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2014-42/1179/en_head.json.gz/1397

Beckman Center Celebrating 25 Years Research / Beckman Center / Synthesis / Panaceia’s Daughters: Noblewomen as Healers in Early Modern Germany Panaceia’s Daughters provides the first book-length study of noblewomen’s healing activities in early modern Europe. Drawing on rich archival sources, Alisha Rankin demonstrates that numerous German noblewomen were deeply involved in making medicines and recommending them to patients, and many gained widespread fame for their remedies. Turning a common historical argument on its head, Rankin maintains that noblewomen’s pharmacy came to prominence not in spite of their gender but because of it. Rankin demonstrates the ways in which noblewomen’s pharmacy was bound up in notions of charity, class, religion, and household roles, as well as in expanding networks of knowledge and early forms of scientific experimentation. The opening chapters place noblewomen’s healing within the context of cultural exchange, experiential knowledge, and the widespread search for medicinal recipes in early modern Europe. Read about Rankin’s experience researching for Panaceia’s Daughters in her blog post Writing Recipes Down. Listen to Rankin talk about her book on the New Books Network podcast. Case studies of renowned healers Dorothea of Mansfeld and Anna of Saxony then demonstrate the value their pharmacy held in their respective roles as elderly widow and royal consort, while a study of the long-suffering Duchess Elisabeth of Rochlitz emphasizes the importance of experiential knowledge and medicinal remedies to the patient’s experience of illness. Learn more about A Woman’s Business in pharmacy in the Chemical Heritage magazine. Discover 4,000 years of women in chemistry on the CHF website. Alisha Rankin is an assistant professor of history at Tufts University. She received her Ph.D. from Harvard University in 2005 and her B.A. from Wellesley College in 1996. Her broad research interests include early modern European history (c. 1450–1700), the history of science and medicine, and women’s history. Along with Panaceia’s Daughters, her first book, she has also coedited a collection of essays titled Secrets and Knowledge in Medicine and Science, 1500–1800. “This book demonstrates that kitchen gardens, still rooms, recipes, and household arts should not be relegated to the margins but, rather, placed squarely within the history of the scientific revolution.”—Pamela H. Smith, Columbia University Kool-Aid package, 1951

医学

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Patient Care Research Education and Training Give Careers About City of Hope City of Hope’s comprehensive cancer center designation has been renewed by the National Cancer Institute By Tami Dennis Contact: Tami Dennis tdennis@coh.org DUARTE, Calif. — City of Hope has been notified of the renewal of the prestigious comprehensive cancer center designation from the National Cancer Institute (NCI), a milestone that marks the institution’s 30th year with an NCI designation. The recognition is the highest level granted by the NCI, part of the National Institutes of Health, awarded only to those institutions with world-class, state-of-the-art programs in multidisciplinary cancer research. “We’re extremely pleased the NCI has once again recognized City of Hope’s outstanding achievements in scientific research, leading-edge treatments and patient care,” said Michael A. Friedman, M.D., City of Hope’s chief executive officer and Irell & Manella Cancer Center Director's Distinguished Chair. “Our innovations have helped scores of millions of people around the world and in our own community, and our patient care has become a model for institutions everywhere. We’re extremely proud not only to receive this prestigious honor, but to continue shaping the future of health.” Institutions must meet rigorous standards to receive the designation, which accompanies increased federal funding, information sharing and resources. Such funding, and the corresponding designation, is especially notable considering the increasingly competitive NCI fiscal environment. To meet the standards, institutions must show depth and breadth of research in laboratory, clinical and population-based research, as well as research that bridges these scientific areas. They must also demonstrate professional and public education efforts, including the sharing of health advances in their communities. In announcing the approval, the NCI commended City of Hope in a variety of areas. It noted that: Many programs have new leadership, which has infused new vision and new capabilities into the scientific programs. Every program has examples of outstanding, even exceptional, science. The leadership of the individual programs is outstanding both scientifically and administratively. The cancer center has shown substantial growth of both new laboratory space and clinical space. The institution maintains unique and differentiating core resources, such as the biological and chemical GMP facilities. The center possesses all the scientific resources and intellectual capacity to succeed. “Membership in the community of NCI-designated cancer centers confers a seat at the table where the strategic plans and initiatives of NCI are formed, and allows the center to represent the needs of its local community in national dialogue,” says the NCI in a description of the designation. “This access also creates opportunities for extensive information sharing and broader scientific collaborations with other NCI centers.” The designation will benefit not only City of Hope, but also the surrounding communities. The accompanying grant, for which an amount has not yet been announced, will help ensure ongoing education and outreach efforts, as well as the dissemination of evidence-based findings and breakthrough discoveries. City of Hope is a leading research and treatment center for cancer, diabetes and other life-threatening diseases. Designated as a comprehensive cancer center, the highest recognition bestowed by the National Cancer Institute, City of Hope is also a founding member of the National Comprehensive Cancer Network, with research and treatment protocols that advance care throughout the nation. City of Hope’s main hospital is located in Duarte, Calif., just northeast of Los Angeles, with clinics in Antelope Valley and South Pasadena. It is ranked as one of "America's Best Hospitals" in cancer by U.S.News & World Report. Founded in 1913, City of Hope is a pioneer in the fields of bone marrow transplantation and genetics. For more information, visit www.cityofhope.org or follow City of Hope on Facebook, Twitter, YouTube, Breakthroughs blog or Flickr. For the latest breaking health news, interviews, photo requests or the most current information and resources available, please call our Media Hotline at 800-888-5323 or email us at media@coh.org. Introduction to City of Hope We Rank Among The Best For the 11th year, U.S.News & World Report has named City of Hope one of the top cancer hospitals in the country. City of Hope's institutional distinctions, breakthrough innovations and collaborations.

医学

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Starvation in Youth Linked to Heart Risk in AdulthoodStarvation in Youth Linked to Heart Risk in Adulthood08/26/11FRIDAY, Aug. 26 (HealthDay News) -- People who experience starvation in their youth are at greater risk for heart disease later in life, a new study has found.In analyzing women who survived the Dutch famine of 1944-1945, researchers from the Netherlands found that the link is particularly strong among those who were undernourished as teenagers.The study authors said their findings, published in the Aug. 25 online edition of the European Heart Journal, provide the first direct evidence of the adverse health effects associated with famine -- a problem that remains a critical problem around the world. In conducting the study, Dutch researchers examined 7,845 women who were under 21 years of age and living in the Netherlands during the final year of World War II -- a time when severe food shortages limited most adults to no more than 800 calories per day.The women, studied in the mid-1990s, were divided into three groups: those who never went hungry; those who were severely affected by the famine; and those who were moderately affected by the food shortages.The investigators found the risk of heart disease was slightly higher overall for the women who were moderately exposed to the famine than those who were not exposed at all. The women who were severely affected by hunger in their youth, however, had a significantly higher risk for heart disease.Those with the highest risk were women who were between 10 and 17 years old when the famine hit and were severely affected by it. As adults, these women had a 38 percent greater risk for heart disease. In taking other risk factors into consideration, such as smoking and education, the researchers pointed out that the women still had a 27 percent greater risk for heart disease. Meanwhile, those with moderate exposure to hunger had no increased risk.The study noted, however, that the women exposed to famine, particularly those who were between 18 and 21 years old at the time, had a lower risk of stroke than those who did not bear the brunt of the food shortages.The authors of an editorial accompanying the report noted that the findings have modern-day relevance because the United Nations Food and Agriculture Organization reports that 925 million people worldwide are undernourished."Since the incidence of CVD [cardiovascular disease] is the number one cause of death globally, and rising in many parts of the world, further research into the impact of undernutrition during sensitive periods of growth and maturation is warranted," study first author Annet van Abeelen, a PhD epidemiology student at University Medical Center Utrecht, and colleagues wrote. Although the researchers cited unhealthy lifestyles, changes in metabolism or traumatic stress as possible explanations for the increased risk of heart disease among adults who experienced starvation in their youth, they suggested that more research is needed to investigate this link."More knowledge in this field may lead to unique opportunities for prevention in the future," van Abeelen, who is also a PhD epidemiology student in the department of clinical epidemiology, biostatistics and bioinformatics at the Academic Medical Center at the University of Amsterdam, explained in a journal news release. "Our study indicates that growth that has been hampered by undernutrition in later childhood, followed by a subsequent recovery, may have metabolic consequences that contribute to an increased risk of diseases later in adulthood," van Abeelen concluded. More informationThe U.S. National Library of Medicine has more about child nutrition. Copyright © 2011 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.Editorial Policy |

医学

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Welcome to CSRPM The Centre for Scientific Research into Plant Medicine (CSRPM) was established in 1975 by the Government of Ghana in recognition of the pioneering work of Dr. Oku Ampofo, a Ghanaian allopathic medical practitioner. Today, CSRPM has become a leading research institution in Africa that has made Research and Development of herbal medicines its core business.Our objective is to make significant contribution to healthcare through quality research in order to realize our vision “ to make herbal medicine a natural choice for all ” An increasing number of people, both locally and worldwide, are turning to the use of natural medicine, particularly herbal medicine, to address their healthcare needs. It is important for these people and for the general good, that they receive the best available care. It is in this regard that the Center for Plant Medicine Research has been mandated to lead the effort to make herbal medicine acceptable to all. By a new act in parliament, the CENTRE FOR SCIENTIFIC RESEARCH INTO PLANT MEDICINE (CSRPM) is now CENTRE FOR PLANT MEDICINE RESEARCH (CPMR) We exist to ensure that the highest standards are applied to the research and development of plant medicine. We do not believe that science and natural medicine exist in different paradigms. Among others, we seek to, and do, subject plant medicine to rigorous phytochemical, pharmacological, toxicological and microbiological analyses. Our interests go beyond research. We are unique in our ability to effectively link research with product development. We possess an impressive array of products (which can be seen on this site) which we have subjected to safety and efficacy tests. Our clinic stands as a model for the effective combination of the principles of modern diagnosis and natural, holistic healthcare. We welcome the co-operation of all individual and organizations in making herbal medicine a natural choice for all. + Read More The Centre for Plant Medicine Research, as part of its core responsibilities, is organizing a two- week training programme for a limited number of herbalists and other traditional medicine practitioners. Date: 1st September, 2014 – 12th September, 2014 Areas to be covered include: Introduction to herbal medicine (practice and regulatio+ Read More Change of Centre's Name By a new law (Act…) passed in December, 2012, the Centre’s name is no more “Centre for Scientific Research into Plant Medicine (CSRPM” but now “Centre for Plant Medicine Research (CPMR). Though the new law is operational, the Act indicates that earlier contracts properly signed under CSRPM are still valid. + View All Posts Copyright © 2013 CSRPM| Designed by Website Admin. (oberenpon@gmail.com)

医学

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« Michigan Natural Resources T... It’s duck time: Annual races...» Breaking new ground: OSF begins work on new $4M physical rehab center By Jason Raiche - staff writer (jraiche@dailypress.net) Save | Comments (2) | Post a comment | ESCANABA - A new physical rehabilitation and wellness center broke ground Wednesday afternoon in Escanaba. The new facility is part of OSF St. Francis Hospital & Medical Group and will be named in honor of John and Patricia Besse, who made a $2.5 million contribution to the project. The new John and Patricia Besse Physical Rehabilitation and Wellness Center will span approximately 14,500 square feet and will be located on the hospital campus along Willow Creek Road. The total cost for the project is expected to be around $4 million. Remaining funds for the facility will be provided by the OSF St. Francis Foundation and the Sisters of the Third Order of St. Francis. Article Photos A groundbreaking ceremony at the site of the future John and Patricia Besse Physical Rehabilitation and Wellness Center took place Wednesday at OSF St. Francis Hospital. The Besses have donated $2.5 million toward the $4 million project. Pictured during the groundbreaking are, from left: Ray LaMarche, OSF Community Advisory Board president; Brenda Lippens, OSF Foundation Council member and past chair; David Lord, president and CEO of OSF St. Francis Hospital & Medical Group; Patricia Besse; Paul Bracket, manager of OSF Rehab Services; Dennis Ness, Ness Contracting; Scott Jensen, OSF Corporate Engineering division; Chuck Lawson, C2AE Architectural Design Firm; and Jim O’Toole, Escanaba City manager. (Daily Press photo by Jason Raiche) The new center will provide a larger area for existing physical and occupational therapy, work hardening, cardiac rehabilitation and athletic training services, as well as new features, including a warm-water therapy pool, a step program for patients converting from treatment to supervised preventive care and a larger gym area for additional therapeutic exercise programs. "It's a great day for our community. It's a great day for our organization, our sisters and ultimately, our patients," said OSF president and CEO Dave Lord during the groundbreaking ceremony. Lord thanked all the people who were involved in the creation of the project, in particular, John and Patricia Besse for their gift to the community and OSF's patients. "This is a most special day and one that John and I had been looking forward to," said Patricia Besse, who spoke during the ceremony. "My sadness today is that my beloved and generous husband John is not to be a part of this groundbreaking ceremony, but he was so excited about the project and was looking forward to watching the building progress of the rehabilitation and wellness center as it became a reality. I can only hope that his spirit smiling and watching over us is up there today." She noted John's legacy and impact on the community will be kept alive for centuries to come and said she and John are humbled and proud to have their name connected to OSF's latest addition. According to Patricia, she and John first became aware of this dream project for OSF's rehabilitation department while she utilized their services there and in speaking with Paul Bracket, manager of OSF Rehab Services. Bracket, who also spoke at the ceremony, mentioned the new facility will not only enhance the strengths of OSF's current rehabilitation and therapy department, but expand to provide additional services that are currently unavailable. The new center will bring standardized and top-notch programs and place many services in one centralized location, he added. Escanaba City Manager Jim O'Toole was also present to celebrate OSF's latest milestone. "The project we are celebrating today has required leadership, foresight, careful planning and philanthropy," he said. "Each of us here today has had a special role in making this project a reality and for that, everyone is to be commended." In addition to the new rehabilitation and wellness center, OSF has received additional funding from the Besse Foundation in the past. These include annual donations for OSF Bay de Noc Hospice, a $10,000 gift in 2000 for dialysis services, a $1 million donation in 2003 used to provide permanent MRI services, and a $5 million gift in 2006 to expand the hospital's emergency department. Since 1884, 0SF St. Francis Hospital & Medical Group has provided care for approximately 45,000 people throughout Delta County and the surrounding communities. © Copyright 2014 Daily Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed. Save | Comments (2) | Post a comment | Subscribe to Daily Press I am looking for:

医学

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Category: Oncology | Surgery | Cosmetic Surgery | News Back to Health News Limb-Sparing Surgery May Offer Little Benefit to Cancer Patients Last Updated: August 11, 2009. It doesn't affect quality of life in most cases, review finds It doesn't affect quality of life in most cases, review finds. TUESDAY, Aug. 11 (HealthDay News) -- Surgery that spares the limbs of some cancer patients may have little or no additional benefit over amputation in terms of health, cost or quality of life, researchers say. Limb-sparing surgery can be just as effective as amputation in removing bone or soft-tissue sarcomas, but the analysis by Canadian researchers found few notable differences in psychological health and quality of life between people who had the two types of surgery. In fact, people who had their limbs saved tended to have more complications either shortly after the procedure or sometime later, the study found. People who had limb-sparing surgery for cancers in the upper areas of the legs, including the hip, did reportedly have advantages over those who'd had amputation, but in general, saving the lower limbs did not necessarily ensure a better quality of life than amputation of all or part of the leg, the researchers found. In terms of money, limb-sparing surgery has higher "up front" costs and rehabilitation costs, but making, maintaining and replacing artificial limbs for amputees adds to those patients' long-term costs, the study noted. The analysis, appearing online Aug. 10 in advance of publication in the Sept. 15 issue of Cancer, reviewed previously published studies on the cost and quality of life for people undergoing limb-sparing surgery versus amputation. Its authors, Dr. Ronald Barr of McMaster University in Ontario and Dr. Jay Wunder of Mount Sinai Hospital and the University of Toronto, called for further and more comprehensive reviews into the matter to help doctors and patients make better decisions when facing the issue. "Future studies that include function, health-related quality of life, economics and stratification of patients by age will be useful contributions to decision-making ... by patients, health-care providers and administrators," Wunder said in a news release from the American Cancer Society. The National Cancer Institute has more about soft-tissue sarcoma. SOURCE: American Cancer Society, news release, Aug. 10, 2009 Previous: Health Highlights: Aug. 11, 2009 Next: Stem Cell Advance May Further Disease Research

医学

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> Research & journals > New Study Finds Links Between Video-Game Playing and Health Risks in Adults Share This: New Study Finds Links Between Video-Game Playing and Health Risks in Adults San Diego, CA, August 18, 2009 – While video gaming is generally perceived as a pastime for children and young adults, research shows that the average age of players in the United States is 35. Investigators from the Centers for Disease Control and Prevention (CDC), Emory University and Andrews University analyzed survey data from over 500 adults ranging in age from 19 to 90 in the Seattle-Tacoma area on health risks; media use behaviors and perceptions, including those related to video-game playing; and demographic factors. In an article published in the October 2009 issue of the American Journal of Preventive Medicine, they found measurable correlations between video-game playing and health risks. Participants reported whether they were players or nonplayers, and weekly usage was collected. Internet usage was assessed, as was the relative importance of the Internet as a social support. The personal determinants examined in this study included self-assessments of depression, personality, health status, physical and mental health, body mass index (BMI), and poor quality of life. Immersion in media environments was evaluated using the participants’ estimates of the time they spent during a typical week surfing the Internet and watching TV, including videos and DVDs. The Seattle–Tacoma area was selected because of its size (13th largest US media market) and its Internet usage level is the highest in the nation. A total of 45.1% of respondents reported playing video games. Female video-game players reported greater depression and lower health status than female nonplayers. Male video-game players reported higher BMI and more Internet use time than male nonplayers. The only determinant common to both female and male video-game players was greater reliance on the Internet for social support. Writing in the article, Dr. James B Weaver III, PhD, MPH, National Center for Health Marketing, CDC, Atlanta, states, “As hypothesized, health-risk factors – specifically, a higher BMI and a greater number of poor mental-health days – differentiated adult video-game players from nonplayers. Video-game players also reported lower extraversion, consistent with research on adolescents that linked video-game playing to a sedentary lifestyle and overweight status, and to mental-health concerns. Internet community support and time spent online distinguished adult video-game players from nonplayers, a finding consistent with prior research pointing to the willingness of adult video-game enthusiasts to sacrifice real-world social activities to play video games. The data illustrate the need for further research among adults to clarify how to use digital opportunities more effectively to promote health and prevent disease.” In a commentary in the same issue, Brian A. Primack, MD, EdM, MS, from the University of Pittsburgh School of Medicine, applauds Weaver et al. for focusing on the current popularity of video games not only among youth, but also among adults. He suggests that many video games are different enough from original forms of play that they may be better defined as “playlike activities.” He writes, “There are noteworthy differences between the oldest forms of play (e.g., chase games) and today’s ‘playlike activities.’ These playlike activities may stimulate the right centers of the brain to be engaging ... However, the differences between today’s ‘playlike activities’ and original forms of play may illuminate some of the observed health-related correlates discovered by Weaver, et al.” Dr. Primack observes that our greatest challenge will be maintaining the balance: “How do we simultaneously help the public steer away from imitation playlike activities, harness the potentially positive aspects of video games, and keep in perspective the overall place of video games in our society? There are massive, powerful industries promoting many playlike activities. And industry giants that can afford to will successfully tout the potential benefits of health-related products they develop. But who will be left to remind us that – for children and adults alike – Hide-And-Seek and Freeze Tag are still probably what we need most?” The article is “Health-Risk Correlates of Video-Game Playing Among Adults” by James B Weaver III, PhD MPH; Darren Mays, MPH; Stephanie S Weaver, PhD, MPH; Wendi Kannenberg, MPH; Gary L Hopkins, MD DrPH; Dogan Eroglu, PhD; and Jay M Bernhardt, PhD MPH. The commentary is “Video Games: Play or ‘Playlike Activity’?” by Brian A Primack, MD, EdM, MS. Both appear in the American Journal of Preventive Medicine, Volume 37, Issue 4 (October 2009) published by Elsevier. Full text of the articles is available upon request; contact eAJPM@ucsd.edu to obtain copies. To schedule an interview with James B Weaver, III, please contact CDC’s Media Relations Office at 404-639-3286. To schedule an interview with Brian A Primack, please contact bprimack@pitt.edu or 412-480-9149. About the American Journal of Preventive Medicine The American Journal of Preventive Medicine is the official journal of The American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. The journal features papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. The journal also publishes official policy statements from the two co-sponsoring organizations, health services research pertinent to prevention and public health, review articles, media reviews, and editorials. The American Journal of Preventive Medicine is ranked 12th out of 105 Public, Environmental & Occupational Health titles and 16th out of 107 General and Internal Medicine titles according to the 2008 Journal Citation Reports© published by Thomson Reuters. Elsevier is a world-leading provider of information solutions that enhance the performance of science, health, and technology professionals, empowering them to make better decisions, deliver better care, and sometimes make groundbreaking discoveries that advance the boundaries of knowledge and human progress. Elsevier provides web-based, digital solutions — among them ScienceDirect, Scopus, Elsevier Research Intelligence, and ClinicalKey — and publishes nearly 2,200 journals, including The Lancet and Cell, and over 25,000 book titles, including a number of iconic reference works. The company is part of Reed Elsevier Group PLC, a world leading provider of professional information solutions in the Science, Medical, Legal and Risk and Business sectors, which is jointly owned by Reed Elsevier PLC and Reed Elsevier NV. The ticker symbols are REN (Euronext Amsterdam), REL (London Stock Exchange), RUK and ENL (New York Stock Exchange). Media Contact:AJPM Editorial Office eAJPM@ucsd.edu

医学

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Chamomile tea: New evidence supports health benefits For centuries, people who�ve felt sick or stressed have tried drinking chamomile tea as a medicinal cure-all. Now, researchers in England have found new evidence that the popular herbal tea may actually help relieve a wide range of health ailments, including colds and menstrual cramps. Their study is scheduled to appear in the Jan. 26 issue of the American Chemical Society�s Journal of Agricultural and Food Chemistry, one of the Society�s peer-reviewed journals. ACS is the world�s largest scientific society. �This is one of a growing number of studies that provide evidence that commonly used natural products really do contain chemicals that may be of medicinal value,� says study leader Elaine Holmes, Ph.D., a chemist with Imperial College London. �The healthcare industry is placing increasing emphasis on functional foods including natural remedies, yet little work has been conducted on the long term effects of such products on human biology.� The herbal plant used in this study was German chamomile (Matricaria recutita), also known as manzanilla, whose flowers and leaves are brewed as a fragrant, flavorful tea. The study involved fourteen volunteers (seven women and seven men) who each drank five cups of the herbal tea daily for two consecutive weeks. Daily urine samples were taken and tested throughout the study, both before and after drinking chamomile tea. The researchers found that drinking the tea was associated with a significant increase in urinary levels of hippurate, a breakdown product of certain plant-based compounds known as phenolics, some of which have been associated with increased antibacterial activity. This could help explain why the tea appears to boost the immune system and fight infections associated with colds, according to the researchers. Drinking the tea also was associated with an increase in urinary levels of glycine, an amino acid that has been shown to relieve muscle spasms. This may explain why the tea appears to be helpful in relieving menstrual cramps in women, probably by relaxing the uterus, say the researchers. Glycine also is known to act as a nerve relaxant, which may also explain why the tea seems to act as a mild sedative, the scientists note. Glycine supplements are sold in stores for that purpose, they add. Levels of both hippurate and glycine remained elevated for up to two weeks after the study participants stopped drinking the tea, indicating that the compounds may remain active for quite some time, according to the researchers. Additional studies are needed before a more definitive link between the tea and its alleged health benefits can be established, they emphasize. Funding for this study was provided by Oxford Natural Products, a pharmaceutical, nutraceutical and technology company located in Oxford, England. The American Chemical Society is a nonprofit organization, chartered by the U.S. Congress, with a multidisciplinary membership of more than 159,000 chemists and chemical engineers. It publishes numerous scientific journals and databases, convenes major research conferences and provides educational, science policy and career programs in chemistry. Its main offices are in Washington, D.C., and Columbus, Ohio. ###� Mark T. Sampson The online version of the research paper cited above was initially published Dec. 21 on the journal�s Web site. Journalists can arrange access to this site by sending an e-mail to newsroom@acs.org or calling the contact person for this release.

医学

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Skin cancer cases in Scotland rise by almost 37% in a decade Cases of skin cancer in Scotland have risen by almost 37% in a decade, official statistics show. Incidences of malignant melanoma rose more in percentage terms than any of the other most common cancers in the decade to 2012. The findings, contained in figures published by ISD Scotland, have prompted renewed warnings about the dangers of unsafe tanning in the sun or by using sunbeds. Scotland's acting chief medical officer, Dr Aileen Keel, said: "The increase in the number of people being diagnosed with melanoma may in part be down to better awareness and improved diagnosis, but there is no doubt that unsafe tanning remains a big issue, particularly among the young. "That is why it's crucial that people listen and act on the health advice to be safe in the sun. "Many people will be planning their summer holidays now and I would urge everyone to take extra care, cover up and use suncream. "Using sunbeds is also potentially dangerous and that is why Scotland led the way by being the first part of the UK to introduce legislation to address the health risks associated with sunbed use." Malignant melanoma is the fifth most common cancer in women and the seventh most common in men. Incidence rates increased over the last decade by 43% in men and 30% in women, levelling out at 36.7% for both sexes. Overall, the latest figures show that about 14,600 males and 15,800 females were diagnosed with some form of cancer in 2012. The total number of diagnoses has risen by around 3,700 over the decade to 30,450 in 2012, a rise thought likely to be due to an ageing population. Over the last 10 years, incidence rates of cancer in Scotland have fallen by 5% in males but increased by 8% in females. Lung cancer remains the most common form of the disease, accounting for 17% of all cancers diagnosed in 2012. For men, the most common cancers are prostate, lung and colorectal cancers, which collectively account for 52% of cancers affecting them. Breast cancer, as well as lung and colorectal cancers, together account for 56% of cancers in women. But the figures do show "considerable variation" between the different types of cancer. On the one hand, the incidence rate of cancer of the kidney across the population has increased by 30% over the last 10 years, and head and neck cancers are up 9.4% over the same period. By contrast, incidences of cancers such as of those affecting the oesophagus, bladder and ovaries have decreased by between 9% and 13% over the same period. Health Secretary Alex Neil said cancer remains a "top priority" for the Scottish Government and he pointed to their £30 million Detect Cancer Early initiative launched in 2012. "It is important to note that while cases of cancer have risen, survival rates are up, this means more people are now living longer after diagnosis," he said. "A healthier lifestyle can reduce the risk of getting cancer, so stopping smoking, drinking less alcohol, taking regular exercise and eating a healthy diet, including fruit and vegetables, can offer many health benefits." Health Tweet

医学

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Helping Young Mothers Help Their Babies and Themselves by Diego Cupolo, Mar 12, 2007 When Sheena Persaud became pregnant at 17, the Queens resident did not know much about taking care of a child. She did not have a high school diploma or many other resources. Such difficult circumstances can often threaten the well being of both mother and child. But Persaud decided to try to improve her odds. She enrolled in the Nurse-Family Partnership, a free city program, and began getting weekly visits from visiting nurse Carol Coleman. Together, they discussed parenting techniques, healthy nutrition and communicating with infants. "The program taught me what to expect when being a mom," Persaud said. "If I didn't join it I wouldn't know half of what I know when it comes to taking care of a baby." Now a graduate of the program, Persaud has earned her GED high school equivalency certificate. She is working in a bakery and but hopes to train for a career in nursing. Her daughter Serena is two. THE HIGH RISKS OF POVERTY Children such as Serena face daunting challenges. More than half - 54 percent - of children of single mothers in New York City are poor. And, according to the Children's Defense Fund, poor children are more likely to die before their first birthday than more affluent children. Once they start school, they are twice as likely as to have to repeat a grade and three and half times as likely to drop out. A lack of parenting skills can take a more immediate toll. New York City government recorded more than 65,000 reports of child abuse and neglect in 2006. In the first 11 months of that year, 40 of the children suspected of being abused died -- though not necessarily because of that abuse. A SIMPLE REMEMDY The Nurse Family Partnership takes a simple approach to such overwhelming problems. Under the program, a registered nurse visits a low-income, first time mother, starting during the woman's pregnancy and ending after the child turns 2. The goal is to help mothers have healthier pregnancies, to improve the child's health and development, and to assist the mothers in becoming more self-sufficient. During the visits, which take place every week or so, the mothers learn how to breastfeed, create a healthy environment for the child and plan their future pregnancies. The nurses also listen to the mothers' concerns. The visitors "give young mothers the sort of cajoling and practical wisdom that in other times would have been delivered by grandmothers or elders," David Brooks wrote in a recent New York Times column. "A first-time mom isn't sure of what's going to happen, you don't know what life is going to offer you and at least this is giving you a head start on it," visiting nurse Eulanda Greene, who works in Jamaica, Queens, said. The program is the brainchild of psychologist David Olds. Working in a day-care center in Baltimore, Olds thought the care and he and his coworkers were providing there was "too little, too late" and that children would be better served if their parents received some assistance earlier. In 1977, Olds and some colleagues came up with the idea to have a registered nurse visit low-income, first-time mothers. This concept, Katherine Boo wrote in a 2006 New Yorker article on the program, "is rooted in a pessimistic view of the future that awaits an American child born poor -- a sense that the schools, day-care centers, and other institutions available to him may do little to nurture his talents. Shrewder, then, to insulate him by an exercise of uncommon intrusion: building for him, inside his home, a better parent." Pessimistic or not, it seems to work. A study conducted in Memphis, one of the first cities where the partnership was implemented, found children whose mothers were in the program spent 80 percent fewer days in the hospital for injuries or swallowing something hazardous than other similar children. Three studies of participants in the program found an array of other benefits. For example, both parent and child were far less likely to spend time in jail than they might have been had they not taken advantage of the program. The RAND Corporation has figured that every dollar invested in the program produces a return of $5.70, coming saving society about $34,148 per child. "When it comes to improving the odds for poor mothers and infants, it's hard to beat the Nurse-Family Partnership," Mayor Michael Bloomberg said in this year's State of the city speech. "Through one-on-one nurturing and guidance, NFP helps first-time mothers build stronger futures for themselves and their children." NEW YORK'S PROGRAM Over the years, the program has expanded and today serves about 20,000 families in 300 communities across the country. It was first introduced in New York City in 2003 with an office in Jamaica. A year later the Department of Health and Mental Hygiene expanded it expanded to Harlem. The program is aimed at the parts of the city with the highest infant mortality and teen pregnancy rates: South Bronx, East and Central Harlem, Central Brooklyn, and Jamaica East. It also tries to reach young mothers in foster care, homeless shelters and at Rikers Island. Now, Bloomberg has pledged to expand the Nurse-Family Partnership by 50 percent in New York City by the end of the year. That would raise the budget to $3 million, enough to serve 1,300 families. Currently, the program can visit 845 families, but only 420 take advantage of this free resource. Many others simply do not know the program exists. One other obstacle to the program's further expansion, according to a report in New York magazine, is the city's shortage of nurses. Though the program costs about $5,500 per family a year, Lisa Landau, director of the Nurse-Family Partnership for the health department, said it will reduces costs for New York City taxpayers in the long term. "There are savings in health care costs, child neglect costs, juvenile justice and there are also lower arrest rates for children and their parents," Landau said. A 2004 report by the health department anticipated, based on previous evidence, that in New York City, the program would reduce child abuse and neglect among participants by 50 percent, and increase the amount of time that mothers in the program wait before having their second child, a change that cuts the risk of the premature births. Having worked in the Jamaica, Queens office for almost four years, Greene said she has already seen the effects. The young mother, she said, make real progress. "We teach them how to understand the baby's cues," Greene said. "They find out that it's normal for babies to cry and always put things in their mouth. I even have them observe other mothers on the streets and they realize so many of the mothers are not really paying attention to their children. A simple thing one client told me is that she saw a toddler walking with his mom and the mom was practically dragging the baby. She has to know he has short legs and he can't walk as fast as she can walk." After graduating from the program, Persaud said she learned how to take care of her daughter, but she also learned something she wasn't expecting: how to take care of herself. "The nurse always motivated me to do something with myself," Persaud said. "She would push me to do things all the time. She even picked me up and took me to get a library card one day so I could study. Because of her I have everything. If it wasn't for her I wouldn't be so active, I would just stay at home and take care of the baby." The comments section is provided as a free service to our readers. Gotham Gazette's editors reserve the right to delete any comments. Some reasons why comments might get deleted: inappropriate or offensive content, off-topic remarks or spam. Last Updated (Mar 28, 2013) Please Consider a Donation to Gotham Gazette

医学

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Back to News Review HBV Journal Review HBV Journal Review September 1, 2010, Vol 7, no 9 by Christine M. Kukka PDF (download) Study Finds Interferon Ineffective Against HBeAg-Negative Hepatitis B Researchers, writing in the August 2010 issue of the American Journal of Gastroenterolgy, reported disappointing results in a recent randomized trial that tested the effectiveness of pegylated interferon (Pegasys) in people infected with hepatitis B “e” antigen (HBeAg)-negative hepatitis B. An accompanying editorial questioned the effectiveness of the interferon in this patient group based on the study results. Pegylated interferon, delivered in a weekly injection, had been recently recommended as a first-choice treatment for HBeAg-negative patients based on results from a single randomized trial, which used a control group. But results from a second randomized controlled trial, involving 138 HBeAg-negative patients, were disappointing. Only 7.5% of the study’s participants achieved undetectable hepatitis B virus (HBV) DNA (less than 400 copies/mL) at 24 weeks over a 48-week course of pegylated interferon. None lost hepatitis B surface antigen (HBsAg), which indicates clearance of the infection. “This study challenges the value and limits the appeal of pegylated interferon therapy for HBeAg-negative chronic hepatitis B,” the editorial noted. HBsAg Levels after 12 Weeks of Interferon Will Indicate Treatment’s Success or Failure A separate study on pegylated interferon treatment in HBeAg-negative patients, published in the August 2010 issue of Hepatology, found that doctors can tell within 12 weeks whether the drug will be effective in patients. The study followed 107 patients who were treated for 48 weeks and then followed for an additional 72 weeks. They tracked HBsAg and HBV DNA levels in the patients who did respond to treatment and found that by week 12, HBsAg declined markedly in those who ultimately responded to interferon treatment. They reported that 24 patients (22%) achieved a low viral load and normal alanine aminotransferase (ALT) levels, which indicates no liver damage, at week 72 from treatment. Starting at week 8, responders showed decreases in HBsAg levels. However, the combination of lowered HBsAg and HBV DNA levels at week 12 was a clear indicator that the patient would respond. Patients who do not show declines in viral load and HBsAg at week 12 should stop treatment, researchers instructed. In a similar study that focused on HBsAg levels in HBeAg-positive patients treated with pegylated interferon, researchers similarly recommended that treatment should be stopped if there were not significant HBsAg declines after 12 weeks of treatment. They reported in the journal Hepatology that 97% of patients who had no declines in HBsAg at week 12 ultimately did not respond. Experts Recommend Conservative Approach to Treating Children with HBV—and No Treatment during Immune-Tolerant Stage In the absence of clear treatment guidelines for children and teens infected with HBV, an expert team of pediatric liver specialists drafted recommendations addressing which children should be treated and when. The panel, organized by the Hepatitis B Foundation, noted that doctors have few treatment options for children today. Pegylated interferon, considered one of the best first-line treatments in adults, has not yet been approved for children. Doctors are left with two antivirals (lamivudine and adefovir--both of which have high rates of drug resistance) and conventional interferon in their treatment arsenal. Given the limited options, the panel concluded that, at this time, there is no effective drug treatment for children in the immune-tolerant stage of hepatitis B, marked by high viral load (HBV DNA), normal ALT levels, and HBeAg-positive infection. Additionally, they noted that prolonged antiviral treatment with the available antivirals would leave children at high risk of developing drug resistance over time. However, they did recommend a conservative approach to children whose immune systems were fighting the infection and who had liver damage, elevated ALT levels, or a family history of liver cancer. “Outside of clinical trials, (conventional) interferon is the agent of choice in most cases,” they wrote. Antivirals are second-choice therapies, but children who are treated with antivirals require careful monitoring for development of drug resistance, they cautioned. “(Until) more clinical data and therapeutic options are available, a conservative approach is warranted,” they noted in the August 2010 issue of the journal Hepatology. HBIG May Play a Role in Transmitting HBV Infection in Transplant Patients Transplanting liver organs from donors who tested positive for the hepatitis B core antibody (which shows a past, resolved hepatitis B infection) to patients who are infection-free often results in HBV infections in transplanted patients. Doctors in the past have used hepatitis B immunoglobulin (HBIG) immediately after transplantation to prevent infection. Now, a group of French researchers suggest that HBIG itself may be the culprit in possibly transmitting hepatitis B to transplanted patients. They studied the transplantation of 77 anti-HBc-positive liver organs into 21 HBsAg-positive patients and 56 HBsAg-negative recipients. The HBsAg-positive patients were treated with HBIG and antivirals. Forty-five of the uninfected received only HBIG and 11 HBsAg-negative recipients received no HBIG. Sixteen months after the transplants, 15 HBsAg-negative recipients (19.4%) tested positive for hepatitis B. HBV infections occurred in nearly one-third of the uninfected who received HBIG. But only 7.7% of those previously infected who also received antivirals became re-infected. Mutations in the HBsAg were found in nine HBIG patients who became infected. “Our study has confirmed the high risk of HBV transmission to naïve (uninfected, transplant) recipients,” the researchers wrote in a recent issue of Hepatology. “HBIG (when used without antivirals) was associated with a significant risk of de novo HBV infection and HBV escape mutations. In these patients, we therefore recommend (treatment) with lamivudine or new (antivirals). The potential benefits of HBIG prophylaxis combined with antiviral drugs require further evaluations.” Liver Cells Created from Patients' Skin Cells Could Lead to New Liver Disease Treatments British scientists have created liver cells from a small sample of human skin, which promises to increase research capabilities into liver disease and potential treatments, according to a report published in the Aug. 25, 2010, issue of the Journal of Clinical Investigation. Because liver cells (hepatocytes) cannot be grown in the laboratory, researching liver disorders has been extremely difficult. But the development of liver cells from human skin provides a mechanism to create diseased liver-like cells from patients suffering from a variety of liver disorders so researchers can use them to study what happens in a diseased or damaged liver cell and to develop potential treatments. Scientists took skin biopsies from seven patients who suffered from a variety of inherited liver diseases and from three healthy control individuals. They reprogrammed cells from the skin samples back into stem cells, which were used to generate liver cells that mimicked a broad range of liver diseases--the first time a patient’s liver diseases have been modeled using stem cells--and to create 'healthy' liver cells from the control group. The study improves the possibility that such liver cell programming can be used to produce new drugs or new cell-based treatments for liver disease. HBeAg Seroconversion from Antivirals Is Rarely Permanent Dutch researchers followed 132 HBeAg-positive patients who were treated with antivirals and experienced HBeAg seroconversion (loss of HBeAg and development of “e” antibodies) to see how sustained the response was. HBeAg seroconversion occurred in 46 of 132 patients, and researchers followed 42 of those who seroconverted over an average of 59 months. Thirty-three of 42 subjects (79%) continued antiviral treatment after seroconversion, and 67% of them experienced a resurgence in viral load. Nine of the 42 (21%) discontinued treatment about six months after HBeAg seroconversion. Only two patients who stopped treatment sustained their seroconversion and low viral load. “…HBeAg seroconversion by (antivirals) is temporary in most patients with chronic HBV infection,” they wrote in the August 2010 issue of Gastroenterology. “Long-term continuation of antiviral treatment, irrespective of the occurrence of HBeAg seroconversion, appears to be necessary.” Elevated cccDNA Levels in HBeAg-Negative Patients Indicates Active Liver Disease HBV’s covalently closed circular DNA (cccDNA) contributes to high rates of viral replication, and is also believed to contribute to development of liver cancer. Chinese researchers investigated the role cccDNA plays in HBeAg-negative disease progression. They monitored 33 HBeAg-negative patients, with and without active liver disease—which was defined as ALT rates of less than 40 IU/L and HBV DNA levels less than 10,000 copies/mL. They found a “significant” correlation between elevated HBV DNA and cccDNA levels—which resulted in active liver disease. They found no significant correlation between HBsAg and cccDNA. “The HBV replicative efficiency, defined as the ratio of HBV DNA to cccDNA, was approximately 20% higher in patients with active disease,” they wrote in the September 2010 issue of the Journal of Medical Virology. “In conclusion, serum HBV DNA, but not HBsAg, reflects the amount of cccDNA and the replication efficiency of HBV in patients with HBeAg-negative chronic hepatitis B.” Health Care Providers Inconsistently Use Gloves to Reduce Sharps Injuries A multinational team evaluated the effectiveness of glove usage in health care settings in preventing injury—and potential transmission of bloodborne diseases such as hepatitis B and C and HIV—from needle sticks and sharps. They studied 13 medical centers in the United States and Canada and surveyed 636 health care workers who had suffered a sharps injury on the job. Among the workers, 195 were in an operating room or procedure suite when injured, and 441 were injured elsewhere. Those outside operating rooms were more commonly gloved when treating patients who were perceived to have a high risk of HIV, HBV, or HCV infection than when treating patients who were not perceived as a risk. Nurses and other employees had lower gloved rates when injured than physicians and physician trainees. Gloves reduced injury risk markedly, and double-gloving reduced risk even more. “Although the use of gloves reduces the risk of sharps injuries in health care, use among health care workers is inconsistent and may be influenced by risk perception and health care culture,” researchers wrote in the Journal of Infection Control and Hospital Epidemiology. “Glove use should be emphasized as a key element of multimodal sharps’ injury reduction programs.” Hepatitis B Patients Twice as Likely to Develop Lymphoma People infected with hepatitis B virus are around twice as likely to develop non-Hodgkin lymphoma, according to a report published in Lancet Oncology. Lymphomas are cancers that develop in lymphocytes, a type of white blood cell. U.S. and Korean researchers studied the records of more than 600,000 people in South Korea, where hepatitis B is common. Of these, 53,000 or about 9% were infected with HBV. After 14 years, rates of non-Hodgkin lymphoma were more common among the HBV-infected people—at a rate of 19.4 cases per 100,000 HBV-infected people, compared to 12.3 per 100,000 uninfected people. Researchers think both hepatitis B and C may cause lymphoma by over-stimulating the immune system as it tries to fight the liver infection. Alpha Fetoprotein Could Be New Indicator When Treatment Is Needed Doctors continue to struggle to identify which HBeAg-negative patients need treatment. Korean doctors followed 152 HBeAg-negative patients, who had never been treated, who received liver biopsies to see if there were any common factors among those who needed treatment. They defined patients who required treatment as having ALT levels that were twice normal and HBV DNA levels greater than 2,000 IU/mL. They analyzed the patients’ test results to see if there was some other factor--other than biopsy results--that indicated when liver damage was occurring and treatment was warranted. They found that patients who meet the treatment criteria tended to be older than 52 and had alpha fetoprotein (AFP) levels greater than 7 µg/mL (up to 10 µg/L is considered normal). AFP levels historically have been used as a tumor marker--when AFP rates rise, liver tumors may be present. When ALT, HBV DNA, and AFP levels (higher than) 7 µg/mL are all combined to determine if treatment is needed, the accuracy for predicting when treatment is needed improves, they noted. “AFP level is associated with liver (damage) in HBeAg-negative chronic hepatitis B,” the researchers wrote in the September issue of the journal Liver International. The addition of an AFP level can serve as a “surrogate indicator” to identify patients who need antiviral treatment. Immunization of Infants Born to HBV-Positive Mothers Effective 93% of the Time Czech Republic researchers followed children born to HBsAg-positive women from birth into their teens to see how effective immediate immunization was in preventing mother-to-child transmission of HBV. They followed 640 newborns--29 were born to HBeAg-positive mothers and the rest were born to HBsAg-positive women. The immunization program included a dose of HBIG and immunization at birth, one and six months of age. Protective surface antibodies were found in 574 of 620 children (93%), and they persisted in 70%, 40%, and 25% of children at ages 5, 10 and 15. Two of the infants in the study developed chronic hepatitis B. Ten children were infected with HBV (with detectable core antibodies) between ages 3 to 15 years of age, but successfully fought off the infection. Natural “boosting” with surface antibodies through the immune system was detected in 38 children (twice in one child). “Our results show that combined active-passive immunization of newborns against hepatitis B provides persistent protection up to adolescence despite a frequent waning of surface antibodies, suggesting there is no need for booster vaccination during adolescence,” researchers wrote in the journal Infection. Antioxidants Appear to Have No Beneficial Impact on Liver Disease European researchers examined 20 randomized clinical trials, involving 1,225 patients, to see if antioxidants, including beta-carotene, vitamin A, C, E and selenium, had any positive impact on liver disease. They reported in the journal Alimentary Pharmacology & Therapeutics that the supplements had no significant effect on survival from a variety of liver diseases, including viral hepatitis. About Hepatitis | News Updates | Community & Support Resource Library | About HCSP | Contact Us | Site Map | Home (C) 2010. Hepatitis C Support Project a project of the Tides Center

医学

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Click for weather forecast McCallums focus on life's blessings Written by Jes-c Brandt From preschool teachers to grocery store clerks, people all around Holyoke have fallen in love with the infectious smile of Blye McCallum. He’s ornery, said his mom Andrea McCallum, but he’s a delight. Blye is being honored this year by the Living to Give V Campaign. Partnering with The Children’s Hospital, they will have a blood drive July 25. Accepting the honor, said Andrea, is one way to give back to the doctors and nurses that did so much for them at The Children’s Hospital. It’s a great hospital, and Blye’s family is grateful for all they’ve done. Now a healthy and lively 4-year-old, Blye was not always so lucky. Blye was born at Melissa Memorial Hospital April 26, 2005, but was there only four hours before Flight for Life took him to The Children’s Hospital. There they found he had a subdural hematoma and a subgaleal hematoma. As a result, Blye was experiencing seizures, and in order to stop them, he was given phenobarbital. Once given the phenobarbital, they knew he would be in the hospital for at least two weeks for it to be administered. Besides an expected release date, Gary and Andrea really didn’t know what to expect for their son’s future. Fortunately the treatment was effective, and the family was able to return home two weeks after Blye was born. Doctors warned there could be problems in the future, but at that point Andrea said they were focusing on their current victory. Four months into his life, however, Blye began to experience problems. He got very sick, and his parents took him back to The Children’s Hospital, where he stayed for a week. During his second stay, Blye was diagnosed with Cerebral Palsy. While there were no signs of CP in his initial CT scans, Andrea shared it is not uncommon for it to be diagnosed later. Right away Andrea and Gary began researching and meeting with metabolic specialists. After a battery of tests, it was confirmed Blye had no other disorders, news that came as a huge relief to the family. “At that point,” said Andrea, “we decided that whatever came our way, we’d meet it head on.” It was that attitude of determination, combined with immeasurable support from friends and family that got Blye and his parents through that first year. It was a tough year, recalled Andrea. There was a Failure to Thrive diagnosis, and Blye remained small. “He’s tough though,” said Andrea, with a smile, “and he made it through.” Living life to the fullest now Andrea said simply, “four years later, we’re still going along.” Blye’s grown physically, but more noticeable is the development of his fun and playful personality. “He’s just like any other 4-year-old,” shared Andrea. “He’s just trapped in a body that won’t cooperate.” Blye makes do with what he’s been given, though. While he can’t speak, communication is no problem. “His eyes will tell you what he can’t,” said his mother, Blye flashing a smile in agreement. He can tell you if he wants a drink or supper, if he’s happy or sad, or whether he agrees or disagrees just by looking at you. Where the family was met with uncertainty and nervousness in the first moments of Blye’s life, they now have routine and a higher level of predictability. They know, for example, that Blye will find great joy in playing with his puppy, Sady, or reading a book. Once a week they have physical therapy and occupational therapy. Monthly visits to The Children’s Hospital are still a part of Blye’s life, where he sees his rehab specialist and neurologist, but these visits are nothing like the frightening stays earlier in his life. And whenever Blye has friends at the hospital, they are sure to visit, said Andrea. Blye is living life like there is nothing out of the ordinary, and that’s how his parents want people to see him. He’s a kid that loves ice cream and the movie “Cars.” He went to preschool and loved it, and he’s just trying to be himself. “We want him to be included,” noted Andrea. “We don’t want him to be treated like a handicapped child or for people to be scared of him.” As Blye gets older, the family is doing their best to provide him with the tools to communicate. They plan to get an electric wheelchair soon and a device called the DynaVox eye gaze system. While Blye is already speaking volumes through his eyes, the DynaVox will allow him to communicate even more precisely. So much has happened since Blye was diagnosed with CP, but Andrea shared she will never forget the support she and her family had when Blye was born. Family dropped everything to be in Denver to support Gary and Andrea. Everyone really stepped up, she shared, and it would have been very difficult without friends and family during those trying times. “It’s cool to be able to rely on people,” said Andrea, remembering all those who have been supportive to them. “We knew they would help when we needed anything.” Of all the people Gary and Andrea are thankful for, they are most thankful for their beautiful son. “We have had struggles, and will continue to have struggles, but you just look at him and it’s worth it,” said a very proud mother, searching for the words to describe just how great her son is. Despite the hardships, they are focused on how good they have it. Of all the things that could have gone wrong, Andrea said, without hesitation, they don’t think they have such a bad deal. “We’re really glad this is all we have.” Aside from that first year, he’s basically a regular kid, and one year isn’t long at all in the grand scheme of things. Blye is loving life, and his parents are loving their time with him. This summer he’ll be spending his time doing what he loves: playing and charming all his adoring fans with his bright eyes and adorable smile.Living to Give honors BlyeBlye McCallum has been chosen as this year’s child to be honored by the Living to Give Campaign. Each year a blood drive is held in memory of Derek Dirks who died July 8, 2004 at the age of 38 of hemochromatosis, a rare blood disease. Organizers hope to honor those who have been affected by blood diseases, raise awareness and collect blood for others who are in need of transfusions. Living to Give V will be held Saturday, July 25, 8 a.m.-noon. The Children’s Hospital Blood Center’s Blood Donor Mobile will be located at the Phillips County Courthouse. Those who wish to donate should stop by the Flower Garden to reserve a time. Children’s Hospital relies on blood donations Every year at The Children’s Hospital, 8,000 units of blood products are transfused into sick and injured infants, children and teens. Without this blood, many of the lifesaving procedures performed at The Children’s Hospital would not be possible. Donated blood gives these children a better chance for a healthy life. The Children’s Hospital is partnering with Living to Give to take life saving blood donations from those who give. Those who may be eligible are those who: — are in good health — have not donated blood in the last 56 days — are symptom free of a cold or flu — are at least 18 years of age, or 17 with written parental consent — weigh at least 110 pounds — have not delivered a baby in the last six weeks — have no history of HIV/AIDS — have not had any tattoos or body piercings within the last year — have not traveled to a malaria risk area within the last year — answered a series of medical history/lifestyle questions to determine eligibility

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Clinical Trials Directory Clinical Research Administration Patient Registries Medical Student Summer Research Fellowship Policy on Conflicts of Interest in Research Activities Clinical trials are strictly controlled human studies of new and emerging therapies. At Hospital for Special Surgery, these trials incorporate state-of-the-art patient care, while carefully evaluating how best to apply the most recent innovations in orthopedics and rheumatology. The safety of study participants is our top priority. Clinical trials at Hospital for Special Surgery must first be approved by an Institutional Review Board (IRB), which includes doctors, administrators, ethicists, and members of the general public. The IRB provides continuing surveillance of the trial as well as periodic review of study results. Before a treatment can be tested in people, it must be shown to be safe and effective in laboratory and animal studies. Volunteers are fully informed of possible risks and sign a consent form before being accepted into a clinical trial. The safety and effectiveness of clinical trials are reviewed by the U.S. Food and Drug Administration. That agency determines if and when a clinical trial provides evidence that the treatment under study offers improvements in care that can be made available to all patients with a particular condition. Before enrolling in a clinical trial, you will undergo the informed consent process. At this time, the investigator will explain the purpose of the trial, its expected benefits, any possible risks or side effects, and what your role will be. This is the time to ask questions! If you want to join the trial, you must sign the informed consent documents. You can leave a clinical trial at any time without penalty.Learn more about the critical role of the HSS Institutional Review Board in protecting people who volunteer to participate in clinical trials. ClinicalTrials.gov provides regularly updated information about federally and privately supported clinical research in human volunteers. ClinicalTrials.gov gives you information about a trial's purpose, who may participate, locations, and phone numbers for more details. View Clinical Trials Clinical Trials by ConditionClinical Trials Directory Related Articles Lupus and APS Clinical Research at HSS Improving Outcomes Through Patient Registries HSS Research and Clinical Trials: Protecting People Who Volunteer to Participate

医学

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Home > Clinical Services > Brain (Neurology) Established in 1961, The Department of Neurology at Montefiore Medical Center is one of the largest and most innovative worldwide. Our mission is to combat each type of neurological disease through state-of-the-art treatments and therapies, technological advancements, and groundbreaking research, and our accomplished team of neurologists, neuropsychologists, neuropsychiatrists, rehabilitation physicians, physical and occupational therapists, nurses, nurse aids, biomedical scientists, basic science, translational research and clinical trials investigators, residents, and fellows works tirelessly towards this goal everyday. It is estimated that one in five Americans suffer from a neurological disease, but we believe this statistic can improve dramatically, not with pharmacological agents alone, but rather with early diagnosis and a smooth transition throughout each critical period of life. Unlike other facilities, our Department of Neurology distinguishes itself through the belief in the continuity of the lifespan, meaning the tracking and treating of any and all neurological diseases should be a seamless process from birth through the final era of life. Many patients lose the connectivity of care between pediatric, adult, and geriatric life stages. For example, numerous adults with borderline cases of Attention Deficit Disorder (ADD) or Autism are not diagnosed early on or occasionally are diagnosed and lose the follow-up treatment and translation required as they develop through adulthood. Brain function - and dysfunction - changes rapidly during development, but we are one of the few destinations that can treat patients each step of the way with the most advanced diagnostics and therapeutic modalities. That is why people from all over the globe, as well as from the New York metropolitan area, come to us for accurate diagnosis and individually tailored treatments and therapeutics. A Rich History of Innovation With nearly 50 years of experience at Montefiore Medical Center, our Department of Neurology has carved many 'firsts' into the history of this medical field. Some of our most noteworthy milestones include: The Sleep Wake Disorders Center was the first dedicated center in the world to be accredited by the American Sleep Disorders Association. Here sleep abnormalities ranging from sleepwalking to sleep deprivation, narcolepsy and numerous others are diagnosed and treated to fend off the ravages of a spectrum of neurological diseases such as Alzheimer's by promoting longevity with the proper therapeutics. The Headache Center, which is more than half a century old, was the first facility of its kind not only in the country, but also worldwide. The Multiple Sclerosis (MS) Clinical Care and Research Center was also the first of its kind in the world and has served as a model for many others that have followed. The Aging and Dementia Program, another first of its kind worldwide, is devoted to the best possible integrated patient care for those experiencing degenerative diseases such as Alzheimer's and Parkinson's diseases and laid the international foundation for all studies pertaining to the aging brain in health and disease. The Neuromuscular Disorder Center was one of the first clinics to treat a series of neuromuscular diseases ranging from early childhood through late adult life. The Epilepsy In-Patient Monitoring Unit is one of six specially designated centers in the state of New York. This world-class facility distinguishes itself among others, as it is proficient at treating infants, children, and adults within one unified program. Whether a patient had seizures as a child or began them as an adult, our monitoring unit will provide a diagnosis of the specific type of epilepsy and an integrated treatment strategy that no other facility can offer.

医学

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Most Young Kids Don’t Get Enough Exercise 11/27/2012 09:14 PM Most Young Kids Don’t Get Enough Exercise By Associated Press Most Young Kids Don’t Get Enough Exercise Survey Shows Children Aren’t Following Recommendations for Daily Physical Activity WebMD Medical News By Bill Hendrick Reviewed by Laura J. Martin, MD More... Most Young Kids Don’t Get Enough ExerciseSurvey Shows Children Aren’t Following Recommendations for Daily Physical ActivityWebMD Medical News Salt in Kids’ Diets Linked to High Blood PressureHigh Blood Pressure a Rising Risk for Kids, TeensOverweight Kids Risk High Blood PressureHigher Blood Pressure in Kids Whose Parents SmokeApril 14, 2011 -- About three out of four children ages 5 to 10 get less than one hour of physical activity daily, according to a new survey.The survey of more than 1,600 U.S. parents was conducted by the YMCA of the USA, also known as Y-USA.It showed that that 74% of children between the ages of 5 and 10 do not get enough exercise on a daily basis, based on the 60 minutes of daily physical activity recommended in the government’s Physical Activity Guidelines for Americans.Only 15% of the parents in the survey indicated that overall physical health is the top concern for their children, even though rates of childhood obesity have been climbing.The survey found that 52% of parents said they’d been forced to cut back, at least to some degree, on their children’s after-school activities, which are common ways for kids to get active playtime, in an effort to save money.Other findings from the survey:74% of parents say they choose to spend family time with their children sitting in front of a TV set.42% of parents say growing technological distractions, including social networks, computer games, and cell phones, are getting in the way of active play.53% say they spend leisure time with their kids playing video games, or otherwise on a computer.58% say their children ages 5 to 10 spend fewer than four days a week playing outdoors.42% of parents say they are more concerned with their children’s financial security than their physical activity; 50% of parents say families play a sport together less than once a week.38% of parents feel extracurricular activities are too expensive and 38% say there is not enough time in the day to achieve a healthy lifestyle for their kids.41% of parents say they are cutting back on extracurricular activities for their kids to save money for the family’s future.About 90% of parents say they provide a healthy home environment for their children, but 41% get 60 minutes of exercise less than one day a week.About 50% of children 5-10 are watching at least two hours of TV a day more than five days a week, and spending an hour in front of a computer three days a week. Parents Are Struggling FinanciallyLynne Vaughan, senior vice president and chief innovation officer at the YMCA, says officials realize that parents are struggling to find the time and resources to incorporate physical activity and healthier habits into the daily lives of their kids. But she points out that getting active does not necessarily require much time or money.The YMCA declared April 16 as Healthy Kids Day as a reminder to parents that health and well-being is essential for children, and being active can be as simple as scheduling a play date with their kids.“The Y is committed to improving our nation’s health and well-being,” says Neil Nicoll, president and CEO of Y-USA. “We know it takes a collective effort to combat the growing rates of obesity and chronic illness in this country.”He says the YMCA wants children, with parental help, “to start making healthier choices at home, so they can lead longer, healthier and happier lives.”Tips for FamiliesThe YMCA offers these tips for families to help them improve physical activity of their children:Make a play date with your youngsters, one that requires physical activity, such as charades.Dance. Have a dance contest.Go bike riding or inline skating. Make sure to wear a helmet.Visit a nearby park or camp out in the backyard and get everyone moving. SOURCES:News release, YMCA.YMCA’s Family Health Snapshot.Department of Health and Human Services: “Physical Activity Guidelines for Americans, 2008.”© 2011 WebMD, LLC. All rights reserved.

