated with violence and to ensure that everyone is considered a valuable part of their community.“We ask you as a parent, as a responsible member of many communities and as a citizen of the United States of America to help craft polices that will protect our precious loved ones from this type of violence,” Richman said.Multiple experts at the hearing also said the lack of mental health coverage by private insurance plans has to be addressed. The state’s Department of Mental Health and Addiction Services primarily serves individuals ages 18 and above who are underinsured or uninsured, Commissioner Patricia Rehmer said. Medicaid has co-pays only for medication, and puts no limitations on outpatient visits or case management services through public mental health services, she said.“The bigger gaps are for individuals with private insurance,” Rehmer said. For example, in the private sector a person who needs “acute inpatient treatment” is limited to five to seven days in a hospital, she said. There are also people who have insurance but choose to pay out-of-pocket to keep their loved ones’ diagnoses from going on a medical record and, consequently, get even less financial support for treatment, Rehmer said.If the stigma surrounding mental illness isn’t addressed, “we will have a very hard time increasing their access to services or at least to utilize whatever means they have to pay for these services,” she said. The legislature's bipartisan task force will reconvene at 6 p.m. today at Newtown High School.j.somers@theday.com School security an arms race?

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Model to Help Patients See How to Sound Out Words Jun. 10, 2010 Traditionally, speech-language pathologists have relied on a patient’s sense of hearing to improve speech sounds. A team of researchers from UT Dallas is hoping to change that by creating a new high-tech tool that will allow patients to use their sense of sight to visualize the movements of the mouth during speech.The Visual Speech Project is made up of researchers from the School of Behavioral and Brain Sciences, Erik Jonsson School of Engineering and Computer Science, and School of Arts and Humanities.The team is working to create a realistic computer animation of a patient’s tongue and lip movements during speech production. The animation will allow patients to compare their own movements to those of an animated model, which in turn will help the patients see the changes they must make in order to produce a sound correctly.“Speech movements of the tongue are hidden by the cheeks and lips and therefore difficult for a patient to truly visualize.”Dr. Jennell Vick“Speech movements of the tongue are hidden by the cheeks and lips and therefore difficult for a patient to truly visualize,” said Dr. Jennell Vick, post-doctoral fellow at the Callier Center for Communication Disorders. “Although our current technology shows these movements using dots in a three-dimensional grid, it’s not a very natural picture of what is actually happening in the mouth. The animation will allow both the patient and clinician to exploit the sense of sight.”Dr. Thomas Campbell, professor and executive director of the Callier Center, and Dr. Rob Rennaker, associate professor in neural engineering, identified the problem as one that researchers from UT Dallas could solve as an integrated team across various schools.Researchers at the Callier Center and in the Department of Computer Science are collecting base-line data on adult talkers with and without cerebral palsy. The researchers are able to measure both disordered and typical speech movements by placing small sensors on the participants’ tongues. The sensors’ movements are tracked in real time.The data is then transferred to colleagues who translate and process the data into a format that can be used by the animators.“We still have a lot of testing to do, especially when it comes to collecting the data and transforming it into animation in real time,” said Vick. “We also need to identify and test the different tongue and lip movements that are common with a variety of disorders.”An expected benefit of using animation over the current technology is being able to exaggerate the speech movements in order to make the differences more obvious to the patient. As a result, the patient will be able to pinpoint the exact placement of the tongue and lips in order to make the correct sounds.“This technology has the potential of improving the quality of life for a wide range of patients, including stroke victims, children with speech disorders and individuals learning a second language,” said Rennaker. “In recognition of the potential clinical impact, and as a model for collaboration across schools and centers at UT Dallas, Dr. Bruce Gnade, vice president for research, has provided the resources to make this project viable and competitive at the national level.” In addition to Campbell, Rennaker and Vick, the Visual Speech Project team includes Dr. Balakrishnan Prabhakaran, professor in ECS; Eric Farrar, assistant professor in ATEC; and Dr. Bill Katz, professor at the Callier Center. Media Contact: Debra Brown, UT Dallas, (214) 905-3049, debra@utdallas.eduor the Office of Media Relations, UT Dallas, (972) 883-2155, newscenter@utdallas.edu

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VA » Health Care » Geriatrics and Extended Care Elder Vet and Son Use Helpful Shared Decision Making Aids Geriatrics and Extended Care Geriatrics and Extended Care Home Guide to Long Term Services and Supports Home and Community Based Services Residential Settings Veteran Shared Decision Making Worksheet Caregiver Self-Assessment Worksheet Locate Services and Resources Geriatric Care and Research Geriatric Research Education and Clinical Centers (GRECCs) Geriatric Patient Aligned Care Team (Geri-PACT) Delirium - For Healthcare Professionals Delirium - For Veterans, Families, and Caregivers Expand Content (accessible version) Profile: Mr. Peterson Step 1: Consider Needs Step 2: Explore Options Step 3: Involve Others Step 4: Take Action Return to: Personal Stories These stories are fictional, but are based on real Veterans' experiences. Mr. Peterson is a 67 year old Vietnam Veteran who served in the Army and recently had a stroke. He has some leg weakness and is currently in a rehabilitation facility. It was his first stroke, so he was put on blood thinning medicine. Although he will be discharged soon, it is not clear to what extent his leg will regain its strength. He is eager to return home where he lives alone. He is concerned he won't be able to manage everything by himself. Mr. Peterson's support system: He rarely sees his neighbors socially. He is used to being independent and has not relied on help from others before. His son lives 2 hours away and usually visits 3 times a month. His son is concerned about his father's ability to live alone. VA helped Mr. Peterson get the support he needed to be as independent as possible. His social worker suggested he look at the online Guide to Long Term care and gave him a copy of the Shared Decision Making Worksheet and suggested that he and his son complete it as a first step to making decisions about long term care. Step 1: What were his needs? Mr. Peterson and his son took a quick look at the Guide to Long Term Care on the son's laptop computer, and they saw the section on Shared Decision Making. They decided to complete the Shared Decision Making Worksheet together. It helped them take stock of their situation. The first section of the Worksheet asked about Mr. Peterson's needs. Mr. Peterson and his son didn't know a lot about long term care services he could receive at home. Together they looked more carefully at the Guide to Long Term Care to learn more about different types of services. In Step 2 Mr. Peterson checked all the long term care services and settings he was willing to consider. Then he wrote a list of things about his health and living situation that are important to him when he thinks about his future. His son reminded him to add notes about a couple of things he'd forgotten. Mr. Peterson knew about some time limitations due to his son’s job, so he asked him to fill out the Caregiver Self-Assessment in the Shared Decision Making section of the Guide to Long Term Care. He wanted to be sure that his son thought about how he could and could not help. He doesn’t want his son to feel guilty. Instead, he wants him to be realistic. And, he wants to retain the solid father-son relationship that they have enjoyed for years. Mr. Peterson also wanted to hear his doctor’s opinion about his desire to return home with some help. After meeting with the doctor he felt more confident that everything in his recovery was pointing toward a “green light” for thinking about options that would work in his home. Mr. Peterson knew that his physical therapist thought he should not be walking up and down steps until he gained more strength in his legs. He decided to talk with his physical therapist to learn more about her concerns about his leg weakness. After Mr. Peterson involved others he completed Step 3 on the Worksheet. Mr. Peterson's preferred options are having a Homemaker/Home Health Aide help him get in and out of the tub and getting Skilled Home Health Care services to provide the physical therapy he needs. He thought that as long as he continued to gain strength in his legs, and is very careful on stairs until then, everyone would agree with his choices – his son, doctor, physical therapist, and social worker. Mr. Peterson reviewed his needs, thought about what was most important to him, learned more about his options for long term care, and thought about his support system. He and his son planned what to do next in Step 4. Mr. Peterson will talk with one of his poker friends to learn more about his experience in a rehabilitation center and what support he needed when he returned home. They will look at the online Guide to Long Term Care and check out the Locate Services and Resources page, found on the left navigation menu, to locate community services. They will talk with the physical therapist again and ask if she can support his returning home now if he is very careful about steps and does his physical therapy exercises regularly. They will set up a time to meet again with the social worker and ask some remaining questions about transportation options and services VA offers. 2 weeks later: After talking with his social worker, Mr. Peterson decided that he wanted to return home with both Homemaker/Home Health Aide and Skilled Home Health Care services. He and his son agreed that returning home would be a trial arrangement. Mr. Peterson knows that he can change his decision in the months ahead if he needs to. His goal was to make the best shared decision for his current needs and preferences. Last updated September 1, 2014

