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2014-42/1180/en_head.json.gz/14139

Wellness Center | Women's Center Home > Health Library > Study of Genetic Condition May Yield Clues to Cause of Allergies Study of Genetic Condition May Yield Clues to Cause of Allergies WEDNESDAY, July 24 (HealthDay News) -- A disorder that affects connective tissue could provide vital clues to the genetic origin of nearly all human allergies and allergic diseases, say the authors of a new study of children. People who have Loeys-Dietz syndrome tend to also suffer disproportionately from allergic diseases, researchers at Johns Hopkins Children's Center and the Johns Hopkins Institute of Genetic Medicine in Baltimore found when looking at a group of 58 children aged 7 to 20 who have the syndrome. "We found that these patients had a very high risk of developing not just one allergy, but all forms of allergic disease," said study author and immunologist Dr. Pamela Frischmeyer-Guerrerio. In their paper, published July 24 in Science Translational Medicine, the researchers contend that the genetic mutation that causes Loeys-Dietz syndrome appears to be closely tied to allergies -- so much so that it might explain why certain people suffer from allergic reactions. However, other allergists are skeptical, saying the genetic link could just be a coincidence. Loeys-Dietz syndrome is caused by the mutation of a gene called TGFb, and the researchers wondered if this mutation also might create a greater susceptibility to allergies and allergic diseases like eczema and asthma. They found that the Loeys-Dietz syndrome patients had elevated levels of the signaling molecule produced by the gene, a protein called transforming growth factor-beta or TGF-beta. TGF-beta serves many roles in the human body. It controls how cells grow in various organs, which is why mutation of the TGFb gene can lead to Loeys-Dietz syndrome, in which blood vessels develop into twisted shapes and physical abnormalities occur like cleft palate and clubfoot. TGF-beta also is known to play a part in regulating the immune system, spurring the body to fight against foreign microbes while suppressing reactions against foreign bodies like food and pollen. In Loeys-Dietz, the elevated TGF-beta signaling seems to prompt an immune response to innocuous substances, in effect causing the development of allergic diseases like asthma and eczema, Frischmeyer-Guerrerio said. "We found the body's regulatory cells were actually producing inflammatory mediators themselves," she said. "Instead of doing their job of suppressing allergic molecules, they're actually producing those allergic molecules themselves and promoting inflammation." She added that researchers found the same sort of immune system misbehavior in allergic children who do not have Loeys-Dietz Syndrome. Taking it a step further, researchers took undifferentiated immune cells -- cells that haven't yet transformed into more specialized cells -- from Loeys-Dietz syndrome patients and immersed those cells in TGF-beta. The cells quickly changed into allergy-promoting immune cells capable of attacking both microbes and allergens like food or pollen. All this suggests that changes in TGF-beta signaling could strongly predispose some people toward developing allergies and allergic diseases, Frischmeyer-Guerrerio said. "One of the hurdles in trying to develop new treatments for allergies is pinpointing the key signaling pathways we need to target," she said. "TGF-beta really seems to be central to one of the key pathways that underlie the development of all forms of allergic disease." However, the case may not be as cut-and-dried as that, said Dr. Mitchell Grayson, an associate professor of pediatrics, medicine, microbiology and molecular genetics in the division of allergy and clinical immunology at the Medical College of Wisconsin. He was not involved with the new study. "What this study does tell us is we need to pay more attention to TGF-beta receptors in allergic disease, but it doesn't tell us that we've found a single pathway. I didn't see here the tie that shows these defects are related to TGF-beta receptor signaling," said Grayson, also co-director of the infection, inflammation and immunity research unit at the Children's Research Institute of the Children's Hospital of Wisconsin. Noting the similar immune response that researchers found in children with and without Loeys-Dietz syndrome, he said, "The problem with that is you don't know if that's related to the same type of TGF-beta receptor defects. It may just be if you're allergic, that's what you do." If TGF-beta does end up being the culprit behind allergies, there are already-approved drugs on the market that are aimed at reducing TGF-beta signaling, study author Frischmeyer-Guerrerio said. One is the blood pressure medication losartan, which did reduce signaling in syndrome patients. "Now, the next step will be for us to look at ways to inhibit this pathway," she said. The U.S. National Library of Medicine has more about Loeys-Dietz syndrome. SOURCES: Pamela Frischmeyer-Guerrerio, M.D., Ph.D., immunologist, Johns Hopkins Children's Center, Baltimore; Mitchell H. Grayson, M.D., associate professor, pediatrics, medicine, microbiology and molecular genetics, division of allergy and clinical immunology, Medical College of Wisconsin, and co-director, infection, inflammation and immunity research unit, Children's Research Institute, Children's Hospital of Wisconsin; July 24, 2013, Science Translational Medicine

医学

2014-42/1180/en_head.json.gz/14159

You are here: Home / Success Stories / Success Story - STELPRD4014218 GRASS VALLEY BUILDS NEEDED RESIDENTIAL DRUG TREATMENT CENTER Aug 01, 2011 -- Nevada County has the highest rate in California for those needing but not receiving treatment for alcohol and illicit drug use. CoRR (Community Recovery Resources) has worked hard to turn rates around, but has been confronted by challenges of their own. CoRR has worked out of an old and ineffective facility with very little space for critical services, and has struggled to qualify for an appropriate loan due to high interest rates and lack of funding. In turn, this has created barriers to provide various services like therapy, counseling, and educational classes. USDA Rural Development provided a 40-year $9.3 million Community Facilities Direct Loan to CoRR to build the "Center for Hope", a residential treatment center in Grass Valley. In June, CoRR broke ground on their new 47,100 square foot "Center for Hope" project. The facility will provide various services that promote self-sufficiency and a full transition back into the community. It is also expected to house up to 50 men, women, and children in order to provide stable care to the patient and his or her family. The availability of these services will employ 40 counselors and staff and help an estimated 2,000 people annually to recover from substance abuse and other related health behavior disorders. Sierra Foothills Construction, a Grass Valley contractor, anticipates about 90% of the work will be done by businesses within the county. This is expected to create 400 local jobs, which is especially important in a county with 12.3% unemployment rates. "We're honored to be selected for this important program for the community," said Keoni Allen of Sierra Foothills Construction at the groundbreaking event. Allen, along with many other community supporters including Congressman Tom McClintock, were on hand to commemorate the start of construction. "This is your victory," McClintock told everyone. "This project is funded, and will ultimately succeed, because this community wanted it and is 110 percent behind it." The strong community support and dedicated work of many individuals has made this project possible. With the completion of this project, the community will be well prepared to fight the growing epidemic of substance abuse. The new facility is expected to be completed in summer of 2012. To see this story with accompanying photos, please click here.

医学

2014-42/1180/en_head.json.gz/14173

SciELO ShareMoreMorePermalinkRevista Panamericana de Salud PúblicaPrint version ISSN 1020-4989Rev Panam Salud Publica vol.10 n.5 Washington Nov. 2001 http://dx.doi.org/10.1590/S1020-49892001001100016 Temas de actualidad / Current topics Guidelines for screening and managing diabetes in the United States of America1 Key words: diabetes, guidelines. Diabetes has reached epidemic proportions in the United States of America, affecting more than 16 million persons. In response to that serious situation, two allied medical organizations recently issued new guidelines on screening and managing the disease. The new guidelines were developed by a consensus group of diabetes experts brought together by the American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE). The AACE is a professional medical organization of some 3 700 physician members who focus on caring for patients with endocrine problems such as diabetes, thyroid disorders, osteoporosis, lipid (cholesterol) disorders, reproductive disorders, growth hormone deficiency, hypertension, and obesity. The ACE is the "scientific arm" of AACE, providing and promoting education and research in clinical endocrinology. The panel of experts assembled by the two groups reviewed research from international studies on diabetes, with the goal of translating that information into practical guidelines that will result in more effective management of this disease. The new guidelines are also intended to help empower patients to manage their disease more effectively and thus avoid such complications as kidney failure, blindness, amputations, and premature heart attacks. The experts panel made recommendations in four major areas, as described below. Lowering the diabetes screening age to 30 for high-risk individuals Current screening guidelines for diabetes diagnosis have resulted in an overall 50% prevalence of complications at the time of diagnosis, indicating that diabetes is present long before the diagnosis is made. That high frequency mandates earlier diagnosis of diabetes, according to the experts panel. Further, prevalence data on newly diagnosed cases of diabetes indicate a younger age of onset within the general population, and especially among high-risk ethnic (minority) populations. Recent data from the Centers for Disease Control and Prevention (CDC) of the United States have shown that diabetes in the country increased 33% from 1990 to 1998, including by more than 70% among people aged 30 to 39. Given those factors, the panel recommended targeted case finding in high-risk individuals 30 years or older, replacing the current 45 years. Ethnic populations account for nearly half of all newly diagnosed diabetes cases in the United States. One in four Latinos are diagnosed with diabetes by the age of 45, and African-American children as young as 5 are exhibiting symptoms of insulin resistance, which is the beginning stage of diabetes. The panel pointed to a number of risk factors for the development of diabetes that should be considered in targeted screening for populations at high risk. These risk factors included: • history of diabetes • cardiovascular disease • overweight • sedentary lifestyle • belonging to a minority group, including Latino/ Hispanic, African-American, Asian-American, Native American, or Pacific Islander • previously identified impaired glucose tolerance or impaired fasting glucose • hypertension • increased triglycerides and/or low high-density lipoprotein cholesterol • history of gestational diabetes • delivery of a baby weighing more than 9 pounds (4.1 kg) • polycystic ovarian disease Lowering the HbA1c blood sugar test to 6.5% Epidemiologic data from various studies, including the United Kingdom Prospective Diabetes Study, have shown an elevated risk for all microvascular and macrovascular complications beginning at 6.5% on the hemoglobin A1c (HbA1c) test, which is a simple blood test given to patients with diabetes to determine how well their blood sugar has been controlled over the preceding 3 months. A number of small cohort trials further corroborate the significance of HbA1c elevations greater than 6.5%. These findings are also consistent with a number of epidemiologic studies implicating the association of hyperglycemia with the development of diabetic complications. Given that, the panel recommended lowering the target for diabetes control to 6.5%. HbA1c levels under 6% are normal for people without the disease. When patients know their HbA1c level and their goals, they are better able to prevent diabetes-related complications. The panel recommended that assessment be performed at least twice per year in patients who are at target. Assessment should be performed quarterly or more frequently in patients who are above target and/or undergoing a change in therapy. Lowering the postprandial blood sugar levels The risk of diabetes comes from tissues that are exposed to abnormally high blood sugar levels both before and after meals. For example, an increased risk of retinopathy is clearly associated with fasting plasma glucose > 110 mg/dL. The panel recommended lowering target levels of blood sugar to 110 before eating (preprandial) and to 140 after eating (2 hours postprandial). Addressing the postprandial levels will not only reduce tissue damage for patients but also alert them to a problem previously unaddressed in blood sugar monitoring. Prior to the development of glycated protein technologies, fasting glucose values were the primary assessment of glycemic control. However, this method is limited because it can only measure the glycemic burden at a single point in time and may not accurately reflect overall glycemic control. With the advent of self-monitoring technology, assessment of fasting and preprandial glucose levels has evolved into an important element in day-to-day decision-making in the management of diabetes. Postprandial hyperglycemia is a key element of the total glycemic burden in patients with diabetes and is an important component of the HbA1c level. The HbA1c can, therefore, be viewed as the summation of both preprandial and postprandial glycemia. In order to maximally reduce HbA1c levels, assessments of both preprandial and postprandial glucose levels are necessary. Additional research The experts panel suggested three areas for additional research. Data regarding the impact of glycemic control on the development of microvascular complications suggest a differential sensitivity to hyperglycemia in some minority populations. This observation appears to be true even after adjustment for comorbid conditions. Further research should be pursued to quantify this phenomenon and to elucidate the mechanism or mechanisms by which such differential sensitivity occurs. There also appears to be a genetic component to the differential sensitivity to hyperglycemia, which is independent of comorbid conditions; this area warrants further study. Finally, epidemiologic evidence suggests there is a robust relationship between post-challenge hyperglycemia and cardiovascular risk. This finding should be explored in a large-scale prospective randomized interventional trial that focuses on postprandial glycemic control. SINOPSIS Pautas para el tamizaje y el manejo de la diabetes en Estados Unidos de América Para responder a una creciente epidemia de diabetes mellitus en Estados Unidos de América, un panel de expertos integrado por dos organizaciones médicas asociadas estudiaron el problema del tamizaje y el manejo de la diabetes y acaba de emitir recomendaciones con respecto a varios aspectos esenciales. Las recomendaciones son, entre otras: 1) iniciar las pruebas para el tamizaje de la diabetes a los 30 años de edad en vez de los 45 en personas en alto riesgo; 2) reducir el valor límite en la prueba de hemoglobina A1c a 6,5%, y 3) reducir las concentraciones límite de glucemia a 110 mg/dL antes de comer y a 140 mg/dL después de comer. El grupo de expertos también recomendó efectuar más investigaciones en algunas áreas. 1 Based on: American College of Endocrinology, American Association of Clinical Endocrinologists. ACE consensus conference on guidelines for glycemic control [report]; World leaders in endocrinology call for new diabetes guidelines [press release]. Jacksonville, Florida, United States of America: ACE, AACE; 2001. Available from: http://www.aace.com [Internet site]. Accessed 23 August 2001. © 2014 Organización Panamericana de la Salud525 Twenty-third Street, NW, Washington, DC 20037, EUA, Fax: (202) 338.0869, Washington, Washington, US, 20037, (202) 338.0869publiper@paho.org

医学

2014-42/1180/en_head.json.gz/14289

Castleview CEO, a career nurse, knows about the TLC biz Mark Holyoak keeps his RN current and helps out at times.By RICHARD SHAWSun Advocate publisher It has often been said that the very best leaders in government, business and institutions come from the ranks of those who toil on the front lines. If that is the case, then Mark Holyoak fits right into that mix. At the heart of it, Holyoak, who has been the CEO at Castleview Hospital for about a year, is a nurse. It's been his life's work. "I was a nurse in various hospitals for 22 years before getting into administration," he said as he sat at a table in his office late Tuesday afternoon. "I am still an RN and I keep my license active." That means at times he actually performs some medical duties in the hospital when help is needed. That is not something most hospital administrators would - or even could - do. Holyoak, who is originally from Cedar City, has served the medical profession in various places, ranging from Las Vegas, Nev. to Omaha, Neb. His experience is varied and extensive. And so is his education. "I went to school at Southern Utah University and came away with a double major in biology and chemistry," he said. "During that same time I served two year a mission for the LDS church in Georgia." It was also during that time that he met Patrice Pulsipher, his wife, while they were both working their way through school as desk clerks at a Best Western Motel in Cedar. They got married and she got her teaching degree from SUU and then they moved to Omaha where he went to nursing school at Creighton University. "You know I was the only one of five siblings that moved away and continues to live away from Cedar City," he said. He worked in Omaha for some time and then the family moved to Las Vegas where he worked with recovering open heart surgery patients. It was there he got into nursing management. After seven years at Sunrise Hospital it was back to Utah, taking a job at the University of Utah Hospital as Director of Surgical Services. While living in Salt Lake, Holyoak became a Phoenix, getting a masters degree in business administration from the University of Phoenix. At some point the rural life called back to him and an opportunity to go to Vernal and serve as Chief Nursing Officer at Ashley Regional Hospital was in the offing. He spent 10 years there, raising his young family. Three years ago Holyoak came to Castleview to help Jeff Manley (then CEO) as he fought his battle with cancer. His position until last year was chief operating officer at the facility. The job of CEO of a large rural hospital is "hard to explain" said Holyoak. He has had some students from the high school spend time job shadowing him and at least some of them came away saying they would never want to do what he does. "Really my job consists of a lot of meetings," he said. "But that all ties together with the mission of developing strategies and the provision of health care in the community." One of the biggest challenges many rural hospitals have is keeping physicians. In many places (Price included) some come for a short time then leave for what seems to be greener pastures. While the overall goal Holyoak spoke of during the interview was to meet the health care needs of the community, he feels a very important part of his job is keeping doctors here. "Physician recruitment and retention is important to our hospital and community," he stated. "I have been able to help with that, and I think my non-traditional path to this job helps with that." While many administrators can talk some of the talk that physicians deal with, only someone who has served on the front lines, like a nurse, can really get down to the meaning of what it is to care for patients. That is where feels he has a good edge. "Turnover of physicians is very hard on a community," Holyoak said. "We have to make every effort to keep them." Holyoak says the coordination of the needs of the physicians and the hospital is imperative. "We need to have a place where the employees want to work, where physicians want to practice and where the individuals in the community want to come for their health care." Holyoak says that he sees the hospital as being an institution that should work toward making the entire community healthier, in many different ways. "This is not just about about the patients who come here, but the entire community," he said. "The hospital is a taxpayer. We have a large payroll that contributes to the well being of the community. We bring in quality people to work here and we want to make sure that our patrons get value for their money." As any institution will have, Castleview has its detractors. One of the complaints heard is that the cost of care at the local hospital is so high that it is less expensive for people to go to Utah County for their care. Some also say the care there is better. But Holyoak said that he believes that people need to come back and "kick the tires a little" and find out what the hospital is about today. "We paid some good money last year to look at data about our competition over the mountain and we spent days going through the list of services we provide to see if our costs were out of line," he explained. "We adjusted our prices where we saw differences. We don't want to be the high priced place, but on the other hand we want to also give value for the care we provide. Value with quality is what we are after." Holyoak sees the future as being bright for both the hospital and those who use its services. Some of that will come from physical expansion of the facility and some will come from the recruitment of new doctors with different specialties. "We are bursting at the seems right now," he said. "Our medical office space is full. An urgent care unit is on the horizon. We are going to add more space for surgery. We now have doctors that can do new things such as Dr. Beecher who is a pain control expert, Dr. Jensen who can do spine surgery and Dr. Pressett who is a specialist in weight loss surgery. I would like to see us get a full time neurologist too." The hospital is also looking at the possibility of basing a helicopter for medical flights right at the facility. It would be available right away if someone needed to be transported to a tertiary facility along the Wasatch Front and it could also be used to do life flights to remote areas in the region where someone needed immediate transport. Like any rural hospital, there are things that Castleview can't do and things they can. Some disciplines and procedures require unique expertise and expensive equipment. Not every hospital, be it rural or urban can offer every kind of service. Holyoak says for instance that Castleview will probably never do open heart surgery or brain surgery. "But with other procedures and care if we can do it, we will do it well," he concluded.

医学

2014-42/1180/en_head.json.gz/14437

Research at UC Davis Health System Health System > Research > MIND Institute to participate in international study of ... Clinical Trials at UC Davis IRB - Human Subjects Research Research Training and Career Development Building Interdisciplinary Research Careers in Women's Health Integrating Medicine into Basic Science Mentored Clinical Research Training Program Stem Cell Training Program NEWS | October 7, 2013 MIND Institute to participate in international study of schizophrenia in 22q11.2 deletion syndrome (SACRAMENTO, Calif.) — Researchers at the UC Davis MIND Institute will participate in an international consortium spanning four continents that will study the genetics of schizophrenia and other psychiatric disorders in chromosome 22q11.2 deletion syndrome through a four-year, $12 million grant from the National Institute of Mental Health to the International Consortium on Brain and Behavior in 22q11.2 Deletion Syndrome. Tony Simon © UC Regents The consortium encompasses 22 institutions in North America, Europe, Australia and South America. Researchers will collaborate on investigations of the genetic causes for the high rates of schizophrenia in children and adults with the disorder. Approximately 25 to 30 percent of teens and young adults with 22q11.2 deletion syndrome go on to develop schizophrenia, compared with only 1 percent of the general population.“This funding will provide us with the opportunity to mount a virtually worldwide collaborative effort to identify the risk and protective factors for psychiatric illness in this very high-risk population,” said Tony J. Simon, a cognitive neuroscientist and professor in the Department of Psychiatry and Behavioral Sciences who directs the 22q11.2 deletion syndrome program at the MIND Institute.“This consortium brings together 22 clinical and five basic science sites with extremely dedicated clinicians who are working together to improve patient care and long term-outcomes for people with 22q11.2 deletion syndrome,” he said.The condition affects an estimated 1 in 2,000 to 4,000 people and is characterized by congenital heart defects that often require surgery, an opening in the roof of the mouth, immune system dysfunction, and significant feeding and swallowing issues. Most children have developmental delays or learning disabilities and delayed language acquisition.Some children also may be diagnosed with autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder or anxiety. Later in life, people with 22q11.2 deletion syndrome are at an increased risk of developing psychiatric illnesses such as depression and anxiety, as well as schizophrenia.All of the consortium sites have extensive experience with applying genomic and brain-behavior strategies to study individuals with 22q11.2 deletion syndrome and schizophrenia. Together, they have provided data on 1,000 genetically and phenotypically characterized individuals with the syndrome, the largest such available sample to date. The consortium's genomic efforts will include whole-genome sequencing to uncover genetic variation that may contribute to the heterogeneity of neuropsychiatric and neurobehavioral phenotypes of schizophrenia and psychosis.“The knowledge that this endeavor will generate will accelerate progress towards early identification and therapeutic intervention for those at greatest risk and will benefit millions throughout the world, whether they have 22q11.2 deletion syndrome or not,” Simon said.Other sites in the United States include the University of Pennsylvania Health System, the 22q and You Center at the Children's Hospital of Philadelphia, UCLA, Albert Einstein College of Medicine, Duke University, Emory University and the State University of New York Syracuse. Other sites are located in Canada, the United Kingdom, Ireland, France, Italy, Spain, Netherlands, Switzerland, Israel, Australia and Chile. At the UC Davis MIND Institute, world-renowned scientists engage in collaborative, interdisciplinary research to find the causes of and develop treatments and cures for autism, attention-deficit/hyperactivity disorder (ADHD), fragile X syndrome, 22q11.2 deletion syndrome, Down syndrome and other neurodevelopmental disorders. For more information, visit mindinstitute.ucdavis.edu UC Davis Health System | 2315 Stockton Blvd. | Sacramento, CA 95817 | 24-hour Sacramento campus operator: (916) 734-2011

医学

2014-42/1180/en_head.json.gz/14470

Students Take Center Stage at National Cardiology Conference Medical student James Kim, an accomplished cello player, is exploring auditory triggers that can cause sudden cardiac death in some people.More than a dozen Rochester physicians, students and scientists are heading to Atlanta this weekend for the annual meeting of the American College of Cardiology. It’s one of the premier meetings of the year for cardiologists and others catching up on the latest in clinical treatments and research in an area that is key to the Medical Center’s strategic plan. Faculty members Arthur Moss, M.D., Charles Phelps, Ph.D., Ronald Schwartz, M.D., and Wojciech Zareba, M.D., Ph.D., will present at symposia and other sessions, informing others about recent advances in preventing sudden cardiac death, teaching physicians how to recognize and treat heart arrhythmias, and discussing new imaging methods to evaluate the heart. The highlights for the Rochester contingent include presentations by six medical students working with the Heart Research Follow-Up Program. The students have worked closely with Moss and Zareba as well as Ilan Goldenberg, M.D., a research associate professor in Cardiology and a mentor to the medical students. Presenters include: Eric Hansen and Bonnie Choy, who are looking at the relationship of body-mass index to risk of sudden death in cardiac patients. James A. Kim, who will discuss auditory triggers for Type 2 Long QT. Judy Liu, who will discuss risk factors for having a second cardiac event in people with Long QT who have already experienced a first significant event, such as fainting. Edward Sze, who is looking at how measures of blood flow to the kidneys might be used to predict subsequent difficulties in patients who have had a heart attack or who have heart failure. Princy Thottahil, who will present data on triggers related to exercise and arousal for Type 1 Long QT syndrome. Judy Liu says doing research "provides me with tools to explore new questions."The new findings build on decades of research. More than 30 years ago, Moss founded one of the world’s first registries for any disease – the International Long QTS Registry. People from more than 1,200 families, including more than 8,000 individuals, now make up the registry, which has allowed researchers to learn ever more about Long QT in an effort to prevent sudden cardiac death. People with the inherited disorder – which causes about one-third of sudden cardiac deaths in young people – have at least one of hundreds of mutations in more than a dozen genes known to cause different forms of Long QT. Study of the disorder has provided a gateway for Moss and others to conduct even larger studies focusing on more common arrhythmias. Those studies have led to worldwide changes in the way physicians treat patients for the risk of heart failure or sudden cardiac death, saving the lives of thousands of people who would have died were it not for the new treatments discovered by the large clinical trials led by Moss and his colleagues. Moss attributes the heavy student involvement with his group to a lecture he gives each year to medical students, along with word of mouth among the students who have worked with his group. Moss notes that every abstract his students submitted to ACC this year was selected for presentation, a rarity for a large group of medical students. Edward Sze“This level of involvement of students in presentations at ACC is very rare – it simply doesn’t occur at most institutions,” added Zareba, who works closely with the students. “Here, we have a wealth of data about sudden cardiac death, and we also have mentors willing to work closely with the students.” Fourth-year medical student Judy Liu is looking at episodes of syncope – fainting – and their role indicating the risk of further dangerous events for people with Long QT syndrome. This is the second trip to ACC for Liu, who took a year off from her medical school studies last year to work with the team, investigating the risk factors for future problems in patients with Long QT who have experienced at least one event before. Most other studies have focused on risk factors before a patient’s first serious rhythm problem. Liu came to Rochester in 2005 after getting her undergraduate degree in psychology, with a minor in Chinese language and Russian literature, from Dartmouth. A native of New York City, she headed back to New York after college and worked in the laboratory of none other than cardiothoracic surgeon and media star Mehmet Oz, pursuing an interest in cardiology and research. After she arrived in Rochester and heard Moss speak to medical students in cardiology, she approached him about doing research. Arthur Moss, M.D.“I felt that pursuing research is an important part of being a physician,” said Liu. “When you practice evidence-based medicine, it’s important to understand what “evidence” means – how to read it, understand it, analyze it, and apply it. I felt that by trying to do research myself, I would gain a better understanding of the whole process.” In her first year, she worked with Moss, comparing how a mutation for Long QT Type 1 is expressed differently in Caucasians and Japanese, a phenomenon perhaps related to other genetic differences between the two groups. In her third year, she explored differences between two groups of Long QT Type 3 patients whose mutation differed; her manuscript was published earlier this year by the American Journal of Cardiology. “Long QT syndrome is not a common condition, but it’s a great window into understanding not only the heart, but also broader topics like genetics and public health,” said Liu. Bonnie Choy and Eric Hansen are looking at the relationship of body-mass index to risk of sudden cardiac death.“This will make me a more rounded physician in the future and will help me understand patients on a whole different level,” she added. “Understanding research provides me with tools to explore new questions, and there are always new questions in medicine. If I can understand the implications of research and apply that knowledge to patients, it will make me confident that I am offering the best care I possibly can to my patients.” Adds Moss: “Research like this helps future doctors get a sense of what it’s like to advance the fund of medical knowledge.” After ACC, Moss heads to Washington to testify at a hearing of the U.S. Food and Drug Administration about the results of a large study, MADIT-CRT, which he headed. In a publication last year in the New England Journal of Medicine, his team found that patients who receive devices that act both as an implantable defibrillator and a cardiac resynchronization device (CRT-D devices) had a remarkable drop in their risk for either heart failure or death. Moss presents the results of MADIT-CRT to FDA next Thursday, March 18, which happens to be Match Day 2010 – the day Liu will learn where she will be doing her residency in internal medicine. For Media Inquiries: Public Relations Department Email Public Relations More about Arthur Moss, MD » Trial Published in the New England Journal of Medicine Reports on New Therapy that Prevents Heart Failure ICDs Extend the Lives of Heart Attack Survivors by a Year: Study University of Rochester Leads Worldwide Heart Research Project More about ACC Annual Meeting Heart Research Follow-Up Program More news from UR at ACC Strong Heart and Vascular Center

医学

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Health Aug 13, 2014 2:41 PM Doctors: Ebola drug poses 'impossible dilemma' DAKAR, Senegal (AP) - Doctors treating a Sierra Leone physician with Ebola defended their decision not to give him an experimental drug, saying Wednesday they feared it was too risky. Calling it "an impossible dilemma," Doctors Without Borders explained in detail their decision in response to a New York Times story on the case. It would have been the first time the experimental drug was tried in humans. The explanation came the same day that another top doctor from Sierra Leone died of the disease, further fueling a debate about how to apportion a limited supply of untested drugs and vaccines and whether they are even effective. Ebola has killed more than 1,000 people and sickened nearly 2,000 in the current West African outbreak that has also hit Guinea, Liberia and Nigeria. Many of the dead are health workers, who are often working with inadequate supplies and protection. At the time the experimental treatment was being considered for Dr. Sheik Humarr Khan, his immune system was already starting to produce antibodies suggesting he might recover, Doctors Without Borders said in the statement. Khan was also due to be transferred to a European hospital that would be more capable of handling problems that might arise, it said. The statement did not specify what drug was considered. But it is believed to be ZMapp, an experimental drug designed to boost the immune system to help it fight the virus. Since Khan's body was already producing an immune response, the doctors may have feared that any boost would kick it into overdrive. In the end, the treating physicians decided against using the drug. They never told Khan of its existence because they felt it would be unethical to tell him of a treatment they might not use. Shortly after their decision, however, Khan's condition worsened, the statement said, and the company providing the medical evacuation decided not to transfer him. He died a few days later, on July 29. "Every day, doctors have to make choices, sometimes difficult, about treatment for their patients," said the Doctors Without Borders statement. "Trying an untested drug on patients is a very difficult decision, particularly in the light of the 'do no harm' principle." ZMapp has since been used on two Americans and a Spaniard. The California-based company that makes the drug, Mapp Pharmaceuticals, has said that its supplies are now exhausted, and it will take months to produce even a modest amount. The drug has never before been tested in humans, and it is not clear if it is effective or even harmful. The Americans are improving - although it is unclear what role ZMapp has played in that - but the Spaniard died Tuesday. The last known doses of ZMapp arrived Wednesday in Liberia, where the government has said they will be given to two sick doctors. They will be the first Africans known to receive the treatment. But the debate over experimental treatments and vaccines will continue. Canada has promised to donate 800 to 1,000 doses of its untested Ebola vaccine to the World Health Organization and already questions are being asked about who will get it and how scientists will determine if it works. Likely candidates for the vaccine are health care workers in Africa who are among the most vulnerable because of their close contact with Ebola patients. Liberia has asked for the vaccine, and Guinea is considering asking for access to it. Unlike ZMapp, which is being given to only a handful of people and is unlikely to yield significant information about the drug's effectiveness, the vaccine could be tested in a small, but more rigorous field trial. "It gives us an opportunity to test the vaccine in an outbreak situation in populations that are at risk," said David Heymann, who professor at London School of Hygiene and Tropical Medicine. Meanwhile, Nigeria confirmed that another person has died from Ebola, bringing the toll in that country to three. The man was under quarantine because he had contact with Patrick Sawyer, a Liberian-American who flew into Nigeria with the disease and died of it last month. » There are multiple updates to this story. Please click here to get the latest information.

医学

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Browse: Home / 2012 / August / 06 / UWM dean helped shape new women’s care law UWM dean helped shape new women’s care lawBy UWM News on August 6, 2012 The women’s health provisions in the Affordable Care Act that went into effect Aug. 1 will help keep women healthier at every stage of life, says Magda Peck, dean of the University of Wisconsin-Milwaukee’s Joseph J. Zilber School of Public Health. Peck was one of 15 national experts on women’s health who served on the Institute of Medicine’s (IOM) Preventive Services Committee. In 2010-11, the committee conducted a study on potential gaps in coverage specific to women. As a result of that study, says Peck, the IOM recommended eight additional services be included in the Affordable Care Act’s preventive care provisions, and all eight were adopted into law. Peck, a public health scientist who is a recognized national leader in maternal and child health, participated in the IOM panel from November 2010-July 2011, while she was professor and associate dean of the University of Nebraska Medical Center College of Public Health. She joined UWM as founding dean of the university’s new Zilber School of Public Health in March 2012. Her work for women’s health was a good fit with UWM’s school, she says, because one research and education emphasis of the new school will be advancing the health of women and children in Milwaukee and other major cities. “It was an honor to serve the nation as a scientific member of the IOM expert panel on preventive services for women,” she says. “We found significant evidence that there were unacceptable gaps in the original law passed. Women have unique health needs, may experience some diseases differently than men and bear a higher burden of many chronic diseases.” While much public and media attention has focused on the law’s contraception mandates, the law’s preventive care provisions for women go beyond that, notes Peck. “All insured women now can access well-woman visits without having to pay additional out-of-pocket costs. And women will be able to receive a range of preventive care services – including screening and counseling for domestic violence, screening for diabetes during pregnancy, and breastfeeding supplies and counseling – without additional co-pay. “This will translate into healthier women at every age and stage of life, and overall cost savings both for women and the nation in the long run.” MEDIA CONTACT: Magda Peck, 414.227.3128. mpeck@uwm.edu. Print Friendly Posted in News Release UWM News

医学

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President Bush Blocks Legislation to Advance Stem Cell Research…Again Categories Fact Sheets On June 20, President Bush vetoed S.5, the Stem Cell Research Enhancement Act, for the second time blocking legislation to advance research on embryonic stem cells. Both S.5 and the stem cell legislation vetoed by the President in the last Congress were approved by bipartisan majorities in both the House and the Senate, with nearly unanimous support from Democrats and the support of lawmakers on both sides of the abortion debate. The overwhelming majority of Americans support the legislation, as do major medical and scientific associations, research universities and institutions, and dozens of patient advocacy organizations representing millions of Americans. If enacted, S.5 would expand federally-funded research on embryonic stem cells, which have the unique ability to develop into virtually every cell and tissue in the body. Harnessing this ability could one day enable researchers to grow customized cells and tissue capable of repairing damaged or diseased organs. Yet the great promise of human embryonic stem cell research is being stymied by President Bush’s stem cell policy. Under this policy, federal research funds can be used on only a small number of existing embryonic stem cell lines, excluding newer and more promising stem cell lines from federal research funds. These limitations are slowing progress on research and setting major obstacles on the path to developing new therapies. President Bush’s Misguided Policy is Impeding Researchers’ Efforts to Find Life-Saving Treatments President Bush’s stem cell policy is impeding embryonic stem cell research and the search for cures. Under the President’s stem cell policy, federal funds cannot be used to support research on embryonic stem cell lines derived after August 9, 2001. Fewer stem cell lines meet this criterion than the Bush Administration once claimed. The lines that do meet the cutoff date are contaminated with mouse cells, and many are becoming unstable. National Institutes of Health (NIH) officials report that fewer than 10 of the eligible lines are healthy enough to be used on a regular basis. Moreover, scientists have had difficulty gaining access to the few eligible stem cell lines, and their very limited number has hindered research progress. The President’s policy also creates tremendous financial and administrative burdens on states and research institutions, including universities across the country, that receive federal funding and wish to pursue research on newer stem cell lines. These institutions are forced to waste valuable time and resources on duplicative infrastructure and equipment, as well as training, to avoid using federally-funded buildings and equipment to conduct research on ineligible stem cell lines. Research has shown that the vast majority of state funding for stem cell research has gone to building infrastructure, purchasing equipment, and training scientists – not to actual research. The Bush Administration’s misguided policy hurts our nation’s competitiveness and hinders international research efforts. Many countries have fewer restrictions on embryonic stem cell research than the United States. We cannot compete globally without the full support of the federal government, which is the primary source of funds for basic biomedical research. Other sources of funding, such as private and state-based funding, are beneficial, but they cannot compensate for the current limits on federally-funded research. Moreover, the Administration’s restrictive policy hinders international research by making it harder for U.S. and foreign scientists to collaborate. While the United States has traditionally been an important research hub, the federal stem cell policy makes it difficult for the United States to work with other countries, where scientists are using newer lines that are ineligible for federal funding. The federal government should be supporting and encouraging our scientists, not impeding their efforts to find life-saving cures. Adult stem cell research is not enough. President Bush and some Republicans claim that adult stem cell research is more promising than embryonic stem cell research, particularly because embryonic stem cell research has not yet led to any human therapies. The great majority of scientists, including the current and former NIH directors, believe that the United States should pursue research on both embryonic and adult stem cells. Adult stem cells have been found in only a few tissues and are not pluripotent – that is, they do not have the intrinsic ability to generate all other types of tissue. While adult stem cells are used in some treatments, primarily with blood diseases, it’s important to note that adult stem cell research has had about a 30-year head start on embryonic stem cell research. (Human embryonic stem cell lines were first derived in 1998, and the first federal grant for embryonic stem cell research was not awarded until 2002.) Alternative methods for deriving stem cells are not a substitute for embryonic stem cells. Some suggest that no change in the President’s policy is needed because scientists will eventually discover ways to obtain embryonic stem cells without destroying an embryo. While the development of alternative sources of stem cells would be welcome, this area of research is only in its earliest stages and is fraught with uncertainty. Meanwhile, the current method for deriving stem cells – using embryos that would otherwise have been discarded as medical waste – can be used today by researchers in the pursuit of curing diseases. This method has produced an estimated 400 stem cell lines worldwide, the great majority of which are off-limits to federally-funded scientists. The possibility that science may one day discover alternative sources of pluripotent stem cells should not be used as a justification for continuing the President’s restrictions on stem cell research. Recently-published studies on stem cells derived from skin cells do not eliminate the need for embryonic stem cell research. Scientists have recently succeeded in reprogramming ordinary skin cells in mice to so that they are virtually indistinguishable from embryonic stem cells. This research is very promising and certainly worthy of additional exploration and funding. Unfortunately, the Bush Administration and other opponents of embryonic stem cell research tout these studies as obviating the need for embryonic stem cell research. It is important to note that these studies were conducted on mice, and scientists do not know whether the technique will ever work in humans. Even the scientists responsible for these studies agree that the development of alternative sources of stem cells is a worthwhile pursuit as a complement to, but not as substitute for, existing mechanisms for generating embryonic stem cells. We need to do all we can to help the millions of Americans who suffer from diseases or conditions that could be treated with therapies generated by stem cell research; they cannot afford to wait decades for an alternative approach that may never pan out. President Bush’s new executive order is meaningless. In an attempt to portray himself as supportive of research into regenerative medicine despite his veto of S.5, President Bush issued an executive order, allegedly to promote research into alternative sources of pluripotent stem cells. The order merely directs the Secretary of the Department of Health and Human Services to support research into alternative sources of stem cells and develop a plan for doing so. The order provides no additional funding for this research, and takes no real steps to broaden research efforts. The Bush Administration has stated that a primary purpose of the order is to ensure that research into alternative sources of pluripotent stem cells is eligible for federal funding. In fact, nothing under existing law precludes federal funding of research into alternative sources of stem cells, and this research has been conducted with NIH funding for years. Advocates for embryonic stem cell research merely want embryonic stem cell research to be able to vie for public funding like all other research. Legislation to Advance Embryonic Stem Cell Research Offers Real Hope to Millions of Americans S.5 would support research on embryos that would otherwise be discarded. An important potential source of embryonic stem cells that is not now eligible for federally-funded research are embryos stored in fertility clinics. The process of in vitro fertilization (IVF) typically produces more embryos than are needed for fertility treatments. Approximately 400,000 frozen embryos that are left over from IVF treatments are now stored in fertility clinics in the United States. Most of these frozen embryos will eventually be destroyed. S.5 would enable these frozen embryos to be donated for embryonic stem cell research that is eligible for federal research funds; stem cell lines derived from these frozen embryos would only be eligible for federal research funds if the embryos would never be implanted in a woman and would otherwise be discarded. S.5 would impose ethical rules on stem cell research that are stricter than the President’s policy. In addition to requiring that federally-funded research could only be conducted on stem cell lines from embryos that would otherwise be discarded, S.5 would also require that the individuals who donated the embryos provided their written informed consent to the donation and did not receive any financial or other inducements for making the donation. The President’s current policy does not include these requirements. In fact, some of the stem cell lines that are currently eligible for federally-funded research may not even meet the strict guidelines in S.5. S.5addresses President Bush’s primary concern about embryonic stem cell research. President Bush has emphasized that there is one line he will not cross on the stem cell issue: he will not support allowing federal taxpayer dollars to be used to destroy human embryos. As the primary reason for vetoing S.5, the President asserts that the legislation would, “compel American taxpayers – for the first time in our history – to support the deliberate destruction of human embryos.” This statement is simply false. S.5 was carefully crafted not to cross this line. Pursuant to the Dickey-Wicker amendment that is attached to the Labor-Health and Human Services appropriations bill each year, federal funds may not be used to destroy human embryos. The Dickey-Wicker amendment does not preclude the use of federal funds to study stem cell lines that were derived from human embryos — as contemplated by S.5 and as currently permitted under the President’s policy — but the derivation process itself cannot be paid for with any federal money. S.5 would not alter the existing prohibition on the use of federal funds to destroy human embryos. S.5 differs from the bill the President vetoed last year in that it includes provisions that the President has supported. In addition to expanding the number of human embryonic stem cell lines eligible for federally-funded research, S.5 would also promote research into finding alternative ways to derive stem cells that do not involve the destruction of an embryo. Specifically, the bill includes the text of last year’s Specter-Santorum bill which the President endorsed. Because our government should do everything it can to develop treatments and cures to help those who are suffering, S.5 would promote all ethical forms of stem cell research without prejudging which ones will prove most effective. Democrats Will Not Let the President’s Policy Stand President Bush’s veto denies hope to millions of Americans. S.5 would merely support use of embryos that would otherwise be discarded to create stem cell lines, subject to strict ethical guidelines, that could one day cure diseases and save lives. The President and other opponents of stem cell research base their opposition on their valuing human life. But as between discarding embryos versus using them to ease the suffering of millions of people, it is clearly the latter approach that values human life. Democrats will continue to fight to expand federally-funded embryonic stem cell research. More than 100 million Americans suffer from cancer, diabetes, heart disease, Alzheimer’s disease, Parkinson’s disease, autoimmune disorders, spinal cord injuries, and other debilitating diseases and conditions. Embryonic stem cell research offers these people and their families hope for better treatments and cures. The President’s veto is a devastating setback for them. That is why the Senate will attempt to override the President’s veto. And that is why leaders of the Senate Labor-Health and Human Services Appropriations Subcommittee have included a provision in their 2008 spending bill to allow federally-funded research on hundreds of additional embryonic stem cell lines and tighten the ethical guidelines on this research. Specifically, the provision would extend the cut-off date for federal funding eligibility from August 9, 2001 in the President’s policy to June 15, 2007, while adding the ethical guidelines from S.5. Importantly, Senators do not view this measure as a substitute for the broader provisions in S.5; rather, it is deemed an incremental solution to advance scientific progress toward treatments and cures in the short term, while the Senate works to override the President’s veto of S.5. Democrats will continue to fight to expand President Bush’s misguided policy – keeping hope alive for the millions of Americans who stand to benefit from stem cell research. For more information on this issue, see the DPC Fact Sheet entitled, “NIH Director Agrees that Federally Funded Scientists Should Have Access to New Embryonic Stem Cell Lines.” ‹ Previous Post Senate Floor Schedule For Thursday, June 21, 2007

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Obamacare isn't going away any time soon. And neither is the fight over Obamacare. How many people are going to see this ad? ... and how many people are going to see the Fact Check on that ad? Lamb’s old plan was provided through a public-private program aimed at lower-income workers called CoverTN, which split the premium costs between an employee, the employer and the state. That’s a big reason why Lamb’s premium was only $52 a month, but in an interview she said she would have gladly paid and could have afforded the full $156 a month. Why was the plan so inexpensive? For one thing, it had a $25,000 cap on annual benefits. It also had no limit on out-of-pocket costs, and it would only cover generic medications. CoverTN was terminated at the end of the 2013 because it did not meet key requirements of the ACA, in particular a ban on such caps on benefits. The Obama administration denied the state’s request for a waiver, and so the plan was shut down. For health-care reformers, such annual caps on benefits were a sign of a substandard plan that could put someone in bankruptcy if they had an accident that resulted in unexpected medical costs. But Lamb doesn’t look at it that way because she already had suffered a major and costly accident that was unrelated to her chronic condition. In 2007, Lamb fell off a horse, requiring seven surgeries at Vanderbilt Medical Center. She saw one surgical bill for $125,000, but after negotiations with CoverTN, the hospital agreed to reduce the charges to below $25,000. In the end she barely paid anything in hospital costs after her accident. “Really after that, I was not worried about something catastrophic” that would exceed the $25,000 cap, she said. (Others might look at this story and decide she was unusually fortunate that the hospital, confronted with a patient who had inadequate coverage for the surgery, decided to eat the difference.) Meanwhile, lupus can result in very high medical expenses, but that is not the case with Lamb. She said her out-of-pocket costs, for doctor visits and drug costs, amounted to just $1,000 a year. “I have very good doctors who have helped me manage my condition,” she said. “I was comfortable with the risk of having this limit.” To put her expenses in context, the American College of Rheumatology says that average cost per patient with lupus is between $14,000 and $28,000, though patients with one form of lupus have significantly higher costs – ranging from $29,000 to $63,000. Once Lamb was required to go on Obamacare, she discovered she qualified for a $15-a-month subsidy, which could be applied to nearly 40 different options. She chose one of the more expensive options—a Platinum plan – because it limited out of pocket expenses to $1,500, as her doctor fees and blood tests would be higher under the Obamacare plans. She also considered a plan with a lower premium, but it would have meant higher out of pocket expenses. “Instead of paying $6,000 a year, I would have been paying $10,000 a year” with the plan with a lower premium, she said. Anyone with a chronic condition would have opted for the plan with the lowest out of pocket maximum, even with a higher premium, so Lamb’s choice makes sense. But it did mean she faced sticker shock, going from $52 a month to $373 a month, even after her subsidy. In other words, AFP has managed to highlight a very unique case—someone with a chronic condition who did not face high annual costs. One Lupus sufferer, Erin Kotecki Vest, blogged that she was amazed at Lamb’s tale of woe after she researched the coverage provided by CoverTN. “Just ONE of my treatments ALONE wipes out everything CoverTN had to offer me,” she wrote. “I would hit CoverTN’s $25,000 annual limit the first week of January.” In contrast to Lamb, this Lupus sufferer is thrilled to be on Obamacare. Kotecki Vest gleefully wrote in November that her family ditched her husband’s employer-provided plan after they discovered they would save nearly $19,000 a year by switching to a plan offered on healthcare.gov. For some reason, Kotecki Vest was not asked to appear in an AFP ad. AFP did not respond to a request for comment. I have hope that this will all sort itself out to the point at which a majority of Americans fully understand and accept that the health insurance system has been improved overall by the reforms. But I think we have to face the fact that everything that's wrong with the American health care system writ large will now be attributed to Obamacare by a large number of Americans. And there will be no convincing them that they were not better off before. The fight is not going to magically go away once the Republicans fail to repeal or lose some more elections. Maybe in a generation or two this will change. But I wouldn't get my hopes up. After all, we're still fighting off those who want to get rid of Social Security and that's been in place since 1938. Government welfare state programs are ground zero for the ideological battle in American politics. And anyway, even the Fact Check is so vague and equivocal in can't help but make people throw up their hands and believe what they want to believe: We can’t quibble with the ad’s words–we certainly would not call it a “lie”–but the lack of context is going to earn it Pinocchios. We wavered between One and Two, but ultimately settled on Two because this is really an exception that proves the rule. Whatever ...

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Home > Institutes > Diabetes, Obesity and Metabolism ... > About Us > Message from the Director Diabetes, Obesity and Metabolism Institute About UsMeet the DirectorMessage from the DirectorOur WorkTeamNewsEventsVideos Diabetes and obesity have reached epidemic proportions in the US and around the world. Founded in 2008, the Mount Sinai Diabetes Obesity Metabolism Institute (DOMI), the research counterpart to Mount Sinai’s nationally ranked Diabetes Center, was created in response to the rise of obesity, diabetes, and metabolic syndrome. It endeavors at the forefront of research to cure these disorders by developing better therapeutic and prevention strategies through basic and clinical research. The DOMI at Mount Sinai is a world leader in diabetes and obesity research, with broad focuses on many sub-disciplines within this space, ranging from very basic science through translational research, to community-based education and prevention programs. Mount Sinai recently has reinforced its commitment to this critical area through the recruitment of Dr. Andrew F. Stewart as its DOMI Scientific Director. Areas of notable strength within the DOMI include excellence in: pancreatic beta cell research with an emphasis on human pancreatic beta cell regeneration and survival for the treatment of Types 1 and 2 diabetes; Type 1 diabetes autoimmunity; CNS control of appetite, feeding behavior and metabolic regulation of muscle, liver and adipocytes; mechanisms of insulin resistance and abnormal hepatic lipid metabolism; insulin, leptin, and growth factor-mediated intracellular signaling in liver, CNS, muscle and beta cells; the glycolytic switch in glycolysis and in cancer growth and metastasis; mechanisms of enhanced breast cancer risk and aggressiveness in women with diabetes; clinical trials in diabetes; bariatric surgery; body composition and metabolic abnormalities in Cushing’s Syndrome; genome-wide association studies in diabetes and obesity; genomics, bioinformatics of diabetes and obesity; direct patient care of people with diabetes, obesity, metabolic syndrome; vascular and renal complications of diabetes; research- and clinic-based personalized medicine in diabetes and obesity; bariatric surgery; direct patient care of patients with diabetes, obesity and metabolic syndrome; and, community outreach and education programs for prevention and management of diabetes. At Mount Sinai, the DOMI has outstanding, state-of-the-art research facilities for high-throughput drug screens, high-content imaging, human and rodent bioinformatics and genomics, facilities for complete state-of-the-art rodent metabolic phenotyping, flow cytometry and cell sorting, in vivo animal and human imaging, microsurgery cores, advanced microscopy of all types, monoclonal antibody production facilities and real-time, electronic medical record-based bi-directional personalized medicine. In addition to the excellent Endocrinology Division at Mount Sinai, the DOMI also has strong, collaborative and complimentary relationships with the Diabetes Centers at Columbia University College of Physicians and Surgeons, and Albert Einstein College of Medicine. This extensive network supports the translational efforts at Mount Sinai to improve current care of Types 1 and 2 diabetes, obesity and metabolic syndrome, as well as to discover novel approaches and therapies to the management and ultimate cure of diabetes. Although many and major strengths exist at Mount Sinai in the landscape of diabetes, we plan to expand further, and welcome inquiries from senior and junior scientists in the general areas, including, but not limited to, basic and clinical research in diabetes, obesity, autoimmunity, artificial pancreas, genomics and bioinformatics, adipocyte biology, inflammation and diabetes, vascular biology stem cell biology, microbiome and metabolism, and other areas. Andrew Stewart, MD Director, Diabetes, Obesity and Metabolism Institute Mount Sinai Health System Atran Building

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ASL University | Bookstore | Catalog | Dictionary | Lessons | Resources | Syllabi | Library Deaf Health Care By Andrea Hadley-Macias, Deaf People and Health Care System Patients are dependent on nurses for the delivery of safe and effective health care and communication is key for success. How does a nurse accomplish this important task with a person who is Deaf or Hard of Hearing? In communication people who are deaf use American Sign Language (ASL) which is a language of its own, few people realize ASL is different from English. There are other methods of communication such as writing, lip reading, and auxiliary aids but most people who are deaf or Hard of Hearing (HOH) chose to use ASL as their method of communication. Besides the rules and guidelines the federal government sets for the health care system in regards to people who are Deaf/HOH there is an underlying moral sense and cultural identity that needs to be addressed. Deaf culture is "a social, communal, and creative force of, by and for deaf people based on American Sign Language. Deaf culture, however, is not restricted to deaf people; families, friends and advocates of the deaf community may also be a part of deaf culture�It involves deaf people partaking in "visual literature" (for example, ASL poetry, plays, story telling, or humor) as well as, sports and many other physical and visual activities. As a result, the psychosocial basis of deaf culture is understood to mean that deaf people�regardless of mode of communication taught in the school will seek out other deaf people and use sign language as a primary mode of communication.� [1] In this awareness of Deaf culture, nurses and other health care providers need to develop a sensitivity to the patient�s preference of communication in order to be effective and administer proper care. According to federal law, nurses and their employers have important responsibilities to be accessible to deaf and hard of hearing patients. �Failing to provide interpreters and adapted equipment may be discrimination on the basis of disability. In addition, failure to establish effective communication with a deaf patient may expose a health care provider to liability for medical malpractice�This right is established under two federal laws.� [2] The Rehabilitation Act of 1973 and the American Disability Act set the rules and guidelines Hospitals or medical care facilities and its employees must follow to adhere to the patient�s rights. Under section 504 of the Rehabilitation Act of 1973 which �requires federal financial recipients� programs to be equally accessible to handicapped persons�provision of qualified sign language interpreters is critical to ensure that deaf persons are able to benefit from and participate equally in the program. The office for Civil Rights of HHS has consistently required hospitals to provide qualified interpreters and TDDs to deaf clients�� [3] How can nurses provide proper care and improve relationships with patients who are Deaf or HOH? By following ADA guidelines and the Rehabilitation Act of 1973 regulations and taking the initiative to become certified ASL interpreters or be able to work with interpreters and to be aware and respectful of Deaf culture and the fact that many ��deaf people do not view their deafness as a disability...�[4] but as an identity. [1] http://www.enotes.com/nursing-encyclopedia/american-sign-language accessed 4/4/2009 [2] http://www.nad.org/hospitalsnursinghomes accessed 4/4/2009 [4] McAleer Moncia, Communicating Effectively with Deaf Patients. Nursing Standard. 52. (2006) accessed 4/42009 Dr. Bill's new iPhone "Fingerspelling Practice" app is now available! GET IT HERE! NEW! Online "ASL Training Center!" (Premium Subscription Version of ASLU) ** Want to help support Lifeprint / ASLU? It's easy! You can learn sign language online at American Sign Language University � hosted by Lifeprint.com � Dr. William Vicars

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SBHC Policy Advisory Council SBHC Survey Divisions > Student, Family, and School Support > Student Services and Alternative Programs > School-Based Health Centers School-Based Health Centers in Maryland What are School-Based Health Centers (SBHCs) or School-Based Wellness Centers?SBHCs are health centers, located in a school or on a school campus, which provide onsite comprehensive preventive and primary health services. Services may also include mental health, oral health, ancillary, and supportive services. You might think of a SBHC as "doctor's office in a school". SBHCs may be staffed by one or more of the following health professionals: A primary care provider, such as a pediatrician, nurse practitioner, or physician assistant A registered nurse (RN or BSN) and/or a licensed practical nurse (LPN) A medical office assistant (MOA) or medical assistant (MA) A billing or clerical staff member A mental health provider, such as a psychiatrist, psychologist, social worker, or other therapist A substance abuse counselor A dentist and/or dental hygienist A health educator A nutritionist or registered dietitian Maryland SBHC Application How many are there? As of July 2013, there were 70 SBHCs in Maryland, with more being planned. Some SBHCs serve more than one school, sharing staff between neighboring schools. Maryland's SBHCs are located in elementary, middle, high, K-8 and special schools.Where are they located?There are SBHCs in 12 of Maryland's 24 jurisdictions. Baltimore City: Baltimore County: Caroline County: Cecil County: Dorchester County: 4 Frederick County: Harford County: Prince George's County: Talbot County: Washington County: Wicomico County: How can I locate a specific SBHC in Maryland? Click here for a contact list for Maryland SBHCs. What is the relationship between SBHCs and school nurses/school health services programs? In school year 2007-2008, all 1,455 public schools in Maryland had school health services, usually staffed by a registered nurse. Some large or rural schools have a full-time nurse, but most schools share a part-time nurse with one or more other schools. School nurses provide acute care for injuries and illnesses, care for chronic health conditions under the supervision of a physician, conduct screening for health problems, and maintain up-to-date health and immunization records. School nurses do not diagnose or treat illness; they refer children for appropriate medical care. In school year 2007-2008, SBHCs served 72 of the 1455 public schools. (There were 61 SBHCs in Maryland, but some serve more than one school.) SBHCs employ a primary care provider (a pediatrician, nurse practitioner, or physician assistant) who works cooperatively with the school nurse to screen, diagnose, treat, and refer children for medical conditions. School nurses often serve as the first contact for health issues in a school. They evaluate the problem at hand and either provide care or refer the student to the appropriate provider of care, which may be a SBHC nurse practitioner, a mental health provider, or the child's own doctor. What is the relationship between SBHCs and the health care community/doctors? SBHCs provide care while children are in school, and help prevent them from missing school due to illness. They do not provide round-the-clock care or emergency coverage. All children should have a primary care provider in the community who oversees their care. SBHCs help make sure they have a doctor by helping parents to locate a convenient pediatrician and secure health insurance coverage. If all children should have their own doctor, why do we need SBHCs? In 2004, 1 out of every 11 Maryland children under age 18 had no health insurance and 1 out of every 4 Maryland children under age 18 lived in poverty (Kids Count, Annie E. Casey Foundation Maryland data profile). Uninsured and poor children have less access to health care and often have more chronic health problems than other children. SBHCs were started in Maryland in 1985 to increase children's access to health care. They have proven effective in diagnosing and treating illness, managing chronic health conditions, and increasing school attendance for children at risk of missing school due to health issues. In some parts of the United States, where SBHCs have been studied, an increase in student achievement has been noted in schools with SBHCs. SBHCs are good for all children, though, not just the poor and the uninsured. Modern parents are busy working and taking care of other children, and it can be expensive and inconvenient to take a child to the doctor for a minor health concern. Many rural Maryland counties have few pediatricians or other child health professionals, so services provided in schools are especially important. In recent years, chronic conditions have increased in children, such as asthma, diabetes, and obesity, which benefit from daily monitoring and treatment in the school setting. Email: SBHCentProg@msde.state.md.us SBHC Standards SBHC Administrative Meetings Center for Adolescent Health & the Law Center for Health & Health Care in Schools Center for School Mental Health at U. of MD. Code of MD Regulations MD Assembly on School-Based Health Care MD Dept. of Health & Mental Hygiene National Assembly on School-Based Health Care

医学

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Cell loss in the brain relates to variations in individual symptoms in Huntington's disease January 7th, 2013 in Neuroscience / Scientists have wrestled to understand why Huntington's disease, which is caused by a single gene mutation, can produce such variable symptoms. An authoritative review by a group of leading experts summarizes the progress relating cell loss in the striatum and cerebral cortex to symptom profile in Huntington's disease, suggesting a possible direction for developing targeted therapies. The article is published in the latest issue of the Journal of Huntington's Disease. Huntington's disease (HD) is an inherited progressive neurological disorder for which there is presently no cure. It is caused by a dominant mutation in the HD gene leading to expression of mutant huntingtin (HTT) protein. Expression of mutant HTT causes subtle changes in cellular functions, which ultimately results in jerking, uncontrollable movements, progressive psychiatric difficulties, and loss of mental abilities. Although it is caused by a single gene, there are major variations in the symptoms of HD. The pattern of symptoms shown by each individual during the course of the disease can differ considerably and present as varying degrees of movement distrubances, cognitive decline, and mood and behavioral changes. Disease duration is typically between ten and twenty years. Recent investigations have focused on what the presence of the defective gene does to various structures in the brain and understanding the relationship between changes in the brain and the variability in symptom profiles in Huntington's disease. Analyses of post-mortem human HD tissue suggest that the variation in clinical symptoms in HD is strongly associated with the variable pattern of neurodegeneration in two major regions of the brain, the striatum and the cerebral cortex. The neurodegeneration of the striatum generally follows an ordered and topographical distribution, but comparison of post-mortem human HD tissue and in vivo neuroimaging techniques reveal that the disease produces a striking bilateral atrophy of the striatum, which in these recent studies has been found to be highly variable. "What is especially interesting is that recent findings suggest that the pattern of striatal cell death shows regional differences between cases in the functionally and neurochemically distinct striosomal and matrix compartments of the striatum which correspond with symptom variation," says author Richard L.M. Faull, MB, ChB, PhD, DSc, Director of the Centre for Brain Research, University of Auckland, New Zealand. "Our own recent detailed quantitative study using stereological cell counting in the post-mortem human HD cortex has complemented and expanded the neuroimaging studies by providing a cortical cellular basis of symptom heterogeneity in HD," continues Dr Faull. "In particular, HD cases which were dominated by motor dysfunction showed a major total cell loss (28% loss) in the primary motor cortex but no cell loss in the limbic cingulate cortex, whereas cases where mood symptoms predominated showed a total of 54% neuronal loss in the limbic cingulate cortex but no cell loss in the motor cortex. This suggests that the variable neuronal loss and alterations in the circuitry of the primary motor cortex and anterior cingulate cortex associated with the variable compartmental pattern of cell degeneration in the striatum contribute to the differential impairments of motor and mood functions in HD." The authors note that there are still questions to be answered in the field of HD pathology, such as, how and when pathological neuronal loss occurs; whether the progressive loss of neurons in the striatum is the primary process or is consequential to cortical cell dysfunction; and how these changes relate to symptom profiles. "What is clear however is that the diverse symptoms of HD patients appear to relate to the heterogeneity of cell loss in both the striatum and cerebral cortex," the authors conclude. "While there is currently no cure, this contemporary evidence suggests that possible genetic therapies aimed at HD gene silencing should be directed towards intervention at both the cerebral cortex and the striatum in the human brain. This poses challenging problems requiring the application of gene silencing therapies to quite widespread regions of the forebrain which may be assisted via CSF delivery systems using gene suppression agents that cross the CSF/brain barrier." More information: "New Perspectives on the Neuropathology in Huntington's Disease in the Human Brain and its Relation to Symptom Variation," by Henry J. Waldvogel, Eric H. Kim, Doris C.V. Thu, Lynette J. Tippett, and Richard L.M. Faull. Journal of Huntington's Disease, Volume 1/Issue 2 (December 2012), DOI 10.3233/JHD-2012-120018Provided by IOS Press "Cell loss in the brain relates to variations in individual symptoms in Huntington's disease." January 7th, 2013. http://medicalxpress.com/news/2013-01-cell-loss-brain-variations-individual.html

医学

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In Case You Missed It:Ditching Real Estate Brokers Tag: Dementia Health Study: US Alzheimer’s rate seems to be dropping The rate of Alzheimer’s disease and other dementias is falling in the United States and some other rich countries — good news about an epidemic… Tony Dorsett struggles with memory loss, personality changes Former University of Pittsburgh and NFL Hall of Fame running back Tony Dorsett stands on the sideline before the start of an NCAA football game between Pittsburgh and Notre Dame on Saturday, Nov. 9, 2013, in Pittsburgh. (AP Photo/Keith Srakocic) by Steve Almasy and Eliott C. McLaughlin (CNN) — Tony Dorsett recalls a 1984 game against the Philadelphia Eagles when he was streaking up the field and an opposing player slammed into him. One helmet plowed into another. Dorsett’s head snapped back, his helmet was knocked askew. “He blew me up,” Dorsett told CNN’s Wolf Blitzer. “I don’t remember the second half of that game, but I do remember that hit.” Dorsett compared the hit to a freight train hitting a Volkswagen. Missing Pa. man with dementia, ex-Steeler, found In this Oct. 12, 1952, file photo, Pittsburgh Steelers football player Ray Mathews gathers in a pass for a touchdown against the Philadelphia Eagles, in Philadelphia. (AP Photo/File) BOYERS, Pa. (AP) – An 84-year-old western Pennsylvania man who reportedly suffers from dementia and once played for the Pittsburgh Steelers is expected to be OK after he spent about 20 hours in the woods after not returning from a walk. Study: Later retirement may help prevent dementia June Springer, poses for a photograph, where she works at Caffi Contracting Services, July 12, in Alexandria, Va. Springer who just turned 90, works as a receptionist. People who delay retirement have less risk of developing Alzheimer’s disease or other types of dementia, a study of half a million people in France found. (AP Photo/Alex Brandon) BOSTON (AP) — 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.

医学

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University of Iowa News Release UI study explains how heart attack can lead to heart rupture For people who initially survive a heart attack, a significant cause of death in the next few days is cardiac rupture -- literally, bursting of the heart wall. A new study by University of Iowa researchers pinpoints a single protein as the key player in the biochemical cascade that leads to cardiac rupture. The findings, published Nov. 13 as an Advance Online Publication (AOP) of the journal Nature Medicine, suggest that blocking the action of this protein, known as CaM kinase, may help prevent cardiac rupture and reduce the risk of death. After a heart attack, the body produces a range of chemicals that trigger biological processes involved in healing and repair. Unfortunately, many of these chemical signals can become "too much of a good thing" and end up causing further damage often leading to heart failure and sudden death. "Two of the medicines that are most effective for heart failure are beta-blockers, which block the action of adrenaline, and drugs that block the angiotensin receptor," explains Mark E. Anderson, M.D., Ph.D., UI professor and head of internal medicine and senior study author. "The third tier of therapy is medication that blocks the action of aldosterone." Aldosterone levels increase in patients following a heart attack, and higher levels of the hormone are clearly associated with greater risk of death in the days immediately following a heart attack. Increased aldosterone levels also are associated with a burst of oxidation in heart muscle, and in 2008, Anderson's team showed that oxidation activates CaM kinase. Anderson's research has also shown that CaM kinase is a lynchpin in the beta-blocker and angiotensin pathways. "We wondered if aldosterone might somehow work through CaM kinase and, if it did, could some of the benefits of aldosterone blockers be attributed to effects on CaM kinase?" Anderson says. Anderson's team, including co-first authors Julie He (photo, right), a student in the UI Medical Scientist Training Program; Mei-Ling Joiner, Ph.D.; Madhu Singh, Ph.D.; Elizabeth Luczak, Ph.D.; and Paari Swaminathan, M.D., devised a series of experiments in mice to investigate how elevated levels of aldosterone damage heart muscle after a heart attack and how Cam kinase is involved. The experiments confirmed that aldosterone increases the amount of oxidized, and therefore, activated CaM kinase in heart muscle. Mice given excess aldosterone, mimicking levels seen in human patients, were twice as likely to die after a heart attack as mice that were not given extra aldosterone (70 percent vs. 35 percent), and the cause of death was heart rupture. Importantly, any treatment that reduced the amount of oxidized CaM kinase or otherwise inhibited CaM kinase activity lowered the risk of cardiac rupture and death in the mice. Interestingly, the researchers found that activated CaM kinase prompted heart muscle cells to produce an enzyme called MMP9 that is implicated in heart rupture. "Although there are many sources of this enzyme, our study showed that heart muscle itself is actually making this protein too and is acting against its own self-interest in doing so," Anderson says. "We don't know why it happens, but inhibiting CaM kinase can prevent it." The MMP9 enzyme is involved in remodeling the "matrix" that surrounds heart cells. This matrix, which acts like mortar between cells, is constantly being broken down and rebuilt. In hearts that rupture after heart attack this remodeling process becomes excessive, weakening the matrix to the point that it ruptures. Because matrix remodeling plays a role in other diseases, including cancer, Anderson notes that the CaM kinase findings may have clinical implications beyond heart disease. Overall, the UI study suggests that blocking the biochemical processes triggered by aldosterone might help prevent cardiac rupture following a heart attack. Anderson notes that a multi-center study currently underway in France is poised to determine if patients would benefit from getting aldosterone blockers right away rather than waiting several weeks. "We think our study provides experimental evidence for why that should work," he says. "We have now identified CaM kinase as a critical component for the disease effects of the three core therapeutic pathways in heart, and we are closer to understanding fundamental elements of these signaling pathways," Anderson says. "The findings enhance excitement that CaM kinase might be an important therapeutic target in heart disease, and developing Cam kinase inhibitors is a major goal for us so that we can move this from experimental findings to clinical testing." The research was funded in part by grants from the National Institutes of Health, the American Heart Association, UI Research Foundation and the Fondation Leducq Award to the Alliance for Calmodulin Kinase Signaling in Heart Disease. The interdisciplinary research team included scientists from four departments in the UI Carver College of Medicine; the Iowa City Veterans Affairs Medical Center; Maastricht University in the Netherlands; University of Leuven in Belgium; and Ohio State University. STORY SOURCE: University of Iowa Health Care Media Relations, 200 Hawkins Drive, Room W319 GH, Iowa City, Iowa 52242-1009 MEDIA CONTACT: Jennifer Brown, 319-356-7124, jennifer-l-brown@uiowa.edu

医学

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Psychology of Medicine Some links and readings posted by Gary B. Rollman, Emeritus Professor of Psychology, University of Western Ontario New Voice: Henry Marsh | New Writing | Granta Magazine Ioften have to cut into the brain and it is something I hate doing. With a pair of short-wave diathermy forceps I coagulate a few millimetres of the brain's surface, turning the living, glittering pia arachnoid – the transparent membrane that covers the brain – along with its minute and elegant blood vessels, into an ugly scab. With a pair of microscopic scissors I then cut the blood vessels and dig downwards with a fine sucker. I look down the operating microscope, feeling my way through the soft white substance of the brain, trying to find the tumour. The idea that I am cutting and pushing through thought itself, that memories, dreams and reflections should have the consistency of soft white jelly, is simply too strange to understand and all I can see in front of me is matter. Nevertheless, I know that if I stray into the wrong area, into what neurosurgeons call eloquent brain, I will be faced with a damaged and disabled patient afterwards. The brain does not come with helpful labels saying 'Cut here' or 'Don't cut there'. Eloquent brain looks no different from any other area of the brain, so when I go round to the Recovery Ward after the operation to see what I have achieved, I am always anxious.There are various ways in which the risk of doing damage can be reduced. There is a form of GPS for brain surgery called Computer Navigation where, instead of satellites orbiting the Earth, there are infrared cameras around the patient's head which show the surgeon on a computer screen where his instruments are on the patient's brain scan. You can operate with the patient awake The idea that . . . memories, dreams and reflections should have the consistency of soft white jelly, is simply too strange to understandunder local anaesthetic: the eloquent areas of the brain can then be identified by stimulating the brain with an electrode and by giving the patient simple tasks to perform so that one can see if one is causing any damage as the operation proceeds. And then there is skill and experience and knowing when to stop. Quite often one must decide that it is better not to start in the first place and declare the tumour inoperable. Despite these methods, however, much still depends on luck, both good and bad. As I become more and more experienced, it seems that luck becomes ever more important.I had a patient who had a tumour of the pineal gland. The dualist philosopher Descartes, who argued that mind and brain are entirely separate entities, placed the human soul in the pineal gland. It was here, he said, that the material brain in some magical and mysterious way communicated with the mind and with the immaterial soul. I wonder what he would have said if he could have seen my patients looking at their own brains on a video monitor, as some of them do when I operate under local anaesthetic.Pineal tumours are very rare. They can be benign and they can be malignant. The benign ones do not necessarily need treatment. The malignant ones are treated with radiotherapy and chemotherapy but can prove fatal nevertheless. In the past they were considered to be inoperable but with modern microscopic neurosurgery this is no longer the case: it is usually now considered necessary to operate at least to obtain a biopsy – to remove a small part of the tumour for a precise diagnosis of the type so that you can then decide how best to treat it. The biopsy result will tell you whether to remove all of the tumour or whether to leave most of it in place, and whether the patient needs radiotherapy and chemotherapy. Since the pineal is buried deep in the middle of the brain the operation is, as surgeons say, a technical challenge; neurosurgeons look with awe and excitement at brain scans showing pineal tumours, like mountaineers looking up at a great peak that they hope to climb. To make matters worse, this particular patient – a very fit and athletic man in his thirties who had developed severe headaches as the tumour obstructed the normal circulation of cerebro-spinal fluid around his brain – had found it very hard to accept that he had a life-threatening illness and that his life was now out of his control. I had had many anxious conversations and phone calls with him over the days before the operation. I explained that the risks of the surgery, which included death or a major stroke, were ultimately less than the risks of not operating. He laboriously typed everything I said into his smartphone, as if taking down the long words – obstructive hydrocephalus, endoscopic ventriculostomy, pineocytoma, pineoblastoma – would somehow put him back in charge and save him. Anxiety is contagious – it is one of the reasons surgeons must distance themselves from their patients – and his anxiety, combined with my feeling of profound failure about an operation I had carried out a week earlier meant that I faced the prospect of operating upon him with dread. I had seen him the night before the operation. When I see my patients the night before surgery I try not to dwell on the risks of the operation ahead, which I will already have discussed in detail at an earlier meeting. His wife was sitting beside him, looking quite sick with fear.'This is a straightforward operation,' I said, with false optimism.'But the tumour could be cancerous, couldn't it?' she asked.'Well, it's possible,' I replied. 'That's why we'll get a biopsy – it's called a frozen section - during the op. If the pathologist says it's not cancerous I don't have to try to get every last little bit of tumour out. And if it's a tumour called a germinoma I don't have to remove the tumour at all and he can be treated with radiotherapy.''So if it's not cancer, and not a germinoma, then the operation is safe,' she said, her voice tailing off uncertainly.I hesitated, not wanting to frighten her but reluctant to make false promises. 'Yes – it makes it a lot less dangerous if I don't try to take it all out,' I said, choosing my words carefully.We talked for a little longer and then I wished them goodnight and went home.Iwoke early on the morning of the operation and lay in bed thinking about the young mother I had operated on the previous week. I had operated on a tumour deep in the right side of her brain and somehow – I do not know how since the operation had seemed to proceed uneventfully – I had caused a major stroke, so that she awoke from the operation paralysed down the left side of her body. I had probably tried to take too much of the tumour out. I had probably strayed too deeply into her brain. I must have been too self-confident. I had been insufficiently fearful. I longed for this next operation, the operation on the pineal tumour, to go well – that there should be a happy ending, that everybody would live happily ever after, Neurosurgeons look with awe and excitement at brain scans showing pineal tumours, like mountaineers looking up at a great peak that they hope to climb.and that I could feel at peace with myself once again. But I knew that however bitter my regret, and however well the pineal operation went, there was nothing that I could do to undo the damage I had done to the young woman. I also knew that any unhappiness on my part was nothing compared to what she and her family were going through. I knew too that there was no reason why the next operation should go well just because I hoped so desperately that it would, or because the previous operation had gone so badly. The outcome of the pineal operation – whether the tumour was malignant or not, whether I could remove the tumour or whether it was hopelessly stuck to the brain and everything went horribly wrong – was largely outside my control. I also knew, however, that as time went by the grief I felt at what I had done to the young woman would fade. The memory of her lying in her hospital bed, her mother sitting beside her with her daughter's newborn baby on her lap, would become a scar rather than a painful wound. She would be added to the list of my disasters – another headstone in that cemetery which the French surgeon Leriche once said all surgeons carry within themselves.As soon as an operation begins, however, the surgeon usually finds that any morbid fear disappears. You take up the scalpel – no longer from the scrub nurse's hand but, in accordance with some Health and Safety protocol, from a metal dish – and full of surgical self-confidence, press it precisely into the patient's flesh. As the blood rises from the wound the thrill and excitement of the chase take over and you feel, more or less, in control of what's happening. At least that is how it seems as the operation starts, and you operate in the blind faith that that is how the operation will continue, although you know that it may not.My assistant and I stood behind the patient, who was propped upright in the sitting position, as we opened the back of his head, splitting the neck muscles apart and then drilling through the bone of his skull.'Really cool. Exciting,' my registrar said.'Well,' I replied, unable to deny my own excitement. 'It's like mountaineering – although it's mountaineering for cowards since it's not our lives that are at risk.'The man's head opened, the muscles retracted, the meninges incised and reflected – surgery has it own ancient descriptive language – I had the operating microscope brought in and I settled down in the operating chair. With this particular operation you are looking along a narrow crevice that separates the upper part of the brain – the cerebral hemispheres – from the lower part of the brainstem and cerebellum. You feel as though you are crawling through a long tunnel. At about three inches' depth – although it feels a hundred times longer because of the microscope's magnification – you will find the tumour. You are looking directly into the centre of the brain, a secret and mysterious place where all the most vital functions that keep us alive and conscious are to be found. Above you, like the great vault of a cathedral roof, are the deep veins of the brain – the Internal Cerebral Veins, and beyond them the basal veins of Rosenthal and then in the midline the Great Vein of Galen, dark blue and glittering in the light of the microscope, names that inspire awe in neurosurgeons, veins that carry huge volumes of venous blood away from the brain, and vessels which, if damaged, will result in the patient's death.In front of you is the granular red tumour and beneath it the tectal plate of the brainstem, where damage can produce permanent coma.On either side are the posterior cerebral arteries that supply the parts of the brain responsible for vision. In the distance ahead, beyond the tumour, a door opened into a distant white-walled corridor once the tumour has been removed, is the third ventricle.There is a fine, surgical poetry to these names which, combined with the beautiful optics of a modern, counter-balanced microscope, makes this one of the most wonderful neurosurgical operations – if all goes well, that is. The disastrous operation of the preceding week, however, had destroyed much of my It was as though I had lost all my knowledge and experience, and every time I divided a blood vessel I shook with fright.surgical self-confidence and I was as nervous as I had been when I had first become a surgeon. As I approached the tumour there were several blood vessels in the way that had to be cut – one needs to know which can be sacrificed and which cannot. It was as though I had lost all my knowledge and experience, and every time I divided a blood vessel I shook with fright. And yet as a neurosurgeon you learn at an early stage of your career to accept intense anxiety as a normal part of the day's work and to carry on despite it – so eventually I reached the tumour. I removed a minute fragment of it which was then sent off to the pathology laboratory and I sat back in my operating chair.'We'll now have to wait,' I said to my assistant with a sigh. It is not easy to break off in the middle of an operation and I sat slumped in my chair, full of nervous excitement: longing to get on with the operation, hoping that my pathology colleague would report the tumour to be both benign and operable, hoping that the patient would live, hoping that I would be able to tell his wife after the operation that all would be well.After forty-five minutes of waiting I couldn't stand the delay any longer and, pushing my chair away from the operating table, leapt out of it and went to the nearest phone – still in my sterile gown and gloves. I rang the path lab and demanded to speak to the pathologist. There was a brief delay and then he came to the phone.'The frozen,' I shouted. 'What's happening?''Ah,' he said imperturbably. 'So sorry about the delay. I was in another part of the building.''What the hell is it?' I asked.'Yes. Well, I'm looking at it now. Ah! Yes, it looks like a straightforward benign pineocytoma . . . ''Wonderful!' I cried, forgiving him instantly. I went back to the operating table where everyone was patiently waiting.'Let's get on with it!' I said.Iscrubbed up again and climbed back into my operating chair, rested my elbows on the armrests and got back to work on the tumour. Each brain tumour is different – some are as hard as rock, some as soft as jelly. Some are completely dry, some pour with blood – sometimes to such an extent that the patient can bleed to death during the operation. Some shell out like peas from a pod, some are hopelessly stuck to the brain and its blood vessels. You can never know for certain from a brain scan exactly how a tumour will behave until you start to remove it. This man's tumour was, as surgeons say, co-operative, and with a good surgical plane – in other words, it was not stuck to the brain. I slowly cored it out, collapsing the tumour in on itself away from the surrounding brain. After three hours it looked as though I had got most of it out.Since pineal tumours are rare and exciting cases, one of my colleagues came into my theatre from his own operating theatre, to see how the operation was going. He was probably a little jealous. He peered over my shoulder.The operation continued uneventfully and by the end it seemed that I had removed all, or almost all of the tumour without injuring any of the surrounding vital architecture of the brain. Since the tumour was a benign pineocytoma it probably would not matter even if post-operative scans showed I had left a small fragment of it behind. I left my assistant to close the wound and, leaving the operating theatres, walked the short distance to the wards.I had only a few inpatients, one of them the young mother I had left paralysed one week earlier. I found her on her own in a side-room. Approaching a patient you have damaged makes the handle of the door You can never know for certain from a brain scan exactly how a tumour will behave until you start to remove it.behind which the patient is lying feel as though it is made of lead. There is a force-field pushing you away from the patient's bed, resisting your attempts to raise a hesitant smile on your face. You are a villain and perpetrator, or at best incompetent, no longer heroic and all-powerful. It is difficult to know what role you now should play. It is much easier to hurry past the patient, looking busy and important, without saying anything at all.I went into the room and sat down in the chair beside her.'How are you?' I asked lamely.She grimaced.'Not too good,' she replied, pointing with her good right arm to her paralysed left arm and then lifting it up to let it fall lifeless onto the bed.'I've seen this happen before,' I said. 'And the patients got better, although it took months. I really do believe you will get largely better.''I trusted you before the operation,' she said. 'Why should I trust you now?'I had no immediate reply to this and could only look uncomfortably at my feet.'But I believe you,' she said after a while, although I think she spoke out of pity.Iwent back to the theatres. The pineal patient had been transferred from the table to a bed and was already awake. He lay with his head on a pillow, looking blearily around himself while one of the nurses washed blood and bone dust left from the operation out of his hair. The anaesthetists and theatre staff were laughing and chatting as they busied themselves around him, rearranging the many tubes and cables attached to him, in preparation for wheeling him round to the ITU. If he had not woken up so well they would have been working in silence.'He's fine,' my assistant happily shouted to me across the room.I went to find his wife. She was waiting in the corridor outside the ITU, her face rigid with fear and hope as she watched me approach her.'It went as well we could hope,' I said, in a formal and matter-of-fact voice, playing the role of a detached and brilliant brain surgeon – but then I could not help but reach out to her, to put my hands on her shoulders, and as she put her hands on mine and we looked into each others' eyes, and I saw her tears, and had to struggle for a moment to control my own, I allowed myself a brief moment of celebration.'I think everything's going to be all right,' I said. ■http://www.granta.com/New-Writing/Henry-Marsh Many Patients With Defibrillators Face a Dilemma -... A Clash Over Vertos Medical’s Promising Procedure ... The Fraying Hospital Safety Net - NYTimes.com Not a Cancer Survivor - NYTimes.com The Body: Visual AIDS Web Gallery: Art, AIDS and A... Making medical theatre | University Affairs New Voice: Henry Marsh | New Writing | Granta Maga... Health Care Where You Work - NYTimes.com

医学

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temple university health system tUportal tUmail Site Map Search about | Maps & Directions | contact | admissions | faculty | alumni & development | library | Tech Support Center | dean's office | Policies & Procedures Education Patient Care Departments and Centers Continuing Medical Education TUSM HOME OFFICE OF news communications News Archive LOSING PROTEIN HELPS HEART RECOVER, SAY TEMPLE SCIENTISTS Contact: Steven Benowitz steven.benowitz@tuhs.temple.edu When a person has a heart attack, portions of the heart muscle die in the next several days or even weeks if deprived of oxygen for long enough. The recovering heart slowly remodels itself, even fostering the growth of new blood vessels, in an attempt to regain some of its former function. But all too often, the remodeling is actually harmful, and the damaged heart is on an inevitable downward slide to heart failure. Now, scientists at the Center for Translational Medicine at Temple University School of Medicine have identified a key target they hope will help stave off the potentially harmful effects of remodeling. They have shown that by turning off the activity of a protein, GSK-3α, in the heart cells of mice that have had a heart attack, they can prevent heart remodeling, preserve heart function and significantly improve survival. Their findings offer new insights into processes underlying remodeling, and perhaps to eventual strategies against heart failure. They reported their results November 5, 2012, at the Late-Breaking Basic Science Oral Session at the American Heart Association’s Scientific Sessions 2012 in Los Angeles. “We need to find ways to prevent and slow down remodeling of the heart after a heart attack – that’s the Holy Grail of heart failure,” said senior author Thomas Force, MD, Professor of Medicine and Clinical Director of Temple’s Center for Translational Medicine. “Our findings are important steps in understanding some of the mechanisms at play in remodeling, and hold promise to eventually lead to new interventions and perhaps even help prevent heart failure.” Focusing on GSK-3α The protein enzyme GSK3 – glycogen synthase kinase 3 – plays a key part in many cellular processes and diseases. It has two forms, GSK-3α and GSK-3β, both of which have particularly important roles in heart disease. While the exact role of GSK-3α in heart cells has been unclear, studies indicate that it is important in regulating the heart’s growth, ability to contract, and its expansion in size associated with heart disease and heart failure. To find out the role of GSK-3α specifically in heart cells, Dr. Force, first author Firdos Ahmad, PhD, a postdoctoral fellow in the Department of Pharmacology and the Center for Translational Medicine, and their co-workers compared mice with normal levels of the protein in their heart cells to mice with heart cells lacking a working GSK-3α. All of the mice in both groups experienced the equivalent of a heart attack. The researchers found that the mice missing the protein in their heart cells had significantly better survival (100 percent) over the next several days or week compared to the normal mice (75 percent survival). After two weeks, they found that both groups had comparable increases in heart chamber size and accompanying reductions in the heart’s left ventricle’s ability to pump blood effectively. Yet, at four weeks after a heart attack, the two groups began to separate, with the mice without GSK-3α in their heart cells showing significantly better preserved heart function. By that time, however, the left ventricle in the non-GSK-3α mice showed a much greater reduction in size than was seen in the hearts of the mice with the GSK-3α protein. As a result, the hearts of the mice without GSK-3α showed greater pumping ability. Eight weeks after experiencing a heart attack, 92 percent of the mice lacking GSK-3α were still alive compared to only 71 percent of the normal mice. “During remodeling, the heart’s ventricles dilate and the ventricle function deteriorates,” explained Dr. Force. “Remodeling after a heart attack is the major cause of heart failure in the United States. We’d like to prevent this by finding something to modulate the process.” Surprising Results The researchers were surprised by the results, since earlier studies have found the opposite – that is, heart attack-induced mice that lack the GSK-3α protein in all of the body’s cells have an increased rate of mortality, along with a less effectively functioning heart. “These results are very unexpected,” Dr. Force said. “We think that since turning off GSK-3α activity in all of the cells causes so many cardiac problems, there must be other processes at work there that are causing these differences from what we see when the protein’s activity is halted in only heart cells. We’d like to find the mechanisms involved in this.” “The results also suggest that inhibiting both GSK forms might be a way of controlling post-heart attack remodeling and retain heart function,” Dr. Ahmad noted, pointing to earlier research showing that inhibiting GSK-3β was also beneficial. Other researchers contributing to this work include Hind Lal, Ronald Vagnozzi, Jibin Zhou, and Erhe Gao, Temple University School of Medicine, and James R. Woodgett, University of Toronto. The work was supported by the National Institutes of Health. Rebecca Harmon 3509 N. Broad St., 9th Floor T: 215-707-8229 Email: rebecca.harmon@tuhs. temple.edu © Temple University for questions email us at tusm@temple.edu

医学

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»How to Beat the Doctor... How to Beat the Doctor Shortage Big changes ahead for patients by Marsha Mercer, AARP Bulletin, March 2013 New ways to attract new doctors To make primary care a more attractive choice, medical experts are exploring a number of fresh ideas — from the more efficient team approach to shortening medical school training from four years to three. Today, Harvard is educating primary care doctors away from the doctor-sees-all-patients practice to a medical team model, which can lighten the doctor's workload and paperwork and still offer excellent care. In Texas — where many small towns have only one doctor, if that — Texas Tech University is about to graduate its first class in an accelerated, three-year family medical program. Highly qualified students shave a year off med school and receive a full scholarship for their first year. Looking for a Doctor? The best place to start is your state medical association. Many provide doctor directories that often include new doctors just setting up practice. If you're a Medicare beneficiary, go to medicare.gov. Under "Forms, Help and Resources" on the home page, select "Find doctors, hospitals and facilities." Type in your ZIP code and you'll get a drop-down menu of medical specialties, including primary care. The tool provides contact information for doctors according to the criteria you enter — geographic location, specialty, etc. Call the office to check whether the doctor is still taking new patients. Clay Buchanan, a former lawyer, is one of those graduating in May. At 48, the Little Rock, Ark., resident is older than most medical students. He shadowed a family doctor as part of his training — and was hooked. "By noon the first day, I loved it," Buchanan says. New York University and several other colleges are planning to experiment with a three-year program. Health clinics offer primary care Community health centers offer another form of primary care. Nationwide, the centers serve 20 million patients a year using a team approach, and are open to all on a sliding fee scale. Under the ACA, they are expected to double their capacity to 40 million patients by 2015. To entice doctors to work at these centers, the National Health Service Corps repays up to $120,000 in loans for each doctor in return for four years' service. Technology, including telemedicine — which could reduce patient trips to the doctor's office — also should help expand health care. Another way to increase health services is to give "physician extenders" — nurses and other medical professionals — more autonomy. Patricia Grady, director of the National Institute of Nursing Research at the National Institutes of Health, supports increasing the role of trained nurses, allowing them to set up independent practices where they could do physical exams and advise patients on exercise and diet. But that position has met with some resistance. The American Academy of Family Physicians and the American Medical Association (AMA) favor training more physicians and nurses but want to keep nurses in teams led by doctors. Nurses and foreign doctors Permitting more foreign doctors to practice here also would increase the pool of primary care providers. Last fall, President Obama signed a three-year extension of a visa waiver program that allows states to place 30 foreign medical school graduates a year in "medically underserved" areas for three years. Most remain in the communities after they satisfy their commitment. Still, the shortage is so acute, even the AMA is lobbying Congress to increase to 50 the number of foreign-educated doctors each state is allowed. In the meantime, more Americans are anxiously searching for a primary care doctor — or waiting months to see one. Marcia Andrews, whose Washington doctor refused to take Medicare, finally found a new doctor who does. The search took her 18 months. Marsha Mercer is a freelance journalist who lives in the Washington, D.C., area. Is a "boutique" doctor for you? Top 5 food trends for 2013 Either the video service is temporarily unavailable or the requested video could not be retrieved. We apologize for the inconvenience. Marital Status and Medicare Eligibility How Medicare works when you're in a same-sex marriage read More From Ask Ms. Medicare Patricia Barry | Ask Ms. Medicare aarpbookstore FeaturedGroups

医学

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Posts Tagged ‘Medicaid’ Is Medicare in Peril if the Supreme Court Rules Against the ACA Could there be collateral damage if the Supreme Court rules to overturn the Patient Protection and Affordable Care Act (ACA)? Some healthcare experts are warning of potential collateral damage if the Supreme Court strikes down the entire ACA: potential chaos for Medicare. “The Affordable Care Act has become part and parcel of the Medicare system, encouraging providers to deliver better, more integrated, better coordinated care, at lower cost,” said Judy Feder, a public policy professor at Georgetown University and former Clinton administration health official. “To all of a sudden eliminate that would be highly disruptive.” Sara Rosenbaum, a professor of health law and policy at George Washington University, is more blunt: “We could find ourselves at kind of a grand stopping point for the entire healthcare system.” It’s not only Democrats warning of potential problems. Gail Wilensky, who ran Medicare and Medicaid during President George H.W. Bush’s administration, doesn’t think it’s likely that the court will strike down the entire health law. But if it does, she warns, “it seems like it takes everything with it, including those aspects that are only very peripherally related to the expansion of coverage.” One reason that so many experts are concerned is that the ACA altered the payment rates for nearly every type of healthcare professional who treats Medicare patients. Every time Medicare sets a payment rate, it must cite a legal authority. Since 2010, according to Rosenbaum, that legal authority has been the ACA. If the law is ruled unconstitutional, she said, every one of those changes “doesn’t exist anymore because the law doesn’t exist.” The result? “You have agencies sitting on two years of policies that are up in smoke,” she said. “Hospitals might not get paid. Nursing homes might not get paid. Doctors might not get paid. Changes in coverage that have begun to take effect for the elderly, closing the donut hole might not happen. We don’t know.” Writing for the Huffington Post, Ethan Rome, Executive Director, Health Care for America Now, says that “The Supreme Court will uphold the ACA not only because it’s constitutional, but because to do otherwise would impose a massive judicial intervention in one of the economy’s most complex sectors and derail a train with millions of individuals and businesses on board. If the conservative justices disregard decades of legal precedents and strike all or part of Obamacare, they would not merely be tearing down the most sweeping piece of social legislation since Medicare and Medicaid, they would be taking away substantial consumer protections and benefits from millions of America’s seniors, families and small businesses. The court would have to take responsibility for dismantling the law piece by piece, a task as difficult as it is unconscionable. The law is two years old. Implementation is moving forward, and hundreds of complicated provisions are in effect, helping millions of Americans. States, businesses, doctors, hospitals and insurance companies have undertaken major, costly changes in anticipation of the improved insurance marketplace developing right now. The fact is that serious wreckage would result from a bad decision. Attempting to unscramble this omelet would be a national nightmare.” Politico’s J. Lester Feder offers this perspective. “If America is hoping a Supreme Court ruling will end the legal uncertainty hanging over the healthcare system once and for all, there’s a chance it could be sorely disappointed. Most legal experts are hoping the Supreme Court will give a clear thumbs up or down to the healthcare law. But they’re worried about the possibility that, if the court strikes down just part of the health law, it could outsource the job of figuring out precisely which provisions of the gargantuan law stay or go. That could mean at least another year of legal proceedings before the country — and the states that have to build the health exchanges — really know the rules its health system will operate under. And that doesn’t even include the wild card of the election. The parties challenging the law attempted to head off this scenario by specifically asking the court to consider whether the individual mandate could be severed from the rest of the law. But if the Supreme Court decided it lacked the capacity — or the desire — to settle questions of how dependent the various parts of the law are on the individual mandate, it could remand the case to the lower courts to work through the details, legal experts say. Another outside possibility is that the Supreme Court could appoint a ‘special master’ to sift through it under the high court’s supervision, though special masters usually oversee complex settlements or disputes among states, not dismantling politically charged legislation.” If the unthinkable happens and the Supreme Court does strike down President Barack Obama’s signature piece of legislation, employers and insurance companies — not the government — will be the primary drivers of change over the next decade. They’ll borrow some ideas from Obamacare, and push harder to slash costs. Business can’t and won’t take care of America’s 50 million uninsured. Workers will pay more of their own medical costs as job coverage changes to plans with higher deductibles. Another part of the equation will be tax-free accounts for routine medical expenses, to which employers can contribute. Employees and their families will be steered to hospitals and doctors that can prove to insurers and employers that they deliver quality care. These networks of medical providers would earn part of their fees for keeping patients healthy, similar to the accountable care organizations in the ACA. Tags: Accountable care organizations, donut hole, Gail Wilensky, High-deductible healthcare plans, Medicaid, Medicare, Obamacare, Patient Protection and Affordable Care Act, President Barack Obama, President Bill Clinton, President George W. Bush, Social legislation, Supreme Court Posted in Healthcare, Hospital Systems | No Comments » Sebelius Asks Civil Right Activists to Defend the ACA Secretary of Health and Human Services Kathleen Sebelius has asked civil rights activists to help defend the Patient Protection and Affordable Care Act (ACA), noting that the healthcare law faces an “enemy” whose goal is to set American health policy back half a century. The remarks come two months before the Supreme Court is expected to issue a ruling that could strike down the law. Sebelius described the ACA as an crucial weapon against racial disparities that have long meant higher infant mortality rates, shorter life spans and limited access to medical services for minorities. “The enemy is at the door and we know that they would like to dismantle these initiatives,” Sebelius told the annual convention of the National Action Network, a civil rights group led by the Reverend Al Sharpton. “Healthcare inequalities have been one of the most persistent forms of injustice,” she said. “Now is not the time to turn back.” Civil rights advocates and the minorities they often represent form a key segment of the Democratic base, especially if the Supreme Court strikes down Obama’s signature domestic policy achievement. Research shows that low-income Americans, including many minorities, have significantly less access to medical care and suffer higher rates of childhood illnesses, hypertension, heart disease, AIDS and other diseases. Designed to bring healthcare coverage to more than 30 million uninsured Americans, the ACA has become a pet target for Republicans mainly because of an `individual mandate that requires most Americans to have healthcare insurance by 2014. “We’ve got folks who are committed to undoing…the important initiatives that we’ve made in the last few years,” Sebelius said. “Frankly, they want to go back and undo Medicare and Medicaid from the mid-1960s. They want to roll us back years and years.” The House of Representatives voted recently to partially privatize Medicare and convert Medicaid to a block-grant program for states, although the legislation is likely to be stalled in the Senate. “I’m here to ask you to help,” Sebelius said. “If we can begin to close the disparities in health, we begin to close disparities in other areas, too.” Sebelius asked religious leaders, health advocates and other minority leaders to help the Obama administration educate the public about the healthcare law’s many benefits. The law, which becomes fully effective on January 1, 2014, has already benefited minorities by extending private insurance coverage to young adults, providing free preventive services for those with insurance and prohibiting coverage denials for children with pre-existing conditions. Tags: AIDS, Block grant program, Civil rights advocates, Department of Health and Human Services, heart disease, House of Representatives, Hypertension, Individual mandate, Kathleen Sebelius, Medicaid, Medicare, Minorities, Mortality rates, National Action Network, Patient Protection and Affordable Care Act, pre-existing conditions, President Barack Obama, Reverend Al Sharpton, Senate, Supreme Court Posted in Healthcare, Hospital Systems | No Comments » When Uninsured Have Dental Pain, They Often Head to the ER Greater numbers of Americans , especially those who lack insurance coverage, are turning to the emergency room for routine dental care. This choice frequently costs 10 times more than preventive care and offers far fewer treatment options than a dentist’s office. The majority of these ER visits are to treat toothaches that could have been avoided with regular checkups but went untreated, often due to a shortage of dentists, particularly those who treat Medicaid patients. The number of ER visits nationally for dental problems increased 16 percent from 2006 to 2009, and a report from the Pew Center on the States states that the trend is just getting started. In Florida, more than 115,000 dental patients visited the ER in 2010, costing more than $88 million. That included more than 40,000 Medicaid patients, a 40 percent increase when compared with 2008. Many ER dental visits involve repeat patients seeking additional care. In Minnesota, nearly 20 percent of all dental-related ER visits are return trips because emergency rooms generally are not staffed by dentists. They are equipped to offer pain relief and medicine for infected gums but not much more. Because many patients can’t find or afford follow-up treatment, they return to the emergency room. “Emergency rooms are really the canary in the coal mine. If people are showing up in the ER for dental care, then we’ve got big holes in the delivery of care,” said Shelly Gehshan, director of Pew’s children’s dental campaign. “It’s just like pouring money down a hole. It’s the wrong service, in the wrong setting, at the wrong time.” For example, in 2009, 56 percent of children enrolled in Medicaid received no dental care. Visiting ERs for dental treatment “is incredibly expensive and incredibly inefficient,” said Dr. Frank Catalanotto, a professor at the University of Florida’s College of Dentistry. Preventive care such as regular teeth cleaning can cost $50 to $100, as opposed to $1,000 for emergency room treatment that may include painkillers for aching cavities and antibiotics from resulting infections, Catalanotto said. Infections can be dangerous, particularly in young children, who often have fevers and suffer from dehydration from preventable dental conditions. In Florida 200 children were hospitalized in 2006 for those types of infections. The recession has only worsened the trend, according to Catalanotto. When someone in the family is laid off, dental tends to take a back seat to food and other necessities. The Wisconsin Hospital Association has estimated that 32,000 patients with dental problems visit hospital ERs every year. The fees paid to dentists by state health programs such as BadgerCare Plus are the fifth-lowest in the country, according to a report by the Pew Children’s Dental Campaign. Raising the fees paid to dentists is not likely in the short term given the state’s budget, said Matt Crespin, associate director of the Children’s Health Alliance of Wisconsin, an affiliate of Children’s Hospital and Health System. “That’s why some of those innovative models have to be looked at,” according to Crespin. Pekin Hospital in central Illinois has seen a significant increase in ER patients with “very poor dental health,” said Cindy Justus, the hospital’s ER nursing director. They include uninsured patients and drug abusers, and many are repeat patients. “There’s just not a lot of options” for them, Justus said. Shortages of dentists, most notably in rural areas, are part of the problem, Gehshan said. In Illinois’ Cook County, — which includes Chicago — ER dental visits rose nearly 77,000 between 2008 and 2011. The cause of the problem is too little financing for dental care in the healthcare system. “And when you lose adult dental coverage like California did in 2009, that creates an even bigger problem,” Gehshan said. “We do have a safety net, and it’s not big enough,” she said. In fact, she said, California’s dental care system can only handle about 70 percent of the need in the state, and that’s if the system were actually at full capacity. Amazingly, 25 percent of all California children have never been to a dentist. As a result, when those children and their parents end up in the emergency room, using time and resources that could be better spent on non-dental emergencies, that costs California’s taxpayers money, Gehshan said. Tags: BadgerCare Plus, Children's Health Alliance of Wisconsin, Dentistry, ER, healthcare insurance, Medicaid, Pew Children's Dental Campaign, Preventive care, Treatment options Posted in Healthcare, Hospital Systems | No Comments » HHS Issues New Rules on Healthcare Insurance Exchanges The Department of Health and Human Services (HHS) has issued its final rule aimed at implementing state health insurance exchange provisions of the federal healthcare law. The rule becomes effective 60 days after it is published in the Federal Register. The regulation outlines details of the exchanges, which are scheduled to launch on January 1, 2014, and offer insurance plan options for individuals and small businesses, as well as federal subsidies for premiums. The final rule outlines the minimum standards states must meet in establishing and operating their exchanges, such as individual and employer eligibility for enrollment. The rule also outlines minimum standards that health insurers must meet to participate in an exchange and the standards employers must meet to participate in the exchange. The regulation offers states “substantial discretion” in how to design and operate their exchanges. HHS will accept comment on nine sections of the exchange rule, including provisions regarding the ability of a state to allow agents and brokers to assist qualified individuals in applying for advance payments of the premium tax credit and cost-sharing reductions for qualified health plans; Medicaid and CHIP regulations; options for conducting eligibility determinations; and verification for applicants. This final rule does not address all of the insurance exchange provisions of the Patient Protection and Affordable Care Act (ACA). “These policies give states the flexibility they need to design an exchange that works for them,” said HHS Secretary Kathleen Sebelius. “These new marketplaces will offer Americans one-stop shopping for health insurance, where insurers will compete for your business. More competition will drive down costs and Exchanges will give individuals and small businesses the same purchasing power big businesses have today.” Among the regulations are a guide to set standards for establishing exchanges; setting up a Small Business Health Options Program (SHOP); performing the basic functions of the exchange; and certifying health plans for participation in the exchange; as well as setting up a streamlined, web-based system for consumers to apply for and enroll in qualified health plans and insurance affordability programs. The announcement is the culmination of more than two years’ work with states, small businesses, consumers, and health insurance plans. The administration examined models of exchanges; convened numerous meetings and regional listening sessions across the country with stakeholders; and consulted closely with state leaders, consumer advocates, employers and insurers. To finalize the rules, HHS accepted public comment to learn from states, consumers, and other stakeholders on how to improve the rules; HHS adapted the proposals based on feedback from the American people. Unfortunately, many state lawmakers are hesitant to move forward with creating the exchanges until the Supreme Court has ruled on the ACA’s constitutionality, according to Joy Johnson Wilson, federal affairs counsel and health policy director at the National Conference of State Legislatures. “It’s fair to say that legislation has kind of slowed,” Johnson Wilson said, noting that many lawmakers are taking a “wait-and-see approach” in anticipation of the high court’s oral arguments this month. Legislators do not want to make plans that have to be revisited and revised, Johnson Wilson said. Despite the ambivalence of some states, they will be given great flexibility in setting up the exchanges. The concept is the eligibility for determining the premium tax credit is going to be done by the exchange…but also in the state-based exchange to allow — whether it’s a web-based broker or a small-business broker or agent — to interact with the exchange in an automated way,” Tim Hill, deputy director in the Centers for Medicare and Medicaid Services insurance-regulation office, said. “Those are all relationships that are regulated on the state level…to determine the fee structure for how agents or brokers can be compensated for bringing business to the exchange,” Hill said. “That’s something we’re going to leave to the state.” Hill said allowing third-party companies or brokers access the exchanges will help inform people about the insurance exchanges. “There are lots of folks out there who can generate interest and marketing…it’s a source of leverage that we want to leverage if the states choose to,” Hill said. Writing on The Hill’s Healthwatch blog, Julian Pecquet notes that “States will have ‘substantial flexibility’ to operate a key provision of President Obama’s healthcare reform law. The long-awaited final rules expand states’ ability to craft insurance marketplaces that meet their residents’ needs. This includes allowing states to structure their health insurance exchange in a variety of ways — for example, as a nonprofit entity established by the state, as an independent public agency or as part of an existing state agency. The final rules also offer each state more time to set up its exchange. The law requires states to ‘demonstrate complete readiness’ to guarantee they’ll be operational 12 months later. If states don’t meet the deadline, a federal exchange will take over. The final rule, however, allows for ‘conditional approval’ if a state is ‘advanced in its preparation’ by January 1, 2013. In addition, states that aren’t deemed ready for 2014 can apply to operate their own exchange in 2015 or any subsequent year. ‘HHS may conditionally approve a state-based exchange upon demonstration that it is likely to be fully operationally ready by October 1, 2013, which provides States with flexibility in meeting exchange development timelines,’ according to the regulation. ‘HHS will provide additional details in future guidance.’” Tags: Centers for Medicare and Medicaid Services, CHIP, Department of Health and Human Services, Federal Register, Health insurance exchanges, Kathleen Sebelius, Medicaid, National Conference of State Legislatures, Patient Protection and Affordable Care Act, Small Business Health Options Program, Supreme Court Posted in Healthcare, Hospital Systems | No Comments » Income Disparities Impact Healthcare Availability There are limited affordable choices for Americans who do not have health insurance through their jobs, especially for those with low and moderate incomes. Few are Medicaid-eligible, and locating a plan on the individual market equals paying high premiums. According to the Commonwealth Fund Health Insurance Tracking Survey of U.S. Adults, 2011, nearly 57 percent of adults aged 19 to 64 in families earning less than 133 percent of the federal poverty level ($29,726 for a family of four) were uninsured for a time in 2011 and 41 percent) were uninsured for a year or longer. In contrast, only 12 percent of adults earning 400 percent of poverty or more ($89,400 for a family of four) were uninsured during the year, with four percent having no healthcare insurance for one year or longer. The lack of health insurance significantly makes it difficult to get needed healthcare. Low- and moderate-income adults who were uninsured in 2011 were much less likely to have a regular source of healthcare than those who did have insurance. Additionally, uninsured low- and moderate-income adults were more likely to cite factors other than medical emergencies as reasons for going to the emergency room. These included needing a prescription drug or lacking a regular primary-care physician. The survey also demonstrates how vital Medicaid and the Children’s Health Insurance Program (CHIP) are in providing health insurance to children in low- and moderate-income families. More than 63 percent of adults with children under 133 percent of the poverty level and nearly 38 percent with incomes between 133 percent and 249 percent of poverty said that some or all of their children were covered by either program. The Patient Protection and Affordable Care Act (ACA) will expand the ability of Medicaid and CHIP to cover children and families by targeting adults in low- and moderate-income families who are at the greatest risk of lacking health benefits through a job. When it becomes fully effective in 2014, the ACA will provide near-universal health insurance through a broad expansion of Medicaid, premium tax credits that cap premium contributions as a share of income for people purchasing private health plans through new state insurance exchanges. Another benefit is new insurance market rules that prevent health insurers from denying coverage or charging people with pre-existing medical conditions higher premiums. Or, as the Washington Post’s Sarah Kliff puts it, “While the private insurance expansion could get thrown into limbo by the Supreme Court, there’s pretty widespread agreement that, absent full repeal of the bill, health reform’s Medicaid expansion is here to stay. And that means a wide-reaching expansion of the entitlement program about two years from now.” According to the Commonwealth Fund’s analysis, as a result of the Affordable Care Act, the majority of the 52 million adults who did not have health insurance in 2010 will gain coverage beginning in 2014. Millions more will benefit as their ability to afford the price of premiums and out-of-pocket costs improves. Karen Davis, President of the Commonwealth Fund, said that “The silver lining is that the Patient Protection and Affordable Care Act has already begun to bring relief to families. Once the new law is fully implemented, we can be confident that no future recession will have the power to strip so many Americans of their health security.” Amanda Peterson Beadle, writing on the thinkprogress.org website, notes that “The Affordable Care Act has already expanded health insurance to 2.5 million 19-to-25 year-olds, banned lifetime limits on health insurance coverage, created pre-existing condition insurance plans providing health insurance options to those who were often uninsurable, and required insurers to cover preventive care without requiring co-payments. But the major provisions of the law to be implemented in 2014 will have the biggest effect on narrowing the income divide.” Tags: Children’s Health Insurance Program, Co-payments, Commonwealth Fund, Commonwealth Fund Health Insurance Tracking Survey of U.S. Adults, emergency room, Federal poverty level, Income inequality, insurance premiums, Medicaid, Patient Protection and Affordable Care Act, pre-existing medical conditions, repeal, State insurance exchanges, Supreme Court Posted in Healthcare, Hospital Systems | No Comments » EHR Adoption Moving Forward The nation’s hospitals must demonstrate that they have collected the vital statistics of more than 80 percent of their patients in digital form if they want to continue receiving as much as $14.6 billion in federal grants for installing electronic health records (EHR) technology. Awards as large as $11.5 million are available to hospitals that can prove “meaningful use” of the equipment, under preliminary rules issued by the Obama administration. Physicians can apply for grants of $44,000 or $64,000, depending on whether they treat patients in Medicare or Medicaid. The rules continue carrying out an initiative in the American Recovery and Reinvestment Act (ARRA) as a step toward overhauling the nation’s healthcare system, specifically in the Health Information Technology for Economic and Clinical Health (HITECH) Act. Hospitals and doctors should achieve “substantial benefits” from adopting digital records, including lower record-keeping costs, fewer pointless tests, shorter hospital stays and reduced medical errors. The percentage of U.S. hospitals that have adopted electronic records more than doubled between 2009 and 2011, to 35 percent, according to the American Hospital Association. Approximately 85 percent of hospitals told the association that they plan to take advantage of government incentives by 2015. The government expects that by 2019, 96 percent of hospitals will adopt electronic records and at least 36 percent of doctors’ practices. In this second stage of adoption of EHR, the government is emphasizing making sure that electronic systems can talk to one another – or are “interoperable.” According to Kaiser Health News, it’s “a real push ahead,” said Farzad Mostashari, the national coordinator for health information technology. The rules require systems be able to transfer patient information across platforms. A “summary of care” — including past diagnoses, procedures and test results – must be able to follow patients across referrals and changes in health care provider. Additionally, the information should be available to some patients, who under Stage 2 requirements must be allowed to view their records online, as well as download and transfer information. Finally, some patients must be able to communicate with their doctors through a secure, online system. According to a survey of 302 hospital IT executives, more than one-quarter said they had already proven to the Centers for Medicare and Medicaid Services (CMS) that they have met the government’s standard for the first stage of meaningful use of health IT. That means they have demonstrated that they have the baseline capabilities in their CMS-approved health IT system to collect and submit data. Stage 2 also deals with security of exchanging patient information electronically, particularly the risk of a doctor mistakenly leaving his laptop or iPad accessible to the public. “A huge, huge, huge portion of all breaches don’t occur because someone hacked into the system; they occur because people left their laptop on the train and they didn’t encrypt it,” Mostashari said. Writing on the practicefusion.com website, Robert Rowley, M.D., says that “Stage 2 is about connectivity. So let us take a step back and re-assess the larger picture. Stage 1 Meaningful Use is about adoption of EHRs into the daily practice of clinicians and hospitals. It is about moving the documentation of healthcare away from paper, and onto a digital platform. The platform didn’t really have to connect with anything, though the capability to connect needs to be built for the technology to be Certified. Stage 2 is about connectivity. Now that EHRs are adopted, implemented and used meaningfully, the next stage is intended to be about connecting the silos together. Stage 3, to come later, will be about inserting Decision Support between the connections, so that best practices (as well as authorizations) become part of the daily fabric of healthcare.” A little-known fact is that EHR adoption is having a positive impact on healthcare IT job creation. According to job resource Medzilla, an estimated 50,000 new jobs have been created in the health IT field since 2009, when the government passed the HITECH Act, which authorized funding for the EHR incentive program. “The statistics over the past few months have been more than encouraging,” said Del Johnson, director of client relations at Medzilla. “Here you have two, previously separate industries that are rapidly growing into one another. Where the two meet you have an opportunity to explore a completely new labor pool.” Tags: American Hospital Association, American Recovery and Reinvestment Act, Centers for Medicare and Medicaid Services, Electronic health records, Federal grants, HITECH Act, Medicaid, Medical errors, Medicare, Obama administration Posted in Healthcare, Hospital Systems, Hospitals | No Comments » Cost of Alzheimer’s High in Dollars and Caregiver Devotion As baby boomers age, the cost of caring for those stricken with Alzheimer’s Disease has nowhere to go but up. By 2050, the cost of treating Alzheimer’s is likely to rise from $172 billion per year in 2010 to more than $1 trillion per year in 2050. The disease could cost Americans $20 trillion over the next few decades, according to a report from the Alzheimer’s Association. “We saw it coming. We knew the numbers were going to be high in the number of people getting the disease. We as an organization have been preparing for this,” said Nancy Rainwater, vice president of communications for the Alzheimer’s Association Greater Illinois chapter. “But to think of trillions of dollars…just the amount of money was pretty staggering.” The statistics were calculated using an analytical model based on data from research and national surveys. Part of the problem lies in how successful treatment has become for other diseases, Rainwater said. “We’re living longer, so that has a lot to do with it,” she said. “There has been so much work in other diseases – cancer, diabetes, heart disease – and people are surviving those diseases. But then there’s a higher risk, as people age, of getting Alzheimer’s. You look at statistics of those diseases, and the rates of death have all declined, whereas Alzheimer’s disease has increased.” Researchers believe that the number of Americans aged 65 and older with Alzheimer’s will more than double to 13.5 million by 2050 as the population ages. By the middle of the 21st century, nearly 50 percent of people with the disease will be in its most severe – and costly – stage. “People in the earlier stages don’t necessarily need as much care or support,” said Darby Morhardt, social worker and research associate professor at Northwestern University’s Cognitive Neurology and Alzheimer’s Disease Center. “But as they deteriorate, as they decline, they have more and more difficulty managing their daily care, so that care needs to be provided by someone. Often that’s where most of the money is spent, on those last years.” What’s most stunning is Alzheimer’s human and financial toll. According to the Alzheimer’s Association’s 2011 Facts and Figures Report, 5.4 million Americans (one in eight older Americans) suffer from the debilitating illness. Joy Johnston of Atlanta knows how difficult caring for a parent with Alzheimer’s can be. Her father, Patrick, like more than five million other Americans, had been diagnosed with Alzheimer’s Disease. “It can be heartbreaking at times,” Joy said in reference to caring for her father. “You have to relearn your relationship with your loved one.” Caring for a family member with Alzheimer’s can take a profound financial and emotional toll. Nearly 15 million Americans are unpaid caregivers for those sick with dementia, according to the Alzheimer’s Association. Do the math, and it adds up to about 17 billion hours of unpaid care valued at $202 billion in 2010 alone. To help with the staggering cost of care, the Obama Administration has included $26 million in the proposed 2013 budget. That money will go to education, outreach and support for families affected by the disease. “Caregivers are often in a situation where their feelings and what they have to do are in conflict,” Dr. Peter Rabins said. “That’s very hard for most of us because we’ve related with people that we love in a certain way. The disease forces a change in that relationship.” Rabins, the director of psychiatry at Johns Hopkins School of Medicine, notes that medical bills can pile up quickly. “That’s a tremendous financial challenge for many families.” Rabins said. Money isn’t the only sticking point. The emotional costs take root as soon as dementia is diagnosed. Family members often begin grieving a death of someone who is still physically present but disappearing mentally. “Those feelings of loss can become quite chronic,” Rabins says. “It’s the sort of crisis that policymakers, clinicians know is happening,” said Len Fishman, CEO of Hebrew Senior Life, the largest provider of elder care services in Massachusetts. “I don’t think the country has absorbed it yet and in a couple of decades when the number of Alzheimer’s cases has doubled, people will look back and say, ‘Why didn’t we know this was coming?’” National statistics suggest that it takes an average three to four people to help care for each Alzheimer’s patient living at home; approximately 11 million Americans are currently helping to care for the estimated 70 percent of Alzheimer’s patients who are able to be at home. That statistic does not include paid caregivers. Although Medicaid pays for Alzheimer’s day programs for some low-income seniors; Medicare does not. As a result, many patients and their families must pay privately for Alzheimer’s care until they’ve spent enough money to qualify for Medicaid. Medicaid does pay for long-term nursing home care, but not the less restrictive assisted living for seniors. Tags: Alzheimer’s Association, Alzheimer’s Disease, baby boomers, cancer, Caregivers, diabetes, heart disease, Medicaid, Medicare, Northwestern University’s Cognitive Neurology and Alzheimer’s Disease Center, Obama administration Posted in General | No Comments » Will California Opt for the Public Option? Although Vermont became the first state in the union to adopt a public option in healthcare, it may soon have company. As Vermont Governor Peter Shumlin said when signing the legislation, “We gather here today to launch the first single-payer healthcare system in America, to do in Vermont what has taken too long – have a healthcare system that is the best in the world, that treats health care as a right and not a privilege, where health care follows the individual, isn’t required by an employer – that’s a huge jobs creator,” Shumlin said. The enormity of creating a public option hasn’t stopped tiny Vermont, which might seem like an unlikely place for a major revamp of the health insurance system: “By most standards, Vermont’s health care system already is one of the nation’s best. The United Health Foundation has ranked Vermont the healthiest state in the country four years in a row. Fewer than 10 percent of Vermonters lack health insurance, one of the lowest rates in the country.” And then there’s California. In a giant warehouse in Alameda, an army of phone operators are employed by a large health insurance plan, and they’re willing to go the extra mile for their customers. They’ll schedule a doctor who will make home visits, a pharmacist who will drop off a prescription, and even help fill out an application for food stamps. “We do things for them that a traditional, commercial health plan doesn’t do,” says Ingrid Lamirault, chief executive officer of the Alameda Alliance for Health, a county-run, not-for-profit insurer. Although the much celebrated, and much maligned, public option may have died in Congress, it’s alive and well in California, which is unique in the nation for having public health insurance plans that are run by its counties. California’s plans stretch from San Francisco to the Mexican border and cover 2.5 million residents. The Alameda Alliance for Health – like a private insurance company — has a network of doctors and hospitals and covers 200,000 people in Oakland and neighboring communities. Much like private health insurance companies, the alliance also runs a managed care plan for Medicaid beneficiaries and additional plans for county workers. The alliance’s Lamirault thinks this is just the beginning. In 2014, when the Patient Protection and Affordable Care (ACA) becomes law, millions of Americans will be able to buy coverage through state-based insurance exchanges. In California, government-run public plans, like the Alameda Alliance for Health, will compete with private insurance companies for all those new customers, those who run the county plans believe they can offer a robust network of doctors and hospitals to bargain shoppers looking for affordable coverage. “I think when some people get to make a choice,” according to Lamirault, “having local offices they can walk into and get help with things and get their questions answered, and when they call customer service they get their calls answered in under two minutes. Those kinds of things are important to them.” California is unique in that many public county systems also contract with private physicians and top-notch research hospitals. They even share the same lobbying group as the big-named insurance companies, the California Association of Health Plans. Some of those companies don’t have a lot of love for their public brethren. “Certainly, there are some health plans that didn’t like the idea of having to compete with these public plans,” said Anthony Wright, a public plan booster and executive director of Health Access, a Sacramento-based health care consumer advocacy group. “Especially ones that, having come out of the Medicaid program, are used to providing care at cheaper rate.” Some California insurance companies say they will happily compete on price so long as the public plans do not get preferential treatment. Doctors and hospitals already accept low reimbursement rates from public plans, often as part of their charity care. That lets the public plans keep their premiums low, although private plans say they are charged higher prices. The preferential treatment is not likely to last beyond the 2014 opening of the exchanges in California to people with higher incomes, the government-run plans will have to pay providers more than they do now, according to Sumi Sousa, officer of policy development at the San Francisco Health Plan. Sousa says the belief that public plans always cost less just isn’t true. “Some commercial providers, because they’re so large, they’re able to spread their cost over a much broader network,” Sousa said. That’s not the case for many county-run health plans in California, which are quite small. Still, says Sousa, the public plans do have low overhead: Executives earn a fraction of the salary paid to the big CEOs, and they have no stockholders. Additionally, the public option is likely to be on California’s 2012 ballot. Jamie Court, executive director of Consumer Watchdog, a Santa Monica-based consumer advocacy group, plans to put an initiative to add a state-run healthcare public option on the ballot. Opponents say the initiative doesn’t improve the way healthcare is delivered and paid for. Despite critics, Court says he’ll push forward on his plans to circulate a petition to the public. “We believe the premium regulation is definitely something that Californians overwhelmingly favor, and we think the public option is something that they still favor,” Court said. Court has written that health insurance requirements are a motivating force for the initiative: “By 2014, all of us will be required to buy health insurance or face tax penalties. The problem is that health insurance companies can charge whatever they like and raise premiums at will in California.” In opposition, Micah Weinberg of the Bay Area Council, say rising rates reflect rising health care costs and extended life spans, and the government should let competition keep rates down. Weinberg calls himself an “enthusiastic supporter of healthcare reform,” and argued on KPCC’s Patt Morrison Tuesday that the system is already making reforms — reforms he feels the public option doesn’t address. “We’re expanding insurance coverage by giving people insurance subsidies to purchase insurance through the exchanges, so that’s exactly what we’re doing. A public option doesn’t get us any closer to that goal and it’s not a helpful addition to what we’re trying to accomplish,” says Weinberg. Tags: Alameda Alliance for Health, Bay Area Council, California, California Association of Health Plans, Consumer Watchdog, Health Access, Healthcare insurance exchanges, Medicaid, Patient Protection and Affordable Care Act, Public health insurance plans, public option, United Health Foundation, Vermont Posted in Healthcare, Hospital Systems | 1 Comment » 2011 Was a Good Year in Medicare Fraud Battle The Department of Justice recovered nearly $4.1 billion stolen in healthcare fraud schemes during 2011, according to the Obama administration. That is a 58 percent increase when compared with 2009. “This is an unprecedented achievement — and it represents the highest amount ever recovered in a single year,” said Attorney General Eric Holder. The Justice Department reported that more than 1,400 people were charged with fraud in 500 cases. More than 700 have been convicted. “We’re regaining the upper hand in our fight against healthcare fraud,” said Health and Human Services Secretary Kathleen Sebelius. The numbers are part of the Health Care Fraud and Abuse Control Program Annual Report, which is submitted to Congress every year. Holder and Sebelius gave credit to their Medicare Fraud Strike Force teams for tracking down crime in areas with “hot spots” of unexplained Medicare billing. The strike forces include prosecutors and investigators from the FBI, the Justice Department and the Health and Human Services Office of Inspector General. According to Sebelius, aggressively pursuing health care fraud is a great investment. “Over the last three years, for every dollar we’ve spent, we’ve put more than seven dollars back in the hands of American taxpayers,” she said. The money goes into the Medicare Trust Fund, the U.S. Treasury and state treasuries. From 2009 to 2011, the federal government collected $7.20 for every dollar spent on fighting fraud, according to the HHS inspector general. That’s an increase from the $5.10 for every dollar spent between 1997 and 2008. “It demonstrates that our collaborative efforts to prevent, identify and prosecute the most egregious instances of health care fraud have never been stronger,” Holder said. “Over the years, we’ve seen that as these crimes harm all of us — government agencies and programs, insurers and healthcare providers, and individual patients.” The Health Care Fraud Prevention and Enforcement Action Teams (HEAT) sent 175 people to prison, with an average sentence of 47 months, according to the Justice Department. The teams were created in 2009. “I expect that we will be expanding those efforts to additional cities,” said Peter Budetti, director for the Centers for Medicare and Medicaid Services’ Center for Program Integrity. The Patient Protection and Affordable Care Act (ACA) sets aside $350 million in healthcare fraud-fighting funds. One of the law’s provisions requires providers and suppliers wishing to participate in the Medicare, Medicaid, and the Children’s Health Insurance Program that have been deemed to be at higher risk of fraud or abuse to undergo license checks and site visits to confirm legitimacy. Writing in the Christian Science Monitor, Warren Richey puts this in historical perspective. According to Richey, “During President Bush’s eight years in office, nearly $1.6 billion was recovered on average each year by federal agents and prosecutors. In contrast, the Obama administration has recovered an average $3.6 billion per year during each of the past three years. Fighting healthcare fraud is essential in an administration that is seeking to dramatically increase the level of federal control over the nation’s health insurance system. But it is unclear from the report to what extent the increased recoveries are a function of more efficient law enforcement or simply the rampant nature of fraud against the government. Estimates are that healthcare fraud diverts more than $60 billion a year from public health care to criminal enrichment. Administration officials insist they are bringing fraud, waste, and abuse under control.” In its fiscal year 2013 budget, HHS proposes to continue making progress against healthcare fraud by increasing support through mandatory and discretionary funding. The mandatory funding level is $1.3 billion. HHS is requesting $610 million in discretionary funds. In its FY 2013 budget request, the Justice Department requested $294.5 million in mandatory and discretionary funding to continue the fight against healthcare fraud. According to Holder, the department’s civil division filed 1,000 new civil cases in addition to 1,000 pending actions. The work resulted in $2.4 billion in recoveries under the federal False Claims Act, he said. “These are stunning numbers,” Holder said. Tags: Centers for Medicare and Medicaid Services' Center for Program Integrity, Children’s Health Insurance Program, Congress, Department of Health and Human Services, Department of Justice, Eric Holder, False Claims Act, FBI, Health and Human Services Office of Inspector General, Health Care Fraud and Abuse Control Program Annual Report, Health Care Fraud Prevention and Enforcement Action Teams, Kathleen Sebelius, Medicaid, Medicare, Medicare fraud, Medicare Fraud Strike Force, Medicare Trust Fund, Obama administration, Patient Protection and Affordable Care Act, state treasuries, U.S. Treasury Posted in Healthcare, Hospital Systems, Hospitals | No Comments » Hedging Their Bets, Insurers Setting Up Health Insurance Exchanges Health insurance companies are trying to play an important role in healthcare reform as the Patient Protection and Affordable Care Act (ACA) threatens to upend their marketplace in 2014 by creating their own exchanges. Health plans are trying to lock in business before government-sponsored health insurance exchanges go online in 2014. According to Kaiser Health News and reported by Minnesota Public Radio, the largest insurers are creating their own private insurance exchanges to protect themselves against competition from the public exchanges. The implementation of the ACA is the most significant change to healthcare since Medicare and Medicaid came on line in the 1960s – and the impact for health insurers is virtually unfathomable. Less than two years from today, the federal healthcare law will bring more restrictions on premium increases, millions of new customers, and the ability for consumers to comparison shop online for the best deal on their health insurance. According to Sabrina Corlette, research professor at Georgetown’s Health Policy Institute, these are just some of the changes coming in 2014. Just how insurance markets will shake out is anyone’s guess, she said. “Insurance companies are grappling with the uncertainty like everybody else and trying to look two years down the road and how to position themselves,” Corlette said. “(What) also needs to be watched closely (is) that it’s working for the consumer.” According to the Obama administration, 28 states are in the process of establishing insurance exchanges under the ACA, despite multiple lawsuits and a spring date with the Supreme Court. Fourteen states, including some with Republican governors, have passed legislation or have the authority in place to set up the regulated insurance markets, according to a report by the Department of Health and Human Services (HHS). Other states have passed executive orders or authorized studies to demonstrate the value of exchanges. The goal is to bring coverage to 16 million uninsured Americans in 50 states and the District of Columbia. In their most recent demonstration of progress in health reform, administration officials promised to provide assistance to states that miss the 2013 deadline to ensure their participation. “We’re going to meet states where they are, and…we’re going to work with them to get them as far down the path as we can,” said an anonymous administration official. According to the report, some states such as Nevada, Alabama, Mississippi, all with Republican governors, and others are making significant progress. The irony is that many of these “red” states are also suing the administration over the ACA’s constitutionality. How does a red state that has taken a lead in lawsuits against the ACA reconcile these differences? Writing in the Richmond Times Dispatch, Michael Martz says that “Six bills have been filed in the legislature proposing varying ways to set up a benefits exchange, which is required under the federal healthcare reform law that (Governor Bob) McDonnell opposes and the state hopes to overturn in the U.S. Supreme Court. But the governor is discouraging legislators from approving any of the bills during this session, despite looming federal deadlines that some lawmakers and insurers fear will leave Virginia with a less-competitive federal exchange for individuals and small businesses to buy health benefits. The state would have to submit a plan for the exchange this year to the U.S. Department of Health and Human Services (HHS) no later than January 1, 2013, to ensure that the entity can begin operating a year later.” “There is plenty of time to act,” the McDonnell administration said in a series of “talking points” on why legislation is not currently needed. “There is no need for members of the General Assembly to make untimely and unnecessary decisions surrounding creation of an exchange during the 2012 session.” Tags: "My Plan by Medica", Bloom Health, Commercial health insurers, Connextions, Department of Health and Human Services, executive orders, Health Policy Institute, Healthcare exchanges, Kaiser Health News, Medicaid, Medicare, Obama administration, OptumHealth, Patient Protection and Affordable Care Act, public option, Supreme Court, United Health Group, Washington and Lee University, “Red” states Posted in Healthcare, Hospital Systems, Hospitals | No Comments »

医学

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Austrianova's encapsulated cell to treat pancreatic cancer Updated on 14 August 2014 Austrianova has developed a technology for encapsulation of living mammalian, Cell-in-a-Box Austrianova has developed a technology for encapsulation of living mammalian Austrinova to manufacture living encapsulated cells for Nuvilex Austrianova's trial data proves efficacy Austrianova creates new pancreatic cancer models Singapore: Singapore-based Austrianova's encapsulated cell technology has demonstrated to treat pancreatic cancer in a phase 2 study, according to a paper published in Biotech Journal Pharmaceutics. Austrianova has developed a technology for encapsulation of living mammalian (Cell-in-a-Box) that protects the encapsulated cells from rejection by the immune system, allows cells to be easily transported, stored and implanted at specific sites in patients. The technology has been proven safe and efficacious in clinical trials carried out in Europe and allows companies to develop any kind of cells as a one-for-all living pharmaceutical. The results from a new previously unreported phase 2 multicentre clinical trial were presented and were compared with data from the first clinical trial previously published in The Lancet and Cancer Therapy. In both trials encapsulated cells were used to allow lower doses of chemotherapy to be used for effective treatment of pancreatic cancer while minimizing the usual side effects. The newly published data from the phase 2 multicentre trial confirmed the results obtained in the previous trial and also confirmed the dose of chemotherapy administered in that trial. The trial also demonstrated that the procedure could be performed in four independent clinical centres located in two different countries. The survival data from these trials compares favourably with recently developed treatments for pancreatic cancer like abraxane and FOLFIRINOX, showing similar efficacy but with less toxicity. Austrianova partner, Nuvilex will aim to provide additional clinical evidence in their upcoming clinical trials. Mr Brian Salmons, CEO, Austrianova stated "This publication summarizes the clinical experience that has been obtained using encapsulated cells in combination with low dose chemotherapy for the treatment of pancreatic cancer in a total of 27 patients and forms the basis for future trials. We are pleased that the data has been published in the rigorously peer-reviewed, international journal Pharmaceutics". Mr Walter H Gunzburg, chairman and CTO, Austrianova said "Pancreatic cancer is a devastating disease. This data strongly supports the use of encapsulated cells as an effective tool in the oncologists arsenal, while at the same time providing a low toxicity treatment option for patients. We look forward to working together with Nuvilex, with the help of the Thailand Center of Excellence for Life Sciences (TCELS), to bring this technology into further trials so it becomes mainstream clinical practice as quickly as possible."

医学

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Shaky Foundations for the New Mammogram Economy Handel Reynolds Eighty-one percent of women 50 and older and 65 percent of women 40 to 49 undergo regular screening mammography in the U.S. So it’s no wonder that a vast collateral economy has developed around the procedure, and continues to grow. Yet not all the foundations of this economy rest on solid ground. Mammography is imperfect and, for a large population of women, it has missed breast cancer or raised unnecessary concern. Screening mammography has traditionally been promoted using simple and direct messages. These simple messages have often been misleading. Advertisements often contain images of young women, thus heightening fears of breast cancer in this age group while masking the reality that the disease is much more common in older women. Promotions also tend to overemphasize the potential benefits of screening while remaining largely silent on its limitations. The statement “Mammography can find breast cancer as small as the period at the end of this sentence” appeared on many promos in the 1980s and 1990s, leading many women to expect too much from the technology. A 2003 survey found that many American women harbor the misconception that mammography can actually prevent breast cancer from occurring. “Screening” is not synonymous with “prevention”; mammography reduces the risk of death only by finding breast cancer early. The public has never been educated on this nuance. So it is not surprising that when breast cancer occurs in a woman who has undergone annual screening, she and her loved ones are often shocked, angry and confused. Mammography Misses In the mid-1990s, when routine screening mammography was becoming widely practiced, delay in diagnosing breast cancer became the most common reason for patients to file medical malpractice lawsuits, and this is still the case. From 1995 to 2001, claims added up to more than $170 million. Even though breast cancer is most common in postmenopausal women, 68 percent of claimants in those years were women younger than 50. Mammography misses up to 15 percent of cancers that are present (false negatives) and finds many things that are not cancer (false positives). What’s more, some of the cancers it finds could have safely gone undetected without affecting the woman’s life or health (overdiagnosis). Part of the problem is that, on a mammogram, a noncancerous abnormality can look very much like cancer. A smooth, round lump in one woman might be a benign tumor; an identical lump in someone else might be cancer. This causes 10 percent to 15 percent of screened women in the U.S. to be recalled for more evaluation. Most (95 percent) screening-detected abnormalities are ultimately found to be noncancerous. An American woman who is regularly screened during her 40s has a 61 percent chance of getting a false positive result. The additional testing after an abnormal mammogram typically involves specialized mammography views or ultrasound, but it may also include a biopsy. As routine screening gained widespread acceptance in the late 1980s and 1990s, the number of small (nonpalpable) breast abnormalities leading to biopsy rose drastically. This led to the development of nonsurgical biopsy techniques, such as stereotactic and ultrasound-guided core needle biopsy, which could be done in the mammography center. Now, for every $100 spent on screening, an additional $30 to $33 is spent to evaluate false positive findings. In the Medicare population, the workup of false positive mammogram results is estimated to total $250 million a year. False Positives Nevertheless, Americans accept the need for false positives as the inevitable consequence of regular mammography. According to one survey, although more than 90 percent of women who had a false-positive mammogram found their experience “scary,” 96 percent reported being happy that they had the test, and 90 percent continued to have mammograms at least as often as before. In another survey, when asked how many false positives are acceptable for each life saved, 63 percent of women said 500 or more and 37 percent said 10,000 or more. False negatives carry a cost, too, of course. Mammography misses up to 15 percent of breast cancers. It is especially likely to be ineffective in women whose breasts are relatively dense. On a mammogram, breast tissue may look mainly white, indicating that it is dense, or dark gray, when it is more fatty. Typically, younger women have denser tissue. Because cancer appears on a mammogram as a white object, looking for it in dense tissue can be like trying to see a polar bear in a snowstorm. New computer-aided technology has been developed to address this problem, but it can lead to false positives. Because the great majority of lumps found on mammography are not cancer, many women have an ultrasound after an abnormal mammogram to see if what they have is a trivial fluid-filled cyst or a potentially serious solid mass. Ultrasound is not degraded by dense breast tissue. On the other hand, it finds a great many noncancerous lumps, so women who undergo this regimen have many more unnecessary biopsies than those screened with mammography alone. Similarly, breast magnetic resonance imaging finds many more cancers than mammography does but also suffers from high rates of false positives. MRI is relatively expensive and, until recently, was not widely available. It’s recommended only for women at extremely high risk of breast cancer (for example, those who have the BRCA1 or BRCA2 genetic mutations). We are seeing increasing use of both these technologies, thanks in part to what happened to Nancy Cappello. In 2004, at the age of 52, this Woodbury, Connecticut, resident was diagnosed with breast cancer two months after a “normal” mammogram. Because her breast tissue was dense, she had a relatively greater risk of cancer, despite having no family history of the disease. And her cancer was harder to detect by mammogram. After her ordeal, Cappello founded Are You Dense?, an organization dedicated to educating women and advocating for supplemental screening. Density Difference In 2006, thanks to her efforts, Connecticut became the first state to mandate insurance coverage for using breast ultrasound (in addition to mammography) to screen women with dense tissue. Three years later, the state went further, demanding that all mammography facilities inform patients about their breast density and suggest ultrasound or MRI for those with dense tissue. Soon, similar legislation was pending in several other states. And efforts are under way to persuade Congress to nationalize the Connecticut model. Since at least 90 percent of mammograms show some amount of dense tissue that could potentially mask breast cancer, if Connecticut’s rules were to be adopted nationwide, some 33 million breast ultrasounds would be added to the 37 million mammograms now done annually in the U.S., increasing yearly expenditures from $4.8 billion to $7.7 billion. This figure does not include additional unnecessary biopsies generated by false positive ultrasound scans. Of the 2.5 million breast cancer survivors in the U.S., 500,000 have stage-zero cancer, otherwise known as ductal carcinoma in situ. Before the advent of screen mammography, DCIS was practically unheard of; now it accounts for one in four or five of all new breast cancer diagnoses. This condition is poorly understood, but many experts believe that, if left alone, as many as one half of all such abnormalities would never progress to lethal invasive breast cancer. Yet because of our inability to distinguish the good actors from the potentially bad ones, all patients diagnosed with DCIS receive treatment. DCIS was partly responsible for the “epidemic” narrative that developed around breast cancer in the late 1980s to early 1990s, just as screening mammography was becoming widely practiced. It was during this time that cause-related marketing was born, thanks in large measure to the work of Nancy G. Brinker, founder of the Susan G. Komen Breast Cancer Foundation (now Susan G. Komen for the Cure). Its annual charity 5K Race for the Cure takes place in more than 100 U.S. cities and several foreign countries, attracting 1.5 million participants annually. At this writing Komen has signed 240 corporate partners. These corporate relationships have added more than $50 million to Komen’s annual fundraising tally. Every October, Breast Cancer Awareness Month, retail products from makeup to vacuum cleaners, breath mints to jewelry, fast food to kitchen appliances carry a little pink ribbon and vague promises to support breast cancer awareness or other efforts. Breast cancer cause-related marketing has, of course, benefited from mammography screening, and not only because it was the mammography-induced breast cancer “epidemic” that called attention to the disease. Mammography’s tendency to overdiagnose also enlarges the population of “survivors and those who love them” -- the people most likely to be influenced by pink marketing. (Handel Reynolds is a breast radiologist at Piedmont Hospital in Atlanta. This is the second of three excerpts from his new book, “The Big Squeeze: A Social and Political History of the Controversial Mammogram,” which will be published on Aug. 7 by Cornell University Press. The opinions expressed are his own. Read Part 1 and Part 3.) Read more opinion online from Bloomberg View. Subscribe to receive a daily e-mail highlighting new View editorials, columns and op-ed articles. Today’s highlights: the editors on success for female Saudi Olympians and on what the ECB must do to save the euro; Susan Antilla on Wall Street’s

医学

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DUKE CANCER INSTITUTE cancer.duke.edu/btc Refer a Patient | Make a Gift | Site Map| Contact Us | Home Leadership/Faculty/Staff Research Programs Clinical Trials/Studies Referral Information Travel/Local Information Support Programs/Services Faces of Hope Voices of Hope Overview | Pediatric Brain Tumor Foundation Institute at Duke | Basic and Clinical Research The Tug McGraw Research Center | Perspective | Renee Raynor, PhD Education: Doctorate in Clinical Psychology, University of Southern MississippiAPA Clinical Internship in Medical Psychology, Duke University Medical CenterPostdoctoral Fellowship in Clinical Neuropsychology, Duke University Medical Center Date Joined The Preston Robert Tisch Brain Tumor Center at Duke: Why Quality of Life Research is Important: When a patient is diagnosed with a brain tumor, his or her life will never be the same. Whether a highly malignant tumor or a low-grade tumor, whether the patient has surgical resection, radiation therapy, chemotherapy, or other type of treatment, he or she has been irrevocably changed by the diagnosis and the effect it has on his or her life. We cannot yet promise survival for these patients; despite remarkable advancements in diagnosis and treatment, brain tumors frequently take the lives of their victims. What we can hope to do, however, is make living with a brain tumor less devastating. By recognizing the negative impact brain tumors have on quality of life, by educating patients/caregivers about what to expect and how to cope, and by offering new treatments to decrease these negative consequences, we can reduce the drain that this diagnosis has on quality of life. Because the brain is the center of intellectual functioning and personality, brain tumors can impair patients� cognitive abilities and alter the way they behave or express emotion. Frequently, we see brain tumor patients who maintain fairly strong and healthy bodies, but who feel they have lost their sense of self, their identity, their worth. I was particularly moved by a young woman with a glioblastoma multiforme who was diagnosed two weeks before she was to complete her residency in medicine. This brilliant woman had worked incredibly hard to complete medical school and a grueling residency program, and just as she was about to enjoy being a physician, she is told her life expectancy is less than one year. When many of us would choose to take to our beds and grieve or take a long delayed exotic vacation as a last wish, this woman made it clear she was going to practice as a doctor just as she had planned to do. But her cognitive speed of processing was slowed and her short-term memory was not what it once had been. I was not sure she was being realistic in planning to take care of patients, but she asked for my help and I joined with her to try to make her dream come true. We started her on medications aimed at improving her cognitive abilities and to give her increased energy during her radiotherapy and chemotherapy. These drugs helped her significantly and much to my surprise, she went to work as a family practitioner in a small practice in her hometown. She worked closely with the other physicians in the group to make sure she was closely monitored to avoid costly mistakes, and she was very responsible in resting or not seeing patients when she had a bad day. When I spoke with one of the senior doctors in her practice about nine months into her work, he told me she was one of the most competent and conscientious young physicians he had ever known. This woman practiced for 11 months before her tumor recurred. When she had recurrence, her cognition became worse and she knew that she had to give up her career as a physician. When I next met with her, I thought she would be devastated at the loss of her career and the very real possibility that her death was near. She was not. She squeezed my hand from her wheelchair and thanked me for helping her �think better� so she could be a �good doctor.� I was astonished and suggested that it had all been in vain since she was now clearly going to lose her battle to stay alive. This woman shook her head and patted my hand and said that she would not trade her 11 months as a doctor for 50 years of healthy living without being a doctor. In my opinion, that is quality of life personified, and that is why I come to work each day. I completed a pilot study using donepezil, an Alzheimer�s drug, to improve short-term memory dysfunction in brain tumor patients. The results showed clear trends toward efficacy, and the manuscript has been submitted for publication so that further research can be conducted with this and similar medications. I just completed data collection evaluating adult brain tumor patients for comorbid psychiatric disorders. This data will be analyzed and the results will be used to plan future intervention studies to improve the psychological distress in brain tumor patients. I also conduct serial neuropsychological assessments and frequent surveys of patient quality of life in conjunction with many of our clinical trials. The goal is to preserve cognitive functioning and reduce psychological stressors in brain tumor patients undergoing treatment with experimental therapies. Future Goals/Directions: I will continue to try to develop interventions that will improve cognitive functioning and reduce psychological distress in brain tumor patients. I believe that through pharmacological and behavioral modalities, we can reduce the negative impact brain tumors have on patients� quality of life. I hope that we can continue to develop more and more effective therapies to successfully treat brain tumors while at the same time reducing the negative effects these therapies can have on cognition, mood, and personality. Until we can help brain tumor patients live longer, my goal is to at least help them live better. Disclaimer Duke & Your Privacy © 2014, Duke University Health System

医学

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Christine Schwab is known as one of the most successful television personalities and authors in fashion, beauty and lifestyle. She has been a recurring guest on the most popular network television shows including: Oprah!, NBC Nightly News, CBS-The Early Show, The Today Show, Live with Regis and Kelly, Entertainment Tonight, The Insider, Rachel Ray, Inside Edition, CNBC News, Fox Network News, E! Entertainment and Weekend Today. Three-time author, Schwab wrote Quickstyle (Random House), The Grown-up Girl’s Guide To Style (Harper Collins) and Take Me Home From The Oscars (Skyhorse). Other writing credits include contributing style editor to Redbook magazine, style columnist for Arthritis Today and featured stories in O, the Oprah Magazine, Newsweek, Vanity Fair, Ladies Home Journal, Women’s World, The Chicago Tribune, The Huffington Post, The Washington Post Book Magazine, The Orange County Register, The Daily Breeze and The OC Magazine. Christine is an Ambassador for the National Arthritis Foundation. Tweets by @schwabchristine 15 Oct 2014 THE OTHER SIDE OFJUVENILE ARTHRITIS – FEAR You ask what do I know about arthritis medications? About 25 years worth of trying, failing, trying, failing and trying again until my joints went into remission. Yes, that’s a long time of trying and failing and a lot of that journey was fearful. So when I see babies, toddlers, first graders, elementary school kids, junior high teens and freshman at college dealing with Juvenile Arthritis my heart breaks because so many of them have or will have this same journey to go through. Some are very lucky and the first, second or third medication puts them in remission. Others take longer. And all along this JA journey is the fear of what are the side effects of these medications, especially the biologics that don’t have any long-term history. Or rather, I am that long-term history having been on a biologic for almost 16 years. What is the future? Should we be afraid? Nobody can know the future at this point because it’s simply too early. But this is what I do know now. Don’t let your fear get in the way of your goals. Don’t let the fear be an obstacle that stands in the way of hope. Every rheumatologist I talk to is positive about the future for JA. We have come a long, long way. Once you find the right medicine, or combinations of medicine you can halt damage. Damage that is often irreversible. I was diagnosed in 1990. Kids diagnosed in that same year often ended up with extensive damage because there were no new treatments. Since 1997 the biologics have grown and expanded and today there are so many more options, so much more hope. So fear? Yes, it’s ok to be afraid. But it’s not ok to let the fear stop you. I was fearful at times and you will be too, but we must all work hard to replace fear with hope. We must keep trying new treatments and combinations until that magical one works, or that new one comes down the research pipeline. JA is a terrible disease. But the hope we have today is far more than the hope the past generations had. We have more options, more information, and better treatments. We have a ways to go, but we have also come so far, we can’t let the fear halt us now. Jack Canfield said it best, “Everything you want is on the other side of fear.” You can join in on the discussion of this issue at: http://www.creakyjoints.org/forums/forum/general-discussion/ 19 Aug 2014 Envious If I had to describe one word that would sum up my feelings about social media this past week it would be “envy.” OK, you find that strange, well, so do I, but still “envy” is the word and I don’t mean in the resentment, bitterness, and green-eyed monster sort of way. I mean it in the coveted, desired, aspire, and wish for kind of way. I am not an envious person by nature. I have a wonderful full life. But even though I have all these good things in my corner, some new Facebook posts last week made me wish for one more thing. I usually go on Facebook at least once a day. That’s when I saw the post. All over Facebook were posts about the Ice Bucket Challenges for ALS. Amyotrophic lateral sclerosis affects the brain and the spinal cord. Motor neurons degenerate and die which makes it increasingly difficult to move muscles. This is one unforgiving disease. It is also misunderstood and gets little attention compared to some other diseases. Most of us know ALS as Lou Gehrig’s disease. Celebrities and Facebook friends were participating in these Ice Bucket Challenges to raise money and awareness for ALS. You dump a bucket of ice water over your head and record it on video and post it on your Facebook page. Then you challenge others to do the same within 24 hours. If they take the challenge they donate $25 to ALS, if they don’t take the challenge they donate $50 to ALS. What a great idea! What a worthy cause! Either way money goes to a very important cause. On August 17th the ALS Association announced that it has received $13.3 million in donations from over 250,000 people and the challenge continues to grow. Can you imagine the amount of research this money will fund? The help and hope it will open up for all of those who suffer? President and CEO of the ALS Association said this past weekend: “Never before have we been in a better position to fuel our fight against this disease. Increased awareness and unprecedented financial support will enable us to think outside the box.” These words are music to the ears of anyone who suffers from any serious chronic disease. I loved seeing so many people who can make a difference, people who just want to give back and help others, celebrities and real people working together for a very important cause. And yet, I was envious. Soon there were Facebook posts about why hasn’t someone thought of something like this for JA kids or RA families. Why didn’t I think of this? Why didn’t one of the many charities for arthritis think of this? Why didn’t you who are reading this think of it? But it’s never too late! When I became an advocate for JA Kids almost two years ago I was very naive. I thought celebrities would gladly lend their name and their fame to helping create awareness for JA Kids. The photos and stories of these children are so heartbreaking who wouldn’t want to help them. One of my close friends offered to put together a video for my Facebook page, Christine’s Kids. He worked tirelessly to create a wonderful video. Sugarland gave me the rights to use one of their songs, Lynda Hayes gave me the rights to one of her songs. The results is six important minutes that tell the story of kids with Juvenile Arthritis who suffer on a daily basis and are misunderstood by the average person. https://www.youtube.com/watch?v=ds1sVc85QtM Very few of my media contacts wanted to talk about JA Kids. My good friend Deborah Norville spoke up, did a PSA and let us use her name and photo to help the JA cause. Al Michaels and Wayne Gretsky sent messages of hop

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Does Deodorant Ingredient Affect Breast Cancer Risk?Does Deodorant Ingredient Affect Breast Cancer Risk?01/12/12THURSDAY, Jan. 12 (HealthDay News) -- For several years, researchers have studied a possible link between substances called parabens -- widely used as a germ-fighting preservative in cosmetics such as deodorant/antiperspirants -- and breast cancer.Investigators have learned that parabens, also found in some drugs and food products, can mimic weakly the action of the female hormone estrogen -- an established risk factor for breast cancer. And the fact that a disproportionate number of breast tumors occur nearer the underarm also had scientists wondering.But now, British researchers who examined breast tissue samples from 40 women who had mastectomies have found that traces of parabens are widespread in tissues, even in the seven women who said they'd never used underarm products."The implication is that in these seven nonusers, the paraben measured must have come from another product or products," said Dr. Philippa Darbre, a cancer researcher at the University of Reading who has long studied the issue. In the study, published online in January in the Journal of Applied Toxicology, Darbre and her colleagues report that one or more kinds of parabens were found in 158 of the 160 samples taken from the tissue collected from the 40 women. They found 96 samples contained all five of the most common paraben esters (forms). The levels of paraben found were higher, by about four times, than Darbre found when she did a similar but smaller study in 2004. "Since 2004, many manufacturers (although not all) have been removing parabens from the underarm deodorant/antiperspirant products and so I was rather surprised when we found higher levels of parabens in these breast tissues (sourced after 2004)," Darbre said.Higher levels of one form of paraben were found in the region of the breast closest to the armpit, she said, and the women had a disproportionate incidence of breast cancer in that area.However, Darbre cautioned that the research cannot be taken to imply cause and effect."Although estrogen is an acknowledged component in the development of breast cancer, it remains to be established as to whether environmental chemicals with estrogenic [estrogen-like] properties contribute a functional component to the disease process," she said. "I remain as ambivalent as ever about hounding any one chemical," she added. "I feel sure the issue is bigger than one chemical." Darbre believes the parabens found in breast tissue come from a wider range of products than underarm cosmetic products. More research is needed, Darbre noted. Meanwhile, she suggests women cut down or cut out the use of cosmetic products as much as possible. "We simply use too much in the modern world -- too much for our body systems and too much for the wider environment," she said.For its part, the American Cancer Society finds no clear link between deodorant/antiperspirants and breast cancer. In a posting on its Web page, it notes that, "There are no strong epidemiological studies in the medical literature that link breast cancer risk and antiperspirant use, and very little scientific evidence to support this claim."Dr. Michael J. Thun, vice president emeritus of epidemiology and surveillance research for the American Cancer Society, reviewed the new study findings. The fact that the preservatives were found in the majority of the breast tissue samples cannot be taken to imply they actually caused the breast cancer, he said, reiterating a point the authors also emphasized."Rather," Thun said, "the study merely confirms earlier, smaller studies which detected parabens in breast tissue of women with cancer. It shows that parabens can be absorbed (probably from personal care products) and the underarm deodorant is not the only source." Other studies have found that parabens, also found in lotions, makeup and sunscreen products, can be absorbed through the skin, according to the American Cancer Society. However, the society says more and larger studies are needed to find out what effect, if any, the parabens might have on breast cancer risk.More informationTo learn more, visit the American Cancer Society. Copyright © 2012 HealthDay. All rights reserved. Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.Editorial Policy |

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Medical Harm Occurs in Nearly 43 Million Hospital Cases Each YearMedical Harm Occurs in Nearly 43 Million Hospital Cases Each Year09/19/13THURSDAY, Sept. 19 (HealthDay News) -- Nearly 43 million cases of patients being harmed by medical care in hospitals occur worldwide each year, and two-thirds of those cases occur in low- and middle-income countries, a new review reveals.Researchers analyzed 4,000 articles published since 1976 that examined substandard care given to hospital patients around the world.The review authors focused on seven key facets of poor care: harm from prescribed drugs; catheter-associated urinary tract infections; catheter-associated bloodstream infections; hospital-acquired pneumonia; blood clots; falls; and bedsores.For every 100 hospital admissions, about 14 cases of substandard care occurred in high-income countries and nearly 13 cases occurred in low- and middle-income countries. These caused nearly 17 million cases of harm in high-income countries, and nearly 26 million cases of harm in low- and middle-income countries.In high-income countries, the most common type of substandard care involved harm from medicines, which occurred in 5 percent of hospital stays. In low- and middle-income countries, blood clots were the most common issue, occurring in 3 percent of hospital stays, the investigators found.Substandard hospital care resulted in 22.6 million years of life lost to death or disability. Low- and middle-income countries had twice as many years lost to death or disability as high-income countries -- 15.5 million versus 7.2 million -- according to the study published online Sept. 18 in the journal BMJ Quality & Safety.Premature death accounted for the largest proportion of years of life lost to death or disability for all seven facets of poor hospital care -- more than 80 percent in low- and middle-income countries and more than 78 percent in high-income countries, according to a journal news release.All patients should be able to rely on safe and high-quality care when they're in a hospital, concluded researchers Dr. Ashish Jha, at the Harvard School of Public Health, and colleagues."When patients are sick, they should not be further harmed by unsafe care," they wrote, adding: "This should be a major policy emphasis for all nations." One expert noted that some of the findings have particular import for the United States."The study's finding that adverse drug events were the most common adverse events in high-income countries - comprising 5 percent of unsafe medical incidents - resonated with what's happening here in the United States," said Robin Diamond, chief patient safety officer at The Doctors Company, a physician-owned medical malpractice insurer based in Napa, Calif. "But we should pay special attention to the fact that adverse drug events are preventable in this country the vast majority of times," Diamond added. "Unless patients are engaged in their own health care, the likelihood of medical error - even as a hospital inpatient - is much more significant," Diamond said. "I hope a major outgrowth of this research will be the development of more standardized data collection systems to help us examine this issue - which is not just limited by our country's boundaries - from a population health standpoint," Diamond added. More informationThe U.S. Agency for Healthcare Research and Quality offers tips for choosing quality health care. Copyright © 2013 HealthDay. All rights reserved. Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.Editorial Policy |

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A Healthy Dose of Failure is Vital to Your SuccessAs an acupuncturist I tend to see people after they have already suffered for years and "tried everything." They are so desperate for some relief that they want to know everything about how to get better, right now. Dynamic Chiropractic – July 4, 2006, Vol. 24, Issue 14 Share Anatomy of a Sunset: How Much Can Licensing Board Members Get Away With Before...? By Donald M. Petersen Jr., BS, HCD(hc), FICC(h), Publisher It was only a few years ago that the California Dental Board was sunsetted by the state legislature. Their crime? Failing to warn the public about mercury fillings. The California Board of Chiropractic Examiners could be facing a similar challenge, as at least one of its members is accused of treating patients with manipulation under anesthesia (MUA), unnecessary medical treatment and fraudulent billing of insurance carriers. A board member, Michael Hamby, DC, appears prominently in a response filed in the Superior Court of California, County of San Joaquin, by Deputy District Attorney James Weydert: "Michael Hamby personally told Nick Ferrua (an outside investigator contracted by this office), D.O.I. Investigator Leighton Johe (and myself) that the only reason he engaged in six (6) M.U.A. procedures in 2003 (2 patients - each receiving 3 consecutive days of treatments) was for his own familiarization/education so that he could receive a certification that would allow him to add another 'qualification' designation on his curriculum vitae (C.V.). "There was never even the slightest suggestion made by Hamby that there was ANY medical necessity/patient care issues involved, for which both Travelers and Zenith Insurance companies paid $1,000's and $1,000's of dollars to him in a workers comp claim needlessly." "A review of the Workers Comp, DWC PR-2 form clearly indicates Michael Hamby as the Primary Testing Physician ordering MUA procedure requiring a medical doctor's participation. He understood even in 2003 that authorizing-ordering medical procedures requiring a licensed M.D.'s involvement was illegal, outside the scope of his license." "Hamby prepared his own billing for these 2 patients, and had to go outside his established chiropractic billing (cpt) codes into a section (2xxxx) reserved for MEDICAL procedures performed by licensed MEDICAL doctors. In submitting his bills to Travelers and Zenith, designating the work he did, exactly as the type of work as only those licensed to practice medicine can perform, can only be viewed as an admission that he was knowingly practicing outside the scope of his license (and also being paid under M.D. only procedure codes amounts, far beyond that earned for chiropractic manipulations)." "Even more incriminating, Hamby evidenced his knowledge and intent to use MUA's for criminal gain (in 2003) when he prepared his billing statements using altered and mislabeled treatment descriptions to conceal the fraudulent nature of his work (again separate from the MUA chiropractic 'use of drugs' issue). Review of the seized patient files and post-op reports confirm that the same exact procedure was given 3 days in a row to a specific patient, yet the filling descriptions were constantly being altered and mislabeled, including added designations to unspecified procedures, all for the same identical procedure. The only purpose for the altered descriptions is to avoid 'red flags' and detection associated with billing for the same EXACT procedure - 3 days in a row." "Hamby not only received payment from both insurance carriers for unnecessary, unauthorized and fraudulently mislabeled procedures, he incredibly padded his bill by engaging in a number of recognized fraudulent billing schemes, i.e. unbundling (charging for numerous individual procedures usually charged as 1 package, inflating the bill)/upcoding (charging for mislabeled, more expensive work than actually done)." "An inspection of billing Hamby prepared and submitted indicates he added a billing modifier (a -22 suffix) to increase the amount paid on the basis that somehow the same exact procedure became more unusual/of greater complexity on subsequent days (though there is absolutely no support in the patient records or post-op reports to support the billing practice). This same pattern of fraudulent billing was also replicated with the second patient. Again, there was no misconception or confusion in 2003, about padding a bill with fraudulent inflated descriptive labels and cpt codes." While these statements are currently only accusations made in a deputy district attorney's response to another case, one has to wonder about their validity. And if they are completely or even partially true, what does that say about the integrity of the California Board of Chiropractic Examiners? At what point do the actions of a particular board member jeopardize the existence of their chiropractic licensing board? Do the rest of the board members have a responsibility to investigate Dr. Hamby's actions and potentially ask for his resignation? Depending on the circumstances, does Dr. Hamby have an obligation to consider protecting the board by resigning? The enemies of chiropractic don't need any more ammunition. Any action by any doctor of chiropractic is a direct reflection on our profession. The actions of those in leadership positions, particularly those responsible for protecting the public, must be without reproach. DMP Jr. Click here for more information about Donald M. Petersen Jr., BS, HCD(hc), FICC(h), Publisher.

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Revision of the International Health Regulations Published: 27.07.04 Updated: 27.07.2004 09:39:07Kuulo Kutsar, Elena Ryabinina, Health Protection Inspectorate, Estonia Contemporary International Health Regulations (IHR) origin dated back to the middle 19th century when cholera epidemics overran Europe. These epidemics started intensive infectious disease diplomacy and cooperation in public health, starting with the first International Sanitary Conference in Paris in 1851.In 1951 WHO member states adopted the International Sanitary Regulations, which were published by WHO in 1969 as the International Health Regulations. These regulations were modified in 1973 and 1981. The IHR were originally intended to help monitor and control six serious infectious diseases: cholera, plaque, yellow fever, smallpox, relapsing fever and typhus; today it covers only cholera, plaque and yellow fever.The IHR are a set code of practices and procedures designed to prevent the international spread of infectious diseases. They are binding international legal instrument that prescribes measures to WHO and member states of WHO for stopping infectious diseases crossing from one country to another. The procedures and practices they require at airports, seaports and ground crossings are intended to prevent the international spread of infectious diseases while at the same time not interfering unnecessarily with the international movements of people and goods.Since the 1980s, a series of developments and events have made it apparent that IHR are inadequate as a legal response to global infectious disease outbreaks, emerging and re-emerging infections, and the rising incidence of particular infectious diseases. WHO and its ruling body, the World Health Assembly (WHA), have been developing new regulations since 1995. Following a series of resolutions passed by WHA between 2001 and 2003, a draft set of improved IHR was issued on the 12 of January 2004. WHO regional consultations have been held in spring 2004 with a view to a final version to be approved by WHA in spring 2005. IHR should come into force in January 2006.Much of the revised regulations reflect what has become good practice by WHO member states in the past decade in response to threats such as SARS, avian influenza and viral haemorrhagic fevers, and outbreaks of unknown etiology.The major changes in the draft revised IHR include: 1. Notification – member states are required to notify WHO of events potentially constituting a public health emergency of international concern and to respond to requests for verification of information regarding urgent national risks.The draft revised IHR define “a public health emergency of international concern” as an event which includes the following four criteria:a) seriousness of the public health impact; b) unusual or unexpected nature of the event;c) potential for the event to spread internationally; d) the risk that travel or trade restrictions may result from the event. 2. National IHR Focal Points – National IHR Focal Points are required to establish; these are the operation link from member states to WHO. 3. Definition of core capacities – a member state must have the basic public health capacities to detect, report and respond to public health risks and potential or actual public health emergencies of international concern. Specific capacities for the implementation of routine measures at points of entry are required. 4. Recommended measurements – WHO’s response may include temporary or standing recommendations for measures for application by the member state affected by a public health emergency of international concern, other states and operators of international transport. 5. External advice regarding the IHR – the draft revised IHR include the procedures for obtaining independent advice concerning IHR implementation from an Emergency Committee during public health emergencies or from an IHR Review Committee which will consider disputes, the development of standing recommendations and evaluate how the IHR are functioning. The responsibility of implementing the IHR rests with WHO and member states. National health administrations are responsible for implementing the revised IHR and WHO will provide technical assistance to all member states. Key obligations for member states include: to notify WHO of all events potentially constituting a public health emergency of international concern; to respond to request for verification of information regarding public health risks; to respond to public health risks that threaten to transmit infectious disease to other member states; to inform WHO of evidence of public health risks occurring in another territory that may result in international infectious disease spread; to provide routine inspection and control activities at international points of entry to prevent international infectious disease transmission; to make every effort to fully implement WHO-recommended measurements; to develop and maintain the capacity to detect, report and respond to certain events defined in IHR. A second draft revised IHR will be distributed to WHO member states in summer - early autumn 2004 for the Intergovernmental Working Group on the Revised International Health Regulations scheduled to be held in Geneva in November 2004.

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Contact: Julie Heflin julie.heflin@louisville.edu UofL scientists uncover how grapefruits provide a secret weapon in medical drug delivery LOUISVILLE, Ky. � Grapefruits have long been known for their health benefits, and the subtropical fruit may revolutionize how medical therapies like anti-cancer drugs are delivered to specific tumor cells. University of Louisville researchers have uncovered how to create nanoparticles using natural lipids derived from grapefruit, and have discovered how to use them as drug delivery vehicles. UofL scientists Huang-Ge Zhang, D.V.M., Ph.D., Qilong Wang, Ph.D., and their team today (May 21, 2013), published their findings in Nature Communications. "These nanoparticles, which we've named grapefruit-derived nanovectors (GNVs), are derived from an edible plant, and we believe they are less toxic for patients, result in less biohazardous waste for the environment, and are much cheaper to produce at large scale than nanoparticles made from synthetic materials," Zhang said. The researchers demonstrated that GNVs can transport various therapeutic agents, including anti-cancer drugs, DNA/RNA and proteins such as antibodies. Treatment of animals with GNVs seemed to cause less adverse effects than treatment with drugs encapsulated in synthetic lipids. "Our GNVs can be modified to target specific cells � we can use them like missiles to carry a variety of therapeutic agents for the purpose of destroying diseased cells," he said. "Furthermore, we can do this at an affordable price." The therapeutic potential of grapefruit derived nanoparticles was further validated through a Phase 1 clinical trial for treatment of colon cancer patients. So far, researchers have observed no toxicity in the patients who orally took the anti-inflammatory agent curcumin encapsulated in grapefruit nanoparticles. The UofL scientists also plan to test whether this technology can be applied in the treatment of inflammation related autoimmune diseases like rheumatoid arthritis. A Common Sense Approach Zhang said he began this research by considering how our ancestors selected food to eat. "The fruits and vegetables we buy from the grocery today were passed down from generation to generation as favorable and nutritious for the human body. On the flip side, outcomes were not favorable for our ancestors who ate poisonous mushrooms, for example," he said. "It made sense for us to consider eatable plants as a mechanism to create medical nanoparticles as a potential non-toxic therapeutic delivery vehicle." In addition to grapefruit, Zhang and his team analyzed the nanoparticles from tomatoes and grapes. Grapefruits were chosen for further exploration because a larger quantity of lipids can be derived from this fruit.

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Home > Health News > Men Who Have Insurance Most Likely to Get Implanted Defibrillators: Study Results show importance of adhering to guidelines, researcher says. FRIDAY, May 9, 2014 (HealthDay News) -- Nearly all the U.S. patients who receive implanted heart defibrillators have insurance and most of them are men, a new study reports. "The striking results show that major disparities are present with [implantable cardioverter defibrillator] implants and this further highlights the importance of adhering to guidelines, so the best possible candidates have access to the life-saving device," said lead author Nileshkumar Patel, of Staten Island University Hospital in New York City. Patel's team of researchers analyzed data from more than 160,000 implantable cardioverter defibrillator (ICD) surgeries performed on adult patients between 2000 and 2011. They found that nearly 95 percent of the procedures involved patients with insurance, and of those, men made up nearly 71 percent. Women with insurance accounted for about 24 percent. The study was scheduled for presentation Thursday at the Heart Rhythm Society's annual meeting in San Francisco. The findings show the need "to look for new ways to enhance the quality of care and continue to educate on the safety and effectiveness of these devices," Patel added in a society news release. Data and conclusions presented at meetings are typically considered preliminary until published in a peer-reviewed medical journal. The U.S. National Library of Medicine has more about implantable cardioverter defibrillator. SOURCE: Heart Rhythm Society, news release, May 9, 2014

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Posted in: World Doctor Accused Of Killing 300 Patients To Free Up Beds A Brazilian doctor is being accused of killing terminally ill patients in order to free up hospital beds. The Daily Mail reports that Virginia Soares de Souza was arrested last month after officials became suspicious as to why so many patients were dying under her watch at the Hospital Evangelico in Curitiba, Brazil. The doctor was accused of killing 7 patients at first, but that number has soared since her arrest. Authorities now believe that De Souza killed at least 20 patients. Investigators are also looking into another 300 other suspicious deaths at the hospital. According to the Mirror, De Souza is accused of killing terminally ill patients with fatal doses of muscle relaxers. She also may have pulled the plug on patient’s life support machines. Investigator Dr Mario Lobato said: “We are looking at nearly 300 cases. In one a patient asked a nurse for a cup of water, yet by the time she returned he had died.” Lobato said that most of the patients died shortly after being treated by De Souza. In most cases, patients had their oxygen levels reduced from 45 percent to 21 percent and were given a muscle relaxant called Pavulon. Lobato said: “All of (deaths) have the same modus operando, the same relationship between the drug and death, and the same time between both.” Three other nurses and doctors have been arrested for allegedly helping De Souza kill patients at the hospital. De Souza’s lawyer said that her client is innocent and will prove it in court. If De Souza is convicted of killing more than 300 people at the hospital, she will take the title of world’s deadliest doctor from Britain’s Harold Shipman. Shipman killed at least 215 patients over the span of 25 years. He later hung himself in prison at the age of 57. Dan Evon Category: World Tags: deadliest doctor, doctor kills patients, terminally ill patients, Virginia Soares de Souza

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Well-known Durban doctor found dead March 11 2014 at 11:07am By Sihle Manda and Sibonakaliso Msane Durban - A well-known Chatsworth doctor was found dead in his surgery soon after midnight on Sunday. Police are investigating the death of Dr Krishna Nair, 55, who lived in Westville, who was found with a wound to his abdomen. He was found in his Chatsworth surgery by his family, accompanied by police, after he didn’t come home. Police spokesman Thulani Zwane said despite the unusual death, no foul play was suspected and there was no sign of forced entry. However, an inquest docket had been opened. Nair’s wife, Gonasagrie, also a doctor, grew concerned when he did not come home nor return unanswered calls on Sunday night. The couple’s son, Yashodhan, 20, a medical student at UCT, said the family were dealing with the loss “but it is difficult”. “He works every day, seven days a week. He usually closes at about 4pm on Sundays, so my mother was expecting him to be home by 8pm. She phoned but there was no answer,” said Yashodhan. Gonasagrie contacted their security company, relatives and police who found her husband’s body at about 1.30am, he said. “I was woken up by a cousin who lives in Cape Town who said I should get a flight back home as early as possible… I was only told of his passing when I touched down,” Yashodhan said. Nair was well-known at the Chatsworth Regional Hospice Association, where he worked with people suffering from terminal illnesses. The hospice’s president, Pramda Ramasar, said that he had worked as a volunteer for two hours every day “He was here on Sunday morning, as usual, and now this? This is a big loss. It won’t be easy to fill his position… The fact that he was so dedicated to treating patients who were nearing the end of their lives, makes it even harder,” she said. Yashodhan said that his father had tried to minimise the suffering of patients he encountered. “Where he found the most suffering was in the people who were terminally ill and often, those people were either neglected by their families or weren’t given appropriate care to make sure they had a reasonable transition to death,” he said. There was was a sombre atmosphere outside the locked practice on Monday, as staff huddled under their umbrellas in the rain. Patients and friends came to confirm the news and pay their respects to a man who many described as “like a father”. The Mercury Comment Guidelines IOL / News / Crime & Courts / Well-known Durban doctor found dead

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HEALTHDAY - ALLERGY RESPIRATORY Nov 9, 2012 9:00 AM by By Denise MannHealthDay Reporter Lone Star Tick Bite Might Trigger Red Meat Allergy: Study FRIDAY, Nov. 9 (HealthDay News) -- New research adds to a growing body of evidence that suggests certain tick bites may cause even the most seasoned of carnivores to develop an allergy to red meat. Here's how it works in humans, experts say: The Lone Star tick, which is found largely in central and southern U.S. regions, injects spit into your body when it bites you. When this occurs, your body develops antibodies to a carbohydrate in the tick's spit that is known as alpha-gal, a carbohydrate that is also present in red meat. The person then eats meat, and an allergic reaction is triggered. This reaction tends to occur within three to six hours after eating meat, and can range in severity from mild hives and itching to full-blown anaphylactic shock (a potentially deadly reaction). The new study found that positive alpha-gal rates are actually 32 percent higher in states where the Lone Star tick is known to lurk, compared with other parts of the country. That said, there were higher than expected rates of alpha-gal positivity even in states where the Lone Star tick is not usually seen, the investigators noted. The findings are to be presented Friday at the American College of Allergy, Asthma and Immunology (ACAAI) annual meeting, in Anaheim, Calif. This red meat-tick connection was first discovered when researchers were trying to determine why a certain cancer drug was causing severe allergic reactions in people in the southern states. As it turns out, the sugars in that drug are also present in beef, pork and cow's milk. "It's called molecular mimicry, and it is fascinating," said Dr. Bruce Hirsch, an infectious diseases specialist at North Shore University Hospital in Manhasset, N.Y. "This new study substantiates the frequency of this risk." Climate change may also mean that Lone Star ticks will start appearing in other regions, so the findings "emphasize the importance of preventing tick bites," Hirsch said. ACAAI president Dr. Stanley Fineman called the tick-meat allergy reaction "unusual." "It is an immune response to saliva of the tick that they leave behind when they bite, and this study really shows a higher prevalence of positive reactions in areas of the country that are endemic to the Lone Star tick," he said. "It is a bigger problem than we probably realized." The reaction can occur up to six hours after the person eats the red meat. "Symptoms include hives, or itching in the mouth and swelling in the throat that occur after eating a hamburger [for example]," Fineman explained. How can you know for sure? "Be a detective," Fineman said. "If you get hives, figure out what you ate just before and if it was a meal with beef, lamb or pork, you should probably check with an allergist, especially if you like to go outside" in areas commonly inhabited by ticks. Research presented at medical meetings should be viewed as preliminary until published in a peer-reviewed journal. More information Learn how to avoid ticks at the U.S. Centers for Disease Control and Prevention. »Comments Top Videos

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HEALTHDAY - CAREGIVING Apr 16, 2013 4:00 PM by By Amy NortonHealthDay Reporter Ultrasound Waves, Bone Marrow Cells Show Promise in Heart Failure Patients TUESDAY, April 16 (HealthDay News) -- People with chronic heart failure might benefit from a combination of "shock waves" to the heart and an infusion of their own bone marrow cells, an early study suggests. The therapy is still experimental, and experts said much more work is needed. But they also said the results, reported in the April 17 issue of the Journal of the American Medical Association, are promising. The study, which included about 100 patients, added a new twist to a therapy heart disease researchers have been trying for about a decade -- using immature cells from patients' own bone marrow to try to aid damaged heart muscle. There has been some success in helping recent heart attack sufferers. Overall, research suggests the cell therapy can cut the risk of a repeat heart attack, and even prolong people's lives. But it has not worked as well for chronic heart failure -- where the heart's pumping ability declines over time, causing fatigue, breathlessness and fluid build-up in the legs. In the United States, close to 6 million adults have heart failure, often developing it after a heart attack first damages the heart muscle. One theory on the limited results for heart failure is that patients' bone marrow cells are not retained in the heart for a long enough time. So in the new study, German researchers first "pre-treated" patients with so-called shock wave therapy, which applies high-dose ultrasound to the chest. For patients, the experience is similar to having a diagnostic ultrasound of the heart, said senior researcher Dr. Andreas Zeiher, of Goethe University in Frankfurt. One day after the shock wave therapy, patients' hearts were infused with a dose of their own bone marrow cells. The idea, Zeiher explained, is that the shock waves might spur the heart to churn out chemicals that attract more bone marrow cells to the damaged portion of heart muscle. After four months, his team found, there was a 3 percent increase in the patients' left ventricular ejection fraction -- the percentage of blood pushed out of the heart with each contraction. That's a "decent" improvement, said Dr. Eduardo Marban, director of the Cedars-Sinai Heart Institute in Los Angeles. And it's possible it could translate into long-term benefits -- like a lower risk of a repeat heart attack or longer life, according to Marban. But, he said, larger studies are needed to prove that. "This is a feasibility and efficacy study," Marban explained. He added that neither shock waves nor bone marrow cells are approved treatments for heart failure. "You're not going to be able to go to your doctor and ask for this." Dr. Gregg Fonarow, a professor of cardiovascular medicine and science at the University of California, Los Angeles, agreed that caution is in order. "Whether these findings can be reproduced, and whether there is any clinical benefit that will result from this approach, will require subsequent, well-designed clinical trials," said Fonarow. The findings are based on 103 patients who'd developed chronic heart failure after a heart attack. Zeiher's team randomly assigned 81 patients to receive shock wave therapy; afterward, 42 of them received an infusion of bone marrow cells, while 39 were given a cell-free "placebo" infusion. The remaining 21 patients received placebo shock wave therapy. (A cushion was placed over the chest so the ultrasound waves could not reach the heart.) They did, however, get a real infusion of bone marrow cells. Four months later, patients who'd received the combination therapy were faring best: On average, the percentage of blood being pushed out of the heart's main pumping chamber ticked up 3 percent. That's "modest," the researchers acknowledged, but it compared with no significant change in the other patients. The combination-therapy group also had fewer heart-related "events," such as heart rhythm problems, hospitalization for heart failure, repeat heart attacks or strokes. There were 32 such complications among the 42 patients, versus 18 among the 21 patients who received only bone marrow cells. Now, one of the big questions is whether the improved heart function fades with time, Zeiher said. Repeat treatments may be necessary. "In principle," Zeiher said, "that can be very easily performed, because the procedure itself is rather simple and -- most importantly -- safe." Marban agreed that, based on years of research experience, bone marrow cell therapy does seem to be safe. It's not clear, though, exactly how it works. Early on, some researchers suggested that transplanted bone marrow cells actually generate new heart muscle. But studies since then have failed to show that's true. The "best guess," Marban said, is that the bone marrow cells secrete certain growth factors that improve the heart's ability to contract. Right now, the standard treatments for heart failure include medications that lighten the heart's workload and moderate exercise. But researchers are looking for new ways to improve the heart's pumping ability, or even regenerate the damaged muscle. Marban and his colleagues are studying the use of heart stem cells -- primitive cells within the heart that are, in theory, capable of generating new heart muscle. The current study was funded by Goethe University. Zeiher and a co-researcher are founders of a company, t2cure, focused on regenerative therapies for heart disease. More information Learn more about heart failure from the Heart Failure Society of America. »Comments Top Videos

医学

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Contests Ebola Coverage Tool-Wielding Robots Crawl in Bodies for Surgery By: AP Email Posted: Tue 8:34 AM, May 29, 2012 / Article PITTSBURGH (AP) - Imagine a tiny snake robot crawling throughyour body, helping a surgeon identify diseases and performoperations. It's not science fiction. Scientists and doctors are using the creeping metallic tools to perform surgery on hearts, prostate cancer, and other diseased organs. The snakebots carry tiny cameras, scissors and forceps, and even more advanced sensors are in the works. For now, they're powered by tethers that humans control. But experts say the day is coming when some robots will roam the body on their own. "It won't be very long before we have robots that are nanobots, meaning they will actually be inside the body without tethers," said Dr. Michael Argenziano, the Chief of Adult Cardiac Surgery at New York-Presbyterian Hospital and Columbia University Medical Center in New York. Argenziano was involved with some of the first U.S. Food and Drug Administration clinical trials on robotic heart surgery more than 10 years ago. Now he says snake robots have become a commonly used tool that gives surgeons a whole new perspective. "It's like the ability to have little hands inside the patients, as if the surgeon had been shrunken, and was working on the heart valve," he said. But Argenziano and experts in robotics say the new creations work best when they're designed for very specific tasks. "The robot is a tool. It is no different in that sense than a scalpel. It's really a master-slave device," he said. Howie Choset has been researching and building robots, particularly snake robots, at Pittsburgh's Carnegie Mellon University for years. Choset believes that his snake robot and others like it help reduce medical costs by making complex surgeries faster and easier. Choset says his new design is smaller and more flexible than earlier models: The diameter of the head is less than the size of a dime. The size of surgical robots allows surgeons to operate with far less damage to the body, helping the patient heal faster. For example, instead of opening the entire chest up during heart surgery, a small incision is made, and the robot crawls inside to the proper spot. Dr. Ashutosh Tewari of Cornell University Medical Center has used robotic tools to perform thousands of prostate operations. He said the precision of the tiny robotic tool is vital not just to cutting out cancerous tumors, but to seeing exactly what nerves to leave intact. Tewari said he's most excited about the potential for surgical robots to do things humans can't do. He said the variety of sensors available for surgical robots keeps expanding, even as they get smaller. He said they may one day be able to test chemicals or blood in the body, or even the electrical connections in nerves. Argenziano noted that robots aren't a magic cure. "The robot is good at certain things and it's not good at other things," he said. Some studies have found that the cost effectiveness of surgical robots varies greatly. In smaller hospitals, the high cost of purchasing and maintaining a robot may not make sense. Choset has also built larger snake robots designed for search and rescue, or just exploration. They can climb poles or trees and then look around through a camera in the head, and slither through places humans can't reach. "We sent our snake robots into these caves off the coast of the Red Sea to look for evidence of ancient Egyptian ships," he said. "To me archaeology is like search and rescue, but everyone's been dead for 5,000 years," reducing the pressure. Another expert at Carnegie Mellon stresses that there's still anenormous gap between humans and even the most high-tech robots.Manuela Velosa noted that robots have been built that excel at oneor two tasks - but not at the variety of tasks humans perform without even thinking. Velosa has been building robots that ask humans for help when they don't know what to do, as well as teams of robots that play soccer against each other. Sometimes, the robots surprise her. During one soccer game against robots from another university, the Carnegie Mellon team scored on a particular play. That sent a positive signal to the robot's computers, which are designed to reward success and discourage failures in the game. Her robots then tried the play again - and scored again. It turned out they had discovered a programing flaw in the other team of robots, just like some sports teams find a flaw in their opponents. In the second half Velosa's robot's kept using the same play, scoring every time, and thus reinforcing the tendency to try the play over and over. The robots crushed the other team. "It was programmed by me, but it looked to me as if they learned," she said. "I believe we are much closer to having robots be able to coexist with humans. The beautiful thing is you see the robots learning.

医学

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Lupus Basics Lupus Articles Autoimmune DisordersRheumatoid ArthritisSclerodermaSjogren's SyndromeSkin Your RightsNavigating the SystemInsurance Coverage After melanoma, people head back to the sun: study NEW YORK (Reuters Health) - People with the most dangerous type of skin cancer tend to stay out of the sun and wear extra sunscreen the year after being diagnosed. But a new small study suggests those precautions don't last. Two to three years after being diagnosed with melanoma, people spent as many days in the sun and were exposed to at least as much UV radiation as their peers without the disease, researchers found. "Something tells us that they relax more when time passes by after diagnosis," Dr. Luise Idorn, the study's lead author from Bispebjerg Hospital in Copenhagen, Denmark, said."We think they just regress back to old habits." Rates of melanoma have been rising in the United States, according to the American Cancer Society. It predicts over 76,000 new melanomas will be diagnosed in 2013. People who have had melanoma have a higher than average chance of getting it again. But that risk can be reduced if they cover up and stay out of the sun, Idorn told Reuters Health.To see how well patients protect themselves, she and her colleagues tracked 20 people during the three summers after they were diagnosed with melanoma. They compared those patients to another 20 melanoma-free people who mirrored the patients in their age, gender and skin type. All study participants recorded the time they spent in the sun and use of sunscreen in daily diaries. They also wore watches that measured UV radiation exposure.During the first summer after patients were diagnosed with melanoma, they spent fewer days in the sun without sunscreen than people in the comparison group, the researchers found.However, patients' daily UV radiation dose rose by 25 percent from the first summer to the second, and increased again in the third summer. People without melanoma, on the other hand, were exposed to similar levels of radiation across all three years. UV exposure tended to be higher among patients than people without skin cancer by the third summer. But that difference was small and could have been due to chance, Idorn and her colleagues reported Wednesday in JAMA Dermatology. Half of the cancer-free group and 60 percent of people with melanoma reported getting sunburned at least once during the study period, they added. "I would have thought that a diagnosis of melanoma would change their behavior. This study indicates they may be more cautious, but only the first year after diagnosis," Idorn said."It's disturbing results that these patients who are really at quite high risk of a second melanoma are not reducing their sun exposure," Brenda Cartmel, from the Yale School of Public Health in New Haven, Connecticut, said. "This is surprising," added Cartmel, who has studied people's behavior after a skin cancer diagnosis but wasn't involved in the new study. The researchers noted that their study was small and did not include information on sun exposure from before participants developed melanoma."It may be more difficult than we realize for people who really enjoy the sun to stay out of it," Idorn said. "It may be a habit or a way of living that is difficult to abstain from, even after a cancer diagnosis."Dermatologist Dr. Brundha Balaraman from Washington University School of Medicine in St. Louis said she found the results "not entirely surprising" because skin cancer is more common among people who spend lots of time in the sun to begin with."It would be interesting to assess sun behaviors before and after the diagnosis of melanoma to determine whether a patient improves from his personal baseline," Balaraman, who also didn't participate in the new research, told Reuters Health in an email.According to Idorn, there's a need for more studies, including focus groups of people with melanoma, to figure out how doctors can help patients reduce their time in the sun. Cartmel told Reuters Health she and her colleagues are working on those types of studies now."I don't think what we are going to advise people to do is going to be different," she said. "I just think somehow we need to get that message over maybe in a different way."SOURCE: http://bit.ly/wjbo5q JAMA Dermatology, online October 2, 2013. Rate This Article

医学

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Massachusetts General Hospital | MassGeneral Hospital for Children Mass General HomeConditions & TreatmentsCenters & ServicesResearch & Clinical TrialsEducation & TrainingCareer OpportunitiesAbout Mass General This Hospital Entire Site MassGeneralHospital for Children Home Find a Care Provider MassGeneral Hospital for Children News Tadgh Murray continues to clear social and medical hurdles with help from the Food Allergy Center. Family Finds Support System in Food Allergy Center 28/Jan/2011 Tadgh Murray won’t be having any cake for his 7th birthday this month. As a child with an allergy known as eosinophilic esophagitis, Tadgh (pronounced “tig,” like “tiger”), is limited to a strict diet of certain meats, vegetables and fruits.“What we call the ‘social foods’ are not in his category,” Tadgh’s father, Denis Murray, says. Cake, ice cream and candy are among the foods that are not allowed, making Tadgh’s medical challenge a social one as well. “Life is surrounded by food; it’s a part of our lifestyle,” says Mariann Murray, Tadgh’s mother. Tadgh’s symptoms first presented when he was a baby with frequent vomiting. As a 2-year-old, he became a patient of MassGeneral Hospital for Children gastroenterologist Qian Yuan, MD, PhD. Dr. Yuan diagnosed Tadgh with eosinophilic esophagitis (EE), an allergic inflammation of the esophagus-- the tube that connects the mouth and stomach. For those with EE, the body’s immune system reacts by sending white blood cells (eosinophils) to the esophagus and making it difficult for food to go down. In addition to his restricted diet, Tadgh’s treatment also involves medication and supplementary drinks, aimed at lowering the amount of white blood cells in his esophagus and giving him the proper nutrition. Tadgh’s vomiting is now controlled, but his specialists are working to rid him of any white blood cells left in his esophagus. Mariann Murray says her son has been fortunate not to need a feeding tube for his condition, though at one point when his diet was made entirely of supplemental drinks, known to be distasteful, he begged for a tube. “Dr. Yuan gave him the strength and the courage to go through it” without a feeding tube, Mrs. Murray says. “Dr. Yuan is just an amazing doctor and we would not have been able to go through this or anything without him,” she adds. “We can call him anytime, he is so supportive and such a positive person. He’s our main support system, he helps all of us, even our daughter,” Mrs. Murray says of Tadgh’s 3-year-old sister, who does not have EE, but often accompanies her brother to his appointments. Personal Team As a patient of the newly formed Food Allergy Center at MassGeneral Hospital for Children (MGHfC), Tadgh now has access to multiple specialists during his appointments. In addition to Dr. Yuan, Tadgh receives care from dietician Carolyn Ann Butterworth, MS, RD, RN; allergist Shuba Iyengar, MD, MPH; and psychologist Nancy Rotter, PhD. “It’s almost like an assembly line of doctors and then it doesn’t prolong the misery of it in a sense because it’s all done in one day and their interacting with each other does help,” Denis Murray says. “They interacted with each other and talked about my son Tadgh, you can tell because they’ve known him for such a long time that there was an immediate personal interest to get him to the next step. With the hard work that they’ve done over the years he has made an unbelievable improvement from way back when to now. I can never thank enough.” Tadgh chose to thank his specialists last year by putting a positive spin on a holiday that has been especially difficult for him: Halloween. Instead of collecting candy, which he could not eat, Tadgh collected donations to give to the MGHfC Food Allergy Center. Tadgh Murray (center), with gastroenterologist Qian Yuan, MD, PhD (left), and allergist Shuba Iyengar, MD, MPH, displays his Certificate of Appreciation for his generous contribution to the Food Allergy Center at MGHfC. Denis Murray says he was impressed with his son’s confidence as he educated people about his condition. “You could see an amazing buildup of confidence in his face, it was an amazing thing to watch and he did it with a full heart. It was great for him and it was good for us,” Mr. Murray says.Tadgh presented more than $100 to the Food Allergy Center as a result. He explains: “I wanted to do it to help other children with what I have, eosinophilic esophagitis, so the doctors can find a cure. It’s been like an honor to do it, it’s really been good.” Tadgh adds of his specialists at MGHfC: “They’ve been always with me and they’ve been always nice to me and they’ve been always trying to fix my EE.” As the Murray family awaits the results of Tadgh’s latest endoscopy, his mother expresses admiration for her son: “He’s very strong. He’s amazing at school; it hasn’t affected his schooling at all.” Mrs. Murray finds additional support and resources from a Facebook group run by parents of children with EE from around the country. The group organizes special activities for its members, for example, by arranging a card exchange on Halloween. Tadgh’s parents typically leave it up to him whether he would like to attend parties and other special events where food will be a focal point. At times he prefers to sit them out, but there’s one upcoming party he’s sure to attend: his own.To support the Food Allergy Center, visit the MassGeneral Hospital for Children donation form. In the "Designation" field, select "Other," and specify "Food Allergy Center." Make an appointment Contact MassGeneral Hospital for Children to schedule an appointment with one of our specialists. Family-centered care We respect that the family is the center of a child’s life and we welcome families to participate in every aspect of their child’s care.

医学

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Wright Medical Buys Solana, Plans to Acquire OrthoProArlington-based Wright Medical Group Inc. has closed on its agreement to acquire Solana Surgical LLC of Memphis and has entered into a definitive agreement to acquire OrthoPro LLC of Salt Lake City, the company announced Thursday, Jan. 30. Under the terms of the Solana acquisition, Wright acquires all of Solana’s outstanding equity for about $90 million, consisting of $47.6 million in cash and $42.4 in Wright common stock. The same basic arrangement applies to OrthoPro for $36 million in cash, with $32.5 million paid at closing and up to $3.5 million more in cash contingent on revenue milestones included in the agreement. The OrthoPro agreement is expected to close in a year, according to a statement from Wright. Both companies add to Wright’s foot and ankle portfolio, increasing the company’s focus on the surgical podiatric market. Wright Medical executives are expected to provide more details about the acquisitions, as well as what the coming integration will mean for Wright’s relocation from Arlington to Memphis, during the company’s Feb. 24 earnings conference call. Smith & Nephew to Buy ArthroCare in $1.5B Deal British medical technology company Smith & Nephew plans to buy U.S. medical device maker ArthroCare in a $1.5 billion deal that it says will strengthen its sports medicine business. Smith & Nephew said Monday it will pay $48.25 in cash for each share of ArthroCare Corp., which is based in Austin, Texas. Smith & Nephew PLC said ArthroCare's expertise in shoulder joint repair will complement its strength in knee repair. ArthroCare has 35.4 million shares outstanding, counting options and restricted stock, according to Smith & Nephew spokesman Charles Reynolds. Smith & Nephew values the deal at $1.7 billion counting ArthroCare's cash. It expects the acquisition to close by the middle of the year. ArthroCare makes surgical devices, instruments and implants and employs about 1,800 people. The company announced on Jan. 7 that it will pay a $30 million fine to resolve an investigation by the U.S. Department of Justice into alleged securities fraud by its former management. The Justice Department also is charging the company with one count of conspiracy to commit securities fraud and wire fraud, but it has entered into a two-year deferred prosecution agreement with ArthroCare. If the company meets requirements set by the Justice Department, it won't bring charges against the company. ArthroCare has said that deal will end the Justice Department's investigation, which was first made public in December 2008. Smucker Files $16 Million Permit for Plant Expansion The J.M. Smucker Co. has filed a $16 million permit with the city-county Office of Construction Code Enforcement as part of its planned plant expansion at 4789 Cromwell Ave. in Oakhaven. No contractor or architect was listed on the permit, which is the first in Smucker’s plan to invest $41 million to upgrade its peanut butter production lines. The Economic Development Growth Engine of Memphis and Shelby County in mid-January unanimously granted the Orrville, Ohio-based company an amended payment-in-lieu-of-taxes agreement for 15 years on personal property and 13 years on real property. In addition to 42 new positions, which will have an average wage of $52,545, created through the expansion, Smucker will maintain its existing 61 employees. The approved tax freeze will save Smucker $13 million, but the company will still pay an estimated $16.2 million in taxes to the city and county over the length of the PILOT. The company said 25 percent of the company’s planned $21.5 million in discretionary spending will be with women- and minority-owned businesses. Kemmons Wilson School Becomes Independent The University of Memphis is making the 10-year old Kemmons Wilson School of Hospitality and Resort Management an independent school within the university. The school has its own bachelor’s degree curriculum with 60 credit hours of coursework. The coursework had been a third of that previously. With the autonomy, the school will also offer concentrations in event management, lodging, and food and beverage services. The Kemmons Wilson School had been a part of the Fogelman College of Business and Economics since it was founded. The school is housed in a full-service hotel and conference center on the university campus and is named for the late founder of Holiday Inn. His son, Kemmons Wilson Jr., said in a statement that the school’s goal is “a real-world environment within an academic setting.” Dr. Radesh Palakurthi, professor and director of the school, said the status as a separate school means it has achieved “the critical mass it needs to offer a more focused program in hospitality and resort management.” Gibson Guitar Launches ‘Government’ Brand Gibson Guitar Corp. has launched a “Government Series” Les Paul guitar commemorating federal agents raiding the Gibson factories in Nashville and Memphis. The guitar – which is available in a “Government Tan” color – is made from wood confiscated during the raids in Nashville. "Great Gibson electric guitars have long been a means of fighting the establishment, so when the powers that be confiscated stocks of tonewoods from the Gibson factory in Nashville – only to return them once there was a resolution and the investigation ended – it was an event worth celebrating,” Gibson said in a statement. The Nashville-based guitar maker was raided by U.S. Fish and Wildlife Service agents on allegations it violated the Lacey Act, which requires U.S. companies to comply with other countries’ environmental export restrictions. While denying wrongdoing, Gibson agreed to pay a $300,000 penalty and other fines. The Government Series II Les Paul, which will sell for around $1,099, features a pickguard that is “hot-stamped in gold with the Government Series graphic – a bald eagle hoisting a Gibson guitar neck.” Fred's Says Bad Weather Hurt Sales, Profits Fred's Inc. said Thursday that its sales were hurt in January by bad weather that also cut into the retailer's profit for the quarter. The discount retailer said that the rough weather disrupted consumers' shopping habits and led to the closure of more than 120 stores during the final week of the month. Fred's, based in Memphis, Tenn., operates 704 discount general merchandise stores in the southeastern U.S. The company said that its revenue from stores open for at least a year fell 1.8 percent in January. That measure is a closely watched gauge that strips away the impact of recently opened or closed stores. Analysts polled by Thomson Reuters were anticipating a 1 percent decline. Fred's adjusted its January results to eliminate the first week of the month to make it comparable with those of the prior year. CEO Bruce Efird said that prior to the last week of January, the company's sales were running in the middle of the company's forecast but fell sharply in that final week due to bad weather. He said that the drop in sales should reduce the company's earnings for its fourth quarter by 3 cents per share. Fred's now expects earnings between 13 and 16 cents per share for its fourth quarter. Analysts polled by FactSet were anticipating earnings of 18 cents per share. $2M Building Permit Filed for Indoor Sports Facility Developer Wes Misenhelter has filed a $2 million building permit application for the indoor sports facility he is building on 237 Woodland Lake Drive in Cordova. The application filed with the city-county Office of Construction Code Enforcement lists the size of the sportsplex at 45,094 square feet. No architect or contractor is listed. Misenhelter last year bought the 5.6-acre site east of Grays Creek on Walnut Grove Road to build Wesscorp Sports & Office Property. The development will include a climate-controlled indoor sports facility with turf soccer field and three separate areas for sports programs. The site also has two outparcels dedicated for office and medical development. Misenhelter filed a $2.3 million construction deed of trust through BankTennessee on Jan. 8, and the sports facility is expected to be fully operational in July. Prudential Collins-Maury Joins Coldwell System Prudential Collins-Maury has joined the Coldwell Banker Real Estate system and will now be known as Coldwell Banker Collins-Maury. “I started the process of exploring affiliation with the Coldwell Banker brand over the last six months and included our management team in the process,” said Doug Collins, president and CEO of Coldwell Banker Collins-Maury. “At the end of the review process, Coldwell Banker was a unanimous decision.” Collins, a former president of the Memphis Area Association of Realtors, shared the news with his staff Tuesday, Feb. 4. The Collierville-based firm, which has nearly 100 agents working in offices in Collierville, Memphis and Southaven, is coming off a strong year in which its sales volume increased by 16 percent to more than $243 million, the best year in the company’s history. High School Hoops Tourney Coming to FedExForum Some of the best high school basketball teams from Shelby County will compete at FedExForum for bragging rights in the SCIAA Fever Basketball Tournament Sunday, Feb. 9. Formerly known as the MIAA City Championships, 2014 will mark the inaugural SCIAA Fever tournament, a winner-take-all style tournament dating back to the 1960s. Past stars of the MIAA City Championships include Memphis’ own Larry Finch, Larry Spicer, John Gunn, James Bradley, Andre Turner, Todd Day, Cedric Henderson, Penny Hardaway and Elliot Perry. The tournament will consist of three girls games and three boys games. Tipoff will begin at 12:15 p.m. with a 16A girls game and conclude that evening with the 16AAA boys game featuring White Station High School, Tennessee’s top-ranked team and the No. 4 team in the nation. During the marquee match with White Station High School, the SCIAA will present the Court of Legends, a special presentation honoring NBA athletes from Shelby County, including Todd Daye, Elliot Perry, Penny Hardaway and Keith Lee. Tickets, which start at $12 and are valid for all six games, are available through Ticketmaster and the FedExForum box office. Ashley Furniture Outlet to Close The Ashley Furniture HomeStore Outlet location at 5228 Summer Ave. inside Perimeter Center is closing its doors due to a “lost lease.” The store, located near Summer and White Station Road, launched a closing sale on Thursday, Feb. 6. The sale will feature a large selection of furniture, bedding and accessories sold at discounts of up to 90 percent. A statement about the store closing did not mention a specific closing date, and the Summer Avenue closing does not affect the three other Memphis-area Ashley stores. “The lost lease in this location in no way reflects on the brand,” said Shawn Roberts, regional vice president of Ashley HomeStore Outlet, in a statement. Council OKs ‘Tax Dead’ Anti-Blight Program The Memphis City Council on Tuesday, Feb. 4, approved an anti-blight grant program for “tax dead” properties – properties with more in back taxes and associated fees than the property is appraised for or could ever be sold for. The five-year pilot program, which was approved last month by the Shelby County Commission, offers up to $200,000 a year to fund grants to community development organizations in the amount of the back taxes and fees due, which are then paid back to the city and county. The program would offer another pool of $100,000 a year in grants to pay property taxes on the properties for the next five years. The program now goes to the Tennessee attorney general’s office for legal review, then back to both city and county bodies for another vote. In other action, council members sent back to committee a proposal by Bill Boyd that would have waived the new monthly streetlight fees on Memphis Light, Gas and Water bills for recently annexed residents of South Cordova in areas without street lights. Other council members said they were prepared to seek similar waivers for residents in their districts in similar situations. And the council may consider some kind of waiver for residents of planned unit developments in which homeowners pay a fee for streetlights as part of a homeowners group. Harrison Creek Apts. Sell for $4.4 Million The 382-unit Villages at Harrison Creek apartment complex on Jackson Avenue in Raleigh has been purchased by an Illinois-based entity named AMG Memphis LLC for $4.4 million. AMG bought the Class C complex in a Jan. 31 special warranty deed from JK Financial LLC and SK Financial LLC, which had acquired it in a 2011 foreclosure sale for $3.9 million. The purchase includes three main parcels and 0.2 acres of vacant land on the east side of Jackson Avenue north of Gragg Avenue. The largest parcel, 3807 Jackson, is a 6.76-acre site containing 208 apartment units built in 1964 and totaling 154,984 square feet. The Shelby County Assessor of Property’s 2013 appraisal is $1.8 million. The 3923 Jackson Ave. parcel is 2.9 acres and contains 98 units totaling 63,206 square feet. The phase was completed in 1966 and has an appraised value of $1.2 million. Last, the 3881 Jackson Ave. parcel is 2.6 acres and contains 76 units totaling 45,168 square feet. The phase was completed in 1964 and has an appraised value of $1.2 million. In conjunction with the purchase, AMG Memphis LLC filed a $3.2 million deed of trust, assignment of leases and rents, and security agreement through Thorofare Asset Based Lending Fund III LP. Adam M. Glickman signed the trust deed as manager of AMG Memphis. Pearl Shaw Named to Tenn. Lottery Board Gov. Bill Haslam has appointed Pearl Shaw to serve on the board of the Tennessee Education Lottery Corp. Pearl Shaw is co-author, along with Mel Shaw, of “Prerequisites for Fundraising Success: The 18 Things You Need to Know as Fundraising Professional, Board Member, or Volunteer” and “The Fundraiser’s Guide to Soliciting Gifts.” The Shaws also write the “FUNdraising Good Times” column that runs Tuesdays in The Daily News. St. Louis School Files Permit for New Facility St. Louis Catholic School has filed a $2.4 million building permit application for a multipurpose building on its campus at 5192 Shady Grove Road. The permit application filed with the city-county Office of Construction Code Enforcement lists the building as including administrative offices, a multiuse room, snack bar and recreation-type facility. Philadelphia, Miss.-based W.G. Yates & Sons Construction Co., which has an office on Poplar Avenue, is listed as general contractor. Started by the Dominican sisters in 1957, the Catholic school is on the northwest corner of Shady Grove and South White Station Road, adjacent to St. Louis Catholic Church. In March 2012, the school broke ground on a junior high wing that added eight classrooms, a science lab, music room and other amenities. St. Louis currently has more than 500 students in preschool through eighth grade, according to the school’s website. MCA Design Contest Winners Announced After hours of design and construction time, two open houses and more than 8,000 votes cast, a contest that allowed Memphis College of Art students to redesign real apartments has come to a close. Voters awarded the Double M team of Bailey Brocato and Ethely Lyons first place in the ReStore for More design contest, a competition created by Memphis College of Art, The Venue Apartments and the Habitat for Humanity of Greater Memphis ReStore, which sells a variety of donated goods to support Habitat’s mission to provide housing for families in need. The Modern West team of Laura Miller and Jess Vandenberg finished second, and the Handmade American team of Sam Herwehe and Evan Lebaroff captured third place. The Venue Apartments awarded $1,000 and six months of free rent to the first-place team, $600 to the second-place team and $300 to the third-place team. The contest allowed students to showcase what they’ve learned in the classroom on a real-world canvas. The Venue provided the three teams with $500 for materials and $50 for supplies, plus a $100 gift certificate and a discount at the Memphis ReStore. The teams were also given a “mystery item” – an identical chest of drawers – to incorporate into their designs. Fred’s Offering Free Blood Pressure Screenings Fred’s Pharmacy is offering free blood pressure screenings at all 360 of its pharmacies during February. To encourage participation, fred’s will donate $1 to the American Heart Association for each screening. The campaign is the beginning a long-term effort by the company to help educate people about being conscious about their heart’s health, and each person screened will have an “I am Heart Smart” name card displayed at the pharmacy to show the progress of the campaign in that location. In addition to the free screenings and financial donation, fred’s Pharmacy also has partnered with the American Heart Association to create a special website, freds.toolsfortheheart.org, that features a “My Life Check” evaluation. Black Girls CODE to Host Web Design Workshop The Memphis chapter of Black Girls CODE will host its first workshop for the 2014 program year Feb. 22 at the Whitehaven branch library, 4120 Millbranch Road. This class will focus on how to build a website. Check-in will start at 9 a.m., and class starts at 10 a.m. Thanks to a grant from the Memphis Chapter of the Society of Information Management, the Whitehaven branch is partnering with Black Girls CODE to offer scholarships to 50 girls ages 10 to 17. Bartlett Mayor’s Son to Lead McDonald Insurance Brooks McDonald is leading McDonald Insurance of Bartlett following the retirement of his father, Keith McDonald, after 32 years of running the firm. The younger McDonald is a 10-year insurance industry veteran. The business has 10 employees and a satellite office in Covington, Tenn. Keith McDonald continues to serve as Bartlett mayor and will seek re-election to another four-year term in the November Bartlett elections. Target Taking Actions on Security, Exec Says An executive of Target Corp. said Tuesday the retailer has taken actions to shore up security following the massive breach of millions of consumers' data during the holiday season. The testimony at a Senate hearing by John Mulligan, executive vice president and chief financial officer at the No. 2 U.S. discounter, also revealed that Target discovered an additional 25 cash registers infected by malicious software on Dec. 18. The company had said earlier that it had removed all the malware from its system by Dec. 15. Mulligan's testimony before the Senate Judiciary Committee was the first public appearance by a Target executive addressing the issue since the breach that occurred between Nov. 27 and mid-December. An estimated 40 million credit and debit card accounts were affected. Mulligan said Target is "deeply sorry" for the effect of the data theft on consumers, and he acknowledged that their confidence in the Minneapolis-based company has been shaken. Sen. Patrick Leahy, D-Vt., the panel's chairman, said the erosion of consumers' confidence — with data breaches on the rise affecting retailers, Internet companies and others — could hinder the U.S. economy's recovery. Nichols Named New Deputy District Attorney Jennifer Nichols is the new deputy district attorney general in the Shelby County District Attorney General’s office. District Attorney General Amy Weirich appointed Nichols to the No. 2 position in the county prosecutor’s office Monday, Feb. 3, succeeding Carter Myers, who is retiring after 30 years in the office. Nichols has been chief prosecutor for the office’s Special Victims Unit. She joined the Shelby County prosecutor’s office in 1991 after earning her law degree from Cumberland School of Law at Samford University in Birmingham and practicing law in Florida. She and Weirich shared an office at the start of their careers as prosecutors. Victorian Village to Host Fundraiser Feb. 23 Victorian Village Inc. on Feb. 23 will host a fundraiser dinner called A Taste of Elegance, a farm-to-table period dinner benefiting Victorian Village Inc. Community Development Corp. The event will be held inside three of the Victorian homes on Adams Avenue. The Mallory-Neely House will provide the backdrop for the charcuterie course, the 1871 Woodruff-Fontaine House will host a dinner and the newly renovated James Lee House will offer desserts. The menu will be period-inspired, and Victorian dress is welcomed. Tickets are $125 and can be purchased at victorianvillageinc.org. All three homes will be open for tours during the event. Dunavant Transportation Hires Recruitment Specialist Dunavant Transportation Group has hired Darlene Beasley as its new driver recruitment and relations manager, responsible for the recruitment and retention of drivers for its Dunavant Sea Lane Express subsidiary. Dunavant Transportation Group acquired Sea Lane Express, which specializes in regional trucking and intermodal drayage operations, in 2011. The company currently has terminal operations in intermodal and port cities including Atlanta and Savannah, Ga., Norfolk, Va., Charleston, S.C., Charlotte and Wilmington, N.C., and Nashville. Beasley, who most recently served as the regional manager of field recruiting for Comcar Industries, will analyze each terminal’s needs for driver recruitment based on customers’ freight requirements. Grizzlies’ Joerger Named Conference Coach of Month Memphis Grizzlies coach Dave Joerger was named the Western Conference Coach of the Month for January. Joerger guided Memphis to an NBA-best 12-3 record (.800) during the month of January, as the Grizzlies won five consecutive games and nine of their last 10 to close out the month. Memphis tied its franchise record for January wins and finished just one victory shy of the franchise record for wins in any month (13 in March 2004 and April 2012). The Grizzlies also won six consecutive road games from Jan. 5-31, the second-longest road winning streak in franchise history. The Grizzlies held all six opponents to 90 points or fewer, including allowing just 77 points on the road against the Milwaukee Bucks on Jan. 15 in the second game of a back-to-back. Memphis emerged as one of the stingier defenses in the month of January, holding opponents to 91.5 points per game on just .431 shooting from the field and .311 shooting from behind the arc. After the return of center Marc Gasol from injury on Jan. 14, Memphis held opponents to a league-low 86.3 points per game. Tennessee VW Workers to Hold Union Vote The United Auto Workers says employees at Volkswagen's Chattanooga plant will vote Feb. 12-14 on whether they want the union to represent them. The Detroit-based UAW said Monday that the National Labor Relations Board set the election. The vote follows an agreement between the UAW and the Germany-based automaker, which decided not to challenge a unionization vote. UAW President Bob King says a statement that Volkswagen "is known globally for its system of cooperation with unions and works councils." The UAW says the Chattanooga plant is VW's only major U.S. facility without a union. Last month, the National Labor Relations Board determined that the UAW and Volkswagen didn't violate federal labor laws last year during the process of moving toward a union representation vote. Board Changes Stance on Teacher Licensing The Tennessee Board of Education has changed its stance on rules effecting the licensing of teachers. In August, the board voted for the policy brought by the state Education Department to use student growth measured through standardized test scores, or value-added data, to determine renewing teaching licenses. The board voted at the time to delay implementation of the new rules until 2015. But The Tennessean reports the board voted last week to step away from the new policy. The vote was on first reading and the board is scheduled to take up the issue again in April. Many teachers opposed the changes because they were concerned that flawed scores could cause qualified teachers to mistakenly lose their licenses. Despite the board's new position, the Tennessee Education Association, the state's largest teachers' union, says it will still push a measure this legislative session that would prevent the state from taking teachers' licenses based on "any statistical estimate utilizing standardized test scores." Miss. Senate OKs Adding 'In God We Trust' to Seal The Mississippi Senate voted Friday to add "In God We Trust" to the state seal, as requested by Republican Gov. Phil Bryant. Currently, it has an eagle and the words, "The Great Seal of the State of Mississippi" without a slogan. Senate Bill 2681 passed the Senate 48-0, with four senators absent. It moves to the House for more work. The bill is called the "Mississippi Religious Freedom Restoration Act," and it says government may not burden a person's right to practice religion. Its chief sponsor is Republican Sen. Phillip Gandy, who is minister of Liberty Baptist Church in Waynesboro. Gandy said he has heard no examples of Mississippi government trying to limit religion, but he has talked to some conservative Christians – particularly Pentecostals and Baptists – who are concerned. "Times are changing, and Christians are afraid of a lot of different things. And some of that is reality, possibly, and some is perception. But we want to do what we can," Gandy told The Associated Press after the bill passed. Some senators, including Democrat David Jordan of Greenwood, pointed out during the debate that the U.S. Constitution already guarantees freedom of religion.

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FIGHT AIDS... We are fast approaching December 1, 2011 when we commemorate yet another year of World AIDS Day. It's now 30 years, June 5, 1981, since the first AIDS case was published by the Centre for Disease Control. It became known as Gay-related immune deficiency (GRID). Today, this disease knows no boundaries and can affect and/or infect anyone. At the end of 2010, it's estimated that 34 million people globally living with HIV, there were 2.7 million new HIV infections, and 1.8 million people died of AIDS-related illnesses.UN AIDS report that "the overall growth of the global aids epidemic appears to have stabilized. The annual number of new HIV infections has been steadily declining since the late 1990s and there are fewer aids-related deaths due to the significant scale up of antiretroviral therapy over the past few years. Although the number of new infections has been falling, levels of new infections overall are still high, and with significant reductions in mortality the number of people living with HIV worldwide has increased.As is customary globally, TODAY will be dedicated to remember those we've lost and to be thankful for the survival of those we love who live with the disease that has no cure. Happy WAD 2011 and show your support by wearing a red ribbon today! thegayte-keeper Time to end the discrimination!

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The National Center for Child Traumatic Stress (NCCTS) works closely with National Child Traumatic Stress Network (NCTSN) members to develop and expand comprehensive external partnerships with national organizations whose missions are closely aligned with the NCTSN mission. Major activities shared with NCTSN partners include:transforming child-serving systemsimproving the awareness, knowledge, and skills of child-serving professionals related to child traumaraising public awareness about child traumaadvancing public policy and support for child traumatic stress treatment and servicessupporting sustainabilityimproving child trauma researchdeveloping and disseminating products for child-serving professionalsdeveloping evidence-based treatments and interventionsinfluencing practice through development of protocols and guidelinescollecting, analyzing, and disseminating dataintegrating child trauma resources provided to special populations of consumers or professionalsimproving family engagement related to treatment, services, public policy, and product developmentimproving cultural and linguistic competence and family engagementOrganizations selected for NCTSN strategic partnerships include:American Psychological Association (APA) The American Psychological Association (APA) is a scientific and professional organization that represents psychology across the United States. The organization, whose mission is to advance psychology as a science and profession, consists of approximately 148,000 members, making it the largest association of psychologists worldwide. The APA consists of 53 professional divisions which focus on initiatives related to the topic area of that particular division. Numerous publications and resources are put out and endorsed by the APA. The APA hosts an Annual Convention, attended by roughly 12,000 psychologists and students, with presentations on virtually every topic within the field of psychology. Furthermore, along with the federal Office of Child Abuse and Neglect, APA co-sponsors the National Conference on Child Abuse and Neglect, the only national meeting focusing specifically on issues of child abuse and neglect that apply to practitioners, policy-makers, community organizers and researchers. Of specific relevance to the NCTSN are the following APA Divisions: Division 56-Trauma Psychology, which provides a forum for scientific research, professional and public education, and the exchange of collegial support for professional activities related to traumatic stress; and Division 37-Society for Child and Family Policy and Practice, which is concerned with professional and scientific issues relative to services and service structures for children and youth. American Professional Society on the Abuse of Children (APSAC) The mission of The American Professional Society on the Abuse of Children (APSAC) is to enhance the ability of professionals to respond to children and families affected by abuse and violence. APSAC focuses on meeting the needs of professionals engaged in all aspects of services for maltreated children and their families. Especially important is the dissemination of state-of-the-art practice in all professional disciplines related to child abuse and neglect. The leadership of the NCTSN and APSAC maintain ongoing contact and the two organizations have collaborated on a variety of initiatives. Together NCTSN and APSAC have made reciprocal announcements regarding upcoming conferences, activities, and products. The NCTSN is involved in APSAC's annual Advanced Training Institute, which offers in-depth training on selected topics, and members of the NCTSN have also participated, on multiple occasions, in APSAC's Annual Colloquium, held nationally to provide research and information for interdisciplinary professionals in the field of child abuse and neglect. Recently, the NCCTS wrote an article on the Network and its activities pending publication in The APSAC Advisor, a valuable quarterly news journals that keeps interdisciplinary professionals informed of the latest developments in policy and practice in the field of child maltreatment. APSAC also sent out information about NCTSN as part of its 2006 membership renewal campaign and has linkages to the NCTSN website. Child Welfare League of America (CWLA) The Child Welfare League of America is an association of over 800 public and private agencies serving abused and neglected children and their families across the country. CWLA is committed to engaging people everywhere in promoting the well-being of children, youth, and their families, and protecting every child from harm. CWLA engages in a wide variety of programs and public awareness activities aimed to strengthen management and operation of local agencies and shape new, more effective approaches to working with children. The CWLA advocates for the advancement of public policy, sets and promotes standards for best practice, and delivers superior membership services, all toward their primary goal of ensuring the safety and well-being of children and families. CWLA serves as a national resource for publications and training pertaining to child welfare. The NCTSN and CWLA have had ongoing contact and continue to identify potential areas for future collaboration, partnerships, and sustainability activities. In 2005, NCTSN members from a number of sites participated in a teleconference training series on child trauma for CWLA members. CWLA also currently promotes NCTSN's Speakers Series among its members. Susan Ko and Chris Siegfried have presented at CWLA's Juvenile Justice Symposium. Members of CWLA have also attended the NCTSN's All-Network Meeting and are active participants in the Foster Care Committee. National Center for Cultural Competence (NCCC) The National Center for Cultural Competence (NCCC) at Georgetown University and the NCTSN have established a partnership based on the joint goal of promoting cultural and linguistic competence in service systems across the country, specifically that relate to child traumatic stress. The NCCC provides training, technical assistance, and consultation in order to advance and maintain cultural and linguistic competence in a wide variety of systems. Major emphasis is placed on translating evidence into policy and practice for programs and personnel concerned with mental health care delivery, administration, education, and advocacy. Together, the NCCC and NCTSN will focus on providing technical assistance, training, and consultation to promote cultural and linguistic competence in systems that serve traumatized children and their families. Some of the more specific activities of this partnership will include: joint participation in topical call series' related to cultural competency and child trauma; consultation with NCTSN partners on conducting organizational, cultural, and linguistic self-assessments; and sharing, disseminating, and collaborating on the development of future resources and products. By promoting cultural and linguistic competence, this partnership will help raise the standard of care for traumatized children and their families across the country. National Council of Juvenile and Family Court Judges (NCJFCJ) The National Council of Juvenile and Family Court Judges was established in 1937 by a small group of judges with the goal of improving courts and systems practice and raising awareness of the core issues that touch the lives of the nation's children and families. This organization provides cutting-edge training, wide-ranging technical assistance, and research to help the nation's courts, judges and staff in their important work. Last year, the NCJFCJ conducted more than 200 educational programs for more than 30,000 judges, court administrators, social and mental health workers, police, probation officers, and others working in the juvenile and family courts at its headquarters and throughout the country. The NCJFCJ and the NCTSN have maintained an ongoing collaboration, sharing materials, developing products and resources, and co-sponsoring trainings and initiatives. Recently, the NCJFCJ collaborated with NCTSN to produce a special Winter 2006 issue of the Juvenile and Family Court Journal on child trauma, and another special issue of this journal is due for publication in 2008. NCTSN members have also produced articles for The Judges Page, an electronic newsletter of NCJFCJ and National CASA. Members of the NCJFCJ have attended the NCTSN All-Network Meeting for the past four years and NCTSN members have participated in NCJFCJ's annual conference and conducted focus groups there. This partnership intends to continue focusing on co-sponsoring trainings, initiatives, and products in the future. National Institute of Mental Health (NIMH) The National institute of Mental Health is part of the National Institutes of Health (NIH), the Federal government's principal biomedical and behavioral research agency, situated in the Department of Health and Human Services. The mission of NIMH is to reduce the burden of mental illness and behavioral disorders through research on mind, brain, and behavior. As an organization, their primary goals are to collect, analyze, and disseminate information on the causes, occurrence, and treatment of mental illness through supporting research and training efforts. The NCTSN is a member of the National Partners of the NIMH Outreach Partnership Program, which is a nationwide initiative of the NIMH with support from NIDA and in cooperation with SAMHSA. The Program enlists national and state organizations in partnerships to help bridge the gap between research and clinical practice by disseminating the latest scientific findings; informing the public about mental disorders, alcoholism, and drug addiction; and reducing the stigma and discrimination associated with these illnesses. As a National Partner, NCCTS joins this 80-member network that includes professional, consumer, advocacy, and service-related organizations with a nationwide membership and/or audience. Through this membership, NCCTS receives and disseminates to the NCTSN a monthly newsletter with timely and comprehensive updates on research findings, funding opportunities, and training and conference information. NCCTS is also invited to join an annual meeting, and has contributed to past meetings with resources, participants, and speakers. The NCCTS also has the opportunity to share resources with the network members of the National Partners, as well as the Outreach Partners (the 51-member network of state level organizations), a related network within the Outreach Partnership Program. Mental Health America (MHA) Mental Health America, formerly known as the National Mental Health Association, is the country's leading non-profit dedicated to promoting mental health, preventing mental disorders and achieving victory over mental illness through advocacy, education, research and services. MHA programs are intended to educate the public, encourage reform and promote the use of effective local and regional prevention and recovery programs. One of their most relevant public education and awareness campaigns is called the Campaign for America's Mental Health, which includes initiatives like the Children's Mental Health Matters Campaign and Childhood Depression Awareness Day. MHA also engages in a wide variety of advocacy programs and prevention/recovery initiatives. MHA and the NCTSN continue to partner on a number of different projects. In the past, MHA and NCTSN have co-sponsored a teleconference call training for MHA affiliates on juvenile justice and child trauma. NCTSN also arranged some additional training for MHA affiliates on terrorism/disaster response. This partnership is continuing to develop and be refined. MHA affiliate organizations are located throughout the country, and efforts will be made in the coming years to link these chapters with NCTSN members in their communities for purposes of education, public awareness, consumer and family engagement, and advocacy Printer-friendly version

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Edex Study how society impacts health Venkata Susmita Biswas - CHENNAI Published: 22nd October 2012 12:00 AM Last Updated: 20th October 2012 01:18 PM Prof. Sushrut Jadhav and Prof. Roland Littlewood | Shiba Prasad Sahu Medical anthropology is a branch of anthropology that studies the various aspects of health and wellness in the context of various cultures and the relationship between the body and culture. The knowledge of medical anthropology can give many professionals an edge over their peers— right from doctors and psychiatrists, to archaeologists and medical historians. Though this multidisciplinary course has numerous lucrative opportunities to offer, it is yet to mark its presence in our universities and medical schools.What is medical anthropology?In the words of Prof Roland Littlewood of University College London, London, “While anthropology is the study of human beings within their community, medical anthropology which is a sub-speciality of anthropology looks at how people become patients. It analyses their socio-economic conditions and other parameters that determine how they will seek treatment and how they understand their own illness.” In the process of this analysis he says medical anthropologists necessarily live with the community they are documenting and note how they live, what their customs and conventions are, “We are more interested in the locals and what they think of their own situation, how they organise themselves, etc. We also focus on what is important to them, if it is religion or something more sacred. As these factors finally determine how they will react to medicine and if that will cure them,” he explains.Prof HK Bhat, a pioneer in the field of medical anthropology in India explains the importance of the study of medical anthropology. He says, “In some cultures, a certain section of the community may be barred from eating a particular food product. And that leads to that section being deprived of certain nutrients. These cultural aspects can have negative or positive impacts and we study these details. This information can help doctors identify the root cause of a problem and treat it accordingly.” Prof Bhat shares a little insight about medical anthropology, “Illness and disease are different things. A patient comes to a doctor with illness and a doctor has the tools to treat the disease. Only when the illness and disease match will the patient be cured. This understanding is very important,” he says. Prof Littlewood tells us that the patient may actually be looking forward to a chat with the doctor about his illness rather than just a prescription. In such cases it is essential that the cultural context of the illness is found and accordingly treated.Citing a case study, Prof Bhat, puts his area of study in perspective, “In a small south African village, there is a community whose 90 per cent members have a bacterial infection. But that 90 per cent does not think of itself as unhealthy. It is instead the 10 per cent of healthy people who think they are ill!” He says that since every community has its own way of treating health problems it is up to people like him to study these cultural aspects and become a mediator between the patient and doctor. He adds that every medical system like ayurveda, unani, yoga, etc, is effective on a certain disease. And that one has to be selective while choosing treatment. “Some societies do not use biomedicine. In such cases we must negotiate with the patient to get him to agree to the medication.”Opportunities in IndiaOne of the areas where medical anthropology has great application is that of mental health. Prof Littlewood who shares his inputs on medical anthropology and its use in the sector of mental health at The Banyan Academy of Leadership in Mental Health in Chennai, says that one can find out what situations lead people to lose mental stability and what can help them. Prof Sushrut Jadhav, University College London, says, “Indian mental health professionals have not had much exposure to the social sciences and to their own culture. They are getting more and more alienated from their own culture which is a lot like what the West tries to do. There is very little dialogue between social sciences and health and between mental health and cultures. This leads to a disconnect between the doctor and patient and eventually to non-compliance on part of the patient to the treatment, especially in the case of mental health.”Prof Jadhav adds that medical anthropology is very important to India because, “In India there is increasing inequality. Doctors and patients are caught up in a class war. All those in the mental health sector are removed from the culture of rural India — the values, the language, what makes them ill, etc.” He says that though there are a few places in India where medical anthropology is taught, in the field of mental health there is hardly any communication between mental health and anthropology. The Indian subcontinent has myriad social stigmas (caste, gender, race, religion, etc) that are included in these studies. “At The Banyan we are now studying the reasons why people become homeless and their problems.”Prof Bhat adds that medical anthropologists can apply their knowledge in public health centres, private hospitals, in projects that study health problems of rural people and even bring to the notice of the authorities a situation that needs their attention. “For example, we have been studying the effects of endosulfan in Kerala and Karnataka, Handigodu syndrome in Karnataka, etc. Also in the radius of our study are some marginalised communities of the country, tribes from north-eastern states. If we can point to what social and medical aspects need attention, we can hope for a better life for them,” he says. Prof Bhat says that there is immense opportunity for anyone who wishes to pursue medical anthropology in India and abroad. He adds that many positions in bodies like WHO, UNICEF and the like are occupied by medical anthropologists.UCL-BALMThe Banyan Academy of Leadership in Mental Health in Chennai is The Banyan’s initiative to study and increase stakeholder participation in the sector of mental health. In an attempt to take this forward, BALM and University College London together launched a short course module which deals with different aspects of mental health. This course hopes to increase the use of medical anthropology in mainstream healthcare in India. Says Mirjam Dijkxhoorn, deputy director, BALM, “As of now, the role of medical anthropology is marginal, but the UCL-BALM course has helped introduce participants (who are often mental health or health professionals) to concepts of medical anthropology and different ways to look at expressions of culture and manifestations of illness.” This three-day course is directed by Prof Jadhav of UCL and the other resource persons include Dr Jane Derges, Dr David Goldberg, Dr Sumeet Jain, Prof Roland Littlewood and Yemi Oloyede from UCL.According to Mirjam, “Psychiatrists, clinical psychologists, psychiatric social workers, occupational therapists, medical anthropologists, other social scientists, and clinical practitioners in mental health from the NGO, public, and private health sectors can all take part in the course taught by BALM. It is useful for any healthcare professional, since it is an attitude and a way of looking at clients and their cultural backgrounds and the way that they view the world and experience their illness. So being sensitive to the client’s cultural beliefs and understanding of an illness will help the treatment process of any health professional.”Neetu Sarin, assistant professor, Ambedkar University, New Delhi, who attended this course this year says, “As an academic I was interested in looking at this interdisciplinary subject that has so far been divorced from other social sciences like psychology and more importantly medicine.” Being a psychiatrist she says, the course has helped her gain a better understanding of her clients. Sarin also adds that though in India there is little influence of medical anthropology, the same subject is studied as sociology in our colleges and universities. Preethi Singh, a student of MA Gender Studies who also took up this course says it answered some important questions about the anthropological and clinical dimensions of gender studies. — susmita@newindianexpress.com

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Home > Content Library of Adult English Medical Content > Endocrinology The Pancreas Anatomy of the pancreas The pancreas is an elongated, tapered organ located across the back of the abdomen, behind the stomach. The right side of the organ--called the head--is the widest part of the organ and lies in the curve of the duodenum, the first division of the small intestine. The tapered left side extends slightly upward--called the body of the pancreas--and ends near the spleen--called the tail. The pancreas is made up of two types of glands: Exocrine. The exocrine gland secretes digestive enzymes. These enzymes are secreted into a network of ducts that join the main pancreatic duct, which runs the length of the pancreas. Endocrine. The endocrine gland, which consists of the islets of Langerhans, secretes hormones into the bloodstream. Functions of the pancreas The pancreas has digestive and hormonal functions: The enzymes secreted by the exocrine gland in the pancreas help break down carbohydrates, fats, proteins, and acids in the duodenum. These enzymes travel down the pancreatic duct into the bile duct in an inactive form. When they enter the duodenum, they are activated. The exocrine tissue also secretes a bicarbonate to neutralize stomach acid in the duodenum, which is the first section of the small intestine. The hormones secreted by the endocrine gland in the pancreas are insulin and glucagon, which regulate the level of glucose in the blood, and somatostatin, which prevents the release of the other two hormones. Online Resources of Endocrinology Endocrinology (Glands and Hormones) Online Resources - EndocrinologyWeight Loss after Diabetes Diagnosis Improves HealthThe Adrenal Glands New York Hospital Queens Recruiting Patients in a Clinical Study for Promising Treatment for Type 2 Diabetes03/25/2010New York Hospital Queens Nationally Recognized Diabetes Expert Says Efforts to Reduce Heart Attacks in Diabetic Patients are on the Right Track03/17/2010New York Hospital Queens Doctor Named Outstanding Clinician06/22/2009Landmark Study Published in New England Journal of Medicine06/09/2009

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Free Medical Clinic receives $10K grant for prediabetes early intervention ... Fuji Japanese Steakhouse coming to Oak Ridge ... Early voting heavy in Oak Ridge ... Free Medical Clinic receives $10K grant for prediabetes early intervention ... Fuji Japanese Steakhouse coming to Oak Ridge ... Early voting heavy in Oak Ridge ... Historically Speaking: Oak Ridger recalls his time in Nagasaki at WWII’s end I think it is curious that I grew up near Three Mile Island, spent three months in Nagasaki and ended up in Oak Ridge,” Carl Bretz, 86, recently said in an interview. By D. Ray Smith Oral histories are valuable resources and give insight into our history. Carolyn Krause provides the story below.***I think it is curious that I grew up near Three Mile Island, spent three months in Nagasaki and ended up in Oak Ridge,” Carl Bretz, 86, recently said in an interview.Bretz grew up around Harrisburg, Pa., near the future site of the worst nuclear power plant accident in U.S. history.He spent three months as a clerk typist with a U.S. Army battalion attached to the Marines in Nagasaki, Japan. He arrived there about six weeks after the U.S. dropped the atomic bomb on Nagasaki on Aug. 9, 1945.This weapon, which ended World War II, was the second and last atomic bomb to be detonated over a populated area. It also prevented a U.S. invasion of Japan that was projected to kill millions on both sides.In 1994, after marrying Oak Ridge family counselor Rosemary Burns, whom he had met at a Unitarian Universalist conference in Radford, Va., Bretz retired here.The methods for producing plutonium in a nuclear reactor and separating it from uranium were pioneered at Oak Ridge National Laboratory, as were many technologies used in nuclear power plants. The larger reactors at Hanford, Wash., produced the plutonium used in the atomic bomb that exploded over Nagasaki.The bomb killed almost 74,000 people and injured another 74,000. Several hundred thousand more people eventually succumbed to illnesses resulting from the bomb’s radioactive fallout.“We commandeered a school as a barracks and office headquarters,” said Bretz of his arrival in Nagasaki, which occurred after the Army had determined that the area no longer had hazardous radiation levels.“We went in with loaded rifles but there was no resistance. The people disappeared. After we got settled, people started trickling back. Some of the children had sores, I assumed, from radiation burns. It was remarkable how they accepted the occupation by the U.S. military. I was utterly amazed.”Bretz served as clerk typist with the Army Construction Engineer Battalion, which participated in the occupation of Japan by the Allied Powers, led by the United States. The occupation transformed Japan into a democracy.Bretz was in Nagasaki and other towns on the Kyushu Island from September 1945 through April 1946. The Construction Engineer Battalion built an airstrip and bridges in the area. Bretz helped dig a latrine outside the school when they first arrived.As a clerk-typist, Bretz kept records, got battalion members ready for discharge and opened and closed battalion offices. He also wrote many letters home to his parents from Nagasaki.He took photos and kept photos taken by a battalion photographer. One photo shows a damaged Catholic church (Nagasaki has had a Portuguese population since the 16th century) and another shows the Mitsubishi torpedo lab.Page 2 of 3 - He made copies of his Army records and kept World War II memorabilia, including his Army uniform and Japanese flags. Most of these collections have been transferred to the American Museum of Science and Energy.Copies of his letters and a DVD and transcript of an interview with him will be available soon at the Center for Oak Ridge Oral History in the Oak Ridge Public Library and eventually on the COROH website.Bretz is a retired Unitarian Universalist minister. But in the early 1940s when he was a high school student, he elected to take the commercial, not the academic, track.His grandfather had been a farmer and his father a railroader, and Bretz was not expected to go to college. He opted for working at a less strenuous job, so he took typing classes in high school in Marysville, Pa.After graduation in 1943, he worked in a Pennsylvania Farm Bureau Insurance Co. in Harrisburg, but hated the job.Then he was drafted.He took basic training at Fort Belvoir in Virginia. Most of the privates ended up fighting — and in some cases dying — in the Battle of the Bulge in December 1944 in Europe.Because of his typing skills, Bretz avoided combat. He was sent to work as a clerk typist at Army camps in Pennsylvania, Alabama and Mississippi. Bretz was stationed on Oahu Island in Hawaii when the atomic bombs fell on Hiroshima and Nagasaki in August 1945.After the war, with assistance from the GI bill, Bretz attended and graduated from Albright College in Reading, Pa. One of the students he knew there was a Japanese woman who had been in a Japanese internment camp in America during the war.Bretz had studied to become an Evangelical United Brethren pastor at Albright’s seminary. Then he decided to attend graduate school at Boston College, where he earned a master’s degree in the psychology of religion. He became an ordained Unitarian Universalist minister and held chaplain or parish positions in New Hampshire, Massachusetts and Iowa.Bretz also worked for the Alabama state government’s mental health department from 1972 until his retirement in 1988. Part of the time he worked for Bryce Hospital in Tuscaloosa, helping mental health patients transition from long-term treatment in the hospital to community-based care.A widower, Bretz has three grown children in Florida, Massachusetts and New Mexico from his first marriage. He lives in an Oak Ridge retirement center and enjoys reading and weaving placemats and other items on a loom he has owned since 1971. Every Tuesday, he goes to the Appalachian Art Craft Center to weave on a 200-year-old loom there.He is pleased to have his letters home, photos, recorded oral history, Army records and other memorabilia from World War II and postwar Japan preserved in Oak Ridge.Page 3 of 3 - ***NEXT WEEK: Carolyn continues with Carl Bretz’s impressions of Nagasaki shortly after it was devastated by the last atomic bomb dropped on a populated area, as revealed in his letters to his parents.

医学

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DOG ARTICLE LIBRARY: Anatomy, Normal Values and Basic Science Arthritis, Bone and Joint Disease Behavior and Training Cases from the Clinic First Aid & Emergency Care Fleas and Ticks Hormone and Endocrine Immune and Blood System Liver and Pancreas Nerve and Muscle Conditions New Puppy or Dog Newborn Puppy Care Nutrition and Feeding Dogs Parasites and Worms Reproduction, Heredity and Fetal Development Senior Dog Care Spaying and Neutering Vaccines and Vaccinations Veterinary Exams and Procedures Home / Dog / Liver & Pancreas / Liver Anatomy Anatomy & Function of the Liver in Dogs Drs. Foster & Smith, Inc. Race Foster, DVM The liver is an extremely important organ in the body. It is responsible for protein, fat, and carbohydrate metabolism; vitamin and mineral storage; digestion of food and detoxification of wastes. Whether portrayed in a medical text or seen in surgery, the liver appears as nothing more than a large reddish-brown mass. With the exception of the attached gallbladder, it has few distinguishing external or internal features. It is divided into several hepatic lobes or sections, but even these are joined together in such a way that they are sometimes difficult to distinguish one from another. However, for all of its simplicity of appearance, the liver is a very complicated and hard-working organ. It is known to perform well over 1,000 different tasks, most of which are necessary to life and could not be done elsewhere in the body. The production of the essential protein 'albumin,' the storage of fat soluble vitamins such as A, D, E, and K, the manufacture of some digestive enzymes, the detoxification of wastes and poisons, the production of blood clotting factors, and the storage of energy are just some of these hepatic functions. Yet, unless there is a total (or near complete) failure to function, it is usually very difficult for numerous liver function tests to show that it is diseased, damaged, or even affected. This is because every major section or lobe of the liver performs exactly the same tasks. Additionally, the liver has tremendous reserve capacities and can greatly increase its output and efficiency. It can shift into overdrive on a moment’s notice. Therefore, if one to four lobes are loaded with cancer, contain a bacterial or viral infection, or are severely traumatized, the remaining sections just work overtime to fulfill the body’s needs. In canine medicine, we believe that many liver conditions go on for a long time before any clinical signs are observed by the animal’s owner or veterinarian. In fact, it frequently happens that by the time we are able to make a diagnosis through lab tests, biopsy, or clinical signs, the condition has already passed and the animal is actually improving. The liver is truly unique in another very important way. Worms, lizards, and salamanders have the ability to grow back (or regenerate) body parts that have been lost or damaged. This is rarely possible in mammals like dogs, except in the case of the liver. We are very familiar with cases in which over three-fourths of the liver is surgically removed because of injury or disease, and then within a year, the organ has grown back to its original size. In these individuals, no functions or abilities of the organ were lost. But even in cases where large portions of tissue were severely damaged rather than lost, the liver constantly amazes clinicians with its ability to recover. Sections that have lost their ability to function, when given supportive medications and a little time, will frequently recover completely. The medium through which the liver carries out its functions is the blood. The liver is an organ through which thousands of miles of blood vessels course, carrying blood in such a way that it comes into contact with each and every liver cell. It is so filled with blood and vessels that a freshly cut section appears just like a saturated sponge. In fact, when compressed, it expels large quantities of blood just as a sponge would. Twenty percent of the blood pumped by each and every beat of the heart goes through the liver. Additionally, the first tissue to get a chance at the nutrients absorbed by the intestines and stomach is the liver. Every blood vessel leaving the gastrointestinal tract goes directly into the liver. The liver takes from, adds to, and changes in some way, all of the blood that passes through its mass. Its cells perform their 1,000 plus tasks 24 hours of every day responding to every need of the body through a complicated array of chemical communications. If a section of an animal’s body needs a compound that is manufactured by the liver, molecular messages tell it to produce and release more. If other products such as glucose get too low in the blood, the liver converts a storage compound (called glycogen) into glucose and then releases it into the veins leaving the liver. Other materials will be collected from the blood and stored for future needs. All at the same time, different molecules will be constantly manufactured by the cells, while other potentially harmful ones will be filtered out and destroyed. As previously stated, each lobe or section of the liver is able to perform every one of these tasks. To list all of the functions of the liver would take an entire book, but we will list some of the more important ones. Production of proteins Proteins are the building blocks of the dog’s body. They are the main component of muscle, skin, cell walls, tendons, connective tissue, blood vessels, etc. The components that make up proteins are called amino acids and they are metabolized in the liver. To name a few of the essential proteins formed in the liver, we will mention the major blood proteins like albumin and many of the globulins. These two groups maintain the pressure gradient within blood vessels, transport all sorts of other compounds, and perform many different immune responses, which protect the body. Proteins cause the blood to clot when a vessel is cut or damaged. Other protein molecules called enzymes are important for many of the chemical reactions that constantly occur within the body. Additionally, many of these and other proteins are stored within the liver for future use. As part of this entire system, the liver must determine which proteins are in short supply and increase the level of production before a crisis occurs. All of this is regulated closely as it would be inefficient for the body to produce too much of anything when it might be wasted. Many of the protein molecules break down automatically within predetermined periods of time. Therefore, not only does the liver produce, metabolize, and store these substances, but it also constantly monitors the supply and demand of any proteins it affects. Metabolism of carbohydrates and lipids Carbohydrates and lipids are the energy stores that run an animal’s body. The storage and release of many of these is done chiefly by and within the liver. Remember, everything that is absorbed through the gastrointestinal tract arrives at the liver first and very little goes out without being affected in some way. Glucose, the internal sugar and most important source of quick energy, is extracted immediately from the blood and converted into glycogen, which is stored until needed. Fatty acids, triglycerides, and other fats are also stored, metabolized, and/or changed within the liver. As with the proteins, if an animal’s liver could not capture and save fats for future use, the animal might starve without a completely balanced diet being provided each and every day. Vitamin production and storage Vitamins, except Vitamin C, are all either made, or stored, or are in some way regulated by the liver. Animals in liver failure must have their diet supplemented with huge quantities of these necessary compounds, If not, they will die. This includes both fat soluble and water soluble vitamins. Many older publications stated that only the fat soluble vitamins were affected, but today we know that both groups are equally managed by the liver. Storage of nutrients We have mentioned general storage before, but to be complete, we must again state that the liver fulfills this function in a way that no other site in the body can. We have mentioned vitamins, fats, triglycerides, and glycogen, but there are many more. Pre-determined quantities of several metals like iron, copper, and zinc are kept within the liver for future use in the rest of the body. These substances can be irritating to other types of tissue, so it is up to the liver to make sure they are always available. Even in the liver, however, these stored quantities are carefully monitored because excessive amounts can damage the cells. Another important storage factor of the liver is often overlooked. It is simply blood. It is estimated up to 15% of all blood within the body is within the liver at any one time. If the animal suddenly loses large quantities of blood due to injury or disease, the liver can immediately shunt a much larger quantity of whole blood with all of its constituents into general circulation within a matter of seconds. The liver plays a major role in the digestive process that occurs within the intestines. Many of the compounds that are produced or excreted by the liver form the bile, which goes from the gallbladder through the bile duct into the small intestine to aid in the breakdown of food. It is true that most of the bile is an accumulation of waste products destined for excretion from the body, but some of its constituents aid in digestion. Again, this function may not be appreciated by most people, but it is very important. The liver breaks down and excretes numerous compounds. Just as the kidneys remove potentially harmful materials from the blood, so does the liver. Examples of this are by-products or wastes from normal cellular activity such as urea from protein metabolism, worn out hemoglobin molecules from red blood cells, cholesterol, naturally produced steroids and hormones, and many more. The liver is also the organ that breaks down some of the sedative and anesthetic agents, antibiotics, and other medications that we administer to our pets. This destruction of unwanted or potentially harmful substances is a life or death matter for the individual. If the liver fails to eliminate these compounds, the animal dies. While a physiologist or medical internist could extend this list of important liver functions for many pages, we hope this gives you some idea of the importance of the liver. Most of its tasks are performed nowhere else in the body. We most appreciate its uniqueness. Every single part of it is capable of every task necessary, and it is the only organ in the body with this capability. The liver has an amazing ability to snap back from injury and it can regenerate lost tissue to heal injured portions. The liver is truly an incredible organ.

医学

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UIC College of MedicineBefore there was a UIC College of Medicine, there was the College of Physicians and Surgeons, known colloquially as “the P & S,” founded in 1881 by five physician educators.1 The founders bought a 97- by 100-foot lot in the northwest corner of Harrison and Honore streets, opposite the entrance to Cook County Hospital, formed a building committee chaired by McWilliams, and chose George H. Edbrooke as architect.2 The four-story, Queen Anne-style building, topped by a 100-foot Gothic tower and faced with Lemont limestone, was completed in 1882. It featured a “dead house” refrigerator with capacity for 100 bodies, a lecture room for 226, a museum gallery, chemical laboratory, library, and a 450-seat amphitheater. The college opened in September 1882 with an initial enrollment of 100 students. In the course of the first year, that swelled to 165. Fifteen years later, the college affiliated with the University of Illinois, which soon absorbed it, along with the private Chicago College of Pharmacy and the private Chicago Charitable Eye and Ear Infirmary. The original college building was razed in 1938. That event led to the discovery of a sealed, lead box concealed in the cornerstone, containing documents relating to the founding of the P & S. The stone was saved, and is now in the courtyard of the College of Medicine West building. The collection retrieved from the box, including the cornerstone itself, held 30 items. Three items from the original inventory are missing. The Psychiatric InstituteThe Department of Psychiatry’s Psychiatric Institute at 1601 West Taylor Street was originally the site of the Illinois State Psychiatric Institute, known as “ISPI.” ISPI (the organization, as opposed to the building), was founded in 1907 as a collaboration between the state and the university “as a clearing house for processing patients to the state hospitals,” according to the Encyclopedia of Chicago. Seriously disturbed patients were “contained” there. ISPI, the building, was dedicated June 12, 1959. It was also known as “Big ISPI” to distinguish it from the Illinois State Pediatric Institute, sometimes known as “Little ISPI.” Big ISPI was the last of three Illinois institutes founded and commended by the state legislature for the “health and welfare of the People of the State of Illinois.” In 1961 the state formed the Department of Mental Health. Its Medical Center Complex comprised IJR, ISPI, and the Illinois Institute for the Developmentally Disabled. A few years later, the state established its zoned system of care, which became the national model during the era of the Great Society’s support of mental health programs. Mayor Richard J. Daley answered a 1965 call for a four-year campus in the city by leading the drive to create the University of Illinois Circle Campus (UICC), a cause he had championed from his earliest days in the Illinois General Assembly in the 1930s. The official title, “The University of Illinois at Chicago Circle," and the more common moniker, "Circle campus," referred to the nearby intersection of three major expressways. The modern UIC was formed in 1982 by the consolidation of the two U. of I. campuses: the Medical Center (West) campus and the Chicago Circle (East) campus. The university has phased out the use of "Circle" as a result of consolidation and expansion. "UIC" is the preferred shortened name today. The state formally transferred ISPI to the university on June 3, 1994. It was the last of three state institutes transferred to UIC – the Institute for Juvenile Research and the Illinois Institute for Developmental Disabilities had been transferred several years earlier. The Institute for Juvenile ResearchFounded in 1909 as the Juvenile Psychopathic Institute, the institute was originally created to investigate the causes of juvenile delinquency, then a rampant problem in Chicago. (Ten years earlier, Hull House reformers Lucy Flowers, Julia Lathrop and Jane Addams successfully lobbied for the creation of the world’s first juvenile court. It was built on Halsted Street, directly across the street from Hull House.) Hired and paid by a five-year, private grant, JPI’s founding Director, William Healy, MD, saw himself as a trailblazer for children’s mental health. He promptly set out on a nationwide fact finding tour, seeking ideas on child guidance clinics. At the time, “there was not even a semblance of anything that could be called a well rounded study of a young human individual,” he wrote. But soon the institute’s work proved so valuable that the court took over its funding. In 1917, it became part of the state’s new Department of Public Welfare, which changed the institute’s name to the Institute for Juvenile Research. As part of a state agency, IJR was naturally oriented toward service. The addition of a privately funded Behavior Research Fund in the late 1920s allowed IJR to develop an extensive research program, producing ground-breaking works that made significant contributions to the understanding and treatment of child and adolescent mental health. By the 1930s BRF-funded seminal research on juvenile delinquency, reading, psycho-physiology, the significance of birth order, and other subjects, had earned IJR an esteemed national reputation. Driven in part by those findings, IJR created permanent clinics in many downstate areas, ultimately building 17 clinics by the end of the 1940s. With the 1966 creation of Illinois’ Zoned Centers for community mental health, these clinics were detached from IJR. The 1960s and early ‘70s marked a second Golden Age for IJR research. A $125,450 grant, for example, included funds for a mobile psychology laboratory the size of a school bus. Intended to “bring the lab” to hundreds of Chicago school children, the lab was sound-proof, light-proof, and air-conditioned. It featured three testing rooms, one-way observation mirrors, a small kitchen, and lavatory. By the early ‘70s, IJR had more than a dozen different program sections. But by the end of that decade, research funds were becoming increasingly scarce. In 1983, the state discontinued IJR’s research department and in 1990 IJR was integrated into the UIC Department of Psychiatry. Since then, IJR has experienced yet another renaissance with more than 35 faculty and 65 professional staff engaged in a broad spectrum of research and training addressing pressing issues such as HIV risk, access to effective school services, epidemiology of drug abuse, services for families in the child welfare system, and innovative treatments for ADHD, disruptive behavior, mood disorder, and anxiety. The Institute also offers child psychiatry clinical services with over 45,000 patients seen annually, and leading training programs in child psychiatry, psychology and social work. The Neuropsychiatric InstituteThe Neuropsychiatric Institute was established in 1942 under the auspices of the Illinois Department of Public Welfare and the University of Illinois. Its mission was to study mental and nervous disorders, and provide psychiatric training for practitioners. This facilitated an affiliation between psychiatric programs in Chicago’s medical schools, and those in the state hospitals. The institute was originally directed as a joint venture between the UIC departments of Neurology and Psychiatry, with neurology patients, offices and labs in the north wing, and psychiatry patients, offices and labs in the south wing. Francis Gerty, MD, first chairman of the Department of Psychiatry, brought together an interdisciplinary group that included Franz Alexander, founder of the Chicago Psychoanalytic Institute; W.S. McCullough, MD, DPH, who developed computational models of brain function; Ladislas van Meduna, MD, developer of metrazol, convulsive shock therapy, and other organic therapies for medical psychosis; and Abraham Low, MD, who developed the recovery method of self-help for recently discharged psychiatric patients. In the 1960s Melvin Sabshin, MD, the department’s second chairperson, created a section of Medical Psychology and added anthropologists and sociologists to NPI to create a framework for a Public and Community Psychiatry Department. In addition to leading the department’s vigorous growth in the direction of Social Psychiatry, Dr. Sabshin developed a strong psychoanalytical psychotherapy group. During the 1980s, under the direction of Lester Rudy, MD, the department began a process of “re-medicalization,” with formation of many specialized programs, such as an Affective Disorders Clinic and a Comprehensive Care Clinic for schizophrenic patients. Close collaborations with basic researchers at the Illinois State Psychiatric Institute (ISPI) were fostered. Today, NPI remains the nucleus of the Department of Psychiatry’s Residency Education and Training Program, and Clinical Services. Within NPI, the department’s research, education, and clinical missions are integrated around patient care. The faculty and staff of UIC’s Department of Psychiatry are dedicated to exploring causes, treatments, and cures for severe mental illnesses. From deep within the cellular level of human functioning, to the complex dynamics of daily human life, our researchers, clinicians, and teachers strive to bring mental health and well being to people in the Chicago area and throughout the world. 1. Charles Warrington Earle, a civil war veteran and founder of the Women’s Hospital Medical College in 1871; Abraham Reeves Jackson, a gynecological surgeon who taught at Rush and became the first president of the P & S; Daniel Atkinson King Steele, a professor of orthopedic surgery and the youngest founder; Samuel Anderson McWilliams, an instructor at the Women’s Hospital Medical College; and Leonard St. John, a Canadian medical graduate of McGill and the first Professor of Demonstrations of Surgery, Surgical Appliances, and Minor Surgery. 2. “To acquire a knowledge of the latest improvements in buildings of this character, (Edbrooke) visited the principal medical schools in the eastern cities, and obtained many valuable suggestions. As a result of his labors the college edifice is scarcely surpassed by any in this country in beauty of design, excellence of construction, or adaptation to its purposes,” states the first annual announcement of the College of Physicians and Surgeons . SourcesUIC College of MedicineText adapted from: http://www.uic.edu/depts/lib/specialcoll/services/lhsc/ead/LHS-EAD-5f.html#a2 Ward, Patricia Spain. "An Experiment in Medical Education; or How the College of Physicians and Surgeons of Chicago Became the University of Illinois College of Medicine." In Medicine in Transition: The Centennial of the University of Illinois College of Medicine, edited by Edward P. Cohen, M.D., 26-51. Chicago: University of Illinois College of Medicine, 1981. The Psychiatric InstituteText by George E. Manning and Deborah Rissing, and adapted from: http://www.uic.edu/depts/lib/specialcoll/services/lhsc/ead/LHS-EAD-5f.html#a2 George E. Manning, History of UIC’s Department of Psychiatry Manning, A Brief History of the UIC Department of Psychiatry Institute for Juvenile ResearchText by George E. Manning and Deborah Rissing, and adapted from:For the Welfare of Every Child: A Brief History of the Institute for Juvenile Research 1901-2004, Fred W. Beuttler, Ph.D., Office of the UIC Historian The Neuropsychiatric InstituteGeorge E. Manning, History of UIC’s Department of Psychiatry Adapted from:Online Encyclopedia of Chicago: Mental Health You are here: Home Staff ABOUT US History

医学

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Dr. Henry Heimlich Widely Criticized Robert S. Baratz, MD, PhD, DDS Henry Heimlich, M.D. is best known for popularizing a method to treat choking in 1974. Shortly thereafter he was dismissed as chief of surgery at the Cincinnati Jewish Hospital and never worked again as a surgeon. Virtually all of his work has been called into question. Now in his mid 80s, Heimlich has also promoted his “maneuver” for treating drowning and asthma. Medical authorities have regularly criticized this use. For example, recent reviews by the American Heart Association and the American Red Cross point out the dangers of adopting his recommendations. For years Heimlich and his associates have promoted abdominal thrusts—the so-called Heimlich maneuver—as a first measure in the treatment of near-drowning. His advocacy appears to be based on observations of eight cases. Heimlich and his spokespeople have regularly stated that "thousands of lives" have been saved by use of abdominal thrusting. However, they have produced no objectively collected, widely accepted data to support the claim. During the past year, the National Council Against Health Fraud has asked Heimlich several times for details on his allegedly successful cases, but he has produced nothing. Periodically the American Heart Association (AHA) reviews its guidelines and recommendations for resuscitation. The process of these reviews is long, extensive, worldwide, and scientific. The AHA committees that are charged with assessing each type of resuscitation e.g. sudden cardiac arrest, traumatic cardiac arrest, lightning strikes, drowning, choking, etc., and are required to review and analyze critically all relevant literature, and grade the quality of data available for assessment of effectiveness. Years of careful consideration go into the guidelines, since their implementation will literally affect the lