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U.S. health spending rose 3.7 pct in 2012 as economy dragged Source: Reuters - Mon, 6 Jan 2014 21:48 GMT By Caroline Humer Jan 6 (Reuters) - U.S. healthcare spending rose 3.7 percent in 2012 to $2.8 trillion, the fourth year in a row in this range as the slow economic recovery tempered private insurance use, drug prices fell and the government held back payment increases for doctors, the Obama administration said on Monday. Since 2009, increases in spending on healthcare have run from 3.6 percent to 3.8 percent, below pre-recession rates which have been falling since their peak in 2003, the report from the U.S. Centers for Medicare and Medicaid Services said. "The relative stability since 2009 primarily reflects the lagged impact of the recent severe economic recession," Anne Martin, an economist in the Office of the Actuary at CMS said during a news briefing. On average, the cost for medical care was $8,915 per person in 2012, up from $8,658 per person in 2011. The report comes as more than 2 million Americans on Jan. 1 began receiving new coverage under President Barack Obama's healthcare reform law, commonly known as Obamacare. The law, passed in 2010 and formally called the Affordable Care Act (ACA), aims to extend insurance to millions of previously uninsured or underinsured Americans through online exchanges that offer government subsidies based on income. It also expands the Medicaid program for the poor in nearly half of the states. The report did not estimate how the ACA might affect 2014 spending, and the data for 2012 is the most recent official government information detailing expenditures for healthcare. Reining in that spending is seen as an important step toward tackling the U.S. budget deficit. Obama's healthcare reform law had minimal impact on national health spending through 2012, the report said. One exception was in the Medicare program for seniors, where the ACA was responsible for reduced payment increases to doctors and hospitals in 2012, it said. Jeanne Lambrew, a senior White House official responsible for healthcare policy, said in a blog post that the report is encouraging. "While there is a debate about how much the Affordable Care Act has contributed to this health cost slowdown, there is no doubt that it reduced Medicare spending growth, and most experts believe that Medicare savings spill over into the private sector," Lambrew said. She also pointed to how health spending is taking a smaller bite out of the economy. Healthcare spending accounted for 17.2 percent of gross domestic product in 2012, slightly down from 17.3 percent in 2011 when spending growth was 3.6 percent, according to the report. "That's relatively stable because the change is subject to revision and also is less than a tenth of a percentage point," Martin said. Spending on hospitals and physicians grew in 2012 but was offset by lower drug costs as cheaper generic versions hit the market, the report said. The growth of enrollment in Medicaid slowed, and Medicare spending growth increased at a slightly reduced pace. Personal healthcare spending on goods and services, which accounts for 85 percent of the national total, grew 0.4 percentage point more in 2012 than in 2011's 3.9 percent rate. Spending by consumers on services not covered by their insurance, or out-of-pocket costs, increased by 3.8 percent, the report said. That has occurred as employer-based insurance plans have increasingly asked consumers to pay a bigger share of the overall cost. There were some signs that use by consumers of medical services increased in 2012 as spending on hospital services rose 4.9 percent, the report said. Gary Claxton, a health economist at the Kaiser Family Foundation who was not involved in the study, said that 2013's healthcare spending growth is expected to have been similar to 2012 but that it is not clear what 2014 will bring. "We are going to get some new coverage under the ACA, but a lot of it is going to have fairly steep cost sharing," Claxton said. "People have to pay more for themselves and they have fewer resources to do it with because the economy is tight." We welcome comments that advance the story through relevant opinion, anecdotes, links and data. If you see a comment that you believe is irrelevant or inappropriate, you can flag it to our editors by using the report abuse links. Views expressed in the comments do not represent those of the Thomson Reuters Foundation. For more information see our Acceptable Use Policy.

医学

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UC Davis Medical Center Health System > Medical Center > UC Davis investigators achieve important step toward treating ... About Finding a Doctor Our Nursing Staff Values and Philosophy 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 Patient & Community Satisfaction MyChart Clinical Trials Search for 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 UC Davis School of Medicine Betty Irene Moore School of Nursing Learn about Job Opportunities Our Medical Group Media Contact(s) Charles Casey NEWS | January 19, 2012 UC Davis investigators achieve important step toward treating Huntington's disease Stem cells show promise for delivering gene therapy for the currently incurable disease (SACRAMENTO, Calif.) — A team of researchers at the UC Davis Institute for Regenerative Cures has developed a technique for using stem cells to deliver therapy that specifically targets the genetic abnormality found in Huntington's disease, a hereditary brain disorder that causes progressive uncontrolled movements, dementia and death. The findings, now available online in the journal Molecular and Cellular Neuroscience, suggest a promising approach that might block the disease from advancing."For the first time, we have been able to successfully deliver inhibitory RNA sequences from stem cells directly into neurons, significantly decreasing the synthesis of the abnormal huntingtin protein," said Jan A. Nolta, principal investigator of the study and director of the UC Davis stem cell program and the UC Davis Institute for Regenerative Cures. "Our team has made a breakthrough that gives families affected by this disease hope that genetic therapy may one day become a reality."Huntington's disease can be managed with medications, but currently there are no treatments for the physical, mental and behavioral decline of its victims. Nolta and other experts think the best chance to halt the disease's progression will be to reduce or eliminate the mutant huntingtin (htt) protein found in the neurons of those with the disease. RNA interference (RNAi) technology has been shown to be highly effective at reducing htt protein levels and reversing disease symptoms in mouse models."Our challenge with RNA interference technology is to figure out how to deliver it into the human brain in a sustained, safe and effective manner," said Nolta, whose lab recently received funding from the California Institute for Regenerative Medicine to develop an RNAi delivery system for Huntington's disease. "We're exploring how to use human stem cells to create RNAi production factories within the brain."Jan NoltaHuntington's disease affects more than a quarter of a million Americans. The disorder can be passed down through families even if only one parent has the abnormal huntingtin gene. The disease is caused by a mutation in the gene, which is comprised of an abnormally repeating building block of DNA that appears on the fourth chromosome. While the building block pattern normally repeats up to 28 times on the chromosome, too many repeats cause an abnormal form of protein -- known as the huntingtin protein -- to be made. The huntingtin protein accumulates in the brain, causing the disease's devastating progression. Individuals usually develop symptoms in middle age if there are more than 35 repeats. A more rare form of the disease occurs in youth when the abnormal DNA pattern repeats many more times.The UC Davis research team showed for the first time that inhibitory RNA sequences can be transferred directly from donor cells into target cells to greatly reduce unwanted protein synthesis from the mutant gene. To transfer the inhibitory RNA sequences into their targets, Nolta's team genetically engineered mesenchymal stem cells (MSCs), which were derived from the bone marrow of unaffected human donors. Over the past two decades, Nolta and her colleagues have shown MSCs to be safe and effective vehicles to deliver enzymes and proteins to other cells. She said finding that MSCs can also transfer RNA molecules directly from cell to cell, in amounts sufficient to reduce levels of a mutant protein by over 50 percent in the target cells, is a discovery that has never been reported before and offers great promise for a variety of disorders."Not only is finding new treatments for Huntington's disease a worthwhile pursuit on its own, but the lessons we are learning are applicable to developing new therapies for other genetic disorders that involve excessive protein development and the need to reduce it," said Nolta, who recently received a prestigious Transformative Research Grant from the National Institutes of Health to study how mesenchymal stem cells can transfer microRNA and other factors into the cells of damaged tissues, and how that process can be harnessed to treat injuries and disease. "We have high hopes that these techniques may also be utilized in the fight against some forms of amyotrophic lateral sclerosis (Lou Gehrig's disease) as well as Parkinson's and other conditions."The article, "Examination of mesenchymal stem cell-mediated RNAi transfer to Huntington's disease affected neuronal cells for reduction of huntingtin," was co-authored by Scott D. Olson, now with University of Texas Health Sciences Center at Houston. Other authors were Amal Kambal, now at Washington University in St. Louis; and Kari Pollock, Gaela-Marie Mitchell, Heather Stewart, Stefanos Kalomoiris, Whitney Cary, Catherine Nacey and Karen Pepper, with the UC Davis Institute for Regenerative Cures. Funding for the research was provided by the California Institute for Regenerative Medicine and Team KJ. UC Davis is playing a leading role in regenerative medicine, with nearly 150 scientists working on a variety of stem cell-related research projects at campus locations in both Davis and Sacramento. The UC Davis Institute for Regenerative Cures, a facility supported by the California Institute for Regenerative Medicine (CIRM), opened in 2010 on the Sacramento campus. This $62 million facility is the university's hub for stem cell science. It includes Northern California's largest academic Good Manufacturing Practice laboratory, with state-of-the-art equipment and manufacturing rooms for cellular and gene therapies. UC Davis also has a Translational Human Embryonic Stem Cell Shared Research Facility in Davis and a collaborative partnership with the Institute for Pediatric Regenerative Medicine at Shriners Hospital for Children Northern California. All of the programs and facilities complement the university's Clinical and Translational Science Center, and focus on turning stem cells into cures. For more information, visit www.ucdmc.ucdavis.edu/stemcellresearch. UC Davis Medical Center | 2315 Stockton Blvd. | Sacramento, CA 95817 | 24-hour Hospital Operator: (916) 734-2011

医学

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Contact information Find a doctor Make a Gift Make an Appointment Barth A. Green, M.D., F.A.C.S. is the Faculty Chair for the Global Institute (GI) for Community Health and Development at the University of Miami Miller School of Medicine and President of Project Medishare (PM), which is a partner of the GI. Dr. Green is presently in Haiti with a group of medical professionals providing emergency care and assessing the situation and how the GI and PM can provide the necessary aid needed. He has organized a team at the University of Miami State side to pull together volunteers and the needed medical supplies. Additionally, Dr. Green indicates that monetary donations are our greatest needed at this time to get our volunteers and medical supplies to Haiti. We are appreciative and grateful for any assistance you may be able to provide. You can make a tax-deductible contribution on-line in less than a minute: You can also donate by calling: 305-284-4443 or by mailing a check to the following address: Global Institute Miller School of Medicine 1801 N.W. Ninth Ave. Suite 470 (M701) Please make checks payable to "UM Global Institute Haiti Disaster Relief Fund.” University of MiamiHealth System University of Miami Health System Additional Information Patient Services Careers Locations Legal Terms of Use Privacy Statement Copyright ©

医学

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Glennon News ER & Trauma Services Getting Ready to Visit Kohl's 4 Kids Request Patient Records Cord Blood Bank Safe Kids School for Patients Epic Care Link Perinatal Outreach Physician Services Dept. Resources in the Community Plastic Surgery - Congenital Lesions of the Skin and Soft Tissue (Birthmarks) Congenital Melanocytic Nevi What are Congenital Melanocytic Nevi?Treatment of Congenital Melanocytic Nevi Sebaceous nevi What are Sebaceous nevi?Treatment of Sebaceous nevi Congenital lesions of the skin and soft tissue represent a group of birthmarks that include congenital melanocytic (pigmented or colored) nevi, sebaceous nevi, and various other skin lesions. Congenital Melanocytic Nevi What are Congenital Melanocytic nevi? Congenital melanocytic nevi (CMN) are the most common congenital skin lesions. They’re made up of abnormal collections of melanocytes (pigment producing cells) within the skin and soft tissue. They vary greatly in their appearance, and can appear within the first year of life as the cells begin to produce more pigment. Their color can vary from pale tan to a deep bluish black, which may be uniform or irregular, and are often thick in texture with hair which ranges from fine, light fuzz to coarse, thick follicles. CMN can be classified based on their expected size at adulthood into small (<1.5cm), intermediate (1.5-19.9cm), and large (>20cm) lesions that are quite extensive and cover a massive area of the body. When large lesions are present, they may be accompanied by smaller satellite lesions of different sizes and numbers that can appear during the first 2-3 years of life. Smaller CMN lesions are, by far, the most common occurring in 1 in 100 births. Intermediate lesions occur in 1 in 1,000 births, large lesions in 1 in 20,000 births and giant (>50cm) lesions in 1 in 500,000 births. Although, the exact cause of these birthmarks is unknown, nevi form during development after a disruption in the migration and differentiation of neural crest cells into melanocytes. This causes immature cells to group abnormally along their course of migration instead of more evenly within the skin. Because of this, nevus cells often extend deep into the fat beneath the involved skin and require removal below the deepest level for more accurate results. Treatment of Congenital Melanocytic Nevi CMN lesions do carry a small but measurable risk of transformation into melanoma (skin cancer). Treatment of CMN must balance the potential risk of malignant change (developing into cancer) with cosmetic and functional concerns caused by both the lesion and its reconstruction. The risk for small or medium lesions is quite low, especially before puberty with less than 1 in 200,000 becoming cancerous. However, it may be recommended to remove them because of either the psychological effects caused by these birthmarks or if there is difficulty following them for significant changes (such as lesions of the back or scalp beneath the hair). Removal can often be accomplished in the office under local anesthesia depending on the child’s age and the location of the lesion. Often, a multiple staged approach will be used to help minimize the length and width of the scar, which will be formed in the most favorable direction possible. For more extensive nevi (large), the lifetime risk of melanoma increases to around 5-8% with a tendency for these cancers to arise earlier in childhood. Because of this and the potentially devastating appearance of these lesions, early removal is often encouraged. Because the lesions must be removed with their underlying fat to improve removal of nevus cells, techniques that replace this full thickness of tissue are preferred. The method of tissue expansion involves a staged approach to removal and reconstruction of these larger lesions. This allows for the replacement tissue to have full thickness of normal tissue. A tissue expander is a silicone balloon attached to tubing with a remote port. It is placed under the skin while deflated and then gradually filled with saline over time, allowing the skin above it to stretch. This skin can then be used to cover a large area of removed nevus, and provides a good thickness and color match for reconstruction. This reconstruction technique requires a minimum of two separate surgeries separated by about 10-14 weeks. During the first surgery, an incision is made usually within the borders of the lesion and a pocket is created beneath the nearby normal skin and fat, but above the muscle layer. A partially filled tissue expander is then placed in this pocket under the skin and its port is positioned in a nearby easily accessible area. After a short healing period, we begin filling the expander in clinic. After treating the skin over the port with a cream that numbs the area, small amounts of saline are injected each week through the port. Over time, the expander gradually grows larger and stretches the normal skin. This actually causes the body to produce more skin similar to what happens during pregnancy. Once enough skin is generated, the expander is removed during a second surgery and the skin flaps are created from the expanded tissue. They are then rotated to cover the area of removed nevus. This process can be repeated many times in many different areas to achieve removal of large areas of lesions with functional and aesthetic results. In some cases, reconstruction will require a combination of tissue expansion and other techniques to achieve the most aesthetic result. For example, the ear and eyelid areas will often require skin grafting to recreate the thin tissues that are being removed. In other cases, where there is not enough local skin for adequate expansion, flaps of skin and soft tissue can be moved from another area of the body using a variety of techniques. We work together with patients and their families, to evaluate each child’s specific birthmark and develop a customized, state-of-the-art treatment plan for removal and reconstruction. What are Sebaceous nevi? Sebaceous (oil) nevi present at birth appear as waxy, hairless, yellow-orange plaques usually on the scalp, head, or neck. Sometimes, the lesions can form in lines called linear sebaceous nevus. Over time, these lesions can become nodular, or wart-like, and itchy, especially at puberty. Sebaceous nevi are composed of cells that normally form oil glands; however, why they form is not fully understood. They carry a high risk (15 – 20%) of transforming into basal cell carcinoma, usually after puberty. Removal with reconstruction is strongly recommended. Sebaceous nevus syndrome is the combination of large sebaceous nevi of the scalp and face associated with developmental delay, seizures, and eye and bony abnormalities. Treatment of Sebaceous nevi The treatment of sebaceous nevi is approached similar to congenital melanocytic nevi, using local removal, serial removal, or tissue expansion depending on the size and location of the lesions. During removal, it is important to avoid excessive tension during closure as the surrounding skin tends to have more problems healing otherwise. Because of this, more stages or tissue expansion may be recommended to ensure healing and a better outcome for the final scar. Back to Plastic Surgery At Cardinal Glennon KidsHealth Library Social Media How to Help 2014 Safe Kids Halloween Party on Oct. 26 Boo at the Zoo! HOME | About Us | Family Resources | Support Services | For Professionals | Find a PhysicianHow to Help | Employment | Virtual Tour | Get Directions | Terms/Privacy | Contact Us | Site Map SSM Cardinal Glennon Children's Medical Center • 1465 S. Grand Blvd. • St. Louis, MO 63104-1095 • (314) 577-5600 © SSM Cardinal Glennon Children's Medical Center. All rights reserved.

医学

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South Bend Memorial sells six acres on 49 to Community HC By KEVIN NEVERS Memorial Health Systems of South Bend�which in October 2007 acquired 53.8 acres along Ind. 49 in the City of Valparaiso, with the idea of building a hospital campus there�has sold six of those acres to Community Healthcare System, which operates three hospitals in Northwest Indiana, including St. Mary Medical Center in Hobart. Memorial Health spokesperson Diane Stover confirmed the sale on Monday but was unable to say what plans Community Healthcare might have for the acreage. And a Community Healthcare spokesperson contacted by the Chesterton Tribune had �no information on that at this time.� Memorial Health had originally expected to break ground on a 100-bed acute-care hospital on the site�located at Ind. 49 and C.R. 500N in Washington Township�in 2010. Its plans included an emergency room, an urgent care center, and outpatient services, with the possibility of later expanding to 250 beds. But Stover told the Tribune that those plans are currently on hold until the economy improves. �That project�s still frozen,� she said. �We decided to freeze that project, to wait for a more friendly borrowing market.� Memorial Health attempted unsuccessfully to purchase Porter hospital in 2006, when the Board of Trustees publicly expressed its interest in a sale or merger. But a task force subsequently opted to sell Porter hospital to Triad Inc., which in turn was acquired by Community Health Systems, the nation�s largest for-profit hospital company. In addition to St. Mary Medical Center in Hobart, Community Healthcare also operates Community Hospital in Munster and St. Catherine Hospital in East Chicago.

医学

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Cancer Patients in Distress Find A Helpful Coping Tool at Fox Chase Cancer Center NCCN and ACS Develop Distress Treatment Guidelines for PatientsPHILADELPHIA (January 11, 2005) -- Almost one third of cancer patients experience severe distress, a mix of anxiety and depressive symptoms that can interfere with their ability to cope with the disease. Yet only a few patients seek outpatient psychological help. Distress Treatment Guidelines for Patients are a definitive and first-of-its-kind resource designed to enhance a patient's quality of life, support patient-doctor communications and increase successful cancer therapies by improving a patients' ability to stick with their treatment plan. This free 32-page booklet is now available through your physician or by contacting the American Cancer Society (ACS) via their website (www.cancer.org) or dialing 1-800-ACS-2345.Leading cancer experts from the member institutions of the National Comprehensive Cancer Network (NCCN) first developed the guidelines for physician use. Fox Chase Cancer Center is a founding member of the NCCN. The ACS has translated the guidelines into easy-to-understand language for patients. Helpful tools within include a medical terms glossary and a comprehensive list of available Internet resources."At first, a cancer diagnosis can be devastating," said panel member Michael Levy, MD PhD, vice chairman of medical oncology at Fox Chase. "The treatment regiments and symptoms can be taxing on the emotional and physical well-being of the patient, their family members or caregivers. Distress Treatment Guidelines acts as a faithful consultant and is a proactive step to conquering the disease."According to Levy, feelings of distress range from powerlessness, depression, and anxiety. Poor concentration, feelings of being overwhelmed, and trouble sleeping or eating may represent severe distress. Distress Treatment Guidelines of Patients also includes the do's and don'ts for coping with distress and the distress thermometer, which assesses the extent of distress and the specific problems that are contributing to it."Whether it is the nurse, social worker or myself, I encourage the patient to tell us everything they are feeling," continued Levy. "The more we know, they better we can help." Levy notes that there is so much to cover during office visits that patients often feel they would be a nuisance to bring up distress or any emotional feelings they have. "Patients tend to focus on questions pertaining to their treatment and symptoms and should recognize that relieving their distress is a major part of their successful treatment plan."The most up-to-date-version of the guidelines is also available at www.nccn.org or 1-888-909-NCCN. Fox Chase Cancer Center, part of the Temple University Health System, is one of the leading cancer research and treatment centers in the United States. Founded in 1904 in Philadelphia as one of the nation’s first cancer hospitals, Fox Chase was also among the first institutions to be designated a National Cancer Institute Comprehensive Cancer Center in 1974. Fox Chase researchers have won the highest awards in their fields, including two Nobel Prizes. Fox Chase physicians are also routinely recognized in national rankings, and the Center’s nursing program has received the Magnet recognition for excellence four consecutive times. Today, Fox Chase conducts a broad array of nationally competitive basic, translational, and clinical research, with special programs in cancer prevention, detection, survivorship, and community outreach. For more information, call 1-888-FOX CHASE or (1-888-369-2427).

医学

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Kaweah Delta helipad operational and ready to accept patients Email to a Friend June 5, 2013 General VISALIA – Kaweah Delta Health Care District’s helipad is now operational and ready to accept or transport patients by helicopter. Kaweah Delta staff have completed several months of intensive training to receive patients who arrive by helicopter. Last month, the community celebrated the completion of the $2.7 million helipad. “The helipad’s installation will have far reaching effects for the region,” said Dr. Nichole Meissner, Director of Trauma at Kaweah Delta. “It will help trauma victims get treatment faster and treatment in the first hour has a significant impact on survival, especially when it comes to trauma.” With the helipad, a person who is traumatically injured in Springville could land at Kaweah Delta in just 12 minutes. A newborn in need of a higher level of care could be at Children’s Hospital Central California in just 18 minutes or Stanford Medical Center in 69 minutes. The community, which helped bring the helipad to Kaweah Delta through $2.3 million in donations to Kaweah Delta Hospital Foundation, will benefit greatly from the helipad, said Dena Cochran, Vice President of Development at Kaweah Delta. The foundation raises money to elevate the level of patient care at Kaweah Delta. Kaweah Delta has one of the busiest emergency departments in the state and treated 86,000 patients this past year. It is also the only level III trauma center in Tulare and Kings counties. Since the designation in 2010, the number of trauma patients has increased over 200 percent to over 1,100 trauma patients each year.

医学

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George Washington Wood M.D. III ORONO AND BANGOR - George W. Wood III, M.D., died on March 27, 2014, at Dirigo Pines Retirement Community in Orono. George was 92 years old.George was born in Macon, Ga., on Dec. 5, 1921. He was the only son and youngest of five children of attorney, George W. Wood Jr., and his wife, Daisy Sloan Hunter Wood. George attended public schools in Macon until his family moved to Coral Gables, Fla., where his father continued his law practice. George finished his early public school education in the Miami area, after which he attended the University of Florida, where he graduated in 1943. He then headed north to New York City to pursue his medical degree at Cornell University Medical College, where he graduated in 1946. While at Cornell, George met and fell in love with Adelle Sawyer, a young college graduate from Bouvé Boston School of Physical Education, which, at that time was associated with Tufts. Adelle was the Physical Education Director at the New York School of Nursing, which was affiliated with Cornell. George and Adelle married in 1944 in New York, and a year later they welcomed the first of their six children. After medical school, George and Adelle and their young family moved to Hartford, Conn., where, in the early 1950s, George completed his internship and residency in Internal Medicine at Hartford Hospital with a specialty in lung diseases, specifically, tuberculosis.In 1952 George and Adelle moved their ever-growing family to Brewer where he set up his private practice in Internal Medicine. At the time, George was the only chest specialist in tuberculosis in Maine. Over the next few years he participated in a significant evolution in the treatment of the disease, an evolution that resulted in the closure of most of the TB sanitariums in Maine. In 1955 George and Adelle moved their family again, this time to Adelle's family home at 840 Broadway in Bangor. The home had been purchased by Adelle's father, Haven Sawyer, in 1917. The home at "840" became the center of the Wood family life and a hub of activity for extended family and friends for years to come. It was here that George and Adelle raised and nurtured their children in the spirit of love, devotion, and commitment to family, to community, and service to others. They also instilled in them a strong work ethic, which came into play early on because there was a lot to take care of around their place, and who better able to handle the work than their six, strong able-bodied children! In the early 1970s George and Adelle bought a cabin on the coast of Maine at Oak Point that became a summer gathering place for the Wood family and friends for many years. To this day every summer Wood children, grandchildren, and their families get together at the cabin.During their years in Bangor, George and Adelle became actively involved in many aspects of community life. Adelle focused her attention on the Girl Scouts, the YWCA, and the Special Olympics, among many special interests. George focused his attention in other areas of the community: he served on the Bangor Planning Board (1964-1966), the Bangor School Board (1966-1970: Chairman, 1967), and the Bangor City Council (1978-1981). George and Adelle were strong supporters of music and the arts in Bangor, including the Bangor Symphony. George served for many years on the Symphony Board and was President of the Board from 1985-1987. They were also strong supporters of their local church, All Souls Congregational Church.During his years as a physician, George was very active in medical professional organizations, associations, and local hospitals. He served on the Executive Committee of Eastern Maine Medical Center and was President of Staff, 1959-1960. He also served on the Executive Committee of St. Joseph Hospital and was Chief of Staff, 1970-1971. George was a member of the Maine Medical Association for many years in the 1960s and 1970s; he was President of the Association, 1972-1973. He was a member of the Maine Delegation of the American Medical Association in the mid-1960s; he was Chairman of the New England Delegation of the AMA, 1970-1971. George served on the Board of Directors of the Maine Lung Association, 1957-1983; he served as President of the Board, 1962-1965. He was also on the Board of Directors of the American Lung Association, 1973-1981. George was a founding member of the Maine Thoracic Society in 1955 and served as its President in 1957.George was also very active on the political front. He served on the Republican State Committee from 1974-1978; he was a delegate to the Republican State Convention several years in the 60s and 70s. At the national level, George was a delegate from Maine and a member of the Platform Committee at the Republican National Convention in 1976. And in 1982 George ran for the Maine State Senate.In 1976, after 25 plus years as an MD in the Bangor area, and guided by his interest in the health and well being of young people, George closed his private practice and accepted a position at the University of Maine Cutler Health Center where he served for the next ten years. He started as an Assistant Director, then became Associate Director, and finally became the Director of the Center, a position he held from 1980-1986. During these years George and Adelle were strong supporters of many activities at the university including sports and the arts. In 1985 George began his many years of service on the Advisory Board of the Collins Center for the Arts. In 1986 George retired from the Health Center and from the practice of medicine, but he remained closely connected to medical and community affairs in Bangor and remained involved in activities at the university. George was a Trustee of the University of Maine from 1987-1998. Also after his retirement, George served on the Board of Directors for the Bangor Theological Seminary for several years starting in 1998.In 1988 George's beloved wife, Adelle, died. A year or so later, George began seeing Nancy Nolde, widow of Dr. John Nolde, a professor at the University of Maine. In earlier years George and Adelle and John and Nancy traveled in the same circle of friends within the University of Maine system and at their nearby summer cottages at Oak Point. A couple of years after the deaths of their respective spouses, the friendship between George and Nancy blossomed into love, and they were married in December of 1990. Nancy welcomed her new large family into her life and became affectionately called "Granncy" by the grandchildren.George and Nancy took up residence in Orono where they were very actively involved in many aspects of life at the University of Maine. Both were devoted to the academic, cultural, and athletic activities at the university, including the Hudson Museum, the University of Maine Foundation, the Black Bear Scholarship Fund, and the Collins Center for the Arts. In the early years of their marriage they traveled a great deal, often to visit Wood family members who lived far and wide in the U.S. And they spent many summers at their cottage on the coast of Maine. In 2003 George and Nancy moved to the Dirigo Pines Retirement Community in Orono where they remained until their respective deaths?Nancy died in April of 2013.George was predeceased by his first wife, Adelle; his second wife, Nancy; and his grandson, Tod Schuetz. George is survived by his six children and their families, Winifred "Wink" Schuetz and husband, Chuck, their daughter, Christine, and her husband, Chris Hobbs; Adelle "Dee" Gautschi and husband, David, their daughter, Heidi Gautschi, and her husband, Marc Dupont, and their daughter, Lola, and Dee and Dave's other daughter, Lisa Gautschi; Katherine "Kate" Black and husband, Greg, and their daughter, Jenna; Beth Whitley and husband, Michael; George "Woody" Wood IV and wife, Holly, and their sons, Geordie and Tyler; and Janet Menser and husband, Mark, their son, Luke and his wife, Rachel, and their son, Sawyer, and Janet and Mark's daughter, Michelle and her fiancé, Chris.The Wood family would like to say a heartfelt thank you to all the wonderful staff at Dirigo Pines Retirement Community. We especially appreciate their devotion and care of our father and Nancy during their time in Kenduskeag and for their ongoing love and dedicated attention to our father in the Arbor this last year. We would also like to give many thanks to the folks at New England Home Health and to the staff at New Hope Hospice for their care for our Dad.A Memorial Service will be held 1 p.m. Friday, April 4, at All Souls Congregational Church, 10 Broadway, Bangor, with the Rev. Dr. James L. Haddix, pastor and teacher, and the Rev. Joan Jordan Grant, officiating. The family invites relatives and friends to a reception at the church following the service. Those who wish to remember George in a special way may make gifts in his memory to the University of Maine Foundation, Two Alumni Place, Orono, ME 04469; or to the Bangor Symphony, 891 Broadway, Bangor, ME 04401. Condolences to the family may be expressed at www.BrookingsSmith.com. Funeral Home Brookings-Smith 133 Center Street Bangor, ME 04401 Published in BDN Maine on Mar. 29, 2014 - ADVERTISEMENT -

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Drawing a Connection Between Tears and Health Posted on: Drawing a Connection Between Tears and Health By Loretta Marmer William Frey, PhD, has been intrigued by the biological basis of crying ever since the day his mother asked him, "Why do people cry tears?" The biochemist thought he could simply look up the answer in the nearest medical library. He was wrong. "I was surprised to find there is almost nothing written about it," he said. While Dr. Frey did manage to dig up a few references in the literature, those were either outdated or of questionable validity. As early as 1872, for example, Charles Darwin suggested that crying does relieve stress, but that tears are purposeless. Less than 100 years later, anthropologist Ashley Montagu proposed that crying tears must be a survival mechanism or it wouldn't have evolved as a human function. According to Montagu's theory, when people cry, bacteria and virus-fighting tears moisten the membranes of the nose and throat to ward off infection. "That theory didn't seem sufficient to me," said Dr. Frey, research director of the Dry Eye and Tear Research Center, HealthPartners St. Paul-Ramsey Medical Center, St. Paul, and professor of pharmaceutics at the University of Minnesota in Minneapolis. "We know that many infants cry without tears when they are first born. It can take days or even weeks before they cry tears. If crying tears were so important, I think it would start (in the first days of life)." Besides, studies show adults sob in only one out of 11 crying episodes, Dr. Frey continued. That means that 90 percent of the time people cry, there are only tears streaming down the face. "Tears running down your cheek can't be doing much for your nose and throat," he concluded. Dr. Frey's research shows that 85 percent of women and 73 percent of men said they feel less sad and less angry after a good cry. Intrigued by this finding, Dr. Frey set out to learn why people generally feel better after weeping and hit upon a new theory about the biochemical nature of human tears. Contrary to conventional wisdom, his theory suggests that all tears are not the same--that emotional tears are different from those shed due to eye irritation. To prove his point, he studied the tears of people who had watched a sad movie compared to those shed by people exposed to onion vapors. "Emotional tears had a higher protein concentration than irritation tears," Dr. Frey said. The finding surprised him, given that the volume of emotional tears is generally larger and would seem to dilute the protein levels. Dr. Frey began to examine how the lacrimal glands produce tears and remove substances from the body. His search turned up an interesting piece of information: Researchers have found that in many species of sea birds, such as the albatross, the lacrimal gland performs a function critical to survival. "The glands remove the toxic levels of salt that would kill the birds," he said. "And there is evidence from other species that the tear gland may have an excretory function," Dr. Frey said. Knowing this, Dr. Frey began to ponder the possibility that tears likewise remove "toxins" or other harmful substances from the human body. His search for traces of stress-related hormones in human tear glands and tears was fruitful; in the early 1980s, he discovered that enkephalins (a type of endorphin), adrenocorticotropic hormone, prolactin and the element manganese all are present in human tears. Dr. Frey was especially interested in the presence of prolactin, a hormone produced by the pituitary gland that helps new mothers produce milk. The presence of prolactin, Dr. Frey thought, might provide clues as to why women seem to cry more frequently and with greater ease than men. "Women cry an average of 5.3 times per month, and men an average of 1.4 times per month...Yet boys and girls under the age of 12 cry the same amount. Something happens between age 12 and 18," Dr. Frey noted. And while he still is not sure of the exact mechanism, Dr. Frey has proposed that prolactin plays a role in the production and excretion of tears. While there may be biological explanations for the difference in crying patterns among men and women, Dr. Frey cautions not to discount societal conditioning. "Boys, at age 12 or 13, are taught that it's unmanly to cry, that it's a sign of weakness," Dr. Frey said. "Boys may try to hide their crying from others and cut themselves off from their emotions. They may even hide feelings from themselves. This has bad consequences later in life, since it's important to know how you feel to maintain close personal relationships," he said. "One way to know how you feel about something is if it makes you cry. If you shut that process down, you don't have access to that self-disclosure." Dr. Frey admits it's difficult to remain emotionally detached when someone around you is crying. "We know it elicits sympathy and empathy. Men don't feel comfortable around people who are crying because they don't want to feel like crying. They are more likely to walk out or disengage and tune out." This withholding of emotions is unfortunate, he said, and could possibly account for a propensity to engage in substance abuse. Also, if it's true that crying relieves stress, then stifling the tears could have serious adverse health implications, such as increased risk of heart attacks. Given the health risks, Dr. Frey urges men, especially, to rekindle their emotional fires. Many men have contacted Dr. Frey hoping he can help them get back in touch with feelings they have not expressed since their pre-teen years. Some may benefit from therapy to learn to get back in touch with their feelings and to cry again, he said. Dr. Frey hopes that as more people learn about his work, society will become more accepting of public displays of emotion. Change needs to start with our children, he said, and the first step is to validate our children's sad feelings. The researcher relates an incident that involved his son nearly 10 years ago. Then six years old, the boy was disappointed that the day's weather precluded a previously promised visit to the zoo. He began to cry. Trying to console the boy, relatives pleaded, "Oh, come on, those are just crocodile tears. Grow up and be a man." "What are these messages? That his feelings are not legitimate?" Dr. Frey asks. "I think it's important that when you see other people cry, you show empathy and sympathy. Don't tell them to stop crying. Nobody cries forever. This is a natural human process for alleviating stress." Dr. Frey is pleased to say he's already seeing a shift in the way Americans view political figures who wear their emotions on their sleeves for all to see. Some 30 ago, Maine Sen. Edmund Muskie's presidential dreams were dashed when he openly wept while rebutting an attack on him and his wife. Yet the public, and even the media, took little note when Dole and Clinton grew teary-eyed in public while talking about emotional issues. "For a long time the public demanded poker-faced politicians," Dr. Frey said. But politicians who could hide their feelings from the Russians could be using the same tactics to hide things from the public, too. "People began to get fed up with politicians who said one thing and then did something else. It's all about distrust. (Now) people are looking for someone they can relate to, who is not afraid to tell us what he really thinks. That has led the pubic to tolerate the show of emotions," Dr. Frey believes. In the meantime, researchers in Boston and New Orleans are following up the ideas Dr. Frey presents in his 1995 book Crying: The Mystery of Tears (Harper and Row). Yet, he says, not many scientists are seriously studying the role of emotional tears, but instead are focusing on the physiological role of tears in dry eye and other ophthalmologic problems. Dr. Frey feels crying warrants further study, as it is a uniquely human function. He encourages everyone--man, woman and child--to take advantage of this singular, human opportunity. "We don't have to follow the stereotypic roles society has forced us into," he said. "We have a right to be human." Email: *

医学

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The Saturday Essay The Puzzle of Chronic Fatigue For 20 years, a doctor in upstate New York has been trying to prove that an outbreak of the strange syndrome in his community was caused by a virus. Now new evidence is reopening the case. Amy Dockser Marcus Updated March 5, 2011 12:01 a.m. ET Ginger Burg at her home in Gasport, N.Y., near Lyndonville. Ms. Burg, who fell ill at age 14, recalls that she and the others who got sick were considered 'crazy, delusional, lazy people.' Nikki Ormerod for The Wall Street Journal One snowy afternoon in October 1985, eight children from the tiny farming community of Lyndonville, N.Y., went sledding together. Within a few weeks, they all got sick. David Bell, the local doctor who treated the children, recalls that their symptoms were similar to the flu: sore throats, fevers, muscle aches and severe fatigue. After three days, they hadn't recovered. Then a week. A month. Ninety days. Nearly 25 years after the "Lyndonville outbreak" of chronic fatigue syndrome, a controversy is brewing among scientists over what causes the disease. A small-town doctor hopes his patients will help provide the answer. WSJ's Jason Bellini reports. A Short History of XMRV Cleveland Clinic More photos and interactive graphics Six months after their sledding trip, the children still couldn't go back to the lone school in town. They had trouble getting out of bed. Light gave them a headache. Four of the eight were so sick that they were essentially disabled, Dr. Bell recalls. Tests ruled out mono and other infections. "We had no idea at all what it was," he says. Over the next two years, the mysterious illness spread throughout this rural village of 862 people halfway between Buffalo and Rochester. It eventually affected 214 people within a 30-mile radius, 46 of them children. For the next 25 years, Dr. Bell, a Boston University-trained physician, would collaborate on studies, maintain a vast database of patients and write books, searching in vain for the cause of the illness from which some of his patients recovered and many did not. The illness would eventually be identified as chronic fatigue syndrome, but scientists still have not found its cause. "I figured I would never know why the kids got sick," Dr. Bell says. More An Illness That's Hard To Live With—Or Define Chronic fatigue syndrome is an incredibly challenging disorder. There is no diagnostic test, no blood test and no scan, so diagnosis is made by excluding other conditions. The common symptoms, such as severe fatigue, muscle pain and weakness, rely on a patient's perception and are hard to measure. In addition, many of the symptoms are also present in other conditions. Some people diagnose themselves, mistakenly thinking they have chronic fatigue syndrome when in fact they have something else. Many others may have a wrong diagnosis, or none at all: The Centers for Disease Control and Prevention believes that of the estimated one million to four million Americans who have it, less than 20% have actually been diagnosed. Now, patients with chronic fatigue syndrome are focusing on new research—and Dr. Bell hopes his lifelong quest to find the cause of the Lyndonville outbreak may eventually come to an end. Chronic Fatigue Syndrome (CFS) by the numbers Number of Americans estimated to have CFS: 1 to 4 million Annual productivity lost to the U.S. economy attributable to CFS: $9.1 billion Annual CFS-related medical costs for an individual with the condition: $3,286 Recovery rate: 31% during the first 5 years of illness, 48% during the first 10 years of illness CFS is most common in women (522 cases per 100,000) and minorities, especially Latinos (726 cases per 100,000) Source: Centers for Disease Control and Prevention In 2009, researchers published a paper in the journal Science announcing that in 67% of the samples of 101 chronic fatigue syndrome patients, they had found a retrovirus called XMRV. Dr. Bell, who had previously suspected a link to retroviruses, wondered if it was the explanation he'd been looking for. Lyndonville patients were elated by the discovery. "Holy smokes! Just when I want to retire this comes along," Dr. Bell, 65, shared with patients on his website at the time. A retroviral link would not only prove a concrete cause but also open the possibility of treating it with anti-retroviral drugs. Dr. Bell sought out his old patients to test them. Although the numbers tested were small, the preliminary results made him take notice: 70% of them came back positive for XMRV-related viruses. Then came a major setback: Other labs trying to duplicate the results of the Science paper were unable to find the retrovirus in patients with the disease. In a high-profile paper published last July, scientists from the Centers for Disease Control and Prevention failed to find XMRV in either patients with the disorder or in healthy controls. The inability of other labs to confirm the results raised questions about the validity of the retroviral finding. The debate over XMRV has become intertwined with the larger disagreement that touches almost every aspect of chronic fatigue syndrome. Not all researchers agree with the criteria the CDC uses to define patients with chronic fatigue syndrome, and use a different definition. Over the years, CFS has been called different names in other countries, including myalgic encephalomyelitis in the United Kingdom. Many patients hate the name chronic fatigue syndrome because they think it trivializes the condition. Patients often report a sudden, flu-like onset, but one of the difficulties is that a diagnosis of chronic fatigue syndrome cannot be made unless symptoms persist for at least six months, making it challenging to determine the initial trigger. Some studies have indicated that CFS may be brought on by trauma like a car accident. A recent study by the CDC found that childhood trauma can be a risk factor—although the CDC points out that childhood difficulties do not cause the disorder. It is still not understood how—or even if—the syndrome spreads. But since the 1930s, there have been at least 12 reported outbreaks in the medical literature of chronic fatigue syndrome in communities around the world. A 2004 outbreak in Norway occurred after one town's public drinking water was contaminated with the Giardia lamblia parasite; 58 people diagnosed with what is called post-infectious fatigue syndrome are being followed there. Enlarge Image Dr. David Bell, near the hill in Lyndonville, N.Y., where eight children went sledding in 1985 shortly before falling ill. He has long suspected a link to retroviruses. Nikki Ormerod for The Wall Street Journal The various controversies have led many patients to feel that they have been maligned—by friends who don't understand why patients look well but cannot function, by doctors who doubt their symptoms, by scientists who still don't understand why people get the syndrome. This is one of the reasons why a possible link between XMRV and chronic fatigue syndrome was so widely embraced by the patient community. It offered a clear-cut explanation for how someone might get sick and a possible path for a way to treat it. The debate over XMRV has been felt deeply in Lyndonville, with its picturesque countryside, red barns, bales of hay, and Amish farmers driving horses and buggies. The community has become a laboratory for research on chronic fatigue syndrome. Scientists continue to study the village because the patients who got sick in the outbreak lived in the same geographic area, fell ill after an infection, and were all treated by one doctor. Dr. Bell, who began working at the University of Rochester after finishing his medical training, wanted to become a country doctor. One afternoon in 1978, he was driving through Lyndonville when he saw a farmhouse with a view of Lake Ontario, and on a whim decided to buy it. Many of his patients were dairy farmers and factory workers who weren't able to pay him in cash but would leave food on his doorstep or fix his broken tractor as payment. He had an office in town but made house calls on horseback. When the outbreak began, Dr. Bell wasn't sure what it was and researched any possible lead, including taking milk samples from the goat whose milk went into the hot cocoa the children drank after going sledding. He suspected an infectious cause because the children all got sick at the same time. Don Duncanson was one of the children who went sledding that October day. At the time, Mr. Duncanson was a healthy 14-year-old on the school wrestling team who says he was used to pain from constant training. The experience of getting sick shocked him. His lymph nodes were painfully swollen. The light gave him a headache. He missed weeks of school unable to move from the sofa. After he returned to school, he was often so tired that he fell asleep at his desk. Some teachers smirked when he told them he didn't feel well. "You're a kid. You think it might be in your head," he says. "I tried not to talk about it." Diagnostic Criteria for Chronic Fatigue Syndrome The cause or causes of CFS have not been identified, and no specific diagnostic tests are available for the condition. In order to be diagnosed with chronic fatigue syndrome, a patient must satisfy two criteria: 1. Severe chronic fatigue that lasts for at least six months and cannot be explained by other known medical conditions whose manifestations include fatigue. 2. A patient also must have at least four of the following symptoms: * malaise after physical exertion * impaired memory or concentration * unrefreshing sleep * muscle pain * multi-joint pain without redness or swelling * tender cervical or axillary lymph nodes * sore throat * headache The symptoms must have persisted or recurred during six or more consecutive months of illness and must not have predated the fatigue. Source: Centers for Disease Control and Prevention Ginger Burg was also 14 when she first fell ill in 1986. One summer afternoon, she recalls being a healthy teenager playing basketball and baseball. The next day, she couldn't get out of bed. Her parents rushed her to the hospital, where doctors told her she had hepatitis, strep throat and pneumonia. When she finally went home, she seemed to get sick constantly. Every time she stood up for longer than a few minutes, she felt dizzy. A neurologist who tested her couldn't find anything wrong and suggested she was a hypochondriac, she says. Perplexed by the cause of the outbreak—which lasted until the end of 1987—Dr. Bell tried to get health authorities to pay attention to Lyndonville. Dr. Bell's office sent lymph-node biopsies of 12 of the sickest children to the CDC, but the biopsies came back normal. Around the same time, CDC investigators studied a similar outbreak in Lake Tahoe, Nev. They couldn't find a cause there, either. In 1988, a CDC-sponsored workshop led researchers to name the condition chronic fatigue syndrome. In 1989, Dr. Bell sent blood samples of his Lyndonville patients to an immunologist named Elaine DeFreitas at the Wistar Institute in Philadelphia. She found evidence of a retrovirus in the blood of two-thirds of 30 pediatric and adult patients diagnosed with chronic fatigue syndrome. This was a significant breakthrough because a retrovirus—unlike other viruses—integrates into a person's DNA, where under certain circumstances it can suddenly start making a virus again. This might explain the waxing and waning of people's symptoms over the years and the severity of their sickness. HIV, the best known retrovirus, is treated with a combination of anti-retroviral drugs that attack the virus at different stages of its replication. Dr. DeFreitas's findings were announced to great fanfare at a scientific conference in 1990 and made the nightly news shows. Then, in a devastating blow to this theory, scientists at the CDC could not replicate her discovery. "We were all convinced for a while [Dr. DeFreitas] was on to it," says Thomas M. Folks, who was one of the CDC scientists who couldn't reproduce her findings. The researchers came to believe that the retrovirus she found was due to contamination that inadvertently got into the samples she tested. "These things happen," says Dr. Folks. Dr. DeFreitas could not be reached for comment. But Dr. Bell, who is listed as a co-author on the paper, disagrees. He says he still believes the CDC did not find the virus because scientists there did not follow Dr. DeFreitas's exact protocol. Dr. Folks, who left the CDC in 2007, says the CDC should have been able to find the virus following their own protocol. He believes that researchers and doctors got close to patients and sincerely wanted to help them. That makes it hard to let go of a finding that appears to offer hope of a solution, he adds. When the CDC couldn't duplicate the findings, funding dried up and interest waned. Dr. DeFreitas eventually discontinued her research. Over the next 25 years, some in Lyndonville would recover, but others would not. Many were stigmatized as having made their illness up. "We were [considered] crazy, delusional, lazy people," recalls Ms. Burg. During this time, some doctors and scientists advanced theories that, whatever the cause of the disorder, its duration and intensity could be influenced by a person's coping style. Nortin M. Hadler, a rheumatologist at the University of North Carolina Hospitals, says the fact that there is no diagnostic test for the syndrome can contribute to the way patients cope. Many patients feel like they must prove they have a disease to feel validated, he says. As a result, "they get sicker and sicker." Despite the CDC's inability to find a retrovirus, Dr. Bell didn't give up on his theory. He wrote books and maintained a database on the children who fell ill during the outbreak. In 2001, he published a follow-up report on 35 of them. When the new discovery was published in Science in 2009, Dr. Bell went to work getting the word out, notifying as many patients from the original outbreak as possible. At the same time, Maureen Hanson, a molecular biologist at Cornell University, also saw the Science paper. Dr. Hanson, who has a family member with chronic fatigue syndrome who had been diagnosed by Dr. Bell, asked him about working together on a retrovirus study. She wanted to test for the family of murine leukemia virus-related viruses, or MLVs, to which XMRV also belongs. Dr. Bell contacted patients he treated over the years for Dr. Hanson to test. He identified 10 people who were still severely ill, 10 people who considered themselves recovered, and 20 healthy people to serve as controls. One of the first calls went to Don Duncanson. Now 40 years old with salt-and-pepper hair, Mr. Duncanson works maintenance at a nearby school and coaches wrestling. Mr. Duncanson says he still feels some of the symptoms. Bright outdoor light hurts his eyes, and there are still days he has to force himself to get out of bed. "It's normal to me now,'' he says. In the new study, Mr. Duncanson was classified as a recovered patient, based on his symptoms. He tested positive for MLV-like virus. Dr. Bell also contacted Ginger Burg. Now 38, she is still severely affected by chronic fatigue syndrome. She spends hours every day lying down and has a constant headache. She can't stand for long before she feels dizzy. Ms. Burg also tested positive. At a meeting in December, an FDA advisory committee on blood issues invited Dr. Hanson to present the Lyndonville study. The committee was trying to determine if patients with chronic fatigue syndrome should be banned from donating blood. In her presentation, Dr. Hanson said that seven of the 10 most severe Lyndonville patients, seven of the 10 recovered patients, and four of the 20 people in the control group tested positive for MLV-like virus. The majority of committee members voted to recommend that people with the disease be banned from donating blood, even though the science remained uncertain. The FDA has not made a final decision, but the American Red Cross, the largest supplier of blood in the U.S., no longer accepts blood from people with the disorder. Dr. Hanson's study has not been published yet. She says she has not finished all the testing. A few days after the committee decision, some papers were published identifying several sources of possible mouse DNA contamination in XMRV studies. Dr. Hanson says she tested her samples for mouse contamination and did not find any. In addition to Dr. Hanson's study, there are large federally-led studies under way. One working group is studying whether XMRV or related viruses are affecting the blood supply. A different study, run by the National Institute of Allergy and Infectious Diseases, involves collecting and testing blood samples from chronic fatigue syndrome patients. These studies on the link between the family of retroviruses and the disorder are likely to carry significant weight in the scientific community. In his office in Lyndonville, Dr. Bell keeps a picture of the virus that Dr. DeFreitas found growing in one of the cells of spinal fluid taken from a child who went sledding in 1985. The picture reminds him of what happened in the past, when conflicting studies caused scientists to lose interest in the retrovirus. "My greatest fear,'' Dr. Bell says, "is that people will throw up their hands and say they are not going to pursue it.'' Write to Amy Dockser Marcus at amy.marcus@wsj.com Email

医学

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Light-induced hormone surge points to benefits of light therapy A report in the November Cell Metabolism reveals powerful effects of light on the adrenal glands, a finding that might explain the broad benefits of bright light therapy for a variety of conditions, including sleep and depressive disorders, according to researchers. The body's two adrenal glands sit atop each kidney, where they secrete hormones that regulate stress response and metabolism. The researchers found in mice that light sparks a cascade of gene activity in the adrenal gland through its effects on the suprachiasmatic nucleus (SCN). Located in the brain region called the hypothalamus, the SCN is the seat of the circadian clock, the body's internal clock that regulates the roughly 24-hour cycle of biological processes. Moreover, the researchers report, the gene expression changes accompany a massive surge of the steroid hormone corticosterone in the animals' blood and brain. That hormonal response increased with light intensity, they found. Glucocorticoids--including cortisone in humans and corticosterone in mice--play many roles throughout the body, including metabolic response to starvation, antiinflammatory immune response, and the timing of circadian rhythms in peripheral organs. Therefore, light-induced secretion of glucocorticoids may play a key role in physiological changes in the body and the brain evoked by light, reported study author Hitoshi Okamura of Kobe University Graduate School of Medicine in Japan First introduced in the early 1980s for the treatment of seasonal affective disorder, bright light therapy has been applied to many sleep disorders, including jet lag syndrome and shift work sleep disorder, the reseachers said. Shift work sleep disorder, which affects people who frequently rotate shifts or work at night, is often accompanied by metabolic symptoms, including hypertension, cancer, and diabetes. "In these patients, light therapy improves not only psychiatric status, but also disordered hormones and metabolisms," Okamura said. "However, effects of light had only been established on melatonin, and the remaining powerful and broad effects of light on body metabolism and hormones remained to be clarified." The researchers examined the activity of the clock gene Per1 in the organs of living animals. The team found that nighttime light exposure induced Per1 expression in the adrenal gland. Further analysis of the gland revealed numerous changes in the activity of almost 200 genes, followed by the delayed release of corticosterone. When the researchers severed the SCN, light's effect on the gland was lost, indicating that the phenomenon is closely linked to the circadian clock, they said. "The surge of blood corticosterone after light exposure indicates that environmental signals are instantly converted to glucocorticoid signals in the blood and cerebrospinal fluid," Okamura reported. "The present light-induced corticosterone release may entrain metabolically peripheral clocks to the environmental light-dark cycle through its prevailing receptors located in virtually all cells in the body." The findings could prove of great clinical and physiological interest, wrote Ueli Schibler and Steven Brown in an accompanying commentary. "If a light-induced pathway were also operative in humans, a question that could readily be examined by recording blood cortisone levels after light exposure, it would be tempting to speculate that cortisone-mediated synchronization of peripheral circadian clocks would be one of the beneficial effects light therapy has on patients with seasonal affective disorder," Schibler and Brown said. "It might also explain why bright light therapy can aid patients with other disorders--such as major depressive disorder and bipolar disorder--not typically associated with the circadian clock," they continued. Source: Eurekalert & others The willingness to accept responsibility for one's own life is the source from which self-respect springs. -- Joan Didion Users Online: 8020Join Us Now!