医学

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American College of Healthcare Execs Recognizes UNH’s Summer McGee Summer McGee WEST HAVEN, CONN. – In recognition of her contributions to the advancement of healthcare management, Summer McGee, associate professor of public management at the University of New Haven, has been awarded a Distinguished Faculty Healthcare Executive Regents Award by the American College of Healthcare Executives. The award recognizes ACHE members who have made significant contributions to the advancement of healthcare management excellence and the achievement of ACHE’s goals. McGee was named the “mentor of the year.” “There is no doubt,” said William M. Jennings, ACHE’s regent for Connecticut and president and CEO of Bridgeport (Conn.) Hospital, “that UNH is going to play an even bigger part in healthcare leadership in our state.” McGee said she was humbled and honored to be recognized and to have UNH singled out for its experiential opportunities for students in healthcare management, including a new UNH student chapter of ACHE devoted to linking healthcare executives to students. “The award reflects not only my, but also the University of New Haven’s, commitment to providing students opportunities to connect students with healthcare leaders in our region,” McGee said. Award winners are chosen based on leadership ability; innovative and creative management; executive capability in developing their own organization and promoting its growth and stature in the community; participation in local, state or provincial hospital and health association activities; participation in civic/community activities and projects; participation in ACHE activities; and interest in assisting ACHE in achieving its objectives. The award was presented to McGee by William M. Jennings at the group’s annual meeting last month in Plantsville, Conn. McGee has a Ph.D. in ethics and public health policy from the Johns Hopkins Bloomberg School of Public Health. The University of New Haven is a private, top-tier comprehensive institution recognized as a national leader in experiential education. Founded in 1920 the university enrolls approximately 1,800 graduate students and more than 4,600 undergraduates. News Releases, 2014-15

医学

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A Mother's Journey Spans Continents Martha Gonzalez Hopes to Persuade Ecuadorean Officials to Recognize PH Imagine that your son was born with not one but two life-threatening congenital diseases, then was diagnosed with pulmonary hypertension when he was only a year old. Martha Gonzalez knows this scenario only too well. Her son, Daniel Torres, has been living with these life threatening conditions for over five years. Martha has lived in the U.S. for more than 20 years, and now she is using her son’s example and all that she has learned about PH over the past five years to help other people in her native Ecuador. She is trying to convince officials in that country to add PH to the list of “catastrophic illnesses” for which the government-funded healthcare system will subsidize treatment. Daniel received an early diagnosis of congenital heart disease during Martha’s pregnancy and was born in 2005 at Columbia Presbyterian Hospital in Manhattan. Daniel also suffered from biliary atresia, an incurable, rare congenital liver disease caused by a blockage in the ducts that carry bile from the liver to the gall bladder. He underwent a liver transplant to reverse the damage when he was 6 months old. Then, after a month of testing when he was 1 year old, Daniel was diagnosed with PH at Children’s Hospital of Philadelphia — a two-hour, nearly 100-mile trip from the family’s home in North Bergen, N.J. By the age of 5, Daniel had undergone a total of six major surgeries, including two open-heart surgeries. Martha and the rest of the family — Daniel’s father Carlos; brother Sergio, 19; and sister Mia, 4 — were devastated at first. “When we heard about PH, the only word that kept repeating in my mind was ‘incurable,’ since Daniel had the liver transplant to cure his liver disease,” Martha says. “I knew how hard those moments were for us. I felt so hopeless at that time to know that he had to fight another incurable disease at his young age. It was a very fearful time for our family.” Turning fear into action When Daniel was diagnosed, rather than become immobilized by self-pity, the family met the challenges head-on and completely changed their way of life to become Daniel’s caregivers and closest allies. “My husband Carlos took a night job so he is available during the day for any emergency,” Martha explains. “He also studied to become an emergency medical technician so he could be prepared to help Daniel in any case of emergency.” “We as a family have become closer than ever,” Martha says. For example, “when we go to clinic, my oldest son Sergio takes care of my youngest, Mia. Sergio is considered a third caregiver of Daniel — knowing all about PH, always asking about it. He also knows the doses of his medications and schedule.” Martha has maintained close ties with friends and family in Ecuador as well, which led her to launch a campaign to educate physicians about PH in that country. “My involvement with the Ecuador government is related to an awareness project that I have planned with countries in South America,” Martha says. “I began with Ecuador because I am originally from there.” The Ecuadorean embassy helped to arrange a visit in May with the directors of cardiology at Hospital Clinica Kennedy, Hospital Pediatrico Leon Becerra, and Hospital de Niños Dr. Roberto Gilbert Elizalde. “Groups of physicians invited me to sit with them in rounds, during diagnosis of patients, and also showed me their advanced cath labs,” Martha says. During those meetings, she was able to give the physicians informational material in Spanish regarding the disease. PHA provided her with material such as Pulmonary Hypertension: A Patient's Survival Guide, the medical journal Advances in Pulmonary Hypertension and information on the international seed grant program. “My impression was that all these physicians were very interested in PH,” she says. “Although some had heard of it, one hospital never had any case of it. In the pediatric centers, my visit coincided with the recent diagnosis of two children with PH.” Martha adds that she is pleased with the response of the physicians she visited, who are interested in coming to PHA’s 2012 International PH Conference and getting actively involved in the PH journey. Obstacles along the way Martha says she was “amazed” to discover that the only PH drug administered in Ecuador is sildenafil. As she began working to change government policy by communicating with Ecuadorean health officials, Martha encountered a number of obstacles. “I did my research and found that there was a list of catastrophic illnesses in Ecuador that included heart malformation and cardiac valve disease,” she recalls. “I called and emailed the authorities to inquire if PH could be included in this list, and they said only if the cardiac malformation causes PH at some point, as if it was secondary PH. I specifically asked what if it is genetic PH, and the answer was no. This disappointed me because if all cancers were included in this list, then why not PH? PH is incurable and, without treatment, is fatal.” She presented the example that if a person was born with no heart malformation and developed cancer later in life, treatment of the illness could be subsidized by the government. However, if a person was born with no heart malformation and 20 years later developed PH due to a mutation of one of his genes, then why could this person’s care not be subsidized? Martha is currently working with PHA on how best to approach the medical establishment and win the battle so PH can be included in this list. “My goal is to put the word out there, be a mom ‘on the road,’” she says. “I will fight for my own country’s PH patients, and after that, I would love to move on to the rest of the countries in South America. I believe that the only way to have subsidized help for the expensive therapies for PH is by including PH in the catastrophic illnesses lists of these countries, especially in healthcare systems funded by governments.” PHA is fighting right alongside Martha in her efforts, targeting many of its education and awareness efforts to a global audience of medical professionals. Worldwide, PHA distributes 44,000 copies of Advances in Pulmonary Hypertension, a medical journal put together by leaders in the PH field, to cardiologists, pulmonologists, rheumatologists and other healthcare professionals. It also offers online resources such as PHA Online University, which is an educational resource for healthcare professionals interested in learning about the latest information in the field of PH. Hope for a cure Martha says that even though her son Daniel is just beginning to comprehend what’s going on with his health, she is thankful for their private insurance and the daily medications that allow him to be just like any other 5-year-old boy who loves to run, jump, swim, play Wii and watch SpongeBob SquarePants. She wants people in other countries to experience this same care. “We enjoy every day with Daniel,” she says. “We feel we are blessed to have found a great PH pediatric center and PHA. We feel that PHA is our security blanket; if we have any questions, we just call PHA and there is always help there for us. Not all is bad for us. PH has brought out the best of us as human beings. We no longer feel hopeless, we now feel hopeful for the cure.”

医学

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| SITE MAP | ABOUT PNHP | CONTACT US | LINKS PNHP RESOURCES Latest NewsQuote of the DayArticles of InterestUpdated Daily! PNHP Blog From the States PNHP Research PNHP Proposals Single-Payer Resources New to Single-Payer? Frequently Asked Questions Lobbying Materials Write a letter to your representative Schedule a Grand Rounds Endorse HR676 PNHP Community MultimediaSlideshows PNHP Student Forum Sign up for PNHP's E-Alerts * Unsubscribe from list? Special Message to the Congress Recommending a Comprehensive Health Program PRINT PAGE EN ESPAÑOL By HARRY S. TRUMAN To the Congress of the United States: In my message to the Congress of September 6, 1945, there were enumerated in a proposed Economic Bill of Rights certain rights which ought to be assured to every American citizen. One of them was: “The right to adequate medical care and the opportunity to achieve and enjoy good health.” Another was the “right to adequate protection from the economic fears of . .. sickness .…” Millions of our citizens do not now have a full measure of opportunity to achieve and enjoy good health. Millions do not now have protection or security against the economic effects of sickness. The time has arrived for action to help them attain that opportunity and that protection. The people of the United States received a shock when the medical examinations conducted by the Selective Service System revealed the widespread physical and mental incapacity among the young people of our nation. We had had prior warnings from eminent medical authorities and from investigating committees. The statistics of the last war had shown the same condition. But the Selective Service System has brought it forcibly to our attention recently—in terms which all of us can understand. As of April 1, 1945, nearly 5,000,000 male registrants between the ages of 18 and 37 had been examined and classified as unfit for military service. The number of those rejected for military service was about 30 percent of all those examined. The percentage of rejection was lower in the younger age groups, and higher in the higher age groups, reaching as high as 49 percent for registrants between the ages of 34 and 37- In addition, after actual induction, about a million and a half men had to be discharged from the Army and Navy for physical or mental disability, exclusive of wounds; and an equal number had to be treated in the Armed Forces for diseases or defects which existed before induction. Among the young women who applied for admission to the Women’s Army Corps there was similar disability. Over one-third of those examined were rejected for physical or mental reasons. These men and women who were rejected for military service are not necessarily incapable of civilian work. It is plain, however, that they have illnesses and defects that handicap them, reduce their working capacity, or shorten their lives. It is not so important to search the past in order to fix the blame for these conditions. It is more important to resolve now that no American child shall come to adult life with diseases or defects which can be prevented or corrected at an early age. Medicine has made great strides in this generation—especially during the last four years. We owe much to the skill and devotion of the medical profession. In spite of great scientific progress, however, each year we lose many more persons from preventable and premature deaths than we lost in battle or from war injuries during the entire war. We are proud of past reductions in our death rates. But these reductions have come principally from public health and other community services. We have been less effective in making available to all of our people the benefits of medical progress in the care and treatment of individuals. In the past, the benefits of modern medical science have not been enjoyed by our citizens with any degree of equality. Nor are they today. Nor will they be in the future—unless government is bold enough to do something about it. People with low or moderate incomes do not get the same medical attention as those with high incomes. The poor have more sickness, but they get less medical care. People who live in rural areas do not get the same amount or quality of medical attention as those who live in our cities. Our new Economic Bill of Rights should mean health security for all, regardless of residence, station, or race—everywhere in the United States. We should resolve now that the health of this Nation is a national concern; that financial barriers in the way of attaining health shall be removed; that the health of all its citizens deserves the help of all the Nation. There are five basic problems which we must attack vigorously if we would reach the health objectives of our Economic Bill of Rights. n The first has to do with the number and distribution of doctors and hospitals. One of the most important requirements for adequate health service is professional personnel—doctors, dentists, public health and hospital administrators, nurses and other experts. The United States has been fortunate with respect to physicians. In proportion to population it has more than any large country in the world, and they are well trained for their calling. It is not enough, however, that we have them in sufficient numbers. They should be located where their services are needed. In this respect we are not so fortunate. The distribution of physicians in the United States has been grossly uneven and unsatisfactory. Some communities have had enough or even too many; others have had too few. Year by year the number in our rural areas has been diminishing. Indeed, in 1940, there were 31 counties in the United States, each with more than a thousand inhabitants, in which there was not a single practicing physician. The situation with respect to dentists was even worse. One important reason for this disparity is that in some communities there are no adequate facilities for the practice of medicine. Another reason—closely allied with the first—is that the earning capacity of the people in some communities makes it difficult if not impossible for doctors who practice there to make a living. The demobilization of 60,000 doctors, and of the tens of thousands of other professional personnel in the Armed Forces is now proceeding on a large scale. Unfortunately, unless we act rapidly, we may expect to see them concentrate in the places with greater financial resources and avoid other places, making the inequalities even greater than before the war. Demobilized doctors cannot be assigned. They must be attracted. In order to be attracted, they must be able to see ahead of them professional opportunities and economic assurances. Inequalities in the distribution of medical personnel are matched by inequalities in hospitals and other health facilities. Moreover, there are just too few hospitals, clinics and health centers to take proper care of the people of the United States. About 1,200 counties, 40 percent of the total in the country, with some 15,000,000 people, have either no local hospital, or none that meets even the minimum standards of national professional associations. The deficiencies are especially severe in rural and semirural areas and in those cities where changes in population have placed great strains on community facilities. I want to emphasize, however, that the basic problem in this field cannot be solved merely by building facilities. They have to be staffed; and the communities have to be able to pay for the services. Otherwise the new facilities will be little used. 2. The second basic problem is the need for development of public health services and maternal and child care. The Congress can be justifiably proud of its share in making recent accomplishments possible. Public health and maternal and child health programs already have made important contributions to national health. But large needs remain. Great areas of our country are still without these services. This is especially true among our rural areas; but it is true also in far too many urban communities. Although local public health departments are now maintained by some 18,000 counties and other local units, many of these have only skeleton organizations, and approximately 40,000,000 citizens of the United States still live in communities lacking full-time local public health service. At the recent rate of progress in developing such service, it would take more than a hundred years to cover the whole Nation. If we agree that the national health must be improved, our cities, towns and farming communities must be made healthful places in which to live through provision of safe water systems, sewage disposal plants and sanitary facilities. Our streams and rivers must be safeguarded against pollution. In addition to building a sanitary environment for ourselves and for our children, we must provide those services which prevent disease and promote health. Services for expectant mothers and for infants, care of crippled or otherwise physically handicapped children and inoculation for the prevention of communicable diseases are accepted public health functions. So too are many kinds of personal services such as the diagnosis and treatment of widespread infections like tuberculosis and venereal disease. A large part of the population today lacks many or all of these services. Our success in the traditional public health sphere is made plain by the conquest over many communicable diseases. Typhoid fever, smallpox, and diphtheria—diseases for which there are effective controls-have become comparatively rare. We must make the same gains in reducing our maternal and infant mortality, in controlling tuberculosis, venereal disease, malaria, and other major threats to life and health. We are only beginning to realize our potentialities in achieving physical well-being for all our people. 3. The third basic problem concerns medical research and professional education. We have long recognized that we cannot be content with what is already known about health or disease. We must learn and understand more about health and how to prevent and cure disease. Research—well directed and continuously supported—can do much to develop ways to reduce those diseases of body and mind which now cause most sickness, disability, and premature death—diseases of the heart, kidneys and arteries, rheumatism, cancer, diseases of childbirth, infancy and childhood, respiratory diseases and tuberculosis. And research can do much toward teaching us how to keep well and how to prolong healthy human life. Cancer is among the leading causes of death. It is responsible for over 160,000 recorded deaths a year, and should receive special attention. Though we already have the National Cancer Institute of the Public Health Service, we need still more coordinated research on the cause, prevention and cure of this disease. We need more financial support for research and to establish special clinics and hospitals for diagnosis and treatment of the disease especially in its early stages. We need to train more physicians for the highly specialized services so essential for effective control of cancer. There is also special need for research on mental diseases and abnormalities. We have done pitifully little about mental illnesses. Accurate statistics are lacking, but there is no doubt that there are at least two million persons in the United States who are mentally ill, and that as many as ten million will probably need hospitalization for mental illness for some period in the course of their lifetime. A great many of these persons would be helped by proper care. Mental cases occupy more than one-half of the hospital beds, at a cost of about 500 million dollars per year—practically all of it coming out of taxpayers’ money. Each year there are 125,000 new mental cases admitted to institutions. We need more mental-disease hospitals, more out-patient clinics. We need more services for early diagnosis, and especially we need much more research to learn how to prevent mental breakdown. Also, we must have many more trained and qualified doctors in this field. It is clear that we have not done enough in peace-time for medical research and education in view of our enormous resources and our national interest in health progress. The money invested in research pays enormous dividends. If any one doubts this, let him think of penicillin, plasma, DDT powder, and new rehabilitation techniques. 4. The fourth problem has to do with the high cost of individual medical care. The principal reason why people do not receive the care they need is that they cannot afford to pay for it on an individual basis at the time they need it. This is true not only for needy persons. It is also true for a large proportion of normally self-supporting persons. In the aggregate, all health services—from public health agencies, physicians, hospitals, dentists, nurses and laboratories—absorb only about 4 percent of the national income. We can afford to spend more for health. But four percent is only an average. It is cold comfort in individual cases. Individual families pay their individual costs, and not average costs. They may be hit by sickness that calls for many times the average cost—in extreme cases for more than their annual income. When this happens they may come face to face with economic disaster. Many families, fearful of expense, delay calling the doctor long beyond the time when medical care would do the most good. For some persons with very low income or no income at all we now use taxpayers’ money in the form of free services, free clinics, and public hospitals. Tax-supported, free medical care for needy persons, however, is insufficient in most of our cities and in nearly all of our rural areas. This deficiency cannot be met by private charity or the kindness of individual physicians. Each of us knows doctors who work through endless days and nights, never expecting to be paid for their services because many of their patients are unable to pay. Often the physician spends not only his time and effort, but even part of the fees he has collected from patients able to pay, in order to buy medical supplies for those who cannot afford them. I am sure that there are thousands of such physicians throughout our country. They cannot, and should not, be expected to carry so heavy a load. 5. The fifth problem has to do with loss of earnings when sickness strikes. Sickness not only brings doctor bills; it also cuts off income. On an average day, there are about 7 million persons so disabled by sickness or injury that they cannot go about their usual tasks. Of these, about 3 1/4 millions are persons who, if they were not disabled, would be working or seeking employment. More than one-half of these disabled workers have already been disabled for six months; many of them will continue to be disabled for years, and some for the remainder of their lives. Every year, four or five hundred million working days are lost from productive employment because of illness and accident among those working or looking for work—about forty times the number of days lost because of strikes on the average during the ten years before the war. About nine-tenths of this enormous loss is due to illness and accident that is not directly connected with employment, and is therefore not covered by workmen’s compensation laws. These then are the five important problems which must be solved, if we hope to attain our objective of adequate medical care, good health, and protection from the economic fears of sickness and disability. To meet these problems, I recommend that the Congress adopt a comprehensive and modern health program for the Nation, consisting of five major parts—each of which contributes to all the others. FIRST: CONSTRUCTION OF HOSPITALS AND RELATED FACILITIES The Federal Government should provide financial and other assistance for the construction of needed hospitals, health centers and other medical, health, and rehabilitation facilities. With the help of Federal funds, it should be possible to meet deficiencies in hospital and health facilities so that modern services—for both prevention and cure—can be accessible to all the people. Federal financial aid should be available not only to build new facilities where needed, but also to enlarge or modernize those we now have. In carrying out this program, there should be a clear division of responsibilities between the States and the Federal Government. The States, localities and the Federal Government should share in the financial responsibilities. The Federal Government should not construct or operate these hospitals. It should, however, lay down minimum national standards for construction and operation, and should make sure that Federal funds are allocated to those areas and projects where Federal aid is needed most. In approving state plans and individual projects, and in fixing the national standards, the Federal agency should have the help of a strictly advisory body that includes both public and professional members. Adequate emphasis should be given to facilities that are particularly useful for prevention of diseases—mental as well as physical—and to the coordination of various kinds of facilities. It should be possible to go a long way toward knitting together facilities for prevention with facilities for cure, the large hospitals of medical centers with the smaller institutions of surrounding areas, the facilities for the civilian population with the facilities for veterans. The general policy of Federal-State partnership which has done so much to provide the magnificent highways of the United States can be adapted to the construction of hospitals in the communities which need them. SECOND: EXPANSION OF PUBLIC HEALTH, MATERNAL AND CHILD HEALTH Our programs for public health and related services should be enlarged and strengthened. The present Federal-State cooperative health programs deal with general public health work, tuberculosis and venereal disease control, maternal and child health services, and services for crippled children. These programs were especially developed in the ten years before the war, and have been extended in some areas during the war. They have already made important contributions to national health, but they have not yet reached a large proportion of our rural areas, and, in many cities, they are only partially developed. No area in the Nation should continue to be without the services of a full-time health officer and other essential personnel. No area should be without essential public health services or sanitation facilities. No area should be without community health services such as maternal and child health care. Hospitals, clinics and health centers must be built to meet the needs of the total population, and must make adequate provision for the safe birth of every baby, and for the health protection of infants and children. Present laws relating to general public health, and to maternal and child health, have built a solid foundation of Federal cooperation with the States in administering community health services. The emergency maternity and infant care program for the wives and infants of servicemen—a great wartime service authorized by the Congress—has materially increased the experience of every State health agency, and has provided much-needed care. So too have other wartime programs such as venereal disease control, industrial hygiene, malaria control, tuberculosis control and other services offered in war essential communities. The Federal Government should cooperate by more generous grants to the States than are provided under present laws for public health services and for maternal and child health care. The program should continue to be partly financed by the States themselves, and should be administered by the States. Federal grants should be in proportion to State and local expenditures, and should also vary in accordance with the financial ability of the respective States. The health of American children, like their education, should be recognized as a definite public responsibility. In the conquest of many diseases prevention is even more important than cure. A well-rounded national health program should, therefore, include systematic and wide-spread health and physical education and examinations, beginning with the youngest children and extending into community organizations. Medical and dental examinations of school children are now inadequate. A preventive health program, to be successful, must discover defects as early as possible. We should, therefore, see to it that our health programs are pushed most vigorously with the youngest section of the population. Of course, Federal aid for community health services—for general public health and for mothers and children—should complement and not duplicate prepaid medical services for individuals, proposed by the fourth recommendation of this message. THIRD; MEDICAL EDUCATION AND RESEARCH The Federal Government should undertake a broad program to strengthen professional education in medical and related fields, and to encourage and support medical research. Professional education should be strengthened where necessary through Federal grants-in-aid to public and to non-profit private institutions. Medical research, also, should be encouraged and supported in the Federal agencies and by grants-in-aid to public and non-profit private agencies. In my message to the Congress of September 6, 1945, I made various recommendations for a general Federal research program. Medical research—dealing with the broad fields of physical and mental illnesses-should be made effective in part through that general program and in part through specific provisions within the scope of a national health program. Federal aid to promote and support research in medicine, public health and allied fields is an essential part of a general research program to be administered by a central Federal research agency. Federal aid for medical research and education is also an essential part of any national health program, if it is to meet its responsibilities for high grade medical services and for continuing progress. Coordination of the two programs is obviously necessary to assure efficient use of Federal funds. Legislation covering medical research in a national health program should provide for such coordination. FOURTH: PREPAYMENT OF MEDICAL COSTS Everyone should have ready access to all necessary medical, hospital and related services. I recommend solving the basic problem by distributing the costs through expansion of our existing compulsory social insurance system. This is not socialized medicine. Everyone who carries fire insurance knows how the law of averages is made to work so as to spread the risk, and to benefit the insured who actually suffers the loss. If instead of the costs of sickness being paid only by those who get sick, all the people—sick and well—were required to pay premiums into an insurance fund, the pool of funds thus created would enable all who do fall sick to be adequately served without overburdening anyone. That is the principle upon which all forms of insurance are based. During the past fifteen years, hospital insurance plans have taught many Americans this magic of averages. Voluntary health insurance plans have been expanding during recent years; but their rate of growth does not justify the belief that they will meet more than a fraction of our people’s needs. Only about 3% or 4% of our population now have insurance providing comprehensive medical care. A system of required prepayment would not only spread the costs of medical care, it would also prevent much serious disease. Since medical bills would be paid by the insurance fund, doctors would more often be consulted when the first signs of disease occur instead of when the disease has become serious. Modern hospital, specialist and laboratory services, as needed, would also become available to all, and would improve the quality and adequacy of care. Prepayment of medical care would go a long way toward furnishing insurance against disease itself, as well as against medical bills. Such a system of prepayment should cover medical, hospital, nursing and laboratory services. It should also cover dental care—as fully and for as many of the population as the available professional personnel and the financial resources of the system permit. The ability of our people to pay for adequate medical care will be increased if, while they are well, they pay regularly into a common health fund, instead of paying sporadically and unevenly when they are sick. This health fund should be built up nationally, in order to establish the broadest and most stable basis for spreading the costs of illness, and to assure adequate financial support for doctors and hospitals everywhere. If we were to rely on state-by-state action only, many years would elapse before we had any general coverage. Meanwhile health service would continue to be grossly uneven, and disease would continue to cross state boundary lines. Medical services are personal. Therefore the nation-wide system must be highly decentralized in administration. The local administrative unit must be the keystone of the system so as to provide for local services and adaptation to local needs and conditions. Locally as well as nationally, policy and administration should be guided by advisory committees in which the public and the medical professions are represented. Subject to national standards, methods and rates of paying doctors and hospitals should be adjusted locally. All such rates for doctors should be adequate, and should be appropriately adjusted upward for those who are qualified specialists. People should remain free to choose their own physicians and hospitals. The removal of financial barriers between patient and doctor would enlarge the present freedom of choice. The legal requirement on the population to contribute involves no compulsion over the doctor’s freedom to decide what services his patient needs. People will remain free to obtain and pay for medical service outside of the health insurance system if they desire, even though they are members of the system; just as they are free to send their children to private instead of to public schools, although they must pay taxes for public schools. Likewise physicians should remain free to accept or reject patients. They must be allowed to decide for themselves whether they wish to participate in the health insurance system full time, part time, or not at all. A physician may have some patients who are in the system and some who are not. Physicians must be permitted to be represented through organizations of their own choosing, and to decide whether to carry on in individual practice or to join with other doctors in group practice in hospitals or in clinics. Our voluntary hospitals and our city, county and state general hospitals, in the same way, must be free to participate in the system to whatever extent they wish. In any case they must continue to retain their administrative independence. Voluntary organizations which provide health services that meet reasonable standards of quality should be entitled to furnish services under the insurance system and to be reimbursed for them. Voluntary cooperative organizations concerned with paying doctors, hospitals or others for health services, but not providing services directly, should be entitled to participate if they can contribute to the efficiency and economy of the system. None of this is really new. The American people are the most insurance-minded people in the world. They will not be frightened off from health insurance because some people have misnamed it “socialized medicine”. I repeat—what I am recommending is not socialized medicine. Socialized medicine means that all doctors work as employees of government. The American people want no such system. No such system is here proposed. Under the plan I suggest, our people would continue to get medical and hospital services just as they do now—on the basis of their own voluntary decisions and choices. Our doctors and hospitals would continue to deal with disease with the same professional freedom as now. There would, however, be this all-important difference: whether or not patients get the services they need would not depend on how much they can afford to pay at the time. I am in favor of the broadest possible coverage for this insurance system. I believe that all persons who work for a living and their dependents should be covered under such an insurance plan. This would include wage and salary earners, those in business for themselves, professional persons, farmers, agricultural labor, domestic employees, government employees and employees of non-profit institutions and their families. In addition, needy persons and other groups should be covered through appropriate premiums paid for them by public agencies. Increased Federal funds should also be made available by the Congress under the public assistance programs to reimburse the States for part of such premiums, as well as for direct expenditures made by the States in paying for medical services provided by doctors, hospitals and other agencies to needy persons. Premiums for present social insurance benefits are calculated on the first $3,000 of earnings in a year. It might be well to have all such premiums, including those for health, calculated on a somewhat higher amount such as $3,600. A broad program of prepayment for medical care would need total amounts approximately equal to 4% of such earnings. The people of the United States have been spending, on the average, nearly this percentage of their incomes for sickness care. How much of the total fund should come from the insurance premiums and how much from general revenues is a matter for the Congress to decide. The plan which I have suggested would be sufficient to pay most doctors more than the best they have received in peacetime years. The payments of the doctors’ bills would be guaranteed, and the doctors would be spared the annoyance and uncertainty of collecting fees from individual patients. The same assurance would apply to hospitals, dentists and nurses for the services they render. Federal aid in the construction of hospitals will be futile unless there is current purchasing power so that people can use these hospitals. Doctors cannot be drawn to sections which need them without some assurance that they can make a living. Only a nation-wide spreading of sickness costs can supply such sections with sure and sufficient purchasing power to maintain enough physicians and hospitals. We are a rich nation and can afford many things. But ill-health which can be prevented or cured is one thing we cannot afford. FIFTH: PROTECTION AGAINST LOSS OF WAGES FROM SICKNESS AND DISABILITY What I have discussed heretofore has been a program for improving and spreading the health services and facilities of the Nation, and providing an efficient and less burdensome system of paying for them. But no matter what we do, sickness will of course come to many. Sickness brings with it loss of wages. Therefore, as a fifth element of a comprehensive health program, the workers of the Nation and their families should be protected against loss of earnings because of illness. A comprehensive health program must include the payment of benefits to replace at least part of the earnings that are lost during the period of sickness and long-term disability. This protection can be readily and conveniently provided through expansion of our present social insurance system, with appropriate adjustment of premiums. Insurance against loss of wages from sickness and disability deals with cash benefits, rather than with services. It has to be coordinated with the other cash benefits under existing social insurance systems. Such coordination should be effected when other social security measures are reexamined. I shall bring this subject again to the attention of the Congress in a separate message on social security. I strongly urge that the Congress give careful consideration to this program of health legislation now. Many millions of our veterans, accustomed in the armed forces to the best of medical and hospital care, will no longer be eligible for such care as a matter of right except for their service-connected disabilities. They deserve continued adequate and comprehensive health service. And their dependents deserve it too. By preventing illness, by assuring access to needed community and personal health services, by promoting medical research, and by protecting our people against the loss caused by sickness, we shall strengthen our national health, our national defense, and our economic productivity. We shall increase the professional and economic opportunities of our physicians, dentists and nurses. We shall increase the effectiveness of our hospitals and public health agencies. We shall bring new security to our people. We need to do this especially at this time because of the return to civilian life of many doctors, dentists and nurses, particularly young men and women. Appreciation of modern achievements in medicine and public health has created widespread demand that they be fully applied and universally available. By meeting that demand we shall strengthen the Nation to meet future economic and social problems; and we shall make a most important contribution toward freedom from want in our land. Provided courtesy of The American Presidency Project. John Woolley and Gerhard Peters. University of California, Santa Barbara. Physicians for a National Health Program 29 E Madison Suite 602, Chicago, IL 60602Phone (312) 782-6006 | Fax: (312) 782-6007 | email: info@pnhp.org © PNHP 2009 Privacy Policy ¤ Find us on a mapProblems with the website? Contact our webmaster

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Wellness Center | Women's Center Home > Health Library > ADHD in Childhood May Raise Risk for Obesity in Adulthood ADHD in Childhood May Raise Risk for Obesity in Adulthood MONDAY, May 20 (HealthDay News) -- Boys who are diagnosed with attention deficit-hyperactivity disorder (ADHD) are twice as likely to become obese adults as those who didn't have the disorder when they were young, a new 30-year study shows. Researchers found that men with childhood ADHD tended to have a higher body-mass index (BMI) and obesity, even if they no longer had symptoms of the disorder. Socioeconomics made no difference; well-off or poor, they tended toward obesity. "The bottom line is, boys who were hyperactive when followed up for more than 30 years turn out to be more likely to be obese than comparable kids from their same communities," said study co-author Dr. Francisco Xavier Castellanos, a professor of child and adolescent psychiatry in the Child Study Center at NYU Langone Medical Center in New York City. "That really seems to be reflective of their early hyperactivity. It doesn't matter what their current diagnosis is so much, so we think these are longstanding issues that likely arose in early adolescence," he added. A lack of impulse control and poor planning skills, symptoms often associated with ADHD, could lead to poor eating habits and food choices as well as the tendency to overeat, the study authors speculated. "It fits with other studies, and suggests that the inability to control one's impulses, the tendency to be relatively reward-driven, may represent a risk of obesity over time," Castellanos said. The study, published online May 20 and in the June print issue of Pediatrics, tracked 111 men diagnosed with childhood hyperactivity, touching base with them at ages 18, 25 and 41. By adulthood, 41 percent had become obese, compared with a non-hyperactive control group that had a 22 percent obesity rate. The results are somewhat confounding, Castellanos said. "The pattern of results to a certain extent was counterintuitive," he said. "We thought we would get the strongest effect in those men who manifested ADHD as adults, and that wasn't the case. That suggests that it's not something that is very tightly related to the current diagnosis, but the tendency to have the diagnosis." The findings run counter to an earlier study that showed that hyperactive adult men had a greater tendency for obesity than men who left childhood ADHD behind, said Dr. Craig Surman, scientific coordinator for the Adult ADHD Research Program at Massachusetts General Hospital in Boston. "So, the simple story here would be we don't know, because you have to replicate studies to know," he said. "The question now becomes why the findings are different." Future research also needs to consider whether women with childhood ADHD are as likely as men with childhood ADHD to become obese, and whether controlling hyperactivity through the use of medication can have an impact, Surman said. ADHD is more common in boys than girls, with 12 percent of U.S. boys aged 3 to 17 receiving the diagnosis, according to the U.S. Centers for Disease Control and Prevention. The link between ADHD and obesity has become a topic of great interest as elevated rates of obesity have been reported in children with the disorder, Surman said. Obesity can lead to heart disease and diabetes later in life. "It's very important to understand the ways ADHD affects life and self-care," Surman said. "We've known for some time that it's not just people's desks and houses that are messy. For some people, it's a lack of ability to control how to care for themselves as well." The U.S. National Institutes of Health has tips for healthy weight loss. SOURCES: Francisco Xavier Castellanos, M.D., Brooke and Daniel Neidich Professor of Child and Adolescent Psychiatry, Child Study Center, NYU Langone Medical Center, New York City; Craig Surman, M.D., scientific coordinator, Adult ADHD Research Program, Massachusetts General Hospital, Boston; June 2013 Pediatrics

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Search Our MissionHow We Help How We Measure Success Our ExpertsSabin Gold Medal Award Our ProgramsGlobal Network Vaccine Advocacy and Education Vaccine Development You are hereHome › Coalition against Typhoid (CaT) featured in The Lancet EventsGold Medal AwardSelection Process Submitted by Sabin on Fri, 2012-02-24 00:00 February 24, 2012 | The LancetA recent expert meeting on typhoid epidemiological modeling, organized by the Coalition against Typhoid, marks one of the first attempts to jolt governments into action against typhoid fever, a disease that is thriving largely unnoticed in many developing countries.John Maurice reports on the issue in this month's edition of The Lancet. In the article he interviews Chris Nelson, director of the Coalition against Typhoid (CaT) secretariat at the Sabin Vaccine Institute, Jeremy Farrar, professor of tropical medicine and director of the Oxford University Clinical Research Unit in Vietnam, Zulfiqar Bhutta, founding chair of the Women and Child Health Division at the Aga Khan University in Karachi, Pakistan, and Seth Berkley, CEO of the GAVI Alliance.A first step in bringing typhoid fever out of the closetThe Lancet. Vol 379 February 25, 2012Whoever invented the phrase “out of sight, out of mind” must have been thinking of typhoid fever. With the exception of a few hardy travelers, the disease has dropped out of sight and out of mind in the rich countries of the world. Gone are the days when the disease decimated armies and rampaged through the filthy streets of 19th century London, New York, and other large cities of the western world, taking the lives of rich and poor alike. Today, it is the poor, the poorest of the poor, living in the slums of the developing world, who bear the full brunt of the mortality and morbidity—216 000 deaths and about 21 million cases a year—wrought by Salmonella typhi. The bacillus infects mainly children. Its hunting grounds cover a vast swathe of the globe, spanning Asia, Africa, and Latin America (figure). Three countries— Pakistan, India, and Bangladesh— together account for about 85% of the world’s cases.The main problem with typhoid fever is that it has dropped out of the minds of the international health community and, sadly, also of the many health officials of the developing countries where the disease is rife. “The disease”, says Chris Nelson, who heads the Coalition against Typhoid (CaT) secretariat at the Sabin Vaccine Institute in Washington, DC, USA, “has become so omnipresent in the developing world as to be invisible”.Access the full article here. Related Updates The Coalition against Typhoid Launches New Website Read more Leaders in Fight Against Typhoid Express Hope in Light of New Vaccines Read more Related Events 8th International Conference on Typhoid Fever and Other Invasive Salmonelloses03.01.13 to 03.02.13Dhaka, Bangladesh View event + Our MissionHow We Help © 2014 • Sabin Vaccine Institute • 2000 Pennsylvania Ave, NW, Suite 7100 • Washington, DC 20006 • t. (202) 842-5025

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'Plugged-In' Teens Vulnerable in Traffic: Study FRIDAY, Oct. 19 (HealthDay News) -- Plugged-in teens who can't part company with their iPods and other electronic devices don't just risk hearing problems and eyestrain. As pedestrians, they may be more likely to be struck by cars, new research finds."Compared to adults, teenagers -- in particular ages 13 to 17 -- were more likely to be using an electronic device when they were injured," said Dr. Nina Glass, a surgical resident at NYU Langone Medical Center in New York City. Her research is to be presented Friday at the American Academy of Pediatrics annual meeting in New Orleans.The research was triggered, she said, by the number of children who came to NYU's emergency room after pedestrian accidents.Glass and her colleagues wanted to find out why, so they collected data on all pedestrians struck by motor vehicles who came to the hospital trauma center between 2008 and 2011. In all, they looked at nearly 1,100 patients. Of those, 13 percent were under age 18.Use of electronics among the teenage pedestrian patients was twice that of adults, Glass found. It was cited by 18 percent of teens and 9 percent of adults.Even so, the teens were more likely than the adults to have minor injuries and to be discharged without admission to the hospital, the researchers found. The majority of the teens' injuries involved scrapes and road rash, Glass said, although there were some head injuries.Besides electronic device use, other, more obvious factors played a role, Glass found. Children were often injured when they were unsupervised, when they crossed mid-block or when they darted into the street.In some cases, multiple factors played a role.Although alcohol use was a factor in 15 percent of adult pedestrian injuries, it was not common among teens. Just 4 percent of teen injuries involved alcohol.The findings support an earlier study done by David Schwebel, a professor of psychology at the University of Alabama at Birmingham. His team set up a virtual pedestrian street to see how listening to music, talking on the phone or texting affected pedestrian safety.He assigned 138 college students to cross the street while either undistracted or talking on the phone, texting or listening to a personal music device.Those listening to music or texting were more likely to be hit by a vehicle. All of those in the distracted condition were more likely to look away from the street.Schwebel's study was published earlier this year in the journal Accident Analysis and Prevention.Although his study looked at a virtual environment and the new study examines actual injuries, "their results support ours," Schwebel said. "Clearly distraction is a significant factor in the large number of pedestrian injuries, and that is especially so among children and teenagers."As pedestrians, Schwebel said, "we use our ears quite extensively to cross streets safely."It's crucial, he said, to both look and listen to stay safe as a pedestrian.What to do?"Parents can be a good role model by trying to be more cognizant when they cross the street," Glass said. That means crossing with the light, crossing at intersections and looking both ways before stepping off the curb.Parents also can talk to their children about appropriate use of electronics, Schwebel said."Mobile phones and music listening devices are wonderful inventions," he said. "They are entertaining, improve communication and sometimes can help us stay safe. But children need to learn when it is appropriate to use their phones and when they should not. Sitting on a park bench is an appropriate place and time to use a phone; crossing a street is not."More informationFor more ways to stay safe as a pedestrian, visit the University of North Carolina Highway Safety Research Center.SOURCES: David Schwebel, Ph.D., professor, psychology, University of Alabama at Birmingham; Nina Glass, M.D., surgical resident, NYU Langone Medical Center, New York City; Oct. 19, 2012, presentation, American Academy of Pediatrics National Conference and Exhibition, New Orleans; March 2012 Accident Analysis and Prevention Related Articles Use Chia Seeds With Caution, Researcher Warns October 21, 2014 Binge Drinking May Boost Blood Pressure in Young Men October 21, 2014 Learn More About Sharp

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November 13, 2012 > Antibiotics Don't Work for Cold and Flu Antibiotics Don't Work for Cold and Flu Get Smart About When to Use Antibiotics Before They Become Ineffective As we enter the cold and flu season, it's important to remember that antibiotics don't work on those illnesses. Antibiotics kill bacteria, and the cold and flu are caused by viruses, according to the Centers for Disease Control and Prevention (CDC). The CDC urges everyone to Get Smart About Antibiotics, the theme for its annual awareness week, this year scheduled for November 12-18. "I try to remind patients that most infections are viral not bacterial," said infectious disease specialist Dr. Dianne Martin, who co-chairs the Infection Control team at Washington Hospital. "Even when kids come down with ear infections, sore throats, runny noses, and chest congestion, they are caused by a virus. Antibiotics won't help." The CDC launched the Get Smart campaign because too many people don't understand that antibiotics don't work on viral infections. That's a problem because taking antibiotics when they are not needed does more harm than good, according to Martin. Widespread inappropriate use of antibiotics is causing an increase in drug-resistant bacteria, she explained. But people go to their doctors when they are sick and ask for antibiotics. They want relief and mistakenly believe antibiotics will cure what ails them. "Physicians have to explain to their patients why an antibiotic is not being prescribed," Martin said. "But some patients are very insistent and for some doctors it's just easier to write a prescription than engage in a lengthy conversation trying to convince a patient that antibiotics won't work."Just Say No It is estimated that more than 50 percent of antibiotics are unnecessarily prescribed in doctors' office settings for upper respiratory infections like cough and cold, according to the CDC. In addition, three out of 10 children who visit an outpatient provider with the common cold receive an antibiotic. "Taking antibiotics unnecessarily increases your chances of becoming sick with an antibiotic-resistant bacterial infection," Martin said. "Antibiotic resistance is not just an issue for the sick person. It is a global health issue. Overuse of antibiotics promotes the development of drug-resistant germs that can spread from person to person." She said there are steps individuals can take to reduce these risks, including * Take the antibiotic exactly as prescribed. Don't skip doses and complete the entire course, even if you feel better.* Only take antibiotics prescribed to you. Do not share or use leftover antibiotics. * Discard any leftover antibiotics once the prescribed course is taken.* Do not ask for antibiotics when your doctor says you don't need them. "We all need to work together to ensure that antibiotics are used properly," Martin said. "Antibiotics are powerful drugs that can save lives. But they won't be effective against existing and new bacterial strains if we continue to misuse them."Get a Flu Shot The best protection against the flu is an influenza vaccination, also called a flu shot, she added. The flu shot contains three seasonal flu viruses that cause your body to build up antibodies capable of fighting off those strains. The viruses are inactivated or killed, so you can't get the flu from a flu shot, according to the CDC. The best time to get your flu shot is now until December. The flu season generally runs from November through April, so that allows the protective antibodies to build up before flu activity is typically at its highest. "We are having an early flu season this year, so I really encourage everyone to get a flu shot as soon as possible," Martin said. "Anyone over the age of 6 months should get a flu shot." She said it's important to wash your hands frequently to avoid spreading germs and keep hand sanitizers in your home, car, and at work. "Get kids in the habit of coughing and sneezing into a tissue instead of their hands," she added. "You should also consider putting together a cold and flu kit so you are ready when someone in the house gets sick." Martin recommended including over-the-counter symptom relievers, cough syrup, throat lozenges, hand sanitizer, tissues, and soup. "That way you have everything you need and you don't have to go to the store and spread your germs," she said. "Parents sometimes feel pressure to send their kids to school when they are sick or go to work themselves. But it's really best to stay home when you are sick. You need to rest so you can be at your best and you don't want to get other people sick." For more information about the flu, visit www.cdc.gov/flu. To find out how to get a flu vaccination, call Washington Hospital's Health Connection hotline at (800) 963-7070. To learn about upcoming Washington Hospital classes and seminars that can help you stay healthy, visit www.whhs.com. Home Protective Services

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Health System > Medical Center > UC Davis Medical Center ranks among top 50 ... About Finding a Doctor Our Nursing Staff Celebrating Nurses What Our Nurses Say Clinical Areas Advanced Practice Nurses Nurse Executive Team Primary Care Clinic Locations & Services Outpatient Pharmacy Locations Welcome to UC Davis Medical Center Continuing Your Care at Home Insurance, Payment & Billing Commitment to Quality & Safety Patient & Community Satisfaction MyChart Clinical Trials Trauma and Injury Prevention Medical Center Leadership UC Davis Health System Executive Leadership Quality & Safety Information 2010-2011 Community Benefit Report Volunteering & Giving Opportunities About Advisers & Friends About Educational Opportunities Learn about Job Opportunities Jobs Online Our Medical Group Learn more aboutUC DavisHealth System'smajor awards and honors UC Davis Health System Strategic Plan NEWS | July 19, 2011 UC Davis Medical Center ranks among top 50 U.S. hospitals, first in Sacramento area Twenty-six UC Davis physicians also included on the list of U.S. News Top Doctors. (SACRAMENTO, Calif.) — UC Davis Medical Center ranks among the top 50 hospitals in the nation and number one in the Sacramento region, according to the results of U.S. News & World Report's 2011-2012 best hospitals survey, published online today. In addition, 26 UC Davis physicians are included on the list of U.S. News Top Doctors.US News also named UC Davis among the nation's Most Connected Hospitals for adopting information technology to enhance patient safety and quality of care. UC Davis was one of 118 hospitals to receive the designation for its leadership in the adoption of electronic health records.U.S. News evaluated about 5,000 hospitals to rank the best in 16 adult medical specialties, from cancer to urology. UC Davis Medical Center ranks 39th in cancer care and 46th in orthopaedics, placing it in the top 1 percent of hospitals nationwide.In addition, U.S. News ranks UC Davis Medical Center as the top hospital in the Sacramento metro area with nine high-performing medical specialties: cardiology and heart surgery; diabetes and endocrinology; ear, nose and throat; geriatrics; gynecology nephrology; neurology and neurosurgery; pulmonology and urology.The rankings will appear in the U.S. News Best Hospitals guidebook, which will be available Aug. 30.This year's rankings include the U.S. News Top Doctors list, which includes 26 UC Davis physicians whose expertise spans 20 specialty areas. Developed in collaboration with Castle Connolly Medical Ltd., a New York City-based company that has worked for nearly two decades to identify the nation's top doctors, the Top Doctors selections are based on nominations submitted by other doctors and reviewed by a physician-led research team.UC Davis Medical Center Chief Executive Officer Ann Madden Rice said the recognition is the result of the hospital's outstanding physicians, superior nurses and dedicated staff, and their commitment to providing exceptional patient care."This honor is a testament to our employees' unwavering commitment to placing UC Davis Medical Center at the pinnacle of patient care in the Sacramento region and the nation," Rice said. "I am deeply proud of our successes in developing new, innovative treatments and technologies that are advancing health and transforming health care here and around the world."The U.S. News ranking summarizes the quality of inpatient care examining the balance of nurses to patients; mortality statistics; patient safety; reputation; the numbers of procedures conducted; and other care-related measures such as technology and patient services. Hospitals that appear on the list often pioneer new treatments, conduct translational research and exploit the latest advances in imaging, surgical devices and other technologies that advance health.UC Davis is one of only 65 hospitals nationwide with a National Cancer Institute-designated cancer center. At the UC Davis Cancer Center, top specialists provide compassionate, comprehensive care each year for more than 9,000 adults and children and offer access to more than 150 clinical trials. Through the Cancer Care Network, UC Davis collaborates with community hospitals and clinics to offer the latest cancer services to patients throughout the Central Valley and Northern California.The UC Davis Department of Orthopaedic Surgery is a leader in state-of-the-art surgery, research and education, with a level I trauma center and a musculoskeletal research center that are among the most sophisticated and interdisciplinary in the nation. The program encompasses nine subspecialties, a 24-hour level I trauma center and programs for pediatric patients at Shriners Hospital for Children - Northern California, as well as access to leading-edge clinical research trials.The U.S. News survey showed that UC Davis Medical Center's nurse-to-patient ratio -- 2.7 registered nurses per patient bed -- is among the nation's highest. In cancer, only Yale New Haven Hospital, the Mayo Clinic and Ronald Reagan UCLA Medical Center have higher nurse-to-patient ratios, with 3.2, 3.1 and three nurses per bed, respectively. In orthopaedics, only Mayo and Ronald Reagan UCLA Medical Center had higher ratios, with 3.1 and three nurses per bed, respectively.In separate specialty and school rankings released by U.S. News earlier this year, UC Davis Children's Hospital ranked among the nation's best in pediatric urology, and the UC Davis School of Medicine ranked among the best medical schools in primary care and research. UC Davis Medical Center is a comprehensive academic medical center where clinical practice, teaching and research converge to advance human health. Centers of excellence include the National Cancer Institute-designated UC Davis Cancer Center; the region's only level I pediatric and adult trauma centers; the UC Davis MIND Institute, devoted to finding treatments and cures for neurodevelopmental disorders; and the UC Davis Children's Hospital. The medical center serves a 33-county, 65,000-square-mile area that stretches north to the Oregon border and east to Nevada. It further extends its reach through the award-winning telemedicine program, which gives remote, medically underserved communities throughout California unprecedented access to specialty and subspecialty care. For more information, visit medicalcenter.ucdavis.edu. UC Davis Medical Center | 2315 Stockton Blvd. | Sacramento, CA 95817 | 24-hour Hospital Operator: (916) 734-2011

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Vet Med Home UC Davis School of Veterinary Medicine Admissions/Students Community Outreach/Extension School Updates Impacts and Accomplishments Browse News Archives Finding Answers in Food Animal Health and Food Safety: Veterinary Medicine Teaching and Research Center Marks 20th Anniversary Is our food safe from BSE? What would happen if foot-and-mouth disease entered California? How can we prepare for West Nile virus? Which vaccines are safest and most effective for food animals? At UC Davis, veterinary researchers are seeking answers to these and other questions about livestock health and food safety. In 1983, 250 miles from the School of Veterinary Medicine campus, the San Joaquin Valley joined the campus as a strategic location for veterinary discovery and education. October 2003 marks the 20th anniversary of the dedication of the school's Veterinary Medicine Teaching and Research Center in Tulare, California. School officials and community leaders envisioned the Tulare facility in the late 1970s as a teaching resource. Center faculty have since trained 550 senior veterinary students; 25 veterinarians have completed the residency in dairy production medicine. James S. Cullor, director, says, "Those veterinarians learned about basic animal reproduction, introductory nutrition, milk production, and food animal medicine. Our vision now encompasses applied research in dairy herd health, animal well-being, on-farm food safety, and environmental health." The center also supports graduate-level research and high school science internships. Veterinary faculty cultivate ongoing interactions with regional commercial dairies, which benefit from veterinary services even as they provide real-world cases for students. Producers also help alert the veterinary profession to health trends and take part in applied studies concerning animal health, productivity, environmental health and animal well-being. From 1999 to 2002 alone, nearly 50 faculty and staff have produced more than 300 articles, book chapters and presentations. Research projects from the late 1980s to the present have touched on topics ranging from management of endemic diseases to vaccine testing, including the following examples: Teaching of veterinary students and specialty residents at the Veterinary Medicine Teaching and Research Center emphasizes herd health and food animal production medicine. Faculty members also provide consulting services to local dairy producers. Milk testing and food safety research take place at the Veterinary Medicine Teaching and Research Center. Local dairy producers participate in health studies relevant to their herds. Accuracy of antibiotic residue tests Development of tools to trace disease outbreaks, evaluate new treatments, and assess health risks Investigation of on-farm food safety: control of potential human pathogens in food products Mastitis research and J-5 vaccine development, which saves dairy farmers $11 million a year Applying the principles of Hazard Analysis and Critical Control Point management The ecosystem's role in the spread of waterborne diseases such as cryptosporidiosis Minimizing environmental pollution from dairy operations Nutrient management Vaccine safety studies Effective diagnostics for samples of E. Coli O157:H7 Calf health and well-being Alternative treatment of dairy wastewater to reduce pathogens and other environmental impacts "Cold sterilization" of milk by laser light to minimize mycobacteria and other pathogens Technologies for record-keeping, disease tracking and data analysis The California Animal Health and Food Safety Laboratory, Veterinary Medicine Extension, Dairy Food Safety Laboratory, Milking Technology Laboratory, and offices of state and federal departments of agriculture also reside at the center. Each unit conducts its own mission while exploiting opportunities for liaison and outreach with producers, faculty researchers, and public agencies. For example, in 2001 when foot-and-mouth disease struck the United Kingdom, these colleagues arranged for more than 300 producers and agricultural officials to Tulare to share strategies to prevent an epidemic in California. Two Tulare-based UC Davis veterinarians also traveled abroad to aid UK control efforts and returned with valuable first-hand experience in handling FMD. The center's newest proposal, the California Dairy Technology Center, will be developed as a full-sized, self-sufficient, teaching and research dairy. The School of Veterinary Medicine, Tulare Joint Union School District and the College of the Sequoias will offer academic and vocational education covering dairy production, business management, and veterinary medicine at all grade levels. Faculty will conduct dairy research and technology transfer projects. Public and private funding will help complete the venture. Bennie I. Osburn, dean of the School of Veterinary Medicine, states, "Veterinary students—even from other veterinary schools—and practitioners from around the world have found an exceptional opportunity in Tulare to learn how management decisions can affect the health of hundreds of animals at a time—and influence the producer's bottom line. These are the professionals who will help answer today's critical questions about livestock health and food safety." More information: Brenda Hastings, Assistant Director, Tulare (559) 688-1731, Ext 226; bhasting@vmtrc.ucdavis.edu Your support of the School of Veterinary Medicine makes a difference Contact us | Animal Health Inquiries | Check us out on Facebook, Twitter, & YouTube | Online Donation Form UC Davis School of Veterinary Medicine • One Shields Avenue • Davis, CA 95616 Copyright © The Regents of the University of California, Davis campus. All Rights Reserved.

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Primary Care Providers May Balk at Giving Teens Antidepressants Many aren't comfortable writing the prescription and most would refer patient to a psychiatrist, study finds WEDNESDAY, Jan. 15, 2014 (HealthDay News) -- Primary health care providers are reluctant to prescribe antidepressants for their teenaged patients, even in cases of severe depression, a new study suggests. The researchers found that those who were more knowledgeable about depression -- and especially those who could consult with an on-site mental health expert -- were more likely to prescribe antidepressants for depressed teens. The study included 58 pediatric primary care providers. Most were doctors, but some were nurse practitioners or other professionals. The study participants were given hypothetical situations describing two 15-year-old girls with depression. One girl met the criteria for moderate depression and the other for severe depression, but neither was suicidal. The participants were asked to make an initial treatment recommendation for each of the girls. Only one-quarter of them said they would prescribe antidepressants for the girl with moderate depression, and one-third said they would do so for the girl with severe depression, according to the study in the January issue of the Journal of Developmental & Behavioral Pediatrics. According to current guidelines, teens with moderate to severe depression should be treated with antidepressants and/or a type of talk therapy called cognitive behavioral therapy, the researchers noted. They added that, in particular, antidepressants have been deemed effective for patients with severe depression. Ninety percent of the practitioners said they would refer the girl with severe depression to a child or adolescent psychiatrist for medication management, and 60 percent said they would do so for the girl with moderate depression. Consultation with a mental health expert is recommended for teens with severe depression, but not necessarily those with moderate depression, the study authors noted. Practitioners who had access to an on-site mental health provider were about five times more likely to recommend antidepressants for the teen girls. In addition, those with more knowledge of depression were about 70 percent more likely to do so. However, practitioners were less likely to say they would prescribe antidepressants if they felt a higher sense of personal burden when seeing patients with mental health problems, the report indicated. The findings suggest that most pediatric primary care providers aren't comfortable recommending antidepressants for depressed teens, said study author Dr. Ana Radovic, of Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, and colleagues. Teen depression "is a serious and undertreated public health problem" in the United States, the team noted in a journal news release. "With the national shortage of child psychiatrists," Radovic said in the news release, "education interventions which take into account a primary care provider's feelings of burden when addressing mental health problems and collaborative care with mental health professionals will be needed to increase appropriate prescribing of antidepressant medications to depressed adolescents." The American Psychiatric Association has more about teens and mental health (http://www.psychiatry.org/mental-health/people/teens ). SOURCE: Journal of Developmental & Behavioral Pediatrics, news release, Jan. 10, 2014

医学

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The concept of detoxification plays a major role in many schools of alternative medicine, including . In this context, the term refers to a belief that toxins accumulated in the body are a major cause of disease, and that health can be promoted by removing them through various means. The toxins referred to in this theory are said to have several major sources: Chemicals added to processed foods, such as preservatives Chemicals that enter the food chain through the use of pesticides, artificial fertilizers, and drugs given to food animals Toxins produced in the intestines due to improper digestion Toxins produced in the bloodstream due to stress Pharmaceutical medications, nearly all of which are regarded as essentially toxic by proponents of detoxification Toxins present in the general environment, such as automobile exhaust, cigarette smoke, the aluminum in antiperspirants, and the formaldehyde released by new carpet Toxins in water Toxins introduced through the use of mercury fillings and other medical procedures These toxins are said to cause a wide variety of chronic illnesses, from to cancer and , and alternative practitioners use various methods with the intention of removing the toxins. One such recommendation has made it into conventional wisdom: drinking at least a quart (or a half-gallon) of water per day. Other detoxification methods include fasting (on juice, water, fruit, or brown rice), using “cleansing” herbs and supplements (such as olive oil and lemon juice to flush the liver, dandelion root to purge the gallbladder, or psyllium seed to cleanse the colon), taking high colonics, receiving intravenous , and/or removing mercury fillings. Removing toxins is often said to cause a temporary flare-up of illness. This reaction is generally interpreted as a positive sign, but also as a call for careful medical management to avoid causing harm on the way to healing. What Is the Scientific Evidence for Detoxification? In general, there is little to no scientific support for detoxification methods. Aside from specific toxicities such as lead or arsenic, medical researchers have observed no general phenomenon of toxification. For this reason, it is difficult to scientifically validate whether detoxification methods actually work. Most detoxification approaches essentially remain unexamined, rather than proven or disproven, and rely on reasonable concepts but no hard evidence for their justification. Mercury-filling removal is a typical example. Many alternative practitioners believe that the mercury in silver fillings is a cause of numerous health problems and should be removed to prevent or treat disease. However, although it is a matter of indisputable fact that mercury can be toxic, scientific evaluation generally indicates that mercury levels in people with mercury fillings are far below those necessary to cause toxic symptoms. Anti-mercury advocates respond that some people are sensitive to mercury in very low amounts, and that those people will therefore benefit from filling removal even if they are not experiencing actual toxicity. This could certainly be true. However, despite numerous unreliable anecdotes, there is as yet no meaningful evidence that removing mercury fillings can treat or prevent any disease. (For information, see Much the same can be said about all of the other popular detoxification methods. However, in the case of one form of detoxification, colon cleansing, the theory behind the technique is definitely wrong. According to this nineteenth-century theory known as “colon health” or “colon hygiene,” years of bad diet cause the colon to become caked with layer upon layer of accumulated toxins. This accumulation is said to resemble sedimentary rock. High colonics, which are essentially enemas that reach far up into the large intestine, are said to release the accumulated buildup and thereby restore health. However, in recent decades, physicians have performed colon examinations to search for colon cancer in millions of patients, and their findings do not support the theory. Most of the patients given these examinations are at least middle-aged, and not very many have devoted their lives to healthy diets and clean colons. According to the colonic hygiene theory, colon examinations on such patients should turn up concrete-like deposits. However, all that shows up during a typical colonoscopy is fresh, pink flesh. Unfortunately, proponents of colonics do not seem to have assimilated this information; they continue to recount theories about the colon that were shown to be untrue decades ago. The safety of detoxification methods varies widely. While drinking a quart of water a day is undoubtedly benign and mercury-filling removal is unlikely to harm anything but one’s pocketbook, other methods might be risky. High colonics have occasionally resulted in serious internal injury, and intravenous therapies, being highly invasive, must be handled with a certain degree of sophistication to avoid causing harm. Considering that detoxification has not been proven useful, we recommend sticking to the more moderate of its various methods if you wish to try it at all. Dodes JE. The amalgam controversy. An evidence-based analysis.

医学

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Search HELI Submit Menu Health and Environment Linkages Initiative - HELI Priority risks Challenges in decision-making Scientific data and assessment tools Maps and spatial information technologies (Geographical Information Systems) in health and environment decision-making The advantages of displaying information in a spatial format are largely related to the visual impact and thus effective communication of the issues. Maps can be extremely powerful communication tools – especially if they are colourful or creative – showing linkages between two or more variables, indicating areas of concern, showing the extent of a problem, and comparing information from different time periods. They can deliver a message without pages of text, and are therefore ideal for busy people or those who want a strategic view of the situation. Although maps are commonplace in many areas of the world and in many disciplines, it must be remembered that they are not easily understood by everyone, and thus need to be carefully constructed to convey the intended message. Obviously, geo-referenced information gives a spatial dimension to environment–health linkages – not only pinpointing issues but also describing the intensity or extent of the cause or effect. Maps can highlight localized issues (for example, exposure to disease from location of disposal sites) as well as more diffuse issues (for example, exposure to radiation from reductions in atmospheric ozone). Both types of information are useful in planning (ex ante) (see Figure 2) and assessment (ex post) of health impacts. Fig. 2 - Use of maps in planning This map depicts an overlay of poverty mapping data with information concerning an outbreak of cholera in the KwaZulu Natal province of South Africa in early 2001. It shows that the disease outbreak originated in areas of very high and high poverty and spread through and towards other poor areas. The map was produced through the cooperation of several government agencies, including Statistics-SA (developer of the national poverty map), the Department of Health (provided disease data), and the Department of Water Affairs (provided information on safe water supplies). It served as the basis for a disease control strategy and helped to target health education messages in affected and high-risk communities. Using this map, the outbreak was effectively contained within three months, with a resulting fatality rate of (0.22%) among the lowest ever observed. From: Henninger N., & Snel, M., 2002. Where are the poor? Experiences with the development and use of poverty maps. WRI and UNEP/GRID-Arendal. Maps of environmental information can be used as early-warning tools (see Figure 3) for health planners. For example, mapping environmental criteria in the determination of malaria prevalence may give insights into areas where malaria may be occurring but is currently not well reported, as well as into possible changes in the distribution of the disease under altered climate regimes. View enlarged mappdf, 530kb The mapping malaria risk in Africa project (MARA/ARMA) has defined the climatic conditions necessary for malaria transmission, and used geographical information systems (GIS) to link this relationship to maps of key climate variables covering the entire African continent. The resulting map of 'climate suitability' for transmission has been demonstrated to give an accurate picture of the true distribution of malaria (1,2). The maps have been used to provide better estimates of the true number of people suffering from malaria, and to help direct disease control. Other studies have used this model to investigate the potential effect of climate change in the future. These indicate that climate change may not necessarily increase the overall area suitable for malaria, but could cause the disease to shift to some new areas (3), and increase the total amount of time for which people are exposed to transmission (2). Other examples include: mapping land degradation, together with long-term rainfall variability, to indicate potential future food production changes; mapping forest fires as an indication of air pollution; and mapping flood-prone areas as early determination of potential cholera outbreaks. Fig. 4 - Use of maps to detect changes over time Some maps can be used to indicate trends over time (see Figure 4), if the same variables are mapped in the same way and at the same scales at regular intervals. Land cover or land use change is often mapped over time intervals, and can be used to track changes in environmental health issues (for example, the rate of urban expansion, agricultural expansion, or infrastructure development). Some data sets can be recorded and displayed in near-real time, such as air pollution dispersion. This enables planners to issue warnings or to take mitigatory actions (such as UV warnings for holidaymakers). From 1970 to 1990, there was significant deforestation of both primary and secondary forests in Thailand: during this thirty-year period, the area covered by primary and secondary forest declined by more than half. Many other regions of the world are affected by deforestation: namely in South America (Brazil), Central Africa (Congo), South-East Asia (Indonesia) and Eastern Europe. Source: World Atlas of Desertification, United Nations Environment Programme (UNEP), International Soil Reference and Information Centre (ISRIC) (1997). Health and Environment Linkages Initiative - HELI Scientific assessment tools Quick Links

医学

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Home Home Archives 2010 Christmas loss: How to help Christmas loss: How to help Thursday, December 09, 2010 Chaplain Mark Grace vice president of mission and ministry at Baylor Health Care System, offers suggestions to churches as they seek to minister to people who have sustained loss. • Facilitate communication. “Find ways to help your members talk about loss. And that means that the pastor has to talk about it from the pulpit in an emotionally and theologically responsible way,” he said. However, he added, resist clichés such as “Have faith, and everything will be OK” or “Don’t ask, ‘Why me?’ Ask, ‘Why not me?’” “Don’t talk about it if all you … (can offer are) … pat answers that ignore the truth of the biblical teaching,” Grace urged. Give grieving people—and people who have worked through the grief process—time and space to voice their own experiences, he recommended. “Let the grieving speak,” he said. “The most powerful witnesses to hope and faith are those in your own congregation who are recovering from their own losses, as evidenced by their having been able to reinvest in life, to talk about their loss with insight and without being overwhelmed by emotion.” • Offer service opportunities. “Provide ways for people in grief to serve others during the holiday season,” he said. “This usually doesn’t apply to people in the first three to six months after the death of a loved one, but it can be very meaningful for people searching for a way to both honor a loved one’s memory while building new holiday traditions and reinvesting in life.” • Develop a list of local resources. Seek out counselors certified in grief recovery. Discover grief support groups. If there is not a local group, consider starting a church-based grief support group. Chaplains—such as the pastoral care staff at Baylor Health Care System—can be valuable resources for congregations as they seek to launch grief support groups, Grace added. < Prev

医学

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On Your Side: Tooth Troubles By: Jeff Anderson Email Updated: Mon 7:29 PM, May 07, 2007 / Article May 7, 2007 Oral health for most Americans is improving, except in one critical age group. Dentists say more and more kids between age two and five are coming in with tooth decay. The Center for Disease Control says nearly 30 percent of children under the age of six are experiencing tooth decay. And unless parents make some changes in their child's oral health, this is a problem that will only get worse. Pediatric dentist Andy Chandler knows he's not necessarily too high up on the list of your child's favorite people. But there are few folks more vital to your child's early years than him. He's on the front lines every day, fighting to keep your child's teeth healthy. Lately he's noticed something troubling. "It's the little kids...children under six," he said. The number of kids in that age group getting cavities and tooth decay is on the rise...something Dr. Chandler says has to stop. And it starts with you, the parent. "They need to be brushing their kids' teeth," he said. And get them to the dentist...something Deandre Butler's mom Latoya Roane has made sure he's done since he was young. "I'm always relieved when I get here and find out he has no dental problems," she said. But it goes way beyond that. Sugar is a big problem, meaning you need to limit the snacks--especially when it comes to sweets and sugary drinks. "Can't be on a bottle or a sippy cup in bed," Dr. Chandler said. If you're in doubt, go to the dentist for an evaluation. "The evaluation is not for fixing cavities. It's to coach the parents." All of this is a recipe to save you money and your child pain for a long time down the road. Doctor Andy, as his patients call him, says you should bring your child in for checkup by the time he or she has eight teeth. And you'll want to avoid giving them bottled water. You may not know it, but most types of bottled water have no fluoride in them.