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HomeThis is the archived site - Click here for the new site Every Outbreak has a Silver Lining Swift Written by Joe Albietz Every time we have an outbreak of a vaccine-preventable illness, medical journals, the skeptical blogosphere, and even one oddball astronomy site seize the opportunity to re-iterate two related points: 1) Vaccines are safe, and they are unrelated to autism. 2) When rates of vaccinations drop, diseases return. These incidents are exceedingly salient to the current public debate surrounding vaccination and more than worthy of the attention they receive. And yet, in spite of the evidence, in spite of our vigilance, people still fear vaccines and outbreaks continue. Faced with a frustrating and seemingly perpetual battle, it is easy for skeptics to become jaded and cynical, feeling as though we are either preaching to a silent choir or an unfortunately vocal brick wall. That’s why I think it is worth taking another look at the most recent measles outbreak to have gained skeptical attention because the situation may not be as bleak as it sometimes appears.1 In January of ’08, an unvaccinated 7-year-old boy on vacation with his family in Switzerland contracted measles. On return to his home in San Diego he managed to infect 11 other children before the outbreak was contained. All of the children infected with measles were unvaccinated, 9 of them intentionally so. Three infants were under a year of age and thus too young to have been vaccinated. This is an entirely typical pattern of infection for a vaccine-preventable outbreak, and while it is extremely important to point out the fact that vaccines do work, that’s not necessarily the most important point for skeptics to hear. You see, the school the index case attended had 376 children. 36 of them had a Personal Belief Exemption (PBE) on file, meaning their families had opted out of vaccination. 7 of these 36 kids contracted measles. This is in sharp contrast to the other 340 vaccinated children in the school, none of whom became infected; like I said, vaccines work. But here’s the silver lining: of the 29 unvaccinated, uninfected children,11 were vaccinated by their parents during the outbreak. These parents were not the unreachable, hopeless vaccine denialists. They were not members of the choir, nor the wall. They were parents who made a decision they felt to be in the best interest of their child. Once it became clear their decision to not vaccinate was a mistake, they changed their minds. True, in this case an undeniable, immediate threat to their child’s health and life was the motivator, but it is reasonable to hope they might find a more subtle, less lethal argument equally persuasive. A majority of these families appear to have been staunch anti-vaccinationists whose fear of vaccines was unlikely to ever be overcome, but not all of them. Families who fail to vaccinate are a far more heterogeneous group than we as skeptics often credit them for. Different families will be persuaded by different arguments, and scientific, rational, personal, anecdotal, even emotional arguments all have value. This outbreak, and others as well, show me that there is still hope. That’s why I’m preaching to the choir now and hoping it does not fall silent. Keep blogging, podcasting, and writing about vaccination. Loudly and publicly confront the campaigns of misinformation spread by anti-vaccinationist groups. Most importantly, continue to talk to the people around you, your family, friends, and co-workers. Individual skeptics can have a real impact, one measured in children’s suffering prevented and lives saved. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5708a3.htm

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Henry Gray (1825–1861). Anatomy of the Human Body. 1918. serves for the articulation of the condyle of the mandible; the posterior portion, rough and bounded behind by the tympanic part of the temporal, is sometimes occupied by a part of the parotid gland. Emerging from between the laminæ of the vaginal process of the tympanic part is the styloid process; and at the base of this process is the stylomastoid foramen, for the exit of the facial nerve, and entrance of the stylomastoid artery. Lateral to the stylomastoid foramen, between the tympanic part and the mastoid process, is the tympanomastoid fissure, for the auricular branch of the vagus. Upon the medial side of the mastoid process is the mastoid notch for the posterior belly of the Digastricus, and medial to the notch, the occipital groove for the occipital artery. At the base of the medial pterygoid plate is a large and somewhat triangular aperture, the foramen lacerum, bounded in front by the great wing of the sphenoid, behind by the apex of the petrous portion of the temporal bone, and medially by the body of the sphenoid and basilar portion of the occipital bone; it presents in front the posterior orifice of the pterygoid canal; behind, the aperture of the carotid canal. The lower part of this opening is filled up in the fresh state by a fibrocartilaginous plate, across the upper or cerebral surface of which the internal carotid artery passes. Lateral to this aperture is a groove, the sulcus tubæ auditivæ, between the petrous part of the temporal and the great wing of the sphenoid. This sulcus is directed lateralward and backward from the root of the medial pterygoid plate and lodges the cartilaginous part of the auditory tube; it is continuous behind with the canal in the temporal bone which forms the bony part of the same tube. At the bottom of this sulcus is a narrow cleft, the petrosphenoidal fissure, which is occupied, in the fresh condition, by a plate of cartilage. Behind this fissure is the under surface of the petrous portion of the temporal bone, presenting, near its apex, the quadrilateral rough surface, part of which affords attachment to the Levator veli palatini; lateral to this surface is the orifice of the carotid canal, and medial to it, the depression leading to the aquæductus cochleæ, the former transmitting the internal carotid artery and the carotid plexus of the sympathetic, the latter serving for the passage of a vein from the cochlea. Behind the carotid canal is the jugular foramen, a large aperture, formed in front by the petrous portion of the temporal, and behind by the occipital; it is generally larger on the right than on the left side, and may be subdivided into three compartments. The anterior compartment transmits the inferior petrosal sinus; the intermediate, the glossopharyngeal, vagus, and accessory nerves; the posterior, the transverse sinus and some meningeal branches from the occipital and ascending pharyngeal arteries. On the ridge of bone dividing the carotid canal from the jugular foramen is the inferior tympanic canaliculus for the transmission of the tympanic branch of the glossopharyngeal nerve; and on the wall of the jugular foramen, near the root of the styloid process, is the mastoid canaliculus for the passage of the auricular branch of the vagus nerve. Extending forward from the jugular foramen to the foramen lacerum is the petroöccipital fissure occupied, in the fresh state, by a plate of cartilage. Behind the basilar portion of the occipital bone is the foramen magnum, bounded laterally by the occipital condyles, the medial sides of which are rough for the attachment of the alar ligaments. Lateral to each condyle is the jugular process which gives attachment to the Rectus capitis lateralis muscle and the lateral atlantoöccipital ligament. The foramen magnum transmits the medulla oblongata and its membranes, the accessory nerves, the vertebral arteries, the anterior and posterior spinal arteries, and the ligaments connecting the occipital bone with the axis. The mid-points on the anterior and posterior margins of the foramen magnum are respectively termed the basion and the opisthion. In front of each condyle is the canal for the passage of the hypoglossal nerve and a meningeal artery. Behind each condyle is the condyloid fossa, perforated on one or both sides by the condyloid canal, for the transmission of a vein from the transverse sinus. Behind the foramen magnum

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Encyclopedia > Malaria Malaria (Italian bad air; formerly called ague in English) is a tropical disease which causes about half a billion infections and 2 million deaths annually, mainly in tropical countries and especially in sub-Saharan Africa. The symptoms are fever, shivering, pain in the joints, vomiting, and convulsions; especially in young children, the disease can lead to coma and death if untreated. Malaria is caused by the protozoan parasite Plasmodium (mainly P.falciparum and P.vivax, but also more rarely P.ovale and P.malariae), one of the Apicomplexa, which travels in the Anopheles mosquito and, after the mosquito bites the host, infects hepatic cells in the liver and then circulating red blood cells. Table of contents 1 Mechanism of the disease 2 Treatment and prevention 2.1 How do these drugs work? 3 Sickle cell anemia and other genetic effects 4 External links Mechanism of the disease Infected female Anopheles mosquitos carry Plasmodium sporozoites[?] in their salivary glands. If they bite a person, which they usually do starting at dusk and during the night, the sporozoites enter the person's liver cells, multiply and turn into merozoites[?] which then enter red blood cells. Here they feed on hemoglobin and multiply further and periodically break out of the cells, causing chills and fever and infecting new red blood cells. Within liver and blood cells, the parasite is relatively protected from attack by the body's immune system. However, circulating infected blood cells are killed in the spleen. To avoid this fate, the parasite produces certain proteins and induces infected blood cells to express them at their cell surface, causing the blood cells to stick to the walls of blood vessels. These surface proteins are highly variable and cannot serve as a reliable target for the immune system. Some merozoites turn into male and female gametocytes[?]. If a mosquito bites the infected person and picks up gametocytes with the blood, fertilization occurs in the mosquito's gut, new sporozoites develop and travel to the mosquito's salivary gland, completing the cycle. Pregnant women are especially attractive to the mosquitos, and malaria in pregnant women is an important cause of still births and infant mortality. Treatment and prevention If diagnosed early, malaria can be treated, but prevention is always much better, and substances that inhibit the parasite are widely used by visitors to the tropics. Since the 17th century quinine has been the prophylactic of choice for malaria. The development of quinacrine[?], chloroquine[?], and primaquine[?] in the 20th century reduced the reliance on quinine. Certain strains of Plasmodium have recently developed resistance to some of those drugs, thus complicating the treatment. In west Africa, where the local strains of malaria are particularly virulent, Larium[?] is now the recommended prophylactic, despite causing psychological problems in some vulnerable people. It seems inevitable that resistance to this will also occur. In addition to the antimalarial drugs, the use of mosquito repellants such as DEET[?], and mosquito nets and screens can reduce the chance of malaria, as well as the discomfort of insect bites. Extracts from the plant Artemesia[?], containg substances unrelated to the quinine derivatives, offer some future promise. How do these drugs work? Vaccines for malaria are under development, but no effective vaccine existed as of 2001. In 2002, the complete genome of the most deadly variant, Plasmodium falciparum, was sequenced. It consists of 25 million base pairs on 14 chromosomes, forming about 5,600 genes. It is hoped that the sequence can provide targets for new drugs or vaccines. The known anti-malaria medications can be taken preventively, which is recommended for travellers to affected regions. Efforts to eradicate malaria by attacking mosquitos have been successful in some areas. Malaria was once common in the United States and southern Europe, but the draining of wetland breeding grounds and better sanitation eliminated it from affluent regions. Malaria was eliminated from the northern parts of the USA in the early twentieth century, and the use of the pesticide DDT during the 1950s eliminated it from the south. Since most of the deaths today occur in poor rural areas of Africa without health care, the distribution to children of mosquito nets impregnated with insect repellants has been suggested as the most cost-effective prevention method. Sickle cell anemia and other genetic effects Carriers of the sickle cell anemia gene are protected against malaria because of their particular hemoglobin mutation; this explains why sickle cell anemia is particularly common among people of African origin. There is a theory that another hemoglobin mutation, which causes the genetic disease thalassemia[?], may also give its carriers an enhanced immunity to malaria. It is thought that humans have been afflicted by malaria for about 8,000 years, and several human genes responsible for blood cell proteins and the immune system have been shaped by the struggle against the parasite. External links Nature Science Update Malaria special: http://www.nature.com/nsu/malaria/index Pine Bluff, Arkansas ... mi²) of it is water. The total area is 2.65% water. Demographics As of the census of 2000, there are 55,085 people, 19,956 households, and 13,350 families residing ...