医学

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Wellness Center | Women's Center Home > Health Library > Caffeine May Help Treat Parkinson's Disease Caffeine May Help Treat Parkinson's Disease WEDNESDAY, Aug. 1 (HealthDay News) -- Caffeine has previously been linked to a lower risk of developing Parkinson's disease, but now new research says the ubiquitous stimulant may also help treat disease symptoms. In a small study of 61 people with Parkinson's disease, Canadian researchers found that giving the caffeine equivalent of about three cups of coffee per day improved motor symptoms, such as slow movement and stiffness. Interestingly, caffeine didn't significantly improve daytime sleepiness, a common symptom in Parkinson's disease. "Caffeine treats Parkinson's disease," said the study's lead author, Dr. Ronald Postuma, an associate professor in the department of neurology at McGill University in Montreal. "There was a modest effect on sleepiness that didn't reach statistical significance, but I think it was clear that it helps patients," he said. "Where we saw the most potential benefit from caffeine was on motor aspects and symptoms. People felt better and were more energetic. You could see on the exam that they were better." Parkinson's disease is a degenerative disorder that causes shaking, stiffness, slow movements and difficulty with balance. More than one million Americans have Parkinson's disease, and more than 50,000 people are diagnosed with the disease each year, according to the National Parkinson Foundation. In the current study, published in the Aug. 1 online edition of the journal Neurology, half of the group of Parkinson's patients was randomly assigned to receive caffeine treatment, while the other half received an inactive placebo. To be included in the study, the volunteers had to consume less than 200 milligrams (mg) of caffeine daily -- about two cups of coffee -- and they couldn't have any heart rhythm problems, uncontrolled high blood pressure, or an active ulcer. For the first three weeks of the study, those receiving caffeine were given 100 mg of caffeine twice daily -- once when they got up and again at lunchtime. During the second three weeks, the dose was increased to 200 mg twice daily. Using a test called the Epworth Sleepiness Scale score, the researchers found that while there was a reduction in this score for those treated with caffeine, indicating less daytime sleepiness, that decrease didn't reach statistical significance. Still, Postuma said he believed that caffeine did help improve the level of daytime sleepiness, and that with a bigger study group, a benefit would likely become clearer. Motor symptoms were judged using the Unified Parkinson's Disease Rating Scale score. There was a modest overall improvement of 5 points in this score. In addition, there were improvements in the speed of movement and the amount of stiffness in the treatment group versus the placebo group. "[This study] is important even though it failed to reveal a benefit for caffeine in improving sleepiness in Parkinson's disease. Interestingly, it did reveal a clinically significant potential motor benefit," said Dr. Michael Okun, national medical director of the National Parkinson Foundation. "It will be interesting to see if these findings hold up, and caffeine becomes a treatment approach in Parkinson disease," he added. Postuma said the mechanism behind coffee's effect on Parkinson's symptoms isn't yet known, but it's believed to block receptors of a substance called A2A adenosine that may play a role in some Parkinson's symptoms. Two new drugs that block A2A adenosine receptors and work in a very similar manner to caffeine are currently in development, he said. "Their results are almost the same as what we're getting. They may be making and selling expensive caffeine," Postuma said. "One interesting aspect about the actions of caffeine in Parkinson's disease is that they are thought to be mediated through blocking the A2A adenosine brain receptor. There are several drugs in Parkinson's trials that have similar mechanisms of action, and it would be interesting to perform head-to-head trials comparing caffeine to these drugs," Okun said. Postuma would like to conduct larger trials on caffeine to see if the effects of the stimulant wear off over time. The good news, he said, is that caffeine is "incredibly safe and well-tolerated." So, "if you've been avoiding caffeine because you think it's bad, you can stop. If you're sleepy during the day, you can try it," Postuma said. People with heart rhythm problems, uncontrolled high blood pressure or active ulcers should talk with their doctors about whether they should have caffeine in their diet, however. Home-brewed coffee tends to have less caffeine than what you get at a coffee shop, Postuma noted. Most people shouldn't go over 400 mg to 500 mg a day (about four to five cups), he advised. And, if you don't want caffeine to interrupt your sleep, try to have your last cup of coffee with lunch. Learn more about Parkinson's disease from the U.S. National Institute of Neurological Disorders and Stroke. SOURCES: Ronald Postuma, M.D., M.Sc., associate professor, department of neurology, McGill University, Montreal; Michael Okun, M.D., national medical director, National Parkinson Foundation; Aug. 1, 2012, Neurology, online Bus, Truck Drivers May Downplay Sleep Troubles College Freshmen Urged to Keep Excess Pounds Away Poor Sleep in Teen Years Linked to Heart Risks in Adulthood Sleep Study Violent TV Shows Keep Young Kids Awake: Study Snoring Kids Should Be Screened for Sleep Apnea: Experts COPD May Contribute to a Bad Night's Sleep Poor Sleep Affects Immune System Much Like Physical Stress Poor Sleep Among Preschoolers May Be Tied to Special Ed Needs Later Mouse Study Sheds New Light on How Memories Are Stored Virtual Tour Planning a visit to Sentara RMH? Take a tour of our campus before you come.

医学

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Marie Bashir Institute for Infectious Diseases and BiosecurityTackling infections, locally and globally You are here: Home / MBI / About us About us WelcomeInstitute LeadershipPartnershipsAffiliationsSupport usContact us Our membershipOur peopleCentres for Research ExcellenceInterest groups Critical InfectionsEmerging ThreatsBiosecurity Resources and Labs Sulawesi, IndonesiaTimor Leste The Broad Street PumpMBI Newsletter Postgrad students OverviewFuture studentsCurrent students Seed Funding Round 1 - 2014 AlveolataAmoebozoaArthropodaEuglenozoaExcavataFungiNematodaPlatyhelminthes Welcome Institute LeadershipDirectorCore ExecutiveDiscipline leadersMBI BoardPartnershipsAffiliationsSupport usContact us MBI Board Members Chairman Professor Bruce Robinson Professor Robinson is an Endocrinologist and Head of the Cancer Genetics Laboratory in the Kolling Institute at Royal North Shore Hospital. He was appointed Dean in March 2007. Professor Robinson graduated from the University of Sydney in 1980 and then undertook studies for a Master of Science degree. His further molecular research work was performed at the Brigham and Women’s Hospital and the Children’s Hospital, Harvard Medical School from 1986-1989 and he was awarded a Doctorate of Medicine from the University of Sydney in 1990. He has developed and led the Cancer Genetics Laboratory since 1990 and has supervised over 30 doctoral and masters students working on the genetic basis for tumour formation and gene therapy. He has published over 200 peer-reviewed scientific articles. In 2003, Professor Robinson was awarded the Daiichi Prize by the Asia and Oceania Thyroid Association for this work on the pathogenesis of thyroid cancer.Prior to his current University appointment, Professor Robinson was Associate Dean (International) in the Faculty of Medicine at the University of Sydney and was Head of the Division of Medicine at the Royal North Shore Hospital from 1998-2006. He also served on the Council of the Endocrine Society of Australia from 2001-2005. He is on the Editorial Board of the International journals ‘Nature, Clinical Practice and Endocrinology’ and ‘Thyroid’. Professor Robinson has a strong interest in furthering relations between Australia and Asia and he is the Founding Chairman of Hoc Mai, the Australia-Vietnam Medical Foundation, which sponsors and supports medical nursing, allied health and scientific exchanges between Australia and Vietnam. He was awarded the People’s Health Medal by the Vietnamese Government in 2008. He is a Fellow of the Australian Institute of Company Directors. Ava Lawler Board Member Ava Lawler Ava has had a 24 year global career in communications spanning the Australian, Chinese, Asia Pacific, UK and South African markets. Throughout this period she has been providing reputation and communications consultancy to organisations across multiple industries and markets . Her consultancy focuses on corporate positioning and brand awareness, change management, integrated communications and issues management. Her client campaigns have included the Bayer, Commonwealth Bank, IBM, Microsoft, Nokia, Telstra and Zoetis. Ava is currently the managing director of Weber Shandwick in Australia. Within this role she is responsible for the financial and strategic performance of the company’s Australian operations. Ava also provides senior level communications counsel to clients across the healthcare, financial services, consumer goods and services, technology and government sectors. Over nineteen years of Ava’s career has been with Text 100 (including its sister company, AUGUST.ONE Communications) where she was on the Global Executive Leadership Team serving as its Global Consultancy Director. She led the firm’s transformation to become a leader in integrated digital communications and consulted directly to the CEO on business strategy and talent management. Ava has spent more than 13 years establishing and managing businesses either locally or across Asia Pacific. In Australia she set-up two PR firms for the Next Fifteen Group (Text 100 and AUGUST.ONE Communications), both of which experienced significantly high growth under Ava’s leadership. Ben Marais Board Member Associate Professor Ben Marais Ben Marais trained as a paediatrician in Cape Town, South Africa. He joined the University of Sydney in 2011 and is currently the Deputy Director, MBI. He works as an Infectious Diseases consultant at the Children's Hospital Westmead. His primary research interest is tuberculosis (epidemiology, strain diversity/evolution, diagnosis, prevention, treatment, drug resistance) with a special focus on how children are affected by the global epidemic. He is CIB on a recently awarded NHMRC Centre for Research Excellence for: Tuberculosis Control: from Discovery to Public Health Policy and Practice. He has a keen interest in international child health; including HIV, TB/HIV, paediatric and emerging infections in general, as well as operations and cross-disciplinary research. An area of that he would like to develop is the measurement of holistic health outcomes that acknowledges the need to maintain biodiversity and ecological resilience, which is essential for optimal and sustainable health of our planet – in keeping with the “One World – One Health” concept. Peter McMinn Board Member Professor Peter McMinn Professor Peter McMinn was appointed to the Bosch Chair of Infectious Diseases at the University of Sydney in 2007. After graduating in medicine from the University of Sydney (1982), Peter commenced working in indigenous health in the Northern Territory followed by periods working for the Royal Flying Doctor Service in Alice Springs and in general practice in Hobart. In 1989, he postgraduate training as a clinical microbiologist at the Institute for Medical and Veterinary Science in Adelaide, followed by four years of research training at the Australian National University, where he studied the pathogenesis of flaviviral encephalitis under the supervision of Dr Lynn Dalgarno. In 1996, Peter moved to Perth to take up a Senior Lectureship in Virology at the University of Western Australia with a conjoint position as Consultant Microbiologist at the Princess Margaret Hospital for Children. Throughout his career, Peter has maintained a strong research and clinical interest in viral encephalitis. He played an early and prominent role in establishing surveillance and public health responses to the emergence of enteroviral encephalitis in Southeast Asia in 1997. Peter has developed extensive research and teaching collaborations in Southeast Asia and has spent long periods in Malaysia, Indonesia, Timor-Leste, the Philippines and Vietnam training local microbiologists in communicable and vaccine-preventable disease surveillance and research. Stephen Simpson Board Member Professor Stephen Simpson Professor Stephen Simpson is Academic Director of the Charles Perkins Centre and Australian Research Council Laureate Fellow in the School of Biological Sciences at the University of Sydney. The Charles Perkins Centre is a new $500 million cross-faculty initiative at the University of Sydney. Its mission is to research and implement cross-disciplinary approaches to alleviating the individual and societal burden of obesity, diabetes and cardiovascular disease. Stephen returned to Australia in 2005 as an ARC Federation Fellow after 22 years at Oxford. Before that he had undertaken his PhD at the University of London, and his undergraduate degree and Honours at the University of Queensland.Together with colleague David Raubenheimer, Stephen developed an integrative modelling framework for nutrition, the Geometric Framework, which was devised and tested using insects but has since been applied to a wide range of organisms, from slime moulds to humans, and problems, from aquaculture and conservation biology to the dietary causes of human obesity and ageing. A synthesis of this body of work can be found in The Nature of Nutrition: a Unifying Framework from Animal Adaptation to Human Obesity, published by Princeton University Press in 2012. In addition to nutritional biology, Stephen’s research on locusts has led to an understanding of locust swarming that links chemical events in the brains of individual insects to landscape-scale mass migration. Stephen has been Visiting Professor at Oxford, a Fellow of the Institute for Advanced Study (Wissenschaftskolleg) in Berlin, Distinguished Visiting Fellow at the University of Arizona, and Guest Professor at the University of Basel. In 2007 he was elected a Fellow of the Australian Academy of Science, in 2008 he was awarded the Eureka Prize for Scientific Research, in 2009 he was named NSW Scientist of the Year, and in 2010 he was named as the Wigglesworth Medallist by the Royal Entomological Society of London. In 2013 Stephen was elected Fellow of the Royal Society, and awarded an Honorary Fellowship by the Royal Entomological Society. He was also co-writer, narrator and presenter of the four-part documentary Great Southern Land, for ABC TV, which was aired to critical and viewer acclaim in September 2012. Tania Sorrell Board Meeting Professor Tania Sorrell Professor Tania Sorrell is Director, MBI and the Professor of Clinical Infectious Diseases and Director of the Centre for Infectious Diseases and Microbiology, University of Sydney at Westmead, New South Wales. She has had a longstanding clinical interest in mycology and infections in the immunocompromised host. Her research has focussed on the pathogenesis of fungal infections, new antifungal drug development, new diagnostics and clinical trials of antifungal diagnostic and treatment strategies. She has served on state and national advisory committees in Infectious Diseases and therapeutics and the Research and Human Ethics Committees of NHMRC. Rosanne Taylor Board Member Professor Rosanne Taylor Rosanne Taylor has been Dean of The Faculty of Veterinary Science since 2009. After graduation from Sydney University, Rosanne started as a rural mixed practitioner at Camden, then in small animal practice and locums while she undertook a PhD on treating inherited neurological disease. She was Branch Manager in NSW Government Animal Welfare, introducing animal research legislation. During her PhD and postdocs at Sydney and University of Pennsylvania she demonstrated the value of stem cell, and gene therapies for lysosomal storage diseases (ACVS Clunies Ross research award, 1999). Rosanne teaches veterinary physiology and cell biology and has a passion for curriculum and learning development, research on clinical learning and completed a Graduate Certificate in Higher Education. She was Associate Dean and Chair of Learning and Teaching (2001-7) and ProDean (2008-9) (Pfizer and Grace Mary Mitchell Awards 2001, Vice Chancellors Teaching Award 2002, and e-learning Award 2009). She sits on AAVMC Governance, JVME editorial boards and the AVA education committee. She enjoys life with 3 children, many pets and frequent escapes to the bush and beach. James Wakim Board Member James Wakim Moss Capital’s Vice Chairman, James Wakim has been a respected identity in Australia’s banking and investment community for over twenty years. He is a career banker with experience across a broad portfolio of banking sectors including marketing, credit, international and corporate.James’s ability to combine in-depth industry knowledge with excellent communication and people skills enabled him to successfully run the Bank of Sydney where he was instrumental in establishing the Bank in Australia through the acquisition of another local foreign owned bank. Prior to Bank of Sydney Ltd, he worked to establish Arab Bank and was the Managing Director & CEO of Arab Bank Australia Ltd for over a decade.James plays an active role in its community support programs. He is currently a board member of FSHD Global Research Foundation and has also held positions on the advisory Board of the Menzies Centre for Health Policy and on the Board of the Westmead Millennium Institute for eight years.Further to this, James was a Director of the Westmead Medical Research Foundation (previously known as Millennium Foundation) for over ten years, a charity for which he was also Chairman of the Board for over five years. James has been personally responsible for raising about $1 million for this Foundation from the general community.In 2008, the International publication ‘Executive PA Magazine’ awarded James ‘Boss of the Year’. He is married with three adult children, and is a proud grandfather. Merrilyn Walton Board Member Professor Merrilyn Walton Merrilyn Walton is Professor of Medical Education (Patient Safety), Sydney School of Public Health, Faculty of Medicine University of Sydney. She is a leading patient-safety academic who works nationally and internationally in the field. For the last 4 years she has been a lead writer and editor for the WHO patient safety curricula guides for Multi professionals and medical schools. Merrilyn has assisted universities in Vietnam, Indonesia, Myanmar, Timor Leste and China to build capacity in patient safety and curriculum development. She was Associated Dean International (2012-14). She is the author of two books and co-authored her latest Safety and Ethics in Health Care with Professors Runciman and Merry. Professor Walton is a statutory member of the National Health Practitioner Registration Agency (AHPRA). She was a member of the Australian Health Ethics Committee of the National Health and Medical Research Council 2009-2012. She is a visiting professor and affiliate of The Buehler Center on Aging, Health and Society at Northwestern University in the USA. Prior to her academic role Merrilyn was the first Health Care Complaints Commissioner in NSW (1993-2000). Board Member Professor Michael Ward Professor Michael Ward holds the Sesquicentenial Chair in Veterinary Public Health and Food Safety at The University of Sydney. He is a veterinary epidemiologist with over 25 years experience in conducting research on infectious diseases, including West Nile virus in the U.S., foot-and-mouth disease in Argentina and bird flu in Romania. He is a veterinary graduate from the University of Queensland (1986) and has held positions within the Queensland Department of Primary Industries as well as the veterinary schools at Purdue University (Indiana) and Texas A&M University. Current research on emerging infectious diseases includes a program on rabies control in eastern Indonesia, and infectious diseases of wild and feral species in northern Australia. He is currently Associate Dean, External Relations within the Faculty of Veterinary Science. Donna Waters Board Member Associate Professor Donna Waters Donna Waters is a registered general and obstetric nurse with 25 years experience in the management of nursing, medical and health services research. Following specialist training in paediatrics, she commenced a 10-year research career at the Royal Alexandra Hospital for Children (now the Children's Hospital at Westmead) before going on to manage an independent nursing and health services research organisation for more than 12 years. She also worked as the Manager of research and projects at the College of Nursing in Sydney and as Associate Professor of Nursing for Justice Health in NSW. As a member of the Governing Council of the Sydney Children's Hospitals Network, Donna is a passionate advocate for the health of children and young people, and for paediatric nursing education. She is currently the Associate Dean (Research) at Sydney Nursing School. Board Member Professor Andrew Wilson Professor Wilson is Director of the Menzies Centre for Health Policy at the University of Sydney and Director of the Australian Prevention Partnership Centre at the Sax Institute. His research and teaching interests include all aspect of health policy but especially in the area of chronic disease. In addition to his academic career, he has been Deputy Director General, Policy, Planning and Resourcing, Queensland Health, and Chief Health Officer, and Deputy Director General, Public Health, NSW Health. He also leads the ‘Solutions’ domain in the University of Sydney Charles Perkins Centre. © 2002-2014 The University of Sydney. Last updated: 19-May-2014 ABN: 15 211 513 464. CRICOS number: 00026A. Phone: +61 2 9351 2222. Authorised by: Director, Marie Bashir Institute for Infectious Diseases and Biosecurity. Contact MBI | Contact the University | Disclaimer | Privacy | Accessibility

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Diseases & Conditions > Brain & Nervous System > Hydrocephalus is a brain condition that gets its name from the Greek word for water (meaning "hydro") and head (meaning "cephalus"). It occurs when cerebral spinal fluid (CSF) — the clear, water-like fluid that surrounds and cushions the brain and spinal cord — is unable to drain from the brain. It then pools, causing a backup of fluid in the skull. Sometimes referred to as "water on the brain," hydrocephalus can cause babies' and young children's heads to swell to accommodate the excess fluid. Older kids, whose skull bones have matured and fused together, experience painful headaches due to increased pressure in the head. If left untreated, hydrocephalus can lead to brain damage, a loss in mental and physical abilities, and even death. With early diagnosis and timely treatment, however, most children recover successfully. Causes of Hydrocephalus When everything is working normally inside the brain, CSF will flow through narrow passageways called ventricles and exit the brain through a small reservoir at the base of the brain called the cistern. CSF is responsible for delivering nutrients to the brain and taking waste away from sensitive areas, where it will eventually be absorbed into the bloodstream. If a blockage exists in any of the ventricles, CSF backs up and causes an excess of fluid in the brain, or hydrocephalus. This accumulation of fluid can also happen when the choroid plexus (the area of the brain that produces CSF) is in overdrive or if the fluid fails to be properly absorbed by the bloodstream. When hydrocephalus is present at birth, it can be the result of conditions like spina bifida (where the primary cause is abnormal development of the spinal cord) or aqueductal stenosis (a narrowing of the small passageway, called the "aqueduct of Sylvius," that connects two major ventricles in the brain). Acquired hydrocephalus is caused by cranial hemorrhage, or bleeding in the brain. This can happen in premature babies or kids who've undergone traumatic head injuries. But not every case of hydrocephalus is due to the causes mentioned here: Some kids can develop hydrocephalus without a known cause. Signs in Babies Symptoms of hydrocephalus vary depending on the age of a child. Infants and babies under the age of 1 year will appear to have significant swelling of the head. Their skull bones — thin, bony plates that have not yet fused together — are connected by fibrous tissue called sutures. These sutures, or "soft spots," have not yet hardened and therefore stretch and protrude to accommodate the excess CSF. As a result, a baby with hydrocephalus will appear to have an abnormally shaped head — usually much larger than other babies the same age. Other signs to look for include: bulging at the soft spots "split" sutures — a gap can be felt between skull bones rapid increase in head circumference swollen veins that are recognizable to the naked eye downward cast of the eyes (called "sunsetting") Depending on the severity of the condition, kids may also experience sleepiness, irritability, vomiting, and seizures. In extreme cases, a child may also experience "failure to thrive," meaning that he or she might miss growth or developmental milestones or may revert to earlier developmental stages. Signs in Older Kids Older children will not have the easily recognizable symptom of an enlarged head because their skull bones have fused together and therefore cannot expand to accommodate the excess fluid. In these cases, pressure on the brain intensifies and causes severe headaches that may wake a child in the middle of the night or early in the morning. Headaches may be coupled with: nausea/vomiting difficulties with balance and motor skills squinting and/or other repetitive eye movements Changes in personality, loss of new developmental abilities (like speaking or walking), and memory loss may also occur in more advanced cases. A child who shows any of the signs and symptoms mentioned above should be evaluated by a doctor right away. The doctor will perform examinations, which may include a medical history and diagnostic imaging — like ultrasound, CT (computed tomography), or MRI (magnetic resonance imaging) — to get a clear picture of the inside of the brain. During imaging, a child will lie still on a table for a few seconds while a machine passes over his or her body, emitting very low (and harmless) frequencies of radiation or sound waves. Shunt Procedure If hydrocephalus is diagnosed, treatment will depend on the age of the child, the cause of the cerebral spinal fluid build-up (whether from a blockage, overproduction of fluid, or another problem), and the child's overall health. Shunt procedures, which have been the standard of care for decades, involve surgically implanting one end of a catheter (flexible tube) into a ventricle of the brain and placing the other end in the abdominal cavity, chambers of the heart, or space around the lungs where fluid is drained and absorbed by the bloodstream. A valve in the shunt system regulates flow to prevent over-draining and under-draining. While shunting is often an effective treatment for hydrocephalus, there is a high chance of failure and complications. About 30% of shunts will stop working within the first year, with about 5% failing in each subsequent year, causing symptoms to recur. A child will need to have surgery to correct the problem — whether it requires replacing a catheter or valve or replacing the entire shunt. Most kids who undergo shunting will require subsequent operations over their lifetimes to regulate shunt problems. Infections are another side effect of shunting, and occur in 5%-10% of shunt operations. Kids will develop typical signs of infection, like fever and neck stiffness, and may feel tenderness along the shunt or belly pain. Most infections develop within the first several months after a shunt procedure and require temporary removal of the device while a child receives intravenous antibiotics for up to 2 weeks. Ventriculostomy A second, increasingly more common treatment for hydrocephalus is an endoscopic third ventriculostomy. During this procedure, a small opening is made in the bottom of the third ventricle (one of four ventricles in the brain) to allow fluid to exit the brain. This minimally invasive approach involves placing an endoscope (small lighted camera) inside the brain to provide surgeons with a view of the surgical site on a computer monitor. Then, using very small instruments, the doctor will make a tiny hole in the bottom of the third ventricle, where a thin membrane separates the inside and outside of the brain. This new "evacuation route" permits fluid to drain normally into the spaces outside the brain while bypassing any obstructions that are causing a backup, so the body can reabsorb the CSF back into the bloodstream as it normally would. When deemed appropriate, third ventriculostomies are the procedure of choice for kids older than 6 months of age due to a higher efficacy rate and lower risk of infection than shunting. Those who undergo the procedure have up to a 90% chance of long-term success, with little need for follow-up procedures. Third ventriculostomies also have shown promise in newborns and may be offered as a treatment to these younger patients in the near future. With timely treatment, many kids with hydrocephalus go on to lead normal lives. Those with more complex medical problems, like spina bifida or bleeding in the brain from prematurity, may experience a higher rate of complications due to their underlying medical conditions. In these kids, early intervention greatly improves the chances of recovery. Reviewed by: Joseph H. Piatt, MD Date reviewed: October 2011 Originally reviewed by: Jeffrey W. Campbell, MD Abusive Head Trauma (Shaken Baby Syndrome)

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John Bowis (United Kingdom) talks to Alzheimer Europe about the European Mental Health Pact (November 2008) Alzheimer Europe (AE): Mr Bowis, you have closely followed the European discussions on the development of a European Pact for Mental Health and Well-being. Which of the proposed actions do you think are of particular interest to people with dementia and their carers? John Bowis (JB): The most important achievement is to have a European Policy - or Pact - for Mental Health. It is on the EU health agenda, where some of us have been pressing for years it should be. The fact that the five specific areas of mental health to be taken forward are children and young people, stigma, suicide, people at work and older people means dementia is up there on the front page. It ties in with the work already under way in the EU research programme on neurodegenerative diseases. Europe, as we know, does not have the power to lay down standards of provision by national health services; we use our position to find and share good practice. However mental health at work is an EU competence and so we can, for example, call for reports on what employers are doing both for employees who start to contract dementia or who are carers for a dementia patient at home. Likewise, where our new policy on Cross Border Health is concerned, people are beginning to realise we need to share standards and measurements for quality and safety and a great deal of work is now tackling this. The other side of the coin is of course that we are looking not just at how we can improve policy and practice for people who have dementia but we are looking for ways of encouraging mental well-being and the prevention - or at least the slowing - of the onset of such diseases. AE: How will the recommendations of the Pact be put into practice? JB: The next steps are that the five key areas will each have a "take forward" group to discuss, debate and progress ideas for each. This may or may not lead to legislation; it may be left to Member States to take forward. AE: In your opinion, which other actions are necessary to make dementia a European public health priority? My hope is that we will have at the very least a Council Recommendation and maybe a full blown Directive setting out where we expect action and the sort of targets to aim at, but leaving the detail to the discretion of each Member State. Alongside this, I do believe we can and should require by EU legislation that firms above a certain size should annually report on their mental health at work company policy. At the very least, this would concentrate their minds and, maybe, prompt them to initiate some imaginative ideas. I have no doubt at all however that some Member State governments would rather we did not do anything of any consequence in this area. If you believe, as I do, that this would not be acceptable, then we need individuals and organisations such as Alzheimer Europe to press their governments and Ministers to look positively on this excellent first step on the way to a better future in Europe for the very large number of our fellow citizens, who have to live with mental health problems and increasingly have to face the prospect of the frailty of mind, that comes with longevity for so many of us. Last Updated: mercredi 14 octobre 2009

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MARGINALIARoutes of ResistanceOur focus on using antibiotics to kill bacteria has blinded us to their diverse functions in the organisms that make these chemicalsRobert L. DoritLast year, some 50 million pounds of antibiotics were used in the United States, an amount that would correspond to roughly 5 tablespoons—or 75 doses—of antibiotics per person. In fact, much of this antibiotic—as much as 70 percent by some estimates—is being used not to treat infections, but instead to promote food production, as antibiotics have become a key ingredient in the American food chain. We are, in short, marinating the living world in antibiotics. Against this backdrop, the emergence of antibiotic-resistant pathogenic bacteria can hardly come as a surprise. Antibiotics, after all, are used to suppress and kill bacteria, and bacteria, like every other living thing, have no greater evolutionary imperative than to stay alive. Our overuse of antibiotics methodically rewards any bacterium fortunate enough to carry a mutation that confers even slight resistance to the substance in its environment. The less-fortunate bacteria die, leaving behind empty ecological space for resistant strains to fill. Slowly and inexorably, we thus enrich the world with bacteria that now scoff at our attempts to control them. The Rise of Resistance It did not take long for antibiotic resistance to emerge once the drugs entered the arsenal of modern medicine. Penicillin, discovered in 1929, came into widespread use on the battlefield during World War II: Some 100 million doses were produced between 1943 and 1945. But even before the end of the war, the first penicillin-resistant strains of bacteria appeared. Over the next five decades, the pattern repeated numerous times. The discovery of every new antibiotic class created excitement by promising to bring bacterial infections to heel. Inevitably, however, the edge of this new tool for the treatment of infections became blunt with overuse as resistant strains grew common. The useful clinical life of new antibiotics, defined as the time between clinical introduction and the rise of resistant strains, is often no more than a matter of three to five years. Over the past decade, moreover, antibiotic resistance, once only a public-health concern, has morphed into a measurable cause of death. Conservatively, untreatable bacterial infections result in some 100,000 deaths per year in the United States. The early promise of the age of antibiotics—an end to infectious diseases—now seems absurdly naive. But every day, in clinics and hospitals around the world, doctors are forced to administer antibiotics to clear up bacterial infections that threaten the lives of patients. And every day, the bacteria—both the pathogens we are targeting and the innocent bystanders that end up as collateral damage—respond by evolving mechanisms to resist the antibiotics. Each dose is a skirmish in a larger war. Yet, focused as we are on what we see as an epic battle between humans and pathogens, we forget that both antibiotics and antibiotic resistance have been part of the microbial world for the past 3 billion years. Yes, the widespread use of antibiotics to combat infections has had profound implications for the evolution of infectious disease, but it is a mere blip in the history of the microbial world. Four out of five antibiotics in use today are based on naturally occurring compounds produced by bacteria and fungi. The organisms that produce antibiotics have not, of course, been doing so over billions of years just so that we might discover them and put them to therapeutic use in the 21st century. So what are antibiotics doing for the organisms that produce them? The explanation most obvious to us, of course, is to see these compounds as part of the competitive arsenal of the bacteria that produce them. In this model, antibiotic-producing bacteria kill their competitors and make ecological space available for themselves and their genetic kin. Seen this way, antibiotics in microbial ecosystems and antibiotics in the clinic do one and the same thing: kill bacteria. To be sure, naturally produced antibiotics in intact microbial ecosystems enable producing strains to kill other bacteria. Some antibiotics, such as a class of proteins called the bacteriocins, are not subtle: A single molecule entering a target cell will kill it. These molecules are designed to kill and nothing more. But the concentrations of many other antibiotics in natural ecosystems seem consistently too low to kill surrounding organisms effectively. Why would bacteria bother to produce antibiotics—which are expensive molecules to synthesize—at concentrations too low to reap the benefits? It now appears that at lower concentrations, antibiotics may well, to the bacteria, mean something utterly different than they do at the massive concentrations encountered in the clinic. In their original context, antibiotics may not be killers at all, but instead messengers enabling cell-to-cell communication both within and across bacterial species boundaries. Off-Label Meaning Researchers such as Fernando Baquero and Jose L. Martinez of the National Center for Biotechnology in Madrid, and Julian Davies of the University of British Columbia, among others, have begun to articulate a radically different perspective on the role played by the now-mislabeled “antibiotics.” Far from being just stone-cold killers, naturally occurring antibiotics appear to be part of the vocabulary of bacteria, words in the nuanced language of this world unseen by humans. Like language, antibiotics are capable of conveying multiple meanings to different recipients. At sublethal concentrations, antibiotics can have profound and unexpected effects on surrounding cells. Several different antibiotics, when present at a small fraction (less than 1 percent) of their lethal concentration, coordinate the expression of whole sets of genes in bacteria that sense the antibiotic. These coordinated responses are not simply the molecular expression of panic (the aptly named “SOS response”) expected when an antibiotic is present. The signal may, for instance, induce Pseudomonas aeruginosa bacteria to develop into a bacterial biofilm—an architecturally complex, surface-bound conglomeration of cells—which, regrettably, makes bacteria much less sensitive to antibiotics in clinical settings. In another irony, low concentrations of antibiotic appear to upregulate the expression of a suite of genes responsible for increased virulence, in effect transforming a benign bacterium into a pathogen. These and other examples, in short, suggest that antibiotics may be far more than just toxic substances designed to kill all bacteria within range. And in the latest of many surprises, George M. Church of Harvard Medical School and his colleagues have isolated hundreds of soil bacteria able to subsist on antibiotics as their sole source of nutrition. This is not resistance but rather downright insolence, as these bacteria think of antibiotics not as threatening molecules, but instead as food. Our ability to understand the origin and role of antibiotics has, in effect, been hindered by the uses to which we put them. In a fit of intellectual narcissism, we assume that if we use them in clinical settings to kill bacteria, that must be what they evolved for. However, when we recast them in a subtler role as agents of competition, and also as regulators and communicators in the bacterial world, we can view their lethal (and thus, for us, salutary) effects in a different light. It is when we administer doses of antibiotics that are orders of magnitude greater than those encountered in nature that a subtle, modulated signal is transformed into a deafening, and increasingly deadly, roar. If antibiotics are part of the whispered conversations of the microbial world, what then should we make of antibiotic resistance? The last 65 years of clinical antibiotic use have exposed a dizzying array of mechanisms that bacteria use to survive the presence of toxic antibiotic concentrations. The diversity and complexity of these mechanisms—enzymes that chemically disable antibiotics, shape-shifting targets that prevent antibiotics from binding, complex pumps that eject the antibiotic from the target cell—have raised an obvious evolutionary question: Where do these mechanisms come from? Part of the answer, unsurprisingly, is self-defense. Many of the bacteria that produce antibiotics also harbor mechanisms that make themselves impervious to that antibiotic compound. In the case of the lethal protein antibiotics discussed previously, the bacteriocins, producer bacteria also synthesize a second protein that pairs up with the antibiotic, rendering it inactive until it reaches its target. More than One Answer In the classic militaristic interpretation, antibiotics exist to target competitors, and resistance genes evolve to protect producers. But here again, we might do well to remember that massive concentrations of antibiotics used in clinical settings, and the consequences of such massive use, may be obscuring subtler phenomena in the microbial world. A second effect, which I will call the Pete Townshend effect, may also underlie some of the evolution of resistance. In this scenario, antibiotics are playing their signaling role, but the levels of this signal molecule are so high in and around the producing cell that they will cause unintended damage as a byproduct of their high concentration. Resistance evolves in producer strains to protect them from the damaging consequences of overwhelming signal strength. As the antibiotic diffuses away from the producer, its concentration declines. The antibiotic loses its lethality and regains its signaling function. If antibiotics have multiple meanings, resistance too must mean more than one thing. Our ability to examine the genomes of both culturable and unculturable organisms has changed the way we look at the origin of antibiotic resistance mechanisms. Resistance is everywhere, and we don’t always know why. We now realize, for example, that the bacteria in a gram of soil harbor hundreds of different genes that can, in the right setting, contribute to resistance. For instance, work by Gerard D. Wright of McMaster University and others, reveals that bacteria in the soil already harbor the rudiments of resistance to all known antibiotics, including entirely synthetic antibiotics with no counterpart in the natural world. Virtually every bacterial cell in these environmental samples is, on average, resistant to eight antibiotics. The collection of mechanisms responsible for resistance in these soil bacteria has come to be called the “environmental resistome” (as it rhymes, as everything must nowadays, with “genome”). The samples used to investigate the resistome are not ones where clinical strains selected for resistance might be congregating (although wastewater streams from hospitals and water treatment plants in large cities harbor their own impressive collection of clinic-selected resistant strains). Instead, virtually every sample used has a stable microbial ecosystem that has never been exposed to clinical levels of antibiotics and has not been in contact with resistant clinical bacterial cultures. Nonetheless, every one of the samples harbors a vast repository of resistance genes. This environmental resistome provides a glimpse of the raw materials that clinical pathogens have accessed in the antibiotic age. What is sobering about the discovery of the resistome is the revelation that the microbial world already possesses a functional arsenal of defenses against the antibiotics we develop for clinical use. The resistome also demands a subtle, but critical, change in our perspective on resistance: Many of the mechanisms involved in so-called resistance may be playing other critical roles in cells coexisting peacefully with their neighbors. If antibiotics at sublethal doses really are signal molecules, perhaps resistance is really a signal modulator, altering the meaning and modifying the effects of the message on the recipient cell. Once again, the context in which we usually first encounter resistance mechanisms—in clinical infections as they become insensitive to therapeutic doses of antibiotics—may be obscuring the many roles these mechanisms play in the microbial world. Rethinking the Fight We cannot lose sight of how profoundly 50 million pounds of annual antibiotic use impacts the microbial world. The widespread use of antibiotics has created a black market for antibiotic resistance mechanisms where bacteria poach ready-made shortcuts to resistance: It has enhanced and rewarded the evolution of a vast network that allows for the transfer of resistance along nongenealogical lines. These mechanisms of horizontal transfer now connect the extensive environmental resistome with any pathogen (or commensal bacterium) exposed to clinical concentrations of antibiotic. As a result, bacteria in the presence of potentially lethal concentrations of antibiotics no longer face the daunting evolutionary challenge of remaining alive while they and their descendants cobble together resistance one point mutation at a time. Instead, fully functional resistance located on moveable genetic elements can now be acquired by swapping with other bacteria, or by taking such elements up directly from the environment. To make matters more challenging, many of these ready-made resistance elements are packaged as a set. Multiple genes encoding resistance to multiple antibiotics now travel as a team (up to 74 different resistances have been found to occur together). The ubiquitous presence of human-administered antibiotics in the environment selects strongly for bacteria that are able to acquire these resistance packs, and may also be selecting for the evolution of increasingly mobile and promiscuous elements equipped with increasingly diverse arrays of resistances. As mobile elements, their Darwinian imperative is to make and move copies of themselves, and that in turn may depend on their ability to keep their host bacteria alive in a sea of antibiotics. Many forces—social, economic and medical—propel excessive antibiotic use. An expanded perspective on the role of antibiotics and resistance in no way contradicts the urgent need to reduce antibiotic consumption. Our current behavior, moreover, drowns out the subtle melody unfolding in microbial ecosystems and superimposes the deafening roar of therapeutic antibiotics and increasingly resistant pathogens in its place. We can hope that new antibiotics will continue to be developed and broadly prescribed, buying us a few more years. We can keep doing what we have always done, and hope we can reach a stalemate with ever more-aggressive bacterial pathogens. Or we can instead start paying more attention to what microbial ecosystems have to teach us, acknowledging the lessons that have always been embedded in a gram of soil. Our relationship to the unseen world extends far beyond pathogens and our efforts to combat them. We can, if we put our minds to it, begin to see a world in a grain of sand. You can find this online at http://www.americanscientist.org/issues/num2/routes-of-resistance/1© 2014 Sigma Xi, The Scientific Research Society

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Melissa Kaplan's Chronic Neuroimmune Diseases Information on CFS, FM, MCS, Lyme Disease, Thyroid, and more... A polio by another name Jane Colby, What Doctors Don't Tell You, 6(9) Research into Post-Polio syndrome and chronic fatigue has-made the astounding discovery that the virus that most often triggers CFS is closely related to the one that causes polio. Just a few decades ago, hospital wards were full of children in iron lungs as a result of polio. No longer. The horrific spectacle appeared to abate with the advent of vaccination, but nothing is without its price. The public breathed a sigh of relief and even the medical profession believed, and still seems to believe, that the dreaded scourge of polio was at last being vanquished. We read predictions that it will be wiped out by the year 2000. But a body of evidence is growing linking Chronic Fatigue Syndrome (CFS), also called myalgic encephalomyelitis (ME), to this terrible disease, largely caused by attempts to eradicate polio. An alternative polio seems to be upon us. The proceedings of the first intemational scientific conference on the Post-Polio Syndrome in the US have been collated in the Annals of the New York Academy of Science. It includes 50 papers written by 118 contributors from a wide range of specialties, including clinical neurology. In particular, papers by Dr Richard Bruno, assistant professor at the New Jersey Medical School's department of physical medicine and rehabilitation and director of Post-Polio Rehabilitation and Research Service at the Kessler Institute for Rehabilitation in New Jersey, and four other specialists compare Chronic Fatigue Syndrome and Post-Polio Syndrome (Dalakas, et al, ed. The Post Polio Syndrome: Advances in the Pathogenesis Treatment,Annals, NY Academy, Sciences, 1995: 273: 1-409). Post-Polio is developing in those who had polio 25-30 years previously. Clinically, it is indistinguishable from CFS. Other researchers demonstrate that CFS is just another form of polio, which has increased with the advent of polio vaccination. As one type of gut virus has been eradicated, so other forms have had the space to proliferate. Up to one in every 500 Americans may have CFS, according to the Centers for Disease Control. To understand the link one needs to understand the microbiological habits of both polio and other enterovirus disease-that is, gut bugs. A historical accident has led to various names being given to viruses, all of which share physical , chemical and epidemiological characteristics of what we consider the classic polio virus, which science refers to as polio viruses 1, 2, and 3 (Dowsett: Journal of Hospital Infection, 1988:11:103-15). ln 1948, a polio-like illness in New York state prompted scientists to culture the virus. But what grew looked to them at that time like a new virus. They called it "Coxsackie' after the small town up the Hudson River where it was found. And they called the disease "Atypical Polio" because its symptoms identified it as a kind of polio, despite the virus being apparently different. This kind of polio, "Atypical Polio,' has since been renamed, 'Chronic Fatigue Syndrome,' or ME. But it remains a kind of poIio despite the change of name. and newer technology has shown up the generic similarities of the most frequent agent that causes it. These techniques place Coxsackie, the virus most often implicated in CFS, in the polio family tree, along with so-called echo viruses. Coxsackie has been further divided into Coxsackie type A (with 24 viruses) and Coxsackie type B (six viruses ). There are 34 echo viruses. In total, there are at least 72 enteroviruses in all, with new ones still being discovered. All this has been unnecessarily confusing and complicated, even for doctors. These days newly discovered enteroviruses are just given a new number, not a new name, since their inter-relationship is recognized. Had the techniques been available that we now have at our disposal, all these viruses might simply have been called "Polio 1 through 72." There are several angles from which to investigate the hypothesis that CFS is a type of polio. One is its clinical symptoms. Dr. Elizabeth Dowsett, consultant microbiologist of the Southeast Essex NHS Trust who is in the forefront of British CFS research, explains that true CFS (as opposed to fatigue states with other etiologies) strikes one clinically as being polio-like, and it has often been diagnosed as a "non-paralytic polio." "These patients have weakness, pain down their spines and are systemically ill," she says. She feels that it has been an unfortunate mistake to turn to the label "Chronic Fatigue" because true CFS is a neurological condition that usually originates with a gut virus infection like Coxsackie. Apart from clinical examination, in some cases of CFS you can actually demonstrate the presence of gut virus infection in the patient. The requirement to put off diagnosing CFS for six months after the patient falls ill has unwittingly militated against this. If tests are not done very rapidly after the onset of infection, it is too late to identify the virus. A blood screening test called the IGM, which shows up recent infection, can be positive up to three months after infection in adults. As the enteroviruses are characterized by their relapsing nature (on average, three-week intervals), it could also be identified on relapse. Apart from modern techniques, a research procedure called the acid elution test can identify your antibody from a circulating virus and can be applied to viruses multiplying in the bowel. Years ago it was difficult to diagnose polio, and it was this very test which was used. A third way to compare CFS with polio is by looking at studies of actual outbreaks which identified the viruses causing it. Here the evidence is particularly striking. A recent paper by Richard T. Johnson, at the Department of Neurology, John Hopkins University School of Medicine, in Baltimore, published in the 1995 Annals of the New York Academy of Sciences mentioned above, sets out evidence that has been available since the 1950s. "In the spring of 1957," he wrote, "we investigated an epidemic of poliomyelitis in Hawaii...of the 39 cases of nonparalytic poliomyelitis, only four were related to type I poliovirus. There were 16 cases of echovirus 9, seven cases of Coxsackie, and four to five other enteroviruses." The very enteroviruses known to be implicated in CFS were here identified as causing "non-paralytic polio." CFS has often been diagnpsed as "non-paralytic polio." And even more interestingly, two of the 38 cases of paralytic disease were not caused by the polio virus at all, but by one of the Coxsackie viruses. So we know that enteroviruses in general can cause varying forms of the disease we call polio. Other parallels between CFS and polio concern neurological damage. In the November 1991 edition of Orthopedics, Dr. Bruno says that "all the evidence available shows conclusively that every case of poliomyelitis, human or experimental, exhibits lesions of the brain. In the experimental animal this included non-paralytic and abortive cases as well as paralytic cases." CFS has been diagnosed by both italicized names. In fact, brain abnormalities can now be demonstrated in the brains of people with CFS using SPECT and MRI scans. One would expect there to be differences in the diseases caused by different viruses, but if these viruses are all of the same family and use the same receptor sites in the body, one would also expect there to be simularities. This is just what we find. Dr. Bruno says: "Despite the differences between poliomyelitis and CFS, an association with the polio virus was suggested by the fact that, of the more than one dozen CFS outbreaks before the introduction of the Salk vaccine, nine occurred during or immediately after outbreaks of polio, and several involved hospital staff who cared for polio patients" (Annals, NY Academy of Sciences, 1995). There is also the case of a woman who fell ill with classical CFS while nursing a lady friend with acute paralytic polio (Hyde et al: Epidemiological Aspects of ME/CFS, Nightingale Research Foundation, Ottowa, Canada, 1994). But if CFS is a type of polio, why doesn't everyone exposed to the relevant viruses develop ME just as they did polio? It has been forgotten that, as Dr. Thomas Stuttaford of The London Times explains, ". . only a small number of those infected with the polio virus became paralyzed; about 90 percent didn't even realize that they had annthing more threatening than a cold." With polio and CFS, the state of your immune system governs whether you will be susceptible. By altering the population's resistance to a particular organism, we alter the balance of infectious agents in the environment. The circulation of wild polio viruses 1-3 has declined through vaccination. However, this has left us open to the other 69 polio-related viruses, which have thrived (see How viruses compete with each other). It is therefore not surprising that since the late 1950s the incidence of CFS has risen, and experts predict that it will be the neurological disease of the 21st century. By suppressing the spread of three enteroviruses we have opened the door to the rest. The argument about whether enterovirus infection persists over many years is still raging. In her 1995 review of the proceedings of the 1994 Post-Polio Conference, Dr. Dowsett draws attention to new evidence of persistent enterovirus infection in the central nervous system of Post-Polio patients. She concluded: "Three separate groups of Virologists from the US, UK and France have found fragments of enteroviral RNA in the spinal cord, cerebrospinal fluid and bIood of some patients with Post-Polio syndrome. The fragments are identified as polio virus by some and as Coxsackie virus by others," she said. It is thought that the emergence of late-onset Post-Polio fatigue may result from age-related changes in brain cells that survived the original polio infection (Bruno, Annals, NY Academy of Sciences, 1995). But it can be observed through case histories that just as we see Post-Polio Syndrome 30 years after initial infection, so we are seeing "Post-CFS" as well. The Nightingale Research Foundation in Ottawa proposes that in fact they are one and the same condition-others believe they may be variations of each other. What has arisen is "two new diseases with different names, with different degrees of acceptance and exactly the same set of symptoms at exactly the same time. It is unrealistic to believe that we are dealing with two different disease processes and two different causes," the researchers concluded. A paper investigating the epidemiological aspects of CFS has revealed further convincing parallels between the behavior of this disease and polio. It describes the onset of CFS as mainly being ushered in by a "minor illness" which has "recently been described as a flu-like illness. . .", The researchers continue: ". . in reality it is identical to and has all of the features and variability of the 'minor illness' of missed or abortive poliomyelitis." In comparisons with epidemic polio going back to 1916, they note that "we see the same two typical features" in a typical year with an epidemic of CFS: "a decreasing incidence from January to reach a summer low; then ... the strong late summer increased incidence, peaking in the August to October period." (Hyde et al: Nightingale Research Foundation. Ottowa, 1994). CFS, or Atypical Polio, is such a serious and devastatingly debilitating multisystem malfunction leading to such profound weakness in some children that they are unable to speak and have to be tube-fed. But they can breathe; enteroviruses have an affinity for certain tissues and many do not attack the respiratory center, causing paralysis, as in polio itself. Children with polio were given intensive physiotherapy and exercised. Now. up to a half of survivors have gone on to develop Post-Polio. It has been predicted that this will eventually rise to 100 percent. What are we doing to our teenage CFS sufferers when we force them back to school, deny home tutoring and tell them to exercise as a form of therapy? The treatment of choice for those with Post-Polio is "adequate rest, energy conservation, the pacing of activities, and reducing physical and emotional stress" (Bruno: Annals NY Academy of Sciences, 1995). What on earth will happen in 30 years' time to children now getting CFS in a climate where they are disbelieved and told to push themselves through the pain barrier? The condition 'Post-CFS,' which we are already seeing in adults, may well await them with a vengeance. We have to ask ourselves the disturbing question: if polio victims had been able to breathe, would we ever have taken that disease seriously? Sidebars This article was excerpted from Ms. Colby's book ME: The New Plague First and Best in Education Ltd. 24 Nene Valley Business Park, Oundle, Peterborough, PE 8 4HL, UK Related Articles Stealth Virus Linked to Monkey Virus Stealth Virus Encephalopathy SV-40 Contamination of Poliovirus Vaccine A very interesting read:The Polio Paradox, Richard L. Bruno a1 Books; Amazon.ca; Amazon US; Amazon UK; Barnes&Noble; Booksamillion http://www.anapsid.org/cnd/diffdx/polio1.html Activism Disability Pain About Melissa Kaplan Books Drugs PetsHerp Care Chemical Sensitivity Finding Support/Doctors/Attorneys ResourcesGreen Iguana Care CopingGenderThyroidHelp Support This Site DiagnosisHormonesCND HomeAdvance Care Directives Differential DxLyme DiseaseAnapsid HomeEmergency Preparedness © 1994-2014 Melissa Kaplan or as otherwise noted by other authors of articles on this site

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Exercise in Pregnancy May Boost Baby's Brain, Study Says SUNDAY, Nov. 10 (HealthDay News) -- Moderate exercise during pregnancy may boost your baby's brain development, according to new research. The study involving 18 moms-to-be and their babies found that "at 10 days, the children have a more mature brain when their mothers exercised during the pregnancy," said study researcher Elise Labonte-LeMoyne, a Ph.D. candidate in kinesiology at the University of Montreal. Other studies have found health benefits for newborns and older children whose mothers worked out during pregnancy, the researcher said. And while animal studies have shown that exercise during pregnancy alters the fetal brain, she believes this is the first study to look at exercise's effect on human brain development. For the study, which was scheduled for presentation Sunday at the Society for Neuroscience annual meeting in San Diego, the researchers randomly assigned 10 pregnant women to an exercise group and eight to an inactive group at the start of their second trimester. The active group was told to engage in at least 20 minutes of cardiovascular exercise three times a week at a moderate intensity -- meaning it should lead to at least a slight shortness of breath. They typically walked, jogged, swam or cycled, Labonte-LeMoyne said. On average, the workout group clocked 117 minutes of exercise a week; the sedentary group 12 minutes weekly. Using an EEG, which records the brain's electrical activity, the researchers measured the newborns' brain activity while sleeping when 8 to 12 days old. They focused on the ability of the brain to recognize a new sound, Labonte-LeMoyne said, noting this reflects brain maturity. The babies whose mothers exercised showed a slight advantage, the investigators found. "The brain is more efficient; it can recognize the sound with less effort," she explained. The differences may translate to a language advantage later in life, she speculated. The researchers are continuing to track the children's development until age 1 to see if the advantage remains. It's possible that exercise speeds up a process known as synaptic pruning, whereby extra nerve cells and connections are eliminated, helping brain development, Labonte-LeMoyne said. The study findings didn't surprise Dr. Raul Artal, professor and chair of obstetrics and gynecology and women's health at Saint Louis University School of Medicine. He has long touted the value of exercise for healthy pregnant women. "It's known that babies respond to stimuli in utero," he said. The new research reinforces the belief that "pregnancy is not a state of confinement or indulgement," Artal added. "It has been documented that pregnant women who lead a normal life, exercise and eat judiciously have better pregnancy outcomes," Artal said, while a sedentary lifestyle, obesity and some diseases can hurt the unborn baby. The American Congress of Obstetricians and Gynecologists states that women with uncomplicated pregnancies who are recreational and competitive athletes can remain active during pregnancy, modifying their routine when medically necessary. Women who were inactive before getting pregnant or who have medical or pregnancy-related complications should be evaluated first by their doctor, the guidelines say. Research presented at meetings is considered preliminary until published in a peer-reviewed medical journal. To learn more about exercise during pregnancy, visit the Nemours Foundation. SOURCES: Elise Labonte-LeMoyne, Ph.D. candidate, University of Montreal; Raul Artal, M.D., professor and chair, obstetrics and gynecology and women's health, Saint Louis University School of Medicine, and editor, Clinical Updates in Women's Health Care; Nov. 10, 2013, presentation, Society for Neuroscience annual meeting, San Diego Absence Seizures Cerebral Abscess Evaluation of First-Time Seizure Refractory Epilepsy

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News Study: Later retirement may help prevent dementia Posted: July 15, 2013 Study: Later retirement may help prevent dementia Working tends to keep people physically active, socially connected and mentally challenged – all things known to help prevent mental decline. By Marilynn Marchione / The Associated Press BOSTON — New research boosts the “use it or lose it” theory about brainpower and staying mentally sharp. People who delay retirement have less risk of developing Alzheimer’s disease or other types of dementia, a study of nearly half a million people in France found. It’s by far the largest study to look at this, and researchers say the conclusion makes sense. Working tends to keep people physically active, socially connected and mentally challenged — all things known to help prevent mental decline. June Springer, who works as a receptionist at Caffi Contracting Services in Alexandria, Va., just turned 90. AP “For each additional year of work, the risk of getting dementia is reduced by 3.2 percent,” said Carole Dufouil, a scientist at INSERM, the French government’s health research agency. She led the study and gave results Monday at the Alzheimer’s Association International Conference in Boston. About 35 million people worldwide have dementia, and Alzheimer’s is the most common type. In the U.S., about 5 million have Alzheimer’s – 1 in 9 people aged 65 and over. What causes the mind-robbing disease isn’t known and there is no cure or any treatments that slow its progression. France has had some of the best Alzheimer’s research in the world, partly because its former president, Nicolas Sarkozy, made it a priority. The country also has detailed health records on self-employed people who pay into a Medicare-like health system. Researchers used these records on more than 429,000 workers, most of whom were shopkeepers or craftsmen such as bakers and woodworkers. They were 74 on average and had been retired for an average of 12 years. Nearly 3 percent had developed dementia but the risk of this was lower for each year of age at retirement. Someone who retired at 65 had about a 15 percent lower risk of developing dementia compared to someone retiring at 60, after other factors that affect those odds were taken into account, Dufouil said. To rule out the possibility that mental decline may have led people to retire earlier, researchers did analyses that eliminated people who developed dementia within 5 years of retirement, and within 10 years of it. “The trend is exactly the same,” suggesting that work was having an effect on cognition, not the other way around, Dufouil said. France mandates retirement in various jobs – civil servants must retire by 65, she said. The new study suggests “people should work as long as they want” because it may have health benefits, she said. June Springer, who just turned 90, thinks it does. She was hired as a full-time receptionist at Caffi Plumbing & Heating in Alexandria, Va., eight years ago. “I’d like to give credit to the company for hiring me at that age,” she said. “It’s a joy to work, being with people and keeping up with current events. I love doing what I do. As long as God grants me the brain to use I’ll take it every day.” Heather Snyder, director of medical and scientific operations for the Alzheimer’s Association, said the study results don’t mean everyone needs to delay retirement. “It’s more staying cognitively active, staying socially active, continue to be engaged in whatever it is that’s enjoyable to you” that’s important, she said. “My parents are retired but they’re busier than ever. They’re taking classes at their local university, they’re continuing to attend lectures and they’re continuing to stay cognitively engaged and socially engaged in their lives.”