医学

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HealthSouth CEO Fired By: Associated Press Updated: Mon 10:14 AM, Mar 31, 2003 / Article The ax has fallen on HealthSouth's founder and CEO. HealthSouth's board of directors unanimously voted to fire Richard Scrushy because of a growing accounting scandal. The company said Scrushy, who built HealthSouth into a leading health care chain, also was being asked to resign from the board. In a further bid to wipe clean its slate, HealthSouth said it would fire longtime outside auditor Ernst & Young, which has said it is cooperating in a federal investigation of the company. The government filed a civil lawsuit this month accusing HealthSouth and Scrushy of overstating earnings by at least $1.4 billion since 1999 to make it appear the company was meeting Wall Street expectations. The scandal also resulted in two former chief financial officers pleading guilty to fraud charges. The company said Scrushy's dismissal was retroactive to March 19, when he was placed on leave. Scrushy could be forced to repay any bonuses and extra compensation based on overstated profits should the company be forced to restate its earnings.

医学

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Health & Happiness Are Not Always Linked 11/15/2012 03:24 PM Health & Happiness Are Not Always Linked By Associated Press Health and Happiness Are Not Always Linked WebMD Health News By Salynn Boyles Reviewed by Louise Chang, MD More from WebMD Optimism May Be Partly in Your Genes Colon Cleansing... Health and Happiness Are Not Always LinkedWebMD Health News Optimism May Be Partly in Your GenesColon Cleansing May Be Risky, Study FindsTai Chi, Qigong Good for Body, Mind, Analysis FindsHappiness, Satisfaction Boost HealthNov. 15, 2012 -- Think good health is a major predictor of happiness? A study says yes, but there's a catch.The new study adds to the evidence examining the impact of health status on happiness in older adults.Several previous studies suggest that people in poor health -- including those with life-threatening diseases, such as cancer, or life-altering disabilities -- are often just as happy as those in good health.The new research also finds this to be the case, with the exception of those whose daily lives are disrupted by their conditions, such as people with chronic severe pain or urinary incontinence.How Health Affects HappinessResearcher Erik Angner, PhD, says his study is the first to directly measure the degree to which different health conditions disrupt daily activity.Angner, who is a professor of philosophy, economics, and public policy at George Mason University in Fairfax, Va., conducted the research along with colleagues from the University of Chicago, the University of Alabama at Birmingham, and the University of Massachusetts Medical School.The investigators developed a measure designed to assess limitations in physical activities due to health conditions.When they surveyed 383 older adults recruited from the practices of primary care doctors in Alabama, they found that health status was an important predictor of happiness.But after taking into consideration other factors associated with happiness, such as economic status, poor health was closely linked to unhappiness only in people who reported that their health status interfered with their daily lives.The study appears in the latest issue of the Journal of Happiness Studies.Most People Adapt to Health DeclinesIn the absence of health-related disruptions in daily activity, most people adapt over time to even the most severe health problems or disabilities, Angner says.He recalls a story told in the late 1700s by the Scottish philosopher Adam Smith about a man who loses his leg and thinks his life is over. But over time he learns to live with the loss of his limb and ends up about as happy as he was when he had two legs.“How many people have thought to themselves, ‘I couldn’t stand it if I went blind or got a life-threatening cancer,’” he says. “But all the evidence suggests that most of us are highly adaptable as far as happiness is concerned.”Psychiatrist Bryan Bruno, MD, who is acting chairman in the department of psychiatry at Lenox Hill Hospital in New York, says many people adapt remarkably well to changes in their health status as long as the decline is not too rapid.He adds that this is not as likely to be the case among people with a history of depression or anxiety.The finding that people do adapt to health impairments has implications for people who worry excessively about the inevitable declines that accompany aging, he says.“These changes are generally gradual and most people do tend to cope reasonably well,” he says.SOURCES:Angner, E. Journal of Happiness Studies, November 2012.Erik Angner, PhD, associate professor of philosophy, economics and public policy, George Mason University, Fairfax, Va.Bryan Bruno, MD, Department of Psychiatry, Lenox Hill Hospital, New York.News release, George Mason University.© 2012 WebMD, LLC. All rights reserved.

医学

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If Everyone Hates the FDA Approval Process, Let’s Fix It by Dan Ollendorf | 12:00 PM October 18, 2013 Comments There is one certainty about the current regulatory process for drug approval in the United States and Europe: No one likes it. Manufacturers are frustrated by the need for large, complex, and lengthy clinical-development programs that often hinge on meeting a single endpoint in one pivotal clinical trial. As a result, the cost to bring a drug to market has been estimated to be well over $1 billion — and it may be much higher. Patients and providers are disturbed by lack of timely access to medicines that show early promise in addressing significant unmet needs. Even regulators, who are responsible for enforcing the current structure, chafe at what manufacturers typically present to them: successful trial results in patients who are carefully selected to show the drug offers benefits but who are not very representative of the broader population likely to receive it. Payers then have a mess on their hands: pressure to pay for premium-priced medications that, when broadly employed, don’t offer much therapeutic benefit over existing alternatives. Can this process be altered? Yes, but it will require a true reinvention of the regulatory drug-review process that addresses all of the flawed assumptions that exist with the current framework. One potential solution is adaptive licensing (also called “staggered approval” and “progressive licensing”), a novel approach that is currently being discussed by manufacturers, regulators, and other stakeholders. Under adaptive licensing, the clinical-development program is restructured to allow for early approval of a new compound for a limited, typically high-risk population based on valid clinical measures from smaller human studies. Approval would be revisited at several points along the clinical-development pathway as candidate populations are broadened, longer-term outcomes are evaluated, and risks of treatment are better understood. Indications for treatment would be broadened (or restricted) accordingly at each step. Initial Reforms Don’t Suffice I would argue that some of the attempts to streamline the current review process are only minor modifications and fall short of what is needed. For example, the “accelerated approval” pathways used by the U.S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA) for certain drugs have generally been limited to small reductions in the time allotted for evaluation of the traditional submission package or use of “surrogate” endpoints (e.g., reductions in blood levels of a cardiac biomarker rather than reductions in risk of stroke or MI). This latter approach has been controversial, because many proposed surrogates have proven themselves merely to be correlates of disease rather than important components of the causal pathway. Advantages of Adaptive Licensing The basic concept at the heart of the adaptive licensing approach is that the review process should be a “learning system.” Breakthrough therapies would be made available to patients much earlier in the regulatory process. Presentation of clinical data to regulators in a stepwise fashion throughout drug development should allow the drug company to better target those patients for whom the benefits of the therapy outweigh the risks and should result in more informed decisions on withdrawing the drug from the market if the risks are simply too great for anyone. (In the current paradigm, safety concerns are often not raised until well after regulatory approval. The reasons: regulators don’t get any hint of safety issues until they are presented with the submission package, and given the significant investment required to bring the drug to regulatory attention in the first place, manufacturers have no incentive to undertake a full exploration of safety.) Unanswered Questions about Adaptive Licensing One is whether current regulatory controls are sufficient to prevent a new medicine from being used for purposes that go well beyond the initial, limited indication. Do manufacturers need to commit to adding their own controls? It also may be the case that manufacturers will need to augment traditional efficacy studies with long-term observational studies that start earlier in clinical development in order to detect potential safety signals much sooner. It is also clear that little progress on implementing adaptive licensing will be made without explicit cooperation from all stakeholders. All parties must feel that they can participate in confidential discussions that involve full disclosure. An ambitious program created by MIT’s Center for Biomedical Innovation, known as NEW Drug Development ParaDIGmS (NEWDIGS), has been created to serve as this “safe haven.” The program has made substantial progress in convening stakeholder workshops to (a) discuss the promise and pitfalls of an adaptive licensing approach, (b) quantify the potential benefits of adaptive licensing through historical case studies, and (c) develop standards for determining candidate compounds for adaptive licensing. An Obstacle: The Existing Mind-Set But the biggest unanswered question is whether we can collectively shift the paradigm enough. I was privileged to be invited to a recent NEWDIGS workshop to help represent the payer community. During the workshop, we discussed an actual compound that had been developed for a rare condition that represented a significant unmet need. The manufacturer had clearly done its homework on adaptive licensing and presented a thoughtful approach to clinical development that featured early authorization based on a clinically-validated endpoint, followed by longer-term studies evaluating both drug safety and “harder” outcomes (in this case, survival). The initial pushback from regulator and payer representatives (including me) was all-too traditional: “How do we know this endpoint is associated with improved health status for the patient?” “How much bigger and longer would the first study need to be to show impact on survival?” The frustration was evident on the manufacturer representatives’ faces. It took us until well into the afternoon to realize that we were asking them to chop a traditional clinical-development program into bite-size chunks rather than engaging in a true rethinking of the approval process. They were presenting us with their best approximation of a clinical-development program that would reduce initial investment, provide useful early clinical information, and mitigate patient risk, and we threw the old process back at them. We did eventually arrive at a good place (i.e., discussions will continue based on the adaptive program as presented) but not without a lot of pain. And so it is clear that yes, adaptive licensing requires cooperation and information-sharing among all stakeholders as well as candidate compounds that meet the criteria for such an approach. But the success of an adaptive approach really only hinges on whether we are willing to shift the current regulatory paradigm — a radical change in thinking about what we as a society want the products of a drug-development program to be, when we want to see results, and how much risk we are willing to bear at each step in the process. Follow the Leading Health Care Innovation insight center on Twitter @HBRhealth. E-mail us at healtheditors@hbr.org, and sign up to receive updates here. More blog posts by Dan Ollendorf More on: Government, Health Dan Ollendorf Dan Ollendorf is the chief review officer at the Institute for Clinical & Economic Review, where he leads efforts to review and synthesize evidence on new and emerging drugs, devices, and health-system interventions. Provide feedback on the insight center

医学

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GAZE EVOKED NYSTAGMUS Timothy C. Hain, MD Please read our disclaimer Return to Index. Page last modified: September 27, 2013 An important point of information to be gained from the fixation test is the adequacy of gaze holding, as impaired gaze holding may indicate the presence of a central (cerebellar or brainstem) lesion. Gaze-evoked nystagmus (GEN) is a drift of the eye which is only present for certain directions of gaze away from straight ahead. It is the most common form of nystagmus encountered in clinical practice. When using EOG recordings, any persistent nystagmus for ocular displacements of 30 degrees or less is considered abnormal. When using infrared recordings, small amounts of weak (0.5 deg to 3.0 deg/sec) gaze-evoked nystagmus can be recorded in normal subjects (Abel et al, 1978). "End point nystagmus" is a variant of GEN. It is basically GEN in persons who are otherwise normal. It is more frequently seen with prolonged gaze holding and also with large eccentricities. It is often somewhat torsional. The judgement as to whether nystagmus is called GEN or "end point", is presently one made by the experience of the examiner. We think it best to avoid the term "end point nystagmus" entirely. Causes of Gaze-evoked nystagmus (GEN) Medication Brainstem or cerebellar disorder (look for rebound nystagmus and DBN on lateral gaze -- see below) Normal variant (often called "end point nystagmus"). Ocular muscle fatigue Congenital nystagmus Causes of gaze-evoked nystagmus are listed in the table above. There are several distinct patterns which can be identified by close scrutiny of the eye position trace. (Note that we didn't say that you can get this by reading the computerized ENG report - - commercial ENG computers don't understand GEN). Ordinary gaze-evoked nystagmus, acquired from an ancient ENG system. There is drift towards the center when the patient looks to either side. Supplemental material on the site DVD: Video of gaze-evoked nystagmus (patient with cerebellar subarachnoid cyst, courtesy of Dr. Dario Yacovino). The most common variety of GEN consists of a drift towards the center of the orbit, interspersed by corrective outgoing saccades attempting to acquire a target which has drifted off the fovea. In this situation, the initial rate at which the eye drifts is directly proportional to how far the eye is from center, because elastic restoring forces are proportional to displacement. Accordingly, as the eye approaches center, the rate of drift decreases, accounting for the characteristic decreasing exponential trajectory of ocular drift. The decreasing exponential pattern may be difficult to appreciate if the patient makes frequent saccades to the target, and one must look for a slow phase in which the patient allowed his eye to drift close to the center. Gaze-evoked nystagmus on lateral gaze and upward gaze is common while gaze-evoked nystagmus on downward gaze is infrequent. Certain patients with congenital nystagmus or with acquired central nystagmus varieties have increasing exponential velocity patterns. More about this is below. Rarely, GEN is due to weak eye muscles, such as in myasthenia gravis. As myasthenia can affect eye muscles to different extents at different times, the variations are many. A nystagmus that comes and goes, and that is asymmetrical between the eyes might be myasthenia. This type of nystagmus can change dramatically after injection of a medication that temporarily improves muscle strength (such as edrophonium). Any change is counted as a positive "tensilon test". Amount of GEN There are several factors which contribute to the amount of GEN. The first relates to the patterns of neural firing associated with maintenance of eye position against elastic restoring forces. Central disorders, particularly those involving the cerebellum, can disrupt the neural "step" of firing, and cause centripetal drift. A second consideration relates to how proficiently the patient can use visual tracking mechanisms such as pursuit or optokinetic responses to offset and eliminate drift, even though it is self-generated. A person can have GEN in the dark, but not in the light, if they have good tracking. On ENG's, we don't think it is necessary to record GEN in the light, because this information is obtained in the saccade test. However, we do think it is prudent to record GEN (and rebound) in the dark. A third factor relates to the frequency with which the patient develops corrective saccades. Because these factors are normally not controlled for, the judgment that a patient has an abnormal amount of GEN is usually a qualitative one, based on the observation that the patient has nystagmus on gaze in one direction, but none in the other, or nystagmus for unusually small displacements from center. Medication and GEN GEN is an extremely common consequence of medication, especially sedatives or anticonvulsants. Phenytoin, for example, can be monitored through watching for GEN. No GEN generally means that the patient is not taking his/her medication. All seditives produce GEN. Alcohol and recreational drugs commonly cause GEN - -Ketamine being an extreme example. Abel LA, Parker L, Daroff RB, et al. End-point nystagmus. Invest Ophthalmol Vis Sci 17:539-544, 1978 Technical Issues regarding GEN There are several major problems in interpreting GEN, mainly deriving from technical error. ENG system saturates Technician/Audiologist doesn't know how to test GEN Patient closes eyes If your equipment doesn't record the eyes looking far to one side (i.e. saturate), you will think there is no GEN. This is mainly an issue with infrared recording systems, which are rarely used in present day ENG equipment (because they saturate) Another common problem is that the person testing for GEN makes one of several common errors -- they may not have the person look far enough, or not encourage them to hold gaze for 10 full seconds. They may allow the person to move their head and eyes. They may allow the person to close their eyes -- no video system can track through closed eyes. All of these errors can be difficult to catch when one is presented with a recording loaded with strange findings. The best way to catch these things is to compare the clinical exam with the recording, and in-service the person doing testing when there are discrepencies. Asymmetric gaze-evoked nystagmus: Alexander's law -- the gaze-evoked nystagmus seen in vestibular disorders. Supplemental material on the site DVD: Video of Alexander's Law Gaze-evoked nystagmus which is of greater when looking in one direction than the other occurs in several situations. In vestibular disorders, when gaze-evoked nystagmus is combined with a spontaneous nystagmus, they add when gazing towards the fast phase of the spontaneous nystagmus and subtract in the opposite direction. This often results in the pattern of a greater overall nystagmus when gazing towards the fast-phase direction of the spontaneous nystagmus. This common clinical pattern is called "Alexander's law" (Robinson et al, 1984), and occurs in patients with peripheral and in some patients with central vestibular imbalance. Brun's nystagmus, which occurs in patients with cerebellar lesions, refers to asymmetrical nystagmus in which there is little or no spontaneous nystagmus in primary position, but an asymmetry exists at the extremes of lateral gaze. Baier and Dieterich recently reported a study of Brun's (see end of this page). Patients with internuclear ophthalmoplegia (INO) often exhibit a discongugate gaze-evoked nystagmus in which the abducting eye exhibits a more prominent nystagmus than the adducting eye. Robinson DA, Zee DS, Hain T, Holmes AM, Rosenberg LF (1984) Alexander's law -- its behavior and origin in the human vestibulo-ocular reflex. Ann. Neurology., 16:714-722. Gaze-evoked nystagmus seen in CN (Congenital Nystagmus) Certain patients with congenital nystagmus or with rare acquired central nystagmus varieties often have "increasing exponential" velocity patterns. Often the eyes "jump the wrong way" -- in other words, one might see right-beating nystagmus in left gaze. These waveforms are usually easy to spot because the nystagmus is so vigorous. Persons with CN also generally have less nystagmus in the dark as well as nystagmus in central gaze. Another clue is the history of nystagmus from infancy. There are people with mild variants of CN who are misdiagnosed as something else -- such as multiple sclerosis, or a cerebellar degeneration. This can be easily figured out with some thought -- these people don't have any neurological findings other than CN, and they don't get worse over time. Gaze-evoked nystagmus seen in INO Patients with a saccadic disorder called internuclear ophthalmoplegia (INO) often exhibit a discongugate GEN in which the abducting eye exhibits a more prominent amplitude nystagmus than the adducting eye. This is easily detected through the saccade test, which shows slowing of adducting saccades. Gaze-evoked nystagmus seen in cerebellar disorders. Patients with cerebellar disturbances often have gaze-evoked nystagmus. The common syndromes are: Too much gaze-evoked nystagmus for medication (see discussion above) Downbeating nystagmus on lateral gaze Rebound nystagmus These are all dealt with elsewhere except for downbeating nystagmus on lateral gaze. An example of this is shown below. Downbeating nystagmus on lateral gaze. Recorded using an Micromedical Technology IR tracking system at Chicago Dizziness and Hearing. This record was obtained in a young woman from a family with a familial cerebellar degeneration. The velocity of downbeating nystagmus increases to an astounding 33 deg/second on right lateral gaze. This pattern of DBN increased by lateral gaze suggests a cerebellar disorder, with the main suspects being paraneoplastic cerebellar degeneration, a Chiari Malformation, or other cerebellar disorder (such as was the case here). This patient also has a left-beating spontanous nystagmus. The movie below, from a patient with a paraneoplastic cerebellar degeneration, shows what this looks like using the video frenzel goggles. Movie of downbeating nystagmus in lateral gaze in case of paraneoplastic cerebellar degeneration (7 meg). If you would like to easily access all of the movies on this site, see the site DVD. According to Baier and Dieterich (2011), about a third of patients with cerebellar strokes have "unidirectional" GEN. This presumably is the same nystagmus previously called "Brun's" nystagmus. This study is very difficult to interpret as the criteria for identifying GEN were omitted from the article, and there was no data concerning the prevalence of spontaneous nystagmus, which might reasonably convert a bilateral GEN into a unilateral. In our experience, "unilateral" GEN is generally associated with an inner ear disturbance. References: Baier B, Dieterich M. Incidence and anatomy of gaze-evoked nystagmus in patients with cerebellar lesions. Neurology 2011:76:361-365 , Timothy C. Hain, M.D. All rights reserved. Last saved on

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In-Charge Nurses and Night Shift Nursing Supervisors - AZRAQ Red Cross/Red Crescent HospitalInternational Federation of Red Cross and Red Crescent Societies, Amman Delegation Office Background:The International Federation of Red Cross and Red Crescent Societies (IFRC) is the world's largest humanitarian network, reaching 150 million people each year through its 187 member National Societies. The Organisation acts before, during and after disasters and health emergencies in order to meet the needs and improve the lives of vulnerable people. Our work is guided by seven fundamental principles (humanity, impartiality, neutrality, independence, voluntary service, unity and universality).The ongoing crisis in Syria has resulted in the migration of over 2 million refugees to neighboring countries. In Jordan, many refugees seek refuge in camps. As the existing camps are nearing saturation, the Jordanian authorities have opted for the creation of a new refugee camp in Azraq, which opened on April 30, 2014.This hospital functions as a secondary level health care facility in Azraq camp and the beneficiaries are the Syrian refugee population residing in the camp.The hospital consists of one operating theater, a delivery suite, inpatient wards and treatment areas, an x-ray and a laboratory. It also provides an outpatient department for referral consultations as well as an emergency room. The hospital is planned to open with 40 beds and the bed capacity will gradually increase as the camp population increases.Position Purpose:Responsible for the day-to-day management of assigned unit, directing and developing nursing staff, collaborating with the international and multidisciplinary professional hospital teamExamples of main activities:• Monitors the quality of care given to patients in the hospital and follows up on the use of set nursing care protocols and procedures• Maintains an overview of unit needs, daily management and problem solving of the unit• Prepares/approves scheduling for the nursing staff of the unit so that the operational needs are met• Coaches and counsels the unit nursing staff, plans, monitors and appraises nursing staff results• Night shift supervisors function as nurse managers for the whole hospital between 8pm - 8am Skills and Qualifications:• Registered nurse in Jordan (Bachelor Degree level licensed nurse)• Good level of spoken and written English• Solid nursing management experience • Up-to-date in clinical nursingWork conditions:• Willingness to work in Azraq Refugee Camp during long hours and demanding conditions• The hospital is new and with modern patient care facilities• Willingness to work in 12 hour shifts / 48 hour working weekDeadline for receiving applications is 12th May, 2014 - Only shortlisted candidates will be contacted. The Federation is an equal opportunity employer

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Miller Home MyUM University of Miami Health System Website Find a Doctor Clinical & Translational Education M.D. Applicants Masters & Ph.D. Applicants Current M.S. / Ph.D.s Current M.D. Students News & Events Media Contacts Miller School In the News UHealth Marketing Giving Make a gift About Miller Administration Faculty Disclosures Contact us Appointments Residency or Fellowship Miller School of Medicine Departments and Centers Miller School Departments, Centers and Institutes Administrative Groups Clinical Enterprise Technology Environmental Health & Safety Facilities & Support Services Faculty Affairs Medical Education Medical Finance Medical Human Resources Medical Information Technology Administrative Groups Continued » ALS Clinical and Research Center Bascom Palmer Eye Institute Batchelor Children's Research Institute Center for Blood Diseases John P. Hussman Institute for Human Genomics Sylvester Comprehensive Cancer Center Centers & Institutes Continued » Clinical Departments & Divisions Dermatology & Cutaneous Surgery Family Medicine & Community Health Neurological Surgery Neurology Departments & Divisions Continued » Biochemistry & Molecular Biology Cell Biology Department of Public Health Sciences Microbiology and Immunology Molecular and Cellular Pharmacology Physiology and Biophysics Interdisciplinary Graduate Programs Human Genetics and Genomics Neuroscience Graduate Program Sheila and David Fuente Graduate Program in Cancer Biology Graduate Programs Continued » Study Finds Hispanic Lung Cancer Patients Tend to Outlive Blacks and Whites A new analysis by a team of researchers at the Miller School’s Sylvester Comprehensive Cancer Center has found that Hispanic lung cancer patients seem to live longer than white or black patients. Published April 23 online in CANCER, a peer-reviewed journal of the American Cancer Society, the study suggests that, as with several other types of cancer, certain yet-to-be-defined genetic and/or environmental factors put Hispanic patients at a survival advantage. Most studies that look at ethnic and racial disparities in lung cancer compare black patients with whites. To evaluate how survival of Hispanic patients compares with other ethnicities after a lung cancer diagnosis, the Sylvester team, led by Brian Lally, M.D., assistant professor of radiation oncology, and Ali Saeed, an M.D./Ph.D. candidate, analyzed patient information from the Survival, Epidemiology, and End Results (SEER) Database, which compiles incidence and survival data from population-based cancer registries in the United States. The investigators identified 172,398 adult patients who were diagnosed with any stage of non-small cell lung cancer (the most common form of lung cancer) between 1988 and 2007 for the study, “The influence of Hispanic ethnicity on non-small cell lung cancer histology and patient survival: An analysis of the Survival, Epidemiology, and End Results (SEER) Database.” Compared with white patients, Hispanic patients had a 15 percent lower risk of dying during the years of the study, whether they were born in the United States or not. “This is important because it shows that our findings are indicative of the Hispanic population in general and not specific to specific groups of Hispanics,” said Lally. Black patients were slightly more likely to die than whites. “Our findings will motivate researchers and physicians to understand why Hispanics have more favorable outcomes and may shed light on potential environmental factors and/or genetic factors that can explain our observations,” said Saeed. The researchers also found that Hispanics were more likely to develop a lung cancer type called bronchioalveolar carcinoma, which is not as serious or life-threatening as other types. Saeed said that could be due to genetic predispositions and/or lower smoking rates. Smokers are at increased risk for developing tumor types associated with a poor prognosis. Saeed noted that the results fit into a phenomenon known as the “Hispanic paradox,” in which Hispanics diagnosed with certain diseases tend to have more favorable outcomes despite socioeconomic factors (such as decreased access to health care and higher poverty rates) that would predict otherwise. This paradox is seen in breast cancer, prostate cancer, cardiovascular disease, and now non-small cell lung cancer. Also part of the study team were Rebecca Toonkel, M.D., pulmonary fellow; Marilyn K. Glassberg, M.D., associate professor of surgery and medicine in the Division of Pulmonary, Critical Care and Sleep Medicine; Dao Nguyen, M.D., professor and B. and Donald Carlin Chair in Thoracic Surgical Oncology; Jennifer Hu, Ph.D., professor of epidemiology and public health and associate director for cancer prevention and control at Sylvester; and David J. Robbins, Ph.D., associate professor of surgery. Brian Lally, M.D. UHealth Becomes First in Southeast U.S. to Use New Heart Failure Monitoring System Elaine and Sydney Sussman Endowed Chair in Interventional Cardiology Presented to Alan W. Heldman Breast Cancer Researcher to Study Personalized Treatment Using Multi-Hormone Combinations Sylvester Opens United Way Raffle Dr. Charles Vogel Receives Breast Cancer Proclamation from Broward Commissioners Read Med Read e-Update University of Miami, Academic Health Centers

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Protocol reduces sternal wound infections in children by 61 percent A two-year effort to prevent infections in children healing from cardiac surgery reduced sternum infections by 61 percent, a San Antonio researcher announced at the Cardiology 2012 conference Feb. 23 in Orlando, Fla. Faculty from UT Medicine San Antonio carried out a new infection-control protocol for 308 children who underwent sternotomies at CHRISTUS Santa Rosa Children's Hospital between 2009 and 2011. UT Medicine is the clinical practice of the School of Medicine at The University of Texas Health Science Center San Antonio. Approach to children not standardized A sternotomy is a surgical incision through the sternum. This particular study was the follow-up to an initial nationwide, multi-institutional study carried out by the group in 2009. The first study revealed that programs across the country had no standardized manner in which to prevent sternal wound infections (Annals of Thoracic Surgery 2011; 91:799-804). "This was noted to be of concern, as the adult cardiac surgical population has well-described protocols to prevent such infections," said S. Adil Husain, M.D., of UT Medicine San Antonio. He is associate professor of cardiothoracic surgery in the School of Medicine. Multiple interventions implemented The protocol tested in the follow-up study included preoperative baths with a skin disinfectant, the use of disposable, single-use electrodes, and administration of antibiotics no longer than an hour before the start of surgery. The number of sternal wound infections decreased from 14 the first year of the study to five the second year. The sternum, also called the breastbone, anchors the rib cage protecting the heart and lungs. To correct congenital heart defects, surgeons in many cases must break open the sternum to gain access to the operation site. More than 350 pediatric cardiac surgical cases are performed annually at the children's hospital with the sternum being opened at least 75 percent of the time. Deep infections may involve areas around heart "Sternal wound infection is relatively infrequent; however, when it occurs it increases the child's length of stay and recovery time," said Cathy Woodward, D.N.P., RN, PNP-AC, of UT Medicine and assistant professor of pediatrics in the School of Medicine. "The bone, muscle and tissue around the heart can become involved when the infection is deep." Dr. Woodward presented the clinical findings in Orlando. The team also included Dr. Husain and critical care specialists Minnette Son, M.D., professor of pediatrics, and Richard Taylor, M.D., associate professor of pediatrics. Multicenter study would be logical next step Children from newborns to age 18 were included in the study. Using a protocol for children with delayed closure of the sternum also produced a lower infection rate, although it was not statistically significant. "Because we had so few infections, we don't have enough statistical power to analyze these results," Dr. Woodward said. "This pilot finding lends itself to the need to do a multicenter study." Provided by University of Texas Health Science Center at San Antonio Use of surgically implanted antibiotic sponge does not reduce rate of sternal wound infections Contradicting previous study results, insertion of a sponge that contains the antibiotic gentamicin at the time of surgical closure following cardiac surgery did not reduce the rate of sternal wound infections after 3 months, ... Averting postsurgical infections in kids: Give antibiotics within hour before first incision Giving children preventive antibiotics within one hour before they undergo spinal surgery greatly reduces the risk for serious infections after the surgery, suggests a Johns Hopkins study to be published in the August issue ... Biodegradable film reduces surgical scarring A new, biodegradable film designed to reduce the severity of scarring following open heart surgery in young children appears to be safe and effective, according to researchers attending the annual meeting of the Society of ... Pneumonia most common infection after heart surgery Pneumonia — not a deep incision surgical site infection — is the most common serious infection after heart surgery, according to new research (Abstract 12247) presented at the American Heart Association's Scientific ... Study cuts Whipple procedure wound infections in half with new measures Thomas Jefferson University Hospital surgeons found that a carefully-selected surgical care check list of 12 measures reduced Whipple procedure wound infections by nearly 50 percent.

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Conference Homepage | Conference Program Welcome to the MIM Virtual Press Room MIM News Blog Conference Media Resources Malaria & Global Health Sites Follow us on: Read session summaries and scientific updates: Malaria Researchers Hunt for Solutions to Potential Threat of Drug and Insecticide Resistance November 4th, 2009 Comments Off NAIROBI, 5 NOVEMBER 2009 – Scientists gathered at the world’s largest malaria conference debated the challenge of malaria drug and insecticide resistance and called on researchers and policymakers to act urgently to contain the problem. The threat of failure of frontline tools for malaria control and treatment—treated bednets, insecticides, and artemisinin combination therapies (ACTs)—could leave millions of people vulnerable to the disease, with little recourse for prevention or effective treatment. This could reverse the massive gains achieved with these tools over the last five years. Staying one step ahead of the malaria parasite, which constantly evolves to become resistant to malaria drugs, will require a redoubling of efforts to develop new classes of effective medicines. The insecticide research and development pipeline will likewise need to be filled with new active ingredients that malaria-carrying mosquitoes have not yet learned to tolerate. Artemisinin is the most effective front-line drug against malaria in the world today. It was recommended as first-line therapy by the WHO in 2002 and has saved millions of lives since then. However, resistance to this life-saving drug is emerging. Some studies published in 2008-2009 reported a doubling of the time to clear the parasite from the blood in some malaria patients in the western region of Cambodia. However, efficacy at 28 days was maintained, and the patients were still cured with the ACTs they had been given. This ‘resistance’, first observed in West Cambodia, has now also been reported in the west of Thailand and in eastern Myanmar. But it has not yet been possible to ascertain if this additional ‘resistance’ is due to the Cambodian strains or to different strains. DHA/PQP (Eurartesim®), a new ACT developed by Sigma Tau and Medicines for Malaria Venture (MMV), and recently submitted to the European Agency EMEA, will also be submitted to the regulatory authorities of Cambodia. The drug could be used for the containment of the strains resistant to artemisinin, if requested by the WHO and the government of Cambodia. In addition, a new generation of drug combinations is under development that could one day replace ACTs. Bednets and indoor spraying are the cornerstones of malaria control, having saved millions of lives, and yet they are entirely dependent on mosquito populations remaining susceptible to insecticides. Bednets are especially vulnerable, as pyrethroids are the only class of insecticides currently available for bednets. If pyrethroid resistance becomes widespread, we lose this vital barrier against infection. The ramp up of control programs will increase pesticide use, and the spread of resistance to all classes of insecticides could become inevitable. High levels of pyrethroid resistance have already been detected in west and southern Africa, and it appears that this is already having an impact of the effectiveness of bednets. New insecticides that work in an entirely different way to current classes are therefore urgently needed to ensure that the expansion of control efforts does not result in a total failure of one of the only weapons we have against mosquitoes. The International Vector Control Consortium (IVCC) is working in partnership with the major chemical companies to develop new active ingredients. Their partners are using data mining programs to find development candidates for these new active ingredients within their extensive chemical libraries. Developing entirely new insecticides takes a great deal of time and hundreds of millions of dollars, but it is crucial that the global community act now to prevent the failure of control programs and avert a new public health catastrophe in the developing world. In the meantime, careful and judicious use of the current insecticides is strongly advised. ON THE GROUND: Dr. Robert Newman Dr. Robert Newman, Director of the World Health Organization’s Global Malaria Program, discusses his personal history with MIM and his goals for malaria control. ON THE GROUND: Dr. Charles Wanga November 4th, 2009 § 1 Prior to the conference, Dr. Charles Wanga, MIM Communications Officer, discusses his hopes for the event and the need for African leadership in malaria research. New Tools and Political Commitment are Needed to Eradicate Malaria Innovation, alongside increased access and operational research for today’s best malaria interventions, provides best hope for eradication NAIROBI, 4 NOVEMBER 2009 – As the 5th Multilateral Initiative on Malaria (MIM) Pan-African Malaria Conference reached its halfway point on Malaria Elimination/Eradication Day, leading researchers, policy makers and public health professionals focused on the long-term goal of malaria eradication. Achieving eradication will require an integrated approach with new and existing tools – including drugs, diagnostics, long-lasting insecticide treated nets (LLINs), indoor residual spraying (IRS), other forms of vector control, and ultimately a vaccine. But beyond the tools, it will also require education; training and empowerment of patients, caregivers and health care workers; and political will, community leadership and sustained donor funding for innovation. Research presented at MIM has highlighted recent achievements in malaria control, raising hopes that dramatic reductions in the burden of malaria may be closer than once thought. For example, just 5 years ago malaria was the leading cause of death in Rwanda. Now, under the leadership of the Ministry of Health, a comprehensive approach to malaria prevention and treatment has led to a decrease in malaria mortality by 60 percent in just two years. Rwanda and other endemic countries can now focus on further efforts towards eradication. Despite these gains, stakeholders gathered at MIM agree that eradication will require true commitment from African policymakers, national malaria control program officers, donors and other implementing partners. Partnerships among these groups have led to some of the most effective malaria control advances in recent years, and will be essential for success. Throughout the week, scientists at MIM have discussed groundbreaking research on new malaria interventions that can help the global community reach effective eradication of malaria. With a promising new vaccine now in the pipeline, innovative new drugs in development, and a strong toolkit of existing interventions, eradication appears to be an achievable goal. However, donors must continue to invest in new tools development to maintain a pipeline of products, such as drugs and insecticides, that can replace existing tools as the malaria parasite and vectors evolve and resistance renders interventions ineffective. Experts gathered at MIM agree that without a concerted effort to massively scale up and sustain use of today’s best tools and tomorrow’s new ones, eradication will not be possible. High tech, cutting-edge, effective, life-saving interventions are pointless if the global community cannot find ways to guarantee that they get to those who need them most. Malaria interventions must be available, affordable and appropriate for local contexts. Research released at MIM – for example, an unprecedented study on access to artemisinin-combination therapies (ACTs) – will provide evidence for policy decisions and discussions around international financing mechanisms that would increase access to lifesaving interventions. Despite recent strides in research and implementation, eradication will not be easily attained. Continued political support combined with sufficient and sustained funding will be necessary to ensure protection for millions of vulnerable persons around the world. Building on the foundation of malaria research, pressure must be placed on both endemic and donor governments so that they maintain support for innovative treatment and prevention, and evidence-based implementation and scale-up. Looking Back: An Oral History of MIM In this official MIM video, African scientists discuss the history of MIM and how it has impacted their careers and their lives. Malaria Consortium on RDT Training at the Community Level November 3rd, 2009 Comments Off The Malaria Consortium presented the results of a multi-organizational Zambian study on the effectiveness of Rapid Diagnostic Testing (RDT) training programs at the MIM Conference today. The study, conducted over the course of one year in Livingstone, assessed the diagnostic accuracy of community workers’ performance when carrying out malaria RDT s. Results showed consistent accuracy for most participants, indicating that well structured training and job-aid can prove effective in mobilizing community workers to use malaria RDTs safely and accurately. Read the full news story here: http://www.malariaconsortium.org/news/malaria_consortium_at_mim_2009_-_chw.htm Malaria Consortium on the Evaluation of ITN Strategies The Malaria Consortium reported on the urgent need for a widespread understanding of insecticide treated net (ITN) distribution strategies throughout Africa, highlighting the potential impact that a large-scale, continuous, effective ITN campaign could have on household coverage. The Consortium’s Director of Monitoring and Evaluation, Albert Kilian, reported that large scale campaigns followed by continuous distribution strategies can result in sustained high ITN coverage, though a mixed model distribution strategy is key to the elimination of malaria. Read the full news story here: http://www.malariaconsortium.org/news/malaria_consortium_at_mim_2009.htm GSK BLOG: Joe Cohen looks back as RTS,S moves forward As GSK’s Joe Cohen presented on the the status of the Phase III trial of RTS,S at a press briefing today at MIM, he reflected on its the vaccine’s past. More Than Medicine: Looking back as RTS,s moves forward By Joe Cohen, GSK Vaccines R & D Looking out at the packed room full of reporters this afternoon, ready to announce the progress we have made with the RTS,S Phase III trial, I could not help but think about the past. One moment in particular comes to mind. It was five years ago, in 2004, in a cramped room in Mozambique. The walls were sweating and so were we as we waited for the results of the very first RTS,S safety and efficacy trial in children. What would be revealed during that unblinding could make or break the vaccine. We were literally at the edge of our seats. Those early results, later published in The Lancet, were proof that this vaccine could work in children. Fast forward five years to today; this time we were the ones giving the good news. From Nairobi, we told the world that more than 5,000 children had been enrolled in the pivotal efficacy trial in just six months. No one person could have done this alone, and I am so grateful to every member of the RTS,S team, which has evolved and grown over the years. It has been my honor to work with them. Today represented a turning point of sorts. It felt like I, along with all the scientists who have worked on this vaccine over the past two decades, was passing the baton to Africa. The future of this vaccine is now in the capable hands of Salim and Patricia, the two African Principal Investigators who joined me at the briefing today, and all of the other talented researchers leading the trial across Africa. As we head into the last part of this journey, they will usher RTS,S into the future on the ground. For years, people have questioned whether this vaccine would ever see the light of day. And doubts still linger. But today we showed the world that our dream can become a reality in just a few short years. Looking into the future of RTS,S, I cannot help but echo the words of Kenya’s most famous son: “Yes We Can.” Indeed we must. This blog entry was originally posted on GSK’s blog, More than Medicine, and can be accessed at: http://www.morethanmedicine.us.gsk.com/blog/. MIM Researchers Focus on New Tools for Malaria that Offer Greatest Promise Toward Achieving Eradication November 3rd, 2009 § 2 New research highlights promising drugs, vaccines, vector control and other tools in the pipeline NAIROBI, 3 November 2009 — On the second day of the MIM Pan African Malaria Conference, leading malaria researchers and product developers provided new insights into interventions currently under development that could improve malaria control, overcome current resistance and accelerate efforts toward eradication. While it is critical that the global malaria community improve access to the best existing interventions, new and improved drugs, diagnostics, vaccines and vector control methods remain the world’s best hope for eradication. Promising research discussed at MIM highlights the need for sustained financing of projects in the R&D pipeline even as the global community invests in research, development and delivery of next-generation compounds and products. New drugs are urgently needed because the old ones are no longer effective against the rapidly evolving malaria parasite. The irrational use of artemisinin-combination therapies (ACT) and the use of artemisinin as a single therapy can result in the malaria parasite developing resistance to arguably the world’s most effective antimalarial. To address this, scientists at MIM disclosed a broad range of new drugs and compound classes in the pipeline, some of which specifically tackle emerging resistance and stopping transmission. With the goal of eradication of malaria in mind, researchers are also focusing on drugs that target malaria parasites other than the deadly falciparum parasite. The hope is to one day develop a simple, affordable one-dose malaria cure. Meanwhile, through the efforts of organizations including the Medicines for Malaria Venture (MMV) and Drugs for Neglected Diseases initiative (DNDi), and their partners, the number of malaria drugs available continues to increase. The last 2 years have seen the launch of two new WHO-prequalified ACTs and there is hope that three additional combination therapies could be pre-qualified in the immediate future. NEW TOOLS IN VECTOR CONTROL A proven arsenal of vector control tools designed to combat malaria-bearing mosquitoes are being scaled up to meet 2010 targets for universal coverage of long-lasting insecticide treated nets (LLINs) and Indoor Residual Spraying (IRS). Scientists agree, however, that research is needed to improve the performance of these tools. Insecticide resistance to the pyrethroid class of insecticides used in both IRS and LLINs, the life-span of LLINs, evaluation methods for delivery of malaria prevention, and the integration of vector control methods are all areas of necessary study. Research on each of these topics is being presented at this year’s conference. Malaria scientists continue to look forward to improved tools (IRS and LLINs) and new means of addressing malaria burden in endemic countries. These include new classes of insecticides, innovative durable wall linings, insecticide treated plastic sheeting made with pyrethroids and carbamates, and potentially the use of fungi as insecticides. Research in these areas can overcome barriers to successful vector control and effectively preventing malaria transmission. As discussed at MIM, progress toward developing an effective malaria vaccine has accelerated in recent years. Public health experts generally agree that vaccines are an efficient, cost-effective way to fight infectious disease, yet the malaria vaccine field has traditionally faced significant challenges. These include the technical complexity of developing any vaccine against a parasite, the costs associated with holding clinical trials, and the lack of financial incentives for private-sector developers. Now, however, there are several clinical trials underway of vaccine candidates against the most deadly type of malaria parasite. Vaccine trials currently underway or recently completed include AMA-1, which is being studied in Mali; MZ2, which is in a Phase 1b clinical trial being conducted by the Albert Schweitzer Institute, in Lambaréné, Gabon; MSP3-LSP, which is in a Phase 2b clinical trial in Bamako, Mali; and RTS,S, which has entered a large-scale Phase 3 trial being conducted by 11 medical research institutions in Burkina Faso, Gabon, Ghana, Kenya, Malawi, Mozambique, Tanzania. Phase III trial of GSK’s malaria vaccine candidate now underway in seven African countries During a press briefing earlier today at MIM, pharmaceutical company GlaxoSmithKline and its partners, the PATH Malaria Vaccine Initiative (MVI) and the Bill & Melinda Gates Foundation, announced that Phase III trials of RTS,S, the world’s most advanced malaria vaccine candidate, are currently underway in seven African countries. Thus far, more than 5,000 children have already been enrolled in this trial, which will eventually enroll 16,000 children. Phase II studies published in the Lancet in 2004 and 2005 demonstrated that the vaccine is capable of reducing clinical episodes of malaria by 35 percent and severe malaria by 49 percent. The current Phase III trial will evaluate the vaccine’s ability to prevent malaria in two age groups: infants aged 6 to 12 weeks and children aged 5 to 17 months. If these trials are successful, data based on efficacy in children 5-17 months of age could be submitted under the European Medicines Agency (EMEA) Article 58 – a regulatory framework for pharmaceutical product intended exclusively for export – as early as 2012. Thus far, GSK has invested $300 million in this project and expects to invest an additional $100 million before its completion. The Bill & Melinda Gates Foundation has also provide the project with more than $200 million of financial support. For more information, please read GSK and MVI’s joint press release: http://www.eurekalert.org/pub_releases/2009-11/bc-wlm110209.php MIM RSS ON THE GROUND: Dr. Bernhards OgutuThe Affordable Medicines Facility-Malaria to begin delivering subsidized ACTs within two weeksON THE GROUND: Dr. Wilfred Mbacham African Leaders Malaria Alliance bed nets Bet Nets Drug R&D Malaria Control Ntoumi Big Think Blog Change Blog Christine Gorman's Global Health Report CSIS Commission on Global Health Blog Global Health Basics Blog Global Health Council Blog Global Health Delivery Blog Global Health Ideas Global Health Progress Karen Grepin's Blog Malaria Free Future Malaria No More The Lancet Student Blog The Pump Handle Blog World Health Care Blog Homepage Photos by John-Michael Maas

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UAMS MyChart Treating Myeloma Facts and Firsts The Myeloma Institute has seen more than 11,000 patients since its founding in 1989. We are one of the largest centers in the world for research and clinical care related to multiple myeloma and related disorders. About the Myeloma Institute Our internationally recognized physicians and scientists use state-of-the-art technologies to develop innovative treatments tailored to each patient’s specific disease. Why Choose the Myeloma Institute Researching the Cure The Myeloma Institute is at the forefront of research. With a dedicated faculty conducting clinical as well as basic science research, we are at the cutting edge of scientific breakthroughs. New! Gareth Morgan, M.D., Ph.D., director of the University of Arkansas for Medical Sciences (UAMS) Myeloma Institute for Research and Therapy, was named an Arkansas Research Alliance (ARA) Scholar at a news conference August 27, 2014 at the State Capitol. Read more Since 1989, our mission has been guided by one enduring principle: CURE. UAMS Myeloma Institute for Research and Therapy is a world leader in multiple myeloma research and treatment. Our team of dynamic scientists and clinicians translates advances from the laboratory into novel clinical treatments, continually expanding the boundaries of myeloma research and therapy toward cure for all patients. The Myeloma Institute has pioneered many breakthrough developments and discoveries. Read more about our significant firsts. What is Multiple Myeloma? Learn about myeloma biology, symptoms, diagnosis and more. What Patients Say About Us The Myeloma Institute has one of the highest volumes of multiple myeloma patients in the world. Our patients have great things to say about us. About Little Rock/Travel Little Rock is the capital and largest city in Arkansas, as well as the state center for business, healthcare and culture. Discover more about Little Rock, including information on travel, lodging, and dining. Read up on the latest Myeloma Institute news, publications and interesting cases.

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Depression HomeDepression Journey Depression Is DevastatingTalk TherapyAntidepressant DrugsOther Treatments for DepressionPostpartum DepressionCoping With DepressionCaring for a Depressed PersonDepression and the Elderly News & Headlines Bipolar DisorderFibromyalgiaSleep DisordersChronic PainSmoking: Quit NowCholesterolDiabetes (Type 2)GERDHeadaches and MigrainesAdult ADHD Free Mind & Mood Email Newsletter De–stress your life, sleep better, and conquer depression with the latest news and insights on mood management, plus special offers. For Women, Risk of Depression Falls as Coffee Intake Rises September 26, 2011 Getty Images By Matt McMillen MONDAY, September 26, 2011 (Health.com) — A few cups of coffee a day may help keep the blues at bay. According to a large new study, women who drink caffeinated coffee are less likely to become depressed—and the more they drink, the more their risk of depression goes down. The study, which was published today in the Archives of Internal Medicine, included more than 50,000 women between the ages of 30 and 55 who periodically filled out surveys about their coffee consumption and health. None of the women had depression symptoms (or a history of depression) at the start of the study, but during the next 10 years roughly 5% received a depression diagnosis or began taking antidepressant medication. Compared to women who drank little or no caffeinated coffee, those who averaged two to three cups per day were 15% less likely to develop depression, even after the researchers took into account a wide range of potentially mitigating factors including marital status, church or community participation, and various health measures. Drinking four cups a day was associated with a 20% lower risk of depression. The study doesn’t prove cause and effect, so there’s no reason to believe that drinking cup after cup will actually prevent depression, the researchers say. “There’s no need to start drinking coffee,” says study co-author Alberto Ascherio, MD, a professor of epidemiology and nutrition at the Harvard School of Public Health, in Boston. “The message is that coffee is safe to drink, with no adverse effects. That’s really all that can be said.” 12 Nondrug Remedies for Depression Big Perks: Coffee’s Health Benefits 12 Surprising Sources of Caffeine Previous research, including a study published last year that was conducted among men in Finland, has linked caffeine consumption to a lower risk of depression and suicide. “A couple of past studies found similar results,” says Daniel Evatt, PhD, a psychiatry research fellow at the Johns Hopkins School of Medicine, in Baltimore, who was not involved in the new research. “This study validates the association, and it was done in the best possible way.” It’s not clear why coffee might protect against depression. Some experts have speculated that the antioxidants in coffee may have health benefits, but in the new study people who drank only decaf were no more or less likely to be depressed than women who drank no coffee at all. The caffeine might be responsible, but the researchers weren’t able to confirm or deny this theory because there wasn’t enough data available to determine whether drinking caffeinated tea or sodas is linked to depression risk in the same way as coffee consumption. Eighty-two percent of the study participants drank coffee, while only 13% and 6% drank tea and soft drinks, respectively. Evatt, who studies the psychological effects of caffeine, is “not terribly convinced” that caffeine can prevent depression. “There’s a very strong indication that there is a real relationship there, but that doesn’t mean that coffee will stop depression,” he says. “We need to come up with a hypothesis for the mechanism at work, and then try to see what’s really happening.” Another possibility is that people who aren’t depressed may simply be more drawn to coffee than their depression-prone peers. Non-depressed people tend to be more “behaviorally activated,” and coffee drinking may therefore fit in better with their lifestyle, says Scott Bea, PsyD, a psychologist at the Cleveland Clinic who was not involved in the study. Similarly, Bea adds, some depressed people may steer clear of coffee because it can heighten anxiety, which often goes hand in hand with depression. “We shouldn’t rush to the conclusion that I should drink more coffee if I don’t want to be depressed,” Bea says. For his part, Evatt stresses that caffeine can have negative consequences for many people, whether they’re experiencing depression symptoms or not. “We shouldn’t put caffeine in too positive a light,” he says. “Some people have a relationship with caffeine that’s similar to an addictive drug. I don’t want to pin it as a public health problem, but people can become dependent on coffee and have troubling withdrawal symptoms.” Editors' Pick: Depression 10 Things to Say (and 10 Not to Say) to Someone With DepressionHow You Might React to a Depression DiagnosisCognitive-Behavioral Therapy: A Proven Weapon Against DepressionHow Exercise May Boost Your Mood10 No Cost Strategies to Fight Depression 10 No Cost Strategies to Fight Depression

医学

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CEO Spotlight Heather Bresch worked her way up from the basement of Mylan to the corner suite. Along the way, she fought the FDA on lax inspection of foreign drug manufacturers, and won. How to outwork the competition. Leslie P. Norton In the near future, the Food and Drug Administration will launch an aggressive inspection of foreign factories that make drugs for consumption in the U.S. Forty percent of the nation's pharmaceutical supply is manufactured overseas, where regulation historically has been light and problems have been growing. The coming inspections owe much to the 2008 heparin scandal, in which Chinese suppliers knowingly adulterated ingredients in the blood-thinning drug. They also reflect the tireless efforts of Heather Bresch, a young former secretary from West Virginia who became CEO of generic drug-maker Mylan (ticker: MYL) in January 2012. Due to her determination, fearlessness, and prodigious work ethic, Bresch accomplished what even the president of the United States has a tough time doing: getting a law passed. The so-called Generic Drug User Fee Act of 2012 was passed last year as part of a legislative overhaul of the FDA. It will level the playing field for all drug makers, enhance the attraction of manufacturing in the U.S., and raise costs for overseas factories that want to sell pharmaceutical products here, including many Mylan rivals. "Keeping a factory compliant with good manufacturing practices costs 25% more," says Bresch, who notes that Pittsburgh-based Mylan "has been running this way all along." A workhorse in platform soles, Bresch is known for making quick decisions. Evan Kafka for Barron's A reputation for ethics and excellence will stand Mylan in good stead as it expands around the world, where aging populations need affordable drugs. "That adds up to a double-digit growth rate for a public company over the next five years, which is pretty attractive," Bresch says. Then again, Mylan hasn't been coasting. Earnings rose more than 25% last year, to $2.59 a share, and the shares are up 38%, to $29.61, since Bresch took charge. The company has said it intends to earn $6 a share by 2018. THE CEO OF MYLAN has honey-colored hair and cuts a trim figure in an eyelet-edged dress. At 43, she is one of the youngest CEOs of a large American corporation—in this case, one with a $12 billion market capitalization and more than $7 billion in annual sales. Her manner is unguarded and she speaks with a disarming twang, a legacy, perhaps, of her upbringing in West Virginia, where members of her large Italian-American family once made their living mining coal and running small businesses. Bresch is as persuasive as a politician, a career that also runs in the family. Her father, Joe Manchin, is the former governor of West Virginia, and now the state's junior senator in Washington, D.C. Years ago, as a state senator, he ran into Mylan's co-founder, Milan Puskar, at a West Virginia University basketball game, and told him Bresch was job-hunting. Puskar gave her a job, in the basement of Mylan's Morgantown, W.Va., factory, typing labels for the company's quality-assurance program. She didn't stay in the basement for long. Bresch soon was promoted to the business-development office at Mylan. By 2002, she was director of government relations, a key role at a company in a heavily regulated industry. She then moved on to spokeswoman, head of strategic development, and chief operating officer, and began pushing for acquisitions that would triple Mylan's size. GENERIC-DRUG MANUFACTURERS wage hand-to-hand combat over each patent expiration. The industry succeeded by incentivizing distributors, but bitter competition put a strain on profit margins. Generics already accounted for two-thirds of U.S. drug sales in the mid-2000s, and competition was coming from Indian manufacturers such as Ranbaxy Laboratories (now a unit of Japan's Daiichi Sankyo (4568.Japan), and Dr. Reddy's Laboratories (RDY). Mylan needed to get bigger. In 2006, Mylan bought India's Matrix Laboratories, a maker of active ingredients and HIV treatments. The next year, Germany's Merck (MRK.Germany) decided to sell its generics division. All the big pharma companies kicked the tires until, out of nowhere, Mylan bid $6.7 billion in a deal that would make it the world's No. 3 generics company, after Teva Pharmaceutical Industries (TEVA) and Sandoz, which is owned by Novartis (NVS). But Mylan was paying more than its own market value for a company twice as large, and its shares promptly collapsed. The deal swelled Mylan's debt load to $8 billion, but also afforded Bresch an opportunity to showcase her business acumen. All of Merck's branded and generic products were intertwined, and disentangling them would be difficult. Mylan's then-CEO, Robert Coury, hired Boston Consulting Group to advise on the project, and put Bresch in charge of the integration. She introduced a system to track every aspect of the process, utilizing red, yellow, and green lights to denote progress. "We broke the record," says Coury. "She shone and delivered, saving the company tons of money. At first we told Wall Street we'd deliver $150 million of [cost-saving] synergies. We stopped counting at $500 million. We couldn't have hit it had it not been for [Bresch's] complex and disciplined model." Bresch is known for making rapid decisions. "She works 100 times harder than the person next to her," Coury says. Not everything went smoothly in these years. In 2008, following a newspaper investigation, Bresch's alma mater, West Virginia University, found that she hadn't fulfilled all academic requirements for an executive MBA degree listed on her resume. She claimed at the time that the university had allowed her to substitute fieldwork for academic experience. The school subsequently granted her the degree after changing various "incompletes" to grades, but the president and several other administrators were forced out amid charges of caving to political pressure. Later, West Virginia revoked the degree, and Bresch didn't challenge it. "It's a no-win for me to comment about this," she says. Despite the contretemps, Bresch was named president of Mylan in 2009, and became CEO in 2012 when Coury stepped aside. Just 52, he has stayed on as executive chairman, and is heavily involved in corporate strategy. IN THE MID-2000S, Bresch began to tackle the issue of regulatory oversight, which would make her famous. "I wasn't aware that there were two different standards for products sold in the U.S.," she says. "If you were a manufacturer in the U.S., you were subjected to a GMP [good manufacturing practice] inspection once every two years to get a clean bill of health." But the law was silent on manufacturing elsewhere. "It took 10, 12, 13 years, or perhaps never, for a [non-U.S.] facility to be inspected that was selling product in the U.S.," she says. Bresch realized that manufacturers were exposing themselves to potentially huge liabilities. The heparin scandal showed how complex the global supply chain had become. Yet, the FDA had no current database of foreign factories, and when the financial crisis hit, it had insufficient funding. Regulators began banging the drum for generic-drug manufacturers to pay user fees for the FDA's services, just as branded drug makers did. And Bresch began agitating for a quid pro quo for the generics industry. She thought the industry ought to agree to user fees, but demand that the funds be used to boost the agency's authority overseas. Enlarge Image Although the next vote to reauthorize prescription-drug fees was scheduled for late 2012, some two years hence, Bresch felt the need to act quickly. "My leadership style is that nothing gets better with age," she says. First, she commissioned a white paper detailing that, even as foreign facilities grew by 185% from 2001 to 2008, the FDA inspected just 8% a year. In September 2010 she attended an FDA open forum on user fees, and asked the crowd, "Do you believe every product you give your children should be held to the same standard if it wasn't made in the United States?" A few months later, she spoke at a Pew Charitable Trusts conference about the heparin scandal. "That was the catalyst for action on Capitol Hill," says Allan Coukell, a pharmacist who also directed Pew's medical-safety division. Bresch sent her chief of staff, Marcie McClintic Coates, to negotiate with the FDA about fees, giving her this advice: "The hardest-working person wins. Period. You need to outwork every FDA lawyer, every pharma lawyer, bury them with your work ethic, because if you know what you are doing and speak intelligently, you win." Coates figures she spent 140 hours just at the negotiating table. Key to her victory were admissions like that of FDA Commissioner Peggy Hamburg that the agency hadn't inspected some sites in 13 years. The FDA declined to comment. BRESCH MADE HUNDREDS of visits to Capitol Hill, wheedling senators to support the Generic Drug User Fee Act on patriotic grounds. "You're letting all my competitors, paying half the tax rate of Mylan, come into our country without the infrastructure or spending…to make sure there's quality medicine," she told them. She worked both sides of the aisle, paying countless visits to Rep. John Dingell, the powerful Democrat who headed the Energy and Commerce Committee. "She is one of the smartest people I've ever dealt with," Dingell says. "She did a super, honest, and honorable job." Adds Sen. Manchin, "All these senators were flabbergasted when they found out she was my daughter. Of course, John Dingell wanted to adopt her." On July 9, 2012, President Obama signed the bill into law. The New York Times singled out Bresch for credit, and Esquire magazine dubbed her one of its "Americans of the Year." "I think I was able to pull every ounce of the fabric of who I am and what's made me, from growing up in a political family to policy being in my blood, to my curiosity about wanting to figure out a problem," Bresch says. Now it's on to new challenges, and back to work at Mylan. The company is investing heavily in research and development, and has numerous drug launches planned. Business is recovering in Europe and booming in Asia, where Mylan has launched a new business with Pfizer (PFE) in Japan. Just last week, it agreed to buy an Indian company that specializes in generic versions of injectable drugs. Bresch, meanwhile, is crusading for wider distribution of EpiPens, which carry an injectable antidote to allergic reactions. She maintains they should be as widely available as cardiac defibrillators. "I grew up in an era when generics were considered inferior," she says. "People thought they were made in a bathtub." But not any more, due in part to Mylan's success and Bresch's quality-control crusade. E-mail: editors@barrons.com Email Latest in CEO Spotlight 1. Katherine Krill: She Knows What Women Want 2. Why Bigger Is Better 3. James Lillie of Jarden: Battle of the Brands 4. "We're Glad to Have You Here" 5. United Rentals' Michael Kneeland: Leadership From the Ground Up

医学

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Researchers reveal possibility of separating anticancer properties of vitamin D Washington, D.C. -- At the right dose, vitamin D is important for bone development and may help protect against the development of several cancers, particularly colorectal cancer. However, large quantities designed to exploit the vitamin's anticancer properties can lead to a toxic overdose of calcium in the blood. Now, research done at Georgetown University's Lombardi Comprehensive Cancer Center indicates that it may be possible to separate the anticancer properties of vitamin D from its other functions. Their study, reported in the journal Molecular Cell, found that mutant forms of the protein that binds to vitamin D in the cell do not allow vitamin D to promote bone development and calcium transport but do permit it to regulate an oncogenic protein known as beta catenin. Some modified forms of vitamin D itself, which do not alter bone and calcium, were also found to regulate beta-catenin. "We found that we might be able to separate the two functions at the molecular level, and this raises the possibility that vitamin D can be chemically modified into a drug that will only have anticancer effects," said Professor Stephen Byers, Ph.D. He and Salimuddin Shah, Ph.D., led an international group of investigators in this study. The human body produces a lot of vitamin D from a brief exposure of the sun. The vitamin is made in the skin when a cholesterol-like molecule interacts with ultraviolet light. It has long been known that a lack of vitamin D can lead to the bone deformities associated with rickets, and the vitamin helps maintain calcium and phosphorous levels in bone and blood. Too much vitamin D, however, can spill calcium into the blood and lead to heart disease and death. Population studies have also uncovered an interesting fact -- that the risk of developing colon cancer is lower in people who live in sunny climates. Epidemiology studies have indicated that vitamin D is responsible for the protective effect of sunlight exposure on the incidence of several other cancers besides colon, including breast and prostate. Byers and the research team suspected that beta catenin may interact with vitamin D in some fashion because of another known fact -- activation of beta catenin causes most colon cancers. To help them understand what vitamin D is doing in the cell, the researchers studied findings by other scientists who had looked at families who develop rickets due to an inherited mutation in their vitamin D receptor. Most of these patients had both rickets and alopecia (baldness). However a small number of families had mutations in the receptor which only led to rickets. "We know beta catenin is also involved in regulation of hair growth and we wondered if these particular mutations might also allow the receptor to regulate beta catenin," Byers said. "We found a mutation which caused rickets but not alopecia but which still allowed beta catenin to bind to the vitamin D receptor," he said. This suggested to the researchers that it may be possible to separate the anti-cancer role of vitamin D from its effects on bone and calcium. If a drug mimic of vitamin D can be developed, it could prove useful in preventing some cancers at their earliest stages, but would probably not offer any therapeutic benefit for later stage cancers, Byers said. "That's because we know that by the time colon cancer is well advanced it fails to respond to vitamin D." About Georgetown University Medical Center Georgetown University Medical Center is an internationally recognized academic medical center with a three-part mission of research, teaching and patient care (through our partnership with MedStar Health). Our mission is carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of cura personalis--or "care of the whole person." The Medical Center includes the School of Medicine and the School of Nursing and Health Studies, both nationally ranked, and the world renowned Lombardi Comprehensive Cancer Center. For more information, go to http://gumc.georgetown.edu.