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MRC Greenwood speaks out about future plans, legacy By khontammymori Graduates of the University of Hawaii Medical School took part in special ceremony at the Kennedy Theater on Sunday. Hawaii’s newest MDs, 55 of them, were introduced as doctors after completing their four-year program. Each of them has a story to tell of their journey to make it to this day. But perhaps one of the most touching is a young man who was born in a refugee camp in Vietnam who has worked to create a bright future. “It speaks volumes to the support I got from my family friends and everyone. Coming here life wasn’t the best for us to begin with, but they kept supporting me financially as well as emotionally. This speaks to them more than it speaks to my accomplishments today,” said Chuong Tran, UH School of Medicine graduate. One of the speakers who stepped up to the podium to congratulate this MD class of 2013 was President of the University of Hawaii MRC Greenwood. This was her first TV appearance since she announced her retirement last week. As she addressed the MD class of 2013 she told them they hold a very special place in her heart because she began her service at the University four years ago as this class entered, and says in many ways they are graduating together. Graduations represent the completion of a journey and the beginning of a new one. A symbolic moment for MRC Greenwood as she wraps up her term as UH’s president and makes plan for her next chapter as a faculty member for UH’s John A. Burns School of Medicine. “We started together this is their commencement into their new career, and it is poignant to me for some of the same reasons,” Greenwood said. Greenwood will be retiring this September as the 14th president and first female CEO of the university. With two years left on her $475,000 annual contract, she reiterated her statement last week that she wants to focus more on her health and her family. “I think there’s always a time in one’s life, when one has to take stock and say I’ve been doing. It’s now time for family, time for reflection, time to write and teach,” she said. And although the University has been plagued with criticism over the Stevie Wonder concert fiasco and come under fire from the Senate’s Committee on Accountability, she hopes she will be remembered by her many accomplishments. “We finished the cancer center. We opened a new campus. We have graduation rates higher than they’ve ever been before,” she highlighted. She says she won’t stop there. “I am a tenured member of the medical school faculty, so as long as I am capable and able, I will probably be serving the University in that capacity,” said Greenwood. After taking a year off, she plans on going back to her roots as a researcher and professor with terms and a paycheck amount that she would not disclose. But a move that the Dean of JABSOM says they will greatly benefit from. “As you know her content area is diabetes and obesity a significant issue here in Hawaii and needs to be addressed throughout the Pacific,” said Dr. Jerris Hedges, JABSOM Dean. But for now she’s looking forward to spending the rest of this Mother’s Day with her family and the people who she says have always been her number one supporters. “My family is ecstatic, they’ve been waiting for me to do this for a while and they’re very happy I’ll have more time for them and I’m going to be able to travel and visit with the grandchildren,” said Greenwood. The UH Board of Regents is scheduled to meet on Thursday. The first thing on the agenda for the executive session, which is closed to the public, is to discuss the vacancy for president. Police week celebrations begin Hawaii hotels bring in record revenues

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Economy Not Key In Residents' Love For ... Economy Not Key In Residents' Love For Grand Forks Gallup and Knight Foundation Study Explores the Ties that Bind People to Place ; Attachment to the Grand Forks Area Increases Significantly GRAND FORKS, N.D. (Sept. 29, 2009) – A Gallup study of Grand Forks and 25 other U.S. communities has found that the worst economic crisis in decades is not a key factor in residents' passion and loyalty for their community. “While the pain from the recession is deep, other factors far outweigh economics when it comes to determining how emotionally attached people are to their communities,” said Warren Wright, managing partner for Gallup, which conducted the study with funding from the John S. and James L. Knight Foundation. In 2009, the second of a three-year study, emotional attachment to Grand Forks increased significantly – and now area residents have the second highest community attachment of the 26 communities studied. The study pinpointed three main factors that bind residents to Grand Forks: social offerings (fun places to gather), openness (how welcoming a place is) and aesthetics (an area’s physical beauty and green spaces). Both aesthetics and openness (particularly to families with young children) were rated significantly higher this year. Also, with certain demographic groups – particularly among younger and single residents – there were significant increases in attachment. “Grand Forks leaders have made a concerted effort to include young adults in their planning, and to build on the region’s assets including creating a beautiful greenway along the Red River and a vibrant arts community and downtown,” said Anne Corriston, program director for Grand Forks. “I believe that acco

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Discovery may help fight late-stage ovarian cancer A potential breakthrough in treating late-stage ovarian cancer has come from University of Guelph researchers who have discovered a peptide that shrinks advanced tumours and improves survival rates for this deadly but often undetected disease. "We're extremely excited about this," said Jim Petrik, a professor in U of G's Department of Biomedical Sciences who conducted the research with PhD student Nicole Campbell. "It has the potential, particularly in ovarian cancer, to have a significant impact." Their findings will appear in Molecular Cancer Therapeutics, published by the American Association for Cancer Research. Ovarian cancer is the most lethal gynecological cancer. Its symptoms, which include nausea, bloating and abdominal pain, are vague and can be attributed to a number of ailments. Often the disease remains undetected until it's well advanced, when the odds of survival are poor. "It's called the silent killer because it really does sneak up on you," Petrik said. He and Campbell discovered that ABT-898, a peptide derived from the thrombospondin molecule, shrinks established late-stage tumours in mouse models of ovarian cancer. In addition to regressing tumours, ABT-898 essentially prunes dysfunctional blood vessels in the tumour while leaving healthy vessels intact. Petrik explains that chemotherapy treatment relies on blood vessels to transport tumour-fighting drugs. But abnormal blood vessels inside tumours make drug delivery inefficient. "This new treatment enhances the ability to deliver chemotherapy drugs inside of the tumour where they need to go. So in combination with chemotherapy, it has fantastic potential." Besides shrinking tumours, ABT-898 improves survival rates because cancer cells do not have time to adapt to the treatment. "This is crucial. Women tend to succumb to ovarian cancer because the inefficient delivery of chemotherapy drugs allows the cells to build up resistance and they no longer respond to treatment," Petrik said. More efficient drug delivery also means doctors can administer lower amounts, alleviating many of the side effects of chemotherapy. As well, said Petrik, "this is a naturally occurring protein that we are exploiting; we are not making anything synthetic." He hopes the research will lead to human trials and, ultimately, to the development of targeted cancer therapies. Petrik has studied ovarian cancer for more than a decade, especially regulation of growth factors and formation of blood vessels in the ovary. A U of G faculty member since 2001, he teaches physiology and anatomy at the Ontario Veterinary College. This latest discovery was possible because Petrik's laboratory had developed a model in which cancer cells are injected directly into healthy mouse ovaries. Ovarian cancer spontaneously occurs in about two months, allowing U of G researchers to follow tumour progression. Most researchers rely on artificially cultured clumps of cells and immunocompromised mice that poorly mimic disease progression in normal animals. "It provides us with a tool to ask questions like this and look at interventions such as this in a way that is far more relevant to the human disease," Petrik said. Provided by University of Guelph New strategy to attack tumor-feeding blood vessels Scientists at the Walter and Eliza Hall Institute have discovered a key molecule needed to kill the blood vessels that supply tumours. Scientists discover a way to kill off tumors in cancer treatment breakthrough Scientists from the School of Pharmacy at Queen's University Belfast and Almac Discovery Ltd have developed a new treatment for cancer which rather than attacking tumours directly, prevents the growth of new blood vessels ... More blood vessels in hormone-resistant prostate tumors Patients with advanced prostate cancer are often treated with hormones, but when the tumours start growing again they have more and different blood vessels, reveals a thesis from the Sahlgrenska Academy, at the University ... Researchers uncovering how ovarian cancer resists chemotherapy York University researchers have zeroed in on a genetic process that may allow ovarian cancer to resist chemotherapy. Experimental drug inhibits cell signaling pathway and slows ovarian cancer growth An experimental drug that blocks two points of a crucial cancer cell signaling pathway inhibits the growth of ovarian cancer cells and significantly increases survival in an ovarian cancer mouse model, a study at UCLA's Jonsson ...