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Cell research could lead to advances against Alzheimer's, cancer By Doug BoydECU News Services Doctoral student Amy Friesland and Dr. Qun Lu are co-first authors on a recent research article. Contributed photo GREENVILLE, N.C. (Jan. 15, 2013) — Research by a team at East Carolina University could help lead to a better understanding of how individual cells perform certain tasks and could have implications for Alzheimer's disease, cardiovascular disease, cancer and other conditions. Dr. Qun Lu, a professor of anatomy and cell biology at the Brody School of Medicine at ECU, said his team’s discovery of a chemical compound involved in cell signaling and a potential small molecule drug lead that could affect the action of Cdc42 subclass of small G-proteins "provides a potentially powerful tool for research … in human pathogenesis." Lu's research is published in the current issue of The Proceedings of the National Academy of Sciences of the United States of America. An abstract of the study, titled "Small Molecule Targeting Cdc42-Intersectin Interaction Disrupts Golgi Organization and Suppresses Cell Motility," is available online at http://www.ncbi.nlm.nih.gov/pubmed/23284167. Lu's study reports the novel small molecules that target Rho family small signaling guanine nucleotide-binding proteins, known as GTPases. The study focuses on the use of computer-assisted virtual screening to discover the first of such small molecules that targets the Cdc42 subclass of proteins and its activator, intersectin, and disrupts Cdc42-mediated cellular processes. Signaling through the Rho GTPase pathway allows cells to accomplish a number of tasks including membrane trafficking, cell cycle control and the regulation of cytoskeletal organization, which strongly influences cell morphology and motility as well as the ultimate fate of the cell. Many human pathological conditions including cancer and neurological disorders involve Rho GTPase dysfunction or de-regulation, making small G-proteins prime candidates for pharmaceutical intervention. ECU doctoral student Amy Friesland is a co-first author of this article. Lu collaborated with the laboratories of Dr. Yan-Hua Chen in the ECU Department of Anatomy and Cell Biology at the Brody School of Medicine as well as with scientists in China. The study is funded in part by grants of nearly $1.2 million from the National Cancer Institute and by the Harriet and John Wooten Laboratory for Alzheimer’s and Neurodegenerative Diseases Research at ECU. Contact: | 252-744-2482 ECU News Services

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ADHD in the News - May 3, 2012 A weekly news digest** from the National Resource Center on ADHD: A Program of CHADD Teen Impulsiveness Has Different Sources in ADHD, Substance Use (US News & World Report, April 29, 2012)"Teens with attention-deficit/hyperactivity disorder (ADHD) and teens who start using cigarettes, drugs or alcohol tend to share at least one personality trait: impulsiveness, experts say. But a new brain-imaging study of nearly 1,900 14-year-olds finds that the brain networks associated with impulsivity in teens with ADHD are different compared to those who use drugs or alcohol. What that finding suggests is that multiple underlying mechanisms drive impulsivity -- in other words, the impulsivity that leads kids to blow off their homework and the impulsiveness that drives kids to take a drag off a joint aren't the same, neurologically speaking..." Full Story Family Involvement Improves Behavior and Academics in Children With ADHD (Good Therapy, April 27, 2012)"The most commonly used methods of treatment for children with ADHD are medication and behavioral therapy. Both approaches have proven to be effective in some areas, but neither has successfully addressed all the issues that families and children with ADHD struggle with. In recent years, professional educators and clinicians have devised new strategies that focus on behavior and family involvement...One of these methods is the Family-School Success (FSS) program, a program created to increase the academic performance and family awareness of elementary-age children with ADHD..." Full Story Dopamine impacts your willingness to work (Vanderbilt University Research News, May 1, 2012)"Slacker or go-getter? Everyone knows that people vary substantially in how hard they are willing to work, but the origin of these individual differences in the brain remains a mystery. Now the veil has been pushed back by a new brain imaging study that has found an individual's willingness to work hard to earn money is strongly influenced by the chemistry in three specific areas of the brain. In addition to shedding new light on how the brain works, the research could have important implications for the treatment of attention-deficit disorder, depression, schizophrenia and other forms of mental illness characterized by decreased motivation..." Full Story Overly long pregnancies linked to behavioral problems in toddlers (NEWS10 ABC, May 03, 2012)"Children born after a longer-than-normal pregnancy are at increased risk for behavioral and emotional problems, a new study suggests. The study found that attention-deficit hyperactivity disorder (ADHD) is an especially common problem among children who were born post-term, defined as birth after a pregnancy of 42 weeks. The study of more than 5,000 infants in the Netherlands found that about 7 percent were born post-term, while 4 percent were born pre-term (before 37 weeks of pregnancy)..." Full Story Prescription mistakes are rampant and under-reported (WPTV TV/NewsChannel 5, April 30, 2012)"Every day, pharmacists count, pour and hand patients their medication. Medication that isn't always right...Instead of the medication to treat [her child's] ADHD, Helena says the pharmacist mistakenly prescribed Nicholas a drug for adults, suffering with schizophrenia..." Full Story Report says more kids have mental-health disorders (The Columbus Dispatch, May 1, 2012)"The most prevalent childhood disabilities have shifted away from the physical to mental-health disorders, researchers say. A report released today by Princeton University and the Brookings Institution notes that the top five limiting conditions of children are now behavioral or developmental..." Full Story **Disclaimer: Neither CHADD, the National Resource Center on ADHD, nor the Centers for Disease Control and Prevention endorses, supports, represents or guarantees the truthfulness, accuracy, or reliability of any included articles nor endorses any opinions expressed in any articles included in ADHD in the News. CHADD and the National Resource Center on ADHD merely provide access to such content as a service to you. ADHD in the News - Archive Search:

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Dr. Robert C. Atkins Obituary NEW YORK (AP) – Dr. Robert C. Atkins, whose best-selling low-carbohydrate, high-protein diet was dismissed as nutritional folly for years but was recently validated in some research, died Thursday, his spokesman said. He was 72. Atkins died at New York Weill-Cornell Medical Center, surrounded by his wife and close friends, said Richard Rothstein, his spokesman. Atkins had suffered a severe head injury April 8 after falling on an icy sidewalk while walking to work. Atkins first advocated his unorthodox weight-loss plan – which emphasizes meat, eggs and cheese and discourages bread, rice and fruit – in his 1972 book, "Dr. Atkins' Diet Revolution." Its publication came at a time when the medical establishment was encouraging a low-fat, high-carbohydrate diet. The following year, the American Medical Association dismissed Atkins' diet as nutritional folly and Congress summoned him to Capitol Hill to defend the plan. Labeling it "potentially dangerous," the AMA said the diet's scientific underpinning was "naive" and "biochemically incorrect." It scolded the book's publishers for promoting "bizarre concepts of nutrition and dieting." Despite this, his books sold 15 million copies, and millions of people tried the diet. Atkins' philosophy enjoyed a resurgence in the 1990s with "Dr. Atkins' New Diet Revolution," which sold more than 10 million copies worldwide and spent five years on The New York Times best-seller list. But criticism of the diet lingered, with many arguing that it could affect kidney function, raise cholesterol levels and deprive the dieter of important nutrients. Atkins said no study showed that people with normal kidney function developed problems because of a high-protein diet, and he never gave in to his detractors. Defending his plan at the American Dietetic Association's convention in 2000, Atkins quipped, "I'm very happy to be here. Not as happy as Daniel in the lion's den." This year, his approach was vindicated in part by the very medical community that scorned him. In February, some half-dozen studies showed that people on the Atkins diet lost weight without compromising their health. The studies showed that Atkins dieters' cardiovascular risk factors and overall cholesterol profiles changed for the better. Still, many of the researchers were reluctant to recommend the Atkins diet, saying a large new study now under way could settle lingering questions of its long-term effects. On the Atkins diet, up to two-thirds of calories may come from fat – more than double the usual recommendation, and violating what medical professionals have long believed about healthy eating. Carbohydrates are the foundation of a good diet, most say. Eating calorie-dense fat is what makes people fat, they say, and eating saturated fat is dangerous. To Atkins, the key dietary villain in obesity was carbohydrates. He argued they make susceptible people pump out too much insulin, which in turn encourages them to put on fat. Fat in foods can be a dieter's friend, Atkins said, in part because it quenches appetite and stops carbohydrate craving. Atkins, a graduate of Cornell University's medical school, first tried a low-carbohydrate diet in 1963 after reading about one in the Journal of the American Medical Association. He said he lost weight so easily that he converted his fledgling Manhattan cardiology practice into an obesity clinic. Besides his work on nutrition, Atkins also argued that ozone gas can kill cancer cells and HIV, the virus that causes AIDS, and he claimed to have treated more than 1,000 patients with ozone therapy. The ozone treatment is a common alternative therapy in Germany and some other nations but has not gained acceptance in the United States. In 1999, Atkins established the Robert C. Atkins Foundation to finance diet research. It has sponsored research at Duke University, the University of Connecticut and Harvard. Last April, Atkins was hospitalized for cardiac arrest, which he said was related to an infection of the heart and was not related to the diet. Besides his wife, Veronica, Atkins is survived by his mother, Norma, of Palm Beach, Fla. Read Full Obituary for Robert Atkins Published online on April 17, 2003 courtesy of Legacy.com. "I am so sorry for the family of Dr. Adkins. I wanted to say I think he was a great man and I always knew his diet plan was the right way to live. I will be forever grateful.I truely felt like I had lost a good friend.He will be in the hearts of alot..."- Laurie Hunter (Brunswick, GA) "Your work and belief in the correct foods to eat have improved my life, especially after menopause. I have lost 20 pounds, gained energy and am healthier per my lab workups at my last doctor's visit."- Deborah Massie (Woodinville, WA) "Thank you for helping me get healthy & slim after a lifetime of failed diets. You changed my life."- Hazel Milcoy (Caterham) "My condolences to Veronica and Norma\Atkins on the loss of their husband and son As a patient of Dr Atkins for the past 5 years, I will miss him very much"- Eleanor Curto (New York, NY) "Deepest sympathies to Dr Atkins family and all who loved him."- Pat Wolf (Rochdale, England) Return to Authors Memorial Site Home About This Site: Authors Memorials The Authors Memorial Site includes obituaries and Guest Books from the Legacy.com network of newspaper and funeral home affiliates.

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Obama Kills Texas Women’s Health Program Over Planned Parenthood by Steven Ertelt | Washington, DC | LifeNews.com | 3/15/12 6:42 PM State The Obama administration made it official today when HHS officials notified Texas authorities that the administration is killing a woman’s health program because the state prohibited Planned Parenthood and abortion businesses from involvement. The Department of Health and Human Services announced today that it will cut off all Medicaid funding for family planning to the state of Texas following the state’s decision to implement a law Governor Rick Perry signed that prohibits any business that does abortions from participating and receiving tax dollars via the program. Cindy Mann, director of the Center for Medicaid and State Operations (CMSO), wrote Texas health officials today, according to a Huffington post report, and claims Texas broke federal Medicaid rules by discriminating against abortion businesses. In the letter, Mann places the blame at the feet of Texas rather than the Obama administration. “We very much regret the state’s decision to implement this rule, which will prevent women enrolled in the program from receiving services from the trusted health care providers they have chosen and relied upon for their care,” she wrote. “In light of Texas’ actions, CMS is not in a position to extend or renew the current [Medicaid contract].” The letter continues, “Medicaid law is very clear; a state may not restrict patients’ choice of providers of services like mammograms and other cancer screenings, if those providers are qualified to deliver care covered by Medicaid. Patients, not state government officials, should be able to choose the doctors and other health care providers that are best for them and their families. In 2005, Texas requested this same authority to restrict patients’ choices, and the Bush Administration did not grant it to them either.” The state banned Planned Parenthood from participating in the program along with any other agencies that do abortions. In response, Health and Human Services Secretary Kathleen Sebelius traveled to Houston to make the announcement that the Obama administration would cut funding of the program and would no longer continue the waiver that Texas had previously been given to continue funding of the program temporarily. The Obama administration claims banning Planned Parenthood violates the rules governing Medicaid while Texas Gov. Rick Perry and Texas officials disagree and maintain rules for Medicaid allow states the right to determine the qualifications necessary for those agencies allowed to participate in the program, which serves approximately 130,000 low-income women in Texas and provides cancer screenings, family planning and other health services to women. The Obama administration made it official today when HHS officials notified Texas authorities that the administration is killing a woman’s health program because the state prohibited Planned Parenthood and abortion businesses from involvement. Gov. Perry told state officials on Thursday to begin searching for ways to continue funding the program. “We’ll find the money. The state is committed to this program,” Perry told reporters after sending a letter to Thomas Suehs, head of the Texas Health and Human Services Commission, asking him to work with legislators to find funding. “Those people that are out there trying to say, ‘Oh they’re going to kill this program’ are just dead wrong,” Perry said of the Women’s Health Program on Thursday. He said the Obama administration is “trying to support an organization that supports them. … But Texans don’t want Planned Parenthood, a known abortion provider, to be involved in this.” In a letter to President Barack Obama, Perry accused the administration of trying to violate states’ rights “by mandating which health providers the State of Texas must use.” “I will not allow these services to be denied by your administration’s political agenda and opposition to enacted Texas law that prohibits abortion providers and their affiliates from receiving taxpayer dollars,” the letter said. In a statement to LifeNews after the Obama administration first indicated it would make today’s decision, Family Research Council Action expressed outrage at President Obama’s decision. “President Obama made a vow when he was running for president that he would stand by abortion giant Planned Parenthood – and that he has done time and time again,” said FRC president Tony Perkins. “He has peppered his administration with radical pro-abortion officials, and just last year he threatened to shut down the whole government if one dollar of federal money was halted to the billion-dollar organization. Now he is willing to risk the health of 130,000 low-income women unless the harbingers of death at Planned Parenthood get their share.” “This administration needs to stop using women and the unborn as pawns in funding President Obama’s radical allies. Some on the left have said there is a ‘war on women’ – they are correct, and its lead general is President Barack Obama,” he added. Defeat Obama 2012 Texas has applied to the Obama Administration for an extension of the program through 2013, with the condition that no funding go to organizations that perform or promote elective abortions or are affiliated with such organizations. Of the more than 1,000 certified WHP providers across the state, this rule excludes fewer than 100 Planned Parenthood providers. Joe Pojman of Texas Alliance for Life says, “The State has an interest in not promoting abortion when it promotes birth control. the fact that Planned Parenthood performs many thousands of elective abortions every year in its 14 abortion facilities in Texas was not lost on the Legislature. President Obama seems to care more about Planned Parenthood than about women’s health.” Last June the Texas Legislature overwhelmingly passed Senate Bill 7, which allows for the renewal of the WHP, on a Senate vote of 21-9 and a House vote of 96-48. The bill prohibits the state from contracting with entities that “perform or promote elective abortions or affiliate with entities that perform or promote elective abortions.” Federal law allows Texas to exclude Planned Parenthood. Texas Attorney General Greg Abbott issued an opinion declaring that federal law allows states to exclude abortion providers and their affiliated organizations from Medicaid. “There are ample alternate WHP providers in Texas who are not involved in abortion. These physicians and clinics typically offer comprehensive primary and preventative care in addition to family planning. These providers could become the medical home for low-income women. The Obama Administration is about to deny WHP funds to these quality providers, and to the women they serve, just because Texas wants to fund these without funding Planned Parenthood,” Pojman added. “Planned Parenthood is a poor investment of public funds. Planned Parenthood offers only a narrow range of services and is unwilling or incapable of offering comprehensive primary and preventative care. Planned Parenthood cannot treat breast cancer. They do not even have one mammogram machine anywhere in Texas. The only time a woman will see a doctor at Planned Parenthood is if she is there for an abortion. Women deserve better,” he said. Share this post: Send to a friend: Obama Kills Texas Women’s Health Program Over Planned Parenthood

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Submit your email address below to receive email alerts about press releases. Learn more. Embargoed for Release: May 18, 2014, 3:00 PM EDT NHLBI Communications Office nhlbi_news@nhlbi.nih.gov301-496-4236Ask for press officer on duty NIH-funded studies find statins provide no benefit to COPD, ARDS outcomes Statin therapy does not prevent exacerbations of chronic obstructive pulmonary disease (COPD) or lower mortality from acute respiratory distress syndrome (ARDS), report two studies that rigorously tested the benefit of the cholesterol-lowering drugs on outcomes in the lung diseases.The findings from the studies funded by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health will be presented at the American Thoracic Society (ATS) annual meeting on May 18, with corresponding online publication in the New England Journal of Medicine.“Treatment options for COPD and ARDS are limited,” said James Kiley, Ph.D., director of NHLBI’s Division of Lung Diseases. “Even though retrospective analysis of some previous studies had suggested that people treated with statins for other reasons did better with their lung diseases, our well-designed prospective study directly comparing statins to a placebo did not show benefits.”“These studies are two more examples of why it is so important to test all potential leads for new therapies in rigorously designed clinical studies in order to give caregivers what they need to make well informed decisions,” Kiley said.Inflammation contributes to worsening lung function and associated complications such as hospitalization, the need for ventilator support, and death in COPD and ARDS. While statins are used primarily to lower cholesterol, they may also reduce inflammation and other pathways important in lung disease.The NHLBI initiated two separate studies to clinically address the effects of statins on lung diseases. The STATCOPE (Simvastatin for the Prevention of COPD Exacerbations) study compared the effects of generic simvastatin against placebo in 885 adults with COPD; the SAILS (Statins for Acutely Injured Lungs from Sepsis) study compared rosuvastatin and placebo in 745 adults hospitalized with sepsis-associated ARDS. No participant in either study was taking statins before being enrolled.Both studies were stopped early because there was very little chance of showing that statins would improve any clinical outcome for either lung disease. COPD patients taking statins experienced no reduction in the frequency of flare-ups or other adverse events. ARDS patients on statins showed no reduction in death or days free of the mechanical ventilator. The SAILS study also found that statins might be harmful to liver and kidney function in ARDS patients, but no increased adverse events were seen in STATCOPE.“There are many indications for taking statins,” Said Dr. Tony Punturieri, program officer in NHLBI’s Division of Lung Diseases for STATCOPE. “People should check with their doctors about their statins. These results just show that statins do not prevent exacerbations of COPD or lower mortality from acute respiratory distress.”SAILS was carried out at 44 enrolling hospitals across the United States as part of NHLBI’s ARDS Clinical Trials Network. STATCOPE involved 45 participating hospitals across the United States and Canada as part of NHLBI’s COPD Clinical Research Network and CIHR's Canadian Respiratory Research Network.“This study is an excellent example of developing international collaborations to address important health research questions that are relevant to patients across the globe,” said Jean Rouleau, M.D., scientific director of the CIHR Institute of Circulatory and Respiratory Health in Montreal, Canada. For more information or to schedule an interview with an NHLBI spokesperson, please contact the NHLBI Office of Communications at 301-496-4236 or NHLBI_News@nhlbi.nih.gov SAILS at clinicaltrials.gov: https://clinicaltrials.gov/ct2/show/NCT00979121STATCOPE at clinicaltrials.gov: https://clinicaltrials.gov/ct2/show/NCT01061671 Part of the National Institutes of Health, the National Heart, Lung, and Blood Institute (NHLBI) plans, conducts, and supports research related to the causes, prevention, diagnosis, and treatment of heart, blood vessel, lung, and blood diseases; and sleep disorders. The Institute also administers national health education campaigns on women and heart disease, healthy weight for children, and other topics. NHLBI press releases and other materials are available online at http://www.nhlbi.nih.gov.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 www.nih.gov.NIH...Turning Discovery Into Health For the MediaNHLBI Communications Officenhlbi_news@nhlbi.nih.gov301-496-4236Ask for press officer on duty Related Health Topics

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Tips, Trends, and News You Can UseLASIK SURGERY FOR CHILDREN Is Refractive Surgery a Legitimate Option for Minors? By Karen Rodemich, Senior Associate EditorWord has been going around about performing laser-assisted in situ keratomileusis (LASIK) on children less than 10 years of age. To some of you, this idea may seem a little premature or absurd. But Jonathan M. Davidorf, M.D., believes that in certain rare cases, LASIK may not just be the correct approach, but the only approach.Specifically, Dr. Davidorf believes that LASIK is appropriate for children less than 10 years of age, as long as one of their eyes is much stronger than the other and if eyeglasses or contact lenses are troublesome for the child to manage. This anisometropia may facilitate the development of amblyopia.Some, such as Paul Peng, O.D., J.D., who's the co-chairman of the Pacific Laser Center at the University of California, Berkeley believe that yes, some children may have difficulty with contact lenses, but that there are better, safer alternatives to LASIK. Dr. Peng believes that performing refractive surgery on a child is aggressive and that surgical intervention is inappropriate. He acknowledges the fact that some children have more trouble with contact lenses than others, but proper patient and parent education can make the task easier. Dr. Peng has been able to fit mentally retarded individuals with contact lenses.Dr. Davidorf agrees that the child's eyes may continue to develop after the procedure, but insists that they'll at least develop at the same rate. He explains that even though actual eye size doesn't change much, refractive error does. By making them more equal, he says he's giving patients some fighting hope for better vision in the future.If, a few years down the line, both eyes need correction, the patient can then elect to have the procedure performed again. In the initial surgical procedure, only the weaker eye is operated on -- and only in those patients who are amblyopic and refractory to conventional treatment methods (e.g., eyeglasses, contact lenses and patching).Dr. Peng says, "If you're trying to treat an anisometropia, surgical intervention isn't the first way to do it, because there's a lack of long-term data on children. The alternative is contact lenses." He continues, saying, "The magic period is around 7.5 years old, so if you really want to intervene and prevent, you have to do it at age 6 because the cortical development is in place."Dr. Davidorf agrees with the views of Dr. Peng and others. He says, "LASIK is totally inappropriate if conventional treatment is working. If not, you have two alternatives." Dr. Davidorf continues, "Do nothing, or think of something else. Doing nothing would be what we've been taught -- that there's really nothing else to do. If you look at doing something else, it might mean considering refractive surgery."At this time, Dr. Davidorf has performed LASIK on two minors. One of the girls had high anisometropic amblyopia and her best corrected visual acuity was 20/70 pre-op. Her best corrected vision post-op was 20/50.Dr. Davidorf's philosophy may seem a bit aggressive and perhaps unnecessary, so to put it into better perspective, consider this: He only performs LASIK on children under a study protocol and he says that evidence is surfacing that shows that there is some benefit to performing this procedure on minors. He's currently involved in a controlled study to see if this is indeed true.Paul Karpecki, O.D., clinical director of refractive surgery, Hunkeler Eye Centers, Kansas City, Mo., believes that LASIK is warranted for children for the same circumstances cited by Dr. Davidorf. However, he says that he does recommend contact lenses or eyeglasses as a first option. "LASIK does help with anisometropia. Glasses don't work for it, and contact lenses aren't always an option, so I think it's valid in this scenario," he says.Dr. Karpecki has performed LASIK on children as young as 9 years old. In total, he's successfully operated on 6 children less than age 16. All were anisometropic and contact lens intolerant.Dr. Karpecki agrees that LASIK on children is aggressive, but that it may be the best treatment. He says that the individual has to be contact lens intolerant and anisometropic. "I don't recommend it as a mainstay. It's for extreme examples. You're not doing it for full correction, but for balancing," he says.Robert T. Spector, M.D., F.A.C.S., is a practicing pediatric ophthalmologist, a clinical investigator for the Artisan lens and a neurologist. He says he's been strictly using reversible optical devices, such as implantable intraocular lenses (IOLs) and Intacs, as well as eyeglasses and contact lenses."We don't know the long-term effect of LASIK and the potential damage it could do in an infant," says Dr. Spector. "Also, LASIK isn't reversible. What appears to be anisometropia early on, with growth, can turn out to be ectasia."He claims that the key to resolving anisometropia is eyeglasses, contact lenses or a product such as the Artisan lens. Another concern Dr. Spector voices regards the patient's stroma. He says, "That's the nub of this issue. Once you chisel away a stroma, you can't get it back."Dr. Peng cites two reasons (functional and legal) why this surgery shouldn't be performed on children. Functional. If you're anisometropic, you'll have different image sizes at the brain level. Although both eyes can resolve 20/20, the different image sizes may cause strain and discomfort. At a young age, this effect may cause amblyopia. If the brain's not seeing things equally through both eyes, one eye will get the short end of the deal. If surgery is performed to mitigate amblyopia after age 8, it's too late. If the intent is to correct anisometropia and eliminate eye strain caused by different image sizes, it seems aggressive. Legal. LASIK is usually considered elective, so someone less than 18 years of age lacks the capacity to make the decision. And it's not a medically necessary treatment for anisometropia, so it's almost illegal and downright unethical. Until a doctor can prove that it's a medical treatment, he can't intervene until the patient is of legal age. That's why Dr. Karpecki says you have to get parental consent and explain the procedure to parents properly so they fully understand. Dr. Peng says that contact lenses will solve the problem of image size. He also reiterates that the procedure is safer with adults. "Plus," he adds, "most surgical centers, including Pacific Laser Eye Center, have a prerequisite that unless your eyes have been stable for at least 6 months, the surgeons won't operate."Whether you're for or against LASIK on children, M.D.s and O.D.s will still test to see if it's beneficial. If you're on the fence now, you may change your mind. O.D. PEOPLE AND PROMOTIONSGhormley honored as Sportsman of the Year. Rex Ghormley, O.D., past president of the American Academy of Optometry, has been selected as the first recipient of the Blanton Collier Sportsman of the Year Award, which he received at the Annual Meeting of the International Academy of Sports Vision last month in Las Vegas. Dr. Ghormley is the team optometrist for the St. Louis Rams, the St. Louis Blues and the University of Missouri Tigers. He's in private practice in St. Louis.UtlraVision's CEO resigns. Vincent Zuccaro, O.D., chief executive officer, co-founder, chairman of the board and director of UltraVision Corp. has resigned from his positions to devote his attention to helping staff develop new products, prepare them for launch and work more closely with customers. William Garriock will serve as chairman, president and CEO until the company finds a replacement for Dr. Zuccaro.IOL pioneer gone but not forgotten. British ophthalmologist Sir Harold Ridley, 94, died on Friday, May 25 of a cerebral hemorrhage. Ridley pioneered the intraocular lens (IOL) and implanted the first one in 1949 after noting that the eyes of World War II aviators were able to tolerate shards of plastic aircraft canopies. In 1999, the American Society of Cataract and Refractive Surgery celebrated the 50th anniversary of the IOL implantation and honored Ridley as one of the "Ten Most Influential Ophthalmologists of the Twentieth Century." The following year, Queen Elizabeth II knighted Dr. Ridley. He is survived by his wife and three children.COMPANY NEWSOSI gains recognition. Ocular Sciences has been included in Business Week's annual list of "Hot Growth Companies." The company was one of 100 best-performing small-cap companies selected from a pool of 10,000 publicly traded firms.Advertising expansion. CIBA Vision recently announced that as a result of the ongoing integration of Wesley Jessen VisionCare, Inc., operations into CIBA Vision operations, it has consolidated its North American contact lens consumer advertising with Publicis, part of the U.S. division of the Publicis Groupe The consolidation makes Publicis the lead agency for all consumer contact lens advertising for CIBA Vision in North America. The leading brands intended for advertising include the Focus and FreshLook families of contact lenses in all modalities. ABOP Killed; Specialties Now Grab the Spotlight By Larisa Hubbs, Executive Editor "Well, that was a lot easier than last year," Dr. Harvey Hanlen commented to the House of Delegates after the proposal to dismantle the board certification effort was unanimously passed -- without questions or comments -- during the AOA's annual meeting last month. The proposal was put forth after a lengthy, involved effort by representatives from the AOA, the American Optometric Student Association, the Association of Schools and Colleges of Optometry, the Association of Regulatory Boards of Optometry, the American Academy of Optometry, the Veterans Administration and a handful of states. These representatives met this past April 29 and 30 in St. Louis to hold a summit on the issue of board certification and continued competency. "This was a very fair conference," said Dr. Alden Haffner to the House of Delegates. "There was no posturing, and it was a frank discussion." During the summit, the participants answered four ONE: The AOA House of Delegates should remove Resolution 1935 (board certification), as amended from the list of active policy pronouncements and place it in the historical archives. Unanimously passed. Is there a need or demand for demonstrating continuing competency in optometry? How can we best measure or demonstrate continued competency in optometry? What measures of continued competency currently exist in the profession? Can board certification be a useful tool to demonstrate continued competency in optometry? After the 2-day meeting, the summit members developed a couple of proposals (see proposals one and two), which were presented to the House of Delegates at the AOA meeting. After the first proposal was quickly passed by the House of Delegates, Dr. Haffner motioned to consider the second proposal, which stipulated that the AOA hold a summit for the purpose of discussing formally recognizing the optometric specialties. Dr. Leland Carr from Oregon seconded the motion, and added "I think the atmosphere is right for this now." Before voting for proposal two, Dr. Alan Roush from Indiana added a word of warning. "I'm not opposed to studying this issue -- if it's done right. TWO: The American Optometric Association should convene a summit, ensuring profession-wide input, to study the issue of formally recognizing specialty areas within optometry. Passed by a majority vote. "The summit just cleaned up a mess that was created 2 years ago. We need to use the ABOP issue as a role model for how not to study the specialty issue." After this brief commentary, the proposal passed by an easy majority vote with a few "nays" among the delegates. Also brought forth in the summit report was a consensus that from here on major policy decision-making by national optometric organizations should be preceded by substantive debate and discussion involving all stake holders. In other House of Delegates news that day, one of the delegates announced that the governor of Oregon had just signed into law the authority for Oregon optometrists to prescribe orals and use injectables. The bill passed by a vote of 19 to 10 in the Senate, and 54 to 3 in the House. This passage was quite a feat because the governor is a former emergency room physician. Optometric Management, Issue: July 2001

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Mitochondrial Dysfunction – A Biomarker for Fibromyalgia and ME/CFS? [ 186 votes ] By Clark Ellis • www.ProHealth.com • June 5, 2013 A recent study from Spain, suggests that mitochondrial dysfunction could be a differentiating marker between fibromyalgia (FM) and chronic fatigue syndrome (CFS), as well as distinguishing both patient groups from healthy controls. This alone could be highly significant but the paper also reports correlation with oxidative stress (where free-radicals damage your cells, and even your DNA), which may highlight potential treatment opportunities. A Bit About Mitochondria Each of the cells in your body contains mitochondria. A mitochondrion is shaped like a tiny capsule and exists within the cytoplasm of your cells. They are referred to as ‘organelles’ because they are to a cell, what an organ is to us. Mitochondria fulfill several tasks for our cells, the most important of which is called oxidative phosphorylation, which is a large part of cellular respiration. Cellular respiration is the process of creating energy from nutrients with the help of oxygen. This energy drives all of the functions of all the cells in your body. Muscle cells that require a lot of energy, contain thousands of mitochondria, whereas other cells which require less energy have fewer. So there is a relationship between the energy requirement of a cell and how much mitochondria it contains. Mitochondria are unique in the body in that they have their own DNA, separate from the chromosomal DNA you find in the nucleus of each cell. This enables them to reproduce independently of the host cell. Everybody inherits their mitochondria from their mother, and your mother inherited it from her mother, and so on. Genomic sequencing has shown that mitochondria are closely related to the bacteria Rickettsia prowazekii, suggesting an ancient shared origin. Mitochondrial diseases already exist where the genes encoded by the mitochondrial DNA have mutated. Each mitochondrion contains several copies of its own DNA, which protects it against mutation, but if too many mutations occur then it can cause the mitochondria not to function correctly. It is not hard to see that this would have a potentially dramatic effect on a person’s health, as everything in each cell is driven by the energy produced by mitochondria. It is perhaps of note, that mitochondrial diseases often present as neurological disorders (Zeviani et al. 2004). With FM recently being reported to present like mitochondrial myopathy, you can see why researchers are looking at the DNA in FM and CFS. However, any mitochondrial dysfunction that may exist in FM or ME/CFS is not necessarily related to mitochondrial genes. It could be as a result of nutrient deficiencies, chemical exposure (Myhill et al. 2012), or as a result of oxidative stress. In the process of generating energy in the form of ATP, mitochondria also produce volatile oxidative byproducts which have the potential to damage the mitochondria and the cells they inhabit. The body has a system in place to clean up these oxidative products, but if there is dysfunction in the process then you’re in trouble. Dr. Cheney has suggested that this may result in the down-regulation of ATP production as a means of avoiding further oxidative stress. However, oxidative products can come about as the result of another disease process such as increased pro-inflammatory cytokines which have been reported elsewhere in these diseases. The History of Mitochondria in FM and ME/CFS Mitochondrial dysfunction has been linked with FM and ME/CFS quite a bit in recent years, but such abnormalities, at least in ME/CFS, were reported as far back as the beginning of the 90s in the UK by the doctors Behan. Since then several doctors have looked closely at mitochondria including Dr. Myhill in the UK, who with colleagues, reported stark mitochondrial dysfunction in CFS patients compared to controls, Dr. Vermeulen in the Netherlands and Dr. Cheney in the US, among others. A 2010 study of mitochondria in FM reported dysfunction and oxidative stress (Cordero et al.), and a recent study from the same group this year suggested that inflammation could be a mitochondrial dysfunction-dependent event. Despite the research attention this area has had over the years, some findings have conflicted and so there is more importance than ever to ensure the accuracy of results and to get into the details of the problem when dysfunction is found. What Exactly is Being Reported? Dr. Castro and his team have reported on a number of markers related to mitochondrial function and how they differ between patients with FM, ME/CFS and healthy controls. This is a story of one thing leading to another – when one measure appeared low, the researchers examined markers that might explain the low reading, and this resulted in several related abnormalities being uncovered which appear to correlate. Below, we go into detail on each of these markers. The researchers looked at blood mononuclear cells (PBMC). The obvious advantage of this over a tissue study is that this could more readily translate to a viable test for these diseases. Levels of CoQ10 and ATP Co-enzyme Q10 is a powerful antioxidant as well as being one of the essential molecules required by mitochondria in the production of energy. That energy is produced in a biochemical form known as ATP (Adenosine triphosphate). So, with CoQ10 and ATP molecules being lower in both patient groups compared to controls, it might explain some of the symptoms we experience, and is clear evidence of a biological problem in the diseases. This study showed that CoQ10 was about half what it should be in ME/CFS and FM groups. The level of ATP was even worse at about a quarter of what it should be. Mitochondrial DNA Mass (mtDNA/gDNA ratio) Although cellular respiration is not the only method your body has to produce ATP it is by far the main producer and so low ATP levels suggest that the mitochondria is affected. Therefore, Dr. Castro and his team looked at the level of mitochondrial DNA in patients compared to controls. It is important to understand that each cell may contain many mitochondria, and each individual mitochondrion itself contains multiple copies of its own DNA. Therefore, this measure – mtDNA – represents the total mass of mtDNA, compared to gDNA. gDNA is an abbreviation for genomic DNA (i.e. chromosomal DNA from a cell’s nucleus). The measure used in this study is the ratio of mtDNA compared to gDNA. In the FM patients, this ratio was found to be low compared to healthy controls, suggesting that there were fewer mitochondria in the cells than there should be. In three FM patients, it was depleted. In CFS patients the ratio was higher than normal, but not significantly so. Levels of Lipid Peroxidation Indicative of Oxidative Stress-Induced Damage Each of our cells has a membrane, composed of lipids, which separates the interior of the cell from the exterior environment. Additionally, each mitochondrion possesses an inner and outer membrane. Lipid peroxidation is the process by which oxidative products (some of which are created as byproducts of cellular respiration) react with these membranes, resulting in cellular damage. Dr. Castro and his team have reported higher levels of lipid peroxidation in ME/CFS (almost double normal levels) and much higher levels in FM (almost three times as high as normal). This strongly suggests that our cells (and likely our mitochondria too) are taking damage via oxidative stress. Citrate Synthase Activity Citrate synthase (CS) is an important enzyme at the beginning of the Kreb cycle (or citric acid cycle) and although this cycle takes place within the mitochondria, this enzyme is expressed by chromosomal DNA rather than the DNA of mitochondria. The Kreb cycle produces a small amount of ATP, but more importantly it is a pre-requisite step before mitochondria can perform the most important part of cellular respiration via the electron transport chain (ETC), by preparing the molecules that are required for the ETC. Without CS, cellular respiration would be severely limited. Additionally, it has been demonstrated by Larsen et al. that CS correlates with mitochondrial mass in healthy subjects. So you can see why the researchers looked here. It is reported here as being on average, less than half the normal level in FM patients, and normal in ME/CFS. Levels of PGC-1α and TFAM Having found that the mass of mtDNA in FM was lower than healthy controls and ME/CFS patients, the researchers looked at two proteins involved in the replication and regulation of mtDNA copy numbers within those mitochondria. These proteins are also involved in protecting mitochondria from oxidative damage – again, you can see why they looked here given the oxidative stress indicated in previous tests. These proteins were found to be significantly lower than normal in FM patients, but insignificantly different in ME/CFS patients, correlating with the results of their other studies. Dr. Castro was kind enough to give us some concluding remarks about the findings and future directions: Most studies that have examined the role of mitochondrial dysfunction in both CFS and FMS patients have been incomplete and contradictory, showing several discrepancies. According to our results, oxidative stress and mitochondrial bioenergetic dysfunction are common events in CFS and FMS patients that are implicated in the activity and severity of symptoms in both illnesses. In most instances, CFS and FMS coexist in the same patient. There is a considerable overlap of clinical symptoms between both conditions. We have shown differences in cellular mechanisms and molecular pathways in mitochondria. The implication of both PGC-1 alpha and TFAM has appointed a new path toward the understanding of pathogenesis in CFS and FMS as well as the development of new tools to distinguish one from another. So as you can see, these findings are exciting and add to the already significant and ever-growing evidence of mitochondrial dysfunction in FM and ME/CFS. This was a fairly small study, looking at 23 CFS patients, 20 FM, and 15 healthy controls. Nonetheless, it reports some useful findings which have promise as legitimate biomarkers for FM and ME/CFS. This is probably the most immediately promising finding here. More research is needed to build on these findings in larger studies with disease controls and patients should encourage such further research to be undertaken by this group and other groups involved in FM and ME/CFS research. Source: Castro-Marrero J, et al. Could mitochondrial dysfunction be a differentiating marker between Chronic Fatigue Syndrome and Fibromyalgia? Antioxidants & Redox Signaling. May 29, 2013. Please Discuss This Article: [ Be the first to comment on this article ] Rejuvenating the Brain - How PQQ Helps Power Up Mental Processing Itching to Find Dry Skin Relief? Natural Support for Mood, Sleep and Mental Focus? L-theanine

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http://rarediseases.org Coats Disease The National Organization for Rare Disorders (NORD) web site, its databases, and the contents thereof are copyrighted by NORD. No part of the NORD web site, databases, or the contents may be copied in any way, including but not limited to the following: electronically downloading, storing in a retrieval system, or redistributing for any commercial purposes without the express written permission of NORD. Permission is hereby granted to print one hard copy of the information on an individual disease for your personal use, provided that such content is in no way modified, and the credit for the source (NORD) and NORD’s copyright notice are included on the printed copy. Any other electronic reproduction or other printed versions is strictly prohibited. The information in NORD’s Rare Disease Database is for educational purposes only. It should never be used for diagnostic or treatment purposes. If you have questions regarding a medical condition, always seek the advice of your physician or other qualified health professional. NORD’s reports provide a brief overview of rare diseases. For more specific information, we encourage you to contact your personal physician or the agencies listed as “Resources” on this report. Copyright 1991, 1999, 2001, 2002, 2003, 2012 NORD is very grateful to J. Michael Jumper, MD, Director, Retina Service and Sara J. Haug, MD, PhD, California Pacific Medical Center, West Coast Retina Medical Group, for assistance in the preparation of this report. Synonyms of Coats Disease Coats syndrome retinal telangiectasis No subdivisions found. Coats disease was first described in 1908 and is a rare disorder characterized by abnormal development of the blood vessels in the retina. The retina is a nerve-rich tissue lining the back of the eye that transmits light images to the brain, which allows a person to see. Therefore affected individuals may experience loss of vision due to changes in the retina and, in severe cases, retinal detachment. In almost all cases of Coats disease, only one eye is affected. Rarely, both eyes may be exhibit symptoms however one eye is often affected more than the other. The specific cause of Coats disease is not known. Coats disease affects males more often than females in a ratio of 3:1. The disorder may occur at any age, but the majority of cases are diagnosed in the first two decades of life. Individuals affected with Coats disease may display few or no symptoms while others may have severe involvement. The most common features at presentation of Coats disease include loss of vision, misalignment of the eyes (strabismus), and/or the development of a white mass in the pupil behind the lens of the eye so that the pupil appears white (leukocoria). Over time, Coats disease may cause detachment of the retina and substantial loss of vision. Additional signs may appear as Coats disease progresses, including elevated pressure inside the eye (glaucoma), clouding of the lens of the eye (cataract), reddish discoloration in the iris due to the growth of new blood vessels in the iris (rubeosis iridis or neovascular glaucoma), shrinking of the affected eyeball (phthisis bulbi), and/or inflammation of eye (uveitis). Eye symptoms result from a developmental malformation, known as telangiectasia, of the blood vessels in the retina. Telangiectasia (tele equals far or end, angio means blood vessel, and ectasia refers to dilation) occurs when there is abnormal widening of groups of small blood vessels, resulting in the leakage of proteins and lipids from the blood. When this occurs in the retina, it is termed exudative retinopathy. This leakage can lead to retinal detachment and the other symptoms discussed above. The specific cause of Coats disease is not known. One hypothesis in the literature is that a mutation of the Norrie disease protein (NDP) gene leads to Coats disease. This gene is an attractive candidate because it has been shown to play a vital role in retinal blood vessel development. One study showed some promise for involvement of the NDP gene in Coats disease, however further studies have not been able to verify this hypothesis. In general, Coats disease is considered a non-genetic, non-heritable condition. Affected Populations It is estimated that about 69% of those affected are male. The average age at diagnosis is 8-16 years, although the disease has been diagnosed in patients as young as 4 months. About two-thirds of juvenile cases present before age 10. Approximately one-third of patients are 30 years or older before symptoms begin. Signs of the following disorders can be similar to those of Coats disease. Retinoblastoma is an extremely rare malignant tumor that develops in the retina. Patients are usually diagnosed before the age of three. Common presenting symptoms include leukocoria, which is the appearance of a distinctive white mass in the pupil area behind the lens of the eye, and strabismus or eye misalignment. The presentation of symptoms in retinoblastoma can be identical to those in Coats disease, therefore it is very important to correctly distinguish Coats disease from retinoblastoma since untreated retinoblastoma can be life threatening. In most cases, retinoblastomas occur spo

医学

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Saw palmetto no better than placebo for enlarged prostate, study finds University of California - San Francisco Saw palmetto, an herbal extract commonly taken to improve urinary symptoms in men with enlargement of the prostate gland, is no more effective than a placebo, according to a new study. The year-long, double-blind study of 225 men was led by Stephen Bent, MD, a staff physician at the San Francisco VA Medical Center, and Andrew Avins, MD, MPH, of the Northern California Kaiser Permanente Division of Research. The results are published in the February 9, 2006 issue of the New England Journal of Medicine. In their study, the researchers randomly assigned patients with enlargement of the prostate, also known as or benign prostate hyperplasia or BPH, to take either saw palmetto or a placebo twice a day for one year. Subjects returned at regular intervals to be assessed for symptoms and side effects. Symptoms were assessed according to a standard symptom score for BPH and objective measures of urinary function. "If you look at the change in symptoms over time between the two groups, it was almost identical," reports Bent, who is also an assistant professor of medicine at the University of California, San Francisco. "There was no statistically significant difference at any time point during the study." The researchers also looked at subgroups of patients -- those with more and less severe symptoms and those with larger and smaller prostates -- and found no difference in any of the subgroups between the herbal extract and placebo. "The results of this study clearly do not support a strong clinical benefit of saw palmetto for BPH," concludes Bent. "However, whether other doses, formulations, or patient populations might respond differently is unknown." The researchers estimate that saw palmetto is used by over two million men in the United States for treatment of BPH, which is said by the National Institutes of Health to affect more than 50 percent of men over 60 and upwards of 90 percent of men over 70. Bent acknowledges that the study results are surprising, since many earlier studies concluded that saw palmetto is effective against BPH. However, he points out a number of differences between the current study and earlier research. "Prior studies were generally small in size and short in duration," he says. "Plus, the vast majority of them did not use the standard symptom score that we used for assessing the severity of BPH," which is now commonly used to judge the efficacy of pharmaceutical drugs for treatment of the condition. Another potential problem with earlier studies has to do with the nature of saw palmetto itself, according to Bent. "This is a very pungent herb, and it took our research team a long time to create a placebo that convincingly duplicates its strong smell and taste. We suspect that prior trials didn't adequately address that problem." As a result, he says, "it's possible that some of the positive findings in earlier work may be due to the fact that the blinding wasn't adequate." In other words, patients in those studies knew whether they were taking the herb or the placebo, and "someone who's taking something that's smelly and likely to be the plant extract is perhaps more likely to report a benefit than someone who's taking an odorless and tasteless tablet." At the end of the current study, 40 percent of patients in the saw palmetto group believed they were taking the herbal extract versus 46 percent in the placebo group, demonstrating that the blinding was adequate, says Bent. Bent notes that his research team took pains to select an herbal product that matched the levels of fatty acids and sterols -- commonly believed to be saw palmetto's active ingredients -- found in most commonly available commercial preparations of the herb. Almost all prior studies of saw palmetto used exactly the same dose, says Bent -- 160 milligrams twice a day -- and the current study used that dose as well. He notes that such consistency of dose is not typical among studies of most other herbal medications. The current study subjects reported no statistically significant side effects from saw palmetto. Bent cautions that while the study is strongly indicative, it is not conclusive. "This is a surprising finding that contradicts the weight of prior evidence," he observes. "There is good reason for other researchers to conduct another study to validate these results, taking care that blinding is done carefully once again." In addition, says Bent, "Some people believe that higher doses may be potentially effective, and that's an area that we did not address." A major new NIH-funded study of saw palmetto and another commonly-used herbal treatment for BPH is currently in the final planning stages, according to Avins, who is a co-author of the current study. The new study will involve several hundred patients at 11 centers nationwide, and researchers hope it will shed more definitive light on the questions of adequate doses and other potentially useful natural treatments for BPH, says Avins. Other co-authors of the current study include Christopher Kane, MD, and Katsuto Shinohara, MD, of SFVAMC; John Neuhaus, PhD, and Esther S. Hudes, PhD, MPH, of UCSF; and Harley Goldberg, DO, of UCSF and KPNC.###The study was funded by a grant from NIH that was administered by the Northern California Institute for Research and Education. The above story is based on materials provided by University of California - San Francisco. The original article was written by Steve Tokar. Note: Materials may be edited for content and length. University of California - San Francisco. "Saw palmetto no better than placebo for enlarged prostate, study finds." ScienceDaily. ScienceDaily, 13 February 2006. <www.sciencedaily.com/releases/2006/02/060213102419.htm>. University of California - San Francisco. (2006, February 13). Saw palmetto no better than placebo for enlarged prostate, study finds. ScienceDaily. Retrieved October 23, 2014 from www.sciencedaily.com/releases/2006/02/060213102419.htm University of California - San Francisco. "Saw palmetto no better than placebo for enlarged prostate, study finds." ScienceDaily. www.sciencedaily.com/releases/2006/02/060213102419.htm (accessed October 23, 2014).

医学

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Surgical Readmission Rates Reflect Initial Care, Study Suggests WEDNESDAY, Sept. 18 (HealthDay News) -- Quality of surgical care is directly related to the likelihood of hospital readmission for additional surgery, according to researchers at the Harvard School of Public Health.Their study, involving nearly 5,000 patients discharged after major surgery, shows that improving initial surgical care will reduce readmission rates and costs."We found that when it comes to surgery, high-quality hospitals -- those with the highest volume or lowest mortality rates -- have lower readmission rates," said the study's senior author, Dr. Ashish Jha, a professor of health policy at Harvard.The study, which is published in the Sept. 19 issue of the New England Journal of Medicine, "shows that readmissions are probably being driven by complications that occurred in the hospital, and the better hospitals likely have fewer complications," Jha said.The findings also support plans by the U.S. Centers for Medicare and Medicaid Services to add surgical conditions to its hospital readmissions penalty program, he said."A lot of us have been concerned about whether they were going to be penalizing good hospitals -- those with good outcomes -- or not," Jha said. "Our findings are reassuring, suggesting that surgical readmissions may be a reasonably good measure of hospital quality."Readmissions for medical conditions such as heart failure and pneumonia can occur for other reasons, Jha said. They often are related to factors such as patient income and severity of illness, rather than care during the initial hospital stay.Some hospitals have put into place systems and practices that reduce the risk of their surgical patients being readmitted, said Dr. Don Goldmann, chief medical and scientific officer of the Institute for Healthcare Improvement, in Boston. Learning why and how these hospitals outperform others will be critical, Goldmann said."If hospitals performing very few surgeries do not have the volume required to create highly reliable care systems despite their best quality-improvement efforts, perhaps they should not be performing them," Goldmann said. "This is a provocative suggestion and deserves careful consideration before being implemented." Nancy Foster, vice president of quality and patient safety policy at the American Hospital Association, said the study shows only an association between readmissions and volume, not a cause-and-effect relationship. Foster wants to know what these higher-volume hospitals do that is different than hospitals doing fewer procedures. "We have identified smaller hospitals that are doing quite well," she said. "So what's the secret they're applying?"It may be that hospitals that do many procedures have standardized their approaches to surgery, Foster said. "And in that process have made sure they are doing the recommended treatments every time," she said.For the study, Jha's team used data from Medicare to calculate 30-day readmission rates for six surgical procedures, including coronary-artery bypass surgery, lung surgery, open and closed repair of abdominal aortic aneurysm, colon surgery and hip replacement. Data were collected on nearly 480,000 patients discharged from more than 3,000 U.S. hospitals.The researchers found that about one in seven patients were readmitted within 30 days. Hospitals that did the most procedures and had the lowest death rates also had much lower readmission rates than other hospitals. These factors are two well-established measures of hospital surgical quality, they said.For example, hospitals that performed the most surgeries had significantly lower readmission rates (12.7 percent) than hospitals that did the fewest (16.8 percent).Hospitals with the fewest deaths after surgery also had significantly lower readmission rates (13.3 percent) compared with hospitals with the highest death rates (14.2 percent), the researchers found. More informationFor more information on patient safety, visit the U.S. National Library of Medicine.SOURCES: Ashish Jha, M.D., M.P.H., professor of health policy, Harvard School of Public Health, Boston; Nancy Foster, vice president of quality and patient safety policy, American Hospital Association; Don Goldmann, M.D., chief medical and scientific officer, Institute for Healthcare Improvement; Sept. 19, 2013, New England Journal of Medicine Related Articles Doctors Often Unaware Their Patients Have Catheters October 23, 2014 Weight-Loss Surgery May Raise Risk of Severe Headaches, Scientists Report October 22, 2014 Learn More About Sharp

医学

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More Than 4 Million People Have Signed Up for Obamacare, White House Says TUESDAY, March 11, 2014 (HealthDay News) -- More than 4 million Americans have signed up for health coverage through state and federal insurance marketplaces established by the Affordable Care Act, the Obama administration announced Tuesday.About 4.2 million people had selected a health plan through the end of February, with slightly less than one month to go before enrollment ends March 31, U.S. Health and Human Services Secretary Kathleen Sebelius said at a news conference. That includes 2.6 million sign-ups through the federal marketplace at HealthCare.gov, and 1.6 million through state-operated marketplaces.Obama administration officials are banking on a last-minute surge in sign-ups as the days tick off to the end of open enrollment."We're finding that as Americans find out how affordable marketplace plans are, more are signing up," Sebelius said. "It's not too late for Americans to sign up and get covered, but they'll want to do it today as we approach that March 31 deadline."The number of people who have signed up for one of the new marketplace health plans remains short of some predictions, however. The U.S. Congressional Budget Office had projected 6 million sign-ups in 2014.Administration officials declined Tuesday to predict whether they will meet the enrollment goal of 6 million, instead emphasizing that they expect a surge in March."We are confident that millions more will continue to enroll, many of them coming in before the March 31 deadline," said Julie Bataille, director of communications for the U.S. Centers for Medicare and Medicaid Services. The troubled October launch of the federal HealthCare.gov marketplace website, and technical difficulties experienced by some state exchanges, made enrolling difficult, if not impossible, in the early days and weeks of enrollment last fall.White House officials argue that they have turned things around, specifically pointing to the percentage of young adults who chose a plan in February. About 27 percent of February enrollments involved adults aged 18 to 35, which is three percentage points higher than October through December.Young adults' participation in the Affordable Care Act is considered crucial to the success of the controversial health-reform law, because their premiums will help to cover older adults who tend to be more prone to illness and disease.To reach more young adults, President Barack Obama on Tuesday made an appearance on comedian Zack Galifinakis' web-based spoof talk show, "Between Two Ferns," to plug HealthCare.gov.The president's appearance prompted more than 19,000 people to click on a link to HealthCare.gov to learn more information, Bataille said.The administration still hasn't reported the number of marketplace enrollees who were previously uninsured. And it hasn't said how many have paid their first month's premium -- a prerequisite for health insurance coverage.Administration officials based their confidence in a last-minute enrollment surge on what happened during the 2003 rollout of Medicare Part D, the prescription drug program for seniors. More than 1 million beneficiaries enrolled during the last week of Part D's open enrollment program, which had lasted for six months.Officials said that of the people who so far have selected a marketplace health plan:55 percent are female and 45 percent are male,31 percent are age 34 and under,25 percent are between the ages of 18 and 34,63 percent selected a Silver plan, while 18 percent selected a Bronze plan,83 percent are eligible to receive financial assistance.More informationVisit HealthCare.gov to learn about the new health plan options.SOURCES: March 11, 2014 news conference with Kathleen Sebelius, secretary, U.S. Department of Health and Human Services, Julie Bataille, director, communications, U.S. Centers for Medicare and Medicaid Services; March 11, 2014, news release, U.S. Department of Health and Human Services Related Articles U.S. Ranks Last Among Wealthy Nations in Access to Health Care October 22, 2014 Many Americans in Debt, Bankruptcy Paying for Cancer Care October 22, 2014 Learn More About Sharp

医学

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Health System > Medical Center > National Autism Awareness Month UC Davis MIND Institute holds National Autism Awareness Month activities Events include educational lecture, open house, inclusive festival UC Davis MIND Institute April is National Autism Awareness Month and the UC Davis MIND Institute, an institute respected internationally for its groundbreaking research into therapies for autism and other neurodevelopmental disorders, is holding a series of free, inclusive events in recognition of the month-long observance. The events also mark the 15-year anniversary of the MIND Institute, founded in 1998. On Saturday, April 27 from noon to 4 p.m. the UC Davis MIND Institute will hold a family-oriented open house. Visit the MIND Institute and see performances by the Star Dancers, I Can Do That!, Dream Achievers, Jordan the Science Wizard, the Latin jazz of Ivan Najera & Friends, magicians, balloon artists, and other special guests. The event will be emceed by local celebrity Jack Gallagher. Representatives from the MIND Institute and community agencies will be on-site to provide resource information. The public is invited to come create art projects, participate in hands-on activities, ride a train, or jump in a bounce house. Food trucks from Sacramento’s FoodMob will sell food, or bring a blanket and a picnic lunch. MIND Institute representatives will be on hand at the Sacramento Kings vs. Dallas Maverick’s game on Friday, April 5 at Sleep Train Arena, as well as at the Sacramento River Cats vs. the Las Vegas 51s game at Raley Field on Saturday, April 6. A portion of ticket sales from the Sacramento Kings and River Cats games will support the MIND Institute. A free poetry reading and art show will be held at the MIND Institute on Monday, April 8, starting at 7 p.m. Enjoy spoken and written poetry from the Sacramento Poetry Center and view the institute’s art collection. The Minds Behind the MIND presentation: “Autism ― From the Teen Years to Young Adulthood,” will be held on Wednesday, April 17, from 5:30 p.m. to 7 p.m. The presentation will feature a panel of experts and community members who will provide updates on promising research, interventions and experiences for teens with autism aging into adulthood. The MIND Institute Resource Center will be open starting at 4:30 p.m. Autism research study information also will be available. Art Spark: A Festival for Children with Special Needs will be held on Sunday, April 21 from 11 a.m. to 1 p.m. at the Crocker Art Museum, 216 ‘O’ St., Sacramento. Performances at the the inclusive celebration of visual and performing arts will feature the El Dorado Dance Academy, AIM HIGHER, Afia Walking Tree, Francie Dillon with Puppet Art Theater. There will be gallery tours and hands-on fun stations for visitors of all abilities. The event is presented by the Crocker Art Museum’s Art Access Committee, I Can Do That!, Short Center South and the MIND Institute. The MIND Institute is located at 2825 50th St., Sacramento. On-street parking is free of charge. For further information about any of the National Autism Awareness Month events, please visit http://www.ucdmc.ucdavis.edu/mindinstitute/events/index.html The UC Davis MIND Institute in Sacramento, Calif., was founded in 1998 as a unique interdisciplinary research center where families, community leaders, researchers, clinicians and volunteers work together toward a common goal: researching causes, treatments and eventual preventions and cures for neurodevelopmental disorders. The institute has major research efforts in autism, fragile X syndrome, chromosome 22q11.2 deletion syndrome, attention-deficit/hyperactivity disorder (ADHD) and Down syndrome. More information about the institute is available on the Web at mindinstitute.ucdavis.edu.