医学

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Remembering Cy Romney: The Lifetime of a Pioneer Supporter of Reproductive Rights by Jodi Magee, Physicians for Reproductive Health September 8, 2010 - 6:00 am I had the great pleasure of knowing and working alongside Seymour “Cy” Romney, MD, for almost two decades. Since learning of his death on August 22, I’ve been reminded of how much he accomplished in his long and highly productive career. Though abortion was legalized in Cy’s lifetime, subsequent attacks on providers and restrictive laws led him to found Physicians for Reproductive Choice and Health (PRCH) in the early 1990s. Although Cy was a noted gynecologic researcher with important scientific contributions to his name, his greatest legacy may be the work we do at PRCH to encourage and support access to quality reproductive health services for all Americans. Cy’s support for abortion rights began early in his medical career. When he became an obstetrician/gynecologist in the 1940s, he was horrified by the many young women he saw suffering from botched attempts to end unwanted pregnancies. Decades later, Cy could still recall a phone call from a fellow physician in New York City who was trying to save a young woman’s life. “Someone had put darning needles through her uterus in an attempt to end the pregnancy,” he recalled. “She was 16 years old and was about six months pregnant. We were confronted with how to terminate the pregnancy and prevent this woman from going into shock and dying. Ultimately, we had to remove her uterus in order to save her life. Doing a hysterectomy on a 16-year-old woman because of a primitive, botched, criminal abortion is an unforgettable experience.” Cy’s desire to help women like this one led him to fight for legal abortion both in New York state and nationally. He was present in 1970 when Governor Nelson Rockefeller signed the law making abortion legal in New York. Three years later, Cy was at a medical conference in Boston when he learned of the Roe v. Wade decision. “None of us will ever forget that night,” he said. “It was a landmark victory for public health, for women and for a compassionate, confidential patient-physician responsibility.” In the early 1990s, legal abortion was under violent attack—anti-choice protestors were vandalizing clinics and even killing physicians, and new laws were making it difficult for women to access abortion services. Cy felt that doctors’ voices were missing from the public discourse on this issue. Believing that doctors could be effective public spokespeople, and that they had a public health responsibility to speak out, he gathered together a handful of other concerned doctors and created Physicians for Reproductive Choice and Health. He wrote hundreds of letters to fellow physicians, cajoling and flattering them to contribute to his vision of a physician-led organization that would work with the women’s movement to protect a woman’s right to choose. In the nearly two decades since its founding, Cy’s vision has grown into a national organization representing doctors from a variety of disciplines in almost every state in the US with programs in public policy, communications and medical education. It has even spawned an international initiative, Global Doctors for Choice. Yet the need to protect abortion rights, both here and abroad, continues unabated. One of the last PRCH events Cy attended was an awards ceremony honoring his former PRCH board colleague George Tiller, MD, who was killed shortly thereafter by an anti-choice extremist—the first such murder in years. In the year since Dr. Tiller’s murder, PRCH’s network has pushed back against such extremism. At this year’s abortion provider awards ceremony, we launched the Abortion Provider’s Declaration of Rights, which captures everything Cy fought for all along: the physician’s right to practice medicine in the best interests of his patients without fear of harassment and violence. Violence and harassment aren’t the only anti-choice activities we combat. PRCH is also involved in fighting laws that impede women’s access to reproductive health—and championing laws that help doctors provide the best care to their patients. In a few weeks, PRCH will bring a group of physicians to Washington, DC, to urge Congress to lift the ban on abortions in military hospitals. I know I’ll be thinking of Cy that day, the trips we took to Washington, the day we celebrated the FDA’s approval of mifepristone medication abortion, and the countless letters he wrote state and federal government officials urging support for sound reproductive health policies. The work of protecting abortion care may never be over, but I am encouraged when I look back over Cy’s lifetime and his distinguished career. He helped achieve so much: legalizing abortion in New York and the United States; training hundreds of physicians as advocates; founding and leading an organization that has become “the voice of the pro-choice physician.” The greatest way we can honor this amazing man and humble doctor is to keep fighting for what Cy believed in—every pregnancy a wanted pregnancy. To schedule an interview with Jodi Magee contact director of communications Rachel Perrone at rachel@rhrealitycheck.org. dr-suzanne-poppema Very well said, Jodi. Dr Romney was a remarkable human being and a “bearer of the flame” for reproductive health and choice for all the years I knew and worked with him as well. He was absolutely right that we physicians need to be not only health care providers but also policy advocates for our patients’ reproductive health needs. We miss him greatly.

医学

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Human infection with influenza A(H7N9) virus in China - update 9 April 2013 - As of 9 April 2013 (14:00 CET), the National Health and Family Planning Commission notified WHO of an additional three laboratory-confirmed cases of human infection with influenza A(H7N9) virus. The latest laboratory-confirmed cases include two patients from Jiangsu – an 85 -year-old man who became ill on 28 March 2013 and a 25-year-old pregnant woman who became ill on 30 March 2013. Both are in severe condition. The third patient is a 64-year-old man from Shanghai who became ill on 1 April 2013, and died on 7 April 2013. To date, a total of 24 cases have been laboratory confirmed with influenza A(H7N9) virus in China, including seven deaths, 14 severe cases and three mild cases. More than 600 close contacts of the confirmed cases are being closely monitored. In Jiangsu, investigation is ongoing into a contact of an earlier confirmed case who developed symptoms of illness. The Chinese government is actively investigating this event and has heightened disease surveillance. Retrospective testing of recently reported cases with severe respiratory infection may uncover additional cases that were previously unrecognized. An inter-government task force has been formally established, with the National Health and Family Planning Commission leading the coordination along with the Ministry of Agriculture and other key ministries. The animal health sector has intensified investigations into the possible sources and reservoirs of the virus. WHO is in contact with national authorities and is following the event closely. The WHO-coordinated international response is also focusing on work with WHO Collaborating Centres for Reference and Research on Influenza and other partners to ensure that information is available and that materials are developed for diagnosis and treatment and vaccine development. No vaccine is currently available for this subtype of the influenza virus. Preliminary test results provided by the WHO Collaborating Centre in China suggest that the virus is susceptible to the neuraminidase inhibitors (oseltamivir and zanamivir). At this time there is no evidence of ongoing human-to-human transmission. WHO does not advise special screening at points of entry with regard to this event, nor does it recommend that any travel or trade restrictions be applied. Related links More on human infection with influenza A(H7N9) virus

医学

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AAFP Leader Voices Blog Fresh Perspectives Blog News From 2014 AAFP Assembly Health of the Public Practice & Professional Issues Government & Medicine Physician Education & Development As We See It: Voices From the AAFP Inside the Academy Chapter Spotlight News in Brief News From 2013 Annual Assembly 2013: The Year in Review About AAFP News In Memoriam News Archives New Guidelines Propose Significant Shift in Cholesterol Management AAFP to Assess Multipart Guidance on Reducing Cardiovascular Risk November 15, 2013 04:47 pm The long-awaited American College of Cardiology (ACC) and American Heart Association (AHA) guidelines on treatment of high blood cholesterol(circ.ahajournals.org) to reduce atherosclerotic cardiovascular risk in adults may significantly shift how family physicians treat patients. The updated cholesterol guidelines, which were published online Nov. 12 in the AHA's journal Circulation, suggest physicians use a new risk assessment tool and grading system to determine who qualifies for statin treatment. The changes could significantly increase the number of people taking the cholesterol-lowering drugs. In addition, guidelines on screening for(circ.ahajournals.org) and managing cardiovascular risk(circ.ahajournals.org), as well as on identifying, evaluating and treating(circ.ahajournals.org) obesity in adults, were published the same day in AHA's journal Circulation. New American College of Cardiology (ACC) and American Heart Association (AHA) treatment guidelines for high blood cholesterol in adults suggest physicians use a new risk assessment tool and grading system to determine who qualifies for statin treatment. The ACC/AHA also released three other guidelines: two on screening for and managing cardiovascular risk, and one on the identification, evaluation and treatment of obesity. The AAFP is reviewing the guidelines for possible endorsement and likely will publish its determinations during the first quarter of 2014. According to Doug Campos-Outcalt, M.D., M.P.A., of Phoenix, clinical methodologist to the AAFP's Commission on the Health of the Public and Science (CHPS), the proposed changes may be warranted, but the Academy currently is not in a position to endorse the updates. Although Patrick McBride, M.D., M.P.H., of Madison, Wis., served as the lone family physician member on the ACC/AHA Task Force on Practice Guidelines expert panel that developed the cholesterol recommendations, he did not do so as an official representative of the AAFP. The Academy and other primary care organizations were not invited to participate in the guideline development process after the National Heart, Lung and Blood Institute (NHLBI) handed that specific task over to the specialty societies earlier this year. Moreover, Campos-Outcalt said the ACC/AHA provided all four guidelines to the AAFP -- including several hundred pages of supporting evidence for each one -- with only a limited amount of time for review before publication. CHPS currently is reviewing the guidelines. "The Academy will assess this cholesterol guideline, along with all of the others, and make a decision as to whether we can endorse or not," Campos-Outcalt told AAFP News Now. That said, he added, "(the expert panel) did a lot of things better than last time. They performed a much more comprehensive and rigorous assessment than in 2003, but I think it will take at least a couple of months to get through this." Path to Simpler Management McBride said he thinks the changes will reduce the complexity of therapy at his own Madison, Wis.-based practice, noting that the panel updated the risk assessment tool to be more contemporary. "The evidence strongly supports not only the use of risk assessment for primary prevention, but that the level of (initiation of) treatment for primary prevention is a 10-year risk assessment of 7.5 percent, which will make treatment for high-risk individuals in primary prevention simpler," said McBride. "We won't have to constantly use follow-up cholesterol measures for LDL treatment targets." McBride took exception to concerns voiced in the popular press that the risk-reduction threshold is too severe and will result in too many people being started on statin therapy. "I think a lot of the arithmetic that's been done in the popular press is wrong, because this (recommendation) is, in fact, putting more appropriate people on treatment and making sure that those who are not appropriate for treatment don't get put on medication," McBride said. "There are a lot more people at risk today than there were 10 years ago because of obesity and other age-related risk factors. There are more people with hypertension and more people with metabolic syndrome today because of changes in our population. "Family physicians are well aware of those population changes," he said. "This guideline is all about putting the appropriate people on treatment." The evidence for setting the new treatment threshold was clear, said McBride. "The cut point was previously set at 10 percent … and we dropped it based on very good evidence that there was a strong benefit to statin treatment for a person with a 7.5 percent 10-year risk, because we also looked at lifetime risk," he said. "I also want to point out to family physicians that this (cut point/recommendation) is true for both men and women, basing the guideline on risk, not gender." Furthermore, said McBride, the data used to create the guideline also indicate that it is the overall management of cholesterol -- regardless of blood cholesterol levels attained -- that resulted in strong evidence of reductions in heart disease and associated mortality. "No clinical trial tested whether treating to a specific LDL level made a difference," he said. "(Researchers) used specific doses of cholesterol medicines, so the new guidelines reflect that." Note of Caution Campos-Outcalt said that although it's impossible to digest the new cholesterol guideline in a single reading, he does have some concerns. "I count 46 total recommendations, 20 of which are graded 'E,' meaning they are based on expert opinion," Campos-Outcalt said. "So I do have to raise some questions when nearly half of your recommendations are based on expert opinion. "This guideline also has some recommendations in it that rest upon evidence presented in the other guidelines that were just released. So, you basically have to assess all of them at once, which is a bit unusual." AAFP EVP Douglas Henley, M.D., said the Academy has expressed its concern to the NHLBI that it wasn't given the opportunity to serve as a full and equal partner in the development of the guidelines. "The reason physicians from a wide range of specialties typically work together on projects like this is to ensure special interests don't interfere with good science," Henley explained. "When you have organizations representing one specialty develop and release these kinds of guidelines, credibility can become an issue." That concern notwithstanding, Campos-Outcalt said his own initial impression is that the expert panel largely followed the Institute of Medicine standards the AAFP uses to develop its own recommendations and, in the process, improved on the 2003 version of the cholesterol guideline. "I think the lesson here is that if you don't base your (original) guidelines on good, solid evidence, they are going to change drastically (from one version to another)," he said. "I think it is fair for people to ask, 'Why did you make those recommendations the last time around?' Sometimes it is better to say nothing than to guess, because these 'revolving guidelines' can cause a lot of confusion." According to CHPS Chair Alan Schwartzstein, M.D., the commission should make its recommendations on the ACC/AHA guidelines to the AAFP Board of Directors in the first quarter of 2014. Health of the Public ACC/AHA Issue New Guidelines on Cardiovascular Risk

医学

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"Birth Defects"Undo Air Travel During Pregnancy ABSTRACT: In the absence of obstetric or medical complications, pregnant women can observe the same precautions for air travel as the general population and can fly safely. Pregnant women should be instructed to continuously use their seat belts while seated, as should all air travelers. Pregnant ... Avoiding Inappropriate Clinical Decisions Based on False-Positive Human Chorionic Gonadotropin Test Results ABSTRACT: Clinically significant false-positive human chorionic gonadotropin (hCG) test results are rare. However, some individuals have circulating factors in their serum (eg, heterophilic antibodies or nonactive forms of hCG) that interact with the hCG antibody and cause unusual or unexpected te... Carrier Screening for Fragile X Syndrome (Replaces No. 338, June 2006) ABSTRACT: Fragile X syndrome is the most common inherited form of mental retardation. The syndrome occurs in approximately 1 in 3,600 males and 1 in 4,000–6,000 females. Approximately 1 in 250 females carry the premutation. DNA-based molecular analysis is the preferred method of diagnosis for frag... Family History as a Risk Assessment Tool ABSTRACT: Family history plays a critical role in assessing the risk of inherited medical conditions and single gene disorders. Several methods have been established to obtain family medical histories, including the family history questionnaire or checklist and the pedigree. The screening tool sel... Guidelines for Diagnostic Imaging During Pregnancy (Reaffirmed 2009, Replaces No. 158, September 1995) ABSTRACT: Undergoing a single diagnostic X-ray procedure does not result in radiation exposure adequate to threaten the well-being of the developing preembryo, embryo, or fetus and is not an indication for therapeutic abortion. When multiple diagnostic X-rays are anticipated during pregnancy, imag... Labor Induction or Augmentation and Autism Abstract: Functional oxytocin deficiency and a faulty oxytocin signaling pathway have been observed in conjunction with autism spectrum disorder (ASD). Because exogenous synthetic oxytocin commonly is administered for labor induction and augmentation, some have hypothesized that synthetic oxytocin... Management of Asymptomatic Pregnant or Lactating Women Exposed to Anthrax ABSTRACT: Anthrax infections are diagnosed by isolating Bacillus anthracis from body fluids or by measuring specific antibodies in the blood of persons suspected to have the disease. It is recommended that asymptomatic pregnant and lactating women who have been exposed to a confirmed environmental... Maternal Phenylketonuria (Replaces No. 230, January 2000) ABSTRACT: Phenylketonuria (PKU) is an autosomal recessive disorder of phenylalanine (Phe) metabolism characterized by a deficiency of the hepatic enzyme, phenylalanine hydroxylase, an enzyme responsible for the conversion of phenylalanine to tyrosine, and elevated levels of Phe and Phe metabolite.... Maternal–Fetal Surgery for Myelomeningocele ABSTRACT: Myelomeningocele, the most severe form of spina bifida, occurs in approximately 1 in 1,500 births in the United States. Fetuses in whom myelomeningocele is diagnosed typically are delivered at term and are treated in the early neonatal period. A recent randomized controlled trial found t... Moderate Caffeine Consumption During Pregnancy ABSTRACT: Moderate caffeine consumption (less than 200 mg per day) does not appear to be a major contributing factor in miscarriage or preterm birth. The relationship of caffeine to growth restriction remains undetermined. A final conclusion cannot be made at this time as to whether there is a cor... Noninvasive Prenatal Testing for Fetal Aneuploidy ABSTRACT: Noninvasive prenatal testing that uses cell free fetal DNA from the plasma of pregnant women offers tremendous potential as a screening tool for fetal aneuploidy. Cell free fetal DNA testing should be an informed patient choice after pretest counseling and should not be part of routine p... Preconception and Prenatal Carrier Screening for Genetic Diseases in Individuals of Eastern European Jewish Descent ABSTRACT: Certain autosomal recessive disease conditions are more prevalent in individuals of Eastern European Jewish (Ashkenazi) descent. Previously, the American College of Obstetricians and Gynecologists recommended that individuals of Eastern European Jewish ancestry be offered carrier screeni... Preimplantation Genetic Screening for Aneuploidy ABSTRACT: Preimplantation genetic screening differs from preimplantation genetic diagnosis for single gene disorders and was introduced for the detection of chromosomal aneuploidy. Current data does not support a recommendation for preimplantation genetic screening for aneuploidy using fluorescenc... Sulfonamides, Nitrofurantoin, and Risk of Birth Defects Abstract: The evidence regarding an association between the nitrofuran and sulfonamide classes of antibiotics and birth defects is mixed. As with all patients, antibiotics should be prescribed for pregnant women only for appropriate indications and for the shortest effective duration. During the s... Update on Carrier Screening for Cystic Fibrosis ABSTRACT: In 2001, the American College of Obstetricians and Gynecologists and the American College of Medical Genetics introduced guidelines for prenatal and preconception carrier screening for cystic fibrosis. The American College of Obstetricians and Gynecologists' Committee on Genetics has upd... Vitamin D: Screening and Supplementation During Pregnancy ABSTRACT: During pregnancy, severe maternal vitamin D deficiency has been associated with biochemical evidence of disordered skeletal homeostasis, congenital rickets, and fractures in the newborn. At this time, there is insufficient evidence to support a recommendation for screening all pregnant w...

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Researchers successfully regenerate complete shoulder joint surfaces in rabbit model using the patient's own cells A team of University of Missouri and Columbia University researchers have found a way to create these biological joints in animals, and they believe biological joint replacements for humans aren't far away. Animal research reveals unexpected biological pathway in glaucoma In a study published today in the Proceedings of the National Academy of Sciences (Early Edition ahead of print), a team of researchers from the Kennedy Krieger Institute and four collaborating institutions, identified a new and unexpected biological pathway that appears to contribute to the development of glaucoma and its resulting vision loss. Tuesday, January 4, 2011 - 11:18 AALAS issues position statement on animal rights terrorists AALAS recently released a position statement condemning threats and harassments made to those who work with animals in research. Friday, December 10, 2010 - 14:27 American Physiological Society condemns threats against researchers The American Physiological Society condemns all acts of violence or intimidation against individuals engaged in legitimate scientific inquiries intended to advance knowledge and improve health. Stem cell therapy, tested in mice, holds promise for epileptics Stem cells taken from the brain of a 13-year-old girl were transplanted into newborn mice and developed into a variety of brain cells almost identical to the animals' own — a procedure that someday could be used to replace the misfiring cells in some epilepsy patients, the researchers said. Wednesday, December 8, 2010 - 12:01 AVMA condemns threats by animal rights activists against UCLA scientist (SCHAUMBURG, Illinois) December 1, 2010—Citing its policy on the use of animals in research, testing and education, the American Veterinary Medical Association (AVMA) today condemned the recent actions of animal rights activists who have targeted a University of California research neuroscientist. Wednesday, December 1, 2010 - 14:51 Gene therapy technique successfully tested in mice eases memory problems linked to Alzheimer's Disease A gene therapy technique which aims to ease memory problems linked to Alzheimer's Disease has been successfully tested in mice. US scientists used the technique to increase levels of a chemical which helps brain cells signal to each other. Partial reversal of aging achieved in mice Harvard scientists at Dana-Farber Cancer Institute say they have for the first time partially reversed age-related degeneration in mice, resulting in new growth of the brain and testes, improved fertility, and the return of a lost cognitive function. Diabetes drug could work against Alzheimer's Metformin, a drug used in type 2-diabetes might have the potential to also act against Alzheimer's disease. This has been shown in a study from scientists of the German Center for Neurodegenerative Diseases (DZNE), the University of Dundee and the Max-Planck-Institute for Molecular Genetics. Wednesday, November 24, 2010 - 12:43 Findings of mouse study suggest new cause, possible treatment for multiple sclerosis Researchers have found evidence that an environmental pollutant may play an important role in causing multiple sclerosis and that a hypertension drug might be used to treat the disease. New path for colon cancer drug discovery through animal research An old pinworm medicine is a new lead in the search for compounds that block a signaling pathway implicated in colon cancer. The findings, reported by Vanderbilt University Medical Center researchers in the November issue of Nature Chemical Biology, suggest a fresh approach for developing therapeutics that target the pathway. New animal research shows a novel approach to Alzheimer's vaccine design New studies identify brain changes in people with Alzheimer's disease. The results give researchers a greater understanding of the disease and may help at-risk individuals by improving early detection. Tuesday, November 16, 2010 - 21:04 Animal studies suggest new paths to treating depression New animal research has identified factors, such as the stress response and immune system, that may play important roles in depression. Scientists have also found that the regulation of nerve cell signals influences depression in animals, and that new drug combinations may more effectively treat it. The findings were presented at Neuroscience 2010, the annual meeting of the Society for Neuroscience and the world's largest source of emerging news on brain science and health. Tuesday, November 16, 2010 - 20:51 Mouse study shows effect of blood pressure drug on Alzheimer's disease A drug used decades ago to treat high blood pressure has been shown to improve learning and memory in mouse models of Alzheimer’s disease, according to a new study by researchers at the National Institute on Aging (NIA), part of the National Institutes of Health. Tuesday, November 16, 2010 - 13:05 Burning pain and itching governed by same nerve cells in laboratory mice There are disorders and conditions that entail increased itching and can be extremely troublesome for those suffering from it. The mechanisms behind itching are not well understood today. For one thing, what is it about scratching that relieves itching? Research with mice shows proteasome inhibitor to be promising treatment for rheumatoid arthritis A new study by Greek researchers suggests that the biologic drug bortezomib (Velcade), a proteasome inhibitor used to treat multiple myeloma (bone marrow cancer), may represent a promising treatment for rheumatoid arthritis (RA). Wednesday, November 3, 2010 - 18:07 A sweet discovery in animal research raises hope for treating Ebola and other fast-acting, deadly viruses New research published in the Journal of Leukocyte Biology suggests that a purified form of a product modified from simple sugar molecules can eradicate killer viruses by mobilizing white blood cells. Wednesday, November 3, 2010 - 18:01 Mouse model confirms mutated protein's role in dementia A team of scientists from Japan and the University of California, San Diego School of Medicine have created a new mouse model that confirms that mutations of a protein called beta-synuclein promote neurodegeneration. Mouse studies suggest treatment target for alcohol problems A molecular pathway within the brain’s reward circuitry appears to contribute to alcohol abuse, according to laboratory mouse research supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health (NIH). The findings, published online today in Proceedings of the National Academy of Sciences, also provide evidence that the pathway may be a promising new target for the treatment of alcohol problems. Tuesday, November 2, 2010 - 17:09 Zebrafish make excellent model organisms for research on human diseases University scientists are using a seemingly unlikely animal to study development, cell function and the effects of debilitating human diseases. Ninety percent of zebrafish's amino acids are in the same order as a human's. Because of these similarities, zebrafish make excellent model organisms for research on human diseases.

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< Go BackBlood Test Shows Promise in Gauging Risk for Pregnancy ComplicationMONDAY, Nov. 4 (HealthDay News) -- A new blood test might help doctors determine if a woman will develop a severe form of high blood pressure, known as preeclampsia, during pregnancy, a new study shows.Preeclampsia can damage the kidneys, liver and brain, and lead to fetal complications such as premature delivery, low birth weight and stillbirth, the experts said.The new test checks levels of a protein called placental growth factor (PlGF), and was assessed in 625 British women.The 61 percent of participants who developed preeclampsia all had low levels of PlGF, the researchers said.They also found that if a woman's PlGF levels fell below a certain threshold before her 35th week of pregnancy, her baby was likely to be delivered within 14 days. In a normal pregnancy, levels of PlGF remain more stable, the researchers said.The study, partly funded by Alere, the test's maker, was published Nov. 4 in the journal Circulation."The test is designed to differentiate women with preeclampsia from those with high blood pressure alone," Lucy Chappell, clinical senior lecturer in obstetrics at King's College in London, said in a journal news release. "Current tests for the condition only detect that it's happening rather than predicting it, and by that time the disease has progressed and has likely already caused organ damage."By using the test to identify women at high risk for preeclampsia, "doctors can better monitor and treat the blood pressure," Chappell said. "It also prevents unnecessary hospitalizations of those who are not likely to develop preeclampsia."Two experts not connected to the study said the test might hold promise.Dr. Jill Rabin is head of urogynecology at Long Island Jewish Medical Center in New Hyde Park, N.Y. She said that although more high-quality trials are needed to confirm the test's value, "this study clearly demonstrates the potential diagnostic utility" of the PlGF screen for pregnant women.And Dr. Jennifer Wu, an ob/gyn at Lenox Hill Hospital in New York City, added that although the test "is currently not available in the U.S., it holds promise in predicting patients who will develop preeclampsia." More informationThe March of Dimes has more about preeclampsia.SOURCES: Jill Rabin, M.D., chief, ambulatory care, obstetrics and gynecology, and head, urogynecology, Long Island Jewish Medical Center, New Hyde Park, N.Y.; Jennifer Wu, M.D., obstetrician/gynecologist, Lenox Hill Hospital, New York City; Circulation, news release, Nov. 4, 2013

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CAP Reference Resources and Publications cap_today/cap_today_index.html CAP TODAY 2013 Archive What happened when lab set sights on parasites Feature Story Anne Ford When Bobbi S. Pritt, MD, director of clinical parasitology and virology in the Division of Clinical Microbiology at Mayo Clinic, set out to improve test utilization among the physicians for whom her laboratory performs assays, she figured that knowledge was power. Simply educate the clinicians, she thought, and surely they would begin to order the most appropriate tests for their patients. It took her some time to realize that while knowledge may be powerful, in some situations, it’s just not powerful enough. That is, despite extensive educational efforts, she saw no decrease in order volume for the assay whose utilization she had hoped to reduce—ova-and-parasite testing. “I don’t think that they [the laboratory’s educational efforts] really did much as far as changing ordering practices,” Dr. Pritt said during “An Algorithm for Detection of Intestinal Parasites: Lessons Learned,” a talk she gave last year at the American Association for Clinical Chemistry annual meeting. “Education is important. It helps establish the laboratory and the laboratorian as a subject-matter expert. It helps get you out of the laboratory, interacting with your clinicians so you can build up that trust ... which is essential if you want to start implementing algorithms down the road. But it doesn’t necessarily get you the impact you want.” (Click on the image to enlarge) In her remarks, Dr. Pritt reviewed the prevalence of parasite-related disease in the United States as well as the most appropriate testing options for it, outlined her laboratory’s efforts to improve utilization of parasitology testing, and supplied recommendations for other labs that might wish to do the same. Her hope: that “some of the principles I’m going to present would be very reproducible in other areas” of the laboratory, not just microbiology. Dr. Pritt presented the case of a previously healthy four-year-old boy who, along with other children from his preschool class, experienced watery diarrhea of two days’ duration after visiting a petting zoo. She asked her audience to indicate which test they’d choose: stool culture for Strongyloides and hookworm, parasitic examination of stool (ova-and-parasite exam), immunoassay for Giardia and Cryptosporidium, immunoassay for Entamoeba histolytica, or some combination thereof. Seeing a marked lack of consensus among audience members, she said, “I think that this is how the physicians feel ... And I think sometimes they just say, ‘Oh, what the heck, let’s just order them all,’ right?” Actually, she said, the tendency is for physicians to order the ova-and-parasite exam, because it’s “probably our most comprehensive exam as far as being able to detect the number of parasites.” So what’s wrong with that? To start with, “most of the time—I hate to say it—the parasites aren’t even probably the main cause of the patient’s diarrhea,” she said. “It’s probably viral or bacterial, so you’re looking for a needle in a haystack, and ... you don’t even have a high pre-test probability that you’re going to find a parasite.” “But you wouldn’t know that if you just looked at public media,” she added, “because we have all these really interesting television shows now, like ‘Monsters Inside Me’” (a documentary series about parasites). “Physicians and their patients have parasites on the brain, so to speak, and so they want to order tests for parasites.” Then there’s the fact that the ova-and-parasite test is not the most sensitive option for detecting North America’s two most common intestinal parasites associated with diarrhea: Giardia and Cryptosporidium. Using ova-and-parasite to rule out Giardia as a cause of diarrhea, for example, could require as many as seven stool specimens. “Can you imagine asking your patient to come back in seven times with a stool specimen?” she asked. “Do you know how popular that will not be?” In addition, the ova-and-parasite test is “a subjective morphologic examination,” she noted. “You need well-trained technologists, and they have to be highly experienced.” All that to say: Unless the patient has lived in or visited an area of the world in which helminths (parasitic worms) are common, an ova-and-parasite test would probably not be indicated. Better options, Dr. Pritt said, are “some special stains [modified acid-fast stain and modified trichrome stain], which are good in certain situations.” There are also antigen detection assays, such as for Giardia and Cryptosporidium and for Entamoeba histolytica, although the latter is not common in North America. “We have some other methods: antibody detection using serum, a stool culture for Strongyloides and hookworm—again, not very common in the United States—and then in some research settings, we have PCR. But when you tell the physician all of this, and you say, ‘These are your options,’ they don’t know which one to order because there’s just so many of them.” That’s why, she said, the preferred approach would be for physicians to use an algorithm to guide their testing, based on how the patient is presenting and what his or her risk factors are. As she presented the algorithm to the audience, it seemed simple enough: “If you happen to have a patient who has watery diarrhea who has AIDS, had contact with farm animals, or was involved in an outbreak, such as municipal water supply or a day care center, like our patient, you would want to consider ordering the Cryptosporidium antigen.” (Indeed, the patient she mentioned earlier in her talk did test positive for Cryptosporidium.) And if the patient is not yet five years old, or is a camper or backpacker who might have drunk out of a stream, “you’d want to also consider ordering the Giardia antigen.” Given that the risk factors for Cryptosporidium and Giardia infection overlap, “we actually recommend that both antigen tests be ordered together” (see algorithm, left). In contrast, a select group of patients (travelers, immigrants, and people living in small pockets of the United States such as Appalachia) may have been exposed to intestinal parasites such as roundworms. “That’s the main situation where you would want to order that ova-and-parasite exam,” Dr. Pritt says. Doesn’t sound too difficult. “I should be able to convince all my physicians to do this, right?” she said. “All right, well, unfortunately, there’s some challenges.” First, she pointed out, “the initial selection of tests, and any sequential tests they may decide to do, all depend on clinical factors. And how many of you feel like you really get all those clinical factors you ask for?” Her laboratory used to include a form asking about the patient’s travel history with every stool collection kit, for example, but repeatedly would get unhelpful answers such as “one hour in the car”—when they were filled out at all. “So the problem you can see here,” Dr. Pritt said, “is that [for the ova-and-parasite exam] the laboratory professionals have little control over ordering decisions. We can’t even go in and cancel tests ... or have an algorithm ... where a single initial test will allow a cascade to happen.” Usually just one test is ordered, “and we don’t know if it’s appropriate or not, because we don’t know all of the inputs—all of that clinical background,” she said. Instead of the laboratory controlling the algorithm, it’s the clinician who controls the algorithm. “So because of that, if we’re going to get them to use the algorithm, we need clinical acceptance.” Toward that end, Dr. Pritt and her colleagues not only sought clinician input when developing the algorithm, but also launched ongoing education for them. “We’re a large teaching hospital, so we have trainees coming in every year, so it’s going to be a large undertaking,” she said. Then, too, she had to grapple with the fact that 80 percent of her laboratory’s intestinal parasite testing volume comes from reference lab clients: “So that’s going to be a big challenge.” She addressed it by attempting to educate the laboratorians at the outside labs, releasing an educational bulletin, a 30-minute educational video, and finally a live televised 60-minute educational program. The result? “Our volumes [of ova-and-parasite testing] actually went up to higher than they had ever been,” she said. Rather than help physicians be more selective in placing specific orders for intestinal parasites, it appears “the educational efforts only served to increase awareness of intestinal parasites and prompt more orders.” Her conclusion: “Educational efforts are not enough by themselves to sufficiently change ordering practices.” That’s probably for a number of reasons, she said. “We’re not reaching the right people, habits and patterns are hard to break, and every year there’s a regular influx of new trainees and clinicians, not just at my institution but at all of those outreach institutions.” In addition, education is time-consuming. “It’s a lot of effort, and the yield isn’t necessarily sustainable after that initial educational impact. And it turns out, we are not the first persons to see this,” she said, pointing to a 1984 study (Schroeder SA, et al. The failure of physician education as a cost containment strategy. JAMA. 1984;252:225–230). Fortunately, the literature also held a potential solution: giving clinicians monthly feedback comparing their test-ordering practices with those of their peers, in conjunction with educational efforts resembling those Dr. Pritt had tried. In a 1990 study, doing so resulted in inappropriate test ordering volume falling by at least one-fifth during the intervention period, a reduction that persisted for two years (Bareford D, Hayling A. Inappropriate use of laboratory services: long term combined approach to modify request patterns. BMJ. 1990;301:1305–1307). “No one ever wants to be the person who isn’t following the guidelines, or isn’t performing up to an expected level,” Dr. Pritt said. “So this actually was pretty powerful. And what I thought was interesting from this paper is they actually said that most of the people, up to a third of the trainees, didn’t even attend the educational conferences, and some of them didn’t even know the algorithms were available. So without the algorithm, without the education, that puts it mostly on the peer feedback that must’ve been driving a lot of this decrease they saw.” And so, Dr. Pritt said, she and her colleagues planned to begin providing peer performance data in addition to making changes to their test-ordering systems, beginning with the outpatient system that Mayo clinicians use. First, “We’ve tried to put common procedures on the top and additional procedures at the bottom, with the thought that people might be more likely to order the Cryptosporidium and Giardia instead of the parasitic examination [which is lower].” Second, “I’m going to group these two tests together under the heading of ‘fecal parasite screen for diarrhea,’” she said. “I think people like screens. They like that terminology. It makes them think that’s the first test they should use.” Finally, “We’re now going to say, ‘See guide for testing algorithm,’ with the guide being on the left-hand bar.” This is a relatively straightforward change to the ordering system, she notes. A more aggressive approach to changing the ordering system with potentially larger impact is to require the ordering clinician to fill in boxes indicating whether the patient has any risk factors for intestinal parasites other than Cryptosporidium or Giardia before allowing them to place an order for the ova-and-parasite exam. She has decided not to pursue this option because of the complexity of parasite risk factors. But “requiring certain pieces of information can be very helpful in other types of tests such as coagulation cascades, in which medication history may be essential for accurate interpretation,” she says. Dr. Pritt acknowledges that many labs do not have strong IT support and the staff it takes to change an ordering system, and thus she cites other possibilities for the laboratory to gain some control over test ordering: Remove a test from the ordering system altogether (if demographically appropriate) or require a specialist’s approval for testing. “Now, I think my infectious disease physicians would probably boycott me and protest if I had them approve every single ova-and-parasite test, since it is a high-volume test ordered by family physicians, internal medicine, ED physicians, a whole spectrum of people,” she said. “But again, extrapolating this idea to other areas of the laboratory, I think this could be very appropriate for some special genetics tests, for example.” Small labs might also consider having trainees review every request for an ova-and-parasite test. “Have them call the clinician or look up the medical record, and even cancel at that point if it’s not appropriate.” Contacted in February, Dr. Pritt said that after making changes to the test-ordering system last August, the laboratory saw an immediate drop in ova-and-parasite test orders. “September is usually our peak volume, but from August to September, we saw our monthly volumes decrease by 100 orders per month, for a total 30 percent decrease compared with volumes seen in September 2011,” she told CAP TODAY. (The peer performance feedback program has not yet been fully rolled out.) She calls the initial results encouraging but says they will monitor to see if the trend is sustained. The key lesson she learned? “Education is a logical choice. It’s what most of us think of when we want to make a change. We say, ‘Let’s go out and educate everyone.’ It might be easy for a small group, and it might have good short-term impact, but overall it’s probably going to have limited impact and limited long-term staying power.” Instead, she said, education needs to be part of a larger, planned, multipronged approach. Anne Ford is a writer in Evanston, Ill.

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AMDA Annual Conference HighlightsCaring for ConsumersGeriatric MedicineLTC FeaturesNews from AMDAPublic PolicyPast Issues Alzheimer's/DementiaCardiovascular DiseaseMental HealthDiabetesInfectious DiseasesNeurologyOncology & HematologyOsteoporosisPain Board RoomCaring TransitionsCommunity LTCDr. B ArchiveDear Dr. JeffGuest EditorialsIDT RoundsLegal IssuesLTC PharmacyMedical EthicsMeditations on Geriatric MedicineMeet Our ColumnistsPublic Policy Career Opportunities via AMDA.com Alzheimer's Disease ChannelElsevier Diabetes ChannelAMDA Product CatalogCalendarJAMDASupplements AMDA CMEAMDA e-UniversityAMDA Live ProgramsAMDA Online Library About AMDAAbout Caring For the AgesAdvertiseContact UsCopyright & Terms of UseEditorial BoardPrivacy PolicySubscriptions Request Print Edition | Advertise | Contact Us | Site Map Read the current issue of Caring for the Ages. Browse the past issues archives. Advance Directives vs. Family Decisions By: Jonathan Evans August 01, 2010 Case An 88-year-old woman with dementia and a history of multiple strokes lived in a nursing facility for 6 years. Impaired in cognition and function, she was deemed mentally incapacitated. She was a Jehovah's Witness, and prior to her incapacity had exercised an explicit advance directive that she was not to have a feeding tube under any circumstances nor receive intravenous hydration to prolong her life. She named one of her daughters as her durable power of attorney (POA) to make additional decisions on her behalf. She required assistance with all basic activities of daily living and was fed by facility staff. Over the past 2 years, she lost the ability to communicate with words. She became gradually less alert, and spent more and more time asleep. She became bedbound. Her weight remained stable. Throughout her nursing facility residence, her family was attentive to her needs and mindful of her advance directive. They attended care conferences and communicated regularly with her attending physician. As her condition declined, her family decided to focus on comfort care and to avoid hospitalization. On three occasions, she had experienced what appeared to be acute strokes with loss of neurological function, decreased alertness, and reduced oral intake. In each instance, the facility's speech therapist contacted the POA directly and recommended intravenous hydration and possibly a feeding tube. In each instance, however, the patient's condition returned to baseline within a day, without initiation of intravenous fluid. She subsequently had another neurological event, and on the basis of the speech therapist's recommendation, the family asked that intravenous fluids be started. There were several family birthdays in the coming weeks and family members wanted to avoid having her die on one of those dates. After more than 2 weeks there was no improvement in her condition. She was unresponsive and profoundly impaired neurologically. A family meeting was held, led by the attending physician. The family decided to forgo feeding tube placement, to consult hospice, and to discontinue the intravenous fluid. The POA indicated that it was �selfish� on their part to keep her alive, acknowledging her advance directive and adding that �she would never want to live like this.� The patient was enrolled in hospice. The patient's granddaughter (the daughter of the POA and a certified nursing assistant) indicated that she would like to be present at the time of death to provide personal care. For several weeks, the patient continued to decline. Death was considered imminent. With the POA's permission, the granddaughter arranged for a friend of hers, a reflexologist, to provide treatments for her grandmother at the facility. The practitioner did so without any appreciable improvement in the patient's condition. The reflexologist indicated to the granddaughter that the treatment could not work as long as the patient was dehydrated, and recommended that intravenous fluid be provided. The POA then contacted the attending physician and asked that intravenous fluids be restarted. The attending physician and the facility leadership team were uncomfortable restarting intravenous fluid. They felt that doing so would violate the patient's advance directive. They discussed this with the POA, who agreed but felt that it was important to maintain harmony within the family. Further discussion ensued involving the medical director, the attending physician, the director of nursing, and the hospice's medical director and clinical director. The granddaughter then informed the facility administration that her attorney had reviewed the advance directive (which had been executed in another state) and felt that it was not legally valid. She suggested that legal action might be necessary. Additional discussion ensued. The facility contacted corporate risk management and considered several options including contacting the long-term care ombudsman, reporting the patient to adult protective services, and sending the patient to the hospital. They wanted to avoid doing anything to inflame the situation, however, and worked with both the attending physician and medical director to try to reach a consensus with the family. Ultimately, intravenous fluids were restarted and continued for 10 days. Seeing no improvement with reflexology treatments, the POA decided to discontinue the intravenous fluids. The patient died comfortably 7 days later with family in attendance. This case demonstrates, among other things, the challenges and limitations of advance directives and, hence, the limits of autonomy. The advance directives have long been hailed as a critical tool to promote autonomy for people who can no longer make or communicate choices on their own behalf. This patient made the effort to both implement an explicit instructional directive and name a proxy decision maker, her daughter, who knew her well. There is little more that an individual can do. In this case however, it appears that on more than one occasion, the patient's wishes were ignored or overruled by her family. In addition, a health care practitioner made explicit recommendations, such as for intravenous hydration, that were contrary to the patient's explicit wishes and plan of care. ▸ Autonomy vs. Power: Autonomy may be a right, but rights require power to be realized. Naming a surrogate decision maker is a way to empower another to act on one's behalf, based on the belief that the surrogate will honor the loved one's beliefs, attitudes, and wishes. The granddaughter's threat to involve her attorney was another way for a family member to exert power. Surrogate decision making assumes that close family members know what their loved ones would want. Various studies, however, have demonstrated that adult children generally assume that their parents would want more aggressive care than is true. Another assumption is that surrogates will always put the needs and desires of their loved ones ahead of their own. Trying to keep a mother from dying on family birthdays illustrates a conflict of interest between family members and their mother. It also illustrates ambivalence toward different goals and treatment choices. Patients often change their mind. It is therefore probably not reasonable to expect that family members, including proxies, won't change their minds either. ▸ Team, Minus One: Numerous studies have shown that advance directives are often ignored or overruled by physicians, particularly in hospitals. This case illustrates how other health care professionals may do the same thing, by imposing their own values, beliefs, and fears upon patients and their families. The right to refuse treatment sometimes comes into conflict with a health care practitioner's own fears of the consequences, which can influence treatment recommendations. This may explain why someone (the speech therapist in this case) would repeatedly make recommendations contrary to the recommendations of every other member of the interdisciplinary team. Unfortunately, this had a detrimental effect for the rest of the team and contributed to confusion and disagreement within the family. ▸ Team, Minus Two: Neither the facility nor the attending physician had any prior experience with reflexology. All were committed to trying to help the family in any way possible by accommodating their wishes without violating the facility's policies and procedures. However, the reflexologist did not communicate about intravenous fluid therapy with any member of the interdisciplinary team. Many members felt that her recommendation to restart intravenous fluids was detrimental to the team. ▸ Desire to Avoid Conflict: The POA, the attending physician, and the facility administration all wanted to avoid conflict with other stakeholders. For the physician and facility, this was especially acute when the granddaughter threatened legal action. The steps that were necessary to avoid conflict with family members appeared to be in conflict with the wishes of the patient, the person with the least power in this situation. ▸ Ethics Committee? Had the facility had an ethics committee or access to one locally, the interdisciplinary team probably would have consulted it early on to help the family members in their decision regarding intravenous fluid therapy. The facility would probably have appreciated the support that the ethics committee could offer regardless of the ultimate decision that the family made, and the ethics committee might have felt less threatening to family members than, say, adult protective services. Advance directives, intended to help individuals get their way when they become incapacitated, are not everything their proponents have hoped. The competing interests of others, ambiguity about the meaning of specific instructions, the significance and finality of specific choices, and the intense emotion and family dynamics involved in end-of-life decision making all have the potential to undermine or negate the seemingly dispassionate and logical decisions that individuals make on their own behalf far from the heat of the moment. <- Back to: Medical Ethics Nothing found in the guestbook. Adding an entry to the guestbook Website Place Please enter here the word as displayed in the picture. This is to prevent spamming. *If you can't read the word, click here. CPGs Play Strong Role in Quality-Driven Health Care Moving into a health care paradigm focusing on value-based services, reimbursement tied to quality and cost effectiveness, accountable care, and person-centered care, AMDA�s clinical practice guidelines (CPGs) have a stronger role than ever before. �These tools have become the standard care process in the PA/LTC setting and contribute to reducing costs,... » Join AMDA NowAMDA is the only national organization guided exclusively by the needs and issues affecting long term care medicine. For a full array of benefits and services exclusively for LTC professionals, click here to join today! Home | News | Clinical Focus | Views | Career Opportunities | Resources | CME | About Us | Site Map Copyright © 2014 - American Medical Directors Association, Inc. All rights reserved.

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DCoE CSTS logo Center for the Study of Traumatic Stress Advancing Psychological Health and Resilience Through Trauma Research, Education, and Consultation CSTS History Center Personnel Disaster Mental Health Courage to Care Joining Forces, Joining Families Anthony Woodson, D.H.A. Associate Administrator F. Edward Hébert School of Medicine Uniformed Services University of the Health Sciences Dr. Woodson is an Associate Administrator in the Center for the Study of Traumatic Stress. He has a Doctorate in Health Administration from Central Michigan University and a Masters in Public Administration from the University of South Carolina. He has over 30 years of expertise in health policy and program formation, implementation, and operations in both military and civilian health systems. In previous professional positions, Dr. Woodson was a senior project manager with Northrop Grumman Information Technology providing strategic planning, contract acquisition management, and process improvement support services to Department of Defense clients. He also served as the chief operating officer for Alexandria Neighborhood Health Services, an entity providing primary care health services to medically underserved populations. Dr. Woodson’s twenty-year military career, as an U. S. Air Force Medical Service Corps Officer, cumulated after serving as Chief of Regional Operations for Health Services Financing Directorate, Office of the Assistant Secretary of Defense for Health Affairs. He was awarded the Defense Superior Service Medal, largely due to his leadership in the highly successful implementation of the first-generation of regional TRICARE managed care contracts. Dr. Woodson’s earlier Air Force assignments include a wide range of senior administrator positions in ambulatory and inpatient medical facilities throughout the United States and abroad. He retired from the Air Force in 1996. He is a Fellow in the American College of Healthcare Executives. A Parent’s Guide to Returning Your Child to School After a Concussion Joining Forces Joining Families Summer 2014 Military Families in Transition: Stress, Resilience, and Well-being (Full Report) Military Families in Transition: Stress, Resilience, and Well-being (Executive Summary) Center for the Study of Traumatic Stress Annual Report (2013) Robert J. Ursano, M.D. Carol S. Fullerton, Ph.D. Stephen J. Cozza, M.D. Brian Flynn, Ed.D. Robert K. Gifford, Ph.D. Nancy T. Vineburgh, M.A. John A. Stuart, Ph.D. David M. Benedek, M.D. Courage to Care: What Military Families Should Know About Depression Courage to Care: Becoming A Couple Again Courage to Care: Suicide Facts for Primary Care Providers Courage to Care: Helping National Guard and Reserve to Re-Enter Workplace Courage to Care: Psychological First Aid Selected Research Psychological and Behavioral Responses in Public Health Workers: A Study of the Florida Department of Health to Multiple Hurricanes Ecological Momentary Assessment of Posttraumatic Stress Symptoms in Service Members Undergoing Rehabilitation Stigma and Barriers to Care: Conference Report Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) Stress & Biomarkers in a Military Population Study (p11 Protein studies) ©2006-2014 Center for the Study of Traumatic Stress

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$30 million expansion plans approved for CMC Jan 05, 2012 | 2940 views | 0 | 13 | | Cartersville Medical Center will soon benefit from a $30 million expansion and enhancement project to include new rooms, technological advancements and an exterior facelift.With the certificate of need approval and funding secured, CMC will break ground on an emergency department expansion and new private patient rooms in September."Funding has been approved by [parent company] HCA, which is a big step in this day and time. Access to capital in the healthcare industry has become very difficult in the tough economy, so the fact that our parent company has basically written us a $30 million check is very positive news," said Keith Sandlin, CMC president and CEO. "We see it as a huge vote of confidence for Cartersville Medical Center, for Bartow County and Cartersville as a community. Obviously, our company realizes that, although things have kind of been flat for the past couple of years, there's still a lot of growth opportunity here."Construction will continue for about a year on the multiple projects simultaneously with a tentative completion slated in fall 2013. The coming additions will add 20 to 30 permanent new jobs within the hospital. Reacting to demands on emergency room services, the CMC emergency department will nearly double from 18 beds to a minimum of 32 beds as a result of the investment. A CT scanner also will be added to emergency room equipment for quicker imaging abilities. Advancements during this project will position the hospital for future growth as a trauma center, a move Sandlin feels will be necessitated by a growing population."We've got 18 beds that we use in the emergency room and we see 50,000 patients each year in those 18 beds, which is kind of off the chart in terms of industry norms. With 18 beds, you would expect to see 30,000 to 35,000 patients," Sandlin said.In addition to emergency room advancements, CMC will transform all patient rooms into private rooms, eliminating 18 semi-private rooms through the addition of a new patient floor. The hospital's newest wing, 2 North, will gain an additional floor containing 20 new beds."One of our existing issues is, we have 18 semi-private rooms out of our 112-bed makeup and nobody wants to be a semi-private room these days," Sandlin said. "The fact that we will be able to offer all private rooms will be much more of a patient satisfier and it helps us with patient throughput, too."Total patient bed count will not increase through the expansion but current rooms will be renovated and the project will ensure every admitted patient is given a private room. With an average occupancy rate of more than 80 percent, CMC will be requesting additional beds from the state in "the not too distant future."As the hospital's interior gets a boost, so will the exterior. Architectural and design plans are being drawn up now for the renovation, which Sandlin revealed will include a largely glass facade."It will really appear to be a new facility from the outside. We're going for better visibility," Sandlin said. "It's hard to believe a lot of our signage and a lot of our facility is 25 years old. We're just kind of looking for a fresh look across the campus."Approval of the project and the necessary funding comes just as the hospital implements advanced technology for better care, including digital endoscopic equipment, a new MRI machine with cardiac imaging capabilities, and the equipment necessary for minimally-invasive hip replacement and high-dose-rate brachytherapy for cancer treatment."We're trying to reinforce the idea in the community that patients don't have to leave this community for top-shelf care," Sandlin said. "This puts us in a position where there's not really a hospital in Rome or a hospital in north Atlanta that will have a competitive edge over what's offered here in Bartow County." Vista Metals to launch $17 million expansion CMC observes Breast Cancer Awareness Month CMC looks to raise Ebola and enterovirus awareness Summer externships prove ‘eye opening’ for Bartow teachers

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Environment May Have Bigger Hand In Autism Than Genetics A In a controversial new study, scientists say environmental factors may play a bigger role in the development of autism than genetics. The findings published in the July issue of the Archives of General Psychiatry come from the largest-ever study of twins and autism. Researchers analyzed data on 192 pairs of twins in which at least one twin had the developmental disorder and found that genetics accounted for 38 percent of the children’s risk for autism while 58 percent of the risk stemmed from environmental factors. They reached this conclusion by comparing the experiences of 54 sets of identical twins and 138 sets of fraternal twins. Not surprisingly, among identical twins — who share 100 percent of their DNA — if one had autism the other twin had a 70 percent chance of also having the disorder. Fraternal twins, however, share just half their DNA but had an autism diagnosis in 35 percent of cases, which is significantly higher than the likelihood of two typical siblings sharing the diagnosis. “The high concordance among individuals who share only half their genes relative to those who share all of their genes implies a bigger role for shared environmental factors,” said the study’s lead author Joachim Hallmayer of Stanford University. The findings are counter to recent research which has focused more heavily on genetic causes and many autism experts were quick to question the results. “It’s a massive claim,” Angelica Ronald, a behavior geneticist at Birkbeck University of London who was not part of the study, told The Los Angeles Times. “It flies in the face of the previous data. I don’t see why the results have come out the way they have.” Others, however, are hailing the findings as a “game changer.” “We now have strong evidence that, on top of genetic heritability, a shared prenatal environment may have a greater than previously realized role in the development of autism in twins,” wrote Clara Lajonchere, vice president of clinical programs at Autism Speaks, in a blog post Tuesday about the study, which the organization provided funding for. Meanwhile, in a separate study also appearing in this month’s Archives of General Psychiatry, researchers reported a link between the use of antidepressants during pregnancy and the development of autism. The risk was low and occurred most during the first trimester, but scientists cautioned that further research is needed and said the consequences of not treating mental health disorders during pregnancy must be considered. More in Autism » Comments (2 Responses) yankeegirl says: July 6, 2011 at 11:32 am Science and common sense dictate that environmental factors play a role. It stands to reason that with autism numbers skyrocketing from 1 in 5000 in the 1970’s to 1 in 110 in 2011, that environmental factors (toxins) play a prominant role in the autism increase. Most likely we have a sensitive population of children who are being exposed early in life to toxins that are overwhelming their immune systems resutling in chronic neuroinflammation/ immune dysfunction. Autistic behaviors (like head banging) are a manifestation of the underlying immune dysfunction triggered by these toxins. The pieces of the puzzle are coming together to reveal a clear picture. Perhaps now we can look at innovative medical treatments beyond traditional therapies. toxic exposures+ vulnerable population+ immune dysfunction/inflammation= autism gingerallen says: July 9, 2011 at 11:35 am We lived in Pontotoc County, Mississippi and I blame the water for my mental problems. We lived in the country. They were always running over water lines causing the dirty contaming water to back up into our lines. I remember my daughter as a child calling me while in the tub. The water was coming out dark brown. She is 20 now and in the psych. hospital for the 5th time hearing voices telling her to kill herself.

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Obesity Town Hall Family Science Days Contact AAAS Meetings Staff Hynes Convention Center All times are US Eastern Standard Time (EST) The 2008 AAAS Annual Meeting in Boston will focus on "Science and Technology from a Global Perspective." David Baltimore, AAAS president, will open the Meeting with the President's Address at 6:30 PM on Thursday, 14 February 2008. Baltimore is Robert Andrews Millikan Professor of Biology at the California Institute of Technology. He shared the 1975 Nobel Prize in Medicine for the discovery of reverse transcriptase. Baltimore has published more than 600 papers, including seminal research on the genetics of cancer, the workings of the HIV virus and AIDS vaccine candidates, and fundamental observations in molecular immunology. He was a founder of the Whitehead Institute for Biomedical Research, president of Rockefeller University and the California Institute of Technology, and a leading figure in national policy commissions on recombinant DNA and AIDS research. The multidisciplinary AAAS Annual Meeting program will feature 165 symposia; plenary and topical lectures; a poster competition; career fair; career workshops; and an exhibit hall. Specific details about the scientific program and speakers will be available at the AAAS Annual Meeting Web site. The program also will include a AAAS Town Hall on Understanding Obesity and Childhood Nutrition, a special public engagement event for teachers, school health professionals, parents, students, scientists and the public. Embargo Notice -- Please note that specific content related to the 2008 AAAS Annual Meeting will remain strictly embargoed until the time of the scientific session or lecture, or the related news briefing, whichever comes first. The theme of the meeting, "Science and Technology from a Global Perspective," emphasizes the power of science and technology as well as education to assist less-developed segments of the world society. The meeting also will focus on ways to improve partnerships among already-developed countries and spur knowledge-driven transformations across a host of fields. The meeting will deal with global issues such as climate change, health, energy, environment, development, and education as well as frontiers in fundamental and applied science.

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Contact: Mithu Mukherjee mithu.mukherjee@sagepub.co.uk SAGE Publications UK Autism in the UK costs more than $41 billion every year, shows new research Los Angeles, London, New Delhi, Singapore and Washinton DC (18 May 2009) � Research published this week in the Journal Autism, published by SAGE, estimate the annual costs of autism spectrum disorder (ASD) to be more than �27 billion a year. The costs of supporting children with ASDs were estimated to be �2.7 billion per year, �25 billion each year for adults. The findings will be presented at the Autism & Employment Workshop taking place today at Goldsmiths, University of London. With the National Audit Office report on the provision of services for Autism imminent, participants at the workshop will review current research, policy and services and discuss the challenges facing people with ASDs finding work and in the workplace. The Economic impacts of autism research, led by Professor Martin Knapp of the London School of Economics, provides the most comprehensive analysis of the economic impacts of ASD in the UK to date. Speaking at the Goldsmiths event, Knapp will reveal the significant costs to the public sector, in particular the health system, social care agencies, education and housing budgets. He will also outline the steep rise in costs for adults, calling for increased early intervention for those with ASDs. Costs were based on estimates for 539,766 people with ASD in the UK: 432,750 adults (aged 18 and over) and 107,016 children and adolescents (aged 0-17). There was no single, nationally representative data source in the UK looking at these costs, so the researchers combined existing data estimating prevalence; intellectual disability; place of residence; service use; lost productivity; and costs per individual. Average annual costs were also aggregated to estimate the lifetime cost of someone with ASD, calculated by combining costs for different age groups with life expectancy estimates. The costs of supporting children with ASDs were estimated to be �2.7 billion per year. For adults, these costs rise to �25 billion each year. Lifetime costs for someone with autism were calculated as �0.8 million for someone with autism without intellectual disability, and �1.2 million for someone with autism who was also intellectually disabled (50 percent higher). Significant costs were attributed to public services. For children, the highest costs were for special education, health and social care and respite care. 95 percent of the total national cost for children was accounted for by services funded by the state, and 5 percent by family expenses. For adults, the largest cost elements were staffed/supported accommodation, lost productivity because the individual with ASD was not employed, and hospital services. For non-intellectually disabled adults, the largest elements were lost productivity for the individual, hospital costs, and lost productivity for parents. 59 percent of the total was attributable to publicly funded services, 36 percent to lost employment for the individual with ASD, and the remaining 5 percent to family expenses. The researchers suggest that the high costs associated with supporting adults with ASD warrant attention, supporting calls for wider provisions of early interventions with children and young people with ASD, which have been shown to alter patterns of behaviour. They also call on the government to review policy frameworks for supporting those with ASDs, in particular reviewing support for independent living and for increasing productivity. The researchers however caution that the effectiveness and cost-effectiveness of intervention must be evaluated further. They add, "given the autistic spectrum includes a number of disorders and a wide range of needs, symptoms and characteristics, it is likely that a wide range of behavioural, educational and medical interventions could be required in order to meet some or all individual needs." They conclude, "the costs presented in this paper certainly do not provide an economic case for early intervention, but they do emphasise the importance of addressing just that question. If early intervention could successfully change some aspects of behaviour that are cost-raising, both in childhood and subsequently, it may allow cost savings to be made and quality of life improvements to be achieved." The research is published in a special issue of Autism which focus on adults with ASD. The Autism & Employment Workshop will be attended by representatives of the National Audit Office, the Department of Health, the National Autistic Society, and Prospects an ASD supported employment consultancy, as well as by researchers, and industry representatives including those from BT and Goldman-Sachs. Economic cost of autism in the UK by Martin Knapp, Ren�e Romeo, and Jennifer Beecham is published in the May 2009 issue of Autism (2009 13: 317-336). Autism is published by SAGE on behalf of the National Autistic Society. http://www.nas.org.uk/ Autism provides a major international forum for research of direct and practical relevance to improving the quality of life for individuals with autism or autism-related disorders. The journal's success and popularity reflect the recent worldwide growth in the research and understanding of autistic spectrum disorders, and the consequent impact on the provision of treatment and care. http://aut.sagepub.com/ SAGE is a leading international publisher of journals, books, and electronic media for academic, educational, and professional markets. Since 1965, SAGE has helped inform and educate a global community of scholars, practitioners, researchers, and students spanning a wide range of subject areas including business, humanities, social sciences, and science, technology, and medicine. An independent company, SAGE has principal offices in Los Angeles, London, New Delhi, Singapore and Washington DC. www.sagepublications.com [

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Follow the Money to These 2 Areas of Unmet Medical Needs Sean Williams | According to the World Health Organization, there are more than 12,000 different diseases and disease-related symptoms that it categorizes. Based on the more than 139,000 clinical studies currently being run worldwide, you'd think we'd have a pretty tight grasp on dealing with the world's most pressing diseases. The reality is that we're not even close, and the evolution of medicine is an ongoing process. Two areas where this process is still in its infancy -- which can also mean big bucks for investors if they back the correct horse -- is in Alzheimer's and Parkinson's disease research. Alzheimer's: Where we've been & where we're headed Based on the 2012 report from the Alzheimer's Association, 5.4 million people in the U.S. have the disease, and it's now become the sixth-leading cause of death. Of the documented cases of demetia, Alzheimer's accounts for about 80% of those cases. At the moment, our understanding of the disease is minimal at best. One of the few FDA-approved drugs, Amyvid by Eli Lilly (NYSE: LLY ) , isn't even a treatment at all. It's merely a process-of-elimination test that determines whether beta-amyloid plague markers exist on the brain and allows physicians to determine if a patient is at risk of onset Alzheimer's based on the results. Other Alzheimer drugs are nearing the end of their patent exclusivity come with a long list of side effects. Other high-profile treatment attempts failed to reach the mark in recent months. Bapineuzumab, an Alzheimer's drug co-developed by Pfizer (NYSE: PFE ) and Johnson & Johnson (NYSE: JNJ ) , failed in multiple late-stage studies and was eventually shelved. Eli Lilly's solanezumab shared a similar fate, but at least received a partial victory when deeper research noted marginal improvement in patients with mild forms of the disease. Solanezumab is one of three compounds taking part in a long-term international Alzheimer's study. Given that we've seen seven Alzheimer pipeline drugs die in late-stage trials, the next most-promising one on the docket is Baxter International's (NYSE: BAX ) IV-administered Gammagard. In mid-stage trials, for those that received the optimal dosing of the drug, Gammagard held the disease at bay for four years. Those patients on the placebo or non-optimal dosing demonstrated a worsening of the disease. The upside is that in optimal dosing, this worked wonders. The downside: This was just a patient pool of 16 people. Late-stage results are due out on Gammagard in the first half of 2013. As FierceBiotech points out, privately held Lundbeck and EnVivo Pharmaceuticals also have two late-stage Alzheimer's candidates that have shown statistical non-inferiority in trials. However, neither lacks the funding to move their drugs forward and, with a history of failure piling up, it could be difficult to find a partner. Having spent $200 billion on Alzheimer's care last year, this is clearly a research area that's bound to merit big investment dollars. The question is, can anyone successfully penetrate the blood-brain barrier without a laundry list of side effects? Parkinson's disease: Where we've been & where we're headed The Parkinson's Disease Foundation estimates that nearly 1 million people within the U.S. suffer from this neurological disorder, and annual health-care costs of the disease are estimated at $25 billion. Like Alzheimer's, we're still in the early stages of our understanding of the disease. Sinemet and Sinemet CR, which were both originally developed by Merck (NYSE: MRK ) , are the most commonly prescribed drugs and are also thought to be the most effective at managing the disease. Unfortunately, long-term use of either drug often leads to decreased motor function. Sinemet is also commonly prescribed as a combination therapy, most notably with Teva Pharamceutical's (NYSE: TEVA ) branded Parkinson's drug, Azilect. However, even this drug combo comes with risks of increased postural hypotension, headaches, joint pain, indigestion, and a load of other cross-drug risks. The need for even more effective Parkinson's drugs with far fewer side effects is readily apparent. We actually had a chance at gaining another FDA approval last week, however, Impax Laboratories' (NASDAQ: IPXL ) Rytary (formerly IPX066) received another Complete Response Letter due to manufacturing deficiencies at its Hayward, Calif., facility. We're probably looking at another six months to a year before Rytary makes it back before the FDA. Beyond Impax, the results haven't been encouraging. Privately held Newron Pharmaceuticals' safinamide is being tested in multiple late-stage studies as an add-on therapy to a dopamine agonist. In its most recent study, which tested a dose of 100mg/day, it proved not statistically significant to the placebo. Similarly, Kyowa Pharmaceuticals' istradefylline failed in multiple small clinical trials. For now at least, the current Parkinson's treatments look very safe from any added competition, but it's clear based on this disease's prevalence and huge costs that big investment dollars are soon going to be flowing its way. Can Lilly grow without solanezumab? Find out now!Over the next two years, Eli Lilly will see nearly $0.40 of every $1.00 in sales exposed to generic competition. How does the company plan to respond to this huge patent cliff? Better yet, what does this mean for investors? In a brand new premium report on Eli Lilly, The Motley Fool's top pharmaceuticals analyst delves into everything investors need to know about the stock today. Simply click here now to claim your copy. Fool contributor Sean Williams has no material interest in any companies mentioned in this article. You can follow him on CAPS under the screen name TMFUltraLong, track every pick he makes under the screen name TrackUltraLong, and check him out on Twitter, where he goes by the handle @TMFUltraLong. The Motley Fool owns shares of Johnson & Johnson. Motley Fool newsletter services have recommended buying shares of, and buying calls on, Johnson & Johnson. Try any of our Foolish newsletter services free for 30 days. We Fools don't all hold the same opinions, but we all believe that considering a diverse range of insights makes us better investors. The Motley Fool has a disclosure policy. CAPS Rating: IPXL Impax Laboratories… CAPS Rating: LLY Eli Lilly & Co. CAPS Rating: TEVA Teva Pharmaceutica…

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Tyrell's Story: Taking Pills for High Blood Pressure Tyrell's story Tyrell's doctor told him he had high blood pressure, he was shocked. "I thought, 'Hey, I'm a physical fitness trainer. I'm in great shape. How could I have high blood pressure?'" He knew that both of his parents have high blood pressure. And one of his uncles recently had a stroke. But Tyrell had always been kind of a health nut. It just didn't seem possible that he could be sick. "My doctor put me on two kinds of pills," the 35-year-old says. "And for a few months I was really good about taking them every day. But they made me a little tired, and I got tired of being tired." Instead of going back to his doctor, Tyrell just stopped taking his pills. Then, a few months later, he was working at his fitness club when he heard sirens. An ambulance had been called because a club member had collapsed while lifting weights. Tyrell found out the next day that the club member had had a stroke, probably caused by high blood pressure. "I learned that it doesn't matter how healthy you feel—if you have high blood pressure, you're sick and you'd better do something about it," Tyrell says. He went back to his doctor, who changed his prescription. The new pills still made him a little tired. But this time, instead of not taking his pills, he went back to the doctor yet again. His new combination of blood pressure pills is working well—with no side effects. "Now I often talk about high blood pressure with my clients," he says. "I tell them about my own high blood pressure—which always kind of surprises them—and let them know about the importance of taking those pills." This story is based on information gathered from many people facing this health issue. For more information, see the topic High Blood Pressure.