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J&J expects 10-plus new drug applications by 2017 by Linda A. Johnson (AP)—Johnson & Johnson is developing what could eventually be game-changing treatments for depression and pain, and it's aiming to apply for approval of more than 10 new medicines by 2017, executives said Thursday during a review of the health care giant's medicine business. The depression drug, a chemical cousin of the powerful anesthetic ketamine, appears to bring relief from crippling depression in just a day—rather than the four to eight weeks needed for existing pills, which don't work for many patients. The pain treatment, while in earlier stages of testing, is not addictive and could replace widely used—and abused—opioid painkillers such as Oxycontin that cause harsh side effects and many fatal overdoses. J&J, which makes everything from baby shampoo and Tylenol to biologic drugs and medical devices, has seen its revenue rebound after a rare decline in 2009, thanks to a surge of 11 new medicines launched since then. Unlike most drugmakers, J&J is well past its worst stretch of its big prescription drugs losing patent protection and seeing their sales slashed by cheaper generic competition. And now the company says it plans by 2017 to apply for approval of 11 new medicines in the U.S. and Europe, plus a polio vaccine for other parts of the world and 25 variations of existing drugs. "Our focus is now on enhancing our pipeline to deliver the next wave of growth," Joaquin Duato, one of two chairman of J&J's worldwide prescription drug business, told analysts and journalists at the daylong meeting. Like its rivals, the company says it is focusing on conditions that lack adequate treatments, as well as expanding sales in emerging markets such as China and India. J&J's 11 experimental drugs, now in mid- or late-stage patient testing, include a potential hepatitis C treatment being reviewed by regulators, a version of its Invega Sustenna schizophrenia shot designed to last three months, drugs for three types of cancer and new vaccines for flu and rabies. Another of the 11 drugs is esketamine, which is chemically related to ketamine, an anesthetic sometimes abused at raves for the high and hallucinations it can produce. J&J this year started mid-stage patient testing of an inhaled, low-dose version of esketamine for patients not helped by other antidepressants. Assuming it's approved, J&J is planning to have it administered in doctor's offices and clinics, but not distributed through pharmacies—to limit the potential for abuse, said Dr. Husseini Manji, head of neuroscience research. He said J&J is also testing variations including a pill version and using esketamine to treat bipolar disorder, adding that doctors and government mental health experts have high hopes for what could be "the biggest breakthrough in psychiatry in 40 years." That's needed because depression is one of the top causes of disability worldwide and leads to more than 38,000 suicides a year— just in the U.S. Current treatments only resolve depression in about a third of patients. The promising pain drug, fulranumab, is currently being tested in patients with osteoarthritis, the joint pains common in older folks from years of wear and tear, and in patients with pain from nerve damage caused by diabetes. It also could be tested for back or other pain types. Manji said it could be a big advance over today's options. Those are mainly anti-inflammatory pain relievers such as naproxen that aren't always effective and addictive narcotic painkillers that are responsible for pill mills, crime rings and thousands of overdoses. If approved, it could usher in a "post-opioid era," Manji said. J&J said it's continuing research on multiple ways to attack Alzheimer's disease, and downplayed the failure last year of one drug it's been developing with Pfizer Inc. Johnson & Johnson also is researching new treatments for heart disease, immune disorders and diabetes. Executives noted the company's drug business is growing fastest among the top 10 drugmakers in the key markets of the U.S., Europe and Japan. The 11 new products it's launched since 2009 brought in 17 percent of total pharmaceutical sales last year, up from 9 percent in 2011. Those products include Zytiga for prostate cancer, anti-clotting drug Xarelto, Incivo for hepatitis C and J&J's first diabetes treatment, Invokana. J&J Q1 profit falls 10 pct despite higher sales Johnson & Johnson's first-quarter profit fell by just over 10 percent as increased sales were offset by higher costs for production, marketing and administration. US OKs first-of-its-kind diabetes drug (Update) The U.S. Food and Drug Administration on Friday approved a first-of-its-kind diabetes drug from Johnson & Johnson that uses a new method to lower blood sugar—flushing it out in patients' urine. Fearing abuse, US blocks generic OxyContin (Update) U.S. health regulators will require generic versions of the best-selling painkiller OxyContin to include recent formulation changes designed to make the pill harder to abuse. FDA links once-promising pain drugs to bone decay Some of the world's largest drugmakers will face an uphill battle next week in their bid to revive a class of experimental arthritis drugs that have been sidelined by safety concerns for nearly two years. US panel backs novel diabetes pill from J&J (Update) A panel of U.S. health experts ruled Thursday that an experimental diabetes drug from Johnson & Johnson is safe and effective, though lingering safety questions must be tracked over the long term.

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Researchers develop new dichloroacetate formulation for cancer treatment by Jessica Luton Shanta Dhar, right, and Sean Marrache Health forums were abuzz in 2007 with news that a simple, inexpensive chemical may serve as a viable treatment to many forms of cancer. The drug dichloroacetate, or DCA, was touted as a cure-all, but after years of work, scientists are still searching for ways to make the unique treatment as effective as possible. Now, researchers at the University of Georgia have discovered a new way to deliver this drug that may one day make it a viable treatment for numerous forms of cancer. They published their findings in the American Chemical Society's journal ACS Chemical Biology. "DCA shows great promise as a potential cancer treatment, but the drug doesn't find and attack cancer cells very efficiently in the doses researchers are testing," said Shanta Dhar, an assistant professor of chemistry in the UGA Franklin College of Arts and Sciences. "We have developed a new compound based on DCA that is three orders of magnitude more potent than standard treatments." Every cell in the body needs energy to divide and grow, and most of them do this by breaking down sugar. When cells misbehave, they are normally deprived of their food and die in a process called apoptosis. Cancerous cells, however, find a way around the natural order by discovering other sources of energy. Dhar's technology, which she calls Mito-DCA, destroys the cancer by focusing on a part of the cell called mitochondria, commonly known as the powerhouse of cells because they generate most of the cell's chemical energy. "By targeting the mitochondria, we can force cancerous cells to die just as regular malfunctioning cells would," said Dhar, who is part of the UGA Cancer Center. "But the drug we have developed affects only cancerous cells, leaving normal cells undisturbed." In their experiments, Dhar and her research team exposed cancer cells to Mito-DCA. The results showed that the engineered chemical substance was able to switch the glycolysis-based metabolism of cancer cells to glucose oxidation, meaning that the cancer cells can once again die via apoptosis. Mito-DCA also suppressed the production of lactic acid in cancerous cells, which allows them to avoid detection by the body's immune system. With this cloaking device damaged, the body's own T-cells are better able to recognize tumors and eliminate them. While the UGA researchers' model focused specifically on prostate cancer, Dhar is hopeful that their technique may prove useful for other forms of cancer. "This is only the beginning of this project," she said. "We will continue to test Mito-DCA and find new avenues for treatment." Explore further: New aspirin-based prodrug may prevent damage caused by chemotherapy More information: The full paper is available online: pubs.acs.org/doi/ipdf/10.1021/cb400944y Journal reference: ACS Chemical Biology Provided by University of Georgia Researchers use nanoparticles to fight cancer Researchers at the University of Georgia are developing a new treatment technique that uses nanoparticles to reprogram immune cells so they are able to recognize and attack cancer. The findings were published ... New platinum compound shows promise in tumor cells (PhysOrg.com) -- MIT chemists have developed a new platinum compound that is as powerful as the commonly used anticancer drug cisplatin but better able to destroy tumor cells. New aspirin-based prodrug may prevent damage caused by chemotherapy (Medical Xpress)—Researchers at the University of Georgia have developed a new prodrug that promises to reduce many of the negative side effects caused by cisplatin, a commonly prescribed chemotherapy treatment. Small molecule offers big hope against cancer DCA is an odourless, colourless, inexpensive, relatively non-toxic, small molecule. And researchers at the University of Alberta believe it may soon be used as an effective treatment for many forms of cancer. How tumors become resistant to drugs, and how process can be reversed to inhibit cancer growth Researchers at the Hebrew University of Jerusalem's Faculty of Medicine have discovered a process whereby tumor cells become resistant to specific drugs, a finding that could significantly influence how anti-cancer ...