医学

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Having a Baby? Price Tag for Delivery Varies Widely Survey of California hospitals finds cost for uncomplicated birth ranges from about $3,300 to $37,000 THURSDAY, Jan. 16, 2014 (HealthDay News) -- The bill for delivering a healthy baby varies enormously among California hospitals, with new mothers facing cost differences of 8- to 10-fold depending on the hospital where they end up giving birth. California women were charged between $3,296 and $37,227 for an uncomplicated vaginal delivery, depending on which hospital they visited, researchers report. In addition, the investigators found that for a cesarean delivery, women were billed from $8,312 to nearly $71,000. This amount of variation represents a huge problem for the consumer-oriented medical system that health care reform has promised to create, said lead author Dr. Renee Hsia, an associate professor of emergency medicine at the University of California, San Francisco. Hsia and her colleagues found that they could only account for 35 percent of the difference between hospital bills, even after considering such variables as length of a patient's hospital stay, the competitiveness of a market, and the ownership and operation of a hospital. That means 65 percent of what a California hospital charges for a normal delivery is based on nothing the researchers could identify. "The proportion of charges we are unable to explain signifies that there is a significant gap in the efficiency in which we charge for hospital care," said Hsia, who is also a faculty member of the UCSF Institute for Health Policy Studies. There's no regulation over what hospitals can charge patients, she noted, and patients often don't know beforehand what they will pay for their care. "Hospitals can charge whatever they want. They can mark up their costs based on whatever they feel they should be, and 'should' is a very subjective determination," Hsia said. "Even though we talk about consumer empowerment, that can't be a reality until patients are able to obtain information about what they will be charged." Hospitals with less competition or in markets with more uninsured people tended to charge significantly less, the researchers found. For-profit hospitals and hospitals located in places with higher costs of living or a more severely ill patient population tended to charge more. To make matters even more confusing, the investigators found that hospitals wound up only receiving about one-third of what they charged, due to discount rates that the hospitals set up with private insurers. On average, the estimated discounted prices paid by insurers amounted to 37 percent of the original hospital bill. The authors calculated that hospitals billed $1.37 billion in "excess charges" that were never paid for these births. These discounts vary from insurer to insurer and hospital to hospital, and even vary within the same hospital, said Stuart Guterman, vice president for Medicare and cost control at The Commonwealth Fund. "The only people who get stuck with paying billed charges are people who don't have health insurance, because they don't have anyone negotiating down their rate," Guterman said. "It makes it very hard to understand what's going on, and it is a symptom of a health care market that's out of control because there's no transparency about what hospitals charge and what they get paid for each service." The study authors reviewed data from 2011 on nearly 110,000 cases in California involving women with private medical insurance, including about 77,000 for uncomplicated vaginal deliveries and about 33,000 for uncomplicated C-section births. The researchers focused on newborn delivery because it is the most common cause for hospitalization, and provides a window into hospitals' billing practices, Hsia explained. Hsia said that she fully expects that this variation in billing can be found in medical services provided by hospitals throughout the United States. Hsia and Guterman both agreed that hospital billing has a direct impact on all health consumers. These bills affect the co-payments and deductibles a person has to cover, and can drive an uninsured person to bankruptcy. "There are legitimate reasons for the cost of care to vary from one place to another, but not as much as they do," Guterman said. "We need to understand whether there's any relationship between that price and the quality of the care. We need to understand that relationship better to know we're paying the right price for a service." The study findings appear in the Jan. 16 online edition of BMJ Open. For more about hospital delivery costs, visit Childbirth Connection (http://transform.childbirthconnection.org/resources/datacenter/chargeschart/statecharges ). SOURCES: Renee Hsia, M.D., associate professor of emergency medicine, University of California, San Francisco, and faculty member, UCSF Institute for Health Policy Studies; Stuart Guterman, vice president for Medicare and cost control, The Commonwealth Fund; Jan. 16, 2014, BMJ Open, online

医学

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Kathi Ovnic, 404/727-9371, covnic@emory.edu March 21, 2002 Emory University Tests Safety and Effectiveness of Device for the Possible Treatment of Alzheimer's Disease Neurologists at Emory University are studying a possible new treatment for Alzheimer's disease using a device called the COGNIShunt, designed to drain cerebrospinal fluid (CSF) from the skull and into the abdominal cavity. By reducing the build-up of CSF around the brain, doctors hope this device will help to stabilize the disease. CSF is the fluid that fills the empty spaces around the brain and spinal cord. The body naturally produces, absorbs, drains and replenishes the fluid. But with age, the replenishing process slows. "Past research shows that toxic and inflammatory substances are found in the cerebrospinal fluid of Alzheimer's patients, which in turn, may lead to brain cell damage," says Allan Levey, M.D., Ph.D., professor of neurology, Emory University School of Medicine and principal investigator of the Emory study. "We hope the COGNIShunt will help to drain off some of those toxins and allow the CSF to better replenish itself." Shunting has long been used as treatment for hydrocephalus, a condition in which an abnormal accumulation of CSF causes neurological problems, including dementia, problems walking and incontinence. In the Emory study, surgeons will surgically implant the COGNIShunt into a normal cavity, or ventricle, in the brain. Then they will tunnel a tube through the neck and into the abdominal cavity for proper drainage. It is a relatively short and common procedure that usually requires a one-to two-day hospital stay. The duration of the study, at Emory and 11 other sites, is 18 months. The first nine months of the study is double-blind placebo, meaning all participants will receive the shunt but the shunt will not be open, or working, in the placebo group. The second nine months of the trial is open-label, meaning participants in the placebo group can have their shunt revised to be opened, so it will work. Eunoe, Inc., the maker of the COGNIShunt, is funding this clinical trial to assess the effectiveness of the treatment and to test the hypothesis that the toxic and inflammatory factors in CSF contribute to the pathology of Alzheimer's disease. An Alzheimer's researcher for 15 years, Dr. Levey points out, "Treatment methods vary greatly in other diseases, but with Alzheimer's, this is the first time more diverse, therapeutic options are being tested. We hope this surgical option will lead to dramatic benefits for these patients, and in the long run, open up even more avenues for surgical treatments. Surgical treatment options sometimes produce dramatic benefits and are rapidly gaining acceptance for related neurodegenerative disorders such as Parkinson's disease." In a pilot study of the COGNIShunt, the device was well tolerated by individuals with mild to moderate Alzheimer's disease. As with most surgical procedures, there are some risks associated with implanting the device. The risks include infections, bleeding or a chance that the shunt or tube could stop working. But doctors hope to prove the benefits of this device will outweigh the risks. Three other Emory doctors will serve as co-principal investigators of the study. They are Jim Lah, M.D., Ph.D., assistant professor of neurology, Nelson Oyesiku, M.D., associate professor of neurosurgery, and Larry Tune, M.D. professor of psychiatry and behavioral sciences. Participants are being recruited for this study. Criteria include mild to moderate Alzheimer's disease with no other causes of dementia. Participants can remain on their prescribed medications throughout the trial. Participants must be between the ages of 62 and 85 and be in good, general health. To find out more about this study, call (404) 728-6453. Return to March Index For more general information on The Robert W. Woodruff Health Sciences Center call Health Sciences Communication's Office at 404-727-5686, or send e-mail to hsnews@emory.edu Copyright © Emory University, 2001. All Rights Reserved.

医学

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Sandy Praeger Explains Affordable Care Act By: Ariana Cohen - Email Updated: Wed 4:41 PM, Sep 11, 2013 Learn More About Affordable Care Act TOPEKA, Kan. (WIBW)-The stated aim of the Affordable Care Act is to improve the quality of health care and make it affordable. Starting on October 1st, the sing-ups for the so-called marketplace for health insurance plans will open. "The whole idea of insurance is the law of large numbers. The more people are insured, healthy and sick, the easier it is to keep the coverage affordable," says Praeger. Praeger says Kansans with company insurance could see an increase in premiums because of the Affordable Care Act. "Because the benefits have to be, in some cases, may be more comprehensive," says Praeger. Praeger says that a major concern for Kansans is misinformation. "Over 40, I think 41, 42, 43 or 44 percent, of Americans thought the law had been repealed, so there is still a lot of confusion," says Praeger. Praeger says if you choose not to buy coverage next year, you will have a minimum of a $95 penalty fee or 1 percent income and up to a maximum of 2.5% of your annual income in ensuing years. Praeger will be holding informational meetings throughout the state starting next week. She says if you are already covered by your employers' health insurance, then you don't need to look at exchanges. Hazmat Team Called For False Alarm Comments are posted from viewers like you and do not always reflect the views of this station.

医学

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Obama pressed on health care plans on ABC News special By Lynn Sweet on June 24, 2009 11:24 PM "ABC News Primetime: Questions for the President -- Prescription for America" airs tonight at 10 p.m. ET VIDEO: Obama: Why Government Should Get Involved in Health Care http://abcnews.go.com/video/playerIndex?id=7923052 VIDEO: President Obama's 'Uniquely American' Health Care Plan President Obama on how to drive down health care costs while providing adequate coverage VIDEO EMBED CODES: http://abcnews.go.com/Politics/page?id=7906361 LINK: http://abcnews.go.com/Politics/HealthCare/story?id=7919991&page=1 EXCLUSIVE: President Obama Defends Right to Choose Best Care In ABC News Health Care Forum, President Answers Questions About Reform By JAKE TAPPER and KAREN TRAVERS June 24, 2009-- President Obama struggled to explain today whether his health care reform proposals would force normal Americans to make sacrifices that wealthier, more powerful people -- like the president himself -- wouldn't face. The probing questions came from two skeptical neurologists during ABC News' special on health care reform, "Questions for the President: Prescription for America," anchored from the White House by Diane Sawyer and Charles Gibson. Dr. Orrin Devinsky, a neurologist and researcher at the New York University Langone Medical Center, said that elites often propose health care solutions that limit options for the general public, secure in the knowledge that if they or their loves ones get sick they will be able to afford the best care available, even if it's not provided by insurance. Watch "ABC News Primetime: Questions for the President -- Prescription for America" Wednesday, June 24, at 10 p.m. ET Devinsky asked the president pointedly if he would be willing to promise that he wouldn't seek such extraordinary help for his wife or daughters if they became sick and the public plan he's proposing limited the tests or treatment they can get. The president refused to make such a pledge, though he allowed that if "it's my family member, if it's my wife, if it's my children, if it's my grandmother I always want them to get the very best care." "There's a whole bunch of care that's being provided that every study, that every bit of evidence that we have indicates may not be making us healthier," he said. Gibson interjected that often patients don't know what will work until they get every test they can. "Often times we know what makes sense and what doesn't," the president responded, making a push for evidence-based medicine. Gibson asked the president if it doesn't make sense to decide what the limitations will be on options in any health care reform proposal before voting on it. "That's what people are afraid of," Gibson said. The president said he understood the American people "know they're living with the devil, but the devil they know instead of the devil they don't." Obama: GOP Senators Are Wrong on Public Option On the "Nightline" edition of the health care forum, Gibson read the president a letter from Republicans on the Senate Finance Committee expressing concern about the creation of a government-run health care plan. "At a time when major government programs like Medicare and Medicaid are already on a path to fiscal insolvency, creating a brand new government program will not only worsen our long-term financial outlook but also negatively impact American families who enjoy the private coverage of their choice," the senators wrote. "The end result would be a federal government takeover of our health care system, taking decisions out of the hands of doctors and patients and placing them in the hands of a Washington bureaucracy." "They're wrong," the president said, arguing that in a Health Insurance Exchange the public plan would be "one option among multiple options." The concern, Gibson articulated, is that such a plan wouldn't be offered on a level playing field. The president rebuffed that, arguing that "we can set up a public option where they're collecting premiums just like any private insurer and doctors can collect rates," but because the public plan will have lower administrative costs "we can keep them [private insurance companies] honest." Obama said he didn't understand those advocates of the free market who constantly say the private sector can do things better and are yet worried about this plan. "If that's the case, no one will chose the public option," the president said. He also suggested, however, that the private sector might not necessarily be better, point out that users of Medicare and Veterans Administration hospitals constantly rate "pretty high satisfaction." Views on Government-Funded Health Insurance According to the latest ABC News/Washington Post poll, 62 percent of Americans support creating a government-funded entity to offer health insurance to those who don't get it elsewhere. But if that caused many private insurers to go out of business because they couldn't compete, support plummets to 37 percent. The White House has shown some flexibility about a government-run plan. In a meeting with a bipartisan group of governors today, the possibility was raised of states offering public plans of their own instead of just one federally administered plan, according to a source with knowledge of the meeting. And White House chief of staff Rahm Emanuel told Democratic senators Tuesday night that the president was open to "alternatives" to the public plan. Sawyer asked Ron Williams, the CEO of Aetna Insurance, "Is the president right that you need to be kept honest?" Williams said he disagreed with the notion of a public plan. "It's difficult to compete against a player who's also the person refereeing the game," Williams said. He proposed working to "solve the problem as opposed to introduce a new competitor who has rule-making ability." Gibson pointed out that the president constantly makes the argument that if you like your insurance you won't have to change it. And yet from the audience, John Sheils, senior vice president of The Lewin Group, a health care policy research and management consulting firm, estimated that up to 70 percent of those with private insurance would end up on the public plan. "There are a whole series of ways that we could design this," the president said, arguing that employers would be given a "disincentive" to shift their employees to the public plan. Another neurologist, Dr. John Corboy of the University of Colorado Health Science Center, asked the president, "What can you do to convince the American public that there actually are limits to what we can pay for with our American health care system and if there are going to be limits, who's going to design the system and who's going to enforce the rules for a system like that? " Obama, however, didn't directly answer the question. "If we are smart, we should be able to design a system in which people still have choices of doctors and choices of plans that make sure that necessary treatment is provided but we don't have a huge amount of waste in the system," he said. He said he had "great confidence" that physicians "are going to always want to do right thing" if they have the right information and a payment structure that focuses on evidence and results and not tests and referrals. "We should change those incentive structures," the president said. "Our job this Summer and this Fall," he said, is to "identify the best ways to achieve the best possible care." The president cited the Mayo Clinic as an example of a medical center where experts had figured out the most effective treatments and eliminated waste and unnecessary procedures. Sawyer said that e-mails ABC News had received argued that "the Mayo Clinic is exactly the point," indicating that private companies are solving this problem, and raising the question as to why the government needs to get involved. "And, unfortunately, government, whether you like it or not, is going to already be involved," Obama said, citing Medicare and Medicaid. One questioner -- Marisa Milton, vice president of health care policy for the HR Policy Association, a public policy advocate for human resource executives -- said that "other industrialized nations provide coverage for all their residents" with "high quality care" without spending more money. "A lot of those countries employ a different system than we do," the president said. "Almost all of them have what would be considered a single-payer system in which the government operates what is essentially a Medicare for all." The president said he didn't think it wise to attempt to "completely change our system root and branch" since health care is one-sixth of the U.S. economy. It "would be hugely disruptive," he said, arguing that citizens would be forced to change their doctors and insurance plans "in a way I'm not prepared to go." End-of-life issues were raised as well; right now it is estimated that nearly 30 percent of Medicare's annual $327 billion budget is spent on patients in their final year of life. Jane Sturm told the story of her nearly 100-year-old mother, who was originally denied a pacemaker because of her age. She eventually got one, but only after seeking out another doctor. "Outside the medical criteria," Sturm asked, "is there a consideration that can be given for a certain spirit & and quality of life?" "I don't think that we can make judgments based on peoples' spirit," Obama said. "That would be a pretty subjective decision to be making. I think we have to have rules that say that we are going to provide good, quality care for all people. "We're not going to solve every single one of these very difficult decisions at end of life," he said. "Ultimately that's going to be between physicians and patients." Who Will Pay for All of This? "How and who will pay for national health care system," asked Christopher Bean, who said he has good insurance with his job at Allint Tech Systems and worries about government interference. "We will have some up-front costs," the president acknowledged. "And the estimates & have been anywhere from a trillion to $2 trillion. But what I have said is whatever it is we do, we pay for." The president criticized the Congressional Budget Office, which recently released a scathing analysis of the cost of the White House's reform plan, for not counting the medical savings his administration believes will happen, or the use of money that already exists in the system that the president wants to re-allocate. "We spend $177 billion over 10 years in providing subsidies for insurers," the president said as an example of the latter. About a third of the costs will come from new revenue," the president said, pushing his proposal to raise taxes on those making more than $200,000 a year through a change in the itemized deduction in the tax code. Gail Wilensky, a senior fellow at Project HOPE who ran Medicare during the administration of President George H.W. Bush, pushed the president for more specifics on how he expects to pay for the plan. "This is not an easy problem," the president acknowledged. "And it's especially not an easy problem when the economy is going through a difficult phase." But the president suggested the stars were aligning for reform, citing efforts being made such as the pharmaceutical industry's recent pledge to help defray the costs of prescription drugs for seniors, and argued that now was the time for reform. "We have to have the courage and the willingness to cooperate and compromise in order to make this happen," the president said. "And if we do, it's not going to be a completely smooth ride, there's going to be times over the next several months where we think health care is dead, it's not going to happen but if we keep our eye on the prize & then I'm absolutely convinced that we can get it done this time." Earlier in the day at the White House, Obama told a bipartisan group of governors he wants them to be kept in the loop as health care reform legislation develops on Capitol Hill. "We're committed to working with them in the weeks and months to come to make sure that when we get health reform done it is in partnership with the states, where the rubber so often hits the road," the president told reporters. But Obama acknowledged the thorny issues they're all facing -- including whether there should be a government-run public plan, who will pay for it, and how to achieve universal coverage. "There's no perfect unanimity across the table in terms of every single aspect of reform," the president said. The biggest bone of contention may be how to pay for reform. "Anything that we do on health care we have to have a long-term plan to pay the bills," said South Dakota Gov. Mike Rounds, a Republican, who attended the meeting. In an exclusive interview with ABC News' Diane Sawyer that aired today on "Good Morning America," Obama indicated that there was a breaking point in the balance sheets where he would say that the cost of reforming the system is too great for the federal government to handle, but he did not put a price tag on it. "I think that if any reform that we get is not driving down costs in a serious way ... if people say, 'We're just going to add more people onto a hugely inefficient system,' then I will say no. Because -- we can't afford it," he said. Taxing Health Care Benefits? One option being considered on Capitol Hill is taxing health care benefits, which are currently tax exempt. Today a key Democratic senator indicated that may be inevitable. "It is hard for me to see how you have a package that is paid for that doesn't include reducing the tax subsidy for health care," said Sen. Kent Conrad of North Dakota, chairman of the Senate Budget Committee, who is regarded among Democrats as something of a deficit hawk. Conrad sees the potential for a significant source of revenue. "Tax subsidies for healthcare. They're huge. Hundreds of billions of dollars a year," he said. Obama said he opposes that approach, instead wanting to pay for the bill partly by reducing the tax deductions wealthier people can take when donating to charity. "We would raise enough money to actually make sure this thing is paid for," Obama said in the ABC interview. "Now members of Congress may have other ideas about how best to do this. I'm happy to listen to them." Conrad said that limiting deductions is "still on the table" in the committee's discussions. While the details are hammered out on Capitol Hill, there is a legislative push and pull and shifting positions at both ends of Pennsylvania Avenue. As a candidate, then-Sen. Obama bashed his rival for the Democratic nomination, Hillary Clinton, for proposing that Americans be mandated to have health insurance. "She'd have the government force you to buy health insurance," he said on Feb. 23, 2008. "I disagree with that approach. I believe that the reason Americans don't have health care isn't because no one's forced them to buy it, it's because no one's made it affordable." But now the president is acknowledging that his thinking on the issue has "evolved" and he could support a law mandating that individuals purchase health care coverage, with fines for those who do not. Obama stressed that there must be some kind of waiver for those who are simply unable to afford it. "People have made some pretty compelling arguments to me that if we want to have a system that drives down costs for everybody, then we've got to have healthier people not opt out of the system," the president told ABC News. Earlier this month in a letter to Congressional leaders working on the reform legislation, Obama said he would consider supporting such a measure, if it has room for exemptions for small businesses and individuals who cannot afford the premiums. Obama's Approval Ratings on Health Care Slip With the health care debate ramping up, with Republicans assailing Democrats for the high price tag and a public option plan, Obama's ratings on the subject slipped slightly in the latest ABC News/Washington Post poll. Only 53 percent of Americans approve of Obama's handling of health care while 39 percent disapprove of it, up from 29 percent who disapproved in April, according to the poll. Concluding the health care forum, Obama expressed optimism that reform is possible. "If the American people get behind this, this is going to happen," the president said. ABC News' Z. Byron Wolf contributed to this report. Copyright © 2009 ABC News Internet Ventures daniellezito If you are uninsured and does not have insurance, you should check out the website http://UninsuredAmerica.blogspot.com -California How is the newly proposed "government health insurance plan" different from the current Medicaid system which is designed to provide health insurance for those who are low income and not part of a private/employer based plan? What makes the Obama administration think that the new public plan can be cost controlled any better than the old public (medicaid) plan? And if their cost control measures are better, why can they not be applied to the current system in order to save cost of creating a new program? | June 25, 2009 12:15 PM My wife and I are very healthy, pro-active about staying healthy, don't participate in unhealthy habits like smoking (as the president engages in) and we do not have health insurance. We don't want to be forced into paying into a health system that will end up caring for those who make poor health decisions like smoking, drinking excessively which lead to expensive health problems. Why should we pay for other people's bad unhealthy habits while we are the ones being a benefit to society by staying healthy, eating right, working and paying our taxes? Mr. President, don't force us to pay a health care tax! Let me spend my money on keeping my family healthy the responsible way, by eating right, taking care of our bodies and preventive medicine. Don't make us pay for your bad habit. | June 25, 2009 3:37 PM When congress exempts itself from a plan that they are trying to sell to the rest of us that should speak volumes on this public option plan, they don't want it for themselves or their families because it stinks. Dara Edward at 12:15, good luck to you. I am in my 40's, always been healthy, don't drink, don't smoke, eat right (vegetarian) and I just got diagnosed with cancer. I know other people who did everything 'right' and have still become sick or have been injured. And when that happens - often you discover that your insurance industry health coverage isn't as wonderful as you thought it was. You find they start denying needed treatments, or even retroactively cancel your healthcare. That's what President Obama is trying to address by offering a CHOICE to many people who currently have none. People whose employers don't offer health coverage; people with so-called "pre-existing conditions" who cannot get any insurance company to cover them; people who can't afford astronomical premiums for health care plans with such high deductibles that it's really not coverage at all. If you're happy, stay with your plan by all means! But let the rest of us have a choice. Bad habits are not the only reason for health, some diseases are inborn, hereditary. Are you invincible to illness or a sudden stroke or heart attack. No one plans to become ill on purpose. Bryson What is missing from all this health care “reform” is money to build new medical, nursing, pharmacy, dental... schools! If you train more people and more people are working in that field of specialization the price will go down simple by the nature of the free market system. Jerre I am happy with my Health Insurance. It is the same as the Congressman as I am a retiree from the Department of Defense. Leave me alone. It is imperative that the American people think about what it means to have a government ran health care system. If we have not encountered medical challenges yet, we will at some time in the future. Dara, I am sorry to hear about the challenges that you are facing, and I wish you the best. It is important to realize that President Obama has mentioned "evidenced based" health care. My perception of that term, is if statistics say you do not need a repeat ct scan, you will not get one. If statistics show your pain medication provides comparable relief to Tylenol...you will be buying over the counter Tylenol. What happens if the budget is met for the month? Do you wait next monnth for a surgery? I am curious about what will the options be if an individual receives a denial. Will they get to appeal it? Who do they appeal it to? If they are attempting to decrease medical costs, where are the cuts taking place? How are they planning on paying for this care? Who will approve the services needed? As hospitals are trying to decrease costs to stay in business due to a decreased reimbursement levels, will they be able to pay for to keep the hospital clean? Will the physicians and hospitals be able to care for individuals in a clean environment? Will they be able to stay in business to provide medical care due to the lower reimbursement rates from the government? Why should the hard working Americans (including business owners) have to pay taxes on a benefit that they earn? Taxing the employer on health care benefits will only increase the unemployment rate, which is already a significant battle. The system might not be perfect...but it is not completely broke! To be honest, when everyone starts receiving the same benefits whether they work or not, is when Americans will stop striving to improve themselves. We think young Americans do not have ambition now...they never will with this option. Then...who is going to fund it when people start quiting their jobs. There are a lot of questions and concerns that should be answered to the people of this great country before the government forces us to take on a healthcare system that could potentially harm us (as individuals and as a country) financially and medically. Leave a comment This page contains a single entry by Lynn Sweet published on June 24, 2009 11:24 PM. Obama, Michelle Obama to meet with Pope Benedict XVI at the Vatican was the previous entry in this blog. GOP counters Obama's ABC News health coverage special is the next entry in this blog.

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The next time you're in a large amphitheater with quite a few folks, try asking this unsolicited yet provocative request:"Raise your hand if you are going to die."Usually about one third of the people raise their hand, but the remainder sheepishly acknowledge that they really didn't want to think about it and hesitate.But as we all know, we all will die. And before death comes aging late in life. One senior at my father's assisted living facility commented: "Getting old ain't for sissies."But many of our population are living longer than ever.It's great to that we're keeping older folks alive longer, isn't it? Well, maybe.Our next big challenge will be caring for the chronic health needs of the over-85 crowd. In England, they have noticed a record number of centenarians:Dr Lorna Layward, from Help the Aged, said: "It's hard to know whether these extra years are providing extra years of good health. "Hopefully, with better medical provision, these extra years can be happy and healthy." Emma Soames, the editor of Saga Magazine, said: "The government has got to get its act together, because the care services in this country are really not fit for purpose at the moment. "We have a whole generation in their 50s and 60s who are looking after elderly relatives." Gordon Lishman, director general of Age Concern, said: "Demographic change presents a number of opportunities and challenges to public services and public spending. "For example, most people living in care homes are over the age of 85. As the number of people over the age of 90 increases, so will the need for care home spaces. "All too often we are failing to respond adequately to the changing demographic challenge facing the UK." The US is in a similar predicament. I have been struck by the increasing number of 90 and 100-year olds I find on the hospital wards on the weekends. Which leads to the next important question.With the current market pressures, will we have enough doctors to tend to these seniors? The yearly threats to shrink physician Medicare reimbursements by the Centers for Medicare & Medicaid Services (a.k.a. CMS) as they continue to follow Congressional guidelines intended to slow the rise of health-care costs leaves many a physician with little incentive to continue with the current rat race. After all, after expenses, some have estimated the average annual primary care physician earns about $80,000 per year - less take-home pay than many nurse practitioners.To amplify staffing concerns, physician recruitment and retention has recently become a global issue. An Indian colleague of mine has commented that many foreign medical physicians who immigrated to the US to find profitable jobs are now moving back to their home countries. Why? Because technology in even remote towns has met or exceeded that of the US and the economics of their health care systems are far more lucrative for them. This, then, leaves many US hospitals and training programs woefully understaffed for many primary care specialties like internal medicine or family medicine. While some would counter that internal medicine training programs should increase the number of trainees, program directors are keenly aware that training extra doctors diminishes the collective bargaining power of current physicians as they struggle to thwart ongoing salary concessions mandated by Congress. So what to do?First, it goes without saying that Congress should avoid further Medicare cuts for physician reimbursement - after all, who will take care of them if they approve these cuts? But the outcome of negotiations is never certain. So we wait on the sidelines.Secondly, civic and community leaders should look at their strategic plans and consider options to facilitate aging-at-home initiatives. What are communities providing in terms of transporation, home meals, distaster preparedness, and even financial planning assistance? Adequacy of assisted living facilities, nursing home facilites and staffing requirements should be carefully considered now as our seniors continue to age.Finally, economic incentives for physicians to enter these much-needed fields of gerontology and internal medicine would go a long way to securing the health of all of our aging senior population.-WesImage credit. Don't worry Wes the robots are coming... they will wipe grannies pooper - give her the meds, water the flowers and drive her to doctors office. Even carry her to the car if need be. Look for it at Bestbuy around 2012 - oh and one more thing -it will plug itself in for the night. Tue Oct 02, 11:49:00 AM CDT meliorix Dr Wes, starting April 2006 the UK government stopped renewing work permits for almost 5000 doctors of non European origin. If conditons in India were as rosy as your friend points they would all be going back home. The truth is that a large number of them are applying for residency positions in primary care specialities after having worked in subspecialities for years. What the Indian colleague of yours points out to is , at best, an isolated urban phenomenon of corporate hospitals catering to the insured /super rich who can afford the bills. These constitute a miniscule percentage of people seeking health care. The Health Minister of the Union Government of India while addressing the annual convocation of the premier medical institute in India had this to say to the pass outs:" Please don't go abroad. Or if you do go for higher education, please come back when you finish that training."

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> Public Policy > Conflicts of Interest and the Future of Medicine $24.95 The United States, France, and Japan Puts the systemic weaknesses of the US health care system in global perspective. First book to compare the effectiveness of strategies used to address conflicts of interest and to propose reforms based on assessment of what works and what doesn't in several countries Examines in detail an area of key public concern: conflicts of interest arising from physician ties to drug firms and other commercial interests. As most Americans know, conflicts of interest riddle the US health care system. They result from physicians practicing medicine as entrepreneurs, from physicians' ties to pharma, and from investor-owned firms and insurers' influence over physicians' medial choices. These conflicts raise questions about physicians' loyalty to their patients and their professional and economic independence. The consequences of such conflicts of interest are often devastating for the patients--and society--stuck in the middle. In Conflicts of Interest and the Future of Medicine, Marc Rodwin examines the development of these conflicts in the US, France, and Japan. He shows that national differences in the organization of medical practice and the interplay of organized medicine, the market, and the state give rise to variations in the type and prevalence of such conflicts. He then analyzes the strategies that each nation employs to cope with them. Unfortunately, many proposals to address physicians' conflicts of interest do not offer solutions that stick. But drawing on the experiences of these three nations, Rodwin demonstrates that we can mitigate these problems with carefully planned reform and regulation. He examines a range of measures that can be taken in the private and public sector to preserve medical professionalism--and concludes that there just might be more than one prescription to this seemingly incurable malady. Show more Conflicts of Interest and the Future of Medicine Table of ContentsForward by Jerome Kassirer Framing the Issues Introduction: Patient Stories 1. The Heart of the Matter Case Studies2. The Evolution of the French Medicine3. Coping with Physicians' Conflicts of Interest in France4. The Rise of a Protected Medical Market: The United States before 1950 5. The Commercial Transformation: The United States, 1950-19806. The Logic of Medical Markets: The United States, 1980 to the Present 7. Coping with Physicians' Conflicts of Interest in the United States 8. The Evolution of Japanese Medicine 9. Coping with Physicians' Conflicts of Interest in Japan Implications10. Reforms 11. Professionalism Reconsidered Conclusion: The Way Forward Appendix: Conflicts of Interest Ideas: Origins and Application to PhysiciansAcronyms and Glossary Acknowledgements About the Author Bibliography Index Conflicts of Interest and the Future of Medicine Author Information Marc A. Rodwin is Professor of Law at Suffolk University Law School. He is the author of Medicine, Money amd Morals: Physicians' Conflicts of Interest (OUP 1993) and numerous articles on health law, ethics, politics and policy. Rodwin has been a research scholar at Tokyo University Law School and the Centre National de Recherche Scientifique in France. He has testified before Congress, advised consumer groups, and lectured in several countries. Conflicts of Interest and the Future of Medicine "Rodwin writes clearly, and he is soft-spoken but stinging in his account of organized medicine's resistance to limits on self-referral, enticements from Big Pharma, and other flows of lucre...an important book on an urgent topic, neglected by both political parties in the ongoing battle over health care reform." --Health Affairs "Will be helpful to scholars as well as intriguing to readers new to the subject." --Journal of the American Medical Association "Rodwin provides broad, well-documented coverage of financing mechanisms and the competing goals of state and markets...Recommended." --CHOICE "Superb, comparative, fascinating...A valuable historical study which is also a major contribution to conflict of interest debates in US and international health care policy, suggesting practical alternatives for the future." --Rosemary A. Stevens, Distinguished Scholar, Weill Cornell Medical College-New York City "Rodwin turns a critical eye to the current proposals...suggests new directions for reform...[and] offers important advice that policy makers must heed if we are to restore trust in our profession." --Jerome P. Kassirer, MD, Distinguished Professor, Tufts University School of Medicine, and Editor-in-Chief Emeritus of New England Journal of Medicine "A wise, powerful, broad-ranging guide to saving the relationship between doctors and patients. Conflicts of Interest is meticulously researched and beautifully written. It explores the past, illuminates the present, and points us toward a promising future. We ignore Marc Rodwin at our peril." --James Morone, Professor of Political Science and Urban Studies, Brown University, co-author of The Heart of Power and author of Hellfire Nation "Rodwin, whose earlier classic on medical conflicts of interest contributed importantly to the public debate, has deepened his analysis in a comparative perspective...He again enlarges and enlightens the debate and offers useful policy alternatives." --David Mechanic, Director of the Institute for Health, Health Care Policy, and Aging Research, Rutgers University "This book specifies the ways in which both government and medical professionals and organizations must change if we are to adequately protect patients. Rodwin's analysis is thoughtful and thorough; his recommendations can help guide us to more effective public policies." --Thomas Rice, Professor of Health Services, University of California-Los Angeles School of Public Health "A fitting sequel to Rodwin's pathbreaking Medicine, Money, and Morals. His analysis of conflicts of interest in medicine in France, Japan, and the US is both fascinating and sensible." --Timothy Stoltzfus Jost, Professor of Law, Washington and Lee University School of Law "The medical profession, the market, and the state exist in a delicate and dynamic balance. By explaining how this balance is maintained or lost in three countries, Rodwin is able to diagnose the ills of American medicine and suggest appropriate treatment." --John D. Lantos, MD, Professor of Pediatrics, University of Missouri, and author of Do We Still Need Doctors? "...Rodwin provides comprehensive, yet accessible information on the complexity of conflicts of interest and how they may shape the future of medicine in different health-care systems. This book is well written and highly topical. It will be of interest for all those who are oncerned about doctors' conflicts of interest, from policymakers and academics to practitioners and the users of medical services." --Ellen Kuhlmann, Social Policy & Administration "It is hard not to be impressed by the depth of learning shown in this book. Rodwin presents a coherent account of the development of medicine in three countries, drawing relevant comparisons as he does so, identifying key sites where conflicts of interest are likely to arise. He is able to show how those sites vary from country to country and explore how they arose through the distinctive evolutionary path of medicine in each. This is a major scholarly achievement... this is a very good book indeed. I would have no problems recommending it for courses on health policy, but I also hope it will be used in medical schools to explore the kinds of challenges the profession faces in relation to conflicts of interest." --Ian Greener, Durham University, Governance "In this rich and learned analysis, Marc A. Rodwin extends his work on conflicts of interest by directly comparing both problems and policies in the United States, France, and Japan. Although he has already published leading work in this field (Rodwin 1993), readers, I suspect, will learn a lot from this comparison, which builds on the analytic baseline from that previous work. A reader interested in conflicts of interest and seeking an introduction to the field could surely use this book for that purpose. ELConflicts of Interest and the Future of Medicine demonstrates convincingly that "self-regulation, disclosure, and minor tweaking of legal rules" (249) are highly unlikely to resolve the problems created by conflicts between the interests of those who make their living from medical care and those who need medical care to live." --Journal of Health Politics, Policy and Law "To Illustrate the various sources of conflicts present in today's health care system, Marc Rodwin's book starts with the story of a hypothetical patient with chest pain seeking medical help in the U.S. France and Japan. ...for each of the three countries, the author provides an in-depth review of history of the nation's medical political economy as it has been shaped by medicine, the market and the state. He examines how conflicts of were influenced by the rise of and social medical insurance, by the changing relations between and the pharmaceutical and medical device industries. The book deals with an important topic that the author thoroughly researched. By reviewing the different strategies developed by each country to respond to physicians' conflicts of interRodwin provides a useful perspective for the ongoing debate on medical ethics." --Key Reporter "Thanks to its comprehensive analysis of the three countries and their different regulatory frameworks this book is not only useful for legal or economic scholars/experts who are interested in dealing with conflicts of interest, but also for those who would like to study the healthcare systems of France, Japan and the USA. It is also useful as a starting point for sociologists and political scientists for studying the role of the medical profession." -- International Journal of Integrated Care "The author presents an in-depth historical analysis and current situation of the physician patient-centered conflict-of-interest problems in a well-researched and written academic style." --World Medical & Health Policy "Marc Rodwin's Conflicts of Interest and the Future of Medicine succeeds admirably both at helping us learn about other countries and at helping us learn from them ... The attentive reader will come away from these chapters with a sophisticated and complex understanding of the evolution of the healthcare financing system in each of the countries ...The book will be of great interest to health policy analysts, health lawyers, physician leaders, regulators, and bioethicists. It is a model of descriptive and analytical comparative analysis ... Rodwin pulls no punches, announcing that the experiences of the three countries have led him to conclude that a number of traditional reforms aimed at conflict of interest in medicine just don't work ... Rodwin supplies detailed arguments for each conclusion, based on the evidence gathered in his national case studies." --The American Journal of Bioethics "...Rodwin provides a fascinating, well-informed account of the changing economics of modern medicine ... unlike many works of policy analysis that present only a thin veneer of history, this book has a solid historical foundation. ...Rodwin's lucid, learned summary of physician conflicts of interest will be enormously useful to historians, particularly those concerned with the post-1970 period. The book's extensive footnotes and bibliography provide a guide to relevant sources in the fields of law, economics, sociology, and policy, and an appendix offers a short legal history of the concept of conflicts of interest and its evolution from Roman fiduciary law to modern civil law. This is a fine piece of work that will be of great use particularly to historians of twentieth century medicine." --Social History of Medicine "The existence of these incentives-and the conflicts of interest they create-is the subject of Marc Rodwin's new book, Conflicts of Interest and the Future of Medicine. In his history-heavy analysis of the growth and symbiosis of medicine and industry in the United States, France, and Japan, Rodwin chronicles the cultural, legal, and institutional factors that have contributed to each country's current landscape of financial incentives in clinical medicine. Each tells a different story of how organized medicine, professional self-regulation, market competition, and payers affect contemporary physician behavior and provides insight into the relationship between this behavior and health care cost." --Journal of Bioethical Inquiry "Dr. Rodwin masterfully reviews most of the reasons leading to conflicts-of- interest and draws attention to the similarities and differences between the United States', Japan's, and France's practices for managing this problem. He presents relevant examples, discusses the historical evolution of the medical ethics in each country, and proposes suitable remedial actions ... This is a well-written and scholastic treatise by an academic who studied and worked in all three countries discussed in this book." --World Medical & Health Policy "This is an important contribution to our understanding of institutionalized conflicts of interest in medicine, and it contributes to our understanding of health-care politics and comparative health policy... Rodwin's vantage point provides insights into the politics of private-sector medicine and the broader political economy of health care... this book provides thoughtful insights on past, current, and future conflicts of interest in medicine for scholars and policymakers alike." --Perspectives on Politics "What makes Marc Rodwin's book quite valuable is the scope of what is considered under the rubric of financial conflicts of interest (FCOI), the multi-national comparisons, his in-depth consideration of the historical context in which FCOI has developed, and the chapter dedicated to reforms aimed at limiting physicians FCOI... it makes a significant contribution to the overall literature on the nature, extent, and consequences of FCOI in medicine today." --The Journal of Law, Medicine & Ethics Medicine in an age of Commerce and Empire Managing the Body Ina Zweiniger-Bargielowska A History of Psychology John G. Benjafield Law, Person, and Community John J. Coughlin Spirit Cure Joseph W. Williams Caring for the Heart W Bruce Fye Medicine, Money, and Morals Economics > Public Economics > Fiscal Policies & Behavior of Economic Agents

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The Cost of Premature Birth: For One Family, More than $2 Million A new report released Wednesday finds that 15 million babies worldwide are born prematurely each year. For any hope of prevention, preterm birth needs to raise its PR profile. By Bonnie Rochman @brochmanMay 02, 20120 Share Anthony Saffery / Photographer's Choice / Getty Images Email Around the world, 15 million babies are born prematurely each year, and 1 million of them die. It would be a mistake to brush it off as something that happens far away in poor African counties without access to quality medical care. Out of 184 countries assessed, the U.S. ranks 131st in premature birth prevention, according to a new report released Wednesday that represents nearly 50 organizations and was published by the March of Dimes, the World Health Organization, the Partnership for Maternal, Newborn and Child Health and Save the Children. It’s a worrisome distinction the U.S. shares with Somalia, Turkey and Thailand. Of every 100 babies born in the U.S., 12 arrive preterm, accounting for about half a million births each year. And that’s even after preterm birth rates in the U.S. have declined for four consecutive years. Contrast that with Belarus, which performs best at 4.1 premature births per 100 deliveries, and Malawi, which has the worst track record at 18.1 premature births per 100 live births. (MORE: C-Sections May Increase Premature Babies’ Risk of Breathing Problems) For Jen Sinconis, the title of the new report — Born Too Soon — is an understatement. Sinconis’ twin boys were born at 24 weeks in Oct. 2006. Sinconis’ placenta detached, and she had to deliver her sons via emergency C-section. Ethan weighed 1 lb., 6 oz.; Aidan weighed half a pound more. “My pregnancy was completely normal and healthy up until five hours before they were born,” says Sinconis, who manages a Starbucks in Seattle. “I had no idea anything would go wrong.” Prematurity just doesn’t have the same public-relations cachet as other diseases — breast cancer, for example, or AIDS. Yet it’s the biggest reason that babies in the U.S. die before their first birthday. Worldwide, more than 40% of deaths of children under 5 are associated with preterm birth. But why it happens remains a mystery in many cases. “We’ve been at this same point in history for other diseases,” says Eve Lackritz, a senior program officer with the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), an initiative of Seattle Children’s Hospital. “Twenty-five years ago, we didn’t have a good understanding of AIDS and what caused it. We need to make that same commitment to research and prevention of preterm birth. Prevention is always less expensive than treatment.” (MORE: Being Born Premature May Hurt Your IQ) The U.S. Institute of Medicine has calculated the annual costs associated with preterm birth at more than $26 billion. Ethan and Aidan Sinconis racked up $2.2 million in medical bills in the first 18 months after they were born. Insurance covered most of the costs, but their parents’ portion approached $450,000. “It destroyed us,” says Sinconis, 35, who has written about her family’s experience in A Pound of Hope. She and her husband, Justin, were forced to file for bankruptcy and sold their possessions on Craigslist to generate cash. Meanwhile, the boys struggled through heart surgery and eye surgery, sepsis, rickets and brain hemorrhages. When they left the hospital after six months, they were ordered to avoid contact with the outside world. Attached to oxygen, heart monitors and feeding tubes, they remained at home in isolation for three years. Now 5½ years old, they’re smaller than other kids their age and struggle socially because they had no playmates for their first three years. They have speech delays, but amazingly, they’re both reading and writing on a second-grade level and will start kindergarten this fall. (MORE: Preemies Face Higher Risk of Death in Early Adulthood) Theirs is ultimately a story of success, but it’s not without its glaring caveats. Ethan still has heart and lung problems, and doctor and therapist visits are still a part of the brothers’ regular routine. Another caveat, as far as the report is concerned, is the definition of preterm birth. For the purposes of the report, preterm birth is considered as occurring before 37 weeks. But there is a movement underfoot, at least in the U.S., to nudge up the benchmark to 39 weeks as research continues to show that babies undergo lots of critical development in the final weeks of a conventional 40-week pregnancy. But even with the less stringent standard of 37 weeks, the report still finds that 11 countries have preterm birth rates over 15%. The majority are in sub-Saharan Africa; 60% of the world’s preterm babies are born there and in South Asia. (MORE: Why Delaying Birth by Just Two Weeks Boosts Baby’s Survival) “This report tells two stories,” says Chris Howson, a co-author of the report and vice president for global programs for the March of Dimes. “One story is grim and should be a wake-up call to the international community that preterm birth is real and common and it kills. But it is also a story of hope and promise because it offers actions to accelerate prevention and reduce mortality.” Some of the report’s recommendations to prevent preterm birth better include: Offer family planning to all women universally because teen pregnancy and improper birth spacing are risk factors for preterm birth Strengthen health services before and between pregnancies so mothers enter pregnancy as healthy as possible Improve basic care for pregnant women worldwide, with better-trained birth attendants and access to antibiotics and emergency obstetric care Invest in research into the causes of preterm birth Some recommendations to reduce mortality from preterm birth include: Implement skin-to-skin kangaroo care, which helps newborns stay warm and promotes breast-feeding Make corticosteroids universally available to women in preterm labor to help their babies’ lungs mature. The report calculates that if the drugs were on hand for every woman in need, 400,000 babies could be saved by 2015. And it’s cheap — just $1 a dose, with two to four doses needed. If inexpensive interventions such as these were available everywhere, notes the report, three-quarters of the 1 million annual deaths from prematurity could be averted. Yet prevention still lags far behind. Implementing every known method of preventing preterm birth would only prevent 8% of these early deliveries, according to Craig Rubens, executive director of GAPPS. Faced with those statistics, Sinconis doesn’t understand why a solution hasn’t been discovered. “With so many premature babies, how are we not investing more?” she says. “These are our children.” Bonnie Rochman @brochman Bonnie Rochman writes about pregnancy, fertility, parenting — the ups and downs of being a kid and having one — for TIME. 0 comments

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The Michael J. Fox Foundation and Intel Join Forces to Improve Parkinson's Disease Monitoring and Treatment Through Advanced Technologies NEW YORK & SANTA CLARA, Calif. --(Business Wire)-- The Michael J. Fox Foundation for Parkinson's Research (MJFF) and Intel (News - Alert) Corporation announced today a collaboration aimed at improving research and treatment for Parkinson's disease - a neurodegenerative brain disease second only to Alzheimer's in worldwide prevalence. The collaboration includes a multiphase research study using a new big data analytics platform that detects patterns in participant data collected from wearable technologies used to monitor symptoms. This effort is an important step in enabling researchers and physicians to measure progression of the disease and to speed progress toward breakthroughs in drug development. Anonymous patient data is aggregated and analyzed for new insight into Parkinson's disease via a new partnership between Intel and the Michael J. Fox Foundation. (Photo: Business Wire) "Nearly 200 years after Parkinson's disease was first described by Dr. James Parkinson in 1817, we are still subjectively measuring Parkinson's disease largely the same way doctors did then," said Todd Sherer, PhD, CEO of The Michael J. Fox Foundation. "Data science and wearable computing hold the potential to transform our ability to capture and objectively measure patients' actual experience of disease, with unprecedented implications for Parkinson's drug development, diagnosis and treatment." "The variability in Parkinson's symptoms creates unique challenges in monitoring progression of the disease," said Diane Bryant, senior vice president and general manager of Intel's Data Center Group. "Emerging technologies can not only create a new paradigm for measurement of Parkinson's, but as more data is made available to the medical community, it may also point to currently unidentified features of the disease that could lead to new areas of research." Tracking an Invisible Enemy For nearly two decades, researchers have been refining advanced genomics and proteomics techniques to create increasingly sophisticated cellular profiles of Parkinson's disease pathology. Advances in data collection and analysis now provide the opportunity to expand the value of this wealth of molecular data by correlating it with objective clinical characterization of the disease for use in drug development. The potential to collect and analyze data from thousands of individuals on measurable features of Parkinson's, such as slowness of movement, tremor and sleep quality, could enable researchers to assemble a better picture of the clinical progression of Parkinson's and track its relationship to molecular changes. Wearables can unobtrusively gather and transmit objective, experiential data in real time, 24 hours a day, seven days a week. With this approach, researchers could go from looking at a very small number of data points and burdensome pencil-and-paper patient diaries collected sporadically to analyzing hundreds of readings per second from thousands of patients and attaining a critical mass of data to detect patterns and make new discoveries. MJFF and Intel initiated a study earlier this year to evaluate the usability and accuracy of wearable devices for tracking agreed physiological features from participants and using a big data analytics platform to collect and analyze the data. The participants (16 Parkinson's patients and nine control volunteers) wore the devices during two clinic visits and at home continuously over four days. Bret Parker, 46, of New York, is living with Parkinson's and participated in the study. "I know hat many doctors tell their patients to keep a log to track their Parkinson's," said Parker. "I am not a compliant patient on that front. I pay attention to my Parkinson's, but it's not everything I am all the time. The wearables did that monitoring for me in a way I didn't even notice, and the study allowed me to take an active role in the process for developing a cure." Intel data scientists are now correlating the data collected to clinical observations and patient diaries to gauge the devices' accuracy, and are developing algorithms to measure symptoms and disease progression. Later this year, Intel and MJFF plan to launch a new mobile application that enables patients to report their medication intake as well as how they are feeling. The effort is part of the next phase of the study to enable medical researchers to study the effects of medication on motor symptoms via changes detected in sensor data from wearable devices. Collecting, Storing and Analyzing the Data To analyze the volume of data, more than 300 observations per second from each patient, Intel developed a big data analytics platform that integrates a number of software components including Cloudera® CDH* - an open-source software platform that collects, stores, and manages data. The data platform is deployed on a cloud infrastructure optimized on Intel® architecture, allowing scientists to focus on research rather than the underlying computing technologies. The platform supports an analytics application developed by Intel to process and detect changes in the data in real time. By detecting anomalies and changes in sensor and other data, the platform can provide researchers with a way to measure the progression of the disease objectively. In the near future, the platform could store other types of data such as patient, genome and clinical trial data. In addition, the platform could enable other advanced techniques such as machine learning and graph analytics to deliver more accurate predictive models that researchers could use to detect change in disease symptoms. These advances could provide unprecedented insights into the nature of Parkinson's disease, helping scientists measure the efficacy of new drugs and assisting physicians with prognostic decisions. Shared Commitment to Open-Access Data MJFF and Intel share a commitment to increasing the rate of progress made possible by open access to data. The organizations aim to share data with the greater Parkinson's community of physicians and researchers as well as invite them to submit their own de-identified patient and subject data for analysis. Teams may also choose to contribute de-identified patient data for inclusion in broader, population-scale studies. The Foundation has previously made de-identified data and bio-samples from its sponsored studies available to qualified researchers, including from individuals with a Parkinson's-implicated mutation in their LRRK2 gene. MJFF has also opened access to resources from its landmark biomarker study the Parkinson's Progression Markers Initiative (PPMI) since it launched in 2010. Parkinson's scientists around the world have downloaded PPMI data more than 235,000 times to date. About The Michael J. Fox Foundation for Parkinson's Research As the world's largest nonprofit funder of Parkinson's research, The Michael J. Fox Foundation is dedicated to accelerating a cure for Parkinson's disease and improved therapies for those living with the condition today. The Foundation pursues its goals through an aggressively funded, highly targeted research program coupled with active global engagement of scientists, Parkinson's patients, business leaders, clinical trial participants, donors and volunteers.�In addition to funding more than $450 million in research to date, the Foundation has fundamentally altered the trajectory of progress toward a cure. Operating at the hub of worldwide Parkinson's research, the Foundation forges groundbreaking collaborations with industry leaders, academic scientists and government research funders; increases the flow of participants into Parkinson's disease clinical trials with its online tool, Fox Trial Finder; promotes Parkinson's awareness through high-profile advocacy, events and outreach; and coordinates the grassroots involvement of thousands of Team Fox members around the world. For more information, visit us on the Web, Facebook, Twitter, LinkedIn and Pinterest. About Intel Intel (NASDAQ:INTC) is a world leader in computing innovation. The company designs and builds the essential technologies that serve as the foundation for the world's computing devices.�As a leader in corporate responsibility and sustainability, Intel also manufactures the world's first commercially available "conflict-free" microprocessors. Additional information about Intel is available at newsroom.intel.com and blogs.intel.com, and about Intel's conflict-free efforts at conflictfree.intel.com. Intel and the Intel logo are trademarks of Intel Corporation in the United States and other countries. *Other names and brands may be claimed as the property of others.

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Internists express support for new payment and delivery models as basis for replacing SGR July 18th, 2012 in Other / "We know that the current Medicare payment system is not serving the needs of patients, physicians or taxpayers," David L. Bronson, MD, FACP, president of the American College of Physicians (ACP), today told the House Energy & Commerce Subcommittee on Health. "Congress needs to do its part by repealing the SGR, once and for all. But the medical profession needs to do its part by leading the adoption of innovative models to align payment policies with the value of care provided to patients." Dr. Bronson pointed to several promising payment and delivery system reforms that are being extensively implemented in the public and privates sectors, and could soon be broadly adopted by Medicare. Specifically, ACP recommended that the Patient-Centered Medical Home model be scaled up for broad Medicare adoption. Features of the medical home contribute to increasing the quality of care and reducing unnecessary costs to patients and the health care system in general. There is an extensive and growing body of evidence on the medical home's effectiveness in improving outcomes and lowering costs. "This model, which is built on a strong, redesigned primary care infrastructure, has demonstrated significant cost savings," Dr. Bronson said. "Congress should accelerate Medicare adoption of the medical home model by providing higher payments to physician practices that have achieved recognition. At a subsequent stage, medical home performance metrics could be added and incorporated into Medicare payment policies." Both as part of his comments and in submitting ACP's statement for the record, Dr. Bronson also recommended that Congress should enact payment policies to accelerate adoption of the related Medical Home Neighborhood model. "The concept of a 'medical neighborhood' is essential to the ultimate success of the medical home," he said. "It recognizes that specialty and subspecialty practices, hospitals, and other healthcare professionals and entities that provide treatment to the patient need to be recognized and provided with incentives—both non-financial and financial—for engaging in patient-centered practices that complement and support the efforts of the PCMH to provide high quality, efficient, coordinated care." ACP proposes that Congress help increase non-primary care specialists' participation in the medical home neighborhood model by offering higher Medicare payments to practices that have achieved neighborhood recognition with standards to be developed by the Secretary of HHS. "Congress should establish Medicare incentives for physicians to incorporate evidence-based guidelines from national medical specialty societies into shared decision-making with their patients," Dr. Bronson implored. ACP's "High Value, Cost-Conscious Care Initiative," which includes clinical, public policy, and educational components, was designed to help physicians and patients understand the benefits, harms, and costs of an intervention and whether it provides good value, as well as to slow the unsustainable rate of health care cost increases while preserving high-value, high-quality care. Programs like this initiative could be incorporated into Medicare payment policies by: reimbursing physicians appropriately for spending time with patients to engage them in shared decision-making based on the recommendations from this initiative and similar efforts by other specialty societies, anddeveloping a way to recognize, with higher payments, physicians who can demonstrate that they are incorporating such programs into their practices and engagement with their patients.ACP also believes that additional steps could be taken now to help physicians move toward models aligned with value to patients, as well as rewarding those who have taken the leadership and risk of participating in new models like medical homes and ACOs. Even as new models are being more thoroughly developed and pilot-tested, physicians in the meantime could get higher updates for demonstrating that they have successfully participated in an approved transitional value-based payment program. "ACP believes that for the first time in many years," Dr. Bronson concluded, "we can begin to see a vision of a better future where the SGR no longer endangers access to care, Medicare recognizes and supports the value of primary and coordinated care, and where every person enrolled in Medicare has access to high-functioning primary care through certified medical homes, and other promising care coordination models, including value-based payment models. "I hope that my testimony today demonstrates that enough progress is being made to move forward on new payment and delivery models as the basis for replacing the SGR," Dr. Bronson concluded. "Getting from here to there, though, will require that Congress enact a legislative framework to eliminate the SGR, stabilize payments during a transition phase, evaluate and implement new models, and specify a pathway and timetable to such models. ACP specifically calls on Congress to work from the Medicare Physician Payment Innovation Act of 2012, H.R. 5707, introduced by Reps. Allyson Schwartz (D-Penn.) and Joe Heck (R-Nev.), the only bipartisan bill that we are aware of that would facilitate such a transition to a better payment system for patients and doctors alike."Provided by American College of Physicians "Internists express support for new payment and delivery models as basis for replacing SGR." July 18th, 2012. http://medicalxpress.com/news/2012-07-internists-payment-delivery-basis-sgr.html

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Challenging the necessity of anti-psychotic drugs July 3rd, 2013 in Psychology & Psychiatry / Trials are currently underway to evaluate how the mental health and behaviour of adults with learning disabilities is affected by the gradual withdrawal of their anti-psychotic medication. Researchers at the University hope to prove that people can be safely taken off these drugs. An estimated 50,000 adults with learning disabilities in England and Wales are prescribed a variety of anti-psychotic medications despite only, at most, one in six of people taking the drugs having ever displayed symptoms of psychosis. Chief investigator of the trial, Professor Mike Kerr of the School of Medicine, said: "The study is investigating an approach to reduce one of the greatest concerns in the healthcare of people with learning disabilities: Sedating medication is prescribed when it isn't effective significantly reducing people's quality of life and their ability to integrate into society. "We hope the study will provide the clear scientific evidence on how to take away these drugs so that we can translate into simple plans for practitioners to use, helping thousands of adults in the UK. "The NHS currently commits considerable financial outlay to an unproven and expensive intervention and cutting out these prescriptions could save £8million annually." The key motivator behind this trial is that anti-psychotic drugs such as risperidone or haloperidol carry a broad spectrum of potential side-effects for individuals concerned, including cardiovascular and neurological damage. Benefits of drug withdrawal would include a reduced risk of conditions such as cardiovascular disease and stroke. Social benefits to be gained from withdrawal are manifold and comprise reduction of sedation; increased alertness and concentration leading to better learning; and greater societal integration.Provided by Cardiff University "Challenging the necessity of anti-psychotic drugs." July 3rd, 2013. http://medicalxpress.com/news/2013-07-necessity-anti-psychotic-drugs.html

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Sites: Go to ClevelandClinic.org Online second opinion from top specialists: MyConsult Clinical Services & Programs HistoryCareersMedia & PressNewsletterFall 2014Summer 2014Spring 2014Fall 2013Spring 2013New Year's 2013Winter 2012Fall 2012Summer 2012Spring 2012Healthy Heart 2012New Year's 2012Fall 2011Summer 2011Spring 2011Winter 2011TestimonialsVirtual TourWorking Together Collaboration Future of Healthcare In March 2011, a press release announced early results from an innovative collaboration between Cleveland Clinic Canada and Sunnybrook Health Sciences Centre in Toronto. Here is the release. Patients coming into the Sunnybrook Emergency Department (ED) will now receive a “pre-triage” assessment immediately upon entering the department.A first for Toronto, the concept of ‘pre-triage’ screening is a result of collaborative efforts between experts at Sunnybrook and Cleveland Clinic. One of the challenges the teams examined in their review of patient flow in the ED was ensuring those who entered the department at the same time were prioritized appropriately.Although patients are assessed as soon as they enter the ED currently, the full triage process of taking vital signs and a patient history can take about 15 minutes per person. In a busy ED, when multiple patients enter the department at once, a pre-triage step can ensure the most seriously ill or injured patients are seen before others. It is anticipated that this will improve patient satisfaction and ensure every patient is prioritized in the most appropriate manner.For the past few months, Cleveland Clinic, drawing upon their expertise in Toronto and in Cleveland, and Sunnybrook Health Sciences Centre have been working together to learn more about how processes in the Emergency Department (ED) can be improved to reduce wait times and enhance the overall experience for patients.“Working with Cleveland Clinic has been a highly beneficial experience for our teams in the Emergency Department,” said Barry McLellan, President and CEO, Sunnybrook Health Sciences Centre. “Based on feedback from our staff and those involved from Cleveland, there has been a great sense of collegiality and willingness to do whatever it takes to improve the experience for patients and their families. We have learned from them and they have learned from us which is exactly what we wanted to achieve.”There has been shared learning from both organizations and despite having origins in systems from the United States and Canada, the teams found there were often more similarities than differences between the hospitals and the needs of their patients. Both organizations have put forth a considerable effort to create innovative ideas to improve the efficient movement of patients in and out of the ED.“Cleveland Clinic is excited to be working alongside Sunnybrook to improve the patient experience,” said Michael Kessel, President and CEO, Cleveland Clinic Canada. “This collaboration is all about leveraging our shared knowledge to create innovative solutions in patient care. At Cleveland Clinic Canada, we are proud to have facilitated this collaboration.”In the future, the organizations will examine other areas where they can both share expertise and work towards a common goal of improving patient care. Make a Gift Cleveland Clinic, Ohio Cleveland Clinic, Abu Dhabi Cleveland Clinic, Florida Copyright & Reprints Policy Cleveland Clinic © Copyright and Moral Rights. 1995-2014. All Rights Reserved. Brookfield Place, Suite 3000 | 181 Bay Street, Box 818 | Toronto, Ontario M5J 2T3 | 416.507.6600

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EDITORS' BLOG Last Updated: Tuesday, 27 April, 2004, 00:20 GMT 01:20 UK UK lung deaths 'twice EU average' A greater proportion of people die from lung diseases in the UK than any other EU country except the Irish Republic, a report has shown. The death rate from respiratory diseases in the UK is 105 per 100,000 people - twice the EU average. The only countries with a higher rate are former Soviet Union countries - Kyrgyzstan, Kazakhstan, Turkmenistan and Uzbekistan - and Ireland. The figures are published by the European Respiratory Society, which is calling for concerted action. These statistics are shocking. Dr Edmund Neville The data show that illnesses such as lung cancer, asthma, pneumonia and chronic obstructive pulmonary disease are now killing more people in the UK than coronary heart disease. Respiratory diseases are now the most common long-term illness among children and the most common illness responsible for an emergency admission to hospital. It is thought smoking, and environmental factors, such as pollution and the cold, damp climate, are among the factors that are to blame. The problem is compounded by a relative shortage of respiratory specialists in the UK. The ERS report also reveals: More people in the UK - 5.1 million - suffer from asthma than anywhere else in Europe. The UK has the highest mortality rates from pneumonia compared with any other European country. The UK has the second highest death rate from lung cancer (66 per 100,000 people compared to a European average of 45.9 per 100,000). The report also predicts that by 2020, COPD (which includes illnesses such as emphysema and bronchitis) is likely to account for over 6 million deaths worldwide - making it the third leading cause of death. Twenty times as many people died from COPD (30,634) than from asthma (1,521) in the UK in 1999. Economic cost The report, the European Lung White Book, estimates that respiratory diseases cost Europe nearly 102 billion Euros a year. In the UK, respiratory disease costs the NHS more than any other disease area. The economic cost of production losses is estimated at �3,194 million per year and the Department of Social Security said in 2000 that 28 million working days were lost due to respiratory related illnesses. Professor Walter McNicholas, European Respiratory Society president, said respiratory diseases had a low profile, despite being a major killer. He said: "Although the highly prioritised diseases in government target areas such as heart disease and cancer are showing real progress, others such as respiratory disease are continuing to be ignored. "Governments around the world must widen their vision to include lung disorders, which are responsible for more than 9 million deaths worldwide each year." The ERS is calling for Europe-wide education programmes on the symptoms of lung diseases, and more training for health workers. Dr Edmund Neville, chairman of the British Thoracic Society, called for a national service framework for respiratory diseases. He said: "These statistics are shocking. Britain has been left wheezing at the bottom of the European lung health league for many years. "Respiratory disease is not being given the national priority it warrants from the huge burden it imposes on both patients and the NHS." A Department of Health spokesperson said it was down to local trusts how record levels of investment in the NHS were spent. GPs had been given new targets to ensure high quality treatment for people with asthma, and a national service framework for people with long-term conditions would be published later this year. Lung disease 'timebomb' revealed Q&A: The rising tide of lung disease British Thoracic Society TOP HEALTH STORIES Stem cell method put to the test Hospitals 'eyeing private market' Low vitamin D 'Parkinson's link'

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Five People Infected with West Nile in Santa Clara Co. Fri Aug 15th, 2014 2:02pm America/Los_Angeles RELATED COVERAGEWest Nile Virus SANTA CLARA CO. — Santa Clara County health officials have confirmed that five people have been infected with West Nile Virus. Officials say two residents were infected with a more severe form of the disease known as West Nile encephalitis. One other person had West Nile Fever and two others had no symptoms. Three of the victims were hospitalized, but only one remains in the hospital. West Nile Virus is transmitted to humans and animals through the bite of an infected mosquito, but the risk of becoming seriously ill is low for most people. This year Santa Clara County has had an unusually large number of birds that died from West Nile. At this time 648 dead birds infected with West Nile have been reported in Santa Clara County, which represents half of all the reported dead birds infected with West Nile Virus in California. Officials say that most cases happen between June and September when the weather is warmer. One way to protect yourself from West Nile is by using mosquito repellent when going outside. (Copyright 2014, KRON 4, All rights reserved.)

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Improving the odds:A new method for bone marrow transplantation Dec 07, 2009 Although bone marrow transplants have long been standard for acute leukemia, current treatments still rely on exact matches between donor and patient. Now, scientists at the University of Perugia, Italy, and the Weizmann Institute of Science have improved on a method of transplanting bone marrow-based stem cells from a mismatched donor, making it safer for use when no exact match exists. They were invited to present their findings at the recent annual American Society of Hematology conference in New Orleans. More than a decade ago, Prof. Yair Reisner of the Weizmann Institute's Immunology Department pioneered a method for transplanting stem cells from family members who are a partial match. Based on these studies (in mice), he joined forces with Prof. Massimo F. Martelli, Head of the Hematology and Clinical Immunology Section at the University of Perugia, to demonstrate in more than 300 patients that the cure rate of these so-called "mega dose" transplants is similar to that of transplants from matched, unrelated donors picked from international bone marrow donor registries. To combat the body's tendency to reject the foreign cells, these stem cells are stripped of immune cells called T cells and given in high doses that overwhelm the host's own immune system. Although removing donor T cells from the bone marrow reduces the risk of graft-versus-host disease - caused when the T cells attack the recipient's tissues - the immune system is slow to recover after the transplant, leaving the patient at risk of serious infection. Doctors are faced with a difficult choice: Either remove the T cells from the bone marrow, increasing the risk of infection, or leave the T cells in the graft, putting the patient at risk for lethal graft-versus-host disease. Martelli, working with Reisner, has now found a way to facilitate the recovery of the immune responses in recipients of T cell-depleted bone marrow transplants. In a clinical trial, 25 of 26 leukemia and lymphoma patients who received mismatched mega dose T cell-depleted stem cell transplants from relatives showed prompt immune recovery, and their immune systems were functioning well several months later. The scientists knew that certain regulatory T cells (T regs), rather than causing graft-versus-host disease, could actually help to prevent it in mice. T regs have also been shown to keep other immune responses in check, including preventing autoimmune attacks on the body's own cells. In the present study, after purifying T regs from the donor's blood, the cells were infused intravenously into the cancer patients, who had previously undergone standard radiation and chemotherapy treatments. Three days later, the patients received the donor stem cells, along with another kind of T cell - those that fight disease. The patients who underwent this procedure showed quick, lasting improvements in immune activity; most experienced no symptoms even though they received large doses of the T cells that are generally associated with lethal graft-versus-host disease. Further follow up on these patients and additional clinical trials will be needed before the procedure can be widely adopted. But these results strongly suggest that T regs used in mega-dose stem cells will further enhance the cure rate for bone marrow transplant patients without a matched donor in the family. Source: Weizmann Institute of Science (news : web) Bone marrow transplant patients may benefit from new immune research Bone marrow transplant (BMT) researchers at The Medical College of Wisconsin Cancer Center in Milwaukee may have found a mechanism that could preserve the leukemia-killing effects of a transplant graft, while limiting the ... Research shows cord blood comparable to matched bone marrow University of Minnesota researchers report that umbilical cord blood transplants may offer blood cancer patients better outcomes than bone marrow transplants, according to an analysis of outcome data performed at the Center ... Cancer drug shows promise against graft vs. host disease A new University of Michigan study in mice suggests that a drug recently approved to fight cancer tumors is also able to reduce the effects of graft-versus-host disease, a common and sometimes fatal complication ... New technology enhances therapeutic potential of cord blood stem cells A CD26 Inhibitor increases the efficiency and responsiveness of umbilical cord blood for bone marrow transplants and may improve care for blood cancer patients according to research from Rush University Medical Center being ... Strategy for mismatched stem cell transplants triggers protection against graft-vs.-host disease A new technique being tested in stem-cell transplants from imperfectly matched donors has revealed a striking, unforeseen response that can suppress graft-versus-host disease, a common and dangerous complication of mismatched ... 'Mini transplant' patients' outcomes similar using related and unrelated donor cells People who undergo nonmyeloablative stem-cell transplants, or “mini transplants,” for leukemia, lymphoma and other blood cancers have comparable outcomes regardless of whether they receive tissue-matched stem cells from ...

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Email Ashwin Patel Faculty, Visiting Scholars & Practitioners Ashwin Patel Adjunct Assistant Professor of Health Policy and Management Bio Ashwin R. Patel, MD, PhD is a physician economist with a strong research interest in disease management, behavioral economics, and health care quality. In particular, he is focused on translating evidence-based academic insights into the actual delivery of health care. Dr. Patel currently serves as Chief Medical Officer of InquisitHealth, a company developing IT solutions to help health plans and hospitals better manage their patients with chronic diseases. He received his MD from Weill-Cornell Medical College and his PhD in Health Economics from the Wharton Business School at the University of Pennsylvania. He also received a BA in Economics and Biology from Cornell University. ashwin.patel@nyu.edu Areas of Expertise EconomicsHealth ManagementHealth Policy © NYU Wagner

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HomeWhen It Comes to Health, Place Matters When It Comes to Health, Place Matters by: Brian SmedleyOct 2, 2013 [ A+ ] /[ A- ] WASHINGTON-The implementation of the Affordable Care Act is an achievement Americans can be proud of. Making sure that all our brothers and sisters, children and grandchildren, have proper health insurance makes us a stronger, more prosperous nation. Amid this important change, however, we cannot ignore the work that remains to be done, especially in communities of color. Insurance cards are not enough. To become a society with better health-not just better health coverage-we must also look at the role "place" plays in the lives of minority communities. Where we live, work and play is surprisingly predictive of lifespan. Within the city of Boston, for instance, people in some census tracts live 33 years less than those in nearby tracts. In Bernalillo County, N.M., the difference is 22 years. Researchers are releasing "Community Health Equity Reports" at the Place Matters 2013 National Health Equity Conference on Oct. 2 in Washington, D.C. Data from Baltimore, Birmingham, Ala., Chicago, New Orleans and other cities demonstrates that where you live is a powerful determinant for how long you'll live. "Health equity" may sound like a jargon term, but it's really a simple and just concept: all people should have equal opportunities for good health. Unfortunately, in conversations, people often reduce health issues to questions of access to health care or to behavior; in other words, if people only ate right, exercised, or saw a doctor regularly, health inequities could be eliminated. Now, to be sure, access to high-quality health care is important, particularly for those who face health risks. And individuals should strive for active lifestyles and healthy diets. But a large and growing body of research demonstrates that the spaces and places where people live, work, study and play powerfully shape the opportunities they have to achieve good health. People of color-who are still subject to persistent social, if not legal, segregation-are disproportionately located in unhealthy spaces. This is a major factor that helps explain the poorer health of many minority groups. Consider the numbers: One in four African Americans, one in six Hispanics, and one in eight American Indians in metropolitan America lives in a census tract in which 30 percent or more of the population is in poverty. But only an estimated one in 25 non-Hispanic whites live in one of these tracts. Neighborhood conditions can overwhelm even the most persistent and determined efforts of individuals to take steps to improve their health. Neighborhoods with high rates of poverty are subject to significant health risks, from the presence of polluting industries to the absence of a grocery offering fresh fruits and vegetables. These same communities typically have poorer quality housing and transportation options, and are hit hardest by the home-mortgage lending crisis, which crushed wealth opportunities and disproportionately affected communities of color. Many of these neighborhoods also experience high rates of crime and violence, which affect even those who are not directly victimized, as a result of stress and an inability to exercise or play outside. Even healthcare providers, hospitals, and clinics are harder to find in these neighborhoods. It's no wonder life-spans vary so greatly among neighborhoods, even those close to each other. Some policymakers are working to address these place-based disparities. Federal programs that stimulate investment in the nation's hardest-hit communities are working to attract businesses, create jobs, and reduce the concentration of health risks. The Healthy Food Financing Initiative creates financial incentives for grocery stores or farmers' markets to open in "food deserts." And the Obama Administration's "Promise Zones" initiative will streamline a host of federal "place-based" projects and offer technical assistance to jurisdictions that seek to stimulate economic activity and build ladders of opportunity Investments in vulnerable communities may be among the most cost-effective strategies to close the health gap and improve the overall health of the nation. A study commissioned by the Joint Center for Political and Economic Studies found that the direct medical costs associated with health inequities-in other words, additional costs of health care incurred because of the higher burden of disease and illness experienced by minorities-was nearly $230 billion between 2003 and 2006. Add the indirect costs, such as lost wages and productivity and lost tax revenue, and the total cost of health inequities for the nation was $1.24 trillion. Our nation's poorest need health insurance. But we cannot afford to stop there. Only by recognizing and then erasing the deep divides that create communities with fewer health opportunities can we create a nation of individuals with the chance to reach their full potentials. (Dr. Brian D. Smedley is vice president and director of the Health Policy Institute of the Joint Center for Political and Economic Studies in Washington, DC. America's Wire is an independent, nonprofit news service run by the Maynard Institute for Journalism Education.) 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医学

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| Alzheimer's Reading Room The Alzheimer's Reading Room Knowledge Base contains more than 4,901 articles. These articles were written to answer and address the most difficult problems and issues faced in Alzheimer's and dementia care. At its core the ARR is about helping everyone to better understand, cope, and communicate with a person living with dementia. Alzheimer's vs Dementia Answers to Your Questions About Alzheimer's Balance Problems an Early Clue for Alzheimer's? clipped from alzheimers.about.comBalance problems may be an early sign that someone has a dementia such as Alzheimer's. Research has found physical symptoms, such as problems with walking and balance, a weak hand grip (a later sign) are associated with an increased risk of developing dementia and Alzheimer's disease. The study tested for physical functioning using a number of tests. It was found that people with good physical performance scores at the beginning of the investigation were three times less likely to develop dementia than those with poor scores.Higher levels of physical function may be associated with a delayed onset of dementia and Alzheimer's disease. For more Insight into Alzheimer's DiseaseSubscribe to The Alzheimer's Reading Room Bob DeMarco is an Alzheimer's caregiver and editor of the Alzheimer's Reading Room. The Alzheimer's Reading Room is the number one website on the Internet for advice and insight into Alzheimer's disease. Bob taught at the University of Georgia, was an executive at Bear Stearns, the CEO of IP Group, and is a mentor. He has written more than 700 articles with more than 18,000 links on the Internet. Bob resides in Delray Beach, FL.More from the Alzheimer's Reading RoomTest Your Memory (TYM) for Alzheimer's or Dementia in Five MinutesThe Thyroid and Alzheimer'sAre Alzheimer's Caregivers the Forgotten?Flavanol-rich Cocoa Consumption Improves Blood Flow to the BrainA Simple Three Minute Test Can Detect the Earliest Stage of Alzheimer's DiseaseEli Lilly Launches Two Late Stage Clinical Trials for Alzheimer's (LY2062430)Dimebon Clinical Trial?Wii a Useful Tool for Alzheimer's Caregivers Five Ways to Keep Alzheimer's Away2009 Alzheimer's Disease Facts and FiguresThe Mini-Cog Test for Alzheimer's and DementiaWhat is Dementia?A Real Solution to the Health Care Crisis80 Percent of Medical Bills Contain Errors -- Fighting Mistakes The Alzheimer's Action Plan: The Experts' Guide to the Best Diagnosis and Treatment for Memory Problems Bob DeMarco alzheimers, care, caregiver, early, sign, Subscribe to Alzheimer's Reading Room Email: Featured Articles Articles on Alzheimer's and dementia care that you should consider reading What's the Difference Between Alzheimer's and Dementia? Test Your Memory for Alzheimer's (5 Best Memory Tests) Communicating in Alzheimer's World Answers to Your Questions About Alzheimer's and Dementia Are Alzheimer's Caregivers the Forgotten? 10 Things a Person Living with Dementia Would Tell You If They Could Dementia and Eight Types of Dementia The First Sign of Alzheimer's Short Term Memory Loss Urinary Tract Infections Can Hasten Memory Loss in Alzheimer's Patients Problems with Balance, Walking, Falling Can Be an Early Sign of Dementia How Do Alzheimer's Patients Die? What is Alzheimer's Disease What is Alzheimer's Disease? What are the Eight Types of Dementia? The Last 25 Articles Alzheimer's Reading List Chicken Soup for the Soul, Living with Alzheimer's Other Dementia Surviving Alzheimer's Alzheimer's Dementia ActivitiesMore Books on Our Reading List Learn More about our Knowledge Base We have more than 4,860 articles ranging across a long list of useful topics including Alzheimer's disease and dementia, Alzheimer's caregiving, Alzheimer's help and information, advice, insight, health, memory loss, and problem solving. Enter keyword(s) below. Check out this search of our articles. How To Do This and That... Alzheimer's Reading Room Knowledge +BobDeMarco+Alzheimer's Reading Room The Alzheimer's Reading Room does not provide medical advice. The contents are for informational purposes only, and are not intended to substitute for professional medical advice, diagnosis or treatment. The views of the individuals that write on this website, contribute articles, or are quoted on this site are not necessarily those of the Alzheimer's Reading Room. For specific, personalized medical advice we encourage you to contact your physician.

医学

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News > Rheumatoid Arthritis and Lymphoma Related Features Rheumatoid Arthritis and Lymphoma Having rheumatoid arthritis can increase the risk of a cancer called lymphoma. If you have RA, here's what you need to know about the arthritis-cancer connection By Nancy Ross Flanigan Frederick Wolfe, MD, director of the National Data Bank for Rheumatic Diseases in Wichita, Kansas, points out another factor that makes it difficult to neatly tie together lymphoma and TNF inhibitors. "If you have severe RA, you are more likely to be prescribed a biologic, but you are also more likely to get lymphoma because of the severity of your disease whether or not you get the biologic," he notes. "It's difficult to disentangle the effect." To tangle matters even more, lymphomas are relatively rare, so researchers must study large numbers of RA patients in order to find enough lymphoma cases to draw meaningful conclusions. But RA itself, although the second most common arthritis diagnosis, is fairly rare, occurring in only one percent of the general population. With those caveats in mind, consider the results of recent studies, which shift the blame away from treatments and suggest that keeping RA in check should be your biggest concern. In research published in Arthritis and Rheumatism, investigators at Harvard Medical School and the University of British Columbia pooled medical databases from Pennsylvania, New Jersey and British Columbia to compare cancer rates between patients using the older disease-modifying anti-rheumatic drug (DMARD) methotrexate and those using a newer, biologic drug such as a TNF-inhibitor. The conclusion? Users of biologic agents are no more likely than users of methotrexate to develop cancer. Similarly, a study of 19,562 patients led by Dr. Wolfe and his colleague, Kaleb Michaud, PhD, showed no evidence for an increase in lymphoma incidence in those on TNF inhibitors. In another investigation, also published in Arthritis & Rheumatism, Swedish researchers mined a national registry of nearly 75,000 RA patients and analyzed medical records and case histories of a subset of 378 RA patients who had developed lymphoma between 1964 and 1995 and 378 lymphoma-free patients. They found a dramatic association between lymphoma and disease activity, which is determined by currently swollen or tender joints, increased levels of inflammatory markers and X-ray evidence of erosion in at least one joint. Compared with patients with low RA activity, those with medium disease activity showed an eight-fold increase in the likelihood of developing lymphoma. For those with high activity, the probability took a staggering 70-fold jump, leading the authors to conclude that with aggressive treatment to suppress the disease activity of rheumatoid arthritis, lymphoma risk might actually be reduced. As for other cancers, Dr. Wolfe and Michaud studied 13,000 patients participating in a research project between 1998 and 2005, looking specifically at links between treatment with a biologic agent and cancer risk. They found that biologic therapy doubled the odds of developing skin cancers, including melanoma, but did not put patients at greater risk for lymphoma, breast, lung, colon or any other cancer. "These increased risks that we identify and report are extremely small," Dr. Wolfe stresses. "Melanoma is serious but not common; most other skin cancers are not serious. I don't think anyone should be concerned." Weighing all the evidence about the rheumatoid arthritis–cancer connection, Dr. Furst offers this advice to patients: "Rheumatoid arthritis is a very serious disease, and overall, the therapeutic benefits of the drugs used to treat it far outweighs their downsides. The risk from not doing anything to contain the disease is much greater." Maureen Lengel, 52, has been through a lot since being diagnosed with arthritis in her teens: several surgeries, including hip replacements, and an assortment of other treatments for rheumatoid arthritis. Lymphoma is the last thing she needs is to worry about. Along with the many difficulties of rheumatoid arthritis, cancer worries lurk in her mind. "I know that people with RA have a higher risk of developing cancer," says Lengel, who keeps up on the latest news related to her disease by reading, sharing and discussing information with her doctor. The worry first set in for Lengel in the mid-1980s, when she realized the methotrexate she was taking for RA was the very same drug her friend’s mother was receiving for breast cancer. She did a little research and learned that higher doses of the drug kill abnormal cells in cancer treatment, whereas the lower doses used for RA merely quench the abnormal behavior of cells. "Whether it is the disease itself or the drugs people take for it that increase the risk, I've seen articles on both sides of the story," she says. "Some say RA drugs may not raise cancer risk, but there are also articles that link cancer, specifically lymphoma, to one of the drugs I’m taking now. Naturally I am concerned." So are many of the patients that Lengel’s rheumatologist, Mary Chester Wasko, MD, sees at the University of Pittsburgh Medical Center. Trying to help them sort out the facts isn’t always easy. "The RA and cancer connection is such a worry of so many patients," says Dr. Wasko. "They read about studies that are highlighted in the press and then wonder why their doctors can't give them a straight answer. It is not that we’re trying to be elusive, it is just that many of the studies have limitations that make interpreting the results difficult." We asked top experts to clarify the connection between cancer and rheumatoid arthritis – lymphoma in particular. Like Lengel, share this information with your doctor and have an open discussion about your own risks. Cancer and RA: same system opposite effects "RA is not cancer – let's be clear about that – but RA has some features that resemble cancer, so treatment we would normally think of as oncolytics have application to RA," says Gary S. Firestein, MD, chief of the Division of Rheumatology, Allergy and Immunology at the University of California, San Diego. Kinship at the cellular level makes such treatment crossovers possible, he says. The two diseases have a faulty immune system in common, says rheumatologist Daniel E. Furst, MD, of the University of California, Los Angeles. "Cancer occurs when the body's normal immune response to cancer cells, which appear in us all the time, fails. The immune system doesn’t catch something that’s abnormal. In autoimmune diseases such as RA, lupus, Sjogrens syndrome, psoriatic arthritis, myositis, sarcoidosis and scleroderma, the immune system overreacts to the normal, turning against itself," says Dr. Furst. Those autoimmune diseases have been linked to an increased risk of cancer – lupus with lung or blood cancer; Sjogrens syndrome with lymphoma; psoriatic arthritis with skin cancer; myositis with all types of cancer; sarcoidosis with skin, liver, lung and lymphoma; and scleroderma with lung cancer. So why has RA's link to lymphoma been studied the most intensively? One reason is that many of the medications suspected of increasing the lymphoma risk are approved to treat RA but not the other autoimmune diseases. Another is that RA involves a cellular process akin to tumor growth. In RA, the delicate lining that surrounds and protects a joint, known as the synovium, becomes inflamed, making the joint swollen and painful. As the disease progresses, the cells that make up the synovium go through a process much like what happens in cancerous tumors: Normal cells multiply unchecked and invade and destroy healthy tissue. To complicate matters, says Dr. Furst, many drugs used to treat RA suppress the immune system, meaning the immune cells that search the body for cells gone bad aren’t able to do their job. "If a drug suppresses not only the abnormality that’s causing the disease but also suppresses immune surveillance, one could get cancer from the therapy," he says. That is the theory. What about the evidence? It has been accumulating for some time. The first hints that RA patients were more vulnerable to cancer surfaced in 1978, when researchers in Finland matched hospital records of patients treated for RA with patients treated for cancer and saw the overlap. That study, as well as subsequent studies of RA patients from around the world, showed a higher incidence of lymphoma, non-Hodgkins lymphoma in particular, in people with RA compared with people without RA. By current estimates, the lymphoma risk is two to four times greater for people with rheumatoid arthritis. Cancer risk of any kind is certainly a weighty matter, but when you consider the rarity of non-Hodgkin's lymphoma – about 18 cases per 100,000 people compared with 119 per 100,000 for breast cancer and 150 per 100,000 for prostate cancer – even the elevated risk is still relatively low (less than 0.1 percent per year). The risk is relatively low, but elevated nonetheless. Patients who have RA want answers, and researchers who study RA want to provide them. Whether it’s the RA, its treatment or some combination of the two that raises patients’ cancer risk is what medical scientists have been trying to determine ever since the 1978 Finland study. Just as detectives first home in on suspects with criminal records, researchers turned their attention to a drug with a known cancer connection. The immunosuppressive drug azathioprine (Imuran) had first been linked to lymphoma in transplant patients who took it to prevent organ rejection. When investigators looked at RA patients who took Imuran to keep the immune system from overreacting against itself, they found the same association. And the longer a person had taken the drug, the higher their risk. Methotrexate (Rheumatrex) was the next drug to come under scrutiny following a 1991 report of a patient developing lymphoma while taking it. A phenomenon called reversible lymphoma, which arises when people begin taking methotrexate and disappears when they stop, has been reported in some 50 RA patients. But large-scale studies have failed to finger methotrexate as the culprit behind the overall rise in cancer risk for people with RA. Now attention has turned to the newer biologic drugs that inhibit tumor necrosis factor (TNF), and for good – or at least logical – reason. TNF is a versatile protein that promotes the inflammation associated with painful, swollen joints and bone tissue destruction in RA, but originally it was pegged for eliminating cancerous tumors. Might drugs that block TNF's pro-inflammatory properties also hamper its tumor-fighting tendencies? That's been the concern since TNF inhibitors such as adalimumab (Humira), etanercept (Enbrel) and infliximab (Remicade) came on the scene during the past decade. But because they've been on the scene for a relatively short period of time, many long-term studies looking at lymphoma risk haven't been done. So far, "the evidence is mixed," says Dr. Wasko. "Some studies point to a slight increase in risk of lymphoma in RA patients who receive TNF inhibitors, but it’s not a consistent finding across all studies." It is possible that TNF-inhibiting drugs have contradictory effects, raising cancer risk in some situations and lowering it in others. That's a plausible scenario given the mercurial nature of the protein they target. TNF is important in containing or eliminating tumor cells, but there’s also some evidence that it may actually promote tumors, says Dr. Wasko. "The net effect could depend on your ethnic background, your exposure to toxins in the environment, or on multiple factors. And it may depend on what type of cancer you’re talking about. The effect on lymphoma risk could be different from the effect on colon or lung cancer risk."

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AIDS Doesn't Discriminate Saturday, 28 September 2002 02:25 0 COMMENTS TweetShare this article with a friendBy Hugh B. Price President, National Urban League It's amazing to recall that at several different times during the horrifying and deadly match of AIDS across the globe in the past two decades, there seemed to be in some quarters a sense that AIDS was the disease of "those people," and therefore, not a problem "we" really needed to worry about. At various times, "those people" were: homosexuals, or homosexuals and intravenous drug users; or homosexuals, intravenous drug users and African Americans; or homosexuals, intravenous drug users, African Americans, and Africans; or ... You get the idea. For too many people for too long, AIDS has always been the problem of "those other people," not us. And it doesn't matter where it's surfaced -- in poor African American and Latino American communities, among the White American middle class, in sub-Saharan Africa, and now, increasingly, everywhere in the world where economic impoverishment and all of its attendant ills are facts of life -- the reaction has largely been the same: First, beleaguered civic leaders and government officials, and many of their populace, deny there is a serious problem until its deadly spread can no longer be hidden. Then, belatedly, they try to mobilize a defense as calamity looms. That scenario played out in sub-Saharan Africa, where at least 20 million are infected with the HIV virus. And the same dynamic is now fully evident in China, the world's most populous country. United Nations officials, world health experts, and AIDS activists inside the country have been warning for years that China's officials were deliberately underestimating the disease's spread. Now, this month, the Chinese government raised its estimate of those infected with either the virus or full-blown AIDS to 1 million people and declared it would manufacture a full complement of AIDS drugs unless Western patent-holding companies lower their prices. Observers remarked that the declaration was "a striking reversal" of the government's hitherto intransigent stance. This likely means that the government itself is truly alarmed about the rate of the disease's spread inside the country. Remember, China's population is more than a billion people. For several years outside observers have estimated the true number of those infected with H.I.V. to be 1.5 million, nearly double the government's estimate of 850,000. And observers have been warning for several years that the scourge in China was poised to "break out" of the relatively small populations its first rooted itself in -- drug users, first; and then, those who were exposed to contaminated blood supplies; and then, prostitutes -- into the general population. That prospect in a country where millions upon millions of people live in conditions of the most serious poverty means the impact of the scourge there could quickly rival and perhaps surpass what has happened in Black Africa. The portrait of the worldwide AIDS scourge is largely one of astonishing misery and shocking numbers. A study released at the recent United Nations conference on AIDS in Barcelona, Spain found that AIDS is intensifying, not decreasing, in those countries already among the hardest hit, and approaching epidemic-level stages in other countries and among certain population groups in many different places. Without substantial improvement in prevention and treatment measures, it said, AIDS could kill 68 million people in the 45 most affected countries by 2020. By comparison, since 1980 AIDS has killed 13 million people in those countries. This means that more countries, or sections of countries, in Latin America, Central Europe, and Asia could become like some sub-Saharan African countries. They could suffer so many deaths from AIDS that, statistically speaking, their populations would approach a negative life expectancy because more of their citizens are dying in a year than being born. Americans are not immune from the characteristic ignorance about AIDS, either. A recent federal study has shown that here high numbers of young, gay, and bisexual males who have the AIDS virus don't know they have it, surely a reflection of a general American belief that the disease has been contained without our borders. But, in fact, there are 950,000 Americans with the H.I.V. virus. These and other frightening numbers mean that all governments of the world and peoples of the world, including those of us in the United States, have a lot of work to do in the fight against AIDS. In fact, there has been tremendous progress on the AIDS front. Researcher have developed treatment regimens that have transformed AIDS from a sure-fire fatal disease to a chronic one in numerous places, and some of these regimens have been shown to work in such poor nations as Uganda. Further, growing numbers of politicians across the globe are devoting more of their energies to the problem. They have been propelled into action by the shocking numbers that characterize the spread of AIDS everywhere within their borders and everywhere one turns. With all the turmoil the world is ensnared in now, we cannot afford to forget the worldwide war against AIDS. For its numbers underscore in the most brutal way one devastating fact: AIDS doesn't discriminate.

医学

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How to have a happy body Sarah Berry Having a happy body doesn't have to be hard, says physiotherapist Anna-Louise Bouvier. Here's how you do it. Helping people have happier bodies at every age ... Anna-Louise Bouvier. With sitting down on the rise, it's no wonder we have unhappy bodies. Scarily, many of us sit for close to 80 per cent of our waking hours. Apart from increasing the risk of developing chronic disease and affecting our circulation and metabolism, being sedentary means back and neck pain are pandemic. Around 80 per cent of Australians suffer pain over the course of their lifetime. These figures are not news to Anna-Louise Bouvier, physiotherapist and Feel Good Physio on the Today Show. In fact, she says our sedentary lifestyle means more and more of the problems she sees are in people who are younger and younger. "Thirty-five to 55 is the peak age for back problems. But, now ... I see people in their 20s with chronic back pain, which is a dull ache," she says. "And over the last ten years I've started to see kids at 10 and 12 with the same problems that their mothers and their grandmothers came in for." Despite an increase of unhappy bodies, having a happy body doesn't have to be hard, she says. Small, simple shifts in what we do and how we do it can make a big difference. "It can be pretty straight-forward, you just have to know what to do."It was the desire to help people understand what to do that lead her to develop Physiocise 16 years ago. Physiocise are functional movement classes targeting bad backs and bad habits. They also teach people the mechanics of their body so they understand why they are experiencing pain. "It's about giving people ideas on what they can do when they do get aches and pains - how to release it," she says. "It's not rocket science but, it's helping people understand how their bodies work ... Many people are dying to know [how to feel better] but, don't quite know what to do."Over 1400 people per week now attend the Sydney classes, from kids right through to those in their 80s. But, with the number of pain problems and a deman

医学

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WHO agency: Air pollution causes cancer Maria Cheng/The Associated Press October 17, 2013 9:39:12 AM LONDON -- What many commuters choking on smog have long suspected has finally been scientifically validated: air pollution causes lung cancer. The International Agency for Research on Cancer declared on Thursday that air pollution is a carcinogen, alongside known dangers such as asbestos, tobacco and ultraviolet radiation. The decision came after a consultation by an expert panel organized by IARC, the cancer agency of the World Health Organization, which is based in Lyon, France. "We consider this to be the most important environmental carcinogen, more so than passive smoking," said Kurt Straif, head of the IARC department that evaluates cancer-causing substances. IARC had previously deemed some of the components in air pollution such as diesel fumes to be carcinogens, but this is the first time it has classified air pollution in its entirety as cancer causing. The risk to the individual is low, but Straif said the main sources of pollution are widespread, including transportation, power plants, and industrial and agricultural emissions. "These are difficult things for the individual to avoid," he said, observing the worrying dark clouds from nearby factories that he could see from his office window in Lyon. "When I walk on a street where there's heavy pollution from diesel exhaust, I try to go a bit further away," he said. "So that's something you can do." The fact that nearly everyone on the planet is exposed to outdoor pollution could prompt governments and other agencies to adopt stricter controls on spewing fumes. Straif noted that WHO and the European Commission are reviewing their recommended limits on air pollution. Previously, pollution had been found to boost the chances of heart and respiratory diseases. The expert panel's classification was made after scientists analyzed more than 1,000 studies worldwide and concluded there was enough evidence that exposure to outdoor air pollution causes lung cancer. In 2010, IARC said there were more than 220,000 lung cancer deaths worldwide connected to air pollution. The agency also noted a link with a slightly higher risk of bladder cancer. Straif said there were dramatic differences in air quality between cities around the world and that the most polluted metropolises were in China and India, where people frequently don masks on streets to protect themselves. "This is something governments and environmental agencies need to take care of," Straif said. "People can certainly contribute by doing things like not driving a big diesel car, but this needs much wider policies by national and international authorities." Other experts emphasized the cancer risk from pollution for the average person was very low -- but virtually unavoidable. "You can choose not to drink or not to smoke, but you can't control whether or not you're exposed to air pollution," said Francesca Dominici, a professor of biostatics at Harvard University's School of Public Health. "You can't just decide not to breathe," she said. Dominici was not connected to the IARC expert panel. A person's risk for cancer depends on numerous variables, including genetics, exposure to dangerous substances and lifestyle choices regarding issues such as drinking alcohol, smoking and exercising. Dominici said scientists are still trying to figure out which bits of pollution are the most lethal and called for a more targeted approach. "The level of ambient pollution in the U.S. is much, much lower than it used to be, but we still find evidence of cancer and birth defects," she said. "The question is: How are we going to clean the air even further?" Online: ■ iarc.fr/en/publications/books/sp161/index.php

医学

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Contact: Nicole Bodnar nicole.bodnar@utoronto.ca Possible link between immune system and Alzheimer's U of T researchers help discover genetic mutation linked to disease An international research team including scientists from the University of Toronto's Faculty of Medicine has discovered a link between a mutation in an immune system gene and Alzheimer's disease. Using data from 25,000 people, researchers from the Faculty of Medicine and University College London's Institute of Neurology discovered that a rare genetic mutation in the TREM2 gene � which helps trigger immune system responses � is also associated with increased risk of Alzheimer's. The discovery supports an emerging theory about the role of the immune system in the disease. "This discovery provides an increasingly firm link between brain inflammation and increased risk for Alzheimer's," says Dr. Peter St George-Hyslop, director of U of T's Tanz Centre for Research in Neurodegenerative Diseases. "This is an important step towards unraveling the hidden causes of this disease, so that we can develop treatments and interventions to end one of the 21st century's most significant health challenges." St George-Hyslop, renowned for identifying five genes associated with Alzheimer's disease, says the breakthrough is, "another win for U of T scientists who are building on a worldwide legacy of expertise in neurodegenerative research." The team began by sequencing the genes of 1,092 people with Alzheimer's and a control group of 1,107 healthy people. The results showed several mutations in the TREM2 gene occurred more frequently in people who had the disease than in those without the disease. One mutation � known as R47H � had a particularly strong association with the disease. The mutation makes a patient three times more likely to develop the disease, although it affects just 0.3 per cent of the population. "While the genetic mutation we found is extremely rare, its effect on the immune system is a strong indicator that this system may be a key player in the disease," says Dr. Rita Geurreiro from UCL, the study's lead author. The study is published now in the New England Journal of Medicine. ###

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Felicia Cosman, M.D. Dr. Cosman joined Helen Hayes Hospital in 1988, where she serves as an osteoporosis specialist, clinical scientist and medical director of the Clinical Research Center. She is also professor of clinical medicine at Columbia University. Dr. Cosman is a graduate of Cornell University and Stony Brook Medical School. She received her internal medicine training and completed her endocrinology fellowship at Columbia Presbyterian Medical Center. Her research has included studies on the causes of osteoporosis and how estrogen, SERMS and vitamin D work as treatments for osteoporosis. Her major research focus is the use of teriparatide, a bone-building medication, in combination with anti-resorptive agents, and in novel cyclic regimens, in the treatment of severe osteoporosis. She is the recipient of research grants from the National Institutes of Health, the Department of Defense, the National Multiple Sclerosis Society and multiple pharmaceutical companies. Dr. Cosman has published over 100 peer-reviewed articles in the osteoporosis field, in journals including the New England Journal of Medicine and the Lancet. She is the author of "What Your Doctor May Not Tell You about Osteoporosis (Warner Books)" and co-editor of "Osteoporosis: An Evidence Based Approach to the Prevention of Fractures (American College of Physicians)." Dr. Cosman serves on the editorial board of Osteoporosis International and is a regular reviewer for the Journal of Clinical Endocrinology and Metabolism, Journal of Bone and Mineral Research and Calcified Tissue International. She has been elected to the Castle-Connolly list of best doctors each year since 2001. In addition, Dr. Cosman has served as clinical director of the National Osteoporosis Foundation since 1996. Menopause And Your Bones: 10 Things You Need To Know About Osteoporosis RA And Osteoporosis: What's The Link?

医学

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Home > Medical > Diseases Updated 13 February 2013 Aids: opportunistic infections Because it weakens the immune system, Aids is associated with opportunistic infections. Pneumocystis jerovici (carinii) pneumonia Pneumocystis jerovici is a fungus that is the most important cause of pneumonia in people with HIV/AIDS. People with HIV usually become susceptible to pneumocystis pneumonia when their CD4 cell count falls below 200/ul. In many people, this will be the first illness that marks the onset of AIDS and around 80% of people with AIDS will get pneumocystis pneumonia at some time. The symptoms of pneumocystis pneumonia are tiredness, fever, breathlessness and a dry cough that does not produce sputum. Symptoms may begin quite suddenly or may develop over a few weeks. In hospital, an X-ray may show a typical pattern of widespread fluffiness in the lungs, and oxygen levels in the blood will be low because the lungs are not functioning properly. The fungus can be seen in the sputum using special tests, but it can be difficult to get a sputum sample from a person with pneumocystis pneumonia and the tests for Pneumocystis jerovici may not be available in all hospitals. Since PCP is a serious condition, a person with AIDS will often be treated for PCP based on the symptoms alone. Treatment for pneumocystis pneumonia is usually co-trimoxazole (“Bactim”, “Septran”, “Purbac”), which is given intravenously in severe cases or orally in mild cases. In severe cases, prednisone may be added to reduce inflammation in the lungs. Treatment is for 14 – 21 days. Patients with very low oxygen levels will need supplementary oxygen by a face mask or even via a ventilator. Anyone with a CD4 cell count below 200/ul should take daily co-trimoxazole to prevent pneumocystis pneumonia. Anyone who has had a first episode of pneumocystis pneumonia must take daily co-trimoxazole for the rest of their lives to prevent recurrences. Even with treatment, about one in five people will die of pneumocystis pneumonia. Cryptococcal meningitis Cryptococcus neoformans is a fungus of which the spores are present in the environment and can be inhaled. The fungus initially grows in the lungs but often spreads to the membranes surrounding the brain (meninges) and is a common cause of meningitis (inflammation of the meninges) in people with late stage AIDS. The usual symptoms of cryptococcal meningitis are headache and altered mental state, with or without a fever. Sometimes there are seizures or signs of nerve damage in a particular region of the brain. In people with AIDS there are a number of other infections of the brain and meninges that can cause similar symptoms. If there are no signs of raised pressure in the brain, a lumbar puncture will be done to obtain a sample of the fluid around the brain (cerebrospinal fluid) in order to make a diagnosis. If cryptococcus is present it may be immediately visible under the microscope in the cerebrospinal fluid or be detectable by a rapid test for cryptococcal protein, otherwise culture of the fluid may be necessary. The initial treatment for cryptococcal meningitis requires admission to hospital, since a drug called amphotericin B must be given intravenously for seven to 14 days. This is followed by another eight to 10 weeks of treatment with a drug called fluconazole, which can be taken by mouth. Without highly active antiretroviral treatment, cryptococcal disease will recur, and lifelong treatment with fluconazole is necessary. Cytomegalovirus retinitis Cytomegalovirus is a member of the herpes virus family and almost all adults are silently infected with this virus during childhood when infection with this virus does not cause any symptoms. Cytomegalovirus is reactivated in the very late stages of AIDS and can attack a number of organs. The eye is vulnerable to cytomegalovirus, specifically the retina, the layer of special light-detecting cells at the back of the eye. Cytomegalovirus retinitis causes failing vision in one or both eyes. The condition is painless. If untreated it will eventually cause blindness. It can be diagnosed by examination of the retina using a hand-held opthalmoscope. The doctor will see tell-tale haemorrhages (bleeding) and exudates (fluffy spots) on the retina. Cytomegalovirus infections can be treated with a drug called ganciclovir. The drug can be given intravenously or orally, but in the case of retinitis it is best given as a slow-release implant placed directly in the eye under local anaesthetic. Treatment for cytomegalovirus retinitis must usually be lifelong or the disease will relapse. Progressive multifocal leukoencephalopathy or PML is caused by a virus called JC virus. In people with AIDS, the virus attacks the white matter of the brain, causing nerve damage. Signs of PML can include mental dysfunction, loss of speech, and paralysis of one side of the body. PML can be recognised on a brain scan. PML is a serious and progressive disease that can only be halted or reversed by highly active antiretroviral treatment. A drug called cidofovir, which acts against the JC virus, has been used in some cases. Molluscum contagiosum is a skin infection which is usually a minor childhood problem, but in people with AIDS it can be extensive and unsightly. Molluscum contagiosum is caused by a pox virus (a group of viruses that cause characteristic skin lesions called "pocks") and is spread by close skin-to-skin contact. The lesions of molluscum contagiosum are pearly nodules in the skin, and each nodule has a core of cheesy material. The nodules are painless, can vary in size, and occur in clusters on the face and/or anywhere on the body. Treatment may be necessary if the nodules occur in an awkward place, such as on the eyelid, but is mainly requested because the condition is unsightly. Treatment can involve pricking each nodule with a toothpick dipped in phenol, or by freezing each nodule with liquid nitrogen. Seborrheic dermatitis is a very common skin condition in people with AIDS. It is probably caused by a fungus, possibly a species of Pityrosporum. Seborrheic dermatitis consists of a red, scaly rash that occurs mostly on the sides of the nose and on the cheeks, forehead and scalp, in the eyebrows and along the eyelashes. It may also occur on the chest and in skin folds in other parts of the body. Treatments include 1% hydrocortisone cream and anti-fungal creams such as miconazole nitrate. Dandruff shampoos such as Selsun, Gill or Niz can help the scalp. In very severe cases, a short course of fluconazole (an anti-fungal drug) can be taken by mouth. Reviewed by Dr Eftyhia Vardas BSc(Hons), MBBCh, DTM&H, DPH, FC Path (Virol), MMed (Virol), Clinical Virologist, Director HIV AIDS Vaccine Division, Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, University of the Witwatersrand and senior lecturer, Department of Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand Obesity may speed ageing of the liver MedicalDiseases

医学

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McCord Hospital shocker January 21 2013 at 01:52pm By Kamini Padayachee sxc.hu Durban - News of the closure of the historic 103-year-old McCord Hospital in Overport has been met with shock and disappointment. The state-aided hospital is set to close its doors in March, resulting in 424 employees losing their jobs, because the health department has not indicated if it will be providing the facility with its annual subsidy. According to its website, US missionary surgeon, Dr James McCord, opened the hospital in 1909 to provide medical care to the Zulu people. It also played a role in the training of predominantly black doctors, nurses and midwives during apartheid. News of the closure comes just days after the KwaZulu-Natal health department said it was considering the closure of Addington hospital for renovations. McCord acting chief executive Kevin Smith said the hospital could no longer operate because of the loss of the subsidy. It received a R89.3 million subsidy from the department last year. On Sunday relatives of patients were upset. Pensioner Colin Boyce, who said his wife was receiving outpatient care, was shocked. Boyce said government funds such as the R200m spent on Zuma’s home in Nkandla could have been used to keep the hospital open. “The government does not have the interests of the people at heart, he said. Similar remarks were made on social networking sites Twitter and Facebook in reaction to news of the hospital’s closure. On the hospital’s Facebook page, Annatjie van der Merwe posted: “So sorry to hear that the hospital is closing down, I had the best service from McCords staff when I had my baby there in July, the medical staff and the after-treatment were great and they always have a smile on their faces, praying for all of you, and that somebody will do something about it, this is really sad!” The hospital was informed in October that there would be a reduction in government funding, but was not told when the complete cut in funding would take place. It had tried to move towards a private model, but this required more funds and a private licence. Then hospital chief executive Helga Holst told The Mercury that a proposal for the health department to take over the facility had been rejected. McCord’s Sinikithemba clinic, which was well known for the care provided to HIV positive patients, also closed last year because of a lack of funding and the patients were moved to alternative public sector facilities. Smith said the hospital’s funding would end in March. “McCord has not received notification of an intention (from the department) to renew this funding. “As a result of the loss of this funding, McCord loses its licence to operate as a state-aided hospital and cannot afford to continue operating.” The South African Medical Association’s coastal branch president Jacob Mphatswe said with the high unemployment rate, the government should look to prevent job losses. “It is not just about the doctors or nurses, what about the ordinary staff? “We cannot have a situation where Addington is collapsing and McCord is closing at the same time. Who is going to absorb the crisis? McCord needs to stay open while Addington’s problems are attended to,” Mphatswe said. Provincial health department spokesman Sam Mkhwanazi did not respond to questions, but said financial assistance had been provided based on a business model. He said that the model had included an agreement with the hospital that McCord would treat HIV patients on behalf of the department while the department provided laboratory services and medication and the hospital also provided a service of training medical interns. Mkhwanazi said that the hospital had stopped providing these services last year “due to reduction of funding from other sources”. The Mercury Comment Guidelines IOL / News / South Africa / KwaZulu-Natal / McCord Hospital shocker

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Drowning Prevention: May 8, 2011 The months between May and August are particularly critical when it comes to drowning. It's the height of swim season when children are out splashing around. Which is why experts encourage parents and caregivers to focus on drowning prevention. Mom Amy Saracino saw how quickly a child could fall victim. "My older son when he was small, probably three or four like she is, just walked into a common pool area, and fell in" Now she keeps a close eye on her four year old daughter. Every year in the state of Florida, the equivalent of three preschool classrooms drown. It's the leading cause of death in children under the age of five. Lee Memorial Hospital's Alex Daneshmand works in pediatric critical care and is called on to treat children, "In one instant they're happy, healthy, having fun, and then and you look hours later and we're unfortunately providing them resuscitation to keep them alive." He advocates using layers of protection, beginning with supervision. "If they're around a body of water we would like the parents to remember somebody needs to be designated to be watching them." he says. "We call them water watchers." Other lines of defense are pool gates, alarms and having an emergency plan including CPR. "By creating these barriers, creating these obstacles around the pool and having these plans around you can prevent these deathss perhaps" he says. Together they build layers of protection that can safeguard children from drowning.