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Baby girl dies of meningitis Julie Kenwell Social networks... Published: 22 Nov 2012 13:000 comments THE Public Health Agency says the local community in Fermanagh is not at risk of infection following the death of a baby girl from meningitis last weekend. It is understood the 13-month-old girl from the Lithuanian community had been living in the Enniskillen area. The PHA has confirmed the young child died after taking ill with meningococcal septicaemia but stressed that any risk to other people was very small. It is believed the baby girl fell ill on Friday, November 9 and died that weekend. A consultant has reassured the local community that the risk of infection to other people was extremely low. Extending her sympathies to the family, Dr Anne Wilson, Consultant in Health Protection for the PHA, said: "Antibiotics are offered only to those people who have had close and prolonged personal contact with the patient. National guidance on this matter is that antibiotics are not widely offered as a preventative measure as they can clear protective organisms from the throat, and as a consequence can increase rather than reduce the risk of infection," According to Dr Wilson, the PHA had taken "well-established steps" to minimise the risk of infection to others by offering antibiotics to those who had recent prolonged personal contact with the child. "The risk of other people contracting this type of infection is negligible, so there is no cause for concern among the wider community; however it is important to be aware of the signs and symptoms of meningitis," she said, "These may include severe headache, dislike of bright lights, vomiting, neck stiffness, non-blanching rash and drowsiness. Should anyone develop any of these they should contact their GP or local A&E department immediately," she added. Further information on meningococcal septicaemia can be found on the Health Protection Agency website http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/MeningococcalDisease/. Powered by Find jobs in Enniskillen Login / Register 8-10 East Bridge Street,

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1. What Is A 10-Year Strategy to End Homelessness? 2. Who Is Completing A 10-Year Strategy to End Homelessness? 3. Why Is A 10-Year Strategy to End Homelessness Important? A 10-Year Strategy to End Homelessness is: • Designed to address the critical problem of homelessness and all related issues through a coordinated community-based process of identifying needs and building a system of care to address those needs. • Predicated on the understanding that homelessness is not caused merely by a lack of shelter, but involves a variety of underlying, unmet needs—physical, economic, and social. • Supported by a community-wide public and private strategy with a goal of ending homelessness that is based upon the successful implementation of three major community-coordinated actions—(1) building infrastructure; (2) strengthening an existing continuum of care system; and (3) planning for sustainable outcomes. More than 100 cities are currently completing “A 10-Year Strategy to End Homelessness,” according to the United States Interagency Council on Homelessness (ICH). Philip F. Mangano, ICH Executive Director, was appointed by President Bush to lead the ICH in March of 2002. The ICH is part of the Domestic Policy Council within the Executive Office of the President and is responsible for the coordination of 20 federal agencies in their response to reduce and end homelessness. The U. S. Conference of Mayors has recently extended the Bush Administration’s challenge to the 100 largest cities to complete 10-Year Strategies to End Homelessness. In June of 2003, the Mayors Conference unanimously passed a resolution that “strongly encourages cities to create and implement strategic plans to end homelessness in 10 years.” Locally, the Department of Health and Human Services (DHHS) staff will be coordinating the city-wide 10-Year Strategy process. The Institute for Urban Research and Development has been selected to be the DHHS Principal Consultant in this planning effort. While Long Beach is one of three cities in the County—the other two being Glendale and Pasadena—that coordinates their own homeless Continuum of Care system and are developing their own 10-year strategies to end homelessness. To ensure coordination and integration with Los Angeles County, the City of Long Beach has been participating in the County’s 10-year strategy to end homelessness which is called the “Partnership to End Homelessness - Bring LA Home.” Several cities that have already completed and are implementing 10-year strategies have recognized that their past efforts focused on “managing” homelessness rather than ending it. Through the 10-Year strategies, these communities have moved beyond efforts to manage homelessness and into strategic goals and objectives that are both preventing homelessness and ending it. Such goals and objectives include: • Preventing homelessness for persons living in poverty (particularly among those who are already clients of other social service systems and public institutions such as hospitals, jails, and foster care); • Developing permanent housing options that improve cost-efficiency and ensure long-term stability; • Improving the availability of affordable housing, creating a livable wage, and necessary support services for people at the lowest end of the economic spectrum; • Collecting accurate data in order to improve system-wide effectiveness in preventing and ending homelessness; and • Analyzing data and evaluating outcomes in order to identify the most effective strategies for each subgroup of the homeless population. Successfully implementing a long-range, community-based, coordinated action plan in Long Beach is important. Although current homeless services programs end homelessness for people every day, they are soon replaced by other persons entering into homelessness. Some expected results from doing a coordinated long-range plan are: • Significant savings from reduced usage of high-cost, publicly-funded services (e.g., jails and emergency room services); • Cleaner, safer streets within residential, business, and recreational areas; • More (80 percent or greater) homeless individuals and families will maintain affordable housing; and • Better tracking of outcomes and resource allocation.

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P. Scott, PhD Contact Dr. Scott 833 Bluemle Life Science Building Mycobacterium tuberculosis type II NADH-menaquinone oxidoreductase catalyzes electron transfer through a two-site ping-pong mechanism and has two quinone-binding sites Bioprospecting open reading frames for peptide effectors Anti-inflammatory compounds parthenolide and bay 11-7082 are direct inhibitors of the inflammasome Taking the chemical out of chemical genetics Effect of rapamycin on mouse chronic lymphocytic leukemia and the development of nonhematopoietic malignancies in Eμ-TCL1 transgenic mice PhD, Biological Chemistry, University of Pennsylvania - 1997 Expertise and Research Interests My laboratory is interested in discovering new ways to treat acute and chronic diseases. There are three main projects in the lab. The first project is aimed at finding new targets for drug discovery. In the traditional drug discovery process, researchers select a target and then attempt to find appropriate drugs to attack the target. We have developed a novel chemical genomic approach called PARIT (Xiong & Scott, Meth. Mol. Biol. (2014) 1088:81-96) that enables rapid discovery of druggable targets in disease pathways of interest. In our approach, collections of diseased cells are given genetic instructions to make molecules in such a way that each cell gets a different set of instructions. The approach is a bit like a lottery: cells that get instructions to make molecules that cure the disease, or selectively kill cells carrying it, can be identified using powerful genetic selection and screening methods that we develop in the laboratory. Molecular "hits" that emerge from the selection/screening process are produced and studied in detail to determine the physiological target and understand how the hit molecule modulates the target's biochemical function. The end result is identification of the best targets for drug development, and molecules that can serve as lead compounds or even drugs. The second project is focused on developing new drugs for the treatment of tuberculosis. Fully one third of the world’s population (> 2 billion people) is currently infected with Mycobacterium tuberculosis (Mtb), nearly ten million new infections occur every year and more than one million people die from the disease annually. To make this terrible situation even worse, multiple- and extensively drug resistant strains of Mtb are becoming more prevalent (~ 5% of all new infections – nearly 500,000 per year – are drug resistant). We have recently elucidated the detailed kinetic mechanism for a unique target in the mycobacterial respiration system, type II NADH dehydrogenase (NDH-2), which accounts for the physiological activity of this essential enzyme, uncovers a novel, druggable site in the enzyme and rationalizes the antimycobacterial activity of a largely forgotten class of antibiotics (Yano, et al., in press). This work has stimulated a new trial by the Global Alliance for Tuberculosis Drug Development aimed at reintroducing these drugs into clinical practice, and will be followed up by a multi-investigator effort to generate and characterize second-generation derivatives guided by our mechanistic studies. The newest project in the lab aims to develop next-generation therapeutics for the treatment of asthma and chronic obstructive pulmonary disease (COPD), which result from airway constriction. Current therapies for asthma and COPD rely on long-acting beta-agonists, which activate the β-2 adrenergic receptor (β2AR) and promote relaxation via the downstream cAMP-dependent signaling pathway. However, the therapeutic benefit of these agents diminishes with prolonged treatment due to tolerance mediated by receptor desensitization. We are interested in developing biased β2AR agonists and/or inhibitors of the desensitization pathway in order to prolong cAMP-mediated relaxation of airway smooth muscle and thereby improve disease management. We are pursuing a multi-pronged discovery effort, including high-throughput screening of small molecule libraries, virtual screening and expression-based chemical genetics in order to achieve this objective. biochemistry; biophysics; molecular biology; enzymology; drug discovery; target discovery; chemical genomics; chemical genetics; chemical biology; intein; combinatorial library; high-throughput screening; small molecule; pepducin; cyclic peptide; protein engineering; protein-protein interaction; tuberculosis; oxidative phosphorylation; electron transfer; kinetics.

医学

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Mono, Lack of Sun Linked to MS 09/19/2011 08:11 AM Mono, Lack of Sun Linked to MS By Associated Press Having a history of mononucleosis and low levels of sun exposure appear to be risk factors for multiple sclerosis. Mono, Lack of Sun Linked to MSStudy Suggests Mononucleosis Virus and Limited Sun Exposure Raise Risk for Multiple SclerosisWebMD Medical News Multiple Sclerosis: Urinary Tract Tests-Topic OverviewMultiple Sclerosis: Intravenous Immunoglobulin (IVIG)-CreditsMultiple Sclerosis: Mental and Emotional Problems-Related InformationSide Effects of MS TreatmentsApril 18, 2011 -- Having a history of mononucleosis and living in an area that gets little sunlight both appear to increase the risk for developing multiple sclerosis, new research finds.Multiple sclerosis (MS) is far more common in regions that get little sunlight most of the year, such as Scandinavia, Canada, and the Northern U.S.Exposure to sunlight allows the skin to produce vitamin D, and vitamin D deficiency has been linked to MS in some studies. Having a history of mononucleosis, which is caused by the Epstein-Barr virus, has also long been suspected of being a possible trigger for MS.In an effort to determine if the two possible risk factors could explain the geographic differences in multiple sclerosis incidence, longtime MS researcher George C. Ebers, MD, and colleagues at the University of Oxford in the U.K. conducted a study in England.Their earlier studies in France, Scotland, and other regions of Europe suggest that differences in sunlight exposure affect MS risk even within small geographical areas.For example, MS rates in Scotland were higher in Glasgow than in the sunnier city of Dundee.“We wanted to find out if having had mononucleosis adds to the multiple sclerosis risk we have documented for low ultraviolet B (UVB) exposure,” Ebers tells WebMD.Sunlight, Mono Explain 72% of Regional DifferenceTo do this, the researchers examined all National Health Service (NHS) hospital admissions in England from spring of 1998 to spring of 2005, identifying almost 57,700 cases of multiple sclerosis and 14,600 cases of infectious mononucleosis.They also used NASA satellite data on UV radiation exposure to calculate sunlight exposure within different areas of the country.The researchers concluded that sunlight exposure and mononucleosis history together explained 72% of the variance in multiple sclerosis incidence within England during this period.Exposure to sunlight accounted for about 61% of this variance, with having a history of mononucleosis accounting for the rest of the risk, the researchers found.The findings do not prove that either low levels of sunlight exposure or having a history of mononucleosis cause multiple sclerosis. But Ebers says they point to the “pressing need” for larger studies to examine vitamin D, infectious mononucleosis, and MS.“The evidence implicating UV radiation in MS is pretty strong,” he says. “It is less strong for infectious mononucleosis, but we need to learn more about this.”Neurologist Recommends Testing, SupplementationNeurologist Karen Blitz-Shabbir, MD, agrees the evidence suggesting a protective role for vitamin D against MS is convincing, and she believes supplementation may even help patients once they have the disease.Blitz-Shabbir, who directs the North Shore MS Care Center in East Meadow, N.Y., recommends that her patients take 1,000 international units (IU) of vitamin D a day.Other than sunlight exposure, supplementation is the most efficient way to get vitamin D. Food sources includes fatty fish and fortified dairy products, but getting vitamin D from food alone would be very difficult.“It is important for MS patients and family members of patients to have their vitamin D levels checked,” Blitz-Shabbir says. “If vitamin D levels are low, 1,000 IU may not be enough.”Late last year, the Institute of Medicine weighed in on vitamin D supplementation, concluding that most Americans under the age of 70 need no more than 600 IU of the vitamin per day to maintain health and older people need no more than 800 IU.The group concluded that the evidence linking higher levels of supplementation to protection against diseases like MS was inconclusive.SOURCES:Ramagopalan, S. Neurology, April 19, 2011; vol 76: pp 1410-1414.George C. Ebers, MD, Wellcome Trust Center for Human Genetics and department of clinical neurology, University of Oxford, England.Karen Blitz-Shabbir, MD, director, North Shore MS Care Center, East Meadow, N.Y.News release, American Academy of Neurology.News release, Institute of Medicine.© 2011 WebMD, LLC. All rights reserved.

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James Reason and the foundation of patient safety Bob Wachter, MD Professor James Reason is the intellectual father of the patient safety field. I remember reading his book Managing the Risks of Organizational Accidents in 1999 and having the same feeling that I had when I first donned eyeglasses: I saw my world anew, in sharper focus. Reason’s “Swiss cheese” model, in particular – which holds that most errors in complex organizations are caused not so much by the inevitable human mistakes but rather by the organization’s incomplete layers of protection, which allow the errors to pass through on their way to causing terrible harm – was an epiphany. It is the fundamental mental model for patient safety, as central to our field as the double helix is to genetics. Last month, I returned to England to give a couple of talks, one at a conference called “Risky Business,” the other at the UK’s National Patient Safety Congress. The former brings together many of the leading thinkers in a variety of risk-heavy fields, including aviation, nuclear power, space travel, the financial system … and healthcare. At the latter, I was asked to give the 2012 James Reason Lecture, a singular honor. Attending both conferences, I spent a lot of the week thinking about Swiss cheese. Two particular case studies I heard stand out – one in which a series of human and technological errors combined to kill 26 men in a friendly fire accident, the other in which highly skilled pilots managed to safely land a mammoth aircraft after one of its engines exploded. Both were instructive, in different ways. At the Risky Business conference, Scott Snook described a tragically famous friendly fire accident: the 1994 incident in which two American F-15 fighters shot down two U.S. Army UH-60 Blackhawk helicopters, killing all 26 men aboard, on a crystal-clear day in the “no fly zone” in Northern Iraq. Snook is a blunt, tough-looking, head-shaven, fast-talking New Jersey native. It’s not surprising to learn that he spent 22 years in the US Army, rising to the rank of Colonel before retiring in 2002. More surprising are his Harvard MBA, his Harvard PhD in Organization Behavior and his present job: Senior Lecturer at Harvard Business School. The test of a conceptual framework is how often it holds true, and in every large-scale accident I’ve studied (Chernobyl, BP, 9/11, Tenerife, Bhopal, and innumerable medical errors), the Swiss cheese model fits. Such errors virtually always involve competent, caring people in hard jobs, trying to do their best with imperfect data and under various pressures, felled by glitchy pieces of technology, poor communication, and really bad karma. And there’s nearly always a cultural mindset that contributes to the whole mess, one that had existed for years and been tolerated because, well, “that’s just how things work around here.” In the friendly fire case (I’ll make a long story relatively short; Snook wrote a whole book about the incident), two Air Force F-15s were flying “lazy eights” in the sky above Northern Iraq, as they’d been doing each day for a couple of years without excitement. Both planes carried only a single pilot and an awful lot of weaponry. There had been reports of Iraqi saber rattling in the preceding weeks, so the pilots were a bit on edge. That morning, they had received their pre-flight briefing; it included a printout of all the coalition planes expected in the zone that day. Helicopters, particularly those from another branch of the Armed Services, were often omitted from the list, and the two Blackhawks that day were no exception. The Blackhawks’ were tasked to shuttle some Kurdish civilians and service personnel from the US, Britain, Turkey, and France to a tribal meeting in the town of Zakhu, in the hills of Northern Iraq, inside the no-fly zone. They took off from an Army base in Turkey, and, as always, flew low and fast; hugging the mountainous terrain was their best protection against being spotted by enemy radar. Flying at 32,000 feet, high above both the F-15s and the Blackhawks, was an AWACS surveillance plane, a specially-outfitted Boeing 707 that directs traffic over an entire region. One of the computer screens on the AWACS malfunctioned that day, so two people who usually sat next to each other (one directing traffic coming into a given zone, the other the outgoing traffic) were placed a few rows away, where they could no longer tap on each others’ shoulders to discuss a confusing finding. The AWACS crewman on the Incoming monitor spotted the Blackhawks on his radar, but then they disappeared from the screen, probably because the helicopters had gone behind a mountain. He placed an electronic arrow on his screen to remind him of the choppers’ prior position, but such arrows were designed to disappear after a few minutes to avoid screen clutter. The F-15s had four ways of guarding against friendly fire incidents. The first was the list of expected flights in their zone, strapped to the pilot’s thigh. By failing to list all flights – in particular the Blackhawks – one slice of Swiss cheese was breached even before the fighter planes took off. The second protection was a technology known as IFF (“Identification Friend or Foe”). Every US or allied plane has a transponder that emits a signal telling others that they are on the same side. The F-15’s rules of engagement require it to “paint” a potential target with its IFF probe; a friendly plane returns an electronic signal that says, “I’m on your team.” But on April 14, 1994, it too proved to be more hole than cheese. The Blackhawk helicopters had their code set for the Turkey frequency when they took off, and neglected to switch to the Iraq frequency when they entered Kurdistan (the later investigation revealed that this happened frequently). This meant that when the F-15s pointed their IFF at the Blackhawks, the response back was “Foe.” It didn’t dawn on the F-15 pilots to try the other frequency for Turkey, which would have entailed turning their dial by one click. Layer Two was breached. The F-15 pilots radioed the AWACS to ask if there were any friendly helicopters in the area. By this time, the electronic arrow had disappeared from the Incoming crewman’s monitor; there appeared to be “no friendlies” in the zone. Inexplicably, the crewman who had seen the Blackhawks earlier did not speak up. No one is quite sure why neither he, nor a few other AWACS personnel who had seen the Blackhawks’ signal, stayed quiet during the minute when they could have prevented tragedy with a single word. Perhaps each expected that someone else would speak up. In any case, they failed to call off the dogs. Layer Three. The final protection was the requirement for a visual identification (“VID”, in service lingo) of a target before attack. The F-15’s swooped down to a position 1000 feet above and 500 feet to the side of the Blackhawks. Russian-built Iraqi “Hind” choppers had threatening side-ordnance hanging off the main fuselage; Blackhawks generally did not. But these particular Blackhawks had been outfitted with two side-hanging fuel tanks that, from a few thousand feet, might have looked like missiles. Moreover, despite the pilots’ extensive VID training, IDing a chopper from that distance is like determining a mini-van’s make and model from five football fields away. And one wonders whether these pilots, who had been flying dull surveillance missions for years, had their adrenaline pumping, which led them to see what they wanted to see, a phenomenon known as confirmation bias. All layers of Swiss cheese having been breached, the F-15 pilots both pulled their triggers. In a chilling bit of Top Gun swagger, as the second missile hit its target, Pilot 2 told Pilot 1, “Stick a fork in them, they’re done.” The pilots returned to base, getting huge atta-boys from their colleagues, and were waiting to be debriefed by their general when they looked up at a TV screen in the general’s waiting room. CNN was reporting that two Blackhawk helicopters were missing in Northern Iraq. One can only imagine how they felt at that moment. While it would be easy to point any number of fingers, James Reason’s model teaches us that to prevent another friendly fire incident, the most important thing is to identify the holes in the Swiss cheese, shrinking them to the degree possible and creating enough different layers that the probability that they will ever line up again is made as low as possible. (The investigators mostly did that, though they did court marshal one person, AWACS supervisor Capt. Jim Wang.) Professor Reason also teaches us to mine cases in which things go right for their lessons. At the Risky Business conference, another speaker was Capt. David Evans, a Quantas training pilot who was on the flight deck when Engine #2 of a giant Airbus 380, carrying 440 passengers and 29 crew, exploded in November 2010. Captain Evans walked right out of central casting – handsome, broad shoulders, with a soothing Australian voice. A few minutes after takeoff, a hydraulic tube ruptured, spilling slippery fluid inside the engine, which caused a turbine to spin too fast and ultimately to explode, sending engine fragments at “infinite energy” in all directions. In an extraordinary bit of luck, only one 75-pound fragment plowed into the fuselage; it missed the passenger compartment by a few feet. But the explosion made a mess of the wing, blowing out not only the left inside engine but several other mission-critical systems like generators and fuel pumps. He and the other pilots (there happened to be five on the plane that day) methodically (they flew two hours before they landed) went through their paces, ticking through checklists, ascertaining the extent of the damage. While they used the technology when they could, they were also skeptical of it in the face of a catastrophic insult. For example, the computer system recognized that one wing was much lighter than the other (duh, it was missing a big chunk of a 25-ton engine) and signaled the pilots to move fuel from the heavier side to the lighter to keep the plane balanced. They wisely decided to ignore that recommendation. On the other hand, the pilots programmed all their data into the plane’s landing app, which told them that – because they’d be coming in steeply, heavy with fuel, and with partly damaged brakes – they’d need the longest possible runway (they choose the main runway in Singapore), and the computer predicted that they’d be able to stop about 100 yards from the end of the 2-mile long runway. The prediction was accurate, nearly to the foot, and no one was hurt. Professor Reason’s model helps us understand why things go right, and sometimes why they go wrong. By causing us to focus more on bad systems than bad people, the model has been responsible for much of the progress we’ve made in patient safety. In my talk at the Patient Safety Congress, I offered the audience my own thoughts on the successes, failures, surprises and epiphanies in the decade or so since the safety movement began. I was thrilled that Professor Reason, now retired, came to the talk. In addition to highlighting the central role of the Swiss cheese model, I made the point that many people took the model as support for an unblinking acceptance of “systems thinking” and “no blame” as an apt response to every error. The effort to rebalance systems thinking with accountability, often attributed to David Marx’s “Just Culture” model, is sometimes regarded as a counterpoint to Reason’s teachings. Yet nothing could be further from the truth. I reminded the audience that in 1997 – three years before Marx first wrote about the “Just Culture” – Reason had done the same. In Managing the Risks of Organizational Accidents, he wrote: A ‘no-blame’ culture is neither feasible nor desirable. A small proportion of human unsafe acts are egregious… and warrant sanctions, severe ones in some cases. A blanket amnesty on all unsafe acts would lack credibility in the eyes of the workforce. More importantly, it would be seen to oppose natural justice. What is needed is a just culture, an atmosphere of trust in which people are encouraged, even rewarded, for providing essential safety-related information – but in which they are also clear about where the line must be drawn between acceptable and unacceptable behavior. I had a chance to chat with James Reason after my lecture, and he was very pleased that I had highlighted this point, since he believes that he is often misinterpreted as sugarcoating the role of bad behavior. Professor Reason asked me to sign his copy of the new edition of my book, Understanding Patient Safety, which I did, proudly. My own interest in patient safety came from seeing terrible errors (and committing a few of my own) and learning – from James Reason – that the way I’d been taught to think about them was all wrong. Having a chance to give a lecture in Reason’s name, with him in the audience, was one of the great thrills of my career. We stand on the shoulders of giants, observed Issac Newton, and I’ve never felt that more acutely than I did last month in a remarkable week in England. Bob Wachter is chair, American Board of Internal Medicine and professor of medicine, University of California, San Francisco. He coined the term “hospitalist” and is one of the nation’s leading experts in health care quality and patient safety. He is author of Understanding Patient Safety, Second Edition, and blogs at Wachter’s World, where this post originally appeared. Hospitalist, Malpractice, The necessary steps healthcare must take for patient safety The difficulty of moving the needle on patient safety To improve patient safety, lawyers need to embrace transparency too Drug shortages can jeopardize patient safety Improving patient safety in ambulatory care Physician burnout is an obstacle to patient safety More in Physician < Previous post Should hydrocodone be changed to a schedule 2 drug? http://twitter.com/WindyCityMed Michael Mank Exceptional post. As I was reading through it, I was beginning to think to myself, “What about personal accountability? What about the response I usually hear from healthcare workers, such as nurses, techs, etc., that say, ‘I did what I was supposed to do.’ without any regard to what was really happening to a patient?” However, I was pleased to find that Mr. Reason does NOT support a ‘no blame’ culture while advocating for improving system processes. In the end, patients win when personal accountability and filling in the holes of the ‘Swiss cheese’ model go hand in hand. http://twitter.com/dfntvmaura Maureen Rudden Not so much a comment but I would like to relate an incident and get your opinion. A couple of years ago a slightly demented, very healthy 98 year old was hospitalized and had surgery for a broken hip. Two days after surgery he was transferred to a convalescent hospital without notifying the family and against their verbal direction. (The OR Surgeon was out of town and could not be reached). When this patient arrived at the CH he arrived w/o orders. (unbelievable but true). At 1300 hrs he arrived via ambulance and was admitted. At 1515 hours his daughter, from out of town arrived, shocked that he was here and quite upset because he should not be here. On entering the room she noticed a nurse preparing to inject him in the stomach, she inquired as to what they were doing and was told, “giving him insulin”. Why, she asked, my father does not have diabetes! The nurse left and the daughter proceeded to talk to her father and noticed several bruises on his arms and back and side. She inquired of the nurse and was told he had fallen out of bed. (Just a note: I was present because this is my step-father) We then went to the Director of Nurses to ascertain what was going on. We were then informed that he had fallen out of bed three times in an hour and a half. We questioned as to why there were no side rails and was told that, “The patient has a right to fall out of bed”. I will never forget that statement or what followed. I was appalled and informed the Director then asked what about lawsuits for negligence and how do you explain to the families about injuries to their loved ones. This person reiterated about allowing the patients to fall as that it their right. If they do get a lawsuits,” after a few their accreditation is lost and and all they have to do is pay a fine and then reapply for new accreditation” “Sometimes it takes a little while but we always receive the accreditation” Needless to say this was an appalling situation, my sister and I spent the next 48 hours with him until he could be released and come home. (Sorry, I did forget to say that the CH would put the bed down on the floor with rubber mats along side if the patient continues to fall) I do not know what your opinion of this situation with the CH but truthfully it terrifies me and I could tell you of many more incidents that I personally know of and have witnessed. Neither one of us are litigious and the error in releasing our father from the original hospital has been taken care of. Since this incident I have been trying to, I guess you might say, be a “watch-dog” for patients in hospitals and CH and also in Home Health. I am not asking for money or anything else but I do want to know your opinion and what, if anything, I might do to be able to protect these helpless individuals. Thank you for listening to me. Maura

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for reference. The original video has been deleted and is no longer available. Family educating others on Tourette SyndromeBRIDGE CITY- by Haley BullNine pills a day, a constant rotation of medications and a binder filled with records keeping track of Cameron Ellis are things his family has dealt with for years. "I didn't really know what to think because I really didn't know what it was," Ellis said.Doctors diagnosed the ten-year old with Tourette Syndrome about five years ago. "A lot of people's question is well what is Tourette's? Well what does it do?," his mother Victoria Buchanan said.It causes motor ticks for Cameron, making daily tasks like walking, schoolwork and sports more difficult."I keep on jerking my neck or my foot twists and I trip myself and my fingers draw up," Ellis said. His family said they had to research the syndrome, that others don't always understand."People would be like what are you doing, why are you being such a freak, can't you stop it?" Buchanan said. "He would have kids that would push him, slap him, he'd come off the bus crying everyday, please don't make me go back, please, you know, I just want to be normal like everybody else.""They didn't really understand. They didn't know what I had and just thought there was something wrong with me," Ellis said.It's why his family said they want more people to learn about the syndrome."Hopefully we can find a cure for it and more awareness," Kevin Buchanan said."Sometimes I just feel like it's not gonna get better," Ellis said. But he's not giving up hope for himself or others. "If there's anyone else out there who has Tourettes, I just have hope for them that they can get better."His family said they're working to bring a motivational speaker to Ellis' school so others can understand what Tourette Syndrome patients go through.

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WebMD Health - Cancer Sep 12, 2012 5:02 AM Wins in War on Cancer Highlighted in New Report Wins in War on Cancer Highlighted in New ReportWebMD Medical News By Denise Mann Reviewed by Louise Chang, MD More from WebMD Smoking Marijuana Tied to Testicular CancerCDC: Cancer Screening Below Target RatesLiving in U.S. Raises Cancer Risk for HispanicsCancer: Minorities Report More PainSept. 12, 2012 -- Seven-year-old Brooke Mulford and her family just returned to their Salisbury, Md., home after an action-packed West Coast tour, which included visits to Disneyland, Sea World, and the San Diego Zoo.Brooke has visited the Magic Kingdom many times over the years, but this trip was even more special than previous ones (and not just because she loves Space Mountain). The family was celebrating Brooke's three-year anniversary of being free from an aggressive form of cancer known as neuroblastoma.Thanks to participation in a clinical trial, Brooke is doing much better today than anyone could have hoped. Her story is one that puts a face on some of the progress made in the fight against cancer. The 2012 American Association for Cancer Research Progress Report highlights stories of survivors, including Brooke, as well as some of the challenges facing researchers. The report will also be published in Clinical Cancer Research.Lots of New Cancer Drugs, More SurvivorsAccording to the new report, 2012 was a big year for cancer researchers, patients, and survivors. The past 12 months have ushered in a new drug for precancerous skin lesions, eight new drugs for several types of cancers (including two new classes of drugs), and four new uses of approved cancer drugs."It is an exciting time for oncology," says Anna Barker, PhD, one of the authors of the new AACR report. "Acceleration in progress is exponential and we can't predict what will happen from week to week."Just last week, the FDA approved Pfizer's Bosulif for the treatment of chronic myelogenous leukemia (CML), a type of leukemia more commonly seen in adults.The number of cancer survivors like Brooke continues to rise every year. There are about 13.7 million cancer survivors in the U.S., the report states.This is a "new day for cancer patients," says Barker. "It's a culmination of a decade's worth of work."She cites the decoding of the human genome as a watershed accomplishment. "We now use that information to tailor treatment."This is the type of information that may help patients like Brooke in the future. While Brooke is cancer-free, she still has many issues related to her treatment, including vision and dental problems, and permanent hair loss. She has tests every six months since completing treatment in April 2010.Her mom, Amy, hopes that a more personalized, targeted approach to cancer treatment could help limit side effects and help choose treatments that are more likely to work based on a tumor's genetic makeup."I hope they can personalize treatment as opposed to just hitting it with everything possible," Amy says.We are getting there, Baxter says. "In the next five to 10 years, we will see some real change in how patients are diagnosed and treated, as well as how we prevent cancer by changing lifestyles."Fully 30% of cancer deaths are related to excess weight and lack of regular physical activity, according to the new report.Looming Budget Cuts Threaten ProgressChallenges remain, including how to fund cancer research in a time of financial cutbacks, as well as how to manage all of the new genomic data. "It's a data tsunami," Baxter says. "We need to figure out how you find those pathways that will be critical for cancer.""It is a good news story," agrees Frank McCormick, PhD. He is the AACR president and the director of the University of California, San Francisco Helen Diller Comprehensive Cancer Center. "There has been a renaissance in interest in immunotherapy, which has had a huge impact on refocusing the field," he says. Immunotherapy teaches our body's own immune system to recognize cancer and launch an attack on it. Brooke's clinical trial involved immunotherapy.The main challenges are shrinking budgets. Cuts are slated to take place starting Jan. 2, 2013, if Congress doesn't find a suitable solution to the federal budget deficit. "This is a bad time to pull back," he says.There have been tremendous strides in treating melanoma skin cancer and in lung cancer, McCormick says. "There have been general increases in survival for breast and several other cancers in the last several years, but some cancers are tough nuts to crack, such as pancreatic cancer."Melanie A. Nix of University Park, Md., is a four-year breast cancer survivor who embodies this progress. She was diagnosed with breast cancer at age 38 just as she was planning to have a preventive breast-removal surgery to lower her risk of developing the cancer.Nix, a mom and software executive, has a strong family history of breast and ovarian cancer, and she had options that weren't there for her other family members. "In my family, breast cancer is genetic, and there some things we can try to do -- if not prevent -- at least reduce our risk for developing breast cancer."SOURCES:Anna Barker, PhD, director, Arizona State University Transformative Healthcare Networks, Tempe.Frank McCormick, PhD, AACR president; director, University of California-San Francisco Helen Diller Comprehensive Cancer.Melanie A. Nix, University Park, Md.Amy Mulford, Salisbury, Md.AACR Cancer Progress Report 2012. 2012 WebMD, LLC. All rights reserved. »Comments More on WebMD Too Much Nail Trimming May Lead to Problems Scoliosis: Daily Yoga Pose May Reduce Spinal Curve CDC: 4 People With Enterovirus D68 Have Died First Ebola Patient Tests Positive in the U.S. The Future of Cancer Detection Doctors, Patients Embrace Technology in Medicine Back-Related Leg Pain: Spine Manipulation Helps Risks of Breast Cancer Screening in Women Over 70 Nuts & Your Health: What to Know Duchess Kate & Prince William Expecting 2nd Baby Methadone Lowers Testosterone in Men Only Eating More Fruit Cuts Heart Disease Risk: Study Is Breakfast Really Your Most Important Meal? Is Any Amount of Alcohol Good for Us? Food Allergies More Common Among Inner City Kids, Study Finds Drug Restores Hair in Alopecia Patients: FAQ New At-Home Colon Cancer Test: FAQ Fast-Slow Walking May Be Better for Diabetes Woman Skips Round of Chemo to Help Cancer Research Diabetes May Raise Risk for Head and Neck Cancer

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You are here: HomeEssaysBootstrapping our way to an ageless future Bootstrapping our way to an ageless future September 19, 2007 by Aubrey de Grey Biomedical gerontologist Aubrey de Grey expects many people alive today to live to 1000 years of age and to avoid age-related health problems even at that age. In this excerpt from his just-published, much-awaited book, Ending Aging, he explains how. An excerpt from Ending Aging, St. Martin’s Press, Sept. 2007, Chapter 14. I have a confession to make. In Chapters 5 through 12, where I explained the details of SENS, I elided one rather important fact—a fact that the biologists among my audience will very probably have spotted. I’m going to address that omission in this chapter, building on a line of reasoning that I introduced in an ostensibly quite circumscribed context towards the end of Chapter 9. It is this: the therapies that we develop in a decade or so in mice, and those that may come only a decade or two later for humans, will not be perfect. Other things being equal, there will be a residual accumulation of damage within our bodies, however frequently and thoroughly we apply these therapies, and we will eventually experience age-related decline and death just as now, only at a greater age. Probably not all that much greater either — probably only 30-50 years older than today. But other things won’t be equal. In this chapter, I’m going to explain why not—and why, as you may already know from other sources, I expect many people alive today to live to 1000 years of age and to avoid age-related health problems even at that age. I’ll start by describing why it’s unrealistic to expect these therapies to be perfect. MUST WE AGE? A long life in a healthy, vigorous, youthful body has always been one of humanity’s greatest dreams. Recent progress in genetic manipulations and calorie-restricted diets in laboratory animals hold forth the promise that someday science will enable us to exert total control over our own biological aging. Nearly all scientists who study the biology of aging agree that we will someday be able to substantially slow down the aging process, extending our productive, youthful lives. Dr. Aubrey de Grey is perhaps the most bullish of all such researchers. As has been reported in media outlets ranging from 60 Minutes to The New York Times, Dr. de Grey believes that the key biomedical technology required to eliminate aging-derived debilitation and death entirely—technology that would not only slow but periodically reverse age-related physiological decay, leaving us biologically young into an indefinite future—is now within reach. In Ending Aging, Dr. de Grey and his research assistant Michael Rae describe the details of this biotechnology. They explain that the aging of the human body, just like the aging of man-made machines, results from an accumulation of various types of damage. As with man-made machines, this damage can periodically be repaired, leading to indefinite extension of the machine’s fully functional lifetime, just as is routinely done with classic cars. We already know what types of damage accumulate in the human body, and we are moving rapidly toward the comprehensive development of technologies to remove that damage. By demystifying aging and its postponement for the nonspecialist reader, de Grey and Rae systematically dismantle the fatalist presumption that aging will forever defeat the efforts of medical science. Evolution didn’t leave notes I emphasised in Chapter 3 that the body is a machine, and that that’s both why it ages and why it can in principle be maintained. I made a comparison with vintage cars, which are kept fully functional even 100 years after they were built, using the same maintenance technologies that kept them going 50 years ago when they were already far older than they were ever designed to be. More complex machines can also be kept going indefinitely, though the expense and expertise involved may mean that this never happens in practice because replacing the machine is a reasonable alternative. This sounds very much like a reason to suppose that the therapies we develop to stave off aging for a few decades will indeed be enough to stave it off indefinitely. But actually that’s overoptimistic. All we can reliably infer from a comparison with man-made machines is that a truly comprehensive panel of therapies, which truly repairs everything that goes wrong with us as a result of aging, is possible in principle— not that it is foreseeable. And in fact, if we look back at the therapies I’ve described in this book, we can see that actually one thing about them is very unlike maintenance of a man-made machine: these therapies strive to minimally alter metabolism itself, and target only the initially inert side-effects of metabolism, whereas machine maintenance may involve adding extra things to the machinery itself (to the fuel or the oil of a car, for example). We can get away with this sort of invasive maintenance of man-made machines because we (well, some of us!) know how they work right down to the last detail, so we can be adequately sure that our intervention won’t have unforeseen side-effects. With the body—even the body of a mouse—we are still profoundly ignorant of the details, so we have to sidestep our ignorance by interfering as little as possible. What that means for efficacy of therapies is that, as we fix more and more aspects of aging, you can bet that new aspects will be unmasked. These new things—eighth and subsequent items to add to the “seven deadly things” listed in this book—will not be fatal at a currently normal age, because if they were, we’d know about them already. But they’ll be fatal eventually, unless we work out how to fix them too. It’s not just “eighth things” we have to worry about, either. Within each of the seven existing categories, there are some subcategories that will be easier to fix than others. For example, there are lots of chemically distinct cross-links responsible for stiffening our arteries; some of them may be broken with ALT-711 and related molecules, but others will surely need more sophisticated agents that have not yet been developed. Another example: obviating mitochondrial DNA by putting modified copies of it into the cell’s chromosomes requires gene therapy, and thus far we have no gene therapy delivery system (“vector”) that can safely get into all cells, so for the foreseeable future we’ll probably only be able to protect a subset of cells from mtDNA mutations. Much better vectors will be needed if we are to reach all cells. In practice, therefore, therapies that rejuvenate 60-year-olds by 20 years will not work so well the second time around. When the therapies are applied for the first time, the people receiving them will have 60 years of “easy” damage (the types that the therapies can remove) and also 60 years of “difficult” damage. But by the time beneficiaries of these therapies have returned to biologically 60 (which, let’s presume, will happen when they’re chronologically about 80), the damage their bodies contain will consist of 20 years of “easy” damage and 80 years of “difficult” damage. Thus, the therapies will only rejuvenate them by a much smaller amount, say ten years. So they’ll have to come back sooner for the third treatment, but that will benefit them even less… and very soon, just like Achilles catching up with the tortoise in Zeno’s paradox, aging will get the better of them. See Figure 1. Figure 1. The diminishing returns delivered by repeated application of a rejuvenation regime. Back in Chapters 3 and 4 I explained that, contrary to one’s intuition, rejuvenation may actually be easier than retardation. Now it’s time to introduce an even more counterintuitive fact: that, even though it will be much harder to double a middle-aged human’s remaining lifespan than a middle-aged mouse’s, multiplying that remaining lifespan by much larger factors—ten or 30, say—will be much easier in humans than in mice. The two-speed pace of technology I’m now going to switch briefly from science to the history of science, or more precisely the history of technology. It was well before recorded history that people began to take an interest in the possibility of flying: indeed, this may be a desire almost as ancient as the desire to live forever. Yet, with the notable but sadly unreproduced exception of Daedalus and Icarus, no success in this area was achieved until about a century ago. (If we count balloons then we must double that, but really only airships—balloons that can control their direction of travel reasonably well—should be counted, and they only emerged at around the same time as the aircraft.) Throughout the previous few centuries, engineers from Leonardo on devised ways to achieve controlled powered flight, and we must presume that they believed their designs to be only a few decades (at most) from realisation. But they were wrong. Ever since the Wright brothers flew at Kitty Hawk, however, things have been curiously different. Having mastered the basics, aviation engineers seem to have progressed to ever greater heights (literally as well as metaphorically!) at an almost serenely smooth pace. To pick a representative selection of milestones: Lindbergh flew the Atlantic 24 years after the first powered flight occurred, the first commercial jetliner (the Comet) debuted 22 years after that, and the first supersonic airliner (Concorde) followed after a further 20 years. This stark contrast between fundamental breakthroughs and incremental refinements of those breakthroughs is, I would contend, typical of the history of technological fields. Further, I would argue that it’s not surprising: both psychologically and scientifically, bigger advances are harder to estimate the difficulty of. I mention all this, of course, because of what it tells us about the likely future progress of life extension therapies. Just as people were wrong for centuries about how hard it as to fly but eventually cracked it, we’ve been wrong since time immemorial about how hard aging is to combat but we’ll eventually crack it too. But just as people have been pretty reliably correct about how to make better and better aircraft once they had the first one, we can expect to be pretty reliably correct about how to repair the damage of aging more and more comprehensively once we can do it a little. That’s not to say it’ll be easy, though. It’ll take time, just as it took time to get from the Wright Flyer to Concorde. And that is why, if you want to live to 1000, you can count yourself lucky that you’re a human and not a mouse. Let me take you through the scenario, step by step. Suppose we develop Robust Mouse Rejuvenation in 2016, and we take a few dozen two-year-old mice and duly treble their one-year remaining lifespans. That will mean that, rather than dying in 2017 as they otherwise would, they’ll die in 2019. Well, maybe not—in particular, not if we can develop better therapies by 2018 that re-treble their remaining lifespan (which will by now be down to one year again). But remember, they’ll be harder to repair the second time: their overall damage level may be the same as before they received the first therapies, but a higher proportion of that damage will be of types that those first therapies can’t fix. So we’ll only be able to achieve that re-trebling if the therapies we have available by 2018 are considerably more powerful than those that we had in 2016. And to be honest, the chance that we’ll improve the relevant therapies that much in only two years is really pretty slim. In fact, the likely amount of progress in just two years is so small that it might as well be considered zero. Thus, our murine heroes will indeed die in 2019 (or 2020 at best), despite our best efforts. But now, suppose we develop Robust Human Rejuvenation in 2031, and we take a few dozen 60-year-old humans and duly double their 30-year remaining lifespans. By the time they come back in (say) 2051, biologically 60 again but chronologically 80, they’ll need better therapies, just as the mice did in 2018. But luckily for them, we’ll have had not two but twenty years to improve the therapies. And 20 years is a very respectable period of time in technology—long enough, in fact, that we will with very high probability have succeeded in developing sufficient improvements to the 2031 therapies so that those 80-year-olds can indeed be restored from biologically 60 to biologically 40, or even a little younger, despite their enrichment (relative to 2031) in harder-to-repair types of damage. So unlike the mice, these humans will have just as many years (20 or more) of youth before they need third-generation treatments as they did before the second. And so on …. See Figure 2. Figure 2. How the diminishing returns depicted in Figure 1 are avoided by repeated application of a rejuvenation regime that is sufficiently more effective each time than the previous time. Longevity Escape Velocity The key conclusion of the logic I’ve set out above is that there is a threshold rate of biomedical progress that will allow us to stave off aging indefinitely, and that that rate is implausible for mice but entirely plausible for humans. If we can make rejuvenation therapies work well enough to give us time to make then work better, that will give us enough additional time to make them work better still, which will … you get the idea. This will allow us to escape age-related decline indefinitely, however old we become in purely chronological terms. I think the term “longevity escape velocity” (LEV) sums that up pretty well.1 One feature of LEV that’s worth pointing out is that we can accumulate lead-time. What I mean is that if we have a period in which we improve the therapies faster than we need to, that will allow us to have a subsequent period in which we don’t improve them so fast. It’s only the average rate of improvement, starting from the arrival of the first therapies that give us just 20 or 30 extra years, that needs to stay above the LEV threshold. In case you’re having trouble assimilating all this, let me describe it in terms of the physical state of the body. Throughout this book, I’ve been discussing aging as the accumulation of molecular and cellular “damage” of various types, and I’ve highlighted the fact that a modest quantity of damage is no problem—metabolism just works around it, in the same way that a household only needs to put out the garbage once a week, not every hour. In those terms, the attainment and maintenance of escape velocity simply means that our best therapies must improve fast enough to outweigh the progressive shift in the composition of our aging damage to more repair-resistant forms, as the forms that are easier to repair are progressively eliminated by our therapies. If we can do this, the total amount of damage in each category can be kept permanently below the level that initiates functional decline. Another, perhaps simpler, way of looking at this is to consider the analogy with literal escape velocity, i.e. the overcoming of gravity. Suppose you’re at the top of a cliff and you jump off. Your remaining life expectancy is short—and it gets shorter as you descend to the rocks below. This is exactly the same as with aging: the older you get, the less remaining time you can expect to live. The situation with the periodic arrival of ever better rejuvenation therapies is then a bit like jumping off a cliff with a jet-pack on your back. Initially the jetpack is turned off, but as you fall, you turn it on and it gives you a boost, slowing your fall. As you fall further, you turn up the power on the jetpack, and eventually you start to pull out of the dive and even start shooting upwards. And the further up you go, the easier it is to go even further. The political and social significance of discussing LEV I’ve had a fairly difficult time convincing my colleagues in biogerontology of the feasibility of the various SENS components, but in general I’ve been successful once I’ve been given enough time to go through the details. When it comes to LEV, on the other hand, the reception to my proposals can best be described as blank incomprehension. This is not too surprising, in hindsight, because the LEV concept is even further distant from the sort of scientific thinking that my colleagues normally do than my other ideas are: it’s not only an area of science that’s distant from mainstream gerontology, it’s not even science at all in the strict sense, but rather the history of technology. But I regard that as no excuse. The fact is, the history of technology is evidence, just like any other evidence, and scientists have no right to ignore it. Another big reason for my colleagues’ resistance to the LEV concept is, of course, that if I’m seen to be right that achievement of LEV is foreseeable, they can no longer go around saying that they’re working on postponing aging by a decade or two but no more. As I outlined in Chapter 13, there is an intense fear within the senior gerontology community of being seen as having anything to do with radical life extension, with all the uncertainties that it will surely herald. They want nothing to do with such talk. You might think that my reaction to this would be to focus on the short term: to avoid antagonising my colleagues with the LEV concept and its implications of four-digit lifespans, in favour of increased emphasis on the fine details of getting the SENS strands to work in a first-generation form. But this is not an option for me, for one very simple and incontrovertible reason: I’m in this business to save lives. In order to maximise the number of lives saved—healthy years added to people’s lives, if you’d prefer a more precise measure—I need to address the whole picture. And that means ensuring that you, dear reader—the general public—appreciate the importance of this work enough to motivate its funding. Now, your first thought may be: hang on, if indefinite life extension is so unpalatable, wouldn’t funding be attracted more easily by keeping quiet about it? Well, no—and for a pretty good reason. The world’s richest man, Bill Gates, set up a foundation a few years ago whose primary mission is to address health issues in the developing world.2 This is a massively valuable humanitarian effort, which I wholeheartedly support, even though it doesn’t directly help SENS at all. I’m not the only person who supports it, either: in 2006 the world’s second richest man, Warren Buffett, committed a large proportion of his fortune to be donated in annual increments to the Gates Foundation.3 The eagerness of extremely wealthy individuals to contribute to world health is, in more general terms, an enormous boost for SENS. This is mainly because a rising tide raises all boats: once it has become acceptable (even meritorious) among that community to be seen as a large-scale health philanthropist, those with “only” a billion or two to their name will be keener to join the trend than if it is seen as a crazy way to spend your hard-earned money. But there’s a catch. That logic only works if the moral status of SENS is seen to compare with that of the efforts that are now being funded so well. And that’s where LEV makes all the difference. SENS therapies will be expensive to develop and expensive to administer, at least at first. Let’s consider how the prospect of spending all that money might be received if the ultimate benefit would be only to add a couple of decades to the lives of people who are already living longer than most in the developing world, after which those people would suffer the same duration of functional decline that they do now. It’s not exactly the world’s most morally imperative action, is it? Indeed, I would go so far as to say that, if I were in control of a few billion dollars, I would be quite hesitant to spend it on such a marginal improvement in the overall quality and quantity of life of those who are already doing better in that respect than most, when the alternative exists of making a similar or greater improvement to the quality and quantity of life of the world’s less fortunate inhabitants. The LEV concept doesn’t make much difference in the short term to who would benefit from these therapies, of course: it will necessarily be those who currently die of aging, so in the first instance it will predominantly be those in wealthy nations. But there is a very widespread appreciation in the industrialised world—an appreciation that, I feel, extends to the wealthy sectors of society—that progress in the long term relies on aiming high, and in particular that the moral imperative to help those at the rear of the field to catch up is balanced by the moral imperative to maximise the average rate of progress across the whole population, which initially means helping those who are already ahead. The fact that SENS is likely to lead to LEV means that developing SENS gives a huge boost to the quality and quantity of life of whomever receives it: so huge, in fact, that there is no problem justifying it in comparison the alternative uses to which a similar sum of money might be put. The fact that lifespan is extended indefinitely rather than by only a couple of decades is only part of the difference that LEV makes, of course: arguably an even more important difference in terms of the benefit that SENS gives is that the whole of that life will be youthful, right up until a beneficiary mistimes the speed of an oncoming truck. The average quality of life, therefore, will rise much more than if all that was in prospect were a shift from (say) 7:1 to 9:1 in the ratio of healthy life to frail life. Quantifying longevity escape velocity more precisely This chapter has, I hope, closed down the remaining escape routes that might still have remained for those still seeking ways to defend a rejection of the SENS agenda. I have shown that SENS can be functionally equivalent to a way to eliminate aging completely, even though in actual therapeutic terms it will only be able to postpone aging by a finite amount at any given moment in time. I’ve also shown that this makes it morally just as desirable— imperative, even—as the many efforts into which a large amount of private philanthropic funding is already being injected. I’m not complacent though: I know that people are quite ingenious when it comes to finding ways to avoid combating aging. Thus, in order to keep a few steps ahead, I have recently embarked on a collaboration with a stupendous programmer and futurist named Chris Phoenix, in which we are determining the precise degree of healthy life extension that one can expect from a given rate of progress in improving the SENS therapies. This is leading to a series of publications highlighting a variety of scenarios, but the short answer is that no wool has been pulled over your eyes above: the rate of progress we need to achieve starts out at roughly a doubling of the efficacy of the SENS therapies every 40 years and actually declines thereafter. By “doubling of efficacy” I mean a halving of the amount of damage that still cannot be repaired. So there you have it. We will almost certainly take centuries to reach the level of control over aging that we have over the aging of vintage cars—totally comprehensive, indefinite maintenance of full function—but because longevity escape velocity is not very fast, we will probably achieve something functionally equivalent within only a few decades from now, at the point where we have therapies giving middle-aged people 30 extra years of youthful life. I think we can call that the fountain of youth, don’t you? 1. I first used the phrase “escape velocity” in print in the paper arising from the second SENS workshop—de Grey ADNJ, Baynes JW, Berd D, Heward CB, Pawelec G, Stock G. Is human aging still mysterious enough to be left only to scientists? BioEssays 2002;24(7):667-676. My first thorough description of the concept, however, didn’t appear until two years later: de Grey ADNJ. Escape velocity: why the prospect of extreme human life extension matters now. PLoS Biology 2004;2(6):e187. 2. Gates disburses these funds through the Bill and Melinda Gates Foundation, http://www.gatesfoundation.org 3. Buffett’s decision to donate most of his wealth to the Gates Foundation was announced in June 2006 and is the largest act of charitable giving in United States history. © 2007 Aubrey de Grey Ending Aging by Aubrey de Grey with Michael Rae, St. Martin’s Press, Sept. 4, 2007, ISBN: 0312367066 - Publisher Topics: Biomed/Longevity Tweet October 25, 2011 by DavidK Both men and women now are very aware of the fact that one certainly goes to the ageing process and aware too that there are a lot of products that is anti-ageing. The market for this product is very wide and a profitable one coupled with balanced diet, healthy living, exercise, happy disposition and avoid drinking to a great degree as Tampa Car Accident Lawyer says so. Log in to Reply September 7, 2011 by LancasterT Very interesting analysis of a complicated issue. We’re quite interested in in learning more about this if you can provide some up to date information. Real HCG Log in to Reply July 5, 2010 by eric25001 3 diet news items help go beyond caloric restriction to a liveable and doable diet that increases life quality and quantity. 1) Lower protein to about 45 grams at age 60 (Low protein fly study) also mice and rats http://www.plosbiology.org/article/info:doi/10.1371/journal.pbio.00302232) 2) Use Mannoheptose (7 carbon sugae) for 5% of calories (Rat study) http://en.wikipedia.org/wiki/Mannoheptulose and 3) use glycerine (C3H8O3) for carbs Yeast study http://www.eurekalert.org/pub_releases/2009-05/plos-gtg050509.php

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ChemotherapyMultiple MyelomaPain Common Treatments for Cancer AcupunctureChemotherapyProchlorperazineRadiation Therapy Popular Recipes for Cancer Pork, White Bean & Kale SoupChicken Cutlets With Grape-Shallot SauceCurried Sweet Potatoes Immune-system therapy shows promise in adults with leukemia Study finds no constipation, colon cancer link Statins tied to lowered liver cancer risk with hep C COLUMN: Help with end-of-life talks NEW YORK (Reuters) - An experimental therapy that tweaks cancer patients' own immune cells to recognize an often-deadly form of leukemia has shrunk tumors and sent the cancer into remission in adults, according to a U.S. study published on Wednesday.Although a similar immune-system approach has shown promise in children with this cancer as well as in adults with a related form of leukemia, it is the first time this particular therapy has worked in adults.Scientists said the finding, which was based on a study of five adults, had "life-saving potential." The study was published in the journal Science Translational Medicine.The experimental therapy targeted acute lymphoblastic leukemia (ALL), a blood-cell cancer that often proves resistant to chemotherapy and can kill in mere weeks. It is more common in children but especially deadly when it occurs in adults.Although current treatments cure an estimated 80 percent to 90 percent of children with ALL, they are effective in only 30 percent or fewer of adult cases, said Dr. Michel Sadelain of Memorial Sloan-Kettering Cancer Center in New York, co-leader of the study.Adults whose ALL has returned after being temporarily beaten back with chemotherapy, Sadelain and his colleagues wrote, "have a dismal prognosis."The study adds to the evidence that harnessing the immune system to destroy tumors could turn back many cancers.For instance, a therapeutic vaccine against deadly melanoma, called Yervoy and manufactured by Bristol-Myers Squibb, was approved in 2011, and scores of other immune-system-based drugs to treat cancer are in the pipeline. IMS Health has estimated that global sales of immune-based oncology drugs could reach $75 billion by 2015.In the new study, scientists started with their patients' T cells, a form of white blood cell. These foot soldiers of the immune system make a beeline for both viruses and cancer cells, which sport molecules that act like homing beacons to attract the T cells.Normal T cells find and attack only invaders studded with homing beacons they're able to recognize. That's why the immune system does not sweep out all cancers, let alone viruses such as HIV: T cells have not been trained to detect their beacons.The scientists therefore re-trained the T cells to do so.After extracting T cells from patients with ALL, a process that takes a few hours, the scientists mixed them with a harmless virus that inserted genes for a three-part molecule: one part that trains T cells to recognize homing beacons on the leukemic cells, called CD19; one part that instructs T cells to kill any such cells they find; and one part that makes T cells survive longer than usual.After 10 to 12 days, the T cells were now genetically-engineered to detect those beacons. The cells were then returned to their five patients, aged 23, 58, 56, 59 and 66."The T cells are living drugs," said Sadelain. "They see the CD19, they kill the cancer cells, and they persist in the body."Four of the patients' leukemia became undetectable in 18 to 59 days. One patient achieved the remission eight days after treatment - a dramatic result considering that several of the patients had bone marrow "chock full of leukemia," Sadelain said.But the treatment wasn't always easy on patients. After one got back his genetically-engineered T cells, he developed a 105 degree fever as the T cells ignited what's called a cytokine storm, in which cytokines - hormones - are produced in vast quantities, leading to plummeting blood pressure and spiking fever. A second patient also suffered this cytokine storm, but in both cases it was managed with steroids.The researchers are raising funds for a larger study, with 50 patients or more, at Sloan-Kettering as well as other cancer centers, including the Dana-Farber Cancer Institute in Boston.They already have successfully treated three additional patients beyond the five described in the paper, Dr. Renier Brentjens of Sloan-Kettering said, and suspect they might get even better results if they began treatment earlier in the disease.SOURCE: http://bit.ly/za7iqw Science Translational Medicine, March 20, 2013.

医学

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HomeNewsPsychological Services Center to Hold Free, Public Anxiety Screenings Psychological Services Center to Hold Free, Public Anxiety Screenings The Psychological Services Center at Marywood University will be holding a free "Anxiety Screening Day" on Thursday, February 2, from 10 a.m. to 6 p.m. at the McGowan Center. Members of the community are welcome. The center will be administering free, confidential screenings that include an educational presentation, a written self-test, a private meeting with a mental health professional and a referral, if appropriate. Amanda Surace, doctoral student and co-organizer of the event, says the Psychological Services Center has been offering this service for more than 12 years, providing confidential and anonymous anxiety screenings to individuals of all ages. "Anxiety is very common," Surace said. "Often, people do not know where to go to get help, so this is an opportunity for people to get help." According to survey research published by the American Psychological Association, 22 percent of American adults reported an extreme level of stress in 2011. Common signs of anxiety are excessive and uncontrollable worrying, feelings of panic or nervousness, difficulty concentrating and difficulty sleeping. "I would like to see more education about anxiety," Surace said, when asked what she hopes to accomplish. "People aren't always aware of what the signs for anxiety are. It could be very debilitating." If you have any questions, please call (570) 348-6269 or visit the Psychological Services Center website.

医学

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March 2012, Gift brings personalized cancer therapy a step closer to reality When Roy S. Herbst, M.D., Ph.D., joined Yale as professor of medicine, associate director for translational research, and chief of medical oncology at Smilow Cancer Hospital at Yale-New Haven last March, his arrival was seen as an important step toward the vision Yale Cancer Center (YCC) Director Thomas J. Lynch, M.D., had begun articulating in 2009. That vision centers on “personalized” cancer treatment—therapy regimens tailored to individual patients’ tumors based on DNA sequencing of tissue biopsies. That vision is now closer to becoming a reality thanks to the generosity of David B. Heller, a grateful former patient of Herbst’s. Prior to joining Yale’s faculty, Herbst was professor and chief of the Section of Thoracic Medical Oncology at MD Anderson Cancer Center at the University of Texas in Houston. At MD Anderson, Herbst met Heller, a patient from Chicago, Ill., who had been diagnosed with lung cancer and referred to Herbst. “We got to know each other as I advised him on his care, helped him with his diagnosis, and talked about different protocols and treatments,” Herbst says. Although Herbst left MD Anderson and Heller continued his treatment at Northwestern University in Chicago, the two maintained a close relationship. Now through the Diane and David B. Heller Charitable Foundation, Heller and his wife, Diane, have made a $1 million gift to support Herbst’s efforts to advance translational research and cancer treatment at Yale. The gift will support efforts that Herbst, an expert in lung cancer research and clinical care, has been leading for some time. Over the last several years, Herbst has spearheaded clinical studies of many anticancer drugs. His work using erlotinib (Tarceva) in combination with bevacizumab (Avastin) was among the first to combine multiple targeted agents for non-small cell lung cancer (NSCLC). As co-principal investigator of the multifaceted Biomarker-Based Approaches of Targeted Therapy for Lung Cancer Elimination (BATTLE-1) trial, Herbst and his colleagues made significant advances in personalized therapy of NSCLC by using molecular analysis of tissue biopsies to determine the most appropriate targeted treatment available for each patient. The Heller Foundation’s new gift supports Herbst’s vision for building translational research at Yale, including an expansive National Cancer Institute (NCI)-funded BATTLE-2 trial, which Herbst designed. The trial’s objective is to further improve the efficacy of targeted therapies by identifying the NSCLC patients most likely to benefit from them. Herbst is committed to promoting similar studies initiated by Yale investigators, and has recently supported translational research collaborations among groups of three or more faculty members—including basic and clinical scientists, and junior and senior investigators—through an internal award mechanism called T-TARE (Translational-Targeted Area of Research Excellence). Out of seven applications received, four were awarded seed funds to strengthen the collaboration and facilitate the submission of new multi-investigator grant applications to the NCI. New translational research initiatives at Yale will be highly collaborative, drawing on Yale’s strengths in anticancer drug design and genome analysis and integrating resources at the Yale Center for Genome Analysis and the new Cancer Biology Institute on Yale’s West Campus. In addition to launching BATTLE-2 and other similar translational research programs, the Hellers’ gift will enable Herbst and colleagues to build an infrastructure that will benefit similar studies of other forms of cancer. The BATTLE-2 trial and other future translational research initiatives will be conducted under the auspices of YCC’s new Translational Research Program, which opened last fall under the leadership of Herbst and Julie L. Boyer, Ph.D., associate director for translational research administration at YCC. Peter (Ja Seok) Koo, Ph.D., associate professor of medical oncology, was also recruited to this effort at Yale from MD Anderson in October. “By facilitating the expansion of our molecular profiling capacity, this gift allows us to develop an innovative translational medicine program under Dr. Herbst’s leadership,” says Lynch, the Richard Sackler and Jonathan Sackler Professor of Medicine. “Ultimately, we want to use molecular profiling to help guide every patient’s treatment.” The founder of the Chicago-based investment management firm Advisory Research, Inc., Heller is himself a beneficiary of genetic screening and personalized medicine. He is also, he takes care to point out, a Harvard man. “I went to Harvard on a scholarship. I never had any money, [and] I got very lucky in life.” The Heller Foundation has a long track record of philanthropy, particularly for academic medicine and scholarships benefiting students from lower-income families. “What greater gift could any human being have than to be able to help other people?” asks Heller. “My wife Diane and I are thrilled that we’re in a position to be helpful to Dr. Herbst and Yale.” David J. Leffell, M.D., the David Paige Smith Professor of Dermatology, professor of surgery, and deputy dean for clinical affairs, says, “True progress in translational research, which will have a direct impact on our ability to cure disease, depends on the generosity of people like the Hellers. Only with the support of grateful patients and their families can we truly leverage our research and clinical strength to create new breakthroughs.” Herbst says, “This is a truly special gift from a man for whom I have enormous respect. I am thankful for the Hellers’ investment in our plans, and I am especially grateful for their astute appreciation of the importance of flexible support in building translational research programs like this at Yale.” (From left) Roy Herbst, pictured with colleagues Peter Koo, Daniel Morgensztern, and Julie Boyer, is spearheading efforts in personalized treatments for cancer. (Photo by Terry Dagradi) Roy Herbst, MD, PhD Thomas Lynch, MD David Leffell, MD To honor his mother and fight melanoma, a rower shows his mettle Brothers follow parents’ example to help fight cancer New Cancer Center head: ‘aspire to cure cancers’ Yale Cancer Center benefits doubly from generosity Tiny particle a big step in cancer gene therapy

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Next Organ Donations: Socialism or Laissez-Faire? by Adam Young Also by Adam Young Loni Wells is desperately ill. The 20-year-old Canadian is among the nearly 3,000 Canadians who require a kidney transplant each year. Suffering from a rare kidney disease called Focal Membrano Proliferative Glomerionephritis (MPGN), Loni required 8 ½ hours of dialysis every day after her kidney's failed completely in February 2000, and later haemodialysis treatments directly to her heart. Because of her kidney disease, Loni suffers from low blood pressure and risks heart failure. She has been diagnosed with osteodystrophy, which is similar to osteoporosis and her body is no longer able to metabolize calcium. Loni requires constant medication, suffers from terrible headaches, has difficulty sleeping because of these and other aches and pains, and her body has difficulty manufacturing red blood cells. Loni Wells suffers like this because of government policy. A misguided and shortsighted policy shared by both Canada and the United States. While nearly 3,000 Canadians languish on government waiting lists for a kidney transplant, where the wait typically stretches for 2 to 5 years, only about 1,100 receive transplants each year. The only option for Loni, her family concluded, was to find a living donor outside her family. Loni's father came up with the idea of creating a website to tell Loni's story and appeal to donors. Over the course of a few days, more than 60,000 people visited the site. And surprisingly 36 complete strangers, motivated by Loni's plight, some from as far away as Florida, offered to fly to Edmonton and give her one of their kidneys. But once these potential matches contacted the local branch office of the Stalinist medical system in Canada, their benevolence was brushed away. Canadian law, like U.S. law, bans the buying or selling of human organs, but doesn't specifically address donations by complete strangers. The transplant monopoly, however, insists living donors be either family or close friends. "There has to be an emotional bond, a close relationship to proceed to any further steps," explained Ed Greenberg of Capital Health in Edmonton. And Loni continues to suffer. "Oh, it crushes my spirit, it makes me mad," said Wells. "Every day I have to get up and I don't feel good, and I'm not eating. Dialysis takes this big chunk out of my life." The problem is that in Canada only the spouse or another family member could successfully donate organs. The government defends this rationing policy by arguing that donors face health and psychological problems and the uncertainty regarding the motivations of organ donors/sellers would place an ethical burden on the standards of health professionals. However, in the past ten years, due to the continuing shortage of organs caused by the state's rationing policy, it became possible for close friends to donate organs. But even then, local government boards of health evaluate the friend to determine if he or she meets the definition of a close friend out of a misplaced fear that this situation could generate discrimination or abuses. It's believed that certain people could be motivated to give because they're touched by the age of the patient, his or her place in society or even physical attractiveness or other "unearned" benefits. A common concern among defenders of the rationing plan is that allowing living donations would open the door to queue-jumping and short-circuiting the waiting list, thereby allowing Loni or anyone else to obtain a kidney or other organ ahead of more needy recipients. But is it ethical to deny a young woman a kidney when she and potentially others through her family’s efforts could readily attain one? How is it ethical to continue to endanger her health and life and prolong her misery? The fear is that laissez-faire with organs would allow the strong to prey on the weak, a myth a professor interviewed by the CBC raised again: "The concern has always been a subtle form of coercion might exist," said Prof. Tim Caulfield, research director of the Health Law Institute at the University of Alberta. But what of the subtle coercion that exists on family members who feel obligated to donate an organ out of familial duty rather than genuine charity? Why is that coercion not as insidious as what is presumed to exist, but of course does not, in market transactions? However, it appears that Loni's unique appeal for help may be a crack in the foundation of the cartelization and monopolization of organ donation. A transplant surgeon, Dr. Philip Belitski, openly questioned the lack of living donor opportunities. "As the need increases, it's apparent the need will not be filled by donation from non-living people." "We need to look more seriously and widely at the potential for living donation," added the chair of the Canadian Council on Donation and Transplantation, in Halifax. And as the CBC reports, as kidney transplants have become safer for both donor and recipient, studies suggests more people are willing to give a kidney to a complete stranger. Surely then, the next step is to coordinate supply and demand, to connect buyers with sellers, through the superior medium of market prices, rather than the current method of Soviet-style bureaucracy. Luckily for Loni, she has found a relative who has so far cleared the early testing for compatibility. And the Wells family is forming the Wellspring Foundation, an organization that will take the lead in forming and will push for the creation of a federal living donor registry of individuals willing to give organs to complete strangers. In time, perhaps the market will take over to the benefit of both donors and recipients. Adam Young writes from Ontario, Canada. Send him MAIL, and see his Mises.org Articles Archive. View Author Archive Adam Young is a freelance Austrolibertarian writer and reviewer. He lives in Canada. Send him mail.

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Home Opinions Increased cancer research funding is vital to Victoria’s scientific reputation 23 April 2012 Professor Neil Watkins By Professor Neil Watkins If Victoria does not increase our cancer research support, we stand to lose our competitive edge in the industry within the next five years. Within the next few months the Victorian Government is set to announce the next round of Victorian Cancer Agency (VCA) Funding. The VCA is a funding agency developed by the Victorian Government to facilitate cancer research in Victoria, and to foster the rapid translation of research findings into clinical practice. Each year it provides grants to researchers to support this strategy. If the VCA grants are not renewed, and in fact funded to a higher level, we will lose our competitive advantage because there simply won’t be enough money to sustain the level of excellence we’ve achieved here in Victoria over the past 20 years. There is an expectation that Victoria will remain the number one centre for cancer research in Australia, but this is largely historical. We now face a challenge: New South Wales and Queensland are both outspending us in cancer research five to six times over. As a result, our top scientists and researchers are being enticed to move their work to laboratories interstate. Victorian cancer researchers successfully obtain nationally competitive grant support that results in published work in prestigious journals, but this will not continue if Victoria is out-bid by philanthropists and competing state governments who rightly see this is an intellectual investment in their future. Of course, VCA funding is not the only cancer research funding available; there are also major grants provided by the National Health and Medical Research Council (NHMRC). However, NHMRC funding barely covers the cost of the research, and we cannot rely on the Federal Government to increase support for medical research in the current economic environment. Even more challenging is the fact that the NHMRC does not fund the huge infrastructure costs associated with medical research. These costs include supporting buildings and equipment, and the added costs for employing professional staff such as superannuation and insurance. What the VCA funds allow us to do is initiate our own independent trials with our own therapeutic development rather than relying on a drug company to finance them. They allow us to support our own researchers to conduct independent research and they bridge the gap between discovery and the large-scale clinical trials that are funded by pharmaceutical companies. VCA funding also promotes collaboration, encouraging groups from all over of Victoria to work together on shared interests. This prevents duplication and waste; it helps consolidate resources in a way that ultimately saves money. It also helps support the crucial steps in taking locally developed technologies and treatments to the clinic. This recognised as a key area that is not supported by the NHMRC.In this way, a VCA grant is a stepping stone to much larger projects, projects which will come to Victoria rather than other states. Monash Institute of Medical Research has two leading innovative therapeutic treatments receiving vital funding which would never have been developed without VCA support. As a result of our research, Victorians will soon see a world-first clinical trial in osteosarcoma, one of the most common forms of bone cancer, at the Peter Mac our partner in this collaboration. This work has been possible because of a VCA grant of $3.8 million over four years. Late last year, as a result of a $3.5 million VCA grant over three years, our research into lung cancer was published in Nature Medicine. This prestigious international journal published our discovery of a mechanism that causes an aggressive type of lung cancer to re-grow following chemotherapy, a finding which offers hope for new therapies. Being at the forefront of science, technology and treatment brings with it investment, educational benefits, workforce development, private investment and international reputation to the state. All of these are at risk if we don’t maintain our competitive edge in Victoria. Cancer research is high-tech and expensive - it requires private sector money to succeed. The only way Victorian researchers will attract the attention of the private sector is we stay number one in Australia. This will not happen without this basic but very important funding. Neil Watkins is Professor of Cancer Biology at the Monash Institute of Medical Research. Previously, he ran a research laboratory at the Kimmel Cancer Centre at John Hopkins University in Baltimore. Medicine, Nursing and Health Sciences Neil Watkins Victorian Cancer Agency MIMR Search for a Monash expert Use our searchable database to find expert media comment. Search Expertline Art Design and Architecture Select more... Academy of Performing Arts Around Monash Art, Design and Architecture Industry Engagement and Commercialisation Monash Sport Monash University Museum of Art Monash Warwick Alliance Authors in conversation - Professor John Rickard, brought to you by Monash University Publishing 24 October, 2014 from 3:00 pm — 4:00 pm 2014 Faculty of Education Conference: Equity and Access in Australian Education 31 October, 2014 from 8:00 am — 4:00 pm Book Launch: Maestro John Monash by Tim Fischer 10 November, 2014 from 6:00 pm — 9:00 pm Event Calendar Leading judge takes out top distinguished alumni award Diabetes in the Asia Pacific region Fellowships honour exceptional citizens World leading researchers recognised Effective gambling regulation is not just ‘red tape’ News administration Authorised by: Director, Office of Marketing and Communications. Maintained by: eSolutions ServiceDesk. Last updated: 06 March 2014. Copyright © 2014 Monash University. 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Abby Johnson: Only Modern Pro-Life Women’s Centers Can Beat Planned Parenthood The former abortion business director says that comprehensive pro-life women’s medical centers are the best way to drive Planned Parenthood out of business. BY PETER JESSERER SMITH Posted 2/19/14 at 10:14 AM COLLEGE STATION, Texas — If the pro-life movement wants to shut down Planned Parenthood, it has to compete utilizing the very thing Planned Parenthood fears the most: modern pro-life women’s centers. So says Abby Johnson, the former Planned Parenthood-director-turned-pro-life-advocate, who has a vision for how the pro-life movement can take down the largest abortion and family-planning provider in America: by offering women more services, both life-affirming and better quality. In this interview with the Register, Johnson draws on her insider knowledge of Planned Parenthood and says the pro-life movement has an opportunity to exploit the Achilles’ heel of Planned Parenthood’s business model. By modernizing crisis-pregnancy centers into pro-life medical centers that serve the health-care needs of low-income women even before they face a crisis pregnancy, she says pro-lifers can establish strong relationships so that women never think of walking into a Planned Parenthood facility. Planned Parenthood’s annual financial report for 2012 shows that the vast majority of its clients seek out other services before they opt for its abortion business. Planned Parenthood’s affiliates collected more than $1 billion in revenue in 2012, but its leading services were 4.5 million STD/STI tests and treatments (41% of services), followed next by contraception (34% or 3.7 million services, 1.6 million of these for emergency contraception). It logged in 1.2 million cancer screenings and 1.2 million pregnancy tests. Abortion is listed as only 3% of Planned Parenthood’s reported services, but it is the most profitable: The 327,166 unborn children aborted are estimated to account for nearly $150 million in revenue. Since leaving Planned Parenthood, Johnson has been helping people out of the abortion industry with her ministry And Then There Were None, and she is now the president of the newly formed board of directors for the Brazos Valley Guiding Star Center, which will open this year to offer comprehensive pro-life women’s services. In keeping with Pope Francis’ comments regarding abortion in Evangelii Gaudium (The Joy of the Gospel), relating to how the Church needs to do much more to “adequately accompany women in very difficult situations,” Johnson believes that putting pregnancy centers on the path to become modern medical centers that can drive Planned Parenthood out of business is exactly how the Church and the pro-life movement can respond to the Holy Father’s call. Abby, what would a first-class crisis-pregnancy center ideally look like if it’s going to compete with Planned Parenthood, which, for many women, is the biggest game in town? It would look like a professional medical facility. You have nursing staff there, a nurse practitioner or a mid-level clinician tha

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Bookmark & Share Delicious National Institute on Drug Abuse (NIDA) For Immediate Release NIDA Press Office 301-443-6245 Studies on combat related substance use and abuse to be funded by NIH and VA Innovative federal partnership should yield important findings about returning military personnel Eleven research institutions in 11 states will receive more than $6 million in federal funding from fiscal year 2010 to support research on substance abuse and associated problems among U.S. military personnel, veterans, and their families. The National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, is collaborating with the Department of Veterans Affairs, to award grants that will examine substance abuse related to deployment and combat related trauma. The National Institute on Alcohol Abuse and Alcoholism (NIAAA), and the National Cancer Institute (NCI) are also NIH partners in this endeavor. NIH is awarding more than $4 million in grant funding; the VA, around $2 million. The funding opportunity announcement, released last July, solicited applications on the causes, screening, identification, prevention, and treatment of substance use and abuse — including alcohol, tobacco, illicit and prescription drugs and associated problems. Institutions that are receiving awards are Brandeis University, Waltham, Mass.; Dartmouth College, Hanover, N. H.; the Medical University of South Carolina, Charleston; the National Development and Research Institutes, New York City; the University of California, San Francisco; the University of Minnesota, Twin Cities; The University of Missouri, Columbia; and VA Medical Centers in West Haven, Philadelphia, Little Rock and Seattle. Most of the research is directed at substance abuse and related conditions experienced by veterans returning from wars in Iraq and Afghanistan. There is a growing awareness that military personnel returning from these prolonged conflicts have a variety of serious problems, including depression, anxiety, sleep disturbances, and substance abuse. Some face these and other diverse symptoms as a result of traumatic brain injury or post traumatic stress disorder related to battle experiences. Many of these conditions are interconnected, and contribute to individual health and family relationship crises. There has been little research on how to prevent and treat unique characteristics of these wartime-related issues. Several projects will look at treatment seeking patterns — why and when veterans ask for help, and why many don't. Scientists will explore treatment strategies, including cognitive behavioral therapy and Web-based approaches as well as the most effective therapies for soldiers who have co-occurring disorders, such as depression and substance abuse. Researchers will also determine if early intervention, within two months of returning from war, can improve outcomes. The research will examine the high rate of smoking among returning military personnel. "Smoking prevalence in the military, especially among men aged 18 to 25 years, is nearly double that of the civilian population," said Cathy Backinger, Ph.D., chief of NCI�s Tobacco Control Research Branch. "NCI research funded under this initiative, looking at reducing smoking by military personnel, will go a long way toward helping service members avoid developing lung cancer and the many other diseases caused by smoking. " In addition, some of the newly funded research projects will examine how veterans attempt to reintegrate into their work and family lives after experiencing war conditions. "These research projects will give us important information about the ways that combat stress and substance abuse affect returning military personnel and their families, " said NIDA Director Dr. Nora D. Volkow. "This knowledge will be used to improve our prevention and treatment approaches, which we hope will reduce the burden of combat-related trauma. Working cooperatively with the VA and other partners will help in finding solutions for this shared concern. " "The Department of Veterans Affairs has a commitment to meet the full range of our veterans� physical and mental health care needs, and that includes addressing substance abuse, " said Dr. Joel Kupersmith, chief research and development officer for VA. "This coordinated research effort is one more way we are turning that commitment into action. " "NIAAA-supported research has documented a significant association between combat deployment of U.S. military personnel to Iraq and Afghanistan and the onset of alcohol problems upon their return to the U.S.," notes NIAAA Acting Director Kenneth R. Warren, Ph.D. "We hope that by developing new strategies to prevent and treat alcohol abuse among returning servicemen and women, these new research projects will improve the lives of military families. " The July 2009 Funding Announcement press release can be found at http://drugabuse.gov/newsroom/09/NR7-30.html. A complete listing of grants can be found below. The National Institute on Drug Abuse is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world's research on the health aspects of drug abuse and addiction. The Institute carries out a large variety of programs to inform policy and improve practice. Fact sheets on the health effects of drugs of abuse and information on NIDA research and other activities can be found on the NIDA home page at www.drugabuse.gov. To order publications in English or Spanish, call NIDA's new DrugPubs research dissemination center at 1-877-NIDA-NIH or 240-645-0228 (TDD) or fax or email requests to 240-645-0227 or drugpubs@nida.nih.gov. Online ordering is available at drugpubs.drugabuse.gov. The National Institute on Alcohol Abuse and Alcoholism, part of the NIH, is the primary U.S. agency for conducting and supporting research on the causes, consequences, prevention, and treatment of alcohol abuse, alcoholism, and alcohol problems, and disseminates research findings to general, professional, and academic audiences. Additional alcohol research information and publications are available at www.niaaa.nih.gov. NCI leads the National Cancer Program and the NIH effort to dramatically reduce the burden of cancer and improve the lives of cancer patients and their families, through research into prevention and cancer biology, the development of new interventions, and the training and mentoring of new researchers. For more information about cancer, please visit the NCI Web site at http://www.cancer.gov or call NCI's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237). The Department of Veterans Affairs (VA) - VA's Office of Research and Development (ORD) aspires to discover knowledge, develop VA researchers and health care leaders, and create innovations that advance health care for our veterans and the nation. For more information about VA Research: http://www.research.va.gov. Complete List of Military Research Grants: National Institute on Drug Abuse: (NIDA Press Office: 301-443-6245) Use and Abuse of Prescription Opioids Among Operation Enduring Freedom/Operation Iraqi Freedom Veterans/ University of Arkansas for Medical Sciences at Little Rock Integrated Treatment of Operation Enduring Freedom/Operation Iraqi Freedom Veterans with Post Traumatic Stress Disorder and Substance Use Disorders/Medical University of South Carolina First Longitudinal Study of Missed Treatment Opportunities Using DOD and VA Data/Brandeis University Integrated Cognitive Behavioral Therapy for Co-Occurring Post Traumatic Stress Disorder and Substance Use Disorders/Dartmouth College Effectiveness of a Web-enhanced Parenting Program for Military Families/University of Minnesota, Twin Cities National Institute on Alcohol Abuse and Alcoholism: (NIAAA Press Office: 301-443-3860) Stress-induced Drinking in Operation Enduring Freedom/Operation Iraqi Freedom Veterans: The Role of Combat History and PTSD/Medical University of South Carolina Veteran Reintegration, Mental Health and Substance Use in the Inner-City/ National Development and Research Institutes, New York City Web-based Cognitive Behavioral Therapy for Substance Misusing and Post Traumatic Stress Disorder Symptomatic in Operation Enduring Freedom/Operation Iraqi Freedom Veterans/ National Development and Research Institutes, New York City Personalized Drinking Feedback Interventions for Operation Enduring Freedom/Operation Iraqi Freedom Veterans/University of Missouri, Columbia National Cancer Institute: (NCI Press Office: 301-496-6641) Enhancing Civilian Support for Military Tobacco Control/University of California San Francisco and The National Development and Research Institutes, Inc. U.S. Department of Veterans Affairs: (VA Press Office: 202-461-7600) Gender Differences in Post-deployment Addictive Behaviors Among Returning Veterans/Va Medical Center, West Haven, Conn. An Ethnographic Study of Post-Deployment Substance Abuse and Treatment Seeking/Va Medical Center, Little Rock, Ark. Tobacco Use and Alcohol Misuse among Participants of the Millennium Cohort Study/ Va Medical Center, Seattle Integrated vs. Sequential Treatment for Post Traumatic Stress Disorder and Addiction Among Operation Enduring Freedom/Operation Iraqi Freedom Veterans/Va Medical Center, Philadelphia About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov. receive future NIH news releases.

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Home > Content Library of Adult English Medical Content > Non-Traumatic Emergencies Asthma Attacks What is asthma? Asthma is a chronic, inflammatory disease of the lungs in which the airways become sensitive to allergens (any substance that triggers an allergic reaction) and irritants (irritating things in the air). Several things happen to the airways when a person is exposed to certain triggers: The lining of the airways becomes swollen and inflamed. The muscles that surround the airways tighten. The production of mucus is increased, leading to mucus plugs. All of these factors will cause the airways to narrow, thus making it difficult for air to go in and out of your lungs, causing the symptoms of asthma. What are the symptoms of asthma? Asthma may resemble other respiratory problems, such as emphysema, bronchitis, and lower respiratory infections. It is often underdiagnosed and many people with the disease do not know they have it. Sometimes, the only symptom is a chronic cough, especially at night, or coughing or wheezing that occurs only with exercise. Some people think they have recurrent bronchitis, since respiratory infections usually settle in the chest in a person predisposed to asthma. What causes asthma? The exact cause of asthma is not completely known. It is believed to be partially inherited, but it also involves many other environmental, infectious, and chemical factors. After a person is exposed to a certain trigger, the body releases histamine and other agents that can cause inflammation in the airways. The body also releases other factors that can cause the muscles of the airways to tighten, or become smaller. There is also an increase in mucus production that may clog the airways. Some persons have exercise-induced asthma, which is caused by varying degrees of exercise. Symptoms can occur during, or shortly after, exercise. In some people, stress or strong emotions can trigger an asthma attack. Each person has different triggers that cause the asthma to worsen. You should discuss this with your doctor. The changes that occur in asthma are believed to happen in two phases: An immediate response to the trigger leads to swelling and narrowing of the airways. This makes it initially difficult to breathe. A later response, which can happen four to eight hours after the initial exposure to the allergen, leads to further inflammation of the airways and obstruction of airflow. What is a risk factor? A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, diet, family history, or many other things. Different diseases have different risk factors. Although these factors can increase a person's risk, they do not necessarily cause the disease. For example, some people with one or more risk factors never develop cancer, while others develop cancer and have no known risk factors. Knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and being clinically monitored for the disease. What are the risk factors for an asthma attack? Although anyone may have an asthma attack, it most commonly occurs in the following persons: Children and adolescents ages 5 to17 Adults older than 65 People living in urban communities Other factors include the following: Family history of asthma Personal medical history of allergies Children most susceptible to asthma attacks include the following: Children with a family history of asthma Children who have allergies Children who have exposure to secondhand tobacco smoke What happens during an asthma attack or asthma exacerbation? Persons with asthma have acute episodes when the air passages in their lungs become narrower, and breathing becomes more difficult. These problems are caused by an over-sensitivity of the lungs and airways. The lungs and airways overreact to certain triggers causing: The lining of the airways to become inflamed and swollen. Tightening of the muscles that surround the airways. An increased production of mucus. Breathing becomes harder and may hurt. Talking and sleeping may be difficult. There may be coughing sometimes with mucus. There may be a wheezing or whistling sound, which is typical of asthma. Wheezing occurs because of the rush of air which moves through the narrowed airways. How is asthma diagnosed? To diagnose asthma and distinguish it from other lung disorders, doctors rely on a combination of medical history, physical examination, and laboratory tests, which may include the following: Spirometry. A spirometer is a device used by your doctor that assesses lung function. Spirometry is the evaluation of lung function with a spirometer. The test is performed by blowing as hard as possible into a tube connected to a small machine (a spirometer) that measures the amount of air breathed out and in as well as the speed it is breathed out.. This is one of the simplest, most common pulmonary function tests and may be necessary for any or all of the following reasons: To determine how well the lungs receive, hold, and utilize air To monitor a lung disease To monitor the effectiveness of treatment To determine the severity of a lung disease To determine whether the lung disease is restrictive (decreased airflow) or obstructive (disruption of airflow) Peak flow monitoring (PFM). A device used to measure the fastest speed in which a person can blow air out of the lungs. To use a peak flow meter, a person takes a deep breath in and then blows as hard and fast as possible into a mouthpiece. During an asthma or other respiratory flare-up, the large airways in the lungs slowly begin to narrow. This will slow the speed of air leaving the lungs and can be measured by a PFM. This measurement is very important in evaluating how well or how poorly the disease is being controlled. Chest X-rays. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. Blood tests. These tests are used to analyze the amount of carbon dioxide and oxygen in the blood. Allergy tests What are the triggers that can cause an asthma attack? According to the CDC, the American Academy of Allergy, Asthma, and Immunology, and other organizations, triggers for asthma include the following: AllergensRespiratory infections and sinusitis Animal protein (dander, urine, oil from skin) House dust/dust mites Cockroach droppings Certain foods Infections can cause irritation of the airways, nose, throat, lungs, and sinuses, and worsens asthma. IrritantsSensitivity to medications Strong odors and sprays, such as perfumes, household cleaners, cooking fumes, paints, and varnishes Chemicals, such as coal, chalk dust, or talcum powder Air pollutants, such as tobacco smoke, wood smoke, chemicals in the air and ozone Changing weather conditions, including changes in temperature, barometric pressure, humidity, and strong winds Chemical exposure on the job, such as occupational vapors, dust, gases, or fumes. Medications, such as aspirin and additives, such as sulfites, cause up to 20 percent of adult asthmatic attacks as a result of sensitivities or allergies to them. These medications often include: Other nonsteroidal anti-inflammatory medications, such as ibuprofen, indomethacin, naproxen Sulfites used as preservatives in food and beverage Before taking any medication, including over-the-counter medications, consult your doctor. ExerciseGastroesophageal reflux Strenuous physical exercise can trigger an asthma attack, often because of the inhaled cool and dry air. Long-term strenuous activities, such as long distance running, are most likely to induce asthma, and swimming is the least likely. GERD, a condition characterized by persistent reflux of stomach acids, is common in individuals with asthma. Symptoms may include heartburn, belching, or spitting up in infants. SmokeEmotional anxiety and nervous stress Tobacco smoke, whether directly or passively inhaled, has been shown to worsen asthma. Wood smoke from wood-burning heating stoves and fireplaces can release irritating chemicals, such as sulfur dioxide. Reactions from stress and anxiety are considered to be more of an effect than a cause. They can cause fatigue, which may affect the immune system and, in turn, increase either asthma symptoms or bring on an attack. Clinical CurriculumSmoke/Car Exhaust InhalationEye Injury Asthma Cases on the UpswingHypothermiaPreventing Unintentional Injuries

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New York bans mercury in vaccines In Pharma | June 29 2005 In the US, the New York Senate last week passed that would prohibit the administration of any vaccine containing more than a trace amount of mercury to children under the age of three or pregnant women. Thimerosal, a preservative used in vaccines that contains 50 per cent ethyl mercury, has been used in vaccines for years as a preservative to help prevent life-threatening bacterial contamination. However, vaccine manufacturing technology has advanced in recent years, and it is no longer necessary to add preservatives containing mercury to vaccines, according to the bill’s sponsor, Sen Dean Skelos. "Childhood vaccinations have had a significant and measurable public health benefit," said Sen Skelos. "But with scientific uncertainty regarding the safety of the mercury-based preservative thimerosal to children, readily available alternatives and a consensus between the major federal health agencies that thimerosal use should be reduced or eliminated, we must err on the side of caution and end its use in New York State. The bill has now been passed on to Governor George Pataki for signature. Two other US states, California and Iowa, have already enacted legislation banning the use of more than a trace amount of thimerosal in vaccines. Similar legislation is pending in the states of Delaware, Florida, Maryland, Massachusetts, Minnesota, Missouri, Nevada, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Utah and Washington. Vaccine manufacturers say that as of 2000, vaccines recommended for use in children and infants have all been available in versions that contain no (‘thiomersal-free’) or only trace amounts (‘thiomersal preservative-free’) of the compound, with the exception of some multidose vials intended for use in the developing world. This is because where several doses are taken from the same container, thiomersal offers better protection from contamination than other preservatives such as 2-phenoxy ethanol, according to the World Health Organisation. Get Alex Jones and Paul Joseph Watson's books, ALL Alex's documentary films, films by other authors, audio interviews and special reports. Sign up at Prison Planet.tv - CLICK HERE. E MAIL THIS PAGE o Occult Elite | o Decadent Empire | o Nazi USA | o World Government | o Political Assassinations | o Geopolitics | o Miscellaneous

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More Protection for Baby As Kari Hyberston prepares for the birth of her second child, there’s plenty on her mind. The busy mom and bank branch manager walks through the room that will become a nursery in the beginning of June. So far, she’s painted the walls and has started stocking the closet with diapers and baby clothes, but there’s plenty left to be done. “You do your best to be prepared, but there’s only so much time,” the 33-year-old Sioux Falls woman says, holding up a tiny outfit in the room with newly bright blue walls. So when her doctor suggested a vaccine in the second trimester of her pregnancy that could protect both her and her coming baby from pertussis, also known as whooping cough, she had no hesitation. “There’s no time in my schedule for whooping cough,” Kari says. “Anything we can do to keep me and the baby healthy is good, as far as I’m concerned.” A risk to babies Newborns are at great risk for pertussis, a disease that causes extended fits of violent coughing, says Sanford obstetrician/gynecologist Pamela Ephgrave. Since the vaccine that prevents pertussis can’t be given to infants until they are a few months old, they are highly susceptible to the condition. If an infant contracts pertussis in the first few months of life, the disease can lead to severe infections, brain damage or even death. The disease has been on the rise in the United States with more and more cases being reported, Dr.Ephgrave said. “This is not something that you want your child to have,” she said. “There have been epidemics in recent years and even deaths with a number of children.” New recommendation It used to be common practice for doctors to wait to give new mothers the vaccine for tetanus, diphtheria and pertussis (Tdap) shortly after their baby’s birth, Dr. Ephgrave said. Studies now show that the Tdap vaccine is safe for both mother and baby to receive during pregnancy and also provides some immunity to pertussis to the infant in the first few weeks of birth. “The mother is able to pass along to the baby some of the antibodies she produces when she receives the vaccine,” Dr. Ephgrave said. “That way the baby even has some protection in the months before the baby’s shots start working.” Dr. Ephgrave recommends that all adults who will be around the baby be immunized. Fathers, grandparents and caregivers all should make sure that their vaccination for pertussis is up to date before the baby is born. “If you’re in close contact with the baby, you run the risk of spreading it,” the obstetrician said. “The TDAP is now considered safe for all people.” Getting protection As she looks around her soon-to-be nursery, Kari said she’s glad to know that her baby will be protected during those important first few months. At a time when she has plenty on her calendar, all she had to do was get a shot during one of her prenatal visits. She has other things on her agenda: buying a crib, planning for her maternity leave from work and figuring out how to fit her 11-year-old son’s basketball, football and baseball games into a family schedule with a newborn, she says. “When your child gets sick every plan you have stops and I don’t have time to stop,” Kari said. “I want to keep us all safe and not miss out on fun as a family.” Posted Date: May 2012 Expectant moms have a new way to protect their baby from whooping cough. Find out why one new mom opted to receive the pertussis vaccine during her pregnancy. Info & Alerts

医学

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New Tecumseth Optometry Clinic – Comprehensive Eye Care Tailored to You in Alliston McCarthy’s Abezee Driving School Better transit comes with price GO Train Aurora Banner Want better transit and less congestion in the GTA? Then be prepared to pay. That was one of the key messages GO Transit president Gary McNeil tried to hammer home during a roundtable discussion at the Newmarket Community Centre yesterday. About 50 people attended the Metrolinx-sponsored meeting to share their thoughts on the various projects included in the Big Move regional transportation plan and also express their views on the various proposals to pay for them. “No one wants to pay, I’m realistic about that, but we will have to pay if we want to improve our system,” Mr. McNeil told the audience. “That’s the sad reality.” During his opening remarks, he pointed to cities such as New York, London and Paris, among others, that employ various taxes, tolls and levies to fund their transportation systems on top of traditional fares. Transportation in the Greater Toronto and Hamilton area is predominantly funded through a combination of fares and municipal property taxes, he explained. The initial wave of projects in the Big Move plan cost a combined $16 billion and included funding for the Viva rapidways, Spadina Subway expansion into Vaughan and various GO Transit service improvements. The second wave is anticipated to cost $34 billion and includes money for the Yonge Subway extension into Richmond Hill, all-day, two-way GO train service and increased funding for roads, regional highways and walking and cycling infrastructure. “The Big Move is not just about transit; it’s about transportation,” Mr. McNeil said. “We need to improve our transit, yes, but we also need to improve our roads because both cars and buses use them.” While most of the projects included in the initial phase of the Big Move were largely funded by provincial dollars, that won’t likely be possible for round two, Mr. McNeil said, noting the province is nearing its debt ceiling. As such, Metrolinx will need to get creative and explore congestion charges, new corporate taxes, parking fees, road tolls and other revenue generators, just as the rest of the world has done, to pay for the next wave of projects, he said. Doing nothing isn’t an option, Mr. McNeil said, as the average commute time in the GTAH stands at 82 minutes and will only get worse with time. It’s already among the worst in North America, he continued. “If we don’t do something about this, the average commute will be 109 minutes,” Mr. McNeil said. “That’s like a movie, a bad movie, where you’re stuck in your car and you can’t get anywhere.” It’s estimated congestion costs the economy about $6 billion per year in lost time and productivity, according to figures presented by Metrolinx. That number is projected to double in 30 years unless something is done today. For people who are missing a tooth, an unattractive gap should actually be the least of your... Provincial program offers incentives to put Simcoe youth to work Are you young and unemployed? If so, then Tracks Employment Services in Simcoe County may be able... Simcoe County employment centre helps get your career on track Tracks Employment Services in Simcoe County is a one-stop resource for job seekers and employers... Engaging Our People McDonald’s is a company that values people. We show appreciation to our wonderful customers by...

医学

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Home > Skin Science > Physiology > Scleroderma Research Foundation Holds Event to Find Cure Best Practices in the Treatment of Hyperpigmentation Long-term Research Links Dairy and High-Sugar Foods to Acne The Biology Behind Eczema and Psoriasis Glycation and the Skin Vitamin C in Skin Care The 3 Stages of Hormonal Skin Care The Fitzpatrick Skin Type Classification Scale Promising New Vitiligo Treatment Offers Hope to Patients for Repigmentation Understanding Inflammation: The Root Cause of Skin Aging Dry vs. Dehydrated Skin: Causes and Treatments Scleroderma Research Foundation Holds Event to Find Cure Thanks to an eclectic and unique gathering of gifted and creative minds, new treatments for a rare autoimmune disease may be just a few short years away … Comedian Bob Saget, author of the new book Dirty Daddy, will host an evening of headlining music, comedy, food and wine at Cool Comedy—Hot Cuisine on Wednesday, April 23 in the Grand Ballroom of San Francisco's historic Palace Hotel. The event is a benefit for the Scleroderma Research Foundation (SRF), America's leading nonprofit investor in medical research to find a cure for the autoimmune disease scleroderma. The word "scleroderma" literally means "hard skin," but the disease is much more, often affecting the heart, lungs, kidneys and other internal organs with life-threatening consequences. In some cases, the joints and muscles are affected, resulting in severe pain and restricted mobility. Vascular damage due to scleroderma can result in the loss of fingers, toes and entire limbs. Saget, an SRF Board Member who lost his sister to scleroderma, will be joined in the fundraising effort by San Francisco radio personality Don Bleu, legendary comedians Dana Carvey and Jeff Garlin, and the Grammy Award-winning band, Train. Cool Comedy—Hot Cuisine is presented by Actelion, a Swiss-based pharmaceutical company specializing in products to help patients with pulmonary arterial hypertension (PAH), one of the most deadly complications of scleroderma. The event has raised more than $14 million to strengthen and accelerate the SRF's collaborative research program. SRF Board chairman, Luke Evnin, PhD, a scleroderma patient and managing partner at MPM Capital, a private equity firm that has invested more than $2.8 billion in life sciences, explains what the SRF's cooperative approach to research is making possible for talented scientists from leading institutions across the nation and around the world: "Our partnerships are helping to develop an understanding of how scleroderma begins, how it progresses and what can be done to slow, halt or reverse the disease process." "Cool Comedy—Hot Cuisine is the single most successful fundraising and awareness building event for scleroderma," says Evnin. The "Hot Cuisine" for the evening will be prepared by celebrity chefs/restaurateurs Susan Feniger, also an SRF Board member, and Mary Sue Milliken (Food Network's Too Hot Tamales and both Bravo Network Top Chef Masters). A five-course menu will feature popular dishes from their Latin inspired Border Grill Restaurants. "It has been an incredible year for scleroderma research and this event will ensure that progress continues for the benefit of patients everywhere," says Feniger. "I think we've given credibility to the old adage that laughter is the best medicine. And we've certainly shown that healthy doses of great food, wine and music are the perfect supplemental prescription." The success of Cool Comedy—Hot Cuisine events held in San Francisco, Los Angeles and New York (an inaugural Las Vegas event is scheduled for June 5, 2014) has raised considerable awareness for scleroderma and enabled the SRF to fund innovative research that is expected to bring new treatments that will prolong as well as improve quality of life for patients. Since its founding in 1987, the SRF has brought some of the brightest minds from academia and industry together in an effort to unravel the mysteries of this life-threatening illness that is estimated to affect one in every 4,000 Americans. The SRF funded two breakthrough discoveries with results published last year in Nature and Science; one linking scleroderma to cancer (and possibly opening the door to a broad new array of treatment possibilities) and the other showing that the disease's signature fibrosis—or scarring—can not only be stopped, but actually reversed in a laboratory setting. The event on April 23 will include a silent auction, cocktail reception, dinner and headlining entertainment. A live auction will feature unique experiences to include premium access to the 2014 Victoria's Secret Fashion Show and after-party in London and access to next month's season 13 American Idol finale and after-party. First-class airfare is provided by event sponsor Delta Air Lines. Other packages tied to the "Hot Cuisine" theme include celebrity chef internships and an in-home dinner prepared by Bravo Network's Top Chef Masters Traci Des Jardins and Mary Sue Milliken. Tickets for Cool Comedy—Hot Cuisine start at $500 and all contributions benefit the Scleroderma Research Foundation. Advance reservations are required. For more information, call 800-441-CURE or visit www.sclerodermaresearch.org. Geneticists Hunt for Scleroderma Triggersposted: November 4, 2009 Scleroderma Webinar to Educate on Diagnosis and Early Management posted: August 19, 2014 Researchers Search for New Treatments to Improve Lives of Scleroderma-sufferersposted: April 7, 2014 New Clues to Potential Treatments for Tissue Scarring in Sclerodermaposted: April 23, 2014 Researchers Find Master Skin Geneposted: April 6, 2009 Related Topics: Physiology

医学

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St. James University Hospital Science Study: New Virotherapy Cures Prostate Cancer In Mice by Erin Podolak June 21st, 2011 at 12:35 pm Finding a cure for cancer has been the mission of millions of scientists around the world. Significant breakthroughs have been made in developing treatments for cancer, and even some preventative measures have been developed like the HPV vaccine that guards against certain strains of the humanpapillomavirus, one of the few viral causes of cancer. But despite advances in immuno and virotherapy, there remains a need for an effective, easily produced, and easy to tolerate treatment for cancer. Researchers working in part at the Mayo Clinic in Rochester MN, and St. James University Hospital in Leeds, UK believe they have developed a new virotherapy with tremendous potential. Their method focuses on prostate cancer in mice, and while very successful it remains to be seen whether this therapy could be translated with the same effectiveness into humans.

医学

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Bariatric Surgery Program Health System > Bariatric Surgery Program > New study may explain how weight-loss surgery reverses ... Karen Finney, UC Davis Health System News Service Pat Bailey, UC Davis News Service Subscribe to the latest RSS news feeds. NEWS | March 23, 2010 New study may explain how weight-loss surgery reverses type 2 diabetes A team of researchers, led by a UC Davis veterinary endocrinologist, has shown for the first time that a surgical procedure in rats that is similar to bariatric surgery in humans can delay the onset of type 2 diabetes. The researchers also have identified biochemical changes caused by the surgeries that may be responsible for that delay.Findings from the study, published online in the journal Gastroenterology, should help researchers identify strategies for preventing and treating type 2 diabetes, a chronic condition in which the body is unable to properly metabolize sugar and fat, leading to serious complications including heart disease, blindness and kidney failure.Type 2 diabetes affects more than 21 million people in the United States, where it results in more than $150 billion in direct and indirect annual costs, according to the National Institutes of Health.“Bariatric surgery currently is considered to be the most effective long-term treatment for human obesity and often leads to marked improvements in diabetes,” said the study’s lead author Peter Havel, a professor with joint appointments in the School of Veterinary Medicine and Department of Nutrition.“It has been thought that reduction of blood sugar, which indicates a reversal of type 2 diabetes, in patients following bariatric surgery was due to post-surgery weight loss,” Havel said. “This study, however, supports the observations from a number of earlier clinical studies reporting that diabetes is often improved prior to substantial weight loss. It also suggests that endocrine changes in hormones produced by the gastrointestinal tract may contribute to the early effects of bariatric surgery, in addition to the later effects of weight loss.”"This study confirms our clinical observations that metabolic regulation — specifically homeostasis of glucose — occurs quickly after gastric bypass surgery," said Mohamed Ali, an associate professor of gastrointestinal surgery and a specialist in bariatric surgery at UC Davis Health System. "It's clear from the outcome that something physiologic is at work with controlling diabetes that is not related to weight loss.“UC Davis has the perfect environment for collaboration between basic and clinical scientists to take this discovery to the next step, which is identifying the molecular signals that set these physiologic changes in motion," said Ali, who was not a participant in this study, but has collaborated with Havel on previous research.About bariatric surgery in humansIn severe cases of obesity — usually when the patient is 80 to 100 or more pounds overweight — bariatric surgery is used to alter or reconstruct the stomach and/or the intestinal tract. In such cases, obesity is not just a weight issue but also a life-threatening health problem that often leads to type 2 diabetes, heart disease and sleep apnea.There are several types of bariatric surgeries available in the United States. The most commonly performed surgical procedure, known as Roux-en-Y gastric bypass surgery, limits the amount of food the stomach can hold and reroutes the digestive tract, resulting in changes in intestinal function and hormones produced by the gastrointestinal tract.In 2008, about 220,000 people with severe obesity in the U.S. had bariatric surgery, according to the American Society for Metabolic and Bariatric Surgery.The new studyHavel and colleagues set out to test a hypothesis that certain bariatric surgical procedures were successful in improving type 2 diabetes, at least in part, because the procedures increased the flux of unabsorbed nutrients to the far end of the small intestine and, in doing so, triggered increased secretion of two hormones. Those hormones — glucagon-like peptide-1 (GLP-1) and peptide-YY (PYY) — are known to have a role in controlling food intake and improving insulin secretion and insulin sensitivity, thereby helping to stabilize blood sugar levels.To test the hypothesis, the researchers carried out a surgical procedure known as ileal interposition in a line of rats that were predisposed to obesity and type 2 diabetes. The rat model, developed in Havel’s laboratory, was known as the UC Davis Type 2 Diabetes Mellitus (UCD-T2DM) Rat. The pathology of type 2 diabetes in these animals is more similar to type 2 diabetes in humans than other existing rodent models of the disease.The ileal interposition procedure involves relocating a short portion of the small intestine known as the ileum further forward in the intestinal tract. Then the researchers compared how long it took for the animals to develop diabetes, compared with a control group of rats that had surgery but without rearrangement of the intestines.They found that the rats receiving the ileal interposition surgery developed type 2 diabetes 120 days later than did the rats in the control group. Furthermore, by the time the rats were one year old, 78 percent of the control group rats were diabetic while only 38 percent of the rats that had received the ileal interposition procedure had developed diabetes.Havel said the delay in onset of diabetes in the rats would be similar to delaying the age of onset of diabetes by approximately 10 years in a person, which would be expected to significantly decrease the amount of time for diabetic complications to develop and to reduce the health-care costs associated with treating this costly and prevalent disease.The researchers also found that, when compared with the control group, the rats receiving the ileal interposition surgery had:• Lower fluctuations in blood sugar levels• Improved insulin production, making them better able to metabolize sugar• Decreased levels of lipids (cholesterol and triglyceride) in the bloodstream, which are known to be risk factors for cardiovascular disease in humans“In addition, results from the study also demonstrated that the ileal interposition surgery increases production of bile acids, which are involved in fat metabolism and can increase the production of GLP-1, the hormone that improves insulin secretion and insulin sensitivity,” Havel said. “This could contribute to the delay in the onset of type 2 diabetes that we observed in the rats in this study.”He noted that further studies are needed to better understand how surgically induced improvements of metabolism can be achieved in order to discover new methods for preventing and treating type 2 diabetes. Havel, postdoctoral researcher Bethany Cummings and their colleagues have received funding from a National Institutes of Health Challenge Grant to continue to pursue research on the effects of bariatric surgical procedures in the UCD-T2DM model of diabetes.Collaborating with Havel on this study were Cummings, Kimber Stanhope, James Graham, Jennifer Lee and Helen Raybould, all at UC Davis; April Strader of Southern Illinois University School of Medicine; and Denis Baskin of the Department of Veterans Affairs Puget Sound Health Care System and the University of Washington, Seattle.Funding for the study was provided by UC Davis, the National Institutes of Health and the American Diabetes Association. Bariatric Surgery Program | 2221 Stockton Blvd. | Suite E | Sacramento, CA 95817 | New patient appointents: (916) 734-2858

医学

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Wake Forest Baptist Conducts Clinical Study for Insomnia Using New Technology WINSTON-SALEM, N.C. – June 30, 2011– Insomnia is the most prevalent sleep disorder, affecting up to 50 percent of the adult population in the United States on a weekly basis. Wake Forest Baptist Medical Center is conducting the first ever, randomized, controlled clinical research study in the country using Brainwave Optimization™ to treat people with insomnia. Brainwave Optimization™ is a non-invasive technology that helps the brain balance itself for optimal performance.The study is made possible by a research grant from Brain State Technologies®, a company based in Scottsdale, Ariz., whose founder developed Brainwave Optimization™ or what is technically known as High-resolution, Relational, Resonance-based, Electroencephalic Mirroring™ (HIRREM™).“Energetic imbalance of the brain, with dominance of the right or left hemispheres, can be seen in conditions such as trauma or stress, for which insomnia is often an accompanying symptom,” said Charles Tegeler IV, M.D., professor of neurology and the primary investigator for the study. “This new technology is intended to facilitate greater balance and harmony in brain functioning, which may result in improved symptoms.”The human brain is made up of the left and right hemispheres that work together as parallel processors with balanced progression from front to back as well. When a person undergoes trauma or a major stressor, their autonomic response for survival kicks in, and the brain can become unbalanced as a result. That occurs naturally. However, sometimes the brain doesn’t balance itself back, Tegeler explains, and that can lead to adverse effects, such as trouble sleeping or anxiety. “In effect, we are allowing the brain to look at itself in the mirror and see itself in an optimized, energetic state,” Tegeler said. “Those areas that are out of balance then begin to work toward a more functional state.”Tegeler said the study is focusing only on insomniacs because it is such a common condition in the general population and because it is a condition for which improvement can be easily measured. Twenty people who tested for moderate to severe insomnia were enrolled and underwent baseline testing. The study participants were randomly placed into two separate groups. The first group underwent eight to 12 Brainwave Optimization™ sessions each while the second group continues as is, acting as the control group. Once the data has been collected, the second group will also undergo the sessions.The Brainwave Optimization™ process begins with specifically placed electrodes affixed to the scalp and connected to a computer to detect the brainwaves of various brain lobes.A brainwave is electromagnetic energy that can be broken down into frequencies. Higher frequencies have more cycles per second and, relative to sound, would be a higher pitch on a musical scale. To reflect the brain’s own optimal wave patterns back to it non-invasively, the frequencies are assigned a musical tone, and played back to the subject via stereo ear buds placed in the ears – this is done in almost real time. As the brain resonates with the transmitted sounds, changes occur in the neural network.One study participant described his experience as having “a big reset button that’s been hit.”While Brainwave Optimization™ has already been used by more than 32,000 people around the world, this clinical study at Wake Forest Baptist is the first attempt to look at a specific health problem – insomnia – in a controlled setting in order to be able to measure outcomes and results. “Sleep problems and sleep deprivation can have far reaching implications on people’s health and well being,” Tegeler said. “Lack of sleep can affect people’s lives with detrimental effects from irritability to sickness to weight gain and more.” 6/30/2011http://www.wakehealth.edu/News-Releases/2011/Wake_Forest_Baptist_Conducts_Clinical_Study_for_Insomnia_Using_New_Technology.htm Bonnie Davis: bdavis@wakehealth.edu,336-716-4977 Related Links Neurology Educational Programs Charles H. Tegeler IV, M.D. Department of Defense Funds Pilot Study at Wake Forest Baptist to Evaluate Effect of ‘Brainwave Balancing’ on PTSD SymptomsPotty Training Before Age 2 Linked to Increased Risk of Later Wetting Problems, Research ShowsWake Forest Baptist One of a Few Centers Worldwide Offering Fertility Preservation Option to Young Boys with Cancer SpotlightNeurology ResearchPatients at Wake Forest Baptist University Medical Center know they will have access to tomorrow’s technology, today.

医学

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What Are Common Dukan Diet Side Effects? A low-carbohydrate diet can lead to ketosis breath. Constipation is a common side effect of the Dukan Diet. View slideshow of images above Allison Boelcke The Dukan Diet is a weight loss plan that primarily focuses on eating lean protein and restricting carbohydrates. Invented by French doctor Pierre Dukan, the plan is comprised of four phases that can vary in length depending on the amount of desired weight loss, and starts out with eating only lean protein, such as eggs, soy, or lean poultry, with non-starchy vegetables being gradually added into the plan. While supporters of the plan claim it is an effective and quick weight loss strategy, it has been found to potentially cause certain side effects. The common Dukan Diet side effects may range from mild and bothersome to life-threatening if the eating plan is not properly followed or supervised by a medical professional. Since the diet calls for limiting carbohydrates, the dieter may not consume enough fiber, which is mainly found in grains. Lack of fiber may eventually lead to nutritional deficiencies and cause issues with digestion. Dukan Diet side effects that may result from an insufficient fiber intake often include nausea, constipation, and diarrhea. Fiber is also found in vegetables and fruits; therefore, this lack of fiber is more likely to occur in the initial phase of the Dukan Diet when vegetables are not permitted. Ad Another one of the most common Dukan Diet side effects is ketosis. Ketosis is a condition that occurs when the body begins to break down fat for energy, rather than glucose, and result in substances known as ketones that accumulate in the bloodstream. Normal amounts of ketones can safely be released from the body through urination, but an excess amount may end up building up in the blood. Symptoms of ketone build-up include bad breath, headache, nausea, and difficulty concentrating. Although most of the common Dukan Diet side effects are not life-threatening and will not generally cause long-term complications, serious health issues may occur if the most restrictive part of the diet is followed for an extended period of time. Losing weight too quickly may cause a dieter to lose muscle mass in addition to fat, and lead to problems with gallstones and the kidneys. This may occur with any type of weight loss plan, not just the Dukan Diet, if a person does not retain enough nutritional components from food. The promoters of the Dukan Diet typically advise taking certain precautions to reduce the likelihood of side effects occurring. It is recommended to take a multivitamin while on the diet to help decrease the risk of nutritional deficiencies. After the desired weight loss is reached, previously restricted foods are reintroduced into the everyday diet and the protein-only portion of the plan is recommended only once per week. Ad What Are the Best Tips for Planning a Dukan Diet Breakfast? What Is Involved in the Dukan Diet Phase 2? What Is the Dukan Diet Attack Phase? How Do I Adapt the Dukan Diet for Vegetarians? What Are the Atkins Diet Pros and Cons? What Is a High Glycemic Index?

医学

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Hospital merger paperwork incomplete November 17, 2011 By Russ Olivo WOONSOCKET — After a preliminary review of Landmark Medical Center’s application to merge with Steward Health Care System, state regulators have deemed the paperwork incomplete, but a Landmark spokesman dismissed the notion that the assessment means the merger is in jeopardy. “It’s not a bump,” said Bill Fischer. “Quite frankly it was expected because if you look at history there’s no hospital conversion that I’m aware of that’s had an application deemed complete on the first pass.” After a 30-day review, state regulators informed the applicants via confidential letter last Thursday that they consider the application lacking in certain information. Landmark and Steward now have until Dec. 27 to rectify the situation. The regulators then have 10 more days to determine whether the amended application is in a condition that warrants continued consideration. “We’re on a new 30-day time clock and it’s on track,” Fischer said. “There’s nothing extraordinary happening here. It’s just a normal flow between the applicant and regulators in a very substantive and thorough process.” Landmark voluntarily entered a form of court-supervised receivership in June 2008, saying it was on the brink of insolvency and that its only hope for survival was to be bought out by a financially sound health care provider. Steward’s bid to acquire the struggling hospital was approved by Superior Court Judge Michael Silverstein in May after a lengthy, contentious vetting process involving at least a half-dozen competing suitors. Steward is a relatively new for-profit hospital group that was formed when the former Caritas Christi Health Care network was acquired by a New York investment company last year. Previously, Caritas Christi had been owned by the Archdiocese of Boston. Under the state’s Hospital Conversions Act (HCA), the merger must be approved by the office of Attorney General Peter Kilmartin and the state Department of Health. Amy Kempe, spokeswoman for Attorney General Peter Kilmartin, declined to say what additional information regulators are seeking in the amended application from Landmark and Steward. “The Office of Attorney General and the RI Dept. of Health sent a joint letter to Steward and Landmark indicating the HCA (application) was incomplete,” Kempe said in a statement. “As for the contents of the letter, it is confidential as it is a pending matter before this office.”

医学

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(En Español) Celiac disease has been known by many different names in the medical literature over the years, including gluten-sensitive enteropathy and celiac sprue (to differentiate it from tropical sprue). CELIAC DISEASE can be defined as a permanent intolerance to the gliadin fraction of wheat protein and related alcohol-soluble proteins (called prolamines) found in rye and barley. CELIAC DISEASE occurs in genetically susceptible individuals who eat these proteins, leading to an autoimmune disease, where the body’s immune system starts attacking normal tissue. This condition continues as long as these food products are in the diet. The resulting inflammation and atrophy of the intestinal villi (small, finger-like projections in the small intestine) results in the malabsorption of critical vitamins, minerals, and calories. Signs and symptoms of the disease classically include diarrhea, short stature, iron-deficiency anemia and lactose intolerance. However, many patients will also present with “non-classical” symptoms, such as abdominal pain, “irritable bowel”, and osteoporosis. Patients may also be screened for celiac disease because of the presence of another autoimmune disease, such as type I diabetes or thyroid disease, or a family history of celiac disease, without having any obvious symptoms. Serum antibodies can be utilized to screen for celiac disease. However, the key to confirming the diagnosis remains a small intestinal biopsy, and the patient’s subsequent clinical response to a gluten-free diet. Clinicians in the United States must maintain a high index of suspicion for this disease, as it is significantly under-diagnosed in this country. What is a wheat allergy? People can also have other medical problems, besides celiac disease, when they eat wheat and related proteins. Wheat allergy is one of the top 8 food allergies in the United States. Allergic reactions after eating wheat may include reactions in the skin, mouth, lungs, and even the GI tract. Symptoms of wheat allergy can include rash, wheezing, lip swelling, abdominal pain and diarrhea. The branch of the immune system activated in allergic reactions is different from the branch thought to be responsible for the autoimmune reactions of celiac disease. What is gluten intolerance? People can also experience ‘intolerance’ to gluten. Food intolerances are not thought to be immune mediated. GI symptoms with wheat or gluten intolerance may include gassiness, abdominal pain, abdominal distension, and diarrhea. These symptoms are usually transient, and are thought NOT cause permanent damage. Patients with lactose intolerance, where the lactose sugar in diary products is not digested well, may also experience gassiness, abdominal pain, abdominal distension, and diarrhea. Like gluten or wheat intolerance, these symptoms will pass once the lactose is out of the person’s system, and will not cause permanent damage. Why is it important to know if you have celiac disease, versus wheat allergy or gluten intolerance? Celiac disease, wheat allergy and gluten-intolerance are treated similarly, in that patients with these conditions must remove wheat from their diet. It is important to note, however, that there is a difference between these three medical problems. Celiac disease is an autoimmune condition, where the body’s immune system starts attacking normal tissue, such as intestinal tissue, in response to eating gluten. Because of this, people with celiac disease are at risk for malabsorption of food, which cause nutritional deficiencies and may result in conditions such as iron deficiency anemia, osteopenia, and osteoporosis. Persons with a wheat allergy or gluten-intolerance usually do not have severe intestinal damage, and therefore are not at risk for these nutritional deficiencies. They also are not at increased risk of developing other autoimmune conditions. Unlike a food allergy or food intolerance, celiac disease is an inherited condition. This means family members may have it, too. For this reason, if someone in your family is diagnosed, it is recommended that first degree relatives (parents, children, siblings) are screened as well. Finally, celiac disease involves the activation of a particular type of white blood cell, the T lymphocyte, as well as other parts of the immune system, which may increase the risk of developing GI cancers, in particular lymphomas, in persons with celiac disease. Since food allergies and intolerances do not involve this particular immune system pathway, these patients are not at increased risk for these cancers. While celiac disease, wheat allergy, and gluten-intolerance may be treated with similar diets, they are not the same conditions. Due to the genetic component, and risk of nutritional deficiencies, other autoimmune diseases, and GI cancers, it is very important for a person to be properly diagnosed. Alvine Pharmaceuticals Clinical Trial for ALV003 in Celiac Disease FDA Final Gluten-Free Rule ACDA Statement on FDA Final Rule Advocacy Sign up for our Action Alerts, contact elected officials and learn more about Celiac issues and legislation. Learn more » Join our Mailing List About Us Living with CD Gluten-Free Labeling Allergen Labeling GF School Lunch Menus School Lunch FAQ Support the ACDA School Nutrition Services FALCPA FDA Guidance ©2005- American Celiac Disease Alliance. All rights reserved. Website by Vico Rock Media Medical information provided on this site has been reviewed by the ACDA's Medical Advisory Board for accuracy. Information contained on this site is not intended to provide, nor does it constitute, medical advice. Dietary changes based on information on this web site should not be initiated without first consulting a physician. If you have questions about this website, please email: feedback@americanceliac.org. This site was last updated August 12, 2014.