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Montreal aims to follow Vancouver’s... By Matt Kieltyka Updated : December 12, 2013 | 6:41 pm Montreal aims to follow Vancouver’s injection site lead The Canadian Press/Darryl Dyck Registered nurse Sammy Mullally holds a tray of supplies to be used by an addict at the Insite safe injection clinic in Vancouver. Vancouver may not be the only jurisdiction in North America to have supervised drug injection sites for long. Montreal Public Health announced Thursday that it intends to apply for Health Canada exemptions to operate four supervised injection sites. The plan, expected to cost $2.7 million a year, includes three permanent sites and one mobile centre that will allow at-risk drug users to inject drugs with clean equipment and under the supervision of nurses. Richard Massé, director of Montreal Public Health, said the city has an estimated 4,000 drug users, a quarter of which are homeless and 18 per cent that are HIV positive. “It’s a fairly significant population,” said Massé. “With these centres, we very well might be able to serve 300 to 600 people a day.” Vancouver is currently the only city in North America with supervised injection sites. It has two, one at the Dr. Peter Centre in the West End treating patients with HIV/AIDS and Insite in the Downtown Eastside (which opened 10 years ago). Massé said his team has visited and consulted with both sites. Insite architect Sean McEwen has even redesigned plans for one of the proposed Montreal sites. “We have been in touch with Insite and the Dr. Peter Centre a number of times and they have provided us with the protocols they have been using,” said Massé. “The evaluations on Insite have been invaluable to us. It’s been significant because we can show the benefits it has to our communities.” But officials in Montreal know they still face an uphill battle in the form of the federal government. The Conservative government in June introduced the Respect for Communities Act (Bill C-2), aimed at toughening the application process for operators looking for Health Canada approval for supervised drug consumption sites. “Our government believes that creating a location for sanctioned use of drugs obtained from illicit sources has the potential for great harm in a community,” said Leona Aglukkaq, the health minister at the time. Massé intends to submit Montreal Public Health’s plans to Health Canada for approval before the legislation is passed, and hopes the Supreme Court of Canada’s ruling against the government in its ill-fated bid to shut down Insite will offer some protection. Mark Townsend, executive director of Insite co-operator Portland Hotel Society, says he’s excited Montreal has put its cards on the table. “We’re desperate to have someone else do it,” said Townsend. “I wanted this to happen a decade ago. It takes the pressure of us and normalizes [injection sites] if we’re not the only ones.” Insite, run in partnership with the Portland Hotel Society and Vancouver Coastal Health, has more than 1.8 million visits since it opened in 2003 and has the public support of the city, police department and provincial government. There hasn’t been a single overdose death at the site in that time, and studies credit the injection site with cutting the spread of transmittable diseases like Hepatitis C and HIV/AIDS. Yet until Thursday, no other city has formally announced it plans to open supervised injection sites of its own. Massé thinks now that Montreal has, other interested cities such as Toronto, Ottawa and Edmonton won’t be far behind. “We have a network of cities looking at it and I think they’ll be ready very soon to apply with Health Canada,” he said. Montreal hopes its application will be approved by the provincial Ministry of Health (which has been supportive of supervised injection sites) within a couple of weeks, clearing the way for Montreal Public Health to file for federal approval. If approved quickly and funding is secured, Massé said the first two injection sites could be operational by spring. -with files from The Canadian Press More from Vancouver :

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Suicide Still Major Concern For Teens Even after Treatment, Study Finds By Sudip Bhattacharya, NAMI Communications Intern In a recent study published in JAMA Psychiatry, most adolescents who were surveyed developed thoughts of suicide after they had already received mental health treatment. The study, which was published on Jan. 9, 2013, surveyed nearly 6,483 adolescents aged 13 to 18. “Suicidal behaviors are common among U.S. adolescents, with rates that approach those of adults,” the study concluded, “Suicidal behaviors are among the leading causes of death worldwide, especially among adolescents and young adults.” In 2010, 4,867 youths between ages 10 and 24 died by suicide. It was the second leading cause of death for those in that age group. According to the study, led by Matthew K. Nock, Ph.D. of Harvard University, 12 percent of adolescents who were surveyed had thoughts of attempting suicide. In fact, one-third of those who had thoughts of suicide had developed a plan for suicide and another one-third had made an actual attempt. As the researchers expected, thoughts of suicide were very low among adolescents between age 10 and 12. Thoughts of suicide increased between the ages of 12 and 17. The study also corroborated previous research finding girls to have higher rates of nonlethal suicidal behavior than boys. However, boys use more lethal methods of suicide such as firearms and therefore are more likely to die by suicide. But again, the most glaring aspect of the study had been the results that over 55 percent of adolescents had developed thoughts of suicide after receiving mental health treatment. In fact, 80 percent of adolescents with suicidal thoughts do receive some sort of mental health treatment. This has brought to question the effectiveness of current mental health treatment for adolescents, and whether new ways of treating adolescents living with mental illness have to be devised. The report said nothing about whether the therapies given were state of the art or carefully done, and it is possible that some of the treatments prevented suicide attempts, said Nock in a recent New York Times article. Despite the fact that some attempts could have been prevented by mental health treatments, the study notes “that treatment does not always succeed in this way because the adolescents in the NCS-A [the first national survey of U.S. adolescents living with a wide range of mental illness and suicidal behaviors] who received treatment prior to their first attempt went on to make an attempt anyway.” Despite the results of the study, it remains vital for adults to be supportive and accessible for adolescents receiving mental health treatment. Studies have shown that asking about suicide, or encouraging loved ones to get help, does not increase the likelihood of suicide, but in fact can help prevent suicide. Click here to learn more about who is at risk for suicide, how suicide can be prevented and how friends and family members can help.

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| | � NAMI Applauds Nobel Prize Winners Statement by Laurie Flynn, executive director, National Alliance for the Mentally Ill For Immediate Release, October 10, 2000 Contacts: Bob Carolla (703) 516-7963 There is perhaps no better way to mark the closing days of the Decade of the Brain, proclaimed by Congress and President Bush, than with the award of the Nobel Prize in physiology and medicine to Paul Greengard of Rockefeller University, Eric Kandel of Columbia University, and Arvid Carlsson of the University of Gothenburg in Sweden. Each scientist has contributed to a revolution in our understanding of the brain and its chemical mechanisms, which has opened the door to more effective treatments for schizophrenia and depression. Their work has brought us to the threshold of the 21st century, with hope for even greater progress yet to come. Every person or family who has been touched by mental illness should join in honoring them. Their leadership has produced much of what we know today about how the brain works. Their contributions also have laid a foundation for future scientific break-through. Americans should be especially proud of the role of the National Institute of Mental Health (NIMH) in supporting the research of Paul Greengard and Eric Kandel. The honor which they will receive represents a fulfillment of the agency's mission and a call to even greater achievement.

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DHS Services A to Z Consumers & Clients - Individuals and Families Divisions & Offices Commissioner and Key Staff Disasters & Emergencies - Help & Information Press Releases, Publications and Reports Commissioner's E-updates Providers & Stakeholders: Contracts, Legal Notices, Licensing, MedComms Get Involved with DHS: Employment, DHS Police, Nurses, Public Boards/Councils DHS Home > Press Releases, Publications and Reports > Press Releases > 2012 > Christie Administration Recognizes April as National Autism Awareness Month Christie Administration Recognizes April as National Autism Awareness Month Trenton, NJ – This month, the Christie Administration is recognizing National Autism Awareness Month to highlight and increase participation in the many programs, services and support offered by the State to individuals with autism and their families. New Jersey has one of the best systems in the nation for identifying, diagnosing and caring for children with Autism Spectrum Disorders (ASD). Autism, a biologically-based disorder that affects the development and functioning of a person's verbal and non-verbal communication skills, social interactions and patterns of behavior, touches about 1 in 50 children in New Jersey, impacting many families across the Garden State. “As government leaders, we have a moral obligation to recognize the individual and unique needs of every New Jerseyan with a developmental disability,” said Governor Chris Christie. “With this year's 2013 budget, my Administration is reaffirming its commitment to help residents with autism and their families with the tools they need to lead fuller, more productive lives.” Throughout the month, members of the Administration, including First Lady Mary Pat Christie, will recognize the importance of autism awareness through visits and activities to showcase the work being done by individuals and organizations in New Jersey to serve people and families affected by autism spectrum disorder. Autism also is an advocacy area embraced by First Lady Mary Pat Christie to bring greater understanding of the developmental disability to the public at large. The Christie Administration has acted on a commitment to support individuals with autism and their families: • Making autism outreach a priority by supporting the Department of Human Service’s Office of Autism; • Protecting funding for the Department of Health’s Autism Registry to make it easier for families to be connected to the appropriate diagnostic treatment and support services in their community. As of November 2011, 8,350 children have been registered in the Autism Registry; • Continuing to support families with children with developmental delays and disabilities from birth to age three with the Department of Health’s Early Intervention Program services, including developmental intervention, speech, physical and occupational therapy. Nearly 21,500 children received early intervention services in state Fiscal Year 2011. The program receives more than $140 million in state and federal funds - 92% percent of which goes directly to support services for children and families. • Providing transition services for adults with dedicated funding for young adults with developmental disabilities who age out of the Department of Education's special education entitlement by ensuring a seamless transition to the Department of Human Services' adult day-programming. • Protecting funding that helps to create employment opportunities for New Jerseyans with disabilities through programs such as Vocational Rehabilitation Services and NJ WorkAbility. • Providing for a realignment of programs for children with disabilities or in need of behavioral health services to occur in order to enable the Department of Children and Families (DCF) to provide family-oriented support services that care for the whole child. Moreover, New Jersey is already a national leader in early intervention and education of children with autism and will soon have a center to coordinate academic and private research being done across the state on the cause of ASDs. The Governor's Council for Research and Treatment of Autism is set to establish the NJ Autism Center of Excellence this summer, consisting of a Coordinating Center and up to three program sites that will develop and conduct clinical research projects. In addition, $8 million in grants will fund the latest research projects that have the potential to improve the physical and/or behavioral health and well-being of individuals with ASDs. With increased concern in communities, continued demand for services and increasing estimates of ASD prevalence, Governor Christie and his Administration remain firmly committed to finding new and innovative ways to help New Jersey families impacted by ASD and improving the lives of their loved ones.A copy of the Governor’s proclamation is attached to the release. # # #www.nj.gov/governor/ Contact