医学

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Inside Boonshoft Web Policy & Guidelines Office of Marketing & Communications Pickoff appointed Chair of WSU Department of Community Health DAYTON, Ohio--Arthur S. Pickoff, M.D., professor and current chair of the Department of Pediatrics, has been appointed, additionally, the new chairperson for the Department of Community Health, effective immediately. The Department of Community Health at Wright State University Boonshoft School of Medicine comprises research centers of excellence, educational programs, and several award-winning community outreach programs. "Over the last few years, I have worked rather closely on several projects with Community Health in my role as educator and researcher at the medical school. The level of expertise and the productivity I found impressed me. One of my goals is to develop linkages and collaborations among the divisions in the Department of Community Health and between those divisions and the university and the school as a whole, especially in the clinical arena." The Department of Community Health ranks 17th out of 125 medical schools for its total research awards granted by the National Institutes of Health in FY 2004 for the area of "Public Health and Preventive Medicine." Its divisions include: Center for Healthy Communities Center for Interventions, Treatment and Addictions Research Howard Part, M.D., dean of the Boonshoft School of Medicine, says that the search committee was impressed by his many outstanding attributes and vision for the department. "Dr. Pickoff brings a wealth of talent to this position," he says, "and his leadership style and vision is a perfect match for this highly successful department." A native New Yorker, Pickoff received his M.D. degree at Albert Einstein College of Medicine and completed his residency at Mt. Sinai Hospital in New York. He completed a postdoctoral fellowship in pediatric cardiology at the University of Miami School of Medicine in Florida, where he was also an NIH trainee in cardiac electrophysiology. Pickoff came to Wright State University Boonshoft School of Medicine in 1999, after serving as director of the Section of Pediatric Cardiology at Tulane University School of Medicine in New Orleans. Pickoff's research interests have focused upon pediatric cardiology, including the pharmacology of anti-arrhythmic agents in the pediatric patient and the electrophysiology of the immature heart, with special emphasis on autonomic modulation of electrophysiological responses. He has received numerous research grants from the American Heart Association and the National Institutes of Health. Pickoff has published 12 book chapters and more than 70 articles in scientific and medical journals. Also active in the community, Pickoff serves as immediate past-president of the Miami Valley Division of the American Heart Association Board of Advisors and, was a research grant reviewer for the Southern and Ohio Valley Affiliates. He sits on the boards of the Children's Medical Center Board of Trustees, the Juvenile Diabetes Research Foundation, the Ohio Valley Affiliate of the American Heart Association, and the American Academy of Pediatrics (Ohio) Executive Board. Pickoff will replace Robert Reece, Ph.D., current chairperson of community health, who is retiring from Wright State after more than 35 years of service. Cindy Young, Director E-mail: som_mc@wright.edu Contact Media: Cindy Young(937) 245-7624 E-mail: cindy.young@wright.edu Web: Robin Suits (937) 245-7625 Email: som_web@wright.edu Wright State Physicians Health Center 725 University Blvd. Dayton, OH 45435

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Mint Hill Chiropractor joins patriotic cause An area chiropractor has been giving away free treatments. It’s not a gimmick, a promotion, or an accident, it’s the Patriot Project. Dr. Mark Pustaver, of Pustaver Chiropractic in Matthews, has signed joined the Patriot Project, an initiative among chiropractors to give free treatment to veterans and active service personell free of charge, and to advocate for more access to and coverage of chiropractic care for military personnel. Pustaver is currently the only North Carolina chiropractor involved in the project, which was started by Dr. Tim Novelli, a chiropractor in North Canton, Ohio. The first goal of the project is to get chiropractic care covered by Tricare, the Department of Defense’s health care program, as well as to provide that care, get chiropractors at Forward Operating Bases overseas, and advocate for the acceptance of chiropractic care as necessary to veterans and active duty men and women. The project began in early 2012, when a patient of Novelli’s called and told him of an “American hero” that needed his help. The hero was Staff Sergeant Dana Bowman, a U.S. Army Golden Knight, who came to Canton to visit family and friends, and had never had chiropractic care before visiting Novelli during that trip. “To make a long story short, he had great results,” Novelli said. By Derek Lacey|2013-07-03T12:41:38+00:00July 3rd, 2013|Around Town|1 Comment Read More Search Our Site

医学

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Low vitamin D levels linked to Parkinson's disease Sunday, November 07, 2010 by: David Gutierrez, staff writerTags: vitamin D, Parkinson's disease, health news (NaturalNews) Low levels of vitamin D in the blood may increase the risk of developing Parkinson's disease, according to a study conducted by researchers from Finland's National Institute for Health and Welfare and published in the journal Archives of Neurology.Researchers took blood samples from 3,000 people between 1978 and 1980, then followed them for 30 years. They found that people with the lowest levels of vitamin D were three times more likely to develop Parkinson's disease in that time than people with the highest levels.Parkinson's disease is a degenerative brain and nervous condition that produces impairment of speech and movement dysfunction. Researchers do not know how vitamin D might affect the development of the disease, but they have suggested that it might help protect the body's nerve cells from damage."Further research is required to find out whether taking a dietary supplement, or increased exposure to sunlight, may have an effect on Parkinson's, and at what stage these would be most beneficial," said Kieran Breen, director of research at Parkinson's UK.Vitamin D, which is produced in the skin upon exposure to sunlight, has long been known to play an essential role in the formation and maintenance of teeth and bones. Newer research suggests that it also plays a critical role in regulating immune function, thereby protecting against infection, cancer, autoimmune disorders and even chronic conditions such as heart disease or Alzheimer's.These new findings have called into question whether recommendations for vitamin D intake have been set too low."At this point, 30 nanograms per milliliter of blood or more appears optimal for bone health in humans," wrote Marian Evatt of Emory University in an editorial accompanying the Finnish study. "However, researchers don't yet know what level is optimal for brain health or at what point vitamin D becomes toxic for humans, and this is a topic that deserves close examination."Sources for this story include: http://news.bbc.co.uk/2/hi/health/10601091.s.... More news on vitamin D 8000 IUs of vitamin D daily necessary to raise blood levels of "miracle" anti-cancer nutrient, declares groundbreaking new researchEpidemic of Vitamin D deficiency sweeping the worldSixty million years of evolution says vitamin D may save your life from swine fluNew vitamin D recommendations promote nutritional deficiency, protect cancer industryThe 10 symptoms of vitamin D deficiency you need to recognizeVitamin D Deficiency Reveals an Instant Health Care Reform SolutionVitamin D proven far better than vaccines at preventing influenza infections Take Action: Support NaturalNews.com by linking back to this article from your website http://www.naturalnews.com/030314_vitamin_D_Parkinsons_disease.html

医学

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Community Health plans $3.9B acquisition By TOM MURPHY AP Tuesday 30 July 2013 02:16:01 PM Twitter Community Health Systems Inc. plans to spend $3.9 billion to acquire Health Management Associates Inc. in a deal that would create a giant U.S. hospital chain just as the health care overhaul starts funneling millions of newly insured people into the health care system.But Community Health wants to buy its fellow hospital operator at a discount, with shareholders assuming some of the risk that the company faces from federal investigations. Investors panned that idea, at least initially, by sending shares of Health Management plunging Tuesday after the deal was announced.Community Health, based in Franklin, Tenn., plans to pay a combination of cash and stock valued at $13.78 for each HMA share. It also will make an additional contingent value right payment of up to $1 per share depending on how the investigations play out.Naples, Fla.-based Health Management, also known as HMA, said Tuesday it has received a fresh round of subpoenas from the U.S. Department of Health and Human Services, Office of the Inspector General, regarding physician relationships and some emergency room operations.Community Health said its deal totals $3.9 billion, or $7.6 billion counting assumed debt. The board members of both companies have approved the deal, but regulators and HMA stockholders still have to clear it.HMA shares sank almost 11 percent, or $1.62, to $13.30 in trading Tuesday. That's 48 cents below the offer price. The stock had climbed more than 60 percent this year as of Monday, when it closed at $14.92.Separately, HMA also said Tuesday it expects to report second-quarter earnings of between 10 cents and 11 cents per share on revenue of about $1.46 billion. That's well below Wall Street expectations.Analysts forecast, on average, earnings of 20 cents per share on $1.73 billion in total revenue, according to FactSet."It's a really poor performance, and if ever there was a reason for change in control, this was it," said Sheryl Skolnick, an analyst who follows the company for CRT Capital Group.HMA said its revenue from established hospitals is expected to fall due in part to a shift in the payer mix, a reduction in surgeries and rising bad debt, which is basically uncollectible revenue.Hospitals have been struggling with declining admissions, as patients continue to cut back on their use of the health care system, a trend that started a few years ago during the Great Recession. Federal funding cuts and growing populations of uninsured patients also have pressured profitability.Community's second-quarter earnings plunged 64 percent as revenue slipped."Unfortunately the economic realities of our individual markets continue to hamper our growth, especially in smaller markets," Chairman and CEO Wayne T. Smith told analysts during a conference call.The federal health care overhaul is expected to help ease the pressure hospitals are facing by reducing the number of uninsured patients they treat. Starting next year, the overhaul will provide income-based tax credits to help people buy coverage, and the state-and-federally funded Medicaid program will expand its coverage in several states.Community said its planned acquisition of HMA will create a company that's well positioned to benefit from the overhaul.The deal would create a chain with about 206 hospitals in 29 states with a heavy presence in the South. That would make it the largest hospital operator based on locations, although competitor HCA Holdings Inc. would still bring in more revenue.Skolnick said she sees a push for growth from Community and pressure on HMA as the key factors behind the proposed deal, not the overhaul's growth opportunity.HMA's largest shareholder, Glenview Capital Management, said last month that it wants to replace the hospital operator's current board with its own nominees to increase value for the company's investors."This is a deal motivated by the hardships at HMA," Skolnick said, adding that the subpoenas represent significant risks that are not going away.The companies expect the deal to close in the first quarter of 2014, if it gets antitrust clearance and 70 percent of HMA shares are voted in favor of it.Community Health shares fell $1.65, or 3.5 percent, to $45.58 in trading Tuesday. HMA

医学

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Musculoskeletal Health B-Complex with Metafolin and Intrinsic Factor 60 Vegetarian Capsules Item Number: DL1804 Amount per Container: 60 Vegetarian Capsules MFG # 200765-60X B Complex with Metafolin®‚ manufactured by Douglas Laboratories‚ is a comprehensive B supplement providing essential B vitamins and intrinsic factor‚ a nutrient necessary for optimal vitamin B12 absorption. B Complex with Metafolin® is unique among other B complex vitamins as it contains Metafolin®‚ a patented‚ natural form of (6S) 5-methyltetrahydrofolate (5-MTHF).As co-enzymes‚ the B vitamins are essential components in most major metabolic reactions. They play an important role in energy production‚ including the metabolism of lipids‚ carbohydrates‚ and proteins. B vitamins are also important for blood cells‚ hormones‚ and nervous system function. As water-soluble substances‚ B vitamins are not generally stored in the body in any appreciable amounts (with the exception of vitamin B-12). Therefore‚ the body needs an adequate supply of B vitamins on a daily basis.Thiamin‚ riboflavin‚ and niacin are all essential coenzymes in energy production. Thiamin is converted quickly into thiamin pyrophosphate‚ which is required for glycolytic and Krebs cycle reactions. Thiamin also appears to be related to nerve impulse transmission. Riboflavin is a component of the coenzymes FAD and FMN‚ which are intermediates in many redox reactions‚ including energy production and cellular respiration reactions. Niacin is also a component of the coenzymes NAD and NADP‚ which are involved in energy production‚ as well as biosynthetic processes.Vitamin B-6 is a coenzyme in amino acid metabolism. It is necessary for the metabolism of homocysteine and the conversion of tryptophan into niacin. Vitamin B-6 dependent enzymes are also needed for the biosynthesis of many neurotransmitters‚ including serotonin‚ epinephrine‚ and norepinephrine.Methylcobalamin (vitamin B-12) and folate are coenzymes in DNA and RNA metabolism. Both of these B vitamins assist in homocysteine metabolism. Folate serves as a methyl donor and methylcobalamin as a coenzyme in the conversion of homocysteine to methionine. Studies indicate that methylcobalamin‚ a coenzyme form of B12‚ may be better utilized and better retained in the body. Metafolin® is a patented‚ natural form of (6S) 5-methyltetrahydrofolate (5-MTHF). 5-MTHF is the naturally occurring‚ predominant form of folate commonly found in cells and is essential for overall health‚ as it participates as a cofactor in a reaction that involves the remethylation of homocysteine to methionine. Unlike synthetic folic acid‚ 5-MTHF can be used directly by the body‚ without the need for an additional conversion via the enzyme (5‚10-methylenetetrahydrofolate reductase (MTHFR)). In certain populations‚ the body’s ability to convert folic acid to 5-MTHF by use of this enzyme may be compromised due to genetic differences. Metafolin® contains only the S isomer of 5-MTHF and has been shown to be the only form of folate to be able to cross the blood-brain barrier.Biotin and pantothenic acid are also coenzymes essential for energy production from dietary fats‚ carbohydrates‚ and proteins. Pantothenic acid is a component of coenzyme A and of phosphopantetheine‚ and is therefore essential for Krebs cycle operation. Biotin is involved in many carboxylation reactions associated with gluconeogenesis‚ the Krebs cycle‚ and fatty acid synthesis.These statements have not been evaluated by the Food and Drug Administration (FDA). These products are not meant to diagnose‚ treat or cure any disease or medical condition. Please consult your doctor before starting any exercise or nutritional supplement program or before using these or any product during pregnancy or if you have a serious medical condition. Official Website: http://www.douglaslabs.com One vegetarian capsule contains:Thiamine ............................................. 50 mg (Vitamin B-1‚ as thiamine HCL)Riboflavin ............................................ 20 mg (Vitamin B-2‚ Riboflavin-5-Phosphate)Niacin .................................................. 50 mg (Vitamin B-3‚ as Niacinamide)Vitamin B-6 ......................................... 20 mg (as Pyridoxal-5 Phosphate)Folate (as 5-MTHF‚ Metafolin®) .......400 mcgVitamin B-12 (as methylcobalamin) 500 mcgBiotin ................................................300 mcgPantothenic Acid ................................. 50 mg (Vitamin B-5‚ as d-calcium pantothenate)Intrinsic Factor (from porcine) ............. 20 mg Adults take 1 capsule daily or as directed by a healthcare professional. No adverse effects have been reported.Store in a cool‚ dry place‚ away from direct light.Keep out of reach of children. Artificial Preservative Free Overall Rating for B-Complex with Metafolin and Intrinsic Factor 60 Vegetarian Capsules By katrina Great for MTHFR I always had terrible itching diarrhea insomnia and irritability from B12 but the intrinsic factor in this took care of all that so now i can take B12 without all the hassle.! from Oceanside, CA Works for MTHFR gene mutation I have good results taking this because of a MTHFR gene mutation. By Vimi from Palm Desert, CA Favorite for B12 This is my favorite B complex for B12 assimilation because of the Intrinsic Factor and its great that it has Metafolin too. from USA 5 Helped Alleviate Tingling Sensations Ive experienced tingling sensations on my face and left side for several years. After diagnostic testing with no known cause my PA suggested taking a good B complex. I have now taken this product for nearly three months and have noticed a remarkable difference. It has also boosted my energy level. √ I would recommend this item to a friend. I feel a difference when I am not taking B-Complex with Metafolin and Intrinsic Factor my Doctor wanted me to take folic acid and a good B-complex this is a good one I have more energy and feel better when taking once a day. small capsule from Vermont I like B-Complex with Metafolin and Intrinsic Factor because it has adrenal included which I feel gives me more adrenal support throughout the day. A regular b-complex is not enough as Ive tried it and I dont have enough energy and dont sleep as well at night. Adrenal added more supportive By Izzy Good for MTHFR I have MTHFR so finding a b complex with methyl folate not folic acid is hard and this one is perfect. I also like that B-Complex with Metafolin and Intrinsic Factor has co-enzyme of b6 b2 and b12. It also has a substantial amounts of all these some brands get skimpy with the mgs. Usually the active forms. Has Methyl folate as Metafolin Pricer than most b complex but you are paying for the active forms of b complex from Sioux Falls, SD I started B-Complex with Metafolin and Intrinsic Factor several months ago under the advice of my chiropractor to increase my energy levels. I will continue to use it to see the long term benefits as I think it takes some time before you see results. By Liudmila from Pensacola, FL B-Complex with Metafolin and Intrinsic F I love pureformulas for the great prices and fast delivery. Pros The best brand. B-Replete 180 Vegetable Capsules B-Complex + Minerals 90 Tablets Magnesium Citrate 90 Capsules Methyl Folate L-5-MTHF (1,000 mcg of Metafolin®) 60 Tablets Ultra B-Complex 100 Tablets

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Home HealthDay Daily Newsfeed HealthDay Daily Newsfeed When a Child With Autism Wanders, It's Crucial to Stay a Step Ahead No locks, alarms, tracking devices can guarantee parents complete peace of mind By Lisa EspositoHealthDay Reporter FRIDAY, March 23 (HealthDay News) -- The Oertel family lives in a red-brick, two-story house tucked in a tree-lined, suburban Maryland cul-de-sac. There's no fence, just a small alarm company sign on the lawn that gives no clue to the system's real purpose. The array of bolts high on the front door, the upgraded locks on the patio and garage doors and the "burglar" alarm are meant less to keep out intruders than to prevent 15-year-old Luke Oertel from silently leaving. Luke has a moderate form of autism, a developmental disorder that affects a child's social interactions, language and behavior. He is among those with autism who wander without a typical child's sense of fear or danger. In June, Luke outsmarted a system of combination locks and wandered five miles away, through the early-morning rush hour, taking a pedestrian underpass beneath a heavily traveled road off the Capital Beltway. Two hours later the police brought him home, still in his green pajamas, handcuffed. It was "sheer terror," said Luke's mother, Gwynne, of the moment when she and her husband realized Luke was missing. To protect their privacy, the family asked that their real names not be used. Last year, "autism wandering" became an official diagnosis in the United States with its own medical code. Some of those afflicted enter strangers' houses. Others end up in traffic or on train tracks. Many find their way to nearby pools or ponds. An aura of constant vigilance exists between Gwynne and Tess Oertel, Luke's older sister. "Are you with him?" Gwynne calls. "Is he up there?" When he's not in the same room, his mother scans doorways and listens for a wrong sound. It's unconscious by now. In the kitchen, a heavy, padlocked chain around the refrigerator keeps Luke from tearing into the food. The pantry is also secured. Today, Luke, a well-built teen with dark red hair and a couple of pimples, is wearing a Washington Capitals hockey T-shirt and thick brown pants. Hidden beneath his sock is an ankle bracelet. It's bulky in the middle where the battery sits, and it's water-resistant. He can't get it off, his mother said, and now he's used to it. There are no scissors in the house. The bracelet allows radio tracking of Luke's whereabouts, within a range of one to two miles. About one in 110 children is estimated to have an autism disorder. Some are hypersensitive to sounds, smells and touch, and an "itchy" shirt or a vacuum's drone can be highly disturbing. It is thought children have individual "triggers" that lead them to wander -- either to get away from something that bothers them or to seek out their particular fascination, such as water. As a result, drowning and exposure to the elements are top causes of death for those with an autism spectrum disorder. From the Kennedy Krieger Institute in Baltimore, Dr. Paul Law led a study that provided the first national figures on wandering. The survey, conducted by the Interactive Autism Network, comprised more than 800 parents of children with autism. Nearly half of these children between the ages of 4 and 10 had wandered at least once. However, because this was a self-selected group of parents -- not a random sample -- the results might not reflect the experience of all families. Law said that no matter how vigilant a parent is, some children bolt. When Samantha Gardner's 5-year-old son wandered off to a Brighton, Mich., ice cream store last summer, she was hyperventilating in the recorded 911 call. Minutes earlier, a store employee had also called 911, reporting a "child that just popped out of nowhere; he seems to be potentially autistic and was running into the road." The staff kept him safe until Gardner arrived. "With my son, 'asks permission' doesn't exist," Gardner said. "He doesn't talk. He can't ask to go to Dairy Queen." When a child wanders, it can take just a few minutes for the worst to happen. Beth Martin of Lawton, Okla., sometimes used a tether to keep her daughter Savannah, who had autism, safe outdoors. But her constant vigilance wasn't enough, and Savannah, 7, drowned in February 2011. Savannah had a history of wandering. "I tried hard to do all the precautions I could," her mother said. "I knew she was a child who could go. I was trying to stay one step ahead." On that day, in a matter of moments, Savannah had slipped away to a nearby pond and although her older brother and a neighbor tried to save her, it was too late. Months later, Martin recalled that painful time. "My husband was deployed and I was uncomfortable with the ponds near our house," she said. "I was looking for a safer place to live." The day before the accident, Martin had the door alarmed because Savannah was getting up at night. "But I was comfortable during the day that she knew not to cross boundaries. It was simple as that. Kids with autism have routines. I was making noodles and she always waited for noodles. I went to the bathroom and when I got out, she was gone." Martin said she shared her story to help other parents. For the Oertels, a factor in their decision to move to Montgomery County, Md., is that it's part of Project Lifesaver. The program provides known wanderers with radio-tracking devices and coordinates with local emergency agencies. Officer Laurie Reyes heads the Montgomery County program, where officers respond to calls about missing children with autism about every other week. Police quickly arrived at the Oertels' home, using police dogs to search the house. Gwynne requested a helicopter, which can detect signals for three to five miles, but the police said it was too early in the search to employ one. Luke might not have been saved without the intervention of two Good Samaritans. A woman in a car spotted Luke on the road in his pajamas, and followed him to a hotel parking lot. She enlisted the hotel security director's help, and they trailed Luke to the Metro station, followed him by foot onto the platform and blocked him from entering a Washington, D.C.-bound train. He recited his phone number for the strangers, and they contacted his mom. Police still had to get Luke safely into the car. Reyes recounted rescue steps: "We'll have to stop traffic. Mom has to grab his favorite food. We tell her, 'We may have to put him in handcuffs, for his safety.' Mom got it." Oertel said she was "fine" with the handcuffs -- although she didn't want to see them applied and asked the officers not to use a Taser on her son. By 8 a.m., he was home. Despite the blistered feet from his escape, Luke has said he wants to do it again. Moving onward Autism advocacy groups want wandering incidents to trigger Amber Alerts, but because that system is meant only for abducted children, wanderers don't qualify. A grassroots movement is afoot to implement "Mason Alerts," named in honor of Mason Allen Medlam, who drowned after wandering. Luke attends a local high school, where he's in a six-year program to learn functional life skills. He continues to plays hockey on a special team. "My first concern is his safety, keeping him safe," Gwynne said. "That's the number one priority. My second is his happiness. So, we're trying to expose him to all different hobbies to see what he likes. If you don't expose him to it, you'll never know." More information AWAARE (Autism Wandering Awareness Alerts Response Education) offers a wealth of resources on wandering. For more on autism and wandering, see related story. SOURCES: Paul Law, M.D., M.P.H.; director, medical informatics, Kennedy Krieger Institute, Baltimore, and principal investigator, Interactive Autism Network; Officer Laurie Reyes, Project Lifesaver Coordinator, Montgomery County, M.D., Police Department; Parents Samantha Gardner, Brighton, Mich., Beth Martin, Lawton, Okla. Copyright © 2012 HealthDay. All rights reserved. Who We Are

医学

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Front Page » November 12, 2009 » Carbon County News » Xander's challenge Published 1,806 days agoXander's challenge Six-year-old Xander Archuleta has many loves; playing with his friends, working with Play Doh, playing video games and, particularly, trains. But he has been forced to put many of the things he likes to do on the back burner. The challenges of a health crisis have set him back time and time again since he was 17 months old. And he will face even more battles as the next year progresses. Over four years ago, the little tyke from Price was diagnosed with leukemia. Ever since, through treatments, remission, recurrence, treatments and remission, all happening a number of times, he has been able to survive. Now he has had a bone marrow transplant (using stem cells). Medical personnel who are working with him are optimistic, although they won't give his mother, Mandy Archuleta, any percentages for his future. His history of disease and medical treatments to tame it would make those of even the most seasoned veteran of adult hospital experiences pale in comparison. The leukemia first showed up in 2005. Then, after the doctors thought they had it beat, it appeared in his spinal fluid when he was three years old. Another set of treatments followed. When Xander was five years old, the doctors once again thought they had it beat. Then, earlier this year (March), it recurred again. This time, it manifested in his eyes. In each occurrence, the treatment had to be changed. Still, a series of chemotherapy sessions and radiation had to be used. "Being in his eyes this time makes it very difficult to treat," explained Mandy. "They don't like to use radiation around his eyes because of the problems it can cause later on down the line. And the chemo really doesn't get to the eyes. Since he was a year and a half (old), he really hasn't ever been off some kind of therapy for very long." All the financial costs incurred through the therapies and treatments are as significant an issue as are the health care issues involved with Xander. And, in the next few months, the expenses will be even higher. He and his mother and will stay at the Ronald McDonald House in Salt Lake City during a time period when his health is still fragile. Things could go south quickly. He has to stay within 20 miles of PCH for up to four months. "I have had good insurance covering a lot of this," said Mandy as she sat in a nurse's station at Primary Children's Hospital. "But I couldn't have done all that we have without the great support system we have had from my family, and friends who have come to help us." Still, money is a problem, as little Xander, who played a video game while his mother sat outside his room being interviewed, doesn't quite understand yet. The living costs alone of staying in Salt Lake when their home is in Price are high. And, the fact that Mandy will not be able to work the entire time Xander is in treatment along the Wasatch Front, makes it even costlier. "I work for NAPA in Price," says Mandy, who relates that Rick Krompel, her boss, is very understanding regarding the situation. "But no money is coming in while I am here." Xander is also missing school this year. He should be in kindergarten. While the school (Creekview) has provided support when he is home, at Primary Children's it is too far away for anyone from the school district to be able to reasonably do anything. He did, however, get to go to preschool for a while last year in between occurrences. "We hope that, once we are out of here, we can get a tutor and get him caught up so he can go back to school, but I pretty much expect he has lost kindergarten for this year," his mother said. Mandy and Xander have made it through many trials because of their family and the community that surrounds them in Carbon County. "So many people have already helped us," stated Mandy. "The Parrot Heads Club and Kiwanis Club have given money, and the Make-A-Wish Foundation gave us a trip to Ohio, where Xander got to ride on a narrow gauge railroad through the central part of the state. They even let him ride up in the engine." The Ronald McDonald House is cheap lodging, considering the costs of other accommodations in Salt Lake City. Still, at $675 per month, it is not easy for a family that has no current income. Mandy's ex-husband has helped a lot, but he recently got laid off from his job, Things are looking a little bleaker these days. That's why, this Saturday, Nov. 14, friends, family and other supportive people are holding a benefit dinner and auction for Xander, so he can get the treatment he needs and stay in place in Salt Lake to get it. The dinner will take place at the Helper Auditorium from 5 to 7:30 p.m. A silent auction will be held at the dinner. Among items to be auctioned off are two rifles, a shotgun, binoculars, a rifle scope, a little giant ladder and a vacuum from Loveless Ash. There are also many overnight stays including some in Park City, Mesquite, Wendover, and Las Vegas, Nev. as well as in Salt Lake, and St. George. There are also many other great items. A donation account has also been set up at Zions Bank in Xander's name. When Xander is better, he will return home to play with friends, play video games and hopefully watch the trains on the tracks that run through Price, dreaming all the while of when he got to ride in a steam locomotive, hopefully, a good memory of long ago. NOTE: To print only the article and included photos, use the print photo(s) with article link above.Carbon County News November 12, 2009 CWD becoming more prevalent Veterans gather to honor fallen heroes and those that served Xander's challenge Turkeys way up in the air FBI warns of foreclosure scams in Utah Long line for flu shots Treating depression during pregnancy Losing while cruising to store Donations gladly accepted at the Children's Justice Center Local archaeologist published in journal Congress directs BLM to collect processing fee Corridor management plan meetings called Xander Archuleta Boys family needs help The Advocate's Gamer Improving girl's soccer team working through preseason About your lifestyle...

医学

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VCA Feline Medical Center Pet CareCat CareVCA Big Pet Project Behavior Counseling - Medication ComplementaryPet Info PrintBehavior Counseling - Medication Complementary Can natural products be used for behavioral therapy?This is a broad topic that includes a variety of therapeutic options, including herbal remedies, homeopathic remedies, nutraceuticals, and supplements. There are few controlled studies to show that any of these treatments are effective in pets. Although the same might be said for most of the drugs used in behavior therapy, most of these have at least been proven to be effective in human behavior therapy. In addition, because these products contain “natural” ingredients, there can be great variation in purity, quality, level of activity, and efficacy from manufacturer to manufacturer and from batch to batch. In addition to the use of the human products available as complementary therapeutics, a number of veterinary products are now on the market for anxiety disorders, cognitive dysfunction, and generalized calming effects. Although these products generally meet a level of quality control and standardization that is similar to pharmaceuticals, efficacy studies are generally lacking. Pheromones are a natural alternative that does provide some sound scientific evidence of efficacy. Other modalities such as aromatherapy, acupuncture, telepathic communication, and TTouch® are beyond the scope of this handout. What are pheromones, and how are they used?There are commercially available pheromones now available for use in dogs and cats in North America, specifically Feliway®, a synthetic cheek gland pheromone for cats, and Adaptil™ (adaptil.com, feliway.com), a synthetic dog pheromone derived from the intermammary sebaceous glands of lactating female dogs. "Pheromones are species specific." Pheromones stimulate the vomeronasal organ and affect areas of the brain that lead to emotional responses. They are species specific; in other words, the pheromones of one species will only have an effect on other members of that species. Each of these pheromone products is available as a spray for use in localized areas (e.g., car, kennel) or as a plug-in diffuser, which aerosolizes the pheromone over about 700 square feet for 30 days. Adaptil™ is also available as a collar for dogs that evaporates pheromones for approximately 1 month. Feliway® may be useful for reducing marking behavior, including some forms of scratching, as well as to help calm a cat in the home, such as in situations where there has been some household change to which the cat is having difficulty adapting. Adaptil™ may help to reduce anxiety, such as when a new puppy is introduced to the home, in cases of separation anxiety or noise phobias, or when there have been changes in the household to which the dog is having difficulty adapting. Dog pheromones may also be useful to help the pet adapt to car travel, boarding, or moving to a new home. What is ginkgo biloba, and how is it used?Ginkgo biloba is an herb that may alter a number of neurotransmitter systems in the brain, including acetylcholine, serotonin, and norepinephrine, and may have antioxidant effects. It may be effective at enhancing blood flow to the brain and may be useful for senior pets with cognitive decline. What is kava kava, and how is it used?Kava kava is an herbal product that may aid in the relief of mild anxiety. Due to reports of possible liver toxicity in humans, the product is no longer available in some countries. There have been no controlled studies of its use in pets, but it has been recommended for anxiety, as a sedative or muscle relaxant, or as a sleep aid and for the treatment of overgrooming in cats. Kava kava should not be combined with other anti-anxiety medications. It may cause gastrointestinal upset and should be avoided in patients with liver disease. What is St. John’s wort, and how is it used?St. John’s wort is a plant that has been recommended as a natural alternative to antidepressants. It is said to sedate, reduce anxiety, improve mood and sleep, and reduce inflammation. It may be useful in compulsive disorders. There have been claims of its effective use in dogs and cats, but no controlled studies. As with pharmaceutical antidepressants, it has been suggested that a period of 3 weeks or longer may be required to achieve therapeutic effects. There are the same contraindications as with other antidepressants. St. John’s wort should not be used in conjunction with other pharmaceutical antidepressants, due to the potential for severe side effects and/or reactions. St. John’s wort may cause increased sensitivity to sunlight. What is valerian, and how is it used?Valerian is a plant that has been used as a natural “tranquilizer” and muscle relaxant in animals, but controlled studies are not available. Valerian is not intended for long-term use but may have benefit as a treatment for helping pets sleep through the night and exposure to periodic stressors, such as travel, thunderstorm phobias, and acute anxiety. Several weeks may be needed to achieve success. What is melatonin, and how is it used?Melatonin is produced in the pineal gland of the brain and is secreted into the blood at high levels during the night and at low levels during the day. Melatonin may be useful to help dogs with sleep disorders and in the treatment of fears and phobias such as thunderstorm and fireworks phobias. It may be used alone or combined with other medications such as antidepressants. Side effects in humans may include sleepiness, headaches, and gastrointestinal discomfort. "Melatonin may be used alone or combinedwith other medications such as antidepressants." What is alpha-casozepine, and how is it used?Alpha-casozepine is a hydrolysate of a protein in cow’s milk. In preliminary studies, it has shown some promise in reducing fear and anxiety in dogs (Zylkene® Vetoquinol, N. America; Merck Animal Health, Europe) and cats. What is L-theanine, and how is it used?Based on some initial studies, L-theanine may also be useful for treating some forms of anxiety in dogs and cats. What is Harmonease®, and how is it used?This product is a combination of magnolia and phellodendron (Harmonease®, VPL), which in preliminary studies has been shown to reduce signs of fear and anxiety. Melatonin may be used alone or combined with other medications such as antidepressants. What is aromatherapy, and how is it used?Both lavender and chamomile aromatherapy may have benefit in reducing anxiety such as that associated with crating or car rides. How might dietary changes and tryptophan be used in treating behavioral problems?It has been suggested that a change in diet can also alter behavior. Although some reports indicate that there may be adverse effects from supplements and preservatives in pet foods, there is no evidence to support this premise. For the most part, these additives increase the nutritional balance and may protect against the toxic effects that might be produced by “spoilage.” In addition, one would expect more signs (e.g., dermatologic, gastrointestinal) than just behavioral changes if there were an adverse reaction to the food or one of its ingredients. An elimination diet (e.g., one that did not contain the suspected offending ingredients) could be used to test this hypothesis. One common suggestion has been that a reduction of protein in the diet may lead to a decrease in aggression, but this has not been validated. In a recent canine study, the level of protein (high vs. low) in the diet or addition of L-tryptophan had no effect on fearfulness or hyperactivity, but a combination of low protein diets with tryptophan supplementation was shown to lower territoriality scores, while high protein diets without tryptophan supplementation were most likely to lead to aggression toward owners. If the pet’s age and health are not an issue, then a feeding trial with a reduced protein diet along with a tryptophan supplement might be considered in pets that exhibit territorial and dominance forms of aggression. Are there any other herbal or natural remedies that have been proven to have some efficacy?A number of products such as docosahexaenoic acid (DHA), S-adenosylmethionine (SAMe), and phosphatidylserine have been found to be useful in improving signs of cognitive dysfunction in senior pets. A combination of these supplements along with antioxidants is often used together for greater effect (see (10) Senior Pet Cognitive Dysfunction). DHA may also help to improve learning and brain development in young dogs. Other products such as Eleutherococcus (Siberian ginseng) to improve mental acuity, Panax ginseng as a stimulant, Passionflower (Passiflora) or skullcap for anxiety, hops for insomnia, and a number of manufactured combinations are available for use in pets, but there is little more than anecdotal data to support their efficacy. What are homeopathic and Bach flower remedies, and how do they work?The basic principle of modern homeopathy is that “like cures like.” The theory is that a patient’s symptoms can be cured by a product that would produce the same behavioral or physical symptoms in a healthy individual. The homeopathic remedy is prepared by repeatedly diluting the substance to render it nontoxic. Although the substance may be undetectable after dilution, the remedy is said to contain the vibrational energy essences that match the patterns present in the ailing patient. These remedies may be made from plants, minerals, drugs, or animal substances. Bach flower remedies are intended to improve the emotional state of the pet, using minute dilutions of plant essences. Rescue Remedy® is a combination of five flower essences intended to relieve panic following emotional or physical stress. Calms and Calms Forte are also combination homeopathic remedies that have been recommended as an alternative to psychotropic drugs. Although there is no scientific evidence to support any claims of efficacy, the extreme dilution of the ingredients are likely to render them safe. This client information sheet is based on material written by: Debra Horwitz, DVM, DACVB & Gary Landsberg, DVM, DACVB, DECAWBM Related Tagsanxiety, pets, remedies, behavior, pheromones, dogs, kava, cats, antidepressants, efficacy, protein, brain, diet, complementary, homeopathic, john, phobias, pheromone, combination, melatonin, wort, behavioral, herbal, supplements, improve, species, addition, tryptophan, ingredients, medication, handout, valerian, intended, combined, senior, travel, reduce, emotional, recommended, gastrointestinal, medications, treatment, plant, aromatherapy, therapy, therapeutic, remedy, cognitive, aggression, disorders, essences, alternative, drugs, evidence, reducing, longer

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Health Highlights: Sept. 25, 2013 Here are some of the latest health and medical news developments, compiled by the editors of HealthDay: FDA Urged to Regulate E-Cigarettes Like Tobacco Products The federal government should start regulating electronic cigarettes like tobacco products in order to prevent children from using them, says a letter sent by 40 state attorneys general to the Food and Drug Administration. The letter notes that e-cigarettes are being marketed to children through cartoon-like characters in ads and by offering fruit and candy flavors, CBS News/Associated Press reported. The attorneys general pointed out that the health effects of e-cigarettes have not been adequately studied and the ingredients are not regulated. The FDA needs to meet an Oct. 31 deadline to release proposed regulations to control the advertising, ingredients and sale to minors of e-cigarettes, the letter stated. In the past, the FDA has announced intentions to tighten oversight of e-cigarettes but has delayed taking action. A Centers for Disease Control and Prevention report released earlier this month found that 1.8 million middle and high school students said they had tried e-cigarettes in 2012. The percentage of students who said they tried an e-cigarette jumped from 4.7 percent in 2011 to 10 percent in 2010, CBS/AP reported. Dr. Drew Pinsky Had Prostate Cancer Surgery in July Television personality Dr. Drew Pinsky revealed Tuesday that he had his prostate removed earlier this year after being diagnosed with cancer. Pinsky said he had a robotic prostatectomy in July and returned to work within 10 days. He said he's cancer-free and the only reminders of his surgery are six small scars on his torso, the Associated Press reported. The 55-year-old host of HLN's "Dr. Drew on Call" wrote about his experience on the network's website. He said he went public about his condition to raise men's awareness about prostate cancer. Pinsky is an addiction specialist who previously appeared on such TV series as "Loveline," "Celebrity Rehab with Dr. Drew" and "Lifechangers," the AP reported. Burger King Launches Lower-Calorie Fries Burger King has introduced new crinkle-cut french fries that the fast-food chain says contain about 20 percent fewer calories than its regular fries due to a new batter that doesn't absorb as much oil. The company says that a small order of the new "Satisfries" has 270 calories, compared with 340 calories for a small order of it regular fries, the Associated Press reported. Satisfries use exactly the same ingredients --- potatoes, oil and batter -- as regular fries and customers won't be able to tell that the new fries are lower in calories, according to Burger King executives. The worlds No. 2 hamburger chain worked with one of its potato suppliers -- McCain Foods -- to develop the lower-calorie fries, said Alex Macedo, head of North American operations at Burger King. He told the AP that McCain can't sell the fries to other fast-food restaurants. Environmental Chemicals a Threat to Pregnancy: Report Americans are exposed daily to chemicals in the air, water, food and everyday products that can damage reproductive health, according to a report from the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine. The groups said doctors need to lobby for stronger environmental policies to better identify and reduce exposure to harmful chemicals, the Associated Press reported. They also want doctors to ask pregnant women about their exposure to different chemicals and to teach their patients how to avoid some of the chemicals considered to be the most dangerous during pregnancy. "What we're trying to get is the balance between awareness and alarmist," ACOG President Dr. Jeanne Conry told the AP. For the report, a committee of specialists from the two groups examined studies about industrial chemicals that people's bodies can absorb from various sources. They noted that certain chemicals have been linked to infertility, miscarriages, birth defects and other reproductive problems. On-the-job exposure poses the greatest risk for women, so doctors should ask pregnant women about their workplaces when they make their first prenatal visit, the committee recommended. They also said that research suggests that nearly all pregnant women are exposed to at least 43 different chemicals. It's unclear how many pose a threat, but some can reach the fetus and are known to be harmful, the AP reported. For example, mercury can accumulate in certain types of fish. When pregnant women eat these fish, the mercury can damage her unborn baby's developing brain. Exposure to certain pesticides in the womb can increase the risk of childhood cancer, according to the committee. Women and their babies aren't the only ones at risk. The committee noted that high levels of pesticide exposure in adult men has been linked to sterility and prostate cancer, the AP reported. The committee advised consumers to choose fresh fruits and vegetables over processed foods when possible and to thoroughly wash produce. Pregnant women and young children should limit their seafood consumption to species with low levels of mercury, such as shrimp, canned light tuna, salmon and catfish. "There's only so much people can do as individuals and families to limit chemical exposures," University of Washington public health dean and environmental health specialist Dr. Howard Frumkin told the AP. He was not involved in the report. But he called the report "a very balanced, reasonable and evidence-based contribution." Current environmental regulations provide sufficient consumer protection and the new report will create "confusion and alarm among expectant mothers" and distract them from proven measures for having a healthy pregnancy, according to the American Chemistry Council.

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No Link Found Between Autism And Number Of Vaccines By: CBS/AP (Posted by Kion Hudson) Updated: Fri 5:43 PM, Mar 29, 2013 / Article (CBS/AP)-- A new study published in the Journal of Pediatrics on March 29 confirms that there is no association between autism and receiving many vaccines at an early age. "The amount of antigens from vaccines received on one day of vaccination or in total during the first two years of life is not related to the development of autism spectrum disorder in children," author Frank DeStefano, director of the Immunization Safety Office of the Centers for Disease Control and Prevention, told NPR. About one-third of parents worry that vaccines cause autism, and 10 percent of parents refuse or delay vaccinations because they think it is safer than what the CDC recommends. One of the top issues is that some parents fear that their children are receiving too many vaccines on a single day and throughout the first two years of the child's life. The maximum number of antigens -- the substances in vaccines that cause the body's immune system to produce antibodies to fight disease -- a child can be exposed to by the age of 2 in 2013 is 315. However, in the late 1990s, that number was in the thousands. Autism and the autism spectrum disorders (ASD) are a group of developmental disorders that cause major social, communication and behavioral challenges. The CDC believes that one out of every 50 children has an ASD. A previous study published in January 2013 by the Institute of Medicine confirmed that the 24 immunizations that children receive before the age of 2 are not only safe, but also help prevent illness, deaths and hospital stays. The vaccines are safe when they are taken on their own and in conjunction with each other. None of them were linked to autoimmune diseases, asthma, hypersensitivity, seizures, child developmental disorders, learning or developmental disorders or attention deficit or disruptive disorders. To look at the effect of vaccines on autism specifically, researchers looked at data from 256 children with an ASD and 752 children without ASDs born between 1994 and 1999. They looked at how many antigens the child was exposed to until they were 2-years-old and the maximum number of antigens a kid received in a single day of vaccination. Simply counting the number of vaccines did not suffice because each vaccine had different numbers of antigens. For example, the older whole cell pertussis vaccine created about 3,000 different antibodies, whereas the newer acellular version only creates six or fewer antibodies. The researchers discovered that the total number of antigens received an the maximum number of antigens received was the same number for children with or without ASD. There was no relationship for kids who had sub-categories of autistic disorder and ASD with regression -- meaning they suddenly lose speech and social skills -- either. DeStefano said that the results were not suprising because kids encounter antigens all the time in everyday bacteria and viruses. "It's not really clear why a few more antigens from vaccines would be something that the immune system could not handle," he says. Geraldine Dawson, the chief science officer for Autism Speaks and a professor of psychiatry at University of North Carolina, Chapel Hill, told TIME that the study was important because it can help provide confused parents who read something conflicting information online with accurate, researched information. "The concern around vaccines has been a very significant issue. Many parents are now deciding to wait or space out vaccines. There has been a concern that when parents are worried about whether vaccines are associated with autism that they are going to choose not to vaccinate their child," says Dawson. "That's one of the reasons we see this as very good news, because we hope this will reassure parents that the number of vaccines your child received during the first couple years of life is not associated with a risk in developing autism." Dawson, who was not involved in the study, said scientists are especially interested in children with autism who experience regression. This typically happens around the child's first or second birthday, which is around the same time they receive vaccines. "This study looked to see if for even this sub group, whether they are more at risk, and again no connection was found," says Dawson.

医学

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Members' corner Experts warn of human and economic cost of inaction on cancer Announcement calls for significant expansion of country level cancer control programmes. Monday 27 August 2012: Montréal, Canada – Ministers of Health and leading international figures at the 2012 World Cancer Leaders’ Summit (WCLS) today committed to reduce the burden of cancer through supporting wider uptake of national cancer control Cancer imparts on all societies a heavy burden of distress, suffering and death which is set to have enormous economic impact if governments do not take action now. This is true throughout the world, but particularly in countries lacking the health infrastructure to cope with the increasing number of people affected by the disease. Without sustained action, cancer incidence is projected to increase by 70% in middle-income countries and 82% in lower-income countries by 2030. It is also estimated that cancer and the other non-communicable diseases (NCDs) - diabetes, cardiovascular and lung disease - will cause an economic loss of output in low and middle income economies exceeding $7 trillion by 2025 - a yearly loss equivalent to 4% of annual output in these countries. “National cancer control programmes evaluate the best ways to control and prevent cancer at country level”, says Dr Oleg Chestnov, Assistant Director-General for Noncommunicable Diseases and Mental Health, World Health Organization (WHO). “Governments who early on committed to address noncommunicable diseases are already seeing progress in reducing cancer, diagnosing sooner and saving lives. Based on these successful examples, more countries should implement similar programmes.” Cancer leaders and government representatives from 50 countries assembled today at the WCLS, heard how nations which have designed and implemented robust NCCPs are now demonstrating marked progress in reducing the incidence of, and deaths caused by, cancer. Also showcased at this meeting was the value of robust data provided by population-based cancer registries in guiding and monitoring NCC planning, plus how governments around the world can articulate the economic case for action. For these reasons, delegates embracing academia, civil society organisations (CSOs) and the private sector, agreed to help support governments in the implementation of strong, action-oriented NCCPs in all countries by sharing best practice and information. “With cancer incidence set to rise dramatically in low- and middle-income countries in the next twenty years, an unsustainable burden is falling on these nations, both economically and socially. The international cancer community must commit support and expertise to help the developing world combat this trend through measures adapted to the specific cancer patterns occurring in these countries," commented Dr Christopher Wild, International Agency for Research on Cancer. A 2011 WHO report noted that the introduction of global interventions which will help avoid many millions of premature NCD deaths would cost approximately $11bn per annum to implement and result in many billions of dollars of additional global economic output. In recognition of the importance of NCCPs in the global fight against the disease, the Union for International Cancer Control (UICC) also today launched a new tool to help countries in their implementation of these critical programmes. The Supporting national cancer control planning: a toolkit for Civil Society Organizations provides CSOs with practical guidance and information to allow them to support their national authority in NCCP development. “We know the cost of inaction against cancer hugely outweighs the cost of action. We therefore urge governments without NCCPs to pledge the appropriate resources and financial support to implement these life-saving programmes. In turn, UICC is helping CSOs support national governments in realising the commitments they have made to improving cancer control," commented Dr Mary Gospodarowicz, incoming UICC President. File Size WCLS Press Release 789.24 KB Programme Destination Sponsors T&C and IP

医学

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As easy as riding a bicycle? tags: Catherine Hess, Cycling, gait freezing, Neuroscience, Parkinson's disease by Wellcome Trust Over the past few weeks, we’ve been publishing the shortlisted entries to the 2012 Wellcome Trust Science Writing Prize, in association with the Guardian and the Observer. This year, one entry in the category for professional scientists was Highly Commended by the judges: published yesterday in the Observer, here is Catherine Hess’s article about why riding a bicycle really isn’t that easy. Most of us remember our first proper bike. It’s a rite of passage, symbolising our transition from “little” to “big” kid. Even more exhilarating is the day we take our first ride without stabilisers. What most of us don’t realise is just how complex the art of riding a bicycle actually is. So complex, in fact, that researchers are just beginning to investigate how on earth we manage to propel ourselves, constantly rocking back and forth with the movement of our legs, on two skinny wheels; simultaneously navigating movement in multiple planes while trying to avoid countless obstacles. Most extraordinary is what the act of riding a bicycle can tell us about the human brain. In 2010 researchers from the Netherlands published a dramatic case study in the New England Journal of Medicine. Medical researchers at Radboud University in Nijmegen examined patients afflicted with Parkinson’s disease, a neurological disorder that results in tremors and involuntary muscle movements. In severe cases, Parkinson’s affects balance, co-ordination and limb control and can leave patients unable to walk or carry out basic tasks. One such patient, a 58-year-old man, suffered from what researchers call “gait freezing”. He was incapable of walking to the extent that he required visual guides to help him move one foot in front of the other and was unable to turn while walking. After a few steps the patient would lose his balance and would require his wheelchair. Astonishingly, however, this patient could still ride his bicycle. Flawlessly.Video evidence, submitted with the published case study (and now available on YouTube), shows the patient, with severe tremors in his arms, shuffling slowly and unsurely down a hallway while being guided by another individual. After several steps he begins to stumble forward until he falls to the ground. In a second video he is seen riding a bicycle with perfect movement and balance, the marked tremors in his arms are gone and he pedals at a consistent pace and with perfect balance and co-ordination. He cycles away from the camera, turns around and cycles back, slowing, stopping and dismounting perfectly. Once dismounted, however, he is again incapable of walking. This phenomenon is called kinesia paradoxica. While the mechanisms involved are still not understood, the knowledge is invaluable. It may lead to new forms of physical therapy and exercise for people with Parkinson’s disease or other neurological disorders that affect movement, co-ordination or balance. Currently, the “bicycle sign” is being suggested as an effective and inexpensive way to differentiate between Parkinson’s and the rarer atypical Parkinson’s. One way in which the two diseases differ is in the ability or loss of ability to ride a bicycle. Individuals with Parkinson’s who were able to ride a bicycle before the onset of symptoms retain the ability to cycle. Those with atypical Parkinson’s do not. But how is it possible for a man to ride a bicycle when he is essentially wheelchair-bound? More importantly, how does anyone adapt to the sensory whirlwind that is bicycle riding? Research teams at the University of California, Davis in America and the University of Delft, Netherlands, are trying to find out. What they have discovered is surprising. While we take it for granted that riding a bicycle is as easy as, well, riding a bicycle, it turns out that it is anything but. Led by Professors Mont Hubbard and Ron Hess, American researchers are attempting to model human-bicycle interactions in a similar manner to pilot-aeroplane or motorist-car interactions. However, there are many more physical and neurological processes involved in riding a bicycle than driving a car. “Riding a bicycle involves continuous use of all the human’s primary sensory capabilities, visual, vestibular [balance] and proprioceptive [the awareness of one's body and limb positioning],” says Hess. “The latter involves sensors in the arms providing information about steering inputs. What is more interesting though is the ability of the trained cyclist to ride a bicycle ‘hands-free’.” Recent research at the University of California, Davis has demonstrated how subtle body leaning by the cyclist enables this behaviour. “Imagine trying this control technique in an automobile or an airplane,” says Hess. The goal of this research is to understand how the cyclist interacts with both the environment and the bicycle and to develop bicycles that maximise performance, whether the rider is a Tour de France cyclist or a disabled cyclist needing greater stability or control. What is clear from research into both the human brain and the bicycle is that despite the bicycle’s simplicity we have yet to fully understand how it is that we manage to control it, and what is happening in the brain when we do. Our first wobbly bicycle ride, then, is a more remarkable event than we ever imagined. Catherine Hess Snijders AH & Bloem BR (2010) Cycling for freezing of gait. New England Journal of Medicine; 362:e46 Aerts MB, Abdo WF & Bloem BR (2011) The “bicycle sign” for atypical Parkisonism. The Lancet; 377, 125-6 Background information on UC Davis and Delft University research provided by RA Hess and M Hubbard, UC Davis. This is an edited version of Catherine’s original essay. Views expressed are the author’s own. Find out more about the Wellcome Trust Science Writing Prize in association with the Guardian and the Observer and read our ‘How I write about science‘ series of tips for aspiring science writers. Read all the essays from 2011 and 2012 in our archive. Image credit: Anthea Sieveking, Wellcome Images (top); Wellcome Images (left) from → Films and Videos, Neuroscience and Understanding the Brain, Wellcome Trust Science Writing Prize ← Wellcome Image of the Month: Men’s Health Meet the Fellow: Q&A with Professor Roger Kneebone → Jackart permalink 19 Nov, 2012 10:23 am The bicycle is truly one of mankind’s perfect machines. Reply sebvastian @ care homes in West Sussex permalink 19 Nov, 2012 4:42 pm That video is truly amazing, it always fascinates me how truly amazing the mind is. We are always learning just how little we know about things like this. It is good there are so many studies out there. Riding a bicycle always seems so easy, you don’t even have to think about it when you are doing it – how amazing that! Livros e bicicletas andar de bicicleta, um turbilhão sensorial « Livros e bicicletas From research to real life: Cycling for Parkinson’s | kaitlyn roland

医学

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Resisting the push to digitize By: Sarah Kliff May 18, 2010 05:06 AM EDT Electronic health records are often discussed as a panacea in health policy, with the potential to streamline record keeping, reduce costs and improve quality of care in one fell swoop. So it’s no surprise that the federal government has propped up the industry with $19 billion for health information technology from the American Recovery and Reinvestment Act, and bolstered that support with provisions in the health care reform law. But as a particularly stringent and new regulation nears, numerous medical groups say that the aggressive government push to digitize is too much, too soon. Health information technology in the United States remains highly fragmented, so any large overhauls, experts warn, must work on a timeline that stretches years into the future. The industry resistance could be a cautionary tale for the Obama administration, which has eagerly rolled out new health care provisions well ahead of deadline. As the accelerated push for electronic health care records shows, the country’s medical infrastructure cannot always keep up with the government’s unusually brisk pace. The regulation in question has to do with funds provided in the American Recovery and Reinvestment Act of 2009, informally known as the stimulus. The law authorized significant grants to hospitals and doctors serving Medicare and Medicaid patients that could demonstrate “meaningful use” of electronic health records. Industry observers expect to see a final rule by the end of the month, but hospitals and doctors have already had a preview of what the Centers for Medicare & Medicaid Services would count as a “meaningful user” of electronic health records. In January, the CMS published a proposed rule on how to determine eligibility. Hospitals and eligible providers would have to meet about two dozen “meaningful use” criteria to receive grant dollars in 2011. Among the requirements for doctors is the ability to e-prescribe and provide patients with access to their own electronic medical rec­ords upon request. But what CMS defined as “meaningful use,” major medical groups saw as an untenable and aggressive rule, one that would require meeting more than 20 benchmarks with a little more than a year to prepare. Both the American Medical Association and the American Hospital Association, alongside at least 50 other, smaller professional associations, have filed public comment protesting the definition. Through media campaigns and lobbying on the Hill, they have pushed for a more lenient implementation deadline, one that accommodates different approaches already under way and does not require providers to meet all requirements at once. “Most hospitals have electronic health records as part of their strategic plan, have identified how they’re going to tackle this problem, and all of a sudden CMS is saying, ‘No, you need to follow our priorities,’” said Chantal Worzala, director of policy at the AHA. “Part of the reason we’re looking for more flexibility is that this will be like changing horses midstream. We want to move faster but don’t want to completely change the game plan.” The lobbying campaign highlights some of the shortcomings of electronic health records: For all their benefits, they are expensive to implement and, for providers, a challenge to adjust to.For hospitals, Worzala said implementation is a “multiyear, multimillion-dollar project.” An electronic health system “is a big purchase for a doctor,” said Steven J. Stack, who chairs the AMA’s Health Information Technology Advisory Group. “It takes a year or more to redesign an office.” A study last month from Arizona State University found that electronic health record implementation was, over the course of the first decade, linked to higher hospital costs and, in some cases, lower quality of care. And while the $44,000 CMS incentive payment for doctors who digitize in 2011 roughly covers the cost of buying an electronic health records system, “it doesn’t factor in the productivity decrease when physicians are learning this or the extra staff they’ll need when that happens,” said Stack. In a recent survey, 68 percent of physician practices said the proposed “meaningful use” regulation would slow physicians’ daily work. Some, however, have said health care providers should stop resisting and work with the provisions that they have. “Even with the incentive of billions of federal dollars to cover much of the cost of the transition, doctors and hospitals have been slow to take even the first steps toward conversion,” the Boston Globe editorial board opined May 7. “Apparently, they feel little or no responsibility for symptoms that get misdiagnosed because of inadequate information about a patient’s past medical care, let alone the tests that get repeated because no one has a record of the previous results.” But even those who have worked with the government on health information describe the rules as well-intentioned but overly burdensome on health providers. “What they’ve done is directionally very reasonable. There’s just a little polish that we hope happens,” said John Halamka, vice chairman of the Department of Health and Human Services’ Health IT Standards Committee. “As we’re on this five-year trajectory, each community is going to need a little different timeline to make this work.” He suggests a “partial-credit” option, in which providers who meet a core 15 requirements can then meet five of 10 other provisions to become eligible for grants. The AHA has proposed easing the timeline for meaningful use, stretching back requirements until 2017 and lowering the number of requirements that hospitals would need to meet. The group’s proposal was bolstered in mid-March, when 249 members of the House sent a letter to CMS, calling the new regulation “too much, too soon for the vast majority of America’s hospitals.” Twenty-seven senators sent a similar letter. The back and forth over medical regulations will very likely become well-trod terrain as Health and Human Services continues to roll out health reform provisions, all of which require definitions to be written. Already, insurers, regulators and consumer advocates have haggled over “medical loss ratios” and determining what counts as a medical cost versus an administrative cost. With each new provision, and its accompanying definitions, a battle is all but certain to begin anew.

医学

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Surge Of Sign-Ups Expected To Hit Healthcare.gov Before March 31 Consumers who at least begin the enrollment process before Monday's deadline can avoid the health law's tax penalty, according to this week's Obama administration decision. The change, which some are calling an extension, has triggered some worry from insurers and a round of new attacks from the overhaul's opponents. The Wall Street Journal: Extension Of Health Law Signup Period Worries Insurers The Obama administration's decision to let some consumers enroll in health plans beyond Monday's deadline sparked concern among insurers and prompted fresh attacks from opponents of the health law. A surge of consumers is expected to hit HealthCare.gov before Monday's deadline to sign up for insurance and avoid a penalty under the Affordable Care Act. In the past, heavy traffic has stalled the federal site (Radnofsky and Mathews, 3/26). The Hill: Insurers Grow Sick Of O-Care The health insurance industry can’t wait for ObamaCare’s first enrollment season to be over so that it can have a break from dealing with the White House, sources on K Street say. Insurers feel that the administration has taken advantage of them by making repeated delays and changes to the law, even as they have gone above and beyond the call of duty to fix problems with the rollout (Viebeck, 3/27). The New York Times: U.S. Announces Further Exemptions For Insurance Enrollment Deadline The Obama administration on Wednesday expanded the list of people who could sign up for health insurance after the deadline, announcing “special enrollment periods” for legal immigrants, victims of domestic violence and tens of thousands of people who experienced various problems trying to complete their applications for coverage (Pear, 3/26). Los Angeles Times: Interest In Obamacare Surges Ahead Of Enrollment Deadline As Monday's deadline approaches to sign up for insurance under President Obama's health law, more than 1 million people a day are visiting HealthCare.gov, Obama administration officials said Wednesday. The site — the main portal for insurance marketplaces in 36 states — drew 1.2 million visitors Tuesday and 1.1 million visitors Monday, according to the administration. … The surge in consumers comes as the administration is taking steps to ensure that Americans who start the enrollment process by Monday but fail to complete it will still be able to get health coverage (Levey and Memoli, 3/26). Reuters: U.S. Extends Obamacare Sign-Up Deadline In Case Of Tech Troubles Americans in most states who tried to apply for medical coverage under President Barack Obama's healthcare law by a March 31 deadline but met with technical difficulties will get an automatic extension to enroll, officials said on Wednesday. The new federal guidelines apply to consumers in the 36 states served by the federal health insurance marketplace and its website, HealthCare.gov (3/26). NPR: That Health Insurance Deadline Now Comes With Wiggle Room We're just five days away from the March 31 deadline to sign up for individual health insurance under the Affordable Care Act. For weeks, administration officials, including the president, have insisted that there would be no extensions to the scheduled end of the six-month open enrollment period. But now there's some wiggle room. Let's review, shall we? (Rovner, 3/26). ABC News: Obamacare Deadline Extended, But Should You Wait? President Obama insisted last month that Monday, March 31, would be “last call” for Americans to sign up for a health insurance plan under the federal law without risking a financial penalty. Like so many other deadlines involving the Affordable Care Act, however, this one turned out to be flexible. The White House effectively extended the open enrollment period Tuesday by allowing anyone who claims to have started the enrollment process on or before March 31 to check a “special enrollment” box. Doing so grants the applicant a hardship exemption and gives them a yet-to-be-determined grace period to complete the enrollment process. The deadline to submit paper applications was also extended to a final-for-now date of April 7 (Neporent, 3/27). Politico: Obamacare Extension For Those ‘In Line’ The Obama administration is giving anyone “in line” for health coverage extra time to get it. But there isn’t really a “line” and nobody’s checking who’s on it. After insisting for months that the March 31 enrollment deadline would hold firm, the administration is giving America some wiggle room. The official deadline remains March 31, and the White House is strongly encouraging people to sign up now to avoid the crush. But it’s leaving the door wide open for people who say they had sign-up difficulty, broadly defined, to get more time (Norman and Cheney, 3/27). The Washington Post’s Wonkblog: Everything We Know About How Obamacare’s March 31 Deadline Works The Obama administration has been adamant that the latest enrollment announcement isn't a deadline extension. The big question, though, is how does the administration make sure people who say they tried to enroll before March 31 actually made that effort? As my colleague Amy Goldstein reported last night, CMS is going with the honor system. People submitting their applications on HealthCare.gov or through a call center after March 31 "attest" that they had trouble enrolling before the deadline (Millman, 3/26). CBS News: Obamacare Deadline Fluid, Depending On Where You Are As open enrollment on the new Obamacare marketplaces comes to a close, consumers across the nation will find that the leeway they're given to meet the deadline will vary depending on where they live. The Obama administration on Wednesday announced that anyone who begins to enroll in a health plan on HealthCare.gov before the March 31 deadline will have more time to finish the process. "Just like election day, if you are in line when the polls close, you get to vote," explained Julie Bataille, a spokeswoman for the Centers for Medicare & Medicaid Services (CMS). "We're doing all we can to ensure that every American who wants to enroll in affordable coverage by the end of the open enrollment period is able to do so” (Condon, 3/27). PBS NewsHour: Obama Administration Extends Health Care Sign-Up Completion Deadline To April 15 Five days before the March 31 enrollment deadline, the Obama administration says that Americans will have more time to sign up on federal health care exchanges if they’ve begun but can’t finish the process on time. Gwen Ifill talks to Mary Agnes Carey of Kaiser Health News and Ceci Connolly of PricewaterhouseCoopers Health Research Institute for a closer look at the extension and its critics (Ifill, 3/26). This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription. Previous From Cost and Quality California, Oregon Also Make Deadline Accommodations Next From Cost and Quality First Edition: March 28, 2014 Recent Morning Briefings

医学

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HomeNewsOpinionSportsObitsCommunityHeadlinesAgendasUSD 480 BoESC Council on AgingSC Tri-Agency Intervention BoardArea Planning CommissionArea Board of ZoningClassifiedsContacts ACA increases district’s healthcare costs by $1.68 million Saturday, 21 September 2013 09:55 By RACHEL COLEMAN No one knows when, if ever, the Affordable Care Act — often called “Obamacare” — will take effect. The foot-thick bill, notorious for having been passed by members of Congress who admitted they hadn’t read the entire document, proposes a massive overhaul of the United States health care system. No one knows whether the plan will work. Or if it will accomplish what was promised. But USD No. 480 finance director Jerry Clay knows one thing: if the bill does what he thinks it will, Liberal’s school district will be out nearly $2 million. “That’s if it goes the way we think it will, and if the board keeps the same plan we’ve had in place,” Clay said, emphasizing the word “if” with irony. “When people say there’s a storm on the horizon, that’s because there is.” For USD 480, the hefty price of the ACA comes because of the 30-hour rule. The bill requires all companies that employ 50 or more people to offer health insurance benefits to people who work 30 hours or more during a regular work week. The way the district’s insurance operates now, Clay said, the only employees eligible for coverage are those who work year-round, and teachers, whose benefits are tied to a labor-negotiated contract. With health-care reform, however, “we have 268 employees that can become eligible,” Clay said. The number was nearly as much a shock as the various requirements set out by the bill. “The first time around, when we were learning about the ACA, all the districts thought we’d be exempt. The rule said you had to average 30 hours a week over a year’s time. But then the clarification came out that school districts could only look at the nine months they operate, and average the hours worked during that time period. You can’t count the months employees are off against them.” Clay began to do the math. With its current plan, the district pays $525 per month for every employee currently receiving health-insurance benefits. This figure is roughly 87 percent of the total cost for a single-person plan. Though some employees opt to sign up for spousal or family coverage, the additional cost of those plans is paid entirely by the employee. The rates for insurance have remained steady, thanks to the district’s use of a health-care consultant. At a rate of $50,000 a year, the consultant seemed pricy to the board, until it realized how much higher insurance rates would have been without the expertise. “When we looked at getting a consultant, our healthcare costs were skyrocketing out of control,” Clay said. “Our insurance was going to go up 35 percent. The year after we hired the consultant, who helped analyze and bid it out, our rate went up only 2 percent, and it has stayed at that level since then.” The district had further cause to be grateful for the consultant when the Affordable Care Act arrived, with its many demands. Insurance plans offered by employers, the ACA notes, must be affordable and adequate. Those terms, of course, are subject to interpretation but the consultant sorted the details, Clay said. “We just had a conference call this morning, and they told us our plan meets both criteria. It is adequate and affordable.” What affordable means, in plain language, is no more than 9.5 percent of an employee’s gross pay. With the added stipulation that all coverage within a company must be nondiscriminatory regardless of title or salary, the threshold for “affordable” is set by the earnings of the lowest-paid employee. “We have to offer the same plan to everyone, and it can’t be too costly for the person making the least,” Clay said. At USD 480, those people are the janitors, the cafeteria workers, the classroom paraprofessionals, the maintenance staff. The combination of challenging, sometimes unpleasant tasks, low hourly wages and no benefits has caused problems for the district, which struggles to hire and retain quality employees. “We lose employees because they’ll go find another job in this community that is higher paying, 12 months and that does offer health insurance,” Clay said. “For USD 480 to be a competitive player in the job market, we’ve had to do better than that with our teachers, and the time has come that we have to do that with our classified employees. It’s just, the cost has been prohibitive in the past, so that it’s never been done. Now, there’s a federal law that says there’s no longer an excuse. You must have to do it. So now we have to determine how we will do it.” That’s when the numbers begin to trigger fear. “If we add 268 employees to our insurance coverage, that’s $1.68 million,” said Clay, “assuming people take it. That’s 65 percent of the $2.58 million we now pay. It’s a large number. It’s not a number I like to look at, by any means, and it becomes a question of where are you going to cut a million seven out of the budget? What’s not important to provide that education to the students? What can I give up today so it will be affordable to do this?” Clay said the district has three choices. It can stick with the current coverage levels, add the new employees to the plan, and find $1.68 million somewhere. It can cut back on its employee roster, letting people go or reducing their hours so that they do not reach the 30-hour mark. Or, it can keep the employees, offer the insurance, but pay a smaller portion of the monthly premium for everyone. For example, Clay said, if the district reduced its contribution to the lowest level allowed by the “affordable” stipulation in the ACA, it could shift $90 of each month’s premium back to the employees. But that would raise its own set of problems. The teachers’ contract, renegotiated each year when the academic year closes on June 1, traditionally sticks on the points of days worked and benefits paid. “Teachers have always wanted a full-pay single insurance,” Clay said. “Right now, we’re at about 87 percent.” Proposing what amounts to a $90 pay cut for each teacher will not be welcome, he said, and will affect the district’s ability to recruit excellent teachers. No matter how he looks at the situation, Clay said there are no easy answers. When he’s not crunching numbers, he asks questions that focus on the human side of the situation. “I hate to see employees not having insurance. I’m not going to say that I approve of the ACA, but our benefits coordinator Amy Zimmerman and I see people struggling because of the lack of insurance.” Employees often incur pay garnishments through the court system because they are slow in paying off medical bills without insurance benefits. “The problem that I have is not with health care reform,” Clay said. “The biggest thing is, why are health insurance rates so high? Why does it cost as much as it does to go see a doctor? When you have health insurance, and you get your statement from your provider, you see that you went to the doctor and the charge was $1,000 for example, and we marked it down to only $400, and then we’ve done this and the hospital is going to accept a payment of $250, and you don’t owe anything else. Is that right?” The people who mop the floors, and clean up the playground and serve food in the cafeteria don’t have insurance, said Clay, “so they don’t get that markdown and then they have this burdensome bill, which would challenge … anybody. We see a lot of that.” Zimmerman said she receives at least one call a day, asking “Am I eligible for health insurance?” “It’s the hardest part of my job,” she said. “I have to tell them, unfortunately, ‘You don’t qualify,’ and the next question they ask is, ‘What are my options? What can I do?’ It’s horrible. You put yourself in their shoes, and you understand. I couldn’t go without healthcare.” The human face of the Affordable Care Act may temper Clay and Zimmerman’s frustration with the complexity, the ever-shifting deadlines for implementation, and the many unknowns. However, at the end of the calculations, they are still faced with the problem of how to pay for the premiums. “We’ve done the steps of figuring out who’s affected, and what it will cost,” Clay said. “Now, it’s up to the board to look at the situation and decide what to do. This will have to be discussed, probably within the next six months.” With facilities needs up for discussion, and a potential bond issue in the near future, Clay said the timing is unfortunate. “Each one of the options I’ve looked at has positives and negatives. The earliest we’ll have to deal with it is for the next school year, but it’s possible it will be delayed. At some point, though, we’re going to have to comply, and we’re going to have to answer the question, ‘Where are we going to find those dollars?’”

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. Atrioventricular Canal (AV canal or AVC) 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 Brigham & Women's Hospital Residency Program, General Surgery, 1979 Royal Melbourne Hospital Internship Program, 1976 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." "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." Joshua's Story "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 Berul, MD, Named Co-Director of Children’s National Heart Institute 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 Addison's Story

医学

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Symptom checkerand free app! Follow us onsocial networks: At MountainView, it’s all about our patients. From the moment you walk through our doors, we want you to know that we are focused on providing high quality health care and the best possible patient experience. We have provided helpful information to help you during your stay or while visiting a patient in the hospital. Having Your Baby Imaging - Red Rock Radiology Las Vegas Institute for Robotic Surgery Rehabilitation - Inpatient Care At MountainView, we take a concierge approach to patient care, and offer dedicated clinical coordinators for many of our surgical programs. Our online directory allows you to search for hundreds of physicians and specialists in your area. MountainView Hospital is dedicated to the health and wellness of our community. This section provides information on our classes, support groups, community partners and helpful resources to help you manage your health. At MountainView, our employees live by the iCare philosophy, and are dedicated to patient safety, clinical excellence and customer service. Learn more about the opportunities available at MountainView Hospital. Otosclerosis occurs when abnormal new bone forms in the inner ear. This growth prevents proper functioning of other ear structures. This condition is a common cause of hearing loss. The Inner Ear The cause of otosclerosis is still unknown, but genetics appears to play a role. Otosclerosis is more common in Caucasians, Asians, females, and in people in their teens through late 40s. Other factors that increase chance of otosclerosis include: Family history of otosclerosis Drinking nonfluoridated water—some studies suggest that nonfluoridated water may cause a susceptible person to develop otosclerosis Hormonal factors, such as pregnancy Viral infections, including measles Gradual hearing loss is the main symptom of otosclerosis. Hearing loss may be of two types: Conductive—involving the small bones of the inner ear Sensorineural—involving the cochlea, which is the sensory organ in the inner ear Early in the disease, you may first notice trouble hearing low-pitched sounds or whispers. Other symptoms may include: A sensation of spinning Balance problems A sensation of ringing, roaring, or buzzing in the ear Your ears may be tested. This can be done with a hearing test. Images may be taken of your ear. This can be done with: Treatments may include: Hearing aids may be effective for conductive and sensorineural hearing loss. In many cases, a procedure called a stapedectomy may improve hearing. The purpose of this operation is to replace the diseased bone with an artificial device that can transmit sound waves to the inner ear. Stapedectomy is effective and frequently returns hearing to a near normal level. Fluoride tablets are sometimes prescribed to stabilize the condition and prevent further sensorineural hearing loss. However, this treatment remains controversial and unproven. Prevention methods include: Drinking fluoridated water Getting the measles vaccination Otosclerosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 4, 2012. Accessed September 17, 2013. Otosclerosis. Massachusetts Eye and Ear website. Available at: http://www.masseyeandear.org/for-patients/patient-guide/patient-education/diseases-and-conditions/otosclerosis. Updated July 3, 2012. Accessed September 17, 2013. Otosclerosis. National Institute on Deafness and Other Communication Disorders website. Available at: http://www.nidcd.nih.gov/health/hearing/pages/otosclerosis.aspx. Updated May 1999. Accessed September 17, 2013. What you should know about otosclerosis. American Academy of Otolaryngology—Head and Neck Surgery website. Available at: http://www.entnet.org/healthinformation/otosclerosis.cfm. Updated October 13, 2011. Accessed September 17, 2013.

医学

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UTEP.EDU | CALENDAR | MY.UTEP NEWS | RESEARCH | SOCIAL & ENTERTAINMENT | MULTIMEDIA | PRESS | CENTENNIAL Country’s Top Nurse Visits UTEP Last Updated on April 3, 2014 at 11:18 am By Laura L. Acosta UTEP News Service The top nurse in the United States talked about the importance of affordable medical care for underserved populations and the expanding role of nurses in health care during her recent visit to The University of Texas at El Paso’s School of Nursing. Nearly 150 undergraduate and graduate nursing students, faculty and staff listened attentively as Mary Wakefield, Ph.D., administrator of the Health Resources and Services Administration (HRSA), congratulated students on their career choice and described the employment opportunities available to them after they graduate, thanks to the Affordable Care Act (ACA). Ronnie Stout, left, director of UTEP’s Center for Simulation, shows Mary Wakefield, Ph.D, and U.S. Rep. Beto O’Rourke one of the simulation mannequins that nursing students use to practice their skills in the simulation lab. Photo by Laura Trejo / UTEP News Service “You don’t have to get beyond one nursing course to know the importance of keeping people healthy and not waiting to care for them after they get to an emergency room,” Wakefield said during her remarks in the Health Sciences and Nursing Building on March 20. “You know the importance of keeping people healthy (through) illness prevention and health promotion, and that’s exactly what the Affordable Care Act is designed to do.” In 2009, President Barack Obama selected Wakefield to head the HRSA, an agency of the U.S. Department of Health and Human Services that is the primary federal agency for improving access to health care services for people who are uninsured, isolated or medically vulnerable. Wakefield is the first nurse in the history of the HRSA to oversee the $8 billion agency, which provides tens of millions of Americans with affordable health care and other help through HRSA’s 100-plus programs and more than 3,000 grantees. “It’s encouraging for us to hear from the top nurse in the country,” said Gabriela Marquez, a sixth semester nursing student. “(She) gave us that motivation that we need as brand new nurses to know that the sky is the limit.” More than $10 million in HRSA funding for the School of Nursing over the past 10 years has had a major impact on educating the next generation of nurses and improving the quality of life in the Paso del Norte region, said School of Nursing Dean Elias Provencio-Vasquez, Ph.D.. “(This administration) values the knowledge and skills that you’ll have when you graduate from these (nursing) programs,” Wakefield told students. Wakefield was in El Paso for the ribbon-cutting of a new health care center in the central part of the city. She was joined by U.S. Rep. Beto O’Rourke, who invited her to meet with students and faculty at UTEP’s School of Nursing and to tour the University’s Center for Simulation. While the topics she discussed were serious, Wakefield often punctuated her speech with humor. “I spent the last 15 minutes looking at this facility (simulation lab) and learning what you’re learning as most of you who are students in this room, and I’m thinking, ‘Where would I be today if I had come out of this program?’” joked Wakefield, who received her master’s and doctoral degrees in nursing from The University of Texas at Austin. “I might have actually been able to make something of myself. It’s a pretty impressive operation (the simulation lab), that’s for sure.” According to O’Rourke, 180,000 El Pasoans are without health insurance. The city also has the longest wait times to see a doctor or a nurse. In addition, nearly 80,000 military veterans live in El Paso and require medical services for health issues including post-traumatic stress disorder and traumatic brain injury. O’Rourke said students coming out of the nursing programs at UTEP can help fill the significant gap in health care services in El Paso. “You can practice what you learned anywhere,” O’Rourke said to students. “It could be Austin; it could be Chicago; it could be Mexico City. I want you to know that El Paso needs you. Not only can you do the most good here, not only is there the greatest need here, I also think that there’s the greatest opportunity to be able to take care of people in a really unique, dynamic, binational community unlike anything else in the world.” Wakefield echoed O’Rourke’s sentiments. She also encouraged students to educate their friends and family about the ACA, which has also created new job opportunities for clinicians. Since the ACA was enacted, Wakefield said 4 million more patients are accessing care in community health centers, which has resulted in 4,500 additional nursing positions since 2009. Currently there are 18,000 nurses working in community health centers across the United States. The ACA also has made it possible to hire 5,000 nurse practitioners in community health centers. “When people are thinking where they want to work, (a community health center) is a place where people might want to work in terms of opportunities when they graduate,” Wakefield said. Wakefield also shared information about the HRSA’s National Health Service Corps’ loan repayment assistance program for qualified health care providers, which received an additional $1.5 billion through the ACA to put graduates to work as quickly as possible in urban, underserved areas and rural frontier communities. The program is open to nurse practitioners and other licensed primary care medical, dental, and mental and behavioral health providers. They will receive up to $50,000 in exchange for two years of service if they practice in a health professional shortage area. The corps is a valuable option, especially for disadvantaged students or minorities who may have challenges in paying their student loans, Wakefield said. Nursing undergraduate student Jose Hernandez didn’t want to miss the opportunity to hear from the country’s top nurse about how the ACA was going to affect his career and the care he provides his patients. “It’s about preventive medicine and not ending up in the emergency room for uncontrolled hypertension,” said Hernandez, who is doing his clinical rotation at a local hospital. “You see it at its worst when you’re in the hospital. If you could prevent it from them getting there, that’s the care that you want give.” UTEP Receives $22.6 Million to Build Southwest Biomedical Training & Research Consortium October Walking Tour Highlights “Haunted Campus” UTEP to Lead Development of Health Impact Assessment Program for Border Region Babies, Caregivers at UTEP Day Care Learn to Sign UTEP Receives $1.2 Million Grant to Prepare Bilingual Speech Language Pathologists New Graduate School Dean Comes Full Circle Microscope Technology will Enhance Array of Studies National Group Honors UTEP President With Diversity Award ON THE MOVE UPDATES Workers Prepare Area Around Geology Lawn, Lhakhang Overnight Paint Crews Finishing Sun Bowl Drive Project Framing Crews Will Start at Student Housing Complex New Exhibit Showcases Entries / Winners of the Centennial Photo Contest This Week in the Centennial Celebration: Oct. 19 – 25 Ecologists Keep Local Mosquitoes in Check UTEP Headlines Video Newscast for 10.17.14 Inside Academic Technologies: 60 Seconds with Dr. Meredith Abarca The UTEP Public Information Office can assist media personnel with interview requests to speak with University administrators, faculty expert sources, or students; or to arrange campus visits for photography / videography shoots. Call or email one of our media contacts with your name, outlet, deadline, and story idea or request to start an inquiry. Veronique Masterson E-mail: news@utep.edu Elizabeth Ashby The University of Texas at El Paso 500 W University Avenue | El Paso, Texas 79968 | 915.747.5526 State Reports | UT System | Customer Service Statement | Required Links

医学

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Genetically modified cell procedure in rats may prove useful in treating kidney failure A protein whose primary role is in the embryonic development of kidneys may play a future role in treating kidney failure. Indiana University School of Medicine researchers have successfully treated acute kidney injury in laboratory experiments using cells that were genetically reprogrammed to produce the protein. Wednesday, June 23, 2010 - 14:10 Lab animal study holds promise for treating clot-induced strokes in humans A synthetic version of a naturally occurring peptide promoted the creation of new blood vessels and repaired damaged nerve cells in lab animals, according to researchers at Henry Ford Hospital in Detroit. Tuesday, June 22, 2010 - 11:58 Mouse study offers novel pathway for new blood pressure treatments Researchers have found that increasing certain proteins in the blood vessels of mice, relaxed the vessels, lowering the animal’s blood pressure. The study provides new avenues for research that may lead to new treatments for hypertension. Gut-residing bacteria trigger arthritis in genetically-susceptible mice A single species of bacteria that lives in the gut is able to trigger a cascade of immune responses that can ultimately result in the development of arthritis. Gene therapy reverses type 1 diabetes in mice Researchers have developed an experimental cure for Type 1 diabetes, a disease that affects about one in every 400 to 600 children and adolescents. New therapy tested in laboratory mice offers hope to spinal muscular atrophy patients Children who suffer from the devastating disease Spinal Muscular Atrophy are set to benefit from a new breakthrough in therapy developments by researchers at the University of Sheffield. Thursday, June 10, 2010 - 13:53 Animal research findings are encouraging in slowing progression of Lou Gehrig's disease Dr. Kelvin Jones is looking at exercise as a new way to slow the degenerative processes of ALS, commonly known as Lou Gehrig’s disease. Jones, a recipient of a 2009 ALS Canada Discovery Grant, has been pioneering research in this field for four years, using mice genetically altered to present familial ALS. He’s found that exercise has a positive impact on the mice, slowing the disease significantly. Wednesday, June 9, 2010 - 11:49 Mouse study may shed light on role of estrogen in lung cancer in women As doctors have substantially brought down the rate of lung cancer in men over the past three decades, they face a stubborn riddle: Why does it continue to grow among women? A new study offers an intriguing possibility that the answer may involve estrogen. In mouse study, discovery of mechanism for clearing blockages from smallest blood vessels Researchers at Northwestern University Feinberg School of Medicine have identified in mice a previously unknown protective mechanism by which the smallest blood vessels remove blood clots and other blockages from the brain. The findings provide insights into mechanisms that may be involved in age-related cognitive decline, Alzheimer’s disease and recovery from stroke. Tuesday, June 1, 2010 - 14:13 Researchers create retina from human embryonic stem cells Complex tissue structure – a first – offers hope to millions with degenerative eye disorders. Thursday, May 27, 2010 - 11:47 Experimental vaccine protects monkeys from new Ebola virus New research has found that an experimental Ebola vaccine developed by researchers at the National Institutes of Health protects monkeys against not only the two most lethal Ebola virus species for which it was originally designed, both recognized in 1976, but also against a newer Ebola virus species that was identified in 2007. Friday, May 21, 2010 - 10:11 Scientists find protein spurs deadly spread of prostate cancer in laboratory mice Researchers from the Kimmel Cancer Center at Jefferson have found that Stat5, a signaling protein previously found to be key to survival of prostate cancer, is also involved in metastasis. SfN President: "Teach the public about the essential role of animal research in medical progress" As scientists engaged in biomedical research, we all know how important animal research is to our lives. When we or our loved ones take medicine, undergo minimally invasive surgery, receive vaccines to prevent polio or hepatitis, or even take a pet to the veterinarian, we have benefitted from health advances made possible through decades of responsible, regulated animal research - SfN President Michael E. Goldberg. Mouse studies promise possible option to surgery for colon cancer patients A team of University of California, San Diego School of Medicine researchers has discovered that common intestinal bacteria appear to promote tumor growths in genetically susceptible mice, but that tumorigenesis can be suppressed if the mice are exposed to an inhibiting protein enzyme. Monday, May 10, 2010 - 15:35 Research with mice could help veterinarians decode animals' pain Humans are not the only ones to grimace when they have pain, scientists have found. Monday, May 10, 2010 - 13:44 Complete regression of malignant brain tumors in animal model after treatment with parvoviruses After the positive results of animal research, researchers are convinced that parvoviruses are suitable candidates for use in treatment of advanced glioblastomas. Wednesday, May 5, 2010 - 09:58 Flaxseed-fed chickens shed light on ovarian cancer In the race to find answers about ovarian cancer, researchers now have something to cluck about. Wednesday, May 5, 2010 - 09:29 Animal research findings: Stem cells from surgery leftovers could repair damaged hearts. Scientists have for the first time succeeded in extracting vital stem cells from sections of vein removed for heart bypass surgery. Monday, April 26, 2010 - 13:06 Researchers find a single gene is responsible for OCD-like behaviors in mice The genetically altered mice, which behaved much like people with a certain type of obsessive-compulsive disorder (OCD), could help scientists design new therapies for this debilitating condition. Monday, April 26, 2010 - 12:36 Research project targets diseases shared between humans and animals Researchers from the Field Museum and the University of Chicago are collaborating on a project to investigate how rare and potentially fatal diseases that stem from animals, such as AIDS, SARS and Ebola, transfer to humans.

医学

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Alsius Corporation Awarded Three-Year GPO Agreement With Novation 12/18/2008 6:24:51 AM IRVINE, Calif., Dec. 18 /PRNewswire-FirstCall/ -- Alsius Corporation (Nasdaq: ALUS - News), the worldwide leader in intravascular temperature management (IVTM(TM)) therapies for critically ill patients, was awarded a three-year contract with Novation LLC to provide intravascular temperature management products to Novation's extensive network of over 2,500 member hospitals. "We are pleased that our intravascular temperature management solution was chosen by Novation," said Bill Worthen, president and chief executive officer of Alsius. "This is the sixth contract that we have been awarded by a major hospital group purchasing organization in the U.S., further validating the adoption and growing industry support for our innovative technology." Novation is a leading group purchasing organization (GPO) representing over $33.1B in annual U.S. healthcare spending. Included is the University HealthSystem Consortium (UHC), an alliance of 103 academic medical centers and 191 of their affiliated hospitals representing approximately 90 percent of the nation's non-profit academic medical centers. The agreement will be effective on January 1, 2009. "The agreement with Alsius represents an excellent example of how Novation seeks to ensure that we're meeting the needs of our members by providing emerging technologies that offer the highest quality of care and demonstrate clinical acceptability," said Cathy Denning, Senior Director - Surgical Contracting of Novation. About Alsius IVTM(TM) Alsius IVTM consists of the CoolGard 3000® and Thermogard XP® systems and a family of single-use catheters, including the Cool Line®, Icy®, Fortius®, Solex(TM) and Quattro(TM) catheters. The catheters are inserted into a major vein through a patient's neck or groin, and circulate cool or warm saline in a closed-loop through balloons that surround the catheters. This approach decreases or increases core temperature from the inside of the body out toward the exterior, allowing for significantly more rapid control of a patient's core body temperature, with greater efficiency and precision, compared to conventional external temperature management products such as cooling and warming blankets and ice packs. About Alsius Corporation Alsius, headquartered in Irvine, Calif., is a medical device company that develops, manufactures and sells proprietary products to precisely control patient temperature in hospital critical care settings. Controlling body temperature, through cooling and warming, is becoming the standard of care for patients in select critical conditions and those undergoing a variety of surgical procedures. Alsius markets a comprehensive suite of catheter-based intravascular temperature management products that address the need for effective, accurate, easy-to-use and cost-effective control of body temperature in critical care patients. For more information, visit http://www.alsius.com. Founded in 1998, Novation is the leading health care contracting services company for more than 2,500 members of VHA Inc. and the University HealthSystem Consortium (UHC), two national health care alliances and nearly 13,000 members of Provista, LLC. Novation offers its customers contract development and management, supply chain data and measurement, and industry knowledge and advocacy. Based in Irving, Texas, Novation develops and manages competitive contracts with more than 500 suppliers. VHA, UHC and Provista members used Novation contracts to purchase more than $33.1 billion in 2007. For more information on Novation, visit http://www.novationco.com. This press release may contain statements regarding plans and expectations for the future that constitute forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. All statements other than statements of historical fact are forward-looking. Such forward looking statements, including prospects for sales under the GPO agreement discussed in this release, are based upon the current beliefs and expectations of Alsius' management, and are subject to risks and uncertainties which could cause actual results to differ materially from those described in the forward-looking statements. The information set forth herein should be read in light of such risks. Additional information concerning such risks and uncertainties are contained in Alsius' filings with the Securities and Exchange Commission, which can be accessed electronically on the Securities and Exchange Commission website at http://www.sec.gov. Source: Alsius Corporation

医学

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groups/system/documents/webasset/afl_custom_fck_flashvideo.jsgroups/system/documents/webasset/custom_fck_externallink.js groups/system/documents/webasset/ss_true_false_selector.htm This is the image that will be used by Facebook when sharing a page as the thumbnail. groups/system/documents/webasset/ss_img_url_form.htm Our History Share this Page My Saved Articles » My ACS » Your Local Offices + -Text Size Our History The Early YearsThe American Cancer Society was founded in 1913 as the American Society for the Control of Cancer (ASCC) by 15 prominent physicians and business leaders in New York City. At that time, a cancer diagnosis amounted to near certain death. Rarely mentioned in public, this taboo disease was steeped in fear and denial. Physicians sometimes did not tell their patients they had cancer, and patients often did not tell their friends and families if they had been diagnosed. The Society’s founders knew they had to raise public awareness about cancer if progress was to be possible. The number of doctors, nurses, patients, and family members to be reached was overwhelming. Despite the enormity of their task, our founders and their colleagues set about writing articles for popular magazines and professional journals; publishing Campaign Notes, a monthly bulletin of cancer information; and recruiting physicians throughout the country to help educate the public. It was in these early years that the Society first used its now-iconic Sword of Hope symbol, which today is part of the organization’s logo. The sword came from a 1928 nationwide poster contest sponsored by the ASCC and the New York City Cancer Committee. George E. Durant of Brooklyn won the contest, receiving a first prize of $500. He selected the sword to express the crusading spirit of the cancer control movement. The twin-serpent caduceus, which forms the handle of the sword, emphasizes the medical and scientific nature of the Society's work. Classically, twined serpents represent healing of the sick and creativity of the healthy. Over the past 80 years, the logo has changed many times. The current American Cancer Society logo presents a contemporary, powerful, and cohesive entity. The trapezoidal shape with the angled edge suggests forward movement, aspiration, and growth. The overall design creates the image of a flag being carried forth toward victory. This symbol is intended to unite people in the common goal to save lives from cancer. The Women's Field ArmyIn 1936, Marjorie G. Illig, an ASCC field representative and chair of the General Federation of Women’s Clubs Committee on Public Health, made an extraordinary suggestion. She proposed creating a legion of volunteers whose sole purpose was to wage war on cancer. The Women’s Field Army, as this organization came to be called, was an enormous success. Its recruits donned khaki uniforms, complete with insignia of rank and achievement, and went out into the streets to raise money and educate the public.In 1935, there were 15,000 people active in cancer control throughout the United States. At the close of 1938, there were 10 times that number. More than anything else, it was the Women’s Field Army that moved the American Cancer Society to the forefront of voluntary health organizations. New DirectionsIn 1945, the ASCC was reorganized as the American Cancer Society. It was the beginning of a new era for the organization. World War II was over; the single greatest threat to modern democracy had been defeated; and the nation could at last focus its attention on the public health enemy at home. Many believed it was time for another bold move. In 1946, philanthropist Mary Lasker and her colleagues met this challenge, helping to raise more than $4 million for the Society – $1 million of which was used to establish and fund the Society’s groundbreaking research program. With the aid and assistance of dedicated volunteers like Lasker and Elmer Bobst, our research program began to bear fruit. In 1947, we also began our famous cancer signals campaign, a public education effort about the signs and symptoms of cancer. Making ProgressAround the same time the cancer signals campaign began, Dr. Sidney Farber, one of the Society’s first research grantees, achieved the first temporary cancer remission in a child with acute leukemia using the drug Aminopterin, thus opening the modern era of chemotherapy for cancer treatment. It was just the beginning of how scientists who the American Cancer Society supported early in their careers would go on to make great leaps in understanding and stopping cancer. Society-funded researchers have contributed to nearly every major cancer research breakthrough we’ve seen in the more than 60 years since the Society’s research program began. They’ve helped establish the link between cancer and smoking; demonstrated the effectiveness of the Pap test; developed cancer-fighting drugs and biological response modifiers such as interferon; dramatically increased the cure rate for childhood leukemia; proven the safety and effectiveness of mammography; and so much more. All told, the American Cancer Society has invested more than $4 billion in research, including giving 47 future Nobel Prize winners the recognition and funding they needed to get started.Expanding Our ReachIn the 1960s and 70s, the American Cancer Society began to expand its reach as an organization, working even more than in the past to involve all sectors in its efforts to fight back against the disease. In the 60s, the Society was instrumental in the development of the Surgeon General’s report on the link between smoking and cancer when early Society-sponsored studies confirmed the connection. This upheaval in the perception of smoking laid the groundwork for tobacco control progress – and for the corresponding lives saved – that continues today. Our advocacy later contributed to the passage of the National Cancer Act in 1971, which granted special funds and authority to expand the National Cancer Institute (NCI) and revolutionized the war on cancer. With the development of the NCI, the American Cancer Society also had to adapt to a new role – that of filling in the gaps of the federal government’s focus in areas such as cancer prevention and education. Likewise, as National Institutes of Health funding for young investigators has diminished, the Society has allocated more research grants to that generation, helping promising young medical researchers enter the cancer field. Today, the American Cancer Society is a global leader in the fight against cancer, with $1 billion in resources annually to save lives by helping people stay well and get well, by finding cures, and by fighting back against the disease. Thanks in part to the Society’s work, there are more than 14 million people alive in the United States alone who have survived cancer. In fact, more than 400 lives are being saved each day that would have otherwise been lost to the disease. And we won’t rest until we expand that progress so that no one – in the US or around the world – will ever lose another birthday to cancer. Last Revised: 6/30/14 Honoring People Who Are Making A Difference ACS Policies Dr. Len's Blog

医学

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Home » Latest Articles and News » Standards for regulation of acupuncture to low in Australia Standards for regulation of acupuncture to low in Australia Source: http://au.news.yahoo.com/latest/a/-/latest/13326985/standards-too-low-for-chinese-medicine-practitioners/ The Australian Medical Association (AMA) says the standard has been set too low for the registration of Chinese medicine practitioners. AMA president Steve Hambleton says the association wants the same standards held for Chinese medicine practitioners as doctors. "We believe the registration standards are quite low and too low," he said. "We've actually argued that continuous professional development should be the same as a doctor - 20 hours per year. The recency of practice needs to be the same." Mr Hambleton says there is also a concerning language barrier. "The English language standard is something that we hold dear in the medical profession - you need to be able to communicate with your local public," he said. In a bid to raise the standards, from July this year it will be mandatory for Chinese medicine practitioners to be registered with the Australian Health Practitioner Regulation Agency. Issue of 'legitimacy' But two medical academics are critical of the move. Associate Professor Hubertus Jersmann from the University of Adelaide says while registration may reduce some illegal practices, it gives credibility to medicines that have not necessarily been proven. "If the Government registers this medicine, many of the populous will think that it's equal to an approval of what they are doing as okay," he told The World Today. "They're giving legitimacy to something that hasn't been legitimised. "Just because for some reason this becomes popular, lots of people want to do unproven, potentially unsafe things on themselves which is their prerogative, I don't think the Government should then say 'oh well, let's regulate it then, at least it's better than unregulated'. "It needs to [come] down to principles and the principle is they cannot show evidence that it's safe and efficacious and they seem to refuse to want to do so." Professor Charlie Xue, the head of the new Chinese Medicine Board and the head of Health Sciences at RMIT University, says regulation will lead to increased scientific evidence about the effectiveness of Chinese medicine. "All healthcare interventions including Chinese medicine needs ongoing assessment of efficacy and safety and being a clinical researcher myself, I am aware that not all Western medical approaches are evidence-based either," he said. "The development of Chinese medicine has been over a very long period of time and the diagnostic methods which has been effectively used to guide clinical practice, they are different from the Western medical approach, but it doesn't mean they are wrong." Professor Xue says the point of regulation is not to boost credibility, but to ensure public safety.He says that is definitely happening in Victoria, which has been registering Chinese medical practitioners for 10 years. Back To Latest Articles and News Palpation in Chinese Medicine DVDby Wang Mingsan TENS TRIO 310The 310 can be used on th... Rang & Dale's Pharmacology, 6th editionby Humphrey Rang, Maureen... Tom Riihimakiby Bob Felt Acurea Standard Cupping Set - 17 pieces17 piece cup vacuum cuppi...

医学

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Search Health Information Weight-Lifting May Boost Heart Health in Black Men: StudyResistance training linked to positive cardiovascular effects, but same impact not seen in whites THURSDAY, Jan. 3 (HealthDay News) -- A little weight training may go a long way toward helping improve the heart health of black men, new research suggests. Just six weeks of resistance exercise appears to have a positive impact on the blood levels of key indicators for inflammation, immune response and/or artery shape among black men. Such indicators, or "markers," are known to rise in conjunction with tissue damage, infection and stress. But after weight training, levels of two of the markers dropped in these patients, the researchers found. However, while the association was observed among black men it was not found among white exercisers. This caveat tracked an earlier finding by the same research team that showed that while black men who lifted weights experienced a drop in an important post-injury/infection inflammation marker known as C-reactive protein, white men did not. "This suggests that resistance exercise training is more beneficial in young African-American men than in [white] men of the same age," Bo Fernhall, dean of the College of Applied Health Sciences at the University of Illinois at Chicago (UIC), said in a university news release. Fernhall, who led the study as a professor in the department of kinesiology and community health at UIC's Urbana-Champaign campus, and colleagues reported their findings online recently in the Journal of Human Hypertension. The researchers noted that in the United States, cardiovascular disease -- particularly in the form of high blood pressure (or hypertension), stroke and kidney disease -- is more prevalent among blacks than whites. "Higher blood pressures in African-American children have been shown as young as 8 to 10 years of age," Fernhall said. "So there's obviously something going on that predisposes the African-American population to end-stage disease, hypertension and stroke and the more debilitating diseases later on in life." The focus of the current investigation was on indicators in the blood that signal arterial trouble, including one involved in blood vessel remodeling and one that signals oxidative stress. Levels of both dropped among black men who lifted weights. Study co-author Marc Cook, a UIC doctoral student, pointed out that this builds on prior research that has shown that aerobic activity also helps to lower levels of oxidative stress markers. "[So] if you don't like cardiovascular exercise, if you don't like running on a treadmill, if you can't play basketball or you're not good at it, you can lift weights and improve your health, especially when it comes to high blood pressure," Cook said. "If you just want to lift weights and you do it on a regular basis, you could improve your function." While the study found an association between cardiovascular health and weight training in black men, it did not prove a cause-and-effect relationship. More information For more on blacks and heart disease, visit the American Heart Association. SOURCE: University of Illinois at Urbana-Champaign, news release, December 2012 Copyright © 2013 HealthDay. All rights reserved. Finger Lakes Health 196 North Street, Geneva, NY 14456 315-787-4000

医学

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CIRM Approves $40.6M in Early Translational Research Grants The governing board of California’s stem cell agency approved 13 grants totaling $40.6 million for research intended to identify, then advance into clinical trials potential therapies from basic research in prostate cancer, heart disease, liver disease, autism, and HIV/AIDS. The Independent Citizens Oversight Committee (ICOC) approved grants for investigators based at 10 institutions under the Early Translational IV Research awards program of the California Institute for Regenerative Medicine (CIRM). The program is designed to fund research that will result in the development of new potential drug or cell therapies, or make what CIRM deems “significant” strides toward such therapies. "The strategies are focused on problems where we think there is a very reasonable chance that they will evolve into clinical studies for treating some of the worst diseases we have in the community,” CIRM president Alan Trounson, Ph.D., said in a statement. Of the 13 grants, the largest was the nearly $6.4 million awarded to John R. Cashman, Ph.D., president and founder of Human BioMolecular Research Institute. Dr. Cashman’s team told CIRM it will use patient-derived human induced pluripotent stem cell-cardiomyocytes toward developing a safer drug envisioned to treat the human genetic heart disorder Long QT syndrome type 3. The institution capturing the largest share of the $40 million in total grants was the Eli & Edythe Broad Center of Regenerative Medicine and Stem Cell Research at University of California, Los Angeles, where four researchers won a combined roughly $13 million. The largest of the four UCLA grants went to Jerome Zack, Ph.D., professor of medicine and microbiology, immunology and molecular genetics. His research team will use an approximately $5.3 million award – second-largest of the 13 grants – to engineer blood-producing stem cells designed to create T cells capable of eliminating HIV-infected cells, to be given to patients through a bone marrow transplant. UCLA’s next largest grant at about $4.1 million was won by Robert E. Reiter, M.D., to develop a monoclonal antibody targeting castration-resistant prostate cancer stem cells, with the goal of long-term remissions through possibly eliminating the cancer stem cells responsible for recurrent disease. Among other winners of early translational awards: Dan Gazit, Ph.D., D.M.D., director of the Skeletal Regeneration and Stem Cell Therapy Laboratory at Cedars-Sinai Medical Center, won $5.3 million – the third largest of the 13 early translational grants – toward using gene-modified stem cells to help speed up healing in segmental bone fractures. Magdalene J. Seiler, Ph.D., of UC Irvine won $4.3 million toward creating sheets of retinal cells to repair damage from both age-related macular degeneration and retinitis pigmentosa. In addition to UC Irvine, UCLA, Cedars-Sinai, and HBRI, the 10 winning institutions included one business, Numerate, as well as Stanford University, UC Davis, UC San Diego, The J. David Gladstone Institutes, Sanford-Burnham Medical Research Institute, and The Salk Institute for Biological Studies. The early translational grants mark the latest large investment for CIRM, which is funded through $3 billion in bonds approved by California voters when they passed Proposition 71 in 2004. In July, the agency approved a $70 million plan to create the Alpha Stem Cell Clinics Network, a new statewide network of sites that will act as a hub for stem cell clinical trials. In May, CIRM awarded $36 million in funds to attract six scientists to the state, and more than $6 million to create a partnership with Sangamo BioSciences to develop a therapy for the blood disorder beta-thalassemia. And in March, the organization announced a plan to set up a stem cell bank and approved nine applications to generate the cells to fill it. KEYWORDS: Autism New CIRM President Makes Cuts Human iPSC-Derived Hepatocytes

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2/4/201311:45 AMNeil VerselNewsConnect Directly2 commentsComment NowLogin50%50% Obama Urged to Mandate Medical Error ReportingEx-Bush Treasury secretary and Alcoa chief Paul O'Neill says president should use upcoming State of the Union address to call for hospitals to submit daily online report of all accidents, infections and medication errors. 7 Portals Powering Patient Engagement(click image for larger view and for slideshow) President Obama made a brief mention of healthcare outcomes -- in the context of healthcare spending -- during his Super Bowl pregame interview with CBS News anchor Scott Pelley on Sunday, but some are looking ahead to what he might say during his annual State of the Union address on Feb. 12. One high-profile healthcare safety advocate, Paul O'Neill, former U.S. Treasury secretary and chairman and CEO of Alcoa, wants the president to seize the prime-time, national platform to make a bold statement about the problem of medical errors. "In your State of the Union message, announce that you have ordered each of the veterans' hospitals and U.S.-based military hospitals to connect with the Internet at 8 a.m. every day to post every hospital-acquired infection, every patient fall, every medication error and every injury to a caregiver that occurred during the previous 24-hour period. Announce that this will commence March 1, and that it is your intention to require all U.S. hospitals and nursing homes to start doing this on April 15," O'Neill wrote in a Jan. 27 op-ed published in the Pittsburgh Post-Gazette. [ Mistakes made in electronic health records should be reported, says group. Read EHR Vendors Endorse Medical Error Reporting System. ] As chief executive, Obama can order Department of Veterans Affairs (VA) and Military Health System to report errors, though it is less clear whether he can place the same requirements on private facilities, even as a condition of participation in Medicare or Medicaid. "To have the desired impact, it is important that this information be reported separately for each facility for each 24-hour period," wrote O'Neill, who served in the George W. Bush administration and now is on the board of the Lucian Leape Institute at the National Patient Safety Institute. "That is because, every 24 hours across the nation there are, on average, 4,658 newly identified hospital-acquired infections, 1,369 patient falls and perhaps as many as 800,000 medication errors." O'Neill, co-founder of the Pittsburgh Regional Health Initiative, has long championed adapting the Toyota Production System to create safer healthcare environments. He said that it was important to post data daily in the name of transparency. "It is not possible today for a citizen to go on the Internet to discover how safely, or how carelessly, a local provider is providing care," he wrote. "And it is not possible for care-giving institutions to gauge their own performance and compare it to others. By your action, you could enable individuals to choose where they go for service, based on the absence of error, not on the basis of proximity or advertising claims. And you would allow care-giving institutions to identify the best performers across the nation and learn how to improve their practices." But he cautioned that the disclosures not be used in a punitive manner, and suggested that Obama promise to end the requirement in three years if it is not result in significant error reduction and cost savings. This non-adversarial approach makes sense to James Conway, principal of the governance and leadership group of Washington-based healthcare analytics and clinical quality improvement firm Pascal Metrics, and a senior fellow at and former senior VP of the Institute for Healthcare Improvement (IHI), Boston, an organization founded by well-known healthcare quality guru and onetime Centers for Medicare and Medicaid Services administrator Dr. Donald Berwick. "I would not want to penalize the organizations that are reporting the higher level of events," Conway told InformationWeek Healthcare. Additional reporting makes people more attuned to problems, Conway said. He explained that organizations with a strong culture of safety tend to have a "preoccupation with failure." That means they are committed to identifying and then rooting out sources of failure, he said. "While the goal is to eliminate these events, we will need to be very careful not to penalize those organizations that report more -- they may be preoccupied with looking for trouble. Others, while having many instances of harm, will see few," Conway later added in an e-mail. "Some hospitals in the United States are experts in finding trouble and some aren't," Conway said. "Some use very sophisticated means of identifying errors," he said, specifically naming the IHI's Global Trigger Tool for Measuring Adverse Events, a system for reviewing patient records based on clues that could indicate potential errors. "You're discovering tenfold more adverse events [with the tool than without it] because it is very sophisticated," he said. This estimate comes from an April 2011 article in Health Affairs, written by University of Utah healthcare quality gurus Dr. David Classen and Dr. Brent James, and contributed to by a team from IHI. The article found that voluntary reporting and even following the U.S. Agency for Healthcare Research and Quality's Patient Safety Indicators missed 90% of adverse events picked up by the Global Trigger Tool. "The least effective tool is voluntary reporting," said Conway, who also is a former executive VP and COO of Dana-Farber Cancer Institute in Boston. When he was at Dana-Farber, the goal was to have the highest level of reported errors and the lowest level of errors that actually reached patients. O'Neill fostered a culture of worker safety at Alcoa. "Paul as chairman of Alcoa woke up every day and looked at safety reports," Conway said. "It drives you to an exceptional level of performance." Federal Meaningful Use Stage 2 requirements will make your medical organization more competitive -- if they don't drive you off the deep end. Also in the new, all-digital Meaningful Mania Part 2 issue of InformationWeek Healthcare: As a nation, we're falling short of the goal of boosting efficiency and saving money with health IT. (Free with registration.) Comment | Email This | Print | RSSMore InsightsWebcasts User Rank: Apprentice3/4/2013 | 10:10:12 AM re: Obama Urged to Mandate Medical Error Reporting This would be great in creating more transparency between healthcare institutions and in creating a competitive environment with institutions capable of seeing the performances of their competitors and in turn trying to improve their own performances. Also, if an institution was to perform exemplary, others may look towards that institutions practices and try to emulate them in order to create a safer, more beneficial healthcare system for everyone. Jay Simmons Information Week Contributor re: Obama Urged to Mandate Medical Error Reporting ItG��s interesting to see how this would work in the long run and if it would be possible to expand from Houston based to statewide or nationwide coverage. One main issue with health information exchange like this has always been security so it would be good to see how they manage to create a safe environment if they were to encompass a broader market. If it does work, it would be great for the health IT field as the exchange of information across providers has always been a factor that has been holding it back from fulfilling its true capacity. Jay Simmons Information Week Contributor

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:: Oncology Imaging :: Bone Imaging :: Link Library :: Find An Imaging Center :: Physicians About PET/CT | Visualizing Disease When disease strikes, the biochemistry of cells and tissue changes. In cancer, for example, cells begin to grow at a much faster rate. In one continuous whole-body scan, PET/CT captures images of changes in the body's metabolism caused by actively growing cancer cells and provides a detailed picture of the body's internal anatomy that reveals the size, shape and exact location of the abnormal cancerous growths. The PET/CT scan begins with injection of a glucose-based radiopharmaceutical which travels through the body, eventually collecting in the organs and tissues targeted for examination. The patient lies flat on a table that moves incrementally through the PET/CT scanner. The CT portion of the exam sends X-rays through the body which are then measured by detectors in the CT scanner. A computer algorithm then processes those measurements to produce images of the body's internal structures. The PET scanner has cameras that detect the gamma rays emitted from the patient, and turns those into electrical signals. These are processed by a computer to generate the images. The table moves slowly through the scanner and many sets of PET and CT images are produced. The CT and PET images are assembled by the computer into a 3-D image of the patient's body. If an area is cancerous, the signals will be stronger there than in surrounding tissue, since more of the radiopharmaceutical will be absorbed in those areas. Each imaging modality can be viewed independently of the other without compromise, or used in concert for complementary functional and anatomic diagnosis. PET/CT is a highly sensitive procedure that aids in the detection of small cancerous tumors and subtle changes in the brain and heart. This enables physicians to identify and treat these diseases earlier and more accurately. Image courtesy of University of Tennessee Medical Center, Knoxville, TN, USA MI LifeNet

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- Tryptophan a-amino-b-[3-indollyl]-propionic acid Unsubstantiated claims Please note that this section reports on claims that have NOT yet been substantiated through scientific studies. Tryptophan may induce sleep and has been used to treat insomnia. It is said to be a natural antidepressant and stress reducer. It may help treat hyperactivity in children and mania in people with bipolar disorder. Tryptophan also decreases the appetite. The FDA has prohibited sales of tryptophan because it is seen as a dangerous chemical. Although controversy continues as to whether tryptophan is the cause for a potentially fatal side effect, at this time it is recommended that no one take supplemental tryptophan. Side effects, toxicity, and interactions The use of tryptophan has been associated with a potentially fatal condition called eosinophilic myositis or eosinophilia-myalgia (EMS). This condition was linked to tryptophan produced by a Japanese company that had recently changed its chemical processes. The cause of the condition has been hotly debated; most scientists doubt that tryptophan itself caused the condition, but rather that it was caused by some intermediate in the reaction. Ongoing studies have implicated 4,5-tryptophan-dione as the probable contaminant. In a study of over-the-counter tryptophan, this contaminant was found to make up 0.5 to 10.3 percent of the samples of tryptophan. The presence of this contaminant in all samples suggests that current tryptophan supplements are not safe to use. Click here for a list of reputable websites with general information on nutrition.

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Funding Announcement: Request for Proposals National Psoriasis Foundation Translational Research Grant The National Psoriasis Foundation (NPF) is seeking grant applications that encourage the advancement of innovative research into psoriasis and psoriatic arthritis. Translational Research Grants fund research initiatives that focus on the rapid translation of basic scientific discoveries into clinical applications with a clear benefit for patients with psoriatic disease. Special for 2015: Psoriatic Arthritis Research Grant In a special collaboration with the Arthritis National Research Foundation (ANRF), the NPF and ANRF will jointly fund one translational research project focused specifically on psoriatic arthritis. To apply for this special opportunity, applicants must meet special eligibility criteria described below. For consideration, eligible applicants must complete the standard Translational Research Grant application and identify their interest in the designated location. Eligible applicants may use a single application to be considered for both the traditional Translational Research Grant and the Psoriatic Arthritis Research Grant. Anticipated number of awards: As many as five new Translational Research Grants will be awarded in 2015. Awards are contingent on the availability of funds and the receipt of sufficiently meritorious applications. Budget and project period: Applicants may request up to $100,000 (direct costs only) per year. The total project period for the application submitted in response to this Request for Proposals is two (2) years. For both the Translational Research Grant and Psoriatic Arthritis Research Grant: The principal investigator must be personally and actively responsible for the conduct of the proposed research, and eligible to apply for research grants under the guidelines of the applicant’s host institution. The principal investigator need not be a United States citizen. For the Psoriatic Arthritis Research Grant only: Priority will be given to applicants who are senior postdoctoral fellows or early stage assistant professors transitioning to independence. Associate and full professors are deemed too senior for this award. Applicants may not have (or have ever had) an NIH R01 grant or equivalent. (“Or equivalent” is defined as receipt of an NIH K08 grant and other support totaling more than $200,000 per year.) The work must be completed at a U.S. nonprofit research institution. Important deadlines: Applications must be received by Wednesday, Oct. 15, 2014. They will be evaluated by an expert panel of peer reviewers and awards will be made no later than April 1, 2015. The Translational Research Grant application is available at www.psoriasis.org/grants. All information regarding application length and format can be found in the Translational Grant Application Packet. For more information on the Translational Research Grant program please contact Research Programs Manager Michael Siegel, Ph.D. at research@psoriasis.org.

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Wellness Center | Women's Center Home > StayWellProducts > Hepatoblastoma What is hepatoblastoma? Hepatoblastoma is a very rare cancerous tumor that starts in the liver. The liver is one of the largest organs in the body. The primary functions of the liver include filtering and storing blood. The liver consists of right and left lobes. This disease primarily affects children from infancy to about 3 years of age. Hepatoblastoma cancer cells can spread (metastasize) to other areas of the body, but this is rare. Anatomy of the liver The liver is located in the upper right-hand portion of the abdominal cavity, beneath the diaphragm and on top of the stomach, right kidney, and intestines. Shaped like a cone, the liver is a dark reddish-brown organ that weighs about three pounds. The liver consists of two main lobes, both of which are made up of thousands of lobules. These lobules are connected to small ducts that connect with larger ducts to ultimately form the hepatic duct. The hepatic duct transports the bile produced by the liver cells to the gallbladder and duodenum (the first part of the small intestine). The liver regulates most chemical levels in the blood, excretes a product called "bile," which makes clotting factors that keep the body from bleeding when injured, and helps remove waste products from the body. What causes hepatoblastoma? Although the exact cause of liver cancer is unknown, there are a number of genetic conditions that are associated with an increased risk for developing hepatoblastoma, including Beckwith-Wiedemann syndrome, Wilson disease, porphyria cutanea tarda, and familial adenomatous polyposis. Other genetic conditions associated with liver cancer include several inborn errors of metabolism such as tyrosinemia, glycogen storage diseases, and alpha1-antitrypsin deficiency. Children who are exposed to hepatitis B or hepatitis C infection at an early age, or those who have biliary atresia, are also at increased risk for developing hepatocellular carcinoma. Some hepatoblastomas have genetic alterations in tumor suppressor genes, which would explain the uncontrolled cell growth. What are the symptoms of hepatoblastoma? The following are the most common symptoms of hepatoblastoma. However, each child may experience symptoms differently. Symptoms may vary depending on the size of the tumor and the presence and location of metastases. Symptoms may include: A large abdominal mass, or swollen abdomen Weight loss, decreased appetite Early puberty in boys Jaundice (yellowing of the eyes and skin) Itching skin Enlarged veins on the belly that can be seen through the skin The symptoms of hepatoblastoma may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis. How is hepatoblastoma diagnosed? In addition to a complete medical history and physical examination, diagnostic procedures for hepatoblastoma may include: Biopsy - a sample of tissue is removed from the tumor and examined under a microscope. Additional blood tests - may include blood chemistries, blood clotting tests, evaluation of liver and kidney functions, and genetic studies. Multiple imaging studies, including: Computed tomography scan (Also called a CT or CAT scan) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays. Ultrasound (Also called sonography) - a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels. Alpha-fetoprotein (AFP) test - alpha-fetoprotein (AFP) levels in the blood can be used to diagnose and follow response to treatment. What are the different stages of childhood liver cancer? Staging is the process of determining whether cancer has spread and, if so, how far. There are various staging symptoms that are used for hepatoblastoma. Always consult your child's physician for information on staging. One method of staging hepatoblastoma is the following: Stage I - usually a tumor that in only in the liver and can be completely removed with surgery. Stage II - usually a tumor that can mostly be removed by surgery but very small amounts of the cancer are left in the liver. Stage III - usually a tumor that cannot be completely removed or cancer cells are found in nearby lymph nodes. Stage IV - cancer that has spread (metastasized) to other parts of the body. Recurrent - the disease has returned after it has been treated. It may come back in the liver or in another part of the body. Treatment for hepatoblastoma Specific treatment for hepatoblastoma will be determined by your child's physician based on: Your child's tolerance for specific medications, procedures, and therapies Treatment for hepatoblastoma is generally aimed at resecting (removing) as much of the tumor as possible while maintaining adequate liver function. Liver tissue can regenerate when removed. Other forms of treatment may include (alone or in combination): Surgery (to remove tumor and part or all of the liver) Percutaneous ethanol injection - a small needle is used to inject an alcohol called ethanol right into the tumor to kill cancer cells Watchful waiting - not starting treatment until symptoms appear or change Long-term outlook for a child with hepatoblastoma Prognosis greatly depends on: The extent of the disease. The size and location of the tumor. Presence or absence of metastasis. The tumor's response to therapy. The age and overall health of your child. Your child's tolerance of specific medications, procedures, or therapies. New developments in treatment. As with any cancer, prognosis and long-term survival can vary greatly from child to child. Prompt medical attention and aggressive therapy are important for the best prognosis. Continuous follow-up care is essential for a child diagnosed with hepatoblastoma. New methods are continually being discovered to improve treatment and to decrease side effects. Walter Green, MD Ronald Schubert, MD Jeffrey Ashby, MD Kimberley Wyrick, DO Shawn Lepley, MD Health Could the Naked Mole Rat Hold Secrets to Longevity? Can I Be Checked for Ewing Sarcoma Before I Have Symptoms? What Are the Symptoms of Malignant Mesothelioma? Firearms--Injury Statistics and Incidence Rates How Doctors Use Biopsies to Help Evaluate Malignant Mesothelioma Minor Problem vs. a True Emergency Health Tip: Smokeless Tobacco Isn't Safe Either Genetics and Cancer - Cowden Syndrome Tote Your Baby in a Sling—Safely Hodgkin Disease Virtual Tour Planning a visit to Sentara RMH? Take a tour of our campus before you come.

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More Than Half a Million Kids Still Getting Codeine During ER Visits SlateThe SlatestYour News Companion by Ben Mathis-LilleyApril 21 2014 1:56 PM More Than Half a Million Kids Are Still Getting Codeine During ER Visits By Daniel Politi A woman arranges "get well" balloons she is selling under a sign pointing to the emergency entrance to Los Angeles County USC Medical Center Photo by David McNew/Getty Images Despite the evidence that the powerful narcotic codeine doesn’t work—and could be fatal—in children, doctors are prescribing the painkiller to hundreds of thousands of children in emergency rooms each year. Somewhere between 559,000 and 877,000 kids are getting the drug from doctors annually, according to a 10-year study published in Pediatrics, reports CBS News. From 2001 to 2010, the number of kids who ended with a codeine prescription after an ER visit dropped from 3.7 percent to 2.9 percent. Even though the decline is good news, doctors say it’s surprising it hasn’t decreased closer to zero, reports NBC News. “Ultimately, we found an incredible number of prescriptions still occurring,” said Dr. Sunitha V. Kaiser, an assistant clinical professor of pediatrics at the University of California, San Francisco, who led the research. Kaiser says all doctors and parents should know there are safe, and more effective, alternatives to codeine for both coughs and pain. "Codeine is a pro-drug, which means it's converted into morphine by your liver," Dr. Dyan Hes explains to CBS News. "In children, not all of the enzymes work the same. In anybody actually, the enzyme can have different levels of activity, so some children can ultra-metabolize this, which means they rapidly convert it to morphine and that can lead to respiratory suppression and eventually death.” Although it isn’t clear why doctors continue to prescribe codeine to kids, some suggest it could have to do with having adult ER doctors taking care of pediatrics patients. Daniel Politi has been contributing to Slate since 2004 and wrote the "Today's Papers" column from 2006 to 2009. You can follow him on Twitter @dpoliti.

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U.S. teens' e-cigarette use associated with smoking -study Source: Reuters - Thu, 6 Mar 2014 16:08 GMT By Toni Clarke WASHINGTON, March 6 (Reuters) - A study published on Thursday found an association between smoking and e-cigarette use among adolescents but didn't answer a pressing public-health question on whether e-cigarettes acted as a gateway to smoking. Published in JAMA Pediatrics, the study found that among those who have smoked, adolescents who also used e-cigarettes were less likely to have given up smoking than those who did not not use e-cigarettes. The authors of the study, Lauren Dutra and Stanton Glantz, a prominent opponent of e-cigarettes, concluded that the "use of e-cigarettes does not discourage, and may encourage, conventional cigarette use among U.S. adolescents." Critics say the results do not support such a conclusion. Dr. Michael Siegel, a professor of community health sciences at Boston University School of Public Health who has spoken publicly in favor of e-cigarettes, said that while the study draws a correlation between smoking and e-cigarette use, there was no evidence to prove e-cigarettes led to smoking. "The authors seem to have an axe to grind," he said. "I could equally argue that what this study shows is that people who are heavy smokers are attracted to e-cigarettes because they are looking to quit." The study was funded by the National Cancer Institute and conducted by the University of California San Francisco's Center for Tobacco Control Research and Education. It comes as the U.S. Food and Drug Administration prepares to gain regulatory control over e-cigarettes, which generated sales of nearly $2 billion last year, and which some analysts believe could eventually exceed the $80-billion tobacco market. The aim of the study was to further understand the relationship between e-cigarette use, conventional cigarette use and quitting among U.S. adolescents. It relied on data from some 40,000 adolescents who completed the 2011 and 2012 National Youth Tobacco Surveys carried out by the Centers for Disease Control and Prevention. The authors said that since the study did not follow its subjects over time, they couldn't determine whether most youths began smoking conventional cigarettes before moving to e-cigarettes, or vice versa. Adult smoking rates have fallen to 18 percent from 43 percent in 1965. Even so, more than 3,200 young people a day under the age of 18 try their first cigarette, a recent government report found, and the use of e-cigarettes by young people doubled between 2011 and 2012. E-cigarettes are battery-powered cartridges that look like cigarettes and contain a nicotine liquid that, when heated, creates an inhalable vapor. This vapor, advocates say, is less dangerous than traditional cigarette smoke since it does not contain lung-damaging tar. Nicotine itself is considered relatively benign compared with cigarettes, but data on the long-term safety of e-cigarettes, which contain a variety of chemicals, is limited. That uncertainty has led a number of cities, including New York, Chicago, Boston and, most recently, Los Angeles, to restrict the use of e-cigarettes in restaurants, bars, nightclubs and other public spaces. We welcome comments that advance the story through relevant opinion, anecdotes, links and data. If you see a comment that you believe is irrelevant or inappropriate, you can flag it to our editors by using the report abuse links. Views expressed in the comments do not represent those of the Thomson Reuters Foundation. For more information see our Acceptable Use Policy.

医学

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Rwanda Steps up to the Challenge of Universal Reproductive Health Care RWAMAGANA, Rwanda — The health centre just on the outskirts of town seems to be a community hub: Near the main clinic men, women and children sit around the perimeter of a courtyard waiting to be seen by a health worker. In another room, women waiting for family planning counselling are watching a television show that dramatizes the seriousness of AIDS. Outside, children play, and men on bicycles and motorbikes come and go. Under the shade of a tree in the yard, Daphrose Nyirasafali, a reproductive health advisor for UNFPA, the United Nations Population Fund, is exhorting the group of about 100 men and women health promoters who will talk to members of their community about family planning and distribute contraceptives. They respond with a cheer. Later they will head back to their communities. The women, many of them who have worked in the past as traditional birth attendants, will talk to other women about the impact that fewer children can have on the health and well-being of the whole family. They will also help monitor pregnant women for any danger signs and to encourage them to get regular pre-natal checkups. The men will make a special effort talk to husbands about the multiple benefits of smaller families. Talking about family planning These Rwandan women are happy that they have support, from the clinic, the community and their husbands, to space births and limit the size of their families. The outreach effort seems to be very effective, even in this mainly Catholic country, where large families – six children or more -- have traditionally been esteemed and been the norm. Most Rwandan women now say they want between three and four children – and educated women want fewer than three. Conversations with women outside of the clinic add a human dimension to the numbers. Josiane, a 30-year-old woman with a two-year-old in her lap, and two more children at home, says she doesn’t have the capacity to raise more. “Myself, I’m a farmer and I will do all I can to have my three children educated. My husband was the one who suggested we stop.” Angelique, 20 years old with one baby, says her husband also encouraged her to use contraception. They want two more children, but she’s using an injectable to space the next birth – six years in the future, she hopes. Marie Louise has three children and is done with childbearing. She also encourages others to choose smaller families, “because with a lot of children you might not be able to give each one their right to education,” she says. Daphrose, 40, has seven children, and is having a hard time making sure they all have enough to eat. “I wasn’t informed when I was younger,” she complains. “Now I want no more children, because I’m a farmer and I’m facing school fees.” She said that she started using contraception four years ago, after years of having a baby every year or two. “My body wasn’t in a good state then,” she said. “I was very skinny – just 50 kilograms.” Now she has a fleshed out a bit, and finds that she has much more energy. In fact, she is so energetic and so enthusiastic about family planning that she has become a community mobilizer herself. “Because of my testimony, all my neighbors have come here too,” she says proudly. Focus on husbands It hasn’t always been that way. When the family planning clinic opened in 2001, some women were reluctant to use contraception, according to Chantal Gahonga, the director of the health centre. Working closely with community leaders in the area, she was able to organize outreach to villages, paying particular attention to husbands. “We encouraged them to tell their wives to come. They started to understand that after all, they have the burden of feeding the family.” The health centre she directs offers a wide range of primary health care: a paediatric clinic, laboratory , pharmacy, prenatal clinic where women with HIV can get antiretroviral drugs to protect their babies, vaccinations, voluntary counselling and testing for HIV, tuberculosis testing and treatment, nutritional supplementation and family planning services. It serves a population of about 53,000 – actually 52,977, according to Ms. Gahonga. Like many health administrators throughout Rwanda, she is in firm command of statistics related to her work. Charts and graphs monitoring the number of clients taking advantage of vaccinations, HIV testing and family planning counselling are posted on the wall behind her desk. She, like other health administrators throughout the country, is held accountable to meeting performance-based benchmarks and indicators. In the decentralized health system, every manager reports to the next level – from the village to the sector to the district to the province, said Cheikh Fall, the deputy representative for UNFPA in Rwanda. “At every level they sign performance-based contracts. And on a yearly basis, they take two or three days to report in front of the President Kagame and development partners. Even we, as the UN have to report. This is why you see health indicators being improved in an incredible way. Health indicators on the rise “It is really innovative and evidence-based approach,” he added. “Every report is backed up by data.” As a result of this, and other innovations, all health indicators in Rwanda are dramatically improving. Use of modern contraceptives increased from 10 to 17 per cent in just three years (2005-2008), a remarkable improvement. Skilled attendance at birth rose from 39 to 52 per cent in the same period. The average family size has decreased from 5.8 in the 2000 DHS to 5.5 in an interim survey (2007-2008). The ideal family size, according to the same survey, is now between three and four children. Maternal and infant deaths are decreasing, especially among impoverished women. Another key innovation is the community-based health insurance system, which means that decent health care is widely available. A few years ago the country instituted Mutell de Sante, a health insurance plan that offers voluntary health insurance for the entire population. It’s based on a pooling of resources at the community level. For an annual premium of less than $2 per household, health services are almost free, and 85 per cent of Rwandans participate. A quiet revolution Dr. Asha Mohamud, a regional advisor for UNFPA, recently made visited this clinic, as well as a number of other health facilities throughout the country to evaluate progress. She was enthusiastic about what she saw. “We knew that Rwanda was ‘called the Singapore of Africa’ due to the fast pace of development, and we saw a quiet revolution is going on under our noses!!” Health Centre director Chantal Gahonga explains family planning methods to health promoters. Photo: Didier Habimana She pointed to a number of innovative approaches in maternal health—where UNFPA is an important partner. Each maternal death is audited to discover the cause of death, and a similar effort is underway for infants. Traditional birth attendants are officially banned from delivering babies but now often monitor pregnancies, encourage women to get regular antenatal care and educate them about potential problems. Women who take advantage of regular prenatal screening can have free institutional deliveries. The country is also working hard to reduce HIV, much of which is legacy of the genocide. It is estimated that half a million women were raped, and the genocide sparked massive movements of people across borders. HIV testing is encouraged, and antriretroviral treatment is widely available. Couples are encouraged to get tested for HIV together, and, if one is found to have the virus, to work out strategies to protect the other. “I have seen the highest number of women accompanied by spouses or partners in one day than in many other health services visited where you see only women or men in some settings!” said Dr. Mohamud. “This offers an opportunity to systematically encourage them to negotiate safe sex.” Learning from Rwanda She added that after her tour of health facilities, she concluded that “Rwanda as a whole is a demonstration project for many of the strategies that UNFPA promotes.” In an address last summer to a World Health Organization-sponsored meeting of health ministers and delegations, Rwanda’s President Paul Kagame challenged other African leaders to also commit to the strategic investments in the health of their people. “It is not pre-ordained that our continent must remain impoverished, illiterate, and in poor health – and if we can make the noted modest achievements in Rwanda, a country that is by no means rich, we can do better regionally and continentally,” the Rwandan leader said. --- Janet Jensen and Didier Habimana Rwanda's Efforts in Family Planning Begin to Pay Off

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RHINELANDER - Walking. We all do it without thinking about it, right? But there is a right and a wrong way to walk.The Oneida County Department on Aging and Health Department's "Walk With Ease" Program is all about getting senior citizens moving. Brenda Husing, RDCD, Oneida County Health Department, says, "It's a program that incorporates not only exercise, but also motivation techniques in dealing with all the different barriers people have, and helping them to overcome that." 62-year-old Robert Tjensvold says he's lost three pounds with the program and says his hip pain is virtually gone. He says the program has helped him learn the right and wrong ways to walk. He tells us, "You can't just get up and go walking. You have to stretch-get your body used to the movement and then you have to start your walking. Then you have to cool down and stretch also."Jolene Schirmacher, Walk with Ease Instructor, says "A lot of people think if they're in a walking class they have to half run or they have to be swinging their arms or they have to keep up with the crowd; and everybody in this program does their own pace."Walkers learn about wearing the right gear and how to walk on different terrains. They are also given educational workbooks provided by the Arthritis Foundation to help outline their walking goals. Husing says, "Walking is a great exercise because its low impact. Its cardiovascular and it can also help with weight management."Tjensvold adds, "I feel terrific. I feel that I'm on my way down in weight. I do need to lose quite a bit and that possibly might let me get out of the diabetes altogether; so that's what I'm working for."Working for a healthier future, one step at a time. You can sign up for the Walk with Ease program at the Oneida County Department on Aging. The program runs for six weeks. Story By: Asavari Phadnis

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Landmark, Steward sign agreement June 7, 2011 By RUSS OLIVO rolivo@woonsocketcall.com WOONSOCKET — Steward Health Care System of Boston is moving full-speed ahead on its plans for acquiring Landmark Medical Center. A week after a Superior Court judge approved the $76 million deal, Landmark and Steward announced yesterday that they have have signed an asset purchase agreement, a core component of the sale. The agreement would make Landmark a part of Steward, parent company of the Caritas Christi Health Care network. “We are excited to have reached an agreement to make Landmark Medical Center a part of Steward,” said Bob Guyon, chief operating officer. “Landmark is not just a health care provider, it is a vital economic engine for the region. Joining Steward will secure Landmark's long-term financial viability and ensure the hospital is always there to serve the Northern Rhode Island community.” Landmark, which filed for receivership in June 2008, saying it was on the brink of insolvency, remains under the supervision of special master Jonathan Savage pending regulatory approval. A decision from the regulators, including state Health Director Michael Fine and Attorney General Peter Kilmartin, is several months away, at best. But Savage says the approval of the asset purchase agreement is further cause for optimism about Landmark's future. “This agreement came together as the result of the hard work and commitment of a broad coalition of stakeholders at Landmark who worked tirelessly to preserve this essential community asset,” he said. Savage said he was particularly grateful to the members and leadership of the United Nurses and Allied Professionals Local 5067, which represents about 600 of the roughly 1,200 patient-care workers at Landmark and the Rehabilitation Hospital of Rhode Island. The latter, in North Smithfield, is included in the asset purchase agreement. Savage said the union was “instrumental in bringing Steward back to the negotiating table at a truly critical juncture in the judicial process.” Steward emerged as a surprise bidder for the hospital in an eleventh-hour pitch on May 27 as talks with the second round of bidders, fielded by Savage months earlier, were falling apart. It was, in effect, the company's second offer on the hospital, because Caritas Christi had bid on Landmark in early 2009, pulling out after a dispute with Blue Cross/Blue Shield of Rhode Island. The Caritas network was later bought out by the Cerberus Capital Management of New York, a private equity firm which formed Steward as its health care arm. At the time, the Caritas group consisted of six hospitals in eastern Massachusetts, but Steward has since purchased others. Steward now includes St. Anne's Hospital in Fall River, Holy Famly in Methuen, St. Elizabeth's in Brighton, Norwood Hospital, Carney Hospital in Dorchester, Good Samaritan in Brockton; Nashoba Valley in Ayer, and Merrimack Valley in Haverhill. Christopher Callaci, general counsel for UNAP, says the agreement marks “a great day” for Landmark and the many patients who depend on the hospital for quality care. “We look forward to working with Steward to continue serving the residents of Northern Rhode Island for years to come.” Guyon said Landmark will soon see benefits as a result of the agreement. He said Steward has invested more than $100 million in clinical information technology to improve efficiency and communication among network physicians. Landmark will have “immediate access to this technology and an experienced management team to oversee its implementation.” Landmark would also experience the benefits of “operating synergies” that come from being part of a larger network, Guyon said. “Our mission is to keep care in the community by investing in our hospitals, growing our world-class physicians network and bringing the latest medical technology to the community hospital setting,” Guyon said. Now that the asset purchase agreement is signed, Landmark and Steward are poised to hammer out the details of another complex part of the merger – a management advisory agreement, said Bill Fischer, spokesman for Landmark. That agreement will include provisions for Steward to funnel operating revenue into cash-strapped Landmark while the marriage is under review by the state regulators, said Fischer. There have been “initial discussions about how we approach the Hospital Conversions Act,” according to Fischer, though he said is premature to provide details about the coming regulatory review.

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Search... Children’s Hospital Researcher Named 2013 Pew Scholar By being named a 2013 Pew Scholar, Children’s Hospital investigator Claudio Giraudo, PhD, joins a “prestigious community of Nobel laureates, MacArthur fellows, Albert Lasker Basic Medical Research Award winners, and hundred of other pioneers who earned Pew grants at the start of their careers.” The Pew Scholars are each awarded $240,000 over four years to conduct their research, and Dr. Giraudo is one of just 22 researchers to be selected out of 134 nominated. The Pew Scholars Program in the Biomedical Sciences “identifies and invests in talented researchers in medicine or biomedical sciences,” enabling “promising scientists to take calculated risks and follow unanticipated leads to advance human health,” according to the Pew website. Since 1985, Pew has awarded more than 500 investigators over $130 million in research funding. After receiving his doctorate in cell biology and biochemistry from the National University of Cordoba, Argentina in 2002, Dr. Giraudo went on to do postdoctoral research at Memorial Sloan-Kettering Cancer Center, Columbia University and Yale University. In 2012 he joined the faculty of Children’s Hospital and the University of Pennsylvania as an assistant professor of pathology and laboratory medicine. Dr. Giraudo’s lab studies “intracellular membrane trafficking and calcium-regulated exocytosis in eukaryotic cells,” researching how immune cells secrete granules that destroy infected cells. With the support of the Pew Scholar grant, Dr. Giraudo hopes “to identify the protein machinery cytotoxic T lymphocytes (CTLs) use to secrete granules that break down cells.” A type of white blood cell, CTLs target and kill other cells, including cancer cells and cells that have been infected with viruses. “This award will give me the chance to study what happens at the cell membrane during the body’s immune response, which could be therapeutically targeted to improve prognosis and quality of life of patients,” Dr. Giraudo said. In addition to better understanding cell-mediated killing, the Pew-supported research project could also shed light on how similar processes lead to disease, such as in diabetes and brain disorders, he added. Privacy PoliciesTerms of UseFeedback Facebook Twitter Copyright © 2014 Discovery To Innovation. All Rights Reserved.

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A medical advance that doesn’t involve government interference Posted on December 3, 2012 at 7:23 am, by Mitch Kokai The latest Bloomberg Businessweek devotes six pages to concierge medicine, a concept that treats health care like most other market-based services. Atlas MD isn’t a free clinic. It’s a concierge medical practice, which means you can’t get an appointment unless you pay cash. Atlas MD’s two physicians, Josh Umbehr and Doug Nunamaker, don’t accept insurance. Instead, they charge most of their adult patients $50 a month for unlimited visits. They also offer free EKGs and biopsies and cut-rate prices on prescription drugs. Two-thirds of their patients have insurance but feel the fee is well worth it for personalized service, including house calls, the doctor’s cell-phone number, and quick responses to e-mails and Twitter messages. The rest of Umbehr and Nunamaker’s clientele are uninsured. For those patients, Atlas is the only way of seeing a family doctor regularly. Contrary to those who say concierge doctors like themselves are getting rich by focusing on personalized care at a high price, Nunamaker and Umbehr, who are in their early 30s, contend that they can grow their practice by appealing to a broader clientele. “I want to be one of the 1 percent,” says Umbehr, who likes to talk business as much as he does medicine; Ayn Rand’s Atlas Shrugged inspired the name of his two-year-old practice. “But the problem with the 1 percent is there’s only 1 percent of them. If you want to build a business model that’s really far-reaching and world-changing, then it’s got to fit everybody.” It was midway through the month when the homeless woman arrived at Atlas MD, so Nunamaker asked her for $25 and examined her immediately. She told him she was always tired and couldn’t keep a job. She was living in a storage shed. Nunamaker gave her a blood test, which revealed an extreme case of hypothyroidism. That explained her exhaustion. “I get why you are so fatigued,” he said. “Your thyroid isn’t working as well as it should.” He put her on medication that would boost the hormone her thyroid gland wasn’t producing and restore her vitality. The woman stayed with Atlas MD for three months until she was feeling better. Then she left. Nunamaker gave her three months of inexpensive prescription refills and wished her well. He would have preferred to see her stay on. But he and Umbehr are proud that they were able to restore her health for $147, including tests and prescriptions. (They made money on her monthly retainer, but not on the tests and labs. Atlas MD provides them at cost.) They estimate that she would have paid as much as $1,500 if she had gone to a regular doctor. Categories: Health care Written by Mitch Kokai View all posts by: Mitch Kokai

医学

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Tobacco industry appears to have evaded FDA ban on 'light' cigarette descriptors New research from Harvard School of Public Health (HPSH) shows that one year after the federal government passed a law banning word descriptors such as "light," "mild," and "low" on cigarette packages, smokers can still easily identify their brands because of color-coding that tobacco companies added to "light" packs after the ban. These findings suggest that the companies have, in effect, been able to evade the ban on misleading wording—thus still conveying the false and deceptive message that lights are safer than "regular" cigarettes. In addition, the companies failed to apply for applications to have these products approved as "new products" as called for by the law. The study was published online March 13, 2013 in Tobacco Control. "The tobacco industry was found guilty by a federal court in 2006 for deceptively promoting 'light' cigarettes as safer after countless smokers who switched to lights died prematurely, thinking they had reduced their health risks. After a new federal law was passed in 2009 to end the tobacco industry's deceptive marketing practices, the industry has apparently circumvented it by using new and sophisticated ways to deceive consumers and has not sought Food and Drug Administration approval for these products as required by law," said study co-author Gregory Connolly, director of the Center for Global Tobacco Control at HSPH and professor of the practice of public health in the Department of Social and Behavioral Sciences. After the U.S. Surgeon General's 1964 report found that cigarette smoking causes disease, tobacco companies began marketing "light" cigarettes with ventilation holes that allowed air to mix with smoke, which the companies said would limit the amount of smoke a person would inhale. However, a 2001 National Cancer Institute (NCI) report found that smokers compensate for the lower smoke yield in "light" cigarettes—and thus ingest as much tar and nicotine as "regular" cigarettes—by smoking more intensely, more often, or by blocking the ventilation holes with their fingers or lips. In 2006, a U.S. federal court ruled that tobacco companies should be banned from any future use of descriptive words that convey a false health message. The FDA—given the authority to regulate tobacco products in 2009 as part of the Family Smoking Prevention and Tobacco Control Act—subsequently issued its ban. To see whether the tobacco companies were complying with or circumventing the ban, the HSPH researchers examined retailer manuals from the tobacco company Philip Morris; manufacturers' annual reports filed with the Massachusetts Department of Public Health; national cigarette sales data; and the results of a 2011 national public opinion survey that included questions about smokers' perceptions of their brands being "light" or regular. The study describes how Philip Morris removed the terms "light," "ultra-light," and "mild" from cigarette packs and substituted new brand names and colors. For example, the "Marlboro Light" brand was renamed "Marlboro Gold," "Marlboro Mild" was renamed "Marlboro Blue," and Marlboro Ultra-light" was renamed "Marlboro Silver." Other tobacco companies made similar changes. The cigarettes themselves remained unchanged, however; the percentage of ventilation in each category of "light" sub-brands was the same after being renamed and given a new color descriptor. Ventilation is the principle determinant of whether a cigarette is called "light." In addition, the study notes that a Philip Morris brochure for retailers stated, "Some cigarette and smokeless packaging is changing, but the product remains the same. For trade use only: not to be shown or distributed to consumers." In the public opinion survey, more than 90% of the smoker respondents said that, one year after the FDA ban, they found it either "somewhat easy" (10%) or "very easy" (82%) to identify their usual brand of cigarettes—in other words, they still thought of certain brands as "light" even though the packages did not use the "light" descriptors. "This study demonstrates the continued attempts of the industry to avoid reasonable regulation of tobacco products. Scrutiny is needed by the FDA and courts to ensure that tobacco manufacturers comply with the law and that their products no longer convey false impressions of reduced risk," said study co-author Hillel Alpert, research scientist in the Department of Social and Behavioral Sciences. The results will be presented at the annual meeting of the Society of Nicotine and Tobacco research on March 14, 2013 in Boston. More information: "Has the tobacco industry evaded the FDA's ban on 'Light' cigarette descriptors?" by Gregory N. Connolly and Hillel R. Alpert, Tobacco Control, online March 13, 2013 Journal reference: Tobacco Control Provided by Harvard School of Public Health FDA warns Web companies not to sell flavored cigs (AP) -- The Food and Drug Administration said Friday that it has warned several companies to stop selling banned flavored cigarettes to U.S. consumers online. Colombia bans sales of loose cigarettes, tobacco adverts A ban on sales of loose cigarettes and tobacco advertising went into effect Thursday in Colombia, the health ministry said. Smokers believe 'silver', 'gold' and 'slim' cigarettes are less harmful Despite current prohibitions on the words 'light' and 'mild', smokers in Western countries continue falsely to believe that some cigarette brands may be less harmful than others. In fact, all conventional brands of cigarette ... Cigarette packaging needs to change, study says The messages that cigarette pack labels convey to smokers and nonsmokers have been evaluated by Roswell Park Cancer Institute (RPCI) researchers in three studies published in the June 2011 issue of the American Journal of ... Norway court upholds ban on tobacco store displays (AP)—A Norwegian court has upheld a ban on the display of tobacco products in stores, handing a defeat Friday to the Philip Morris company.

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News tagged with public health services Youth suicide: More early detection and better coordination are needed Although progress has been made in recent years, the matter of youth suicide in Quebec still needs to be more effectively addressed. In fact, a new study in the Canadian Journal of Psychiatry shows that more lives could ... Five things you should know about Ebola virus Last week, the first case of the Ebola virus was confirmed in the United States, a fact that has no doubt caused concern as the number of fatalities in West Africa continues to rise. In an effort to get a ... UN Ebola czar heads to West Africa The UN's new pointman on Ebola said Tuesday he will travel to West Africa this week to shore up health services in the four countries hit by the worst-ever outbreak of the virus. Community pharmacies could play bigger part in tackling poor health Community pharmacies could play a vital role in tackling major public health concerns such as obesity and smoking because the vast majority of people in England live within easy walking distance, say researchers. HIV battle must focus on hard-hit streets, paper argues In U.S. cities, it's not just what you do, but also your address that can determine whether you will get HIV and whether you will survive. A new paper in the American Journal of Public Health illustrates the ef ... Auckland scientist leads climate change health impact report Climate change impacts on human health were the focus of an Auckland academic's contribution to the latest report from the Intergovernmental Panel on Climate Change (IPCC). BMJ investigation: Public health funds raided to fill holes in local authority budgets A year after responsibility for public health was transferred from the NHS to local authorities, the BMJ found numerous examples of councils disinvesting in a wide range of public health services, including those for substa ... Gap in life expectancy between rural and urban residents is growing Reducing health inequalities and increasing life expectancy in the United States have both been primary goals of the national health initiative, Healthy People 2020. Unfortunately, according to a new study ... A study analyses the health status of immigrant population in Raval neighbourhood in Barcelona To know the incidence and risk factors for some diseases in Barcelona's immigrant population in Spain is the main objective of a study published in the Journal of Travel Medicine. The article is signed by exp ... Inside the Bloomberg public health toolbox As Mayor Michael Bloomberg's term comes to a close, the latest research conducted by Columbia University's Mailman School of Public indicates that he leaves a legacy of ambitious public health policies from pioneering restrictions ... Report reveals new data on access to mental health crisis care in Virginia A new statewide study gives an objective and detailed review of Virginia's emergency mental health system, sheds light on persistent gaps in available services and illustrates the need for timely access to mental health services, ... Race a bigger health care barrier than insurance status Race appears to be a larger factor in disparities in health care use than whether or not a person has health insurance, finds a new study in the Journal of Health Care for the Poor and Underserved. Blacks ... Public health does not 'lose out' when merged with Medicaid programs State public health departments do not necessarily lose funding when merged with larger Medicaid programs, according to a just-released study. The findings from this first-of-a-kind research should help allay concerns that ... California's new mental health system helps people live independently A new analysis by Oregon State University researchers of California's mental health system finds that comprehensive, community-based mental health programs are helping people with serious mental illness transition to independent ...

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Immunosuppressive drugs: Beyond glucocorticoids Prednisone is likely your go-to immunosuppressant. But because of associated adverse effects, having more options would help. Azathioprine, cyclosporine, mycophenolate mofetil, and leflunomide are commonly used for treating immune-mediated human diseases and may soon be incorporated into immunosuppressive protocols in veterinary medicine as well. Aug 01, 2010 By Barrak Pressler, DVM, PhD, DACVIM VETERINARY MEDICINE Glucocorticoids are the most commonly used drugs for immunosuppression in dogs and cats with immune-mediated diseases. Prednisone in particular induces rapid, nonspecific inhibition of the immune system by reducing inflammation-associated gene transcription, inhibiting intracellular signaling pathways, downregulating cell membrane expression of adhesion proteins, and slowing cell proliferation. The inflammatory responses of most leukocytes—including neutrophils, macrophages, lymphocytes, and antigen-presenting cells—are blunted by glucocorticoids, so immunosuppression with this class of drugs downregulates both the innate and acquired immune systems. Photos by Greg Kindred Systemic immunosuppression is required to treat most small-animal autoimmune diseases; however, glucocorticoids, unfortunately, modulate metabolic pathways in many nonimmune-system cell populations as well, possibly resulting in life-threatening side effects. For example, prednisone has been associated with hypercoagulability, hypertension, increased susceptibility to opportunistic infections, congestive heart failure, pancreatitis, and insulin resistance and secondary diabetes mellitus. In addition, although the expected glucocorticoid-associated clinical signs of weight gain, alopecia, polyuria, polydipsia, and polyphagia are usually only temporary annoyances in veterinary patients, some owners may find the inappropriate urination, continuous begging for food, or pica to be intolerable, leading to frustration or even euthanasia. The widespread use of organ transplants in people has motivated pharmaceutical companies to develop newer immunosuppressive agents that more specifically target the immune system and, thus, decrease the likelihood of adverse effects. When these agents are used in dogs and cats, the synergistic immunosuppressive effects may allow veterinarians to maintain disease remission with a lower glucocorticoid dose than would be possible otherwise. Because use of these alternative immunosuppressive drugs is increasing, veterinarians must be aware of those few studies that have evaluated the effectiveness, recommended doses, or prognosis when these drugs are administered in conjunction with or in place of prednisone. This article reviews the mechanisms of action and evidence-based rationale for using the most commonly recommended nonglucocorticoid immunosuppressive drugs and introduces medications that may eventually become standard-of-care for treatment of some immune-mediated diseases in veterinary patients. 1234567891011Next Related linksGlucocorticoid use in catsIs it immune-mediated neutropenia?Overcoming the diagnostic and therapeutic challenges of canine immune-mediated thrombocytopenia Hot topics on dvm360Follow dvm360 on Twitter, Facebook, and Pinterest Sell veterinary clients on your service Why veterinarians should be more like a Louisiana shoeshiner Texts from your veterinary clinic cat Learning goodbye: Veterinarians fill a void by focusing on end of life care ADVERTISEMENT

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War medicine now is helping Boston bomb victims By Marilynn Marchione, The Associated Press Tourniquets crucial to saving lives in Boston AF capt. injured in Boston bombing in serious condition Marathon rescuer with ties to Corps visited by press, FBI 3 Guardsmen were among those who ran toward blasts in Boston The bombs that made Boston look like a combat zone have also brought battlefield medicine to their civilian victims. A decade of wars in Iraq and Afghanistan has sharpened skills and scalpels, leading to dramatic advances that are now being used to treat the 13 amputees and nearly a dozen other patients still fighting to keep damaged limbs after Monday's attack.“The only field or occupation that benefits from war is medicine,” said Dr. David Cifu, rehabilitation medicine chief at the Veterans Health Administration.Nearly 2,000 U.S. troops have lost a leg, arm, foot or hand in Iraq or Afghanistan, and their sacrifices have led to advances in the immediate and long-term care of survivors, as well as in the quality of prosthetics that are now so good that surgeons often choose them over trying to save a badly mangled leg.Tourniquets, shunned during the Vietnam War, made a comeback in Iraq as medical personnel learned to use them properly and studies proved that they saved lives. In Boston, as on the battlefield, they did just that by preventing people from bleeding to death.Military doctors passed on to their civilian counterparts a surgical strategy of a minimal initial operation to stabilize the patient, followed by more definitive ones days later, an approach that offered the best chance to preserve tissue from large and complex leg wounds.At the same time, wartime demand for prosthetics has led to new innovations such as sophisticated computerized knees that work better than a badly damaged leg ever would again.“This is a clear case where all of the expertise that was gained by prosthetic manufacturers was gained from the wars. It's astonishing how well they function and the things people can do with these prostheses,” said Dr. Michael Yaffe, a trauma surgeon at Beth Israel Deaconess Medical Center in Boston.The hospital has performed amputations on three blast victims so far. A few other patients there may yet need them. Yaffe is a lieutenant colonel in the Army Reserve, and many other doctors treating Boston blast victims also have had military training.(Page 2 of 3)The military partnered with the American Academy of Orthopaedic Surgeons to train doctors throughout the United States on advances learned from the wars, said Dr. Kevin Kirk, an Army lieutenant colonel who is chief orthopedic surgeon at San Antonio Military Medical Center.Help, too, has come from Israel, which for decades has dealt with the aftermath of Palestinian bombs, like the ones in Boston, often laden with nails, ball bearings and other metals.“Unfortunately, we have great expertise,” said Dr. Pinchas Halpern, director of emergency medicine at Tel Aviv's Sourasky Medical Center.Halpern, who gave lectures in 2005 at Brigham and Women's Hospital and Massachusetts General about responding to attacks, has been in email contact with doctors in Boston this week.Among the topics he covered in his lectures were how to coordinate ambulances to distribute the wounded to area hospitals according to their type of injury, performing more CT scans than usual to locate deep shrapnel wounds, and ways to identify and classify wounds.Dr. Paul Biddinger of Mass General's emergency department said the hospital took much of Halpern's advice.“We improved our plans for triage, site security, reassessment and inter-specialty coordination” following Halpern's visit, Biddinger said.Blast victims can be challenging to treat because they typically have multiple complex physical injuries that may include loss of limbs, fractures, brain damage, and vision and hearing impairment, said Dr. Paul Pasquina, chairman of physical medicine and rehabilitation at the Uniformed Services University and Walter Reed National Military Medical Center.“It's very important that during their acute medical and surgical care that rehabilitation is applied early on, to get them up as soon as possible” to reduce risks from being immobile, including blood clots, deconditioned muscles and other problems that will make recovery more difficult,” he said.A multidisciplinary approach that involves everyone from plastic and orthopedic surgeons to therapists is important, said Dr. James Ficke, chairman of the department of orthopedics and rehabilitation at San Antonio Military Medical Center. He also advises the U.S. Army Surgeon General on orthopedics.(Page 3 of 3)“As a doctor, one of the lessons I learned most dramatically is, I don't have any preconceptions of what they can or can't do as a patient. There was a patient who lost his leg completely and had no hip joint and recently did a marathon in Austin in 4:33.”John Fergason, chief prosthetist at Center for the Intrepid, an outpatient rehab center that is part of Brooke Army Medical Center, said advances include computerized knees that allow amputees with above-the-knee amputations to walk down steep ramps, to walk up steps and go from a walk to a run.After every war, “you see a tremendous spike in prosthetic innovation,” largely because of increased research money, said Hugh Herr, a prosthetic expert at MIT and a double-amputee himself. Federal funds let his MIT lab do basic research on a bionic foot-ankle-calf system, and he founded a company that has commercialized that device.If Boston victims are generally healthy and motivated, and their legs are amputated below the knees, or perhaps even above the knees, “it's possible they could run the marathon a year from now,” he said. “It would take a lot of effort, but it's indeed possible with today's technology.”One amputee's story is encouraging.Dan Berschinski, 28, used to run marathons but now works with the Amputee Coalition, an advocacy and support organization based in suburban Washington, D.C. He was an infantry officer in Afghanistan when he stepped on an IED in August 2009. The blast blew off his entire right leg and most of his left leg. After treatment in the field and in Germany, he was sent to Walter Reed.His biggest initial challenge was intense pain, treated with narcotic painkillers, and phantom leg and foot pain. Doctors used to consider phantom pain a psychological problem but now consider it real, physical pain. Treatment includes nerve blockers.Recovery and rehab took about three years, including 10 months of daily physical therapy to strengthen his arms and core — muscle power he'd need to learn to walk on prosthetics.The bionic legs he uses cost $60,000 apiece, are hydraulically operated and equipped with microchips and a gyroscope that sense when to relax and stiffen to help him walk. Walter Reed was involved in developing the legs, said Zach Harvey, former prosthetics chief at Walter Reed.Berschinski used to run marathons but now competes in triathlons — swimming, biking with his arms and racing in a wheelchair.“I'm very happy with my progress,” he said.———Associated Press writers Malcolm Ritter in New York, Lindsey Tanner and Sharon Cohen in Chicago, and Daniel Estrin in Jerusalem contributed to this report. Page Previous 1 2 3 Next Answers by RallyPointSEE MORE ANSWERS The bombs that made Boston look like a combat zone have also brought battlefield medicine to their civilian victims. A decade of wars in Iraq and Afghanistan has sharpened skills and scalpels, A link to this page will be included in your message.

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Health & Wellness My Health Login Vanderbilt Department of Pediatrics Vanderbilt Kennedy Center A–Z SERVICES GUIDEfor patientsand visitors Monroe Carell Jr.Children's Hospitalat Vanderbilt2200 Children's WayNashville, TN 37232 MAPS / PARKING DOCTORS A–Z SERVICES A–Z SERVICES DOCTORS MAPS / PARKING GUIDE Entire Site Home / News and Events / Publications / Hope Magazine / Previous Magazine Issues / Summer 2008 / An Unbreakable Bond An Unbreakable Bond Media - Press Relations Our Team Family Focus E-Newsletter Hope Magazine by Jessica Ennis photos by Dana Johnson David and Laurie Novak thought they were done raising kids. The couple, who live in Henderson, Tenn., had three grown children of their own in addition to the 10 foster children they had cared for over the years. But in December 2003, a phone call changed everything. It was the Tennessee Children's Home calling about a 17-month-old girl named Alexia who had been in and out of two other homes that week. The children's home has called on the Novaks several times to care for children who are often hard to place in other foster homes. The organization asked if the Novaks would take the girl, and possibly her baby brother, Robbie. The Novaks were told that Alexia was healthy, but her bones broke easier than other children's because she had a minor condition called Osteogenesis Imperfecta (OI). They agreed to take Alexia and Robbie, assuming they would only be caring for the children just until they were adopted or were returned to their biological family. "Alexia came to us as a normal child, but she was so fragile," Laurie said. "There is no way she had ever walked before, although we were told she could walk with braces." She was very small for her age, and very quiet. She would smile, though her smiles would turn into pained grimaces when Laurie or David would pick her up. "We realized that she hurt everywhere from all her past fractures," David said. "I remember very carefully holding her," Laurie added. "We got on the Internet to try to find out as much information as we could about her disease." What they found was troubling. OI is a genetic disorder characterized by bones that break easily, often from little or no apparent cause. It's a relatively rare disease, affecting 20,000 to 50,000 people living in the United States. It is a collagen defect that can cause a variety of potentially debilitating symptoms and conditions including short stature, poor muscle development in arms and legs and a barrel-shaped rib cage, spinal curvature, respiratory problems, hearing loss and brittle teeth. Two weeks after getting Alexia, Robbie came to live with the Novaks. The 2-month-old boy had OI and only weighed 6 pounds. After just four days with them, Robbie woke up screaming. Even when a cast covered half his body, Robbie Novak found a way to smile. Photo courtesy Novak family. "He was inconsolable; we assumed we were dealing with a fracture, but not absolutely sure, as we had not dealt with anything like this before," David said. The Novaks rushed him to their local emergency department, not knowing for sure what was broken, and not even knowing Robbie's legal last name. He had broken his tibia and it was casted up to the knee. The weight of the tibia cast broke his femur. He spent three days in the hospital hooked up to morphine while the Novaks tried to find a doctor who would treat him. It was very overwhelming for the Novaks; all their years of parenting and fostering children had not prepared them to care for two small children who were so fragile. The couple had many heavy-hearted discussions questioning if they could provide the type of care that Alexia and Robbie desperately needed. Then they prayed. If they couldn't take care of them, who would? After being connected with a family who had a child with OI, they learned of a relatively new drug called Pamidronate that takes away bone pain and helps strengthen weak bones in children with OI. After a trip to Shriner's Hospital in Lexington, Ky., they were able to start Alexia on the therapy, but were told Robbie must wait until he was 2 to begin treatment. They soon learned that the Monroe Carell Jr. Children's Hospital at Vanderbilt provided the treatment to children as young as newborns, and both of the children could be treated in Nashville. The results were dramatic - Alexia and Robbie were no longer in pain, and their bones became stronger. Their personalities started to shine. "They are our little miracles," Laurie said. "They are ‘normal' kids because of Pamidronate." Although Alexia and Robbie are able to do most things normal children can do, they still are at great risk of breaking their bones and require quarterly trips to Children's Hospital where they are examined by doctors and receive two full days of Pamidronate infusions. The medicine is not a cure, but their fracture rate is much lower. With their bone pain gone, they move more and develop more muscle, which helps protect the bone. While they are at Children's Hospital, the siblings love to take advantage of the activities offered to patients. "We always find out what's going on at the hospital, because the kids love the distraction. Robbie loves bingo night and still plays with a little toy airplane he won last time we were there," Laurie said. "The kids love music, too, and Robbie really gets into the show." Robbie and Alexia Novak are very close, and have always enjoyed the beach. Photo courtesy Novak family. Alexia has suffered at least 60 breaks and Robbie has experienced around 25 so far. They've both had several surgeries to straighten their bowed bones with metal rods, and will likely have dozens more as they grow older. Gregory A. Mencio, M.D., director of Pediatric Orthopaedics at the Children's Hospital, is Robbie and Alexia's surgeon. "We have about 20 to 30 OI kids in our practice, and we see them a lot," Mencio said. "In terms of OI, Robbie and Alexia's are moderate, they don't have bad deformities and they can walk normally. The treatments will help cut down on the fractures, and will allow them to run and play and do what other kids do." "Robbie has re-learned to walk several times because of his surgeries. He has the barreled rib cage, and tends to have respiratory issues, and can get pneumonia easily," Laurie said. On Robbie's fourth birthday, Laurie recalls Robbie telling her, "I 4? I reelry 4?" Then he looked down at his feet, and looked himself up and down and said, "But I still widdle!" "I told him, ‘This bad bone disease is always going to keep you smaller than your friends, but you have a big spirit and big dreams.' He talks real big; he wants to be a football player or a soccer player." But Robbie doesn't let his size nor his disease define him. He has a mischievous streak and is constantly testing his limits. The Novaks have on more than one occasion caught him dangling precariously while using the furniture and other objects as his own personal jungle gym. Alexia is more laid back and is always smiling. She recently started taking tap dance class, although Laurie had a difficult time convincing her teacher, who feared she would get hurt, to let her participate. "We don't stop her from doing what she wants to do, within reason," Laurie said. "I told the teacher, I have a little girl begging me to take tap dance." Alexia didn't start walking independently until she was almost 4, and now there is no stopping her, unless she has a fracture, but even then she is back up and going as soon as possible. She has very weak ankles and her left leg is nearly 2 inches shorter than her right, requiring her to wear a lift. Alexia had her first dance recital on May 18, and Laurie and David even pushed back a surgery to replace metal rods in her legs so she could take the stage with her classmates. "She was amazing," Laurie said. "You would never know all that she has been through the past five years as she sang and danced to "I Love To Walk In The Rain" in her raincoat, hat and boots. To us, she was the best in her class. Both children are intelligent, strong-willed and incredibly close. Robbie loves looking after his older sister. The Novaks are determined to let them live their lives as normally as possible. "We try to treat them as normal kids; they have to pick their toys up just like everybody else. There's no special treatment," David said. "They get stronger and respond better if they do more." In 2006, the Novaks adopted Robbie and Alexia. "God has a plan. It was meant to be," Laurie said. Last Edited: May 14, 2012 Patient Privacy After-hours clinics Vanderbilt University is committed to principles of equal opportunity and affirmative action.2200 Children's Way | Nashville, Tenn. 37232 | 615.936.1000© 2014 Monroe Carell Jr. Children's Hospital at Vanderbilt

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Department of Medicine University of Pittsburgh Educational & Training Programs Flow Cytometry Facility Diseases We Treat Rheumatoid Arthritis Center Lupus Center Myositis Center Scleroderma Center Vasculitis Center Flow Lab Services Divisions of the Department Internal Medicine Residency Training Division of Rheumatology and Clinical Immunology S700 Biomedical Science Tower 3500 Terrace Street Welcome to the Division of Rheumatology and Clinical Immunology The Division of Rheumatology and Clinical Immunology has a tradition of excellence in patient care, education, and research for over fifty years. Our clinical activities emphasize care of both common and rare rheumatic diseases. We have outpatient clinics devoted to all types of autoimmune diseases and musculoskeletal disorders. Our facility have a clinical and research interested in rheumatoid arthritis, systemic lupus erythematosus, myositis, vasculitis, and scleroderma. Our reputation is evidenced by a ranking of #10 in the 2011 U.S. News and World Report Survey. We are committed to a mission of providing the highest quality care for patients with arthritis and autoimmune diseases and mentoring and training medical students, residents, fellows, and young faculty. Our research mission is to better understand arthritis, autoimmune, and other connective tissue diseases in order to improve diagnosis and therapies, with the ultimate goal of finding a cure or preventing these disorders. Faculty members are involved in both clinical and laboratory research. Our research programs are centered in the clinical areas noted above and include the disciplines of clinical epidemiology, health services, and laboratory research. Our research includes collaborative efforts with other programs in the School of Medicine and the Graduate School of Public Health. Approximately one third of our fellowship graduates during the last five years have elected an academic career in teaching, patient care, or research. Remarkable advances in drug discovery, mechanisms of disease, epidemiology, outcome research, and other related fields make a career in academic rheumatology an exciting career opportunity. The University of Pittsburgh and UPMC have a long tradition of multidisciplinary collaboration. The faculty in the Division of Rheumatology, combined with cutting-edge clinical, educational, and patient care resources, provide for ongoing success of rheumatology at the University of Pittsburgh. To view the Division of Rheumatology's on-line annual report, click here. To learn more about what's happening in the Division of Rheumatology right now, click here. This Web site is maintained by the Center for Research on Health Care (CRHC) Data Center.

医学

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Contact: Marc Lukasiak marc.lukasiak@chp.edu Ear infection expert from Children's Hospital of Pittsburgh leads interactive demo on diagnosis Discussion to include controversies in management PITTSBURGH � Oct. 9, 2006 � A Children's Hospital of Pittsburgh pediatrician is leading national efforts to improve the diagnosis and treatment of one of the most common infections of childhood through innovate training methods. Middle ear infection, also known as acute otitis media (AOM), is the pediatric illness for which antibiotics are most often prescribed. Three out of four children will experience an ear infection by age 3. However, diagnosis remains difficult and experts often are divided on treatment options, according to Alejandro Hoberman, MD, chief of the Division of General Academic Pediatrics at Children's. Dr. Hoberman will lead a unique and interactive discussion on how to accurately diagnose and treat AOM at 8 a.m. on Thursday, Oct. 12, 2006, at Children's. His presentation is titled "Diagnosis and Treatment of Acute Otitis Media: Can We Agree?" His dynamic presentation will involve active participation by audience members and include discussion on adequate diagnosis and treatment. The Continuing Medical Education (CME) event also will be available via live Web cast through Children's Web site at www.chp.edu. "Ear infections affect the vast majority of children, yet they can be difficult to diagnose and clinicians not always agree on adequate treatment. Experts remained divided between the so-called 'watchful waiting' approach and treatment with antibiotics," said Dr. Hoberman, also the Jack L. Paradise Endowed Professor in Pediatric Research at Children's and a professor of pediatrics at the University of Pittsburgh School of Medicine. "Our projects will help improve accuracy in making the diagnosis and help determine which treatment approach works best." Dr. Hoberman's research contributions include various randomized clinical trials evaluating diagnosis, management and prevention of AOM. He has developed multimedia educational programs aimed at improving diagnostic accuracy in children with AOM. Together with Phillip Kaleida, MD, another Children's pediatrician, Dr. Hoberman developed a program, ePROM (enhancing PRoficiency in Otitis Media) which was supported by the Centers for Disease Control and Prevention and the Association of American Medical Colleges. This program has helped to train students, medical residents and practitioners across the country in the diagnosis of AOM. Dr. Hoberman also will discuss various prevention and management clinical trials conducted at Children's in children with AOM, and present a recently funded National Institutes of Health study that will evaluate the efficacy of antibiotics in young children with ear infections. Editor's Note: Registration for the live Web cast, and the post-event archived session, is available through Children's at http://www.or-live.com/cpi/1556/.

医学