医学

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Richard Jonas, MD Division Chief, Cardiac Surgery Cardiac Surgery Bio Dr. Jonas is chief of Cardiovascular Surgery and co-director of the Children's National Heart Institute. He is a world-renowned pediatric cardiac surgeon specializing in optimizing the developmental and cognitive outcomes of patients after surgery for congenital heart disease. He is a pioneer of corrective surgery, personally performing more than 350 complex congenital reconstructive procedures annually. Dr. Jonas has trained a large number of cardiothoracic surgery residents and fellows during his career and maintains active NIH-supported laboratory and clinical research programs. Dr. Jonas also has helped in the development of a number of international cardiac surgical programs around the world and is a coveted international speaker and guest surgeon. He is the author of the leading pediatric cardiovascular surgery textbook in the field, Comprehensive Surgical Management of Congenital Heart Disease. He is also a co-author of two other textbooks in pediatric cardiac surgery. Safe cardiopulmonary bypass is critical to the success of a cardiac surgical program. Dr. Jonas maintains active laboratory and clinical research programs. He has spent his career studying ways to improve the safety of cardiopulmonary bypass, particularly as it relates to neurological development. His development of a clinical research program in cardiopulmonary bypass techniques has revolutionized the field of pediatric cardiac surgery. Using safer strategies for bypass has resulted in improved outcomes, quicker intensive care unit recovery, shorter lengths-of-stay, fewer neurological injuries, and better long-term neurodevelopmental outcomes. Dr. Jonas continues to study advanced bypass techniques within the Children’s National Heart Institute in a dedicated research laboratory. He also has authored more than 300 peer-reviewed manuscripts. Hypoplastic Left or Right Heart Syndrome (HLHS) Tetralogy of Fallot (TOF) Total Anomalous Pulmonary Venous Return (TAPVR) Transposition of the Great Arteries (TGA) Tricuspid Atresia Education & Training Residency Program, Cardiothoracic Surgery, 1982 Green Lane Hospital Fellowship Program, Cardiothoracic Surgery, 1982 Residency Program, General Surgery, 1979 Royal Melbourne Hospital Internship Program, 1976 Patient Stories: Ryan's Story Ryan was born with a rare condition -- his heart developed outside his body. Find out how Children's doctors worked together to help Ryan thrive. Ryan B.'s Story "Ryan's life had been saved by an amazing team of doctors and nurses." Violet's Story "Our fears and concerns were handled by the team at Children's National. You cannot be in better hands." Turner's Story "These people weren't just coming to work, they had a passion for making our son healthy." Maren's Story "Randy and I knew Children's was the best choice for Maren and us as a family. I never had to beat myself up, wondering if we had made the right choice. It was already settled in my mind that the best choice was made." Matthew's Story "The doctors and staff of Children's National mend the broken hearts of not only the children, but the family of those children as well. My son is alive and well today because of the miracle that happened at Children's National." Alex's Story "He is proud of his scar. He likes to tell people he is special and when they ask him why, he will tell them he had a bad heart and the doctors at Children's National made it all better." Addison's Story "If you are reading this because your child has been diagnosed with hypoplastic left heart syndrome, just know that you are in good hands at Children's." Derek's Story "The doctors and nurses at Children's have always done everything that they can to make my experiences pleasant. In a sense, many have become an extension of my family." Ian's Story Ian was born with a heart that was not fully formed, the specialists at Children's National rebuilt his heart to function normally and gave him all the energy he'll ever need. "His experience has made him, and us, much stronger people. I am forever grateful to Children's National for saving his life." Brayden's Story "The world of congenital heart defects is scary, but to know that there are people like those at Children's National to help guide you along the way is very comforting." Camdyn's Story "The nurses, techs, and doctors at Children's National were absolutely amazing. They were always professional, compassionate, and kind. Each person there touched us in ways that are unimaginable." Athena's Story "To all the parents out there with a baby with hypoplastic left heart, good days will come. These babies overcome what seems impossible and have so much love to offer." Charlotte's Story "It is a little scary to see your baby with tubes, lines, gauze, and all of the other medical gear occupying their body, but once the nurses explain what it all does and how it helps your baby, you will feel much better." Riley's Story "Richard Jonas, MD, and his fellows came in and explained it all to me the best they could. One even drew me a picture. I was dealing with an issue that I really had no idea was such a big issue." Scott's Story "You should know that your child is being cared for at the finest children's hospital in the world and he or she could not be in better hands." "I know how difficult it is, when you don't have all the answers, and are not getting much sleep in the hospital with your child. I want to assure you that the answers will come." "We realize that we were very lucky we lived so close to one of the best children's hospitals with the best cardiac surgeons!" Julyan's Story "When we go to doctor visits, the staff always remembers Juju. They make you feel at home, talk to you about everything, and listen. Children's National is a great hospital. " Jax's Story "I know this is a scary time for you. But it's okay: you have Children's National." Bret Baier talks with Kathie Lee Gifford and Hoda Kotb on the Today Show discussing his new book and his son's heart condition. Charles I. Berul, MD, has been named Co-Director of the Children’s National Heart Institute at Children’s National Medical Center. Effects of hematocrit on cerebral microcirculation and tissue oxygenation during deep hypothermic bypass(2001) CirculationImproving results of the modified Fontan operation in patients with heterotaxy syndrome(2002) American Thoracic SurgeryNeurodevelopmental status at eight years in children with Dtransposition of the great arteries The Boston Circulatory Arrest Trial(2003) Journal of Thoracic Cardiovascular SurgeryPrediction of safe duration of hypothermic circulatory arrest by near infrared spectroscopy(2001) Journal of Thoracic Cardiovascular SurgeryRandomized trial of hematorit 25 vs 35 during hypothermic cardiopulmonary bypass in infant heart surgery(2008) Journal of Thoracic Cardiovascular SurgerySurgical aortic valvuloplasty in children and adolescents with aortic regurgitation acute and intermediate effects on aortic valve function and left ventricular dimensions(2008) Journal of Thoracic Cardiovascular SurgeryThe influence of hemodilution on outcome after hypothermic cardiopulmonary bypass Results of a randomized trial in infants(2003) Journal of Thoracic Cardiovascular Surgery Read More of Charlotte's Story

医学

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Contact Us +972-3-514-3755 Clinical Trials & Product DevelopmentRetrospective StudiesEpidemiological Studies PHYSICIANSVarda Shalev, MD MPAVarda Shalev, MD MPA is the Director of the Department of Medical Informatics at Maccabi Healthcare Services and a primary care physician. She has been at the forefront of the development of a doctor-friendly electronic medical record and a sophisticated physician support system including alerts, reminders and decision support. With an MD degree from Ben-Gurion University Medical School, she completed her residency in family medicine (with honors) and earned an MPA in Public Health Administration at Clark University. After a two-year fellowship in medical informatics at the Johns Hopkins University Hospital, Dr. Shalev established the Department of Medical Informatics at Maccabi and was responsible for planning and developing its computerized medical systems. She has pioneered the development of multiple disease registries to support chronic disease management. Shalev's research interests are in epidemiology and medical informatics in community healthcare. She is a member of the European Health Telematics Association and the American Medical Informatics Association. Dr. Shalev is a faculty member at the Tel Aviv University School of Public Health. EPIDEMIOLOGISTS & DATA ANALYSTS Gabriel Chodick, PhD Gabriel Chodick, PhD is the Unit Head, Epidemiology and Database Research, in Maccabi's Department of Research and Evaluation. He earned an MS and PhD degrees in Epidemiology from Tel Aviv University, where he also completed his masters in Health Administration. He was a Fulbright visiting scholar at the School of Public Health at the University of North Carolina at Chapel Hill and completed a two-year post-doctoral fellowship at the National Cancer Institute in Bethesda, Md. Dr. Chodick is responsible for the database epidemiological studies at Medical Informatics Department. He is a lecturer at the School of Public Health in Tel Aviv University where he teaches both undergraduate and medical school epidemiology courses for over ten years. Dr. Chodick has an adjunct position at the Division of Cancer Epidemiology & Genetics at the NIH.STATISTICIANS Inbal Goldstein, Msc Inbal Goldstein,Msc is a biostatistician at Maccabi's Medical Informatics Department. She earned a Bsc in Industrial engineering& management from the Technion Israel institute of technology, and an Msc. in Biostatistics at Tel Aviv university. Mrs. Goldstein works as part of the database epidemiological studies team at Medical Informatics Department.BUSINESS DEVELOPMENT STAFFSabina Abrahami, RN, BASabina Abrahami is the Director of Business Development for Maccabi's Database aand Clinical Research Services. She has almost 20 years of experience in sales and marketing in the pharmaceutical industry and previous experience in hospital and community healthcare. Sabina received her degree from Tel Aviv University. a site by nascent Copyright © 2010 Maccabitech.

医学

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HOPKINS BAYVIEW RESEARCHER CHIPS AWAY AT OLESTRA CONTROVERSY Media Contact: Sandy Reckert Phone: (410) 550-0128 E-mail:gstephenson@welchlink.welch.jhu.edu According to research by a Johns Hopkins Bayview Medical Center physician, potato chips made with olestra don't cause any more digestive problems than regular-fat potato chips and, despite containing only half the calories, are just as filling. Olestra, a nonabsorbable fat substitute, has been making news headlines since its approval by the FDA two years ago for use in snack products. It has been criticized for causing abdominal cramping and loose stools based on two clinical studies in which subjects were required to consume olestra at every meal for 56 consecutive days. According to a Jan. 14 Journal of the American Medical Association article, the Hopkins Bayview researcher's study challenges past findings by looking at olestra under more normal circumstances. "This was the first study of its kind on the fat substitute. Instead of looking at mass consumption of olestra, we looked at what happens to people when they consume it under conditions typical for the use of snack foods," says lead researcher Lawrence Cheskin, M.D., a gastroenterologist and director of both the division of digestive diseases and the Johns Hopkins Weight Management Center at Hopkins Bayview. In this unprecedented double-blind study, 1,100 people were selected to participate in a potato chip taste test while watching a movie of their choice at a Chicago, Illinois, multiplex cinema. Half of the people were given chips made with olestra the other half were given regular-fat potato chips. While the setting was unique for a clinical trial, the study was structured to meet rigorous controlled clinical trial standards. Within four days of the study, participants were interviewed by an independent marketing firm. Nearly 16 percent who ate the olestra chips reported experiencing gastrointestinal symptoms. However, nearly 18 percent said they had gastrointestinal symptoms after eating the regular-fat chips. In addition, there was no indication of increasing symptoms with higher consumption in either test group. These similar results confirm other, relatively recent findings that digestive symptoms are quite common in the general population, with more than two-thirds of adults reporting them during a three-month period. Findings also indicate that overall preference for olestra potato chips was slightly less than with regular-fat chips (22 percent lower olestra chip consumption). Despite consuming less (2.1 ounces on average), the olestra group reported feeling just as full as the group who had eaten the regular-fat chips (2.7 ounces on average). Dr. Cheskin notes that this may be important for people who want to control their weight. "Fat substitutes may be a valuable tool for people who need to reduce their fat and calorie intake for health reasons." Funding for this study was provided by Procter and Gamble Corporation. Dr. Cheskin is a consultant to Procter and Gamble. The terms of this arrangement are being managed by the Johns Hopkins University in accordance with its conflict of interest policies. Search Press Releases News Media Home | Hopkins Medicine Home

医学

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Read or download The Human Miracle Urdu /اردو Introduction: A short voyage through the human bodyThe body’s transport network: The circulatory system 1The body’s transport network: The circulatory system 2The body’s transport network: The circulatory system 3The digestive system 1The digestive system 2The digestive system 3The body’s purificatio plant: The excretory system 1The body’s purificatio plant: The excretory system 2Splendid communication within the body: The hormone systemYour internal air-conditioning: The respiratory systemA resistant structure: The skeletal systemPowerhouses in the body: The musclesConclusion: Human beings are created by AllahThe deception of evolution < < The Body’s Transport Network: The Circulatory System - 1 A large part of the processes that take place within your body are linked to the circulatory system, thanks to an exceedingly complex structure. A network of arteries and veins nourish the 100 trillion or so cells in your body, visiting every one individually. In this chapter, we shall be closely considering this complex system composed of the heart, veins, blood and a great many more components. Blood:The River Of Life That Flows Through Your Body Many needs in all living things—such as carrying nourishment and gasses like oxygen to the cells, and eliminating waste products from the body—are met by substances carried by the circulatory system. In human beings, the liquid that performs all these functions is the blood. Every single cell in your body, from a skin cell on your fingertip to the specialized retinal cells in your eyes, depends on what blood provides. Blood cells travel through the body by means of the veins and arteries. Blood flows through the arteries and veins that interpenetrate the body like a transport network or river delta, visiting every single corner of the body. During its travels through the arteries, that river carries numerous substances that the cells require. We can think of these as cargo packages carried by the river, containing food, water and various chemical substances. The most urgent package to be delivered is oxygen, because if deprived of oxygen, cells will soon die. Thanks to the specially constructed system in your body, however, the packages are delivered to every cell in time and to the correct “addresses.” You seldom feel the flowing of this river during the course of your day-to-day life. However, the human body has been created with such a consummate artistry that though everywhere is interpenetrated by blood vessels, they are invisible from the outside. That is because the 2-mm (0.07-inch) layer of skin that covers your body conceals the capillaries in a masterly fashion.1 That epidermal layer is actually so thin that the slightest scratch will cause some blood to leak through it. Were the vessels not covered by a very fine and attractive skin, there is no doubt that even the most attractive people in the world would appear hideously repellent. Blood performs a great number of vital functions inside the body, such as carrying waste and toxic substances to the liver, supporting the immune system, regulating body temperature rather like an air-conditioning unit, and carrying nutriments to the relevant regions. Communication via hormones within the body is also performed almost entirely by the blood. Blood’s Vital and Inimitable Features 1. Responsibility for Transportation Blood cells moving in the veins All the vital processes in the body take place thanks to the circulatory system. You can see, hear, breathe, walk and stay alive thanks to the venous network shown above. Substances of all kinds that the body requires are carried to the relevant organs by the blood. Nutrients such as glucose, amino acids and minerals—and most importantly, oxygen—are just a few of these. In addition, the blood works like a waste disposal system, collecting unwanted substances from every cell. And each of the 100 trillion or so cells in the body produces waste products as a result of its daily functions. These waste products, including such potentially toxic compounds as carbon dioxide and urea, are removed from the cells by means of the bloodstream. The blood carries the non-gaseous wastes to the kidneys, where they are distilled. The carbon dioxide produced in the cells is carried to the lungs, from where it is expelled from the body. It is unconscious blood cells that do all this. However, these cells can, in a very conscious manner, distinguish between waste and useful substances carried in the blood, and know which are to be deposited where. For example, they never carry toxic gasses to the kidneys, nor metabolic by-products to the lungs. Neither do they send waste products to any organ in need of nutrients— an error that would lead to the death of the entire body. The blood cells perform their functions with no confusion, error, misunderstanding or deficiency, in a most conscious manner, indicating the existence of a Mind and Consciousness that controls, regulates and organizes them. That cannot be the human being in question, because people live their entire lives quite unaware of these processes. Yet the circulation system continues to function, and flawlessly. To claim that the blood cells acquired their ability to distinguish, select and decide by chance, and that they do these things of their own will, would be totally illogical and irrational. It is Allah, the Almighty, Who gave the blood these features and created this flawless system. ONE SINGLE INSTANCE IS SUFFICIENT TO COMPREHEND THE NONSENSICAL NATURE OF DARWINISM! A most illogical belief, Darwinism claims that millions of random events gave life to inanimate substances and gave rise to perfect structures that function quite flawlessly. The following example will be enough to see how nonsensical Darwinism truly is. Albumin, one of the carrying proteins in the blood, attaches to itself fats such as cholesterol, hormones, toxic bile and drugs such as penicillin. Moving through the bloodstream, it then deposits the toxins it has collected in the liver in order to be neutralized, and carries nutrients and hormones wherever these are required. Now ask yourself a few questions: How can a molecule such as albumin, made up of atoms, with no intelligence or consciousness, distinguish between fats and toxins, drugs and nutrients? Moreover, how is it able to recognize the liver, bile duct and stomach, never confusing one for the other, and can always deposit the substances it carries in exactly the right place and precisely the right proportions? If you are shown the waste products, drugs and nutrients carried in the blood, you will be unable to distinguish one from the other unless you have had medical training. Even then, you will definitely be unable to determine how much of each one should be deposited at each organ. The albumin molecule, a compound consisting of a few non-sentient atoms, knows things that the great majority of people cannot unless they have received medical training. And albumin has been performing its functions in all human beings flawlessly, for millions of years. No doubt, the way that a collection of atoms can exhibit such purposeful consciousness comes about through Allah’s infinite might and knowledge. 2. Troop Carrying An immune-system cell patrolling the blood vessels Another of the blood’s duties is to carry the cells of the immune system that fight disease. Any foreign bodies like viruses and bacteria that enter the body are neutralized by the antibodies and leucocytes in the blood. In addition, immune system cells patrol the bloodstream and so monitor the entire body. (For more details, see The Miracle of the Immune System by Harun Yahya.) The blood also constitutes one of the body’s main avenues of communication. There is a magnificent communications system among the cells in the human body. They exchange information with one another, just as if each one were truly conscious. The cells send to one another chemical messages in the form of hormones, carried by the blood. (For details, see the chapter on “Splendid Communication within the Body: The Hormonal System.”) 4. Wound Healing One of the blood’s most miraculous features is its clotting mechanism. Thanks to this clotting, or coagulation, blood loss from a damaged vessel is reduced to the minimum possible. During the clotting process, dozens of proteins, enzymes and vitamins serve in regimented order. Because of this feature, scientists have shown the clotting mechanism as an example of flawless planning. (For details, see pp. 41-47) 5. The Regulation of Balances Within the Body One of the vital cargo packages carried by the blood is heat. Arteries filled with blood spread heat through the body, just like the piping that carries hot water throughout a building. But unlike the pipes in a building, the body’s heat source is not a single boiler, but all the many cells in the body. Thanks to the blood, heat produced by each cell is distributed equally to all the others. Were there no heat distribution system in your body, you would experience grave problems. As the result of any muscular activity you perform—running for instance, or carrying a heavy load—your legs or arms would overheat, and other regions of your body would remain close to room temperature—an imbalance that would inflict serious damage on your metabolism. For that reason, the equal distribution of heat is of the greatest importance. The receptor and regulatory center in the hypothalamus Body temperature rises. Body temperature falls. Normal body temperature of 37 degrees Centigrade (2) Blood vessels contract, sweat glands are inactive, the hair stands on end, shivering begins. (1) Blood vessels expand sweat glands are active hair lies flat. Cold perceptor Heat perceptor Various changes take place in your body depending on the pace of the actions you perform. When body temperature rises, for instance, the regulator in the brain (the hypothalamus) arranges for blood vessels to expand and for your sweat glands to go into operation (1). The body’s temperature immediately goes down. When the body loses heat, the same regulatory center acts in reverse, ensuring that blood vessels contract and that shivering takes place. (2) As a result of these measures, body temperature then rises. In the same way, the blood again goes into action along with the sweat glands in order to reduce excessive heat. Blood vessels under the skin dilate, making it easier for heat carried in the blood to be released to the air. When we engage in strenuous physical activity, therefore, your face grows flushed because of blood vessel dilation. Blood also plays an important role in keeping your body temperature from cooling off. When you feel cold, your skin turns paler, because blood vessels under the skin contract according to the chill in the air. The quantity of blood in those regions close to the air is therefore reduced, and heat loss from within the body is reduced to a minimum. A Tissue Consisting of Floating Cells Structurally, the blood is very different to the other fluids in the body. In one sense, blood is actually a tissue, just like bone or muscle. However, while the cells that comprise these other tissues are bound tightly together, cells composing the blood are not attached to one another. Individual blood cells—known as erythrocytes, leucocytes and thrombocytes—move freely distributed within the blood plasma. Blood consists of 55% plasma and 45% blood cells. Water comprises from 90 to 92% of the plasma, the rest consisting of plasma proteins, amino acids, carbohydrates, fats, hormones, urea, uric acid, lactic acid, enzymes, alcohol, antibodies, and elements such as sodium, potassium, iodine, iron and bicarbonate. The blood cells float in this complex fluid. The Components of Blood Erythrocytes: Small Red Cells The 25 trillion or so small red cells in the human body never cease carrying their loads. These cells, known as erythrocytes, travel all through the body inside the veins and arteries, carrying oxygen or carbon dioxide. However, these cells need a special structure in order to be able to carry a substance. For example, for a cell to carry oxygen, the most ideal shape for it is to be flat. This increases the cell’s surface area and facilitates contact with the oxygen molecules. Indeed, the shape of the erythrocyte is reminiscent of a round, flat cushion, whose shape permits the greatest possible surface contact with the oxygen atom. Under normal circumstances, some 2.5 million erythrocytes are produced in the body every second.2 It’s vitally important that the number of erythrocytes be regulated. A rise in their number for whatever reason—a reduction in body temperature, for instance—can lead to serious problems. When there is an excessive drop in body temperature the number of erythrocytes remains the same, although the blood fluid decreases. The viscosity of the blood is reduced, as the number of erythrocytes increases in terms of units per volume. This can lead to congestion in the veins, obliging the heart to work harder. It’s therefore of vital importance for the number of erythrocytes to be regulated. Various white blood cells When blood is examined under the microscope, many different kinds of cells can be seen (left). The large numbers of red blood cells give the blood its distinctive color. The blood assumes its bright red color when the red blood cells are loaded with oxygen. Otherwise, blood has a pinkish brown appearance. It is not enough for the body’s transportation system for red blood cells to be flat. Erythrocytes that carry oxygen would be pointless if they could not offer it to the cells in a usable manner. The cells of the body require molecules to bind oxygen to them—molecules that must combine with the oxygen in the ideal manner, in a three-dimensional form, and carry the oxygen safely. However, they must not bind too tightly to the oxygen, and when they arrive at the cell to which they will release the oxygen, they must separate from it with no difficulty. In short, in order for the oxygen to be transported and used where necessary, a very special molecule with a most particular creation is needed. That molecule is hemoglobin, which gives the erythrocyte—and thus, the blood itself—its red color. Since hemoglobin performs two entirely separate functions, it has been described as an extraordinary molecule. As hemoglobin deposits carbon dioxide in the lungs, it takes up oxygen and moves from there to the muscles, which oxidize nutrients and produce carbon dioxide. When the hemoglobin reaches the muscles, it carries out a reverse procedure, depositing oxygen and taking up carbon dioxide—all in a seemingly conscious and disciplined manner. In 1996, scientists discovered that in addition to carrying oxygen, the hemoglobin molecules in the erythrocyte structure also carried another molecule of vital importance: nitrogen monoxide (NO). There is a very important reason why hemoglobin carries this gas. With the assistance of NO, hemoglobin monitors how much oxygen is to be provided to the tissues.3 Therefore, hemoglobin’s transportation of nitrogen monoxide is of the very greatest importance to human health. Air sacs in the lung Capillaries in tissue Capillaries in the lung Cells anywhere in the body Hemoglobin is a molecule ideally created for carrying oxygen. The flawless molecular structure and functions of hemoglobin attracted the interest of scientists. In his book The Great Evolution Mystery, the evolutionist Gordon Rattray Taylor writes the following: The hemoglobin molecule knows what to do, when and how, and acts under the inspiration of Allah. The formation of blood, for instance, is a saga in itself. ... [It contains] at least eighty components, many of them still insufficiently understood. A component of central importance, of course, is the haemoglobin which picks up oxygen in the lungs, while giving up carbon dioxide; and then having travelled to the muscles, gives up oxygen and accepts carbon dioxide, which the muscles produce as a result of burning fuel, much as a car produces carbon monoxide. It is a remarkable molecule indeed which at one moment has an affinity for oxygen and a few seconds later loses that affinity; that it simultaneously changes its preferences with respect to carbon dioxide makes it even more remarkable. There could be no more amazing example of adaptation to a task.4 As summarized by Taylor, the hemoglobin molecule is able to make decisions when and where required, just like a conscious entity. Hemoglobin does not only carry oxygen; when it passes by a muscle in urgent need of oxygen, it also immediately realizes that it must deliver that oxygen, and acts in the knowledge that it needs to collect the carbon dioxide being released, and heads directly for the lungs to deposit its new load. The hemoglobin never confuses oxygen and carbon dioxide, and always moves to the correct destination. It is most thought-provoking that a molecule should behave in a way that requires thought, decision-making, selection and preference. Thanks to the extraordinary consciousness exhibited by this molecule, human beings are easily able to survive. An average of 900 million erythrocytes are produced in the human body every hour, and each erythrocyte cell contains some 300 million hemoglobin molecules. These molecules possess the ability to perform all of these processes without the slightest confusion. Bearing in mind the number of hemoglobin molecules in the human body and the way that all of them, without exception, possess the same abilities, you can see even more clearly the importance of this subject. It is obvious to every rational person that such selectivity could never come about by chance, and that random events could never provide these features to all the billions of hemoglobin molecules in the human body. It is Allah Who created the hemoglobin molecule and placed it, with all its characteristics, inside the human body. That is Allah, your Lord. There is no deity but Him, the Creator of everything. So worship Him. He is responsible for everything. (Surat al-An‘am: 102) The Hemoglobin-Based Distribution of Oxygen Represents an Impossible Dilemma for Evolutionists The blood’s inability to distribute oxygen and take up carbon dioxide without hemoglobin represents an impossible dilemma for evolutionists. That is because evolutionists maintain that blood and the other systems in the human body all developed gradually through a series of stages. In other words, according to this claim, there must have been a time when blood already existed, but when the hemoglobin molecule was not yet present in it. Yet from the point of view of the theory of evolution, this constitutes a major contradiction. Blood cannot perform its function in the absence of the hemoglobin molecule, and an organism will swiftly die if oxygen fails to reach its cells. That organism has no time to wait for the hemoglobin molecule to form. Hemoglobin needs to have formed at the same time as the blood. In other words, it is essential that the blood, together with all its properties and structures, should emerge in a single moment. Evolutionist claims regarding gradual development collapse at this point, and it can be seen that blood was created by Allah in a single instant. The Wisdom in the Erythrocyte’s Shape Healthy red blood cells As already stated, the erythrocyte cell is shaped like a flat, round cushion. That ideal shape increases the cell’s surface area and facilitates contact with oxygen. In the event that this shape is deformed, exceedingly serious diseases result. In sickle cell anemia, the erythrocytes contain an abnormal form of hemoglobin known as hemoglobin S. When deprived of oxygen, this hemoglobin breaks down into elongated crystals within the erythrocyte, which crystals lengthen the cell, giving it a sickle-like shape. Since the erythrocytes have assumed a crescent-like form, the passage of oxygen from the blood to the tissues is made more difficult. This leads to an oxygen deficiency and increased production of sickle-shaped red cells. The condition can reach fatal proportions within a few hours.5 Apart from such diseases, the shape of the erythrocyte is the same in everyone. Thanks to that shape, they can easily carry oxygen to wherever it’s needed. The fact that the erythrocytes are round and flat in everyone who has ever lived, or will live in future, can never be explained in terms of coincidences. Allah has perfect knowledge of all, and sets out and arranges everything down to the very finest detail. Great is the glory of Allah, the Lord of the worlds. Normal red blood cells (erythrocytes) are able to pass through the veins easily (1). Red blood cells that have been deformed, assuming a sickle-like shape (2), lead to congestion in the veins BLOOD: THE MIRACULOUS AND INCOMPARABLE FLUID Scientists investigating the phenomena taking place in the blood are still trying to replicate the flawless system in it. Yet to date, they have registered no concrete success. Indeed, researchers have begun abandoning their endeavors to imitate this extraordinary fluid, have altered the direction of their studies of blood, and are now trying to produce a different liquid capable of carrying oxygen. However, scientists encounter various difficulties in their researches. Blood clots as soon as they withdraw it from the veins and expose it to the air. Also, blood cells do not behave in the same way under the microscope as they do in the body. And since blood does not remain alive either in plastic tubes or glass bottles, the cells must be taken out and examined one by one. Bearing all this in mind, science has been analyzing not blood in living things but blood in the laboratory. (R. von Bredow, Geo, November 1997) This extraordinary substance, the likes of which cannot be produced in the laboratory, has been produced in the body since the appearance of the first human being. To claim that a substance that cannot be replicated with today’s most advanced technology could have arisen by chance events represents a total departure from reality. This substance, that gives life to so many organisms, is one of the manifest proofs of Allah’s creation. Erythrocytes’ Ability to Change Shape Erythrocytes are so small that a single drop of blood can contain 250 million of them. This gives them an advantage in being able to move with ease in the veins. However, the human body contains blood vessels with a diameter even smaller than the erythrocytes’. At first glance, this might seem to represent a problem, because the erythrocyte must squeeze through blood vessels that are even narrower than itself. How does this difficult process take place? At this point, the erythrocytes’ flexible structure goes into operation. Thanks to their flat, exceedingly flexible structure, they are able to travel through even the narrowest blood vessels. This flexibility is another example of these cells’ creation. If erythrocytes lose just a little of that flexibility, serious consequences arise. In some diabetes patients, for example, sensitive tissues in the eyes become congested by erythrocytes that have lost their flexibility, which can lead to blindness in extreme cases.6 As just one example shows, every part of the human body is created with an exceedingly sensitive, flawless equilibrium. The Economy Provided by the Body’s Recycling System Erythrocytes Old erythrocyte cells going to the spleen Formation of new erythrocytes Tissue cells Red bone marrow Iron passing to the blood from the spleen Iron passing to red bone marrow Loss of iron (through urine, sweat, etc.) Provision of iron from foodstuffs Iron deficiency is usually observed in the liver. The illustration above shows how iron absorption occurs in the body. The constantly renewed red blood cells are an important source of iron. The recycling system in the human body has a flawless structure. In your body, a great many processes are carried out every single moment. Harmful wastes, dead cells, and foreign bodies that enter the body are destroyed by the immune system. A great many other unnecessary substances are constantly moving about, yet none of these inflict any harm, because there are systems in the body to expel these substances or to reuse them in the processes within the body. Take constantly renewed erythrocyte cells, for example. These cells’ lifespan is approximately 120 to 130 days. Old cells die in the liver, the spleen and the bone marrow, and new erythrocytes are constantly produced to replace them. Ten million erythrocytes die every second, and 200 billion new ones are produced every day to replace those, so that all the erythrocytes in the human body are replaced every four months or so.7 The iron molecule inside dying erythrocytes is stored with the recycling system for use in the production of new ones. This is an example of magnificent industrial planning.8 Clearly, such planning could not have come about by itself. It is Allah Who created the erythrocyte together with these features. Leucocytes: Micro-Troopers In a single drop of blood, there are some 400,000 miniature soldiers known as leucocytes. Under normal conditions, the number of leucocytes in a cubic inch of blood is between 7 and 10 million, although if a powerful defense is required, this figure can suddenly leap to as high as 30,000.9 The duty of these troops is to defend the body from micro-enemies. The leucocytes are programmed to destroy everything, living or inanimate that does not belong in the body. They therefore seek out, locate, follow and, at the right moment, destroy bacteria, viruses and harmful substances of all kinds that enter the body. In structural terms, leucocytes are different from the other cells in the blood. For example, erythrocytes have no nucleus, but leucocytes do possess a nucleus as well as all the organelles. But leucocytes live for only a few days, or in the event of an infection, only a few hours. Contrary to what you might assume, such a brief life span is very important from the point of view of protecting the body. Because leucocytes engaged in defense, that is the worn-out ones die. But at that very moment, new healthy ones with a far greater defensive capacity are produced.10 In fact, leucocytes do not consist of only one type of cell, but rather of different kinds of troops, and “leucocyte” is a general term for cells that fight on the body’s behalf. These are classified under two main groups. The first consists of granulocytes that initially encounter and combat the enemy. The second group is made up of lymphocytes that produce special weapons to wield against the enemy, in the form of antibodies. Lymphocytes have different properties from those of the other cells in the blood. A much larger number of lymphocytes live in tissues than in the blood. These cells in the tissues, in the body’s depths, construct the equivalent of military bases and defend the tissues from germs. That being so, therefore, what is the reason for the presence of lymphocytes in the blood? With their life spans and other features they possess for the body’s defense, leukocytes are clear evidence of creation. Various images of leukocutes can be seen in the pictures to the side. The yellow cells are lymphocytes, the small ones leokocytes. In fact, lymphocytes use the bloodstream as their transportation system. Just like a police patrol, they travel around the body by means of the blood and quickly reinforce tissues containing old and weak leucocytes. It is impossible for such a rational, rapid system to have come about by chance, as evolutionists would have us believe. Clearly, cells consisting of unconscious atoms could not have acquired their selective ability and responsiveness, or the features that allow them to protect the body, all by themselves. The way that this minute entity fights to protect other cells is therefore a very important clue. The way that a cell too small for you to see with your naked eye sacrifices itself on your behalf, and the fact that in your body there are billions of cells possessed of just the same self-sacrificing properties, are just some of the millions of miracles before your eyes. The perfection in the structure of the leucocytes, their self-sacrifice, martial knowledge and abilities are not the result of their own preferences, but of their creation by Allah. So far, those who seek to prove otherwise have been unable to do so, nor will they have any more success in the future. In Surat an-Nur, Allah has compared those who deny Him to mirage: But the actions of those who disbelieve are like a mirage in the desert. A thirsty man thinks it is water but when he reaches it, he finds it to be nothing at all, but he finds Allah there. He will pay him his account in full. Allah is swift at reckoning. (Surat an-Nur:39) Evolutionists’ Distorted Logic on This Subject A huge number of germs enter the human body every day. The immune system seeks to neutralize them in the first stage. However, some germs and foreign bodies manage to enter the circulatory system and represent a threat to life. Such bodies are known as antigens. The body seeks to destroy antigens, or to prevent them multiplying, by producing the substances known as antibodies. Antibodies neutralize antigens by locking onto their three-dimensional structure, just like keys fitting a lock. To help understand this system, lock-and-key analogy between antibodies and antigens requires careful consideration. Immune cells are capable of producing antibodies for each of the hundreds of thousands of different antigens that occur in nature. That enables the body’s cells to instantly produce keys adapted to these hundreds of thousands of locks. But what’s really interesting is that the human body can produce antibodies even against artificial antigens manufactured in the laboratory. In the same way that the cells can produce suitable keys for locks in nature, they can also produce keys for locks that do not exist in nature. How can a mechanism within the body possess such astonishing information about the outside world? Of course, that cannot be explained in terms of random coincidences. How does a cell come to acquire knowledge of hundreds of thousands of foreign bodies, even of a very different antigen produced in the laboratory? Even if you accept that defensive cells in some way recognize antigens in the body, it’s still quite astonishing that they can recognize one they’ve never encountered before. Moreover, in the same way that the defensive cells immediately identify this foreign substance entering the body, they also possess the ability necessary to immediately identify and produce the weapons (or antibodies) effective against it. To say that these cells, equipped with abilities like identification, and taking appropriate measures that require intellect and consciousness, came into being by chance is illogical. In the same way that evolutionists cannot explain, in terms of their own theory, the way these cells identify all forms of foreign bodies, so they seek to gloss over the issue with exceedingly illogical, unscientific explanations. Ali Demirsoy, a Turkish evolutionist and scientist, says the following about the defense cells’ recognition of artificial antigens: “However, a cell that has previously developed a mechanism for producing antibodies against a chemical substance artificially synthesized in the 20th century is clairvoyant.”11 B cells B cells, a component of the immune system, contribute to the defense of the body by producing the antibodies that fight specific invaders. In the same book, Professor Demirsoy admits that there has so far been no explanation of this: “How and in what form do plasma cells acquire this knowledge, and how do they produce specially formed antibodies accordingly? No definitive explanation has so far been forthcoming.”12 In these words, Demirsoy is admitting that the cell possesses a number of extraordinary properties. That is because the word “clairvoyant” is used to describe someone who possesses certain information before the fact. Possession of knowledge by a cell—especially about entities far from its own environment—is something extraordinary. One cannot, of course, expect a cell that comes into being by means of a combination of inanimate atoms to possess powerful instincts or advanced knowledge by chance. Such a claim would exceed the bounds of reason and logic. However, since evolutionists are in a hopeless state, they must accept the miraculous properties possessed by living things since their creation. Yet they try to account for the source of this perfection in other terms, in order to deny that these characteristics were specially created—in other words, to deny the existence of Allah. After passing that point, evolutionists offer explanations that have nothing whatsoever to do with science, merely engaging in propaganda that seeks to gloss over their despairing state. They attempt to hypnotize listeners by saying “This is a miracle of evolution” or “this cell is apparently clairvoyant,” as if they were an evolutionary talisman. The fact is, however, that cells too small to be seen with the naked eye and constantly being renewed, possess the extraordinary ability and equipment to identify and destroy all enemies that threaten the human body before they have even seen them. To ascribe such a situation to chance underscores the intellectual weakness of those who aim to deny the existence of Allah. Antigen combining with antibody 1) Immune cells immediately identify foreign cells that enter the body. At the same time they identify and produce the most effective weapons--antibodies--for use against the enemy. 2) Antibodies eliminate antigens by combining with them. In a very important way, the body’s cells create weapons tailored to the particular enemy. 3) As can be seen, antibodies lock onto antigens with a three-dimensional structure, much as a key fits into a lock, to eliminate the antigens. Evolutionists suggest that mutations have given the cells such perfect functioning and characteristics. In his book Inheritance and Evolution, Demirsoy goes on to say that, “It is maintained that this mechanism [the antibody’s recognition of antigens] came about in the form of mutations that developed by chance.” Detailed examination of the above quotation helps understand the stratagems that evolutionist scientists resort to. The author states that some circles maintain that this mechanism came into being as the result of mutations. A reader lacking a detailed knowledge of biology might well think that this sentence represented a scientific explanation and a proven truth. The fact is, however, that the claim that the antibody’s recognition of antigens came about by chance mutations is completely hollow, of no scientific value, and has been written with the sole aim of distracting and influencing the reader. This method of deceiving people resembles hoodwinking by means of word games those ignorant of the outside world, or who has completely lost his memory. If such people are shown a skyscraper equipped with the most advanced technology and told that that building “formed as the result of an earthquake,” even if they believed that such a thing was logically impossible, they would have no means of disproving it. Nonetheless, someone who uses his reason and conscience will still appreciate that such an event could never have taken place. To say that a complex cell came into existence through mutations is hardly different. First of all, any tiny cell possesses a technology far superior to that of any huge skyscraper. Indeed, many scientists say that the cell is the most superior and complex structure they have yet encountered. Secondly, the effect on the cell of mutation—which is claimed to have endowed the cell with its characteristics—is generally even more destructive than the effects of an earthquake on a skyscraper. It is absolutely impossible for such a destructive factor to produce, by chance, a cell able to produce individual antibodies for hundreds of thousands of antigens, and displays a memory and intelligence far greater than those of human beings. According to the theory of evolution, the cell acquired these features as the result of many consecutive mutations. That’s analogous to a city’s being erected as the result of many consecutive earthquakes! Let us accept for a moment, albeit in defiance of scientific facts and no matter how impossible such a thing may be—that each mutation did give the cell some beneficial feature. Yet even that is not sufficient, because the immune cell could not have waited for millions of years to acquire all its characteristics. If the cell is unable to fulfill its function, that spells death for the organism in question. Defensive cells, together with all their properties, must therefore have been present in the living thing right from the very first moment. In addition, immune cells do not just possess a very superior reproductive capacity. There are many classes of cells in the immune system, each with very different properties and functions. Bearing in mind the properties of such cells, and their varying abilities, it can once again be seen how the theory of evolution’s “chance” account collapses in the face of the facts. Immune cells’ ability to estimate the physical structures of other living cells and their ability to produce tactics in accordance with this, right down to the finest detail, were created by Allah, the Almighty. Your deity is Allah alone, there is no deity but Him. He encompasses all things in His knowledge.(Surah Ta Ha: 98) Plasma: The Vital Component of Blood The fluid in which the blood cells (erythrocytes, lymphocytes) swim is known as plasma. This is no simple liquid, but a special compound containing a great many special substances. Plasma consists of 92% water, 6% to 8% protein, and quantities of dissolved salts, glucose, fat and amino acids, carbon dioxide, nitrogenous wastes and hormones. Plasma distributes the nutrients you obtain from the food you eat throughout your body. It also carries waste products that cells produce to the relevant organs in order to expel them from the body. . . If plasma did not have this responsibility of transport and delivery, then the food you eat would serve no purpose, nutrients would not reach your tissues, and your body would swiftly become poisoned because the waste products it produces could not be expelled. Among the plasma’s other tasks include: Ensuring blood pressure is kept at a specific level, Assisting in the equal distribution of heat in the body, Maintaining the acidity of the blood and other tissues at a specific level. Plasma proteins each have very different functions. They come in three main forms: albumin, fibrinogen and globulins. Albumin is the most numerous plasma protein. It performs a sort of carrying service in the body. Albumin’s most important function is to prevent excessive liquid passing from the capillaries to the surrounding structures.13 In order to understand the importance of this, look at the path traced by nutrients in the body. In order for them to reach the requisite tissues from the arteries, nutrients must cross the tissue wall, which possesses very small pores. Nevertheless, no substance can cross that wall by itself. What matters here is blood pressure. Just as in a sieve, the liquid plasma component of the blood and the smallest molecules cross the wall under pressure. If there were no such barrier and these substances were able to reach the tissues in excessive quantities, then edema would form in the tissues. Albumin absorbs the water just like a sponge, and due to its high density in the blood, it thus forestalls that danger. Water and most dissolved substances are able to cross the capillary wall with ease. But this is not possible for proteins. For that reason, such proteins as albumin remain inside the vessel at the point of transition and prevent liquid from seeping out. Albumin binds to itself fats such as cholesterol, hormones and yellow bilirubin, a poisonous bile-duct product. In addition, it binds onto penicillin and some other drugs, refusing to let them to pass. It deposits toxins in the liver, and carries nutrients and hormones to the places in the body where they are needed.14 Fibrinogen, another protein in plasma, plays an important role in blood clotting. Yet another protein in blood, the gamma globulins, transmit protective substances such as antibodies that form in response to the body’s being stimulated by a particular infection. These are just a few of the proteins in the blood. In addition, gasses such as oxygen, nitrogen and carbon dioxide are also present in dissolved form in plasma. Glucose, one of the solid substances in the blood, is also very important, being used as fuel for the brain and muscles. For that reason, its level in the blood is regulated by hormones. If the glucose falls below a specific level, trembling and fainting ensue, followed shortly afterwards by coma, and often death. Plasma 55% Basic functions Transportation of other substances Salts (electrolytes) Osmotic equilibrium the prevention of changes in pH and the regulation of membrane permeability Plasma proteins globulin Osmotic equilibrium, the prevention of changes in pH, blood clotting, defense and lipid transportation Plasma constitutes an important part of the blood. The proteins and salts in plasma perform vitally important functions. Blood clotting, removal of toxins from the body, and the transportation of nutrients are just a few of the tasks that proteins perform. Plasma carries out the transportation-delivery function within the body, with never any confusion or error. These proteins exist in the plasma of all humans, performing exactly the same functions. It is of course Allah, the Lord of All, Who endows the proteins constituting the liquid plasma with their intelligence. Each of these substances, of such exceeding importance to human life, is the product of a very special creation, as becomes clear when one considers their functions and characteristics. As you have seen, there are close interrelations between the substances in the blood. The absence of just one of these substances of vital importance to all human beings, or its presence in the wrong amount or with different properties, leads to serious problems in the body. This shows that all the properties of blood were created together by Allah. Thrombocyte Throbocytes traveling widely dispersed through the blood. Every part of the body is equipped with a system consisting of millions of vessels, through which blood constantly flows. As the result of the small scratches or cuts that the body is occasionally subject to, the liquid flowing through these tubes leaks to the surface. Under normal conditions, one might expect all the blood in the body to flow through this hole, so that even the tiniest cut leads to the death of the individual. Yet that is not what happens. The blood begins to clot around the wound, and the coagulated blood then blocks the gap, just like hardened putty.This situation resembles a hole in the bottom of a bucket being repaired by being blocked up in order to prevent water leaking out of it. This, there can be no doubt, is a great miracle. This property of blood saves the life of every human on Earth. Were it not for that coagulating ability, then even the tiniest scratch would end in death. However, people never think about this miracle that lies right before their very eyes and so preserves their lives. So, how does this miracle come about? How does blood coagulate? As the answer to this question is pursued, a very clear miracle of creation emerges. Coagulation is reminiscent of the first aid provided by ambulances called to the scene after an auto accident. Clotting blood Scan formation Drying fibrin Blood flowing in your capillaries immediately beneath the skin leaks out as the result of the slightest scratch or cut (top). Shortly afterward, blood around the cut begins to coagulate (middle picture). Fibrin with its soft structure begins to dry after stopping up the wound, and forms a hard shell to protect the wound until the healing process is complete (bottom). When bleeding takes place anywhere in the body, blood platelets known as thrombocytes hasten to the site. Thrombocytes are distributed throughout the bloodstream, so wherever bleeding occurs there will inevitably be thrombocytes somewhere near. A substance known as the von Willebrand protein acts rather like the traffic police, indicating the site of the accident and requesting first aid. It halts the thrombocytes when it detects them and causes them to halt at the scene. The first thrombocyte to arrive on the scene emits a special substance, just as if it were calling for back-up, and calls other teams to the site. A microscopically small cell realizes that there is a problem and is able to communicate with others, which understand the message being sent out and do what is requested of them. Tiny entities invisible to the naked eye thus communicate with one another and organize themselves. At this point, some 20 enzymes in the body combine and together, begin producing a protein called thrombin over the wound. The absence of just one of these enzymes would mean that the system would not function, and death would be the result. However, everything has been planned, and the system has been constructed in a flawless manner. Thrombin is produced only at the site of an open wound. This resembles the first-aid team providing the necessary medicine for the patient at the scene. In addition, that production of this protein must be in just the right quantity, and moreover, it must start and end at exactly the right time. The enzymes responsible for manufacturing the protein issue among themselves the commands to start and stop. Once a sufficient quantity of this protein has been produced, tiny fibers known as fibrinogen form, serving a very important purpose: They form a web over the wound, to which arriving thrombocytes adhere and accumulate. As more and more thrombocytes accumulate, the bleeding slows. Afterward, once the wound is completely healed, the scab dissolves by means of similar processes.15 Consider that these enzymes and proteins consist of strings of inanimate, blind, unconscious atoms. Yet each one of these assumes a function right from the outset once an injury has occurred. They swiftly hasten to the scene, organize themselves to halt the bleeding, produce the requisite proteins as if filling an order, communicate with others to call for assistance, understand the messages received from one another, and fulfill their functions. The system functions flawlessly, right down to the finest detail. Now, consider what would happen were there to be any flaw in this vital system: If blood began to coagulate in the absence of any wound, or if the scab that formed over the wound peeled away from it, or if the proteins that play a role in coagulation had trouble communicating—if any one of these occurred, then we would face clotting in the vessels leading to such vital organs as the heart, lungs or brain, and death would ensue due to loss of blood. Your body does not need coagulation to take place only around visible wounds. We also need a clotting system to repair the breaks in capillaries, which happen very frequently but of which, of course, you are generally unaware. When you bang your knee against a table or chair, a large number of these capillary vessels rupture, leading to internal bleeding. But thanks to the clotting system, the bleeding immediately stops, to be followed by the healing process begins. Left: Cells providing coagulation. Right: Fibrin threads imprisoning blood cells (during clotting). If no clotting occurred, the result would be the disorder known as hemophilia. Hemophiliacs need to be protected from even the slightest blow, because particularly in the advanced stages of the disease in even the smallest bleeding cannot be stopped, and that leads to the patient’s death from blood loss. THE MAGICAL SUBSTANCE THROMBIN Thrombin is a protein that coagulates the blood. However, although thrombin is present in the bloodstream it does not lead to clotting in the capillaries it moves through, thereby halting the normal flow of blood. So how does thrombin suddenly acquire its coagulating property in moments of need? Thrombin is widely present in the bloodstream but in the form of the inactive protein prothrombin. Since prothrombin is still inactive, it cannot enable the formation of the substance fibrin which is necessary for the clotting process by putting the fibrinogen into action. Living things are thus protected from deadly uncontrolled clotting. Consider that if only fibrinogen and prothrombin assumed duties in the blood clotting system, this could have deadly effects. In that case, when a person was injured, the prothrombin would roam aimlessly through the bloodstream, not affecting the fibrinogen, and the person concerned would die from loss of blood. Since prothrombin lacks the ability to turn fibrinogen into fibrin, there is a need for some mechanism to set prothrombin into action—and such a system actually does exist. During the clotting process, another protein called Stuart factor affects the prothrombin, converting it into the active thrombin. Thrombin in turn converts fibrinogen into fibrin, and blood clotting thus takes place. However, if the Stuart factor, prothrombin and fibrinogen were the only proteins to play a role in coagulation, the Stuart factor would immediately start working and the organism’s blood would solidify. For that reason Stuart factor is not present in the blood in an active form, but needs to be activated in order to start working. At this point, coagulation displays more striking properties. It is not enough for the active Stuart factor to set the prothrombin in motion. You can mix Stuart factor and prothrombin together in a test tube, but after it takes time thrombin to form, any individual will already have died of blood loss. Yet another protein, known as accelerin, is needed to set the Stuart factor in motion. When all of these come together, the accelerin and Stuart factor immediately act on the prothrombin, turning it into thrombin and halting the bleeding. To summarize, two separate proteins are needed to activate one proenzyme. Yet the processes involved in coagulation go still further. Initially, in fact, the accelerin is in the form of the inactive proaccelerin. So what activates the proaccelerin? Thrombin! As you will recall, however, thrombin is further along than proaccelerin in this chain reaction. This means that thrombin, which plays a role in the production of accelerin, is rather like a grandchild appearing before the birth of its own grandparent. Yet since the Stuart factor acts on the prothrombin at a very slow rate, there is always some thrombin in the bloodstream. (Michael Behe, Op cit., pp. 85-90.) All this is a rather superficial account of the coagulation process. Yet from this brief description, you can still see how blood clotting, which we encounter frequently in our daily lives—is actually exceedingly complex, a marvel of creation. This system functions by means of dozens of components working together, and could not function properly in the absence of any one of them. To suggest that it came into being by chance is a most illogical and irrational claim. Moreover, evolutionists claim that living things evolved in stages. But as you have seen, all proteins and enzymes in the clotting process depend on one another for clotting to occur. In the absence of any one, the others serve no purpose, and will even lead to the death of the body concerned. Therefore, the living organism will have no time to wait for all the components to be present, and will thus die. Whatever appearance it now displays, and whatever physical and chemical features it now possesses, it must have had them all since it first appeared. This is one of the proofs that Man was created by Allah in a single moment. Say: “Have you thought about your partner deities, those you call upon besides Allah? Show me what they have created of the earth; or do they have a partnership in the heavens? Have We given them a Book whose Clear Signs they follow? No indeed! The wrongdoers promise each other nothing but delusion.” (Surah Fatir:40) It is essential that the clotting property in our blood exist, but it also needs to be subject to strict supervision. As you can clearly see from the information provided, such a system can definitely not form in the living body by chance. This system, whose every detail is the product of planning and calculation, is an indication of the Allah’s infinite knowledge, intellect and power. To maintain that this system came about by chance in fact expresses the logical collapse of Darwinism. Is He Who creates like him who does not create? So will you not pay heed? (Surat an-Nahl:17) 1.John Farndon and Angela Koo, Human Body Fact finder, Great Britain: Miles Kelly Publishing Ltd., 1999, p. 63. 2.Bilim ve Teknik Dergisi (“Journal of Science and Technology”), February 1998, p. 62. 3.Ibid, p. 61. 4. Gordon Rattray Taylor, The Great Evolution Mystery, New York: Harper & Row Publishers,New York p. 108. 5.Arthur C. Guyton and John E. Hall, Textbook of Medical Physiology, 9th edition, Guyton & Hall, p. 432. 6. Bilim ve Teknik Dergisi (“Journal of Science and Technology”), February 1998, p. 62. 7.Regina Avraham, The Encyclopedia of Health, Chelsea House Publishers, Chapter 4, “The Circulatory System,” p. 49. 8. Prof. Dr. Ahmet Noyan, Yasamda ve Hekimlikte Fizyoloji (“Physiology in Life and in the Field of Medicine“), 10th edition, Meteksan Publishing., March 1998, pp. 670-673. 9.Regina Avraham, Op. cit., p. 50. 10.Arthur C. Guyton, Textbook of Medical Physiology, 7th Edition, W.B. Saunders Company, p. 75. 11.Prof. Dr. Ali Demirsoy, Kalitim ve Evrim (“Inheritance and Evolution”), Ankara: Meteksan Publishing Co., 1995, p. 420. 12. Ibid., p. 416. 13.Eldra Pearl Solomon, Introduction to Human Anatomy and Physiology, 1st edition, Philadelphia:W.B. Saunders Corp., 1992, p. 48. 14. Bilim ve Teknik Dergisi (Journal of Science and Technology), February 1998, p. 66-67 15.Michael Behe, Darwin’s Black Box, New York: Free Press, 1996, pp. 79-97. You can read Harun Yahya's book The Human Miracle online, share it on social networks such as Facebook and Twitter, download it to your computer, use it in your homework and theses, and publish, copy or reproduce it on your own web sites or blogs without paying any copyright fee, so long as you acknowledge this site as the reference. Recently Added

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Cybermarketing: 8 Ways to Maximize Your Laboratory's Website LMT Communications, Inc. · Marketing · Feb 2000 "In the not-too-distant future, the Internet will be a fundamental business tool for the laboratory simply because of the speed of communication," says Bob Cerza, general manager of Bonadent Dental Laboratories in Auburn, New York. "And we plan to be on the forefront of it." By using their websites in creative ways, laboratories are promoting their products and services, educating the general public, offering technical assistance and business services and enhancing dentist-lab communication. While owners and managers acknowledge that their websites are certainly not replacing traditional communication methods, they provide an opportunity to offer unique value-added services and reach a vast audience. LMT took a trip through cyberspace to learn how laboratories are using their websites as resourceful marketing tools: Client convenience. Some laboratories are making it easier for their dentist-clients to send in cases by putting business forms on-line. Jade Dental Laboratory Group's site allows clients to print out copies of its mailing label and features coupons for 10% discounts. The dentist-client prints out a copy of the coupon then sends it in with the case. PJ's Dental Lab in Hartford, Wisconsin has its prescription form on its website for clients to print out. Dental Domain, an e-commerce solutions provider, has combined an on-line prescription form with web technology. The Chestnut Hill, Massachusetts-based company has created an on-line prescription software application to facilitate prescription communication between labs and their clients. Created by Dr. Arnold Rosen, the company's president, a maxillofacial prosthodontist and former director of dentistry at Tufts Northeast Medical Center Hospital, the on-line prescription asks for the same comprehensive information found in a traditional prescription, but offers one clear advantage: it will not let the doctor submit an incomplete form. If a page is unfinished, the "smart form" alerts the user with an instant message that lists exactly what information is still needed. Once the user submits the form, the information goes into the laboratory's database. The lab then gets a real-time, automatic e-mail, alerting it that a new case has been submitted. "The application eliminates data entry and gives the laboratory a jump on the work coming in," says Dr. Walter Golub, vice president of marketing and sales. "But its biggest advantage so far is a dramatic reduction in follow-up phone calls. We also anticipate a reduction in shade-related remakes, since doctors have the ability to upload images of the patient and a shade tab." As usage increases, Golub predicts that laboratories will be better able to plan their workflow and inventory needs. Americus Dental Labs, New York, New York, is the only laboratory in the industry currently using the application. Bonadent Dental Laboratories, posts a case feedback form on its site. "Our case feedback form allows our doctors to get critical information to us quickly and easily," says Cerza. The form enables the laboratory to respond immediately if it receives a negative report. "I never e-mail the client back; I immediately get on the phone and act on it," says Cerza. And although a small amount of Bonadent's clients currently use the on-line form—a printed version is still included with all invoices—Cerza says he expects its usage to increase as more and more clients go on-line. Laboratories with out-of-town or out-of-state clients are making shipment tracking easier by providing a link to its shipper's website. MicroDental Laboratories in Dublin, California, for example, provides a link to Airborne Express. By providing the dental office's staff with a link, you give it the freedom to track their own cases. Product marketing. On-line product news and photos of restorative options enable the dentist to browse the information at his leisure. Issaquah Dental Lab's website features a product questionnaire through which dentists can indicate that they want more information on certain services, then submit the request electronically. In response, the lab "snail-mails" a packet of information and, if the dentist is not a current customer, also includes prescription forms. This soft-sell approach saves time and adds an interactive element to the website, a key strategy for getting dentists to visit the site repeatedly. "It gives us the opportunity to serve a lot of out-of-town doctors without having to travel," says Pam Bainbridge, CDT, general manager of the Issaquah, Washington laboratory, who says they have gotten information requests from all over the world since putting the questionnaire on-line three years ago. The site also offers product incentives like a free diamond prep kit with a client's first all-ceramic case. Public awareness and education. To create a greater public awareness of dental technology and treatment options, Boos Dental Lab's website features a patient resource page that explains the role of the dental laboratory and describes several available products. It also encourages the consumer to provide the dentist with the lab's contact information. CQC Prosthodontics in Rochester, New York, takes its public information one step further. Its general public information page includes photos and a detailed, A-Z glossary of dental technology terms, materials and even job descriptions in the field. In addition, the site features descriptions of how restorations are fabricated from beginning to end. The laboratory's goal for the glossary is twofold: to educate the public and to offer a service to their doctors. "So often doctors don't have the time to really explain to a patient what products are available in terms he can understand," says Bob Ingrassio, president. "Now doctors can refer patients to our site, where they can explore the glossary. It's a way for our laboratory to support the dental office." In 1999, the site's consumer Q&A section received between 200-300 questions from consumers all over the world. Marketing assistance. Laboratories are also using the web to provide marketing assistance to their dentist-clients, a service especially valuable for clients without a website of their own. For example, by putting case studies on-line, Derby Dental Laboratory of Louisville, Kentucky, allows its clients to refer patients to the laboratory's site to view some of their casework. The case studies also give the laboratory the opportunity to highlight some of its work. CQC Prosthodontics is launching its clients into cyberspace by creating dentist home-pages that link from the laboratory's website. The dentist-client provides the laboratory with the information and photos he wishes to post, then the laboratory outsources the job, paying $50 to $75 for each page created. "It's a lot of work and it's not going to bring in a dollar for us directly," says Ingrassio. "However, it is a value-added service; we're not looking for a direct return." To date, four clients have taken advantage of the free service, reports Ingrassio. Technical and practice management assistance. Savvy laboratory owners know that one way to be valuable to their dentist-clients is to be a resource of information. Summit Dental Lab in Waco, Texas, for example, includes step-by-step shade-taking advice on its site. And, if your laboratory is experiencing recurring technical problems with a client, it may be less awkward to refer him to your site, rather than to instruct him verbally. MicroDental Laboratories complements its printed newsletter with a quarterly on-line version, Profiles in Dentistry. Designed to teach dentists how to achieve excellent esthetics, it features technical articles, case presentations, treatment planning strategies, seminar information and product Q&A. As an added service to its dentist-readers, Ottawa Dental Laboratory's website provides an icon for downloading Adobe Reader, the software necessary to view the Ottawa, Illinois laboratory's library of newsletters, Ottawa Quarterly. Thayer Dental Laboratory, Mechanicsburg, PA, even includes on-line practice management and marketing articles written by owner Greg Thayer for the Pennsylvania Dental Journal, including Maximum Marketing for Minimum Dollars. And, by periodically updating and adding new articles and tips, you give your clients a reason to return to the site. Event promotion. To advertise its in-house seminars, Dental Prosthetics in Tucson, Arizona, puts a complete course description along with a registration and billing form on its website. The dentist-attendees can either register via e-mail or print out the forms and mail them to the laboratory. Americus Dental Lab, New York, New York posts photos of events and even provides links to the websites of some of the shows it will be attending so dentist-clients can obtain more detailed information. Cosmetic imaging. Hans Hansen, CDT, owner of Parkview Dental Laboratory in Brisbane, California believes there is a direct correlation between the shape of a person's face and the size, shape, subtle contours and length of his teeth. He—along with two other California laboratory owners, Peter Keri, CDT, Peter Paul Dental Laboratory and Axel Altermann, Altermann Dental Laboratory and Dicom Imaging Sytems, Inc.—has incorporated this proportional analysis technique into a website offering cosmetic imaging services to dental consumers. Photos of the consumer are scanned into the computer, measurements are taken and calculated and then before-and-after photos are sent to the consumer either via e-mail or regular mail. Initially, they offered the service only to clients' patients; all of the people who have used the $200 service have had the work performed. The partners are now in the process of launching an advertising campaign to promote the service to the general public. "People have two concerns before committing to cosmetic work. First is the price, and second is 'how am I going to look?'," says Hansen. He and his two partners expect to see a real boom in business from consumers across the country once radio and print ads are launched. "We are not seeking additional work or new accounts; the objective is to generate public awareness of the importance of a person's smile as it relates to his image, self esteem and quality of life." On-line personnel recruitment. As more and more job hunters turn to the Internet, laboratories are also using their websites as a recruiting tool. Thayer Dental Laboratory's website features a career section that provides the company's background, benefits package and an on-line employment form for prospective employees to complete and e-mail directly to the laboratory. "If a technician is impressed by our site and thinks our laboratory might be a good place for his future, the on-line form is a convenient way for him to make contact," says Thayer. And, there's no denying that the Internet reaches a much larger audience than a typical print ad. However, says Thayer, that fact can also be a drawback: the laboratory receives resumes from all over the country and the expense of moving the person may not be cost efficient. Of the 15 to 20 qualified responses the laboratory has received, it has interviewed seven applicants, but not hired anyone yet. The applicants were either at a lower skill level than necessary for the position or lived too far away. Laboratory owners on the forefront of the Internet revolution are experiencing its benefits and they—along with experts—only expect it to get better. "The truly revolutionary impact of the Internet is just beginning to be felt," writes Peter Drucker in the October 1999 issue of The Atlantic Monthly. "In the mental geography of e-commerce, distance has been eliminated. There is only one economy and only one market. The competition is not local anymore—it knows no boundaries." For example, Thayer Dental Laboratory has increased its out-of-state clients by approximately 6% in the past three years, an increase that owner Greg Thayer directly attributes to the lab's website. "The site allows a dentist in Austin, Texas, for instance, to seek a new laboratory anywhere in the country," he says. "A dentist can read about our specialized implant procedures and the fact that we have a dentist on staff, which makes him feel comfortable sending that first case to us." And, by year's end, CQC's Ingrassio expects that the laboratory and some of its clients will be e-mailing images back and forth to speed up and enhance case communication. "If we have a problem or just want to make a point on a complex case, we can e-mail the image or post it on our website, then talk about the case as if we're together," says Ingrassio. "There's a big, big future for that." See the sites Following is a list of the website addresses referenced in this article that are still current as of January 2004: Americus Dental Lab, New York, New York: http://www.americuslab.com Bonadent Dental Laboratories, Auburn, New York: http://www.bonadent.com CQC Prosthodontics, Rochester, New York: http://www.cqcinc.com Dental Domain, Chestnut Hill, Massachusetts: http://www.dentaldomain.com Issaquah Dental Lab in Issaquah, Washington: http://www.issaquah-dl.com MicroDental Laboratories, Dublin, California: http://www.microdental.com Ottawa Dental Laboratory, Ottawa, Illinois: http://www.ottawadentallab.com PJ's Dental Lab in Hartford, Wisconsin: http://www.pjsdental.com Summit Dental Lab, Waco, Texas: http://summit-dental.com Thayer Dental Laboratory, Mechanicsburg, Pennsylvania: http://www.thayerdental.com © 2014 LMT Communications, Inc. · Articles may not be reprinted without the permission of LMT See All Related Topics (1) See All Mentioned (2) Bob Ingrassio Works at CQC Gregory Thayer, CDT President at Thayer Dental Laboratory See All Recommendations (1) Alireza Esfandyari, CDT Dental Technology at Academy Dental Lab Selling Your Business to a Laboratory Group LMT Communications, Inc. · Management · Jan 2002 Are you the owner of a successful laboratory who’s not quite ready to retire, but looking to relinquish some of your management responsibilities and put your succession plan into action? If soâ€�"and... LMT Communications, Inc. · Technical · May 2011 Questions and Answers: Partials Loyalty Rewards Programs: Build Loyalty, Control Cash Flow and Add Value LMT Communications, Inc. · Marketing · Nov 2011 Loyalty rewards programs are an effective way to maintain strong relationships with your top clients, encourage their repeat business, optimize cross-selling opportunities and regulate cash flow. Going for Gold? While rising gold prices have convinced some participants of LMT’s 2012 Fee Survey to incorporate alloy surcharges, others are trying to simplify pricing with flat rates for certain restorations.

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USA Physicians Named 'Top Doctors' This year, four physicians from the University of South Alabama Physicians Group and USA Mitchell Cancer Institute appear in the America’s Top Doctors directory issued by U.S. News and World Report. They are the only doctors in our region to receive this honor. Drs. Michael Finan, Johnson Haynes, Arnold Luterman, and William Richards were each listed among the top physician specialists in the United States. To be included in the America’s Top Doctors directory, physicians rank in the top one percent of primary and specialty care for their expertise. Dr. Michael Finan is associate director for clinical affairs and professor and chief of the gynecologic and oncology division at the Mitchell Cancer Institute and is a professor of obstetrics and gynecology at the USA College of Medicine. He specializes in the management of cancers of the uterus, cervix, ovaries, and the lower genital tract. He is also the first gynecologist in Mobile to perform robotic surgery. Prior to joining USA, Dr. Finan served as the residency program director of gynecologic oncology and chair of the cancer committee at Ochsner Clinic Foundation in New Orleans. Dr. Johnson Haynes Jr. is professor of internal medicine and director of the USA Comprehensive Sickle Cell Center. Dr. Haynes also serves as assistant dean for diversity and cultural competence at the USA College of Medicine. His interests are in the research and treatment of sickle cell disease. Dr. Haynes is a graduate of the USA College of Medicine and conducted his residency training at the USA Medical Center. Dr. Haynes completed his clinical fellowship in pulmonary medicine at USA, as well as fellowship in pulmonary vascular research at the University of Colorado in Denver. Dr. Arnold Luterman recently retired as the Ripp-Meisler professor of surgery at the USA College of Medicine and medical director of the USA Burn Center. He is a nationally known burn care expert and is noted for his leading-edge burn and wound treatment and research. He helped establish the USA Burn Center in 1981 and has played a vital role in the care of burn victims in our region for more than 30 years. Dr. William Richards serves as professor and chair of surgery at the USA College of Medicine. He directs the laparoscopic and bariatric surgery programs at USA and is also a member surgeon with the USA Mitchell Cancer Institute. Dr. Richard’s clinical interests focus on surgical treatment of achalasia, paraesophageal hernias, Barrett’s esophagus, adrenal tumors, gastroesophageal reflux disease, Type 2 diabetes and motility disorders of the gastrointestinal tract using minimally invasive surgical procedures. He has performed thousands of laparoscopic procedures since 1989 and is internationally recognized for his research and surgical expertise in these disorders. In addition, 24 USA physicians were named regional Top Doctors this year. Regional Top Doctors rank in the top 10 percent of primary and specialty care physicians within a given area. U.S. News Top Doctors was created in collaboration with Castle Connolly Medical Ltd. It draws from their database of America’s Top Doctors, all recommended for their clinical skills by other doctors and individually vetted by a physician-led research team. Consumers can search for a Top Doctor by location, hospital affiliation, and a full range of specialties and subspecialties. Got news to share? Feel free to email your ideas to agivens@health.southalabama.edu August Med School Café - Cerebral Aneurysms: Preve... COM Class of 2018 Introduced to Medical School Dur... Mark Your Calendar: Lions Club Run for Sight

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NCCOR Blog A place to search and comment on NCCOR-authored content and childhood obesity research and trends United States proposes major update to food labels in bid to combat obesity Feb. 27, 2014, Reuters Posted on March 26, 2014 by Coordinating Center By Tom Clarke Packaged foods sold in the United States would display calorie counts more prominently and include the amount of added sugar under a proposal to significantly update nutritional labels for the first time in 20 years as health officials seek to reduce obesity and combat related diseases such as diabetes. The Food and Drug Administration (FDA) said on Feb. 27 that its proposal would also ensure that the amount of calories listed per serving reflects the portions that people typically eat. That change may result in per serving calorie counts doubling for some foods such as ice cream. First lady Michelle Obama, who has used her White House position to launch the Let’s Move! campaign to fight childhood obesity, announced the proposal for the FDA. The principle behind the updates are “very simple,” Obama said in a statement. “You as a parent and a consumer should be able to walk into your local grocery store, pick up an item off the shelf, and be able to tell whether it’s good for your family.” While the FDA already requires companies to list the amount of sugar in a product, under the proposal they would also be required to list the amount of added sugar. Natural sugar is contained in fruits. Added sugar includes corn syrup and concentrated juice as well as white and brown sugar. In addition, the labeling on vitamin content would change, with

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Swine flu nothing new to scientists in College of Ag SciencesMay 7, 2009 Swine flu nothing new to scientists in College of Ag Sciences University Park, Pa. — Swine flu is no mystery to scientists in Penn State's College of Agricultural Sciences, who have been keeping a wary eye on the virus in pigs for decades and researching better vaccines to prevent it, methods to limit its spread and ways to predict and gauge the risks it poses to human health. The disease in pigs is relatively mild and rarely kills the animals, but when the swine virus combines with genes from human and avian influenzas — as it seems to have done in the current outbreak causing so much fear around the world — all bets are off. "It is unclear at this point, given considerable information about previous outbreaks, where this particular virus will end up," said Vivek Kapur, a renowned microbiologist who heads Penn State's Department of Veterinary and Biomedical Sciences. "It is too soon in the outbreak to be sure. Influenza A viruses are notorious for re-assorting and mutating, and based on our understanding of previous outbreaks, this virus may come back with a vengeance this winter, or simply disappear over the next few weeks or months. "When the virus jumps to humans, it becomes a different organism altogether — unpredictable and potentially dangerous. Several times in the last 100 years, influenza has proved deadly, and so we must always remain vigilant." Kapur pointed out that influenza, or what is commonly called the flu, annually kills about a million people worldwide (between 30,000 and 50,000 in the United States die of flu each year). Typically, flu is a late-fall, early-winter phenomenon. "There are probably hundreds or thousands of localized outbreaks that don't turn into pandemics," Kapur noted. "From an influenza perspective, most are mild and peter out, and they don't get the publicity that the current outbreak has." However, the involvement of swine influenza and perhaps avian influenza in the current outbreak could make this flu different, contends extension veterinarian Dave Wolfgang, who said it is not unusual to have a few pigs suffering with flu. But he is quick to point out that the mixed virus strain identified in the current outbreak has not been seen in pigs in the United States or Pennsylvania. "The real fear, of course, is that this strain will spread rapidly among the human population because people have no immunity to swine and avian flu, and that has the potential to start a pandemic. But what we are seeing right now is that this flu has a high attack rate — meaning it spreads easily — but it doesn't seem to have a high mortality rate." If the disease infects hundreds of thousands or millions of people, even if only a very small percentage become quite ill, that could still lead to many deaths, Wolfgang said. A high attack rate but very low mortality rate is characteristic of swine flu, compared to a low attack rate with a high mortality rate for the current H5N1 avian flu. It is a lethal combination of the two -- a virus strain that would have a high attack rate and high mortality rate, with human influenza genes somehow rolled in -- that keeps scientists up at night. "In the modern world with people traveling so much, we are always going to have influenza and infectious diseases," Wolfgang said. "Small reassortments in influenza happened all the time, every day, every year, but most turn out to be insignificant." Veterinary scientist Lester Griel has been investigating ways to influence the immune systems of swine to resist influenza. He currently is conducting contract research for a company that is interested in ways to reduce aerosol distribution of influenza and limit the spread of disease among pigs. "These viruses change rapidly, with mutations and recombinations," he said. "The reason this was originally called swine flu is that the overall background of this new organism is definitely swine but it does have elements of human and bird flu. "These type of influenzas circulate in birds, pigs and humans," Griel added. "The reason many of these new strains originate in places like Southeast Asia and Mexico is that the pig houses and chicken houses are often closely attached to human houses and there is much more intimate contact between animals and humans than there are in other parts of the world." The current flu outbreak shows how closely linked animal health is to human health, Griel said. "The American Medical Association has stated that of the 1,500 diseases that can affect people, about 50 percent of them are transmissible between animals and humans," he said. "The American Medical Association and the American Veterinary Medical Association have been working on the theme for the last three years, 'One World, One Health, One Medicine.' There is not as much difference between animal medicine and human medicine as most people think. "Because of these zoonotic diseases (animal diseases which can infect humans), a lot of the disease-protection activities that veterinarians are involved in have a significant effect on human health." A virologist in the college, Biao He, studies the genetic material of viruses and is working to develop a viral vehicle to deliver antigens in vaccines, mostly targeting the H5N1 avian flu virus. "Swine are considered to be a reservoir for flu virus where swine, avian and human influenza combine and reassemble. The pig is the mixing vessel to create many different kinds of virus. We worry most about a completely new strain emerging to which humans would have no immunity." He believes that veterinary scientists play a huge role in protecting human health. The insight and knowledge they provide about flu is critical. "In the college, we have people who keep a close eye on what flu strains are circulating," he said. "If we know what is coming we can prepare. If we don't do surveillance we will get blindsided. "So animal diagnostics are vital. One of the difficulties is the time it takes to make vaccine. We need to make hundreds of millions of doses. There is a possibility that this strain will come back next winter, but now we have the virus and we can make the vaccine." In the College of Agricultural Sciences, researchers are uniquely positioned to monitor zoonotic diseases, He noted. Obvious examples of human-health threats that have proved particularly menacing in recent years are HIV, which came from monkeys, and Ebola, which came from bats. "The odds are that the next emerging disease epidemic will come from animals," He said. "If a virus only infects humans we have a chance to get rid of it — like smallpox. But we will never get rid of flu because there are reservoirs of influenza in animal populations. "Our college is really at the front line of defending against emerging viruses," He said. "People traditionally value agriculture from an economic perspective, but perhaps a more important aspect is protecting animal health by minimizing the threat from emerging viruses to guard human health." Molecular mechanisms that allow viruses to adapt to and thrive in new environments are the focus of biologist Mary Poss's research. Although she has not worked with influenza viruses, because of her work with other pathogens, she has considerable insight into how emerging diseases such as swine and avian flu spread. Poss noted that epidemiological modeling currently being done in the college will help experts to predict the spread and impact of the disease if it emerges this winter in a deadly way, and how susceptible people are to being infected. Because the H1N1 virus has "multiple parentages," Poss worries it could have a significant effect on the human population. "Historically, we know that an out-of-season outbreak, known as the Spanish flu, in the summer of 1918 was followed by a severe winter pandemic that proved to be fatal for many thousands of people," she said. "So perhaps we should not be comforted by the mild nature of this spring outbreak. Only time will tell. "But this outbreak is a very good example of why we need to study more than just the genes," Poss added. "We also must understand wildlife movement such as bird migrations and agricultural practices that involve animals like swine because we now know that everything we do on this planet is connected and has an impact on human health." Contacts: Jeff Mulhollemjjm29@psu.eduWork Phone: 814-863-2719 Last Updated May 13, 2009 Share this story submit to redditLinkedInSubmit this story to StumbleUponPin this story on PinterestShare on TumblrEmail this articlePrint this article Related ContentPandemic Evolution?Microbiology experts to visit for American Society for Virology meetingProbing Question: Can a pandemic be predicted?TagsAg Sciences, avian flu, biology, biomedical science, College of Agricultural Sciences, flu, H1N1, Influenza, microbiology, pandemic, swine flu, veterinary science, virologyCampusGreater AlleghenyCollegeAgricultural Sciences News for:

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Links Categories Our Partners and Other Advocates American Academy of Pediatrics Lists publications and services, gives health tips for families, and includes sections on professional education, advocacy and research. American Academy of Pediatrics - California AAP-CA is an organized group of over 5,000 board-certified pediatrician members of all four California regional Chapters. We are committed to the attainment of optimal physical, mental, and social health and well-being for all infants, children, adolescents and young adults living in California. American Academy of Pediatrics: State Children's Health Insurance Program (Title XXI) Includes SCHIP reports on eligibility and funding, a summary of SCHIP provisions, and state responses to the SCHIP. American Medical Association Includes a Family Focus section and KidsHealth page, covering the following topics: children's nutrition, safety and accident prevention, baby development, childhood infections, and emergencies and first aid. American Public Health Association This website includes a number of features, including general information about the APHA and a "What's New" section with current additions. California Adolescent Health Collaborative The California Adolescent Health Collaborative (AHC) is composed of 40 public and private organizations committed to improving the health and well-being of California's rapidly growing adolescent population. Formed in 1996, the AHC brings together individuals and organizations concerned with a broad range of adolescent health issues to promote a common agenda that emphasizes positive youth development and crosses categorical and disciplinary boundaries. California Budget Project The California Budget Project (CBP) serves as a resource to the media, policymakers, and state and local constituency groups seeking accurate information and analysis of a range of state policy issues. California Children's Health Initiatives CCHI is a collaboration of local Children's Health Initiatives (CHI) in 30 counties across California. Collectively, the CHIs have insured more than 88,000 previously uninsured children into the locally funded Healthy Kids program. California Children's Hospital Association The California Children's Hospital Association (CCHA) advances the needs of the State's Children's Hospitals through public and legislative advocacy. California Immigrant Policy Center The California Immigrant Policy Center is a non-partisan, non-profit statewide organization founded in 1996. The Policy Center seeks to inform public debate and policy decisions on issues affecting the state's immigrants and their families in order to improve the quality of life for all Californians. California Pan-Ethnic Health Network To improve access to health care and eliminate health disparities by advocating for public policies and sufficient resources to address the health needs of our communities. The California Partnership The California Partnership is a statewide coalition of community based organizations that fight poverty in California. We work together for our common goals by organizing and advocating at the local, state and national levels for the programs and policies that reduce and end poverty. California Rural Legal Assistance CRLA seeks to insure that all low-income rural communities in California have access to justice and the provision of basic human-rights. California School Health Centers Association The California School Health Centers Association (CSHC) is the statewide organization leading the movement to put health care where kids are - in schools. Our mission is to promote the health and academic success of children and youth by increasing access to high quality health care and support services provided by school health centers. Center on Budget and Policy Priorities The Center on Budget and Policy Priorities is one of the nation's premier policy organizations working at the federal and state levels on fiscal policy and public programs that affect low- and moderate-income families and individuals. Center for Children and Families Georgetown's Center for Children and Families (CCF) is an independent, nonpartisan policy and research center whose mission is to expand and improve health coverage for America's children and families. The Center for Health and Health Care in Schools The Center for Health and Health Care in Schools is a nonpartisan policy and program resource center created to strengthen health care delivery systems for children and adolescents. Children's Specialty Care Coalition The Children's Specialty Care Coalition is a non-profit association dedicated to educating and advocating for access to quality healthcare for California's children with special healthcare needs. Community Health Councils, Inc. Community Health Councils (CHC) is a non-profit community-based health promotion, advocacy and policy organization. Our mission is to improve health and increase access to quality healthcare for uninsured, under-resourced and underserved populations. Families USA Families USA is a national nonprofit, non-partisan organization dedicated to the achievement of high-quality, affordable health and long-term care for all Americans. First Five Association of California The First 5 Association of California works to improve the lives of California's youngest children and their families through an effective, coordinated, and inclusive implementation of the California Children and Families Act at the local and state levels. Health Access Health Access is a leader in the movement for health care reform in California, promoting state-sponsored universal health care and advocating for specific incremental reforms that promise to provide immediate health care services to California's most vulnerable populations. Institute for Child Health Policy Organization and financing for children and youth with special needs. Insure the Uninsured Project ITUP identifies, assists, and promotes new approaches to expand health care and coverage for California's uninsured. The project focuses on developing common ground and establishing connections among interested and influential parties, to bring about public and private health care reform. Kaiser Family Foundation The Henry J. Kaiser Family Foundation is an independent philanthropy focusing on the major health care issues facing the nation, providing facts and analyses for policymakers, the media, the health care community, and the general public. Latino Coalition for a Healthy California Latino Coalition for a Healthy California is the leading organized voice for policies, services, and conditions to improve the health of Latinos. Maternal and Child Health Access The mission of Maternal and Child Health Access is to improve the health of low income women and families through advocacy, education, training and direct services. MomsRising.org is working to bring together millions of people who share a common concern about the need to build a more family-friendly America. We are working to create both cultural and legislative change. National Center for Education in Maternal and Child Health Provides national leadership to the maternal and child health community in three key areas - program development, policy analysis and education, and information dissemination - to improve the health and well-being of the nation's children and families. National Health Law Programs The National Health Law Program is a national public interest law firm that seeks to improve health care for America's working and unemployed poor, minorities, the elderly and people with disabilities, serving legal services programs, community-based organizations, the private bar, providers and individuals who work to preserve a health care safety net for the millions of uninsured or underinsured low-income people. National Immigration Law Center The National Immigration Law Center is a national support center whose mission is to protect and promote the rights and opportunities of low-income immigrants and their family members. PICO California PICO seeks to create new public policies and to change existing public policies in health care, education, housing, fair wages, immigration and other areas that emerge as priorities from our member congregations. Regional Council of Rural Counties The Regional Council of Rural Counties is dedicated to representing the collective unique interests of its membership, providing legislative and regulatory representation at the State and Federal levels, and providing responsible services to its members which will enhance and protect the quality of life in rural California counties. Small Business California Small Business California is a proactive, non-partisan business advocacy organization whose only agenda is the well being of California small businesses. Working for all California small businesses for a better business environment, SB-Cal is responsive to the needs of California small business owners. Small Business Majority Small Business Majority is a national nonprofit organization of business entrepreneurs working to ensure prosperity in the 21st century economy by building a politically aware and active community of small business leaders. Teachers for Healthy Kids brings together health insurance plans and teachers dedicated to improving the health of students and increasing their chances of academic success. Working together with parents, school nurses, school support staff, administrators, government agencies and community groups, the project seeks to ensure that all children can obtain no or low cost health coverage. To improve lives by mobilizing the caring power of communities. Western Center on Law and Poverty The Western Center on Law and Poverty is a non-profit legal services program devoted to high-impact poverty law litigation and legislative advocacy in the state of California. Zero to Five An excellent source of quality information about the health, development and education of pre-school children, including links, news items, a searchable database of services, tips for parents, and Hispanic resources for families, educators, and anyone interested in issues that affect children. Consumer [return to top] California Health Scope The Pacific Business Group on Health California Consumer HealthScope is an independent source of information to help you select the best quality health plans, hospitals and medical groups. California HMO Report Card The California Office of the Patient Advocate website includes an HMO Report Card, which can be used to compare the quality of California HMOs. The California Patient's Guide This guide is intended to inform you of your rights as a patient to receive quality medical care and what steps you can take if you encounter problems. Health Consumer Alliance HCA is a partnership of consumer assistance programs operated by community-based legal services organizations. Our common mission is to help low-income people obtain essential health care. Health Finder Government site for health information, choosing quality care and other issues. Health Rights Hotline The Health Rights Hotline provides free assistance and information about your rights in health care. We serve residents of El Dorado, Placer, Sacramento and Yolo counties in California. KidsHealth.org From the Nemours Foundation, health care information for kids, teens, parents and professionals with features such as health games, "How the Body Works" animations, and the KidsVote health poll. Mejorando la calidad de la atención médica Consejo acerca de lo que se puede hacer para obtener una buena calidad de la atención médica y evitar errores medicales. (Advice in Spanish on what people can do to obtain quality care) Foundations [return to top] The California Endowment The California Endowment's mission is to expand access to affordable, quality health care for underserved individuals and communities, and to promote fundamental improvements in the health status of all Californians. The California HealthCare Foundation is an independent philanthropy committed to improving the way health care is delivered and financed in California. By promoting innovations in care and broader access to information, our goal is to ensure that all Californians can get the care they need, when they need it, at a price they can afford. David and Lucile Packard Foundation The David and Lucile Packard Foundation is a private foundation. We accept grant proposals only for charitable, educational, or scientific purposes, primarily from tax-exempt, charitable organizations. Government [return to top] California Office of the Governor Information on the Governor of California, including the budget, policy and other statewide issues. Includes information on how to contact the Governor. California State Assembly Find your local Assemblymember and learn about legislation being considered by the State Assembly. Includes the ability to search for legislation by topic and bill number. California State Senate Find your local Senator and learn about legislation being considered by the State Senate. Includes the ability to search for legislation by topic and bill number. Centers for Medicare and Medicaid Services Administrator of federal Medicare, Medicaid and SCHIP programs. Department of Health Care Services Information on the administration of the Medi-Cal program as well as public information on other DHCS services. Managed Risk Medical Insurance Board Information on initiatives and policies surrounding the Healthy Families, Access for Infants and Mothers and other MRMIB programs. Project Vote Smart Profile information for federal elected officials and candidates is available in five categories: contact and biographical information, key votes, issue positions, campaign contributions, and interest group ratings from over 100 groups across the ideological spectrum. SmartVoter.org Smart Voter is produced by the League of Women Voters of California to provide voters with comprehensive nonpartisan information about the contests on their ballot in an easy-to-use presentation and to provide a means for candidates to publish information about themselves and their candidacy directly to voters. THOMAS - Federal Legislative Information Federal legislative information available to the public via the Library of Congress. You can search for legislation by topic or by bill number. U.S. Department of Health and Human Services Find press releases, fact sheets and policy forums, in addition to information on Health and Human Services Agencies such as the Food and Drug Administration, Centers for Disease Control, and the Administration for Children and Families. Also includes a section called "Healthfinder" where you can search topics A-Z. U.S. House of Representatives News and legislation from the U.S. House of Representatives. Includes information on how to locate your Representative and provides their contact information. U.S. Senate News and legislation from the U.S. Senate. Includes information on how to locate your Senator and provides their contact information. The White House Resources on the Presidency of the United States including an online contact form to inform the President of your views on politics and policy. Research [return to top] Agency for Healthcare Research and Quality AHRQ research provides evidence-based information on health care outcomes, quality and cost, use and access. Information from AHRQ's research helps people make more informed decisions and improve the quality of health care. California Health Interview Survey AskCHIS allows you to select health topics from the California Health Interview Survey that interest you and create tables and graphs. Centers for Disease Control and Prevention The general information feature includes access to a variety of CDC reports, guidelines, publications, public health data, products, and subscription information. Child Trends, Inc. Child Trends is a non-profit research organization that focuses on research and data analyses on children, youth, and families. Child Trends Databank Child Trends Databank is an important online information resource featuring the most up-to-date data and research on over 70 indicators of child and youth well-being, with new indicators added each month. The Institute for Health Policy Solutions IHPS is an independent, not-for-profit organization with the mission of developing solutions to health system problems in order to expand health care coverage and improve the health and well-being of families and communities through research, policy development, and analysis. Kaiser State Health Facts Online facts about health in California. Medi-Cal Policy Institute The Medi-Cal Policy Institute, established in 1997, is an independent source of information on the Medi-Cal and Healthy Families programs. National Center for Health Statistics A highlight of this site is Faststats, an alphabetized index of virtually all health-related subjects. The National Library of Medicine The National Library of Medicine website offers free access to Medline. Office of Disease Prevention and Health Promotion Features the Guide to Clinical Preventive Services, Second Edition, the Put Prevention Into Practice Home Page, and the Healthy People2000 Home Page. Office of Health Policy The Office of Health Policy (HP) is responsible for major activities in the areas of policy coordination, legislation development, strategic planning, policy research and evaluation, and economic analysis. The Office also calculates the Federal Medical Assistance Percentages (FMAP) which is used in determining the amount of Federal matching funds for some State welfare and health programs. PolicyArchive PolicyArchive.Net is a proposed new Internet-based archive of public policy research. It will initially collect and disseminate summaries and full texts of foundation-funded policy research. It will offer a subject index, an internal search engine, research abstracts, information on researchers and funders, email notifications of new research and even user-generated research reviews. Over time, it will expand to include policy research by universities, governments and international organizations. Public Policy Institute of CA An independent, non-partisan research group dedicated to improving public policy through objective research on economic, social and political issues in California. The RAND Corporation is a nonprofit institution that helps improve policy and decision making through research and analysis. UCLA Center for Health Policy Research The Center's research program provides analysis, information, and data on key health policy areas and issues to improve health outcomes. The Urban Institute The Urban Institute sponsors analyses of various issues affecting children. It's ‘Assessing the New Federalism' project maintains an extensive database of state level facts about children and families.

医学

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Original URL: January 2007 Clinical Update: Comprehensive Herpetic Eye Disease: An Update on Three Culprits By Barbara Boughton, Contributing Writer The herpesviruses are major contributors to infectious disease in humans, and include such threats to personal and public health as cytomegalovirus and Epstein-Barr virus. But perhaps the most recognizable members of this family are human herpesviruses 1, 2 and 3. They are also known, respectively, as herpes simplex type 1, simplex type 2 and varicella-zoster virus. Herpes Zoster The varicella-zoster virus, which is the herpesvirus famous for causing childhood chickenpox, can be reactivated in adult years as herpes zoster, commonly known as shingles. Herpes zoster accounts for 1 percent of all visits to dermatologists. “As we have become an older population, the incidence of herpes zoster has increased,” said Vincent P. de Luise, MD, assistant clinical professor at Yale University. Diagnosis. There are one million new cases of zoster each year in the United States, and between 25 percent and 40 percent of all cases have ophthalmic complications, according to Dr. de Luise. In most cases, herpes zoster ophthalmicus is mild, and usually results in short-term inflammation, such as a temporary keratitis, which usually resolves without topical antiviral treatment. However, a minority of patients can go on to develop recurrent iritis, and are at risk for secondary glaucoma, cataracts, corneal scarring or retinitis that can be sight-threatening. People who are immunocompromised, such as those with HIV or those undergoing treatment with chemotherapy, are especially at risk for serious complications of zoster ophthalmicus, according to Dr. de Luise. Zoster can affect the eye when the trigeminal nerve is involved in the infection. Typically, the virus manifests in an initial painful eruption of vesicles on the forehead, the side of the nose, upper eyelid and eye. The most problematic aspect of zoster is the development of chronic and persistent pain, called postherpetic neuralgia (PHN). In zoster ophthalmicus, PHN usually affects the forehead as well as the eye. The pain of PHN can be severe and disabling, and can so affect patients’ quality of life that they can develop secondary depression and even, rarely, become suicidal. “When PHN develops from the trigeminal nerve, it can be very severe around the eye, and the pain can be incapacitating,” Dr. de Luise said. “It can be devastating.” Treatment. The treatment of herpes zoster includes oral antivirals, administered ideally within the first 72 hours of onset. These medications decrease pain, shorten the duration of viral shedding, and decrease the incidence of keratitis or iritis. Unfortunately, they do not affect the incidence or severity of PHN. There are several antivirals available for herpes zoster infection, including acyclovir (Zovirax), famciclovir (Famvir) and valacyclovir (Valtrex). Dr. de Luise usually uses valacyclovir, since it has the best bioavailability. Artificial tears can also decrease discomfort from the virus. If inflammatory keratitis is problematic, corticosteroid drops and cycloplegics are an option. And if PHN develops, the ophthalmologist should refer the patient to a pain specialist, since the management of this condition is complex. Prevention. With the May 2006 approval of a new vaccine for herpes zoster, Zostavax, the future picture of this condition has become brighter. Results of a clinical trial showed that the new vaccine decreased the incidence of herpes zoster by more than 50 percent and the incidence of PHN by over 65 percent in the age 60-and-older population, the population most at risk for herpes zoster.1 The CDC Advisory Committee on Immunization Practice recently recommended that adults 60 years of age and older be vaccinated with Zostavax. Herpes Simplex 1 and 2 There are two strains of HSV that are clinically important. Historically, most oral and ocular herpes simplex infections have been caused by HSV-1, while most genital herpes infections have been caused by HSV-2. But increasing numbers of ocular infection with HSV-2 are being reported. Diagnosis. Most frequently, initial HSV infection is asymptomatic, with the virus taking up silent residence in the trigeminal ganglion. More than 90 percent of adults demonstrate antibodies to HSV-1, though most cannot recall a symptomatic herpes simplex infection. Most cases of symptomatic herpes are reactivations of the virus. According to David B. Glasser, MD, assistant professor of ophthalmology at Johns Hopkins University, ocular involvement typically includes a follicular conjunctivitis with a tender preauricular node or blepharoconjunctivitis, with vesicular skin lesions. Systemic symptoms and a low-grade fever may be present. Lid margin ulcers and dendritic conjunctival or corneal lesions may also be seen. Most cases are unilateral, Dr. Glasser said. Birth canal exposure can lead to primary HSV infection in newborns. Serious sequelae in infants can include disseminated skin lesions, encephalitis and even death. Survivors may present later with retinal necrosis. According to a 2006 study, one in four people over age 30 is infected with HSV-2.2 “The recent epidemic of genital herpes simplex type 2 infection is likely to result in an increase in neonatal ocular herpes and in delayed cases of acute retinal necrosis syndrome,” the authors of the paper write. Treatment. Treatment calls for topical trifluridine, 1 percent, every two hours until significant epithelial healing has occurred, and then every four hours for approximately one week. Epithelial toxicity due to topical antivirals is inevitable after 10 to 14 days of continuous use. Topical cycloplegics and lubricants may be useful adjuncts. Debridement of the dendritic lesion in addition to use of antivirals may be useful as well, and theoretically reduces viral antigen load presented to the stroma. Dr. Glasser noted that systemic antivirals enter the tear film in sufficient concentrations to treat ocular disease, and can be an effective alternative to topical therapy. “They avoid the epithelial toxicity associated with topical drops, and can be particularly useful in children, where tearing dilutes the topically applied medications,” he said. Systemic antivirals include acyclovir, 400 mg, five times per day, valacyclovir, 1 gm, two times daily, or famciclovir, 250 mg, three times a day. Because of the convenience of less frequent dosing, most patients and clinicians prefer valacyclovir. Dr. Glasser described some complications of ocular herpes and its treatment. “Trophic epithelial ulceration may follow the occurrence of a dendritic lesion. It is important to differentiate trophic ulceration and antiviral toxicity from ongoing epithelial infectious disease. Trophic ulcers are due to abnormal epithelial healing, with no replicating virus. They often demonstrate a raised, rolled edge with pooling of fluorescein or rose bengal in the base, but no epithelial staining as would be seen in a dendritic lesion. Trophic ulcers are treated with aggressive preservative-free lubricants and cessation of topical antivirals. Recalcitrant cases may respond to autologous serum drops or amniotic membrane transplantation. “These patients need to be monitored carefully for development of stromal thinning or superinfection,” he said. “Stromal disease is seen in about 20 percent of those with recurrent ocular HSV, with rates as high as 60 percent in children. Stromal involvement, resulting in scarring and irregular astigmatism, accounts for most visual loss due to HSV. Nonnecrotizing stromal disease is primarily an immune phenomenon, and may encompass interstitial keratitis with unifocal or multifocal patchy interstitial opacities or disciform edema, with a round or oval area of epithelial and stromal edema. Necrotizing stromal keratitis is less common.” Dr. Glasser described the mainstay of therapy for stromal HSV disease as topical corticosteroids, such as prednisolone, with an antiviral cover to prevent recurrence of active infectious keratitis. “The antiviral cover should be continued until the topical steroid has been reduced to the equivalent of one drop of 1 percent prednisolone per day. Topical trifluridine is effective, but prolonged use can lead to epithelial toxicity. Twice a day dosing with oral acyclovir, 400 mg, or valacyclovir, 500 mg, is also effective, penetrating better than topical drops for treatment of deep stromal disease, and avoiding the risk of epithelial toxicity. Topical lubricants and cycloplegics, and systemic matrix metalloproteinase inhibitors such as tetracyclines are useful adjuncts.” Prevention. Dr. Glasser added that the control of herpes recurrences is paramount in reducing the risk of visual loss due to stromal disease. Oral acyclovir, 400 mg, twice a day, has been shown to reduce the risk of both epithelial and stromal recurrences by about half.3 Many clinicians now use valacyclovir, 500 to1000 mg once daily for prophylaxis. ___________________________ 1 Oxman, M. et al. N Engl J Med 2005;352:2271–2284. 2 Pepose, J. S. et al. Am J Ophthalmol 2006;141:547–557. 3 Rezende, R. A. et al. Am J Ophthalmol 2006;141:1120–1125. Copyright © 2014 American Academy of Ophthalmology

医学

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Chronic Heartburn Could Spur Asthma in Some Patients Study reinforces the link, and a new test might be better at spotting the problem, experts say FRIDAY, Jan. 25 (HealthDay News) -- Chronic heartburn is a major cause of asthma in adults, a new study suggests. The finding could help add asthma to the known health risks -- including esophageal cancer -- already associated with chronic heartburn, which is formally known as gastroesophageal reflux disease (GERD) and is one of the most common digestive disorders in Western nations. GERD occurs when a muscle at the end of the esophagus fails to close properly. This allows stomach contents to leak back (reflux) into the esophagus and irritate it. GERD symptoms include frequent heartburn, chest discomfort, dry cough, difficulty swallowing, hoarseness or sore throat, and regurgitation of food. In this study, researchers used a new, specially designed catheter that measures levels of acid reflux exposure within the patient's airway. They believe that this new method (known by the acronym HMII) was much more effective than conventional techniques in identifying patients with GERD-induced asthma. The researchers also found that for the majority of patients, asthma symptoms eased after they underwent surgery for GERD, according to the study published Jan. 23 in the journal JAMA Surgery. "We have observed for some time a strong association between GERD and certain pulmonary [lung] diseases, including adult-onset asthma," study author Dr. Blair Jobe, director of the Institute for the Treatment of Esophageal and Thoracic Disease at the West Penn Allegheny Health System, said in a health system news release. "The real challenge, however, has been our limited ability to effectively diagnose these patients and determine who precisely may benefit from surgical intervention," he added. According to Jobe, the newly devised test "is much more sensitive as means of detecting GERD in asthmatic patients than what we have traditionally relied upon." The findings are strong enough to warrant consideration of HMII testing in adults with asthma that is not responding to asthma medications or in those who also have GERD symptoms, he said. One expert wasn't surprised by the findings. "GERD is a common condition affecting millions of Americans," noted Dr. David Bernstein, gastroenterologist and chief of the division of hepatology at North Shore University Hospital in Manhasset, N.Y. He said that "reflux of gastric acid through the esophagus and into the lungs is a common cause of chronic cough and asthma." But it may be too early to advocate for widespread diagnostic testing using the new method, he added. "This new technique is interesting and needs to be further evaluated before it can replace currently accepted diagnostic techniques," Bernstein said. However, he believes that surgery is not always warranted for patients with reflux-linked asthma symptoms. "Surgery for GERD-induced asthma is seldom necessary due to the ability of high-dose anti-acid medications in controlling the vast majority of reflux cases," Bernstein contends. "It is premature to recommend anti-reflux surgery without an adequate trial of anti-acid medications." The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about GERD. SOURCES: David Bernstein, M.D., gastroenterologist and chief, division of hepatology, North Shore University Hospital, Manhasset, N.Y; West Penn Allegheny Health System, news release, Jan. 23, 2013

医学

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Gut Bacteria in Preemies Could Lead to Life-Threatening Infections FRIDAY, March 21, 2014 (HealthDay News) -- Babies born prematurely are at risk for life-threatening bloodstream infections called sepsis beginning 72 hours after they are born, according to a new study. The lower intestines -- often called guts -- of preterm babies contain infectious bacteria, said the research team from Michigan State University, the University of Minnesota and the Washington University School of Medicine in St. Louis. Sepsis occurs when the immune system is having a significant response to a bacterial infection. The body releases chemicals into the blood to fight off the infection. This can lead to shock, organ failure and inflammation throughout the body. In extreme cases, sepsis can be life-threatening, according to a Washington University news release. Premature infants can develop sepsis early on due to germs in the mother's amniotic sac or the birth canal. It's also not uncommon for preterm babies to develop sepsis through the use of IVs, catheters and other tubes. The researchers found that sepsis can also develop after the first few days of life -- known as late-onset sepsis. About 20 percent of premature babies develop late-onset sepsis, according to the news release. Of these babies, 10 percent to 20 percent of those who do not respond to antibiotics die from their infection. Some gut germs may be even more deadly. "There is a tremendous emphasis in intensive-care units throughout the world on stopping infections related to the insertion of IVs, catheters or other tubes, but that leaves a sizable subset of people who get bloodstream infections from germs that don't necessarily reside on the skin," study senior author Dr. Phillip Tarr, a distinguished professor of pediatrics at the Washington University School of Medicine, said in the news release. "It's been suspected that these other infections come from the gut," Tarr said. "This research proves that." In conducting the study, the researchers examined more than 200 premature babies. They collected stool samples as soon as possible after birth to find out what types of bacteria were in the babies' guts. Babies were treated in a hospital with strict rules on infection-control and sepsis rates below the national average. Despite steps to prevent infection, 11 of the infants developed sepsis by three days of life or later. Most of the babies that developed late-onset sepsis had three types of possibly harmful gut germs in their bloodstream: E. coli, S. marcescens and group B strep bacteria, according to the study, which was published March 19 in the journal Clinical Infectious Diseases. The study authors also compared the bacteria found in the blood samples taken from the 11 infected infants to the bacteria found in their stool samples. In seven infants, the bacteria found in stool samples -- taken days or weeks before sepsis developed -- were the same as the bacteria found in blood samples taken later. The researchers concluded that bacteria from the gut caused the infections, rather than bacteria from another part of the body. The researchers also found matching germs in the stool samples of other babies who were in the hospital at the same time. The researchers suggested that bacteria could be spread among infants, but not always cause illness. "No one can be completely sterile; it is inevitable that bacteria will be encountered by infants in these settings," said Tarr, who is also a professor of molecular microbiology. "We do not know the origin of these bacteria in most cases." "However, this study tells us that at least in a subset of infants who develop bloodstream infections, the germ that invades their blood flourishes in their gastrointestinal tracts for at least a few days before it causes sepsis," he said. Doctors could help protect premature infants from dangerous bloodstream infections by developing treatment strategies that target the gut, not just the skin, the researchers said. The new findings could be applied to other patients who are vulnerable to these types of infections, not just preterm infants, study co-author Dr. Barbara Warner, a professor of pediatrics who treats patients at St. Louis Children's Hospital, said in the news release. "[Such patients] include people in intensive-care units or with chronic illnesses, or cancer patients who take medicine that may suppress their immune systems," Warner said. "Late-onset sepsis is not just a disease in preterm infants -- it's a cause of serious illness and death among many acutely ill and immunocompromised patients," she said. The March of Dimes describes common health challenges among premature infants. SOURCE: Washington University School of Medicine in St. Louis, news release, March 19, 2014 A Parent’s Guide to Choosing Child Care Help Your Babysitter Prepare for Anything All Pregnant Women Need Flu Shot: Ob/Gyn Group

医学

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Middle-aged drinking 'impairs memory' By Helen Briggs Health editor, BBC News website Patterns of alcohol consumption may have an impact on dementia risk 'Moderate alcohol dementia risk' Problem drinking in middle age doubles the risk of memory loss in later life, research suggests. A US study found men and women in their 50s and 60s with a history of alcohol abuse were more likely to have memory problems up to two decades later. The study, in The American Journal of Geriatric Psychiatry, adds to growing evidence that excessive drinking can impair mental processing later. Researchers say it is a public health issue that needs to be addressed. Scientists questioned 6,500 US middle-aged adults about their past alcohol consumption. They were asked three specific questions: Had people annoyed them by criticising their drinking? Had they ever felt guilty or bad about their drinking? Had they ever had a drink first thing in the morning to steady nerves or get over a hangover? Those who answered yes to one of these questions were considered to have a problem with alcohol. They had more than double the risk of developing severe memory impairment, the study found. "We know that alcohol is bad for the brain in general, but it's not just how much you drink but how it affects you," lead researcher, Dr Iain Lang, from the University of Exeter Medical School, told the BBC. "The amount that you drink is important - what is also important is if you experience any problems in your drinking or if other people tell you you have a problem." He advised drinking within recommended daily and weekly amounts and to cut down if affected by any of the items in the questionnaire, as this could increase dementia risk. Hidden cost Dr Doug Brown, director of research and development at the Alzheimer's Society charity, said there was a hidden cost of alcohol abuse, given mounting evidence that alcohol misuse can impact on cognition later in life. "This small study shows that people who admitted to alcohol abuse at some point in their lives were twice as likely to have severe memory problems, and as the research relied on self-reporting that number may be even higher. "This isn't to say that people need to abstain from alcohol altogether. As well as eating a healthy diet, not smoking and maintaining a healthy weight, the odd glass of red wine could even help reduce your risk of developing dementia." Dr Eric Karran, science director at Alzheimer's Research UK, said: "Although studies such as this one can be very useful for observing health trends, it's important to note that they are not able to show cause and effect, and it's not clear whether other factors may also have influenced these results." 18 JULY 2012, HEALTH The American Journal of Geriatric Psychiatry - Home

医学

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Beyond Analysis and Rett Syndrome Research Trust UK Celebrate One Year Anniversary With Record-Breaking Fundraising Success 12/13/2012 11:24:22 AM London, UK - 13 December 2012 - After an incredible year of hard work, determination and data analysis, Beyond Analysis is delighted to announce that its Charity of the Year, Rett Syndrome Research Trust UK, has raised more than £500,000 since July this year as it heads towards its £750,000 goal. As part of the partnership over the past year, Beyond Analysis has provided the charity with analytical and campaign support to help grow its community of supporters and donations. Included in the on-going support, Beyond Analysis provided consultation and support over a free CRM system and integrated automatic feeds from Just Giving and the Rett Syndrome Research Trust UK website, giving the charity a crucial central record of its activity. ‘Change Makers’ Workshops were also held with key fundraisers to enable the charity to help their supporters use its new standardised marketing and data capture tools and materials. Rett Syndrome is an incurable childhood neurological disorder. It most often affects young females when they reach 6-36 months old and disables their speech, normal movement and ability to use their hands. Beyond Analysis has been more than a business partner to Rett Syndrome Research Trust UK, with the entire UK team throwing themselves into a number of fundraising activities on behalf of the charity. Activities have included a pub quiz and bake off day, as well as sponsored endurance events including a team entry into this year’s Royal Parks Half Marathon. The charity aims to top this year’s goal by raising £1 million in 2013. Paul Alexander, co-founder and chief executive officer of Beyond Analysis, said of the work undertaken by everyone at Beyond Analysis: “We’re immensely honoured to be working with Rett Syndrome Research Trust UK to raise awareness of this charitable cause. We have also been absolutely delighted by the results and are proud that everyone here at Beyond Analysis has embraced this worthwhile cause. We’re looking forward to next year’s challenge by providing analytical and campaign support, as well as implementing test and learn methodology to intelligently increase revenue for this important cause”. Rachael Bloom, executive director and parent of a 17-year-old daughter with the disease, said: “We feel very privileged to have worked with such a supportive company and are appreciative of the expertise and fundraising support that Beyond Analysis has brought to our charity. Rett Syndrome is not a disability that many people know about, but thanks to Beyond Analysis, more people are aware of the condition and what we can do as a charity to give these girls and their families a better life. Their ability to analyse data together with their insight to spot patterns within data means that we have been lucky enough to be introduced to opportunities that we didn’t know existed. As a result, they have increased our efforts to use data to boost our fundraising efforts and find a cure for the disease.” About Rett Syndrome Research Trust UK Rett Syndrome Research Trust UK exists for one reason only; to accelerate treatments and cures for Rett Syndrome and related MECP2 disorders. Rett Syndrome Research Trust UK was formed by a small group of parents of daughters with the condition Rett Syndrome, an incurable childhood neurological disorder. This condition affects young females between 6-36 months and disables their speech, normal movement and ability to use their hands. Common symptoms include Parkinson-like tremors, extreme anxiety, seizures and orthopaedic problems. While most of these females do live into adulthood, all are at an increased risk of suffering from sudden unexplained death. The charity works to speed the time it takes to translate these spectacular laboratory developments into treatments and cures for their own children, as well as for girls and women around the world living with Rett Syndrome today. For more information visit http://www.reverserett.org.uk About Beyond Analysis Beyond Analysis is a leading customer insight and strategy business. We believe that the customer should be at the heart of everything we and our clients do, and we’re passionate about using the power of data to achieve this: finding it; collating it; interpreting it; unlocking its value. We work with some of the world’s largest consumer brands to harness the power of their data and adopt a customer-led approach to their decision making. We bring together multiple data sources to interpret consumer trends and give our retail and financial clients a clear line of sight to help them grow their business. Founded in the UK in 2007, most of Beyond Analysis’ 64 employees are headquartered in London. We opened an office in Sydney in 2008, and, following the launch of our unique retail and financial services proposition in 2009, further offices in Warsaw (2010), New Delhi (2010) and Singapore (2011). We also have a partnership with UCS Solutions, an IT solutions and services provider, in South Africa. Amongst others, Beyond Analysis works with Waitrose, Kingfisher Plc (B&Q, Screwfix, Castorama), Commonwealth Bank of Australia, Visa Europe, Visa Inc., Flight Centre, Virgin Blue and Just Giving. For further details please go to www.beyondanalysis.net Contact Information: Claire Hutchison/Evie Porter BA@berkeleypr.co.uk With deCODE genetics, Inc. (DCGN) Deal, Amgen (AMGN) Aims to Discover Drugs Like We Meant to in 1999 10 Questions to Distinguish Real From Fake Science Millions Waiting for Medical "Breakthroughs" Against Neglected Diseases, DNDi Reveals What Do Autistic People Want From Science? Pfizer Inc. (PFE) -- American's Happiest Company? Top 20 R&D Spenders - Not Good Investments Best Biotech CEO of 2012: This Year's Nominees... Who are the 10 Most Well-Connected People in Biotech? Pepsi's New Fat Blocking Soda Unleashed on Japanese Consumers A Note to the Pharm Industry on Obama's Victory • BioSpace.com

医学

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Teams plan for cancer relay Mar 04, 2013 | 1023 views | 0 | 6 | | Each spring Bolivar Countians pool their resources and show their support in Relay For Life's fight against cancer.More than four million people in over 20 countries take part in this global phenomenon to raise much-needed funds for saving lives.Several hundred locals participated in last year's event at the Cleveland High School track and drew in $79,000 in donations.Plans to reach $80,000 in 2013 are already underway.This year’s theme is Rock ‘n Roll Relay — Rockin’ for a Cure and Rollin’ out Cancer.A Bolivar County Relay For Life team and committee meeting will be at the Cleveland School District office at 5:15 p.m. on Thursday."Anyone with a team or anyone interested in forming a team needs to be there," said event co-chair Nancy Nassar. "We will go over details and discuss the different things people will be doing for fundraisers."Meetings will continue on a monthly basis until the main event takes place June 7 at the CHS track.Teams typically average 10 members, but there is no rule against having more or less."We just ask that every team member raise at least $100 in order to get a T-shirt," said Nassar.Some teams hold special events prior to the big affair to help build their fundraising totals.The Morrison Chapel Baptist Church team will be organizing a 5k walk/run on April 13 to boost team funds. Those interested in registering for the event should contact Nassar at 662-719-1210.Even those not intending to join a team are encouraged to attend the official relay in June."We want to stress that this is a community event," said Nassar. "Even if someone is not on a team they can support the cause by buying a hamburger or hot dog or walking around the track."Everyone is affected by cancer. Relay For Life is a great way to show your support. We are confident we'll reach our goal this year."Nassar said some new activities will be added to the schedule in 2013, but they are being kept secret for the meantime.The typical format of Relay is summarized as an organized, overnight community fundraising walk.Teams take turns walking around the track, while food, games and entertainment build camaraderie during the event.The atmosphere is family-friendly for the entire community.To learn more about Bolivar County Relay For Life, visit the Facebook page at www.facebook.com/AmericanCancerSocietyRelayForLifeClevelandMs.Learn more about the organization behind the movement at www.relayforlife.org. Walking to fight cancer

医学

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Cartwright Inquiry The facts about the Cartwright Inquiry Unethical Experiment at National Women’s Hospital 1984 McIndoe Paper Metro Article The Cartwright Report Timeline & Summary Medical Follow-up Linda Bryder: Revisionism Controversy 2012 Posted on 7 December, 2011 by Phillida 9 The Cartwright Inquiry & the Reform of Patients Rights & Medical Ethics Continuing Controversy Recent Revisionism The Purpose of www.cartwrightinquiry.com THE CARTWRIGHT INQUIRY AND THE REFORM OF PATIENTS RIGHTS & MEDICAL ETHICS In June 1987 Phillida Bunkle and Sandra Coney published an article ‘An “Unfortunate Experiment” at National Women’s Hospital’, Metro magazine. The article described unethical research conducted at Auckland University’s prestigious Post-Graduate School of Obstetrics and Gynaecology. The School was located at National Women’s Hospital which was New Zealand’s leading teaching hospital in Obstetrics and Gynaecology. The results of this research into the ‘natural history’ of CIS of the cervix had been published in 1984 in the prestigious medical journal Obstetrics and Gynaecology in an article by Mcindoe, Mclean, Jones and Mullins. The authors provided an retrospective anlysis of the results for groups of women who had been addequately treated and their leisions eliminted and those who had been followed with continuing evidence of disease. The 1987 Metro article by Bunkle and Coney explained that women with precancerous carcinoma in situ of the cervix (CIS), and some with micro invasive cancer of the cervix or vaginal vault had, without their knowledge, received repeated diagnostic biopsies and cervical smears, but had been left untreated or undertreated in order to study the extent to which these lesions developed into invasive cancer. The result was that many developed invasive cancer and some died. The article revolved around the experiences and case notes of patient Clare Matheson, known then as patient ‘Ruth’, who developed invasive cancer after initially having only diagnostic biopsies. The article provided evidence that in 1966 the study of CIS had been formalised into a research programme, which had never been formally ended. Even when, in the early 1970’s, deaths occurred and the dangers had become apparent, the institution did not act to save the remaining patients, and marginalised critics of the programme within the hospital. The Board, senior clinicians and professors of Auckland University, particularly its head, Professor Bonham were implicated The government responded by setting up a judicial inquiry entitled the ‘Committee of Inquiry into Allegations Concerning the Treatment of Cervical Cancer at National Women’s Hospital and into Other Related Matters’. The processes and evidential rules of a judicial inquiry are those of a court of law, but with additional powers of independent of investigation. Headed by District Court Judge Silvia Cartwright in became known as the Cartwright Inquiry. The findings and recommendations of the Inquiry were published by the Government on 5th August 1988 in what has become known as the Cartwright Report. The Report found that the allegations made in the original Unfortunate Experiment article were largely correct. Cartwright was critical of the objectification of patients and the connection this implied to inhuman treatment. The Cartwright reforms were based on four important and related innovations: An understanding of ‘treatment’, which went beyond medical procedures and included respect for the patient’s human dignity, including their right to effective communication and informed consent. A human rights approach to patient’s rights. The development of a legislated Code of Patients Rights. An independent Health Commissioner, external to the medical professions, charged with adjudicating medical providers conformity to the Code and enforcing its provisions and compensating victims. This system of accountability to patients external to the medical profession remains unique but is usually seen as a substantial reform of the health system. The recommended changes also included the implementation of a successful population based, free-to-user, national cervical screening programme with provision of ethnically appropriate community-based lay smear takers, and the establishment of independent ethics committees focused on protecting patients composed of half lay membership and chaired by a layperson. The Judge also recommended an independent recall and review of cases where the women might still be at risk. This was resisted by the Hospital. The independent recall identified an additional death and another case of invasive cancer while one quarter of the affected women needed further follow up. The development of a patient-centred health system also led to the participation of consumer representatives, including Maori and Pacific Islands women, at many levels of health policy decision making. The Cartwright Report located responsibility within the structures of power within the hospital and university in which important differences of professional opinion became personalized. Following investigation the Medical Council of New Zealand upheld professional charges against Professor Bonham, Professor Seddon and Dr. Bruce Faris. The charges against Associate Professor Green were not heard because he was unfit. An application for judicial review of the Inquiry by Valarie Smith, a friend and neighbour of Professor Green, and Dr. Faris, a gynaecologist , was struck out by the High Court. There have been a number of public media challenges to the conduct of the Inquiry and the content of the Report. These include in March 1989 claims the Inquiry was ‘based on a scam’ in the Dominion Sunday Times by Dr Graeme Overton, a National Women’s gynecologist. This was followed in November 1989 by an article ‘Trial In Error’ in the New Zealand Listener; in which Wellington GP Dr Erich Geiringer attacked the Cartwright Inquiry as ‘unbalanced’ because the matter was raised by feminists. Finally a July 1990 Metro article by Jan Corbett entitled ‘Second Thoughts on the Unfortunate Experiment at National Women’s Hospital’ repeated accusations that the inquiry was a ‘radical feminist witch-hunt’. The Government officially replied to these allegations and continued to support the Report. These challenges have however been reinvigorated by further controversy from within Auckland University. A history of the ‘Unfortunate Experiment’ at National Women’s Hospital by history Professor Linda Bryder, published by Auckland University Press in 2009 and internationally in 2010 questions the reality of the ‘experiment’ and the findings of the Cartwright Inquiry. Professor Bryder also argues that there were no adverse effects on the women involved and that the recommendations for reform made little contribution to changes already underway within medicine and patients rights. Professor Bryder’s claims have been refuted in a number of academic publications. In 2008, Dr Margret McCredie, Professor Charlotte Paul and others had published a paper in The Lancet Oncology which examined cases in the hospital from 1955-1976 and provided convincing support for the Inquiry’s findings about the risks to women who received only diagnostic biopsies compared to those in whom lesions were removed and successfully followed up to ensure they had been eliminated. The study showed that women who initially had their lesions fully removed had a progression rate of 0.7% at 30 years while those having only diagnostic procedures had a progression rate of 31.3%. Of these women, the rate of invasion in those who also had evidence of continuing abnormalities two years after diagnosis was 50.3%. Delays in treatment of curative intent were thus shown to be dangerous. Following the Publication of Professor Bryder’s book, an Auckland law professor Jo Manning, edited a collection entitled The Cartwright papers: essays on the cervical cancer inquiry 1987-88 which reviewed the Cartwright legacy generally positively and offered a variety of criticism of Professor Bryder’s book. Professor Ronald Jones, writing in the New Zealand Medical Journal has asked ‘Why did so many women develop cancer?’ during the research period. The most important medical refutation of Linda Bryder’s thesis was by Margret McCredie, Professor Charlotte Paul, Professor Ron Jones and others writing in the Australian and New Zealand Journal of Obstetrics and Gynaecology, 2010, contrasting the medical experiences of the women in the study decade with those in the periods before and after. Analysis of the case notes and a review of the original slides and smears showed that Associate Professor Green was not saving women from invasive surgery because cone biopsy had already replaced hysterectomy for the treatment of CIN3 before the study began, and that the women who initially had only diagnostic biopsies eventually had far more procedures, including repeated surgery, than those whose lesions were initially removed. The paper also showed that ‘ women initially managed by punch or wedge biopsies alone had a cancer risk ten times higher than women initially treated with curative intent’. Finally in early 2011 an interchange of views on Cartwright in the New Zealand Medical Journal displayed significant differences between those who support Professor Bryder’s position and others who seek a more patient-centred reconsideration of the lessons learned from the Unfortunate Experiment. Recent exchanges have focused once again on the scientific misconduct which invalidated Associate Professor Green’s results. The Inquiry heard, and subsequent analyses confirmed, that he removed cases where invasive cancer developed from his study series. A document by Professor Charlotte Paul explaining the implications of accepting these fraudulent results for Professor Bryder’s thesis is made public on this site for the first time. Meanwhile the three original protagonists, Clare Matheson, Phillida Bunkle and Sandra Coney have written complaints to Auckland University about serious inaccuracies concerning them in Professor Bryder’s book. These complaints have been dismissed by the University of Auckland. These documents are made public on this site for the first time. This site aims to provide the original texts of the key documents concerning the Cartwright Inquiry and the implementation of its recommendations, along with subsequent research findings which have supported its conclusions. It is hoped that the provision of these texts will allow readers to identify the weaknesses in recent criticism of the Cartwright Inquiry and the important reforms which followed. It concludes with the texts of the hitherto unpublished responses of the University of Auckland to concerns raised about these errors. Posted in Uncategorized | Tagged cartwright inquiry, cervical cancer, cervical screening, CIS, clare matheson, health and disability commission, informed consent, Linda Bryder, medical ethics, metro article, national womens hospital, patient's rights, Professor Green, unfortunate experiment | 9 Replies

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Hematology/Oncology Fellowship 2014 Update from Dr. McAllister-Lucas Linda McAllister-Lucas, MD, PhD Division Chief and Fellowship Program Director, Hematology/Oncology Thank you for visiting the Children's Hospital of Pittsburgh Hematology/Oncology and BMT Fellowship website. I look forward to sharing information with you about our program, which is designed to train the future academic leaders in our field. We provide outstanding training and mentorship in clinical care, and the extraordinarily rich research environment of our Division, our Department of Pediatrics, our University of Pittsburgh Cancer Institute and our University of Pittsburgh School of Medicine affords virtually limitless opportunities for our trainees. Children’s Hospital of Pittsburgh provides a comprehensive and balanced clinical experience. We are consistently ranked as one of the best Children’s Hospitals in the nation with all subspecialties represented. We are the only dedicated children's hospital in the Pittsburgh metropolitan area, and we also serve a wide geographic region outside of Pittsburgh, including the Western half of Pennsylvania and portions of Ohio, West Virginia and New York. This large catchment area leads to extensive exposure to both common and rare hematologic and oncologic disorders of children, adolescents and young adults. We are excited to share with you the wealth of research opportunities that are offered to our Pediatric Hematology and Oncology Fellows. We are proud to provide excellent and diverse mentorship and support to those interested in clinical research, including the option of completing master’s level training during fellowship through our Institute for Clinical Research Education (ICRE). For those interested in basic laboratory research, a broad range of training experiences are available, including those within the Division of Hematology Oncology as well as throughout the larger university community of collaborative research. Our Fellowship Program is rooted in a strong, collaborative relationship among the fellows and faculty. We work as a team to provide state-of-the art care for our patients, advance our field through cutting edge research, and train the best and brightest pediatric hematologists and oncologists who will lead us to a future of improved understanding and treatment of hematologic and oncologic disease. Please explore our website to find further information about our fellowship program including clinical care, research opportunities, didactic curriculum and information about our fellow alumni. Please feel free to contact us if you have any additional questions about our program. Faculty Research Activities Fellowship Didactic Curriculum Hematology/Oncology Fellowship Graduates How To Apply

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Click for link to dabl®, founding sponsor and provider of disease management systems for cardiovascular diseases. Welcome to Educational Trust The need for a Website The diagnosis and management of hypertension is dependent on accurate measurement of blood pressure - if the measuring device (sphygmomanometer) produces inaccurate figures, it follows that incorrect management decisions will be made. It follows, therefore, that the consumer, whether medical or lay, should be able to obtain information on the accuracy of a device. However, the majority of devices on the market have not been evaluated independently for accuracy. In an effort to provide this information papers have been published in the medical literature from time to time, but such surveys have the disadvantage of being obtainable only by journal subscribers, and the information soon becomes outdated in that this forum cannot keep pace with the availability of new devices. This website was founded to overcome these difficulties by making up-to-date evidence-based information available on the Internet to consumers and the device manufacturing industry. It is hoped that by doing so, blood pressure measurement will become more accurate, resulting in improved management and benefit to many millions of patients at risk from heart attack and stroke. It is anticipated that this portal will be used to facilitate the speedy announcement of validation results and consumer information on blood pressure measuring devices. How the website was established The following fundamental steps were put in place to ensure the integrity and independence of the website: The dabl® Educational Trust Limited was established by William J. Rickard and Prof Eoin O'Brien in 2003 to oversee the website as a not-for-profit educational venture An Advisory Board was appointed consisting of international experts in blood pressure measurement, who could be called upon to advise on the structure and content of the website and to ensure its independence Staff have been trained to up-date the website with evidence-based information on blood pressure measurement Foundation sponsorship was provided by dabl® Ltd who is the leading provider of disease management systems and research tools for the prevention and management of Stroke, Heart Attack, High Blood Pressure, Anticoagulation and a range of other Cardiovascular conditions. For high blood pressure, dabl®ABPM is the only system in the world which links to a range of validated blood pressure monitors and automatically provides an interpreted one page blood pressure report for the medical team and the patient. On-going sponsorship is being provided by a number of manufacturers committed to enhancing knowledge and education in hypertension. William J Rickard, Managing Director, dabl®Educational Trust Limited © Copyright dabl®Educational Trust Ltd 2002-2013. All rights reserved. Please read Disclaimer before using this website. << Back<< | Top | Sitemap| >>Next Page>> For optimal viewing please use MS Internet Explorer version 5.0 or greater or Netscape Navigator version 4.0

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