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Meet Our Executives & Experts My Saved Articles » My ACS » Newsroom Welcome to American Cancer Society Press Room Press Releases Embargoed password protected site Rumors, Myths & Truths The Road To More Birthdays Blog Most Recent Releases Meet our Executives and Experts OTIS W. BRAWLEY, M.D. Otis W. Brawley, M.D., F.A.C.P., chief medical officer for the American Cancer Society, is responsible for promoting the goals of cancer prevention, early detection, and quality treatment through cancer research and education. He champions efforts to decrease smoking, improve diet, detect cancer at the earliest stage, and provide the critical support cancer patients need. He also guides efforts to enhance and focus the research program, upgrade the Society’s advocacy capacity, and concentrate community cancer control efforts in areas where they will be most effective. Further, as an acknowledged global leader in the field of health disparities research, Dr. Brawley is a key leader in the Society’s work to eliminate disparities in access to quality cancer care. Dr. Brawley currently serves as professor of hematology, oncology, medicine and epidemiology at Emory University. From April of 2001 to November of 2007, he was medical director of the Georgia Cancer Center for Excellence at Grady Memorial Hospital in Atlanta, and deputy director for cancer control at Winship Cancer Institute at Emory University. He has also previously served as a member of the Society’s Prostate Cancer Committee, co-chaired the U.S. Surgeon General’s Task Force on Cancer Health Disparities, and filled a variety of capacities at the National Cancer Institute (NCI), most recently serving as assistant director. Dr. Brawley is a member of the Centers for Disease Control and Prevention Advisory Committee on Breast Cancer in Young Women. He was formerly a member of the Centers for Disease Control and Prevention Breast and Cervical Cancer Early Detection and Control Advisory Committee. He served as a member of the Food and Drug Administration Oncologic Drug Advisory Committee and chaired the National Institute of Health Consensus Panel on the Treatment of Sickle Cell Disease. He is listed by Castle Connelly as one of America’s top doctors for cancer. Among numerous other awards, he was a Georgia Cancer Coalition Scholar and received the Key to St. Bernard Parish for his work in the U.S. Public Health Service in the aftermath of Hurricane Katrina. Dr. Brawley is a graduate of University of Chicago, Pritzker School of Medicine. He completed his internship at University Hospitals of Cleveland, Case-Western Reserve University, his residency at University Hospital of Cleveland, and his fellowship at the National Cancer Institute. Preventing Drug Shortages TEDMED2012 Otis Brawley at Health Journalism 2012 MEDIA COVERAGE The Cancer Breakthroughs That Cost Too Much & Do Too Little (Newsweek, August 2012) Armstrong's Cancer Foundation Still Strong (Cable News Network, August 2012) Asprin May Aid Cancer Recovery (New York Times, August 2012) Wheary: Keep the focus on women and cancer (Newsday, February 2012) The Chief Complaint: Dr. Otis Brawley (Atlanta Magazine Feature, February 2012) How We Do Harm A Doctor Breaks Ranks About Being Sick in America (Macmillan Books, January 2012) How doctors do harm (Cable News Network, January 2012) Journal of the National Cancer Institute SOCIAL MEDIA To schedule an interview, please contact the American Cancer Society Media Relations Team

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Pet Columns, Office of Public Engagement, College of Veterinary Medicine at the University of Illinois at Urbana-Champaign Home | Contact Us | Directory | Intranet Search CVM: University of Illinois at Urbana-Champaign College Pet Memorials Multimedia Faculty Biosketches Facilities Design Group Home > Office of Public Engagement >Pet Columns Back to search page.Pug Eyes: Clearing Up the Haze Pet Column for the week of August 5, 2013Related information: Services - OphthalmologyOffice of Public Engagement2001 S. Lincoln Ave.Urbana, Illinois 61802Phone: 217/333-2907Kody CarrInformation SpecialistSource - Dr. Amber LabelleWith their playful spirit, passion to please, and zest for life, pugs are one of the most loved and celebrated breeds. Originating around 400 B.C., pugs have wagged their way into homes from Buddhist monasteries in ancient China and royal castles of medieval England to the houses of many modern day families.Though the breed itself is extremely resilient, the same cannot be said for pugs' eyesight. Dr. Amber Labelle, a veterinary ophthalmologist at the University of Illinois Veterinary Teaching Hospital in Urbana, is working to better understand one of the most prevalent eye diseases of the pug breed, pigmentary keratopathy. Pigmentary keratopathy (PK) is a condition in which brown pigment progressively clouds the cornea, the clear tissue that allows light to enter the eye. PK often results in partial or complete blindness. The cause of PK is not fully understood, but there is a strong correlation between genetic makeup, trauma to the eye (such as chronic irritation, corneal ulcers, or scarring), and the development of PK. No treatments are available to remove completely pigment that becomes established in the cornea as a result of PK. However, through early detection and prompt intervention, the effects of PK can be minimized.A yearly examination by a veterinarian or veterinary ophthalmologist is advisable in order to detect PK in its early stages. Once PK has been diagnosed, its progression can be greatly reduced through the application of eye medications known to suppress pigmentation of the eye."Pigmentary keratopathy is a disease that affects approximately 80 percent of pugs," says Dr. Labelle, who recently concluded a study on the prevalence of PK in pugs. "This number holds true regardless of whether your pug is a show dog or an everyday house pet."Seeking to improve the lives of future generations of pets, the pug-lover community has been supportive of Dr. Labelle's work, allowing their animals to be evaluated for her studies. At one "Pug Fest" event held in Milwaukee, Dr. Labelle and her assistants examined 77 pugs in two days."What has been really amazing about working with the pug breed has been the willingness and support of the owners," says Dr. Labelle. "They understand that this isn’t a problem that they have created, but that it is a concern for everyone who loves pugs."Despite this support, there are obstacles to continuing the PK studies and research into companion animal health in general. "One of the greatest challenges that every researcher faces is getting funding to support the work," says Dr. Labelle.For the most up-to-date information on Dr. Labelle's work on pigmentary keratopathy visit her blog, PugEyes.com. Extension Activities

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Posts Tagged ‘Employer-sponsored healthcare insurance’ Healthcare Costs Wiping Out Your Income Gains If Americans’ incomes are not growing, part of the blame can be placed on the high cost of healthcare. According to the Washington Post’s Sarah Klitt, “All evidence points to American voters not really caring about rising healthcare costs. But here’s one pretty compelling reason they should: The escalating cost of healthcare has wiped out nearly all income gains made by the average American family in the past decade.” Research in the September issue of Health Affairs notes that American physicians are paid more per service than in other countries — in some instances, double the amount. There is also a larger gap between fees paid for primary care and specialty care, when compared with other industrialized countries. These higher fees translate to higher incomes for American physicians than those earned by their foreign counterparts, and are the primary driver of higher overall spending on physicians’ services. The study — by Miriam Laugesen of the Mailman School of Public Health at Columbia University and Sherry A. Glied, also of the Mailman School and presently Assistant Secretary for Planning and Evaluation at the Department of Health and Human Services (HHS) — compared fees paid by public and private payers for primary-care office visits and hip replacement surgery in Australia, Canada, France, Germany, the United Kingdom, and the United States. The researchers determined that American primary-care physicians on average are paid 27 percent more by public payers for an office visit, and 70 percent more by private payers for an office visit, compared to the typical amount paid in other nations. The largest difference in fees paid to American physicians versus fees paid to doctors in other countries was for hip replacements. American physicians earned 70 percent more for these procedures by public payers, and 120 percent more by private payers, than the average fees paid to physicians in other countries. “The gap between the fees paid for primary care and those for orthopedic services such as hip replacements is significantly bigger in the United States than it is in other countries,” Laugesen said. “For decades, policymakers and medical leaders in this country have debated financial incentives to spur more doctors to become primary-care physicians. Our work shows that continuing attention needs to be paid to the difference in payments across specialties, and how we can get better value for those expenditures.” Additionally, American physicians reported higher salaries when compared with the other countries, despite the fact that there was minimal difference in the volume of services provided. Laugesen and Glied suggest that the differences may reflect the fact that American physicians are paid more for their skill and time than doctors in other countries. Whether or not those higher payments have merit is a question that the study did not address. American primary-care physicians earned the highest average annual incomes ($186,582) while French ($95,585) and Australian ($92,844) primary-care physicians earned the lowest. American orthopedic surgeons earned the highest average annual incomes at $442,450, followed by $324,138 for surgeons in the UK. Although UK surgeons earned 50 percent more than surgeons in the other comparison countries, they earned 30 percent less than American orthopedic surgeons. A study by the RAND Corporation determined that rapidly rising healthcare costs have eaten nearly all the income gains made by middle-income American families over the past 10 years, leaving them with just $95 per month in extra income, after accounting for taxes and price increases. Had healthcare costs risen only as fast as the cost of other goods and services from 1999 to 2009, the same family would have had an additional $545 per month to spend in 2009. “Accelerating healthcare costs are a primary reason that the so many American families feel like they are just treading water financially,” said David Auerbach, the study’s lead author and an economist at the RAND Corporation, a non-profit research organization. “Unless we reverse the trend, Americans increasingly will notice that health costs compromise their other spending options.” Between 1999 and 2009, healthcare spending in the United States nearly doubled, from $1.3 trillion to $2.5 trillion. During the same timeframe, the percentage of the nation’s GDP devoted to health care rose from 13.8 percent to 17.6 percent. Per-capita healthcare spending rose from $4,600 to just over $8,000 a year. Although the numbers are arresting, they don’t necessarily translate to the daily routine of American families because many healthcare costs are hidden, according to the researchers. Auerbach and co-author Dr. Arthur L. Kellermann, director of RAND Health, combined information from multiple sources to describe the obligation that rising healthcare costs placed on middle-income families with employer-sponsored health insurance from1999 to 2009. “The complex way that the United States pays for healthcare often obscures the consequences of healthcare cost growth for most American families,” Kellermann said. “This makes the challenge of controlling healthcare costs that much harder.” Tags: Department of Health and Human Services, Employer-sponsored healthcare insurance, GDP, Health Affairs, Income, Mailman School of Public Health at Columbia University, Medical inflation, physicians, RAND Corporation, RAND Health Posted in Healthcare, Hospital Systems | No Comments »

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Fly study uncovers molecular link between obesity and heart disease At Sanford-Burnham Medical Research Institute (Sanford-Burnham), a team led by Sean Oldham, Ph.D., and Rolf Bodmer, Ph.D., recently created a simple model to link high-fat diet, obesity and heart dysfunction. Using fruit flies, they discovered that a protein called TOR influences fat accumulation in the heart. Tuesday, November 2, 2010 - 16:15 Research with mice yields secrets of helper T cells involved in autoimmunity Scientists at the National Institutes of Health have redefined the roles of several cytokines involved in the generation of immune cells implicated in severe autoimmune diseases. The study in mice showed that development of Th17 immune cells can occur without the presence of transforming growth factor (TGF)-beta, a mediator thought to be required for Th17 cell development. Thursday, October 28, 2010 - 16:36 Research with common fruit fly providing important insight into human brain disorders Genes involved in fruit fly learning processes are similar in structure and function to those in humans and other mammals. Thursday, October 28, 2010 - 11:05 Haptoglobin as an early serum biomarker of virus-induced type 1 diabetes in rats Type 1 diabetes (T1D), formerly known as juvenile diabetes, is a multifactorial disease of complex etiology characterized by the autoimmune destruction of pancreatic beta cells. In addition to genetic susceptibility, it is generally accepted that environmental factors play important roles in triggering disease, with virus infection having perhaps the strongest association. Wednesday, October 27, 2010 - 14:12 Monkeys aid research on training brain waves to power devices Scientists are reporting progress in their efforts to channel brain waves to power mechanical devices, a development that could someday help paralyzed people regain mobility. Wednesday, October 27, 2010 - 13:59 Dogs benefit, as well as aid, in brain tumor research An operation commonly performed to remove brain tumors from the pituitary glands of humans is now available to dogs, thanks to a collaboration between a neurosurgeon and some veterinarians in Los Angeles. And that is turning out to be good for humans. Monday, October 25, 2010 - 10:43 Scorpion toxin could be key to reducing heart bypass failures A toxin found in the venom of the Central American bark scorpion (Centruroides margaritatus) could hold the key to reducing heart bypass failures, according to research from the University of Leeds. Study in mice provides first direct evidence that response to alcohol depends on genes Many studies have suggested that genetic differences make some individuals more susceptible to the addictive effects of alcohol and other drugs. Now scientists at the U.S. Department of Energy’s (DOE) Brookhaven National Laboratory provide the first experimental evidence to directly support this idea in a study in mice. New sensor derived from frogs may help fight bacteria and save wildlife Princeton engineers have developed a sensor that may revolutionize how drugs and medical devices are tested for contamination, and in the process also help ensure the survival of two species of threatened animals. To be fair, some of the credit goes to an African frog. Research in animals indicates Vitamin E may be in front line of prostate cancer fight Survival rates of the world's most common cancer might soon be increased with a new vitamin E treatment which could significantly reduce tumour regrowth. Tuesday, October 19, 2010 - 12:43 Researchers report on liver transplantation studies using animal and iPS cells Two research teams from the Okayama University Graduate School of Medicine (Okayama, Japan) have reported breakthrough studies in liver cell transplantation. One team found that the technical breakthrough in creating induced pluripotent stem cells (iPS) from mouse somatic cells (nonsex cells) in vitro had "implications for overcoming immunological rejection." Whereas a second team using liver cell xenotransplantation - transplanting cells of one species into another (in this case transplanting pig liver cells into mice) - found that transplanted liver cells from widely divergent species can function to correct acute liver failure and prolong survival. Tuesday, October 19, 2010 - 11:31 Animal research gives hope for new class of Alzheimer's disease drugs Finding a drug that can cross the blood-brain barrier is the bane of drug development for Alzheimer's disease and other neurological disorders of the brain. A new Penn study, published this week in the Journal of Neuroscience, has found and tested in an animal model of Alzheimer's disease a class of drug that is able to enter the brain, where it stabilizes degenerating neurons and improves memory and learning. Cat study reveals reasons for heightened vision in the deaf Deaf people with enhanced vision can thank otherwise idle brain cells for their heightened sense, a new study in cats suggests. That's because the brain recruits cells normally devoted to hearing to help them see better, the research revealed. Promising new drug from mouse studies aims to treat pancreatic cancer Very little is known about the causes of pancreatic cancer. However, the discovery of a protein that produces cancerous cells has led University of Minnesota researchers Ashok Saluja, Gunda Georg, and Selwyn Vickers to the drug Minnelide. Surprising similarities between human and zebrafish tumors Most human cells have 23 pairs of chromosomes, the large bundles of DNA that store all of a cell’s genetic information. However, scientists realized more than 100 years ago that tumor cells usually have extra copies of some chromosomes. This trait, known as aneuploidy, appears to give tumor cells a survival edge. Thursday, October 7, 2010 - 14:52 Antibody reverses final throes of cancer in mice For the first time, a treatment in mice has shown promise against the final, metastatic stages of terminal cancer. Unusually, the antibody targets healthy tissue, not tumour cells, suggesting normal cells play an unwitting role in terminal cancers. Better cholesterol drugs may follow scientist's findings in animal research Thanks to a discovery by a Saint Louis University researcher, scientists have identified an important microRNA that may allow us to better control cholesterol levels in blood. Tuesday, October 5, 2010 - 15:33 Mechanism involved in addictions and forms of obesity discovered in laboratory rats Laboratory animal research results help explain the mechanisms that underlie the formation of reward-cued spatial memories in both the laboratory model and human dentate gyrus. Understanding this mechanism not only explains the biology of an important form of learning, but may also lead to potential treatments for addiction and obesity. Tuesday, October 5, 2010 - 10:50 Discovery in animal research will be used to explore therapies for the hyperactive immune system in lupus Researchers at the Dana-Farber Cancer Institute in Boston have identified a new type of cell in mice that dampens the immune system and protects the animal's own cells from immune system attack. This "suppressor" cell reduces the production of harmful antibodies that can drive lupus and other autoimmune diseases in which the immune system mistakenly turns on otherwise healthy organs and tissues. Tuesday, October 5, 2010 - 10:38 Lasker Award winner's research with rodents provides therapy for macular degeneration The 2010 Lasker~DeBakey Clinical Medical Research Award honors a scientist who discovered Vascular Endothelial Growth Factor (VEGF), a key participant in blood-vessel formation, and exploited this knowledge to devise an effective treatment for wet age-related macular degeneration (AMD). Napoleone Ferrara (Genentech) has provided a therapy that can, for the first time, improve sight for people with this illness, many of whom were previously destined for blindness. Tuesday, September 21, 2010 - 11:10

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What You Can Do > Arthritis Stories > Weight Loss > Betsy Isaacs: Walking Off the Weight Related Features Betsy Isaacs: Walking Off the Weight Serious diagnoses incited her 80-pound weight-loss. Walking and a healthy diet made it happen. By Mary Jo DiLonardo For about six years, Betsy Isaacs left her home only about once a week. Weighing in at 357 pounds, the Sugar Grove, N.C., woman only went to the grocery store and when she did she had to ride in a wheelchair or an electric cart. “I had fatigue so bad. I had body pains, especially in my legs, hips and lower back. It hurt so bad when I tried to walk,” says Isaacs, 50. “The more weight I gained, the less I was able to do.” Mentally, Isaacs said she was depressed because she couldn’t work in her garden or walk to her mailbox or even bend down to put on her shoes. She finally decided to go to the doctor for all her pain and came home with a shocking triple diagnosis: diabetes, fibromyalgia and osteoarthritis in her hips and knees. “I was really upset, especially about the diabetes,” says Isaacs. “My grandparents had diabetes and I didn’t want to go through what they went through with insulin and all that.” Movement as Medicine Instead, Isaacs’ doctor started her on medication and gave her one big prescription: movement. “She said that I needed to walk a little bit – even if it was just in the house or on the porch or down the driveway.” Isaacs’ doctor told her about a wellness center about 20 miles away where there was an Arthritis Foundation Walk with Ease Program. Isaacs enrolled in the program and started walking with a group several times a week around an indoor track. “I felt I was going to be out of place because I was so big, but they accepted me for who I was and not for what I looked like,” says Isaacs. In the beginning, she could often only go one lap around the track, but at then end of the six-week program, she walked one mile – a full 18 laps. “I found out the more I walked, the better I started to feel,” she says. But walking wasn’t the only way she fought her weight and pain issues. She decided to go on a self-imposed diet, cutting fried foods, sugars, heavy starches and sodas out of her daily menu. “Once I started taking all those foods out of my diet, I felt so much better,” says Isaacs who also changed her portion sizes, switching from a 9-inch dinner plate to a 7-inch salad plate. Her husband Kenny, who has osteoarthritis in his hip and back, is on the diet and exercise bandwagon, too. In addition to eating right, he takes turns with his wife on the stationary bike he bought for her last Christmas. The two also enrolled in an Arthritis Foundation Tai Chi class. “We encourage each other. If I’m tired one day and don’t think I can make it around the track, he says, ‘C’mon, we can do it,’” she says. “Having someone else with you really helps with the motivation.” So far, Kenny has lost 45 pounds and Betsy has lost 80 pounds. Her goal is to lose about another 80 more, putting her below 200 pounds. So she keeps eating right, walks a mile three times a week, takes tai chi and an aerobic swim class for arthritis three times a week, and rides a stationary bike three times each week. She hasn’t missed a day of exercise since she started in June 2008. Even when she visited her daughter in the hospital for three months, Isaacs found a way to get in her fitness time, walking in the hospital hallways and parking lot. “There are ways you can work it out,” she says. “I have always been overweight all my life and my weight has always been up and down like a yo-yo. I thought enough is enough. You have to hit that point that you can’t do it for others. You have to do it for yourself.” Betsy Isaacs’ Diet Before: three pieces of fried chicken, mashed potatoes, two biscuits and lots of butter, and a candy bar or cupcake for dessert Now: half plate of steamed vegetables, quarter plate of baked chicken or fish, quarter plate of salad

医学

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Print this page Email to a friend Acupuncture May Help Ease Hay Fever Study found patients who had treatment for 8 weeks fared better with symptoms By Amy NortonHealthDay Reporter MONDAY, Feb. 18 (HealthDay News) -- Hay fever sufferers may find some relief with acupuncture, a new study suggests, though the therapy's appeal in the "real world" is yet to be seen. The study, of 422 people with grass and pollen allergies, found that those randomly assigned to a dozen acupuncture sessions fared better than patients who did not receive the procedure. On average, they reported greater symptom improvements and were able to use less antihistamine medication over eight weeks. The advantage, however, was gone after another eight weeks, according to findings reported in the Feb. 19 issue of the Annals of Internal Medicine. Still, that doesn't necessarily mean that acupuncture's benefits fade, said lead researcher Dr. Benno Brinkhaus, of Charite-University Medical Center in Berlin. Hay fever symptoms were much better in all three study groups by week 16, and Brinkhaus said that's probably because pollen season was dying down at that point. The study was well done and "positive," because acupuncture seemed helpful, said Dr. Harold Nelson, an allergist at National Jewish Health, a Denver hospital that specializes in respiratory diseases. But Nelson doubted whether the time, inconvenience and expense of acupuncture sessions would seem worthwhile to many hay fever sufferers -- especially because there are simpler ways to manage the condition. "I don't know how many people will want to wait in an acupuncturist's office, then sit with 16 needles in them for 20 minutes, and do that 12 times, when they could use a nasal spray," Nelson said. Specifically, Nelson pointed to prescription nasal sprays that contain anti-inflammatory corticosteroids. The sprays -- which include brand names like Flonase and Nasonex -- are taken daily to help prevent hay fever symptoms. Patients in this study were not using nasal steroids. They were taking antihistamines as needed -- which, Nelson said, is not the most effective way to manage hay fever. Still, Nelson added, there are people who want to avoid medication, and they may be interested in acupuncture as an option. Many studies have suggested that acupuncture helps ease various types of pain, such as migraines and backaches, as well as treat nausea and vomiting related to surgery or chemotherapy. According to traditional Chinese medicine, acupuncture works by stimulating certain points on the skin believed to affect the flow of energy, or "qi" (pronounced "chee"), through the body. But some recent research suggests that the needle stimulation also triggers the release of pain- and inflammation-fighting chemicals in the body. No one is sure why acupuncture would help with hay fever, but there is evidence that it curbs inflammatory immune-system substances involved in allergic reactions. For the new study, Brinkhaus and colleagues recruited 422 adults with hay fever. They randomly assigned the patients to one of three groups: one that received 12 acupuncture sessions over eight weeks; one that received a "sham" version of acupuncture; and one that received no acupuncture. In the sham version, acupuncturists used real needles, but inserted them only superficially and into areas of the skin that are not traditional acupuncture points. Patients in all three groups were allowed to take antihistamine medication when their symptoms flared up. After eight weeks, the study found, patients given real acupuncture reported more symptom improvement than those in either of the comparison groups. On average, their quality-of-life "scores" were 0.5 to 0.7 points better -- which, in real life, should translate to a noticeable difference in hay fever symptoms, according to Nelson. Brinkhaus, who is a medical doctor and acupuncturist, said he would recommend acupuncture to patients who are not satisfied with allergy medication -- either because it's not working or because of the side effects. Dr. Remy Coeytaux, who co-wrote an editorial published with the study, agreed that acupuncture is worth a shot. "Absolutely, give it a try if you are interested," said Coeytaux, an associate professor of community and family medicine at Duke University School of Medicine, who studies acupuncture. According to Coeytaux, one of the strengths of this study is that it compared acupuncture against both antihistamines alone and sham acupuncture. The fake procedure was used to help control for the "placebo effect" -- where people feel better after receiving a treatment just because they believe it will work. But Coeytaux said it's also time for studies to move beyond testing real acupuncture against sham versions. One reason is that those fake procedures may actually have physiological effects of their own -- making them poor placebos. Instead, Coeytaux said, it may be time for more studies that compare acupuncture head-to-head with other therapies, to see how it stacks up. For now, hay fever sufferers who want to try acupuncture may face some obstacles. Depending on where you live, there may not be many licensed acupuncturists nearby; in the United States, most states require practitioners to be licensed. Then there is the cost. Acupuncture prices vary, but they typically run around $100 for a session, and health plans often do not cover it. Nelson added that people who want a "natural" remedy for their hay fever woes might also consider allergy shots. That means getting a series of injections that expose you to tiny amounts of the substance causing your allergies, to train your immune system to tolerate it. Learn more about hay fever from the American Academy of Allergy, Asthma and Immunology. SOURCES: Benno Brinkhaus, M.D., professor, Charite-University Medical Center, Berlin, Germany; Harold Nelson, M.D., professor, medicine, National Jewish Health, Denver; Remy Coeytaux, M.D., Ph.D., associate professor, community and family medicine, Duke University School of Medicine, Durham, N.C.; Feb. 19, 2013, Annals of Internal Medicine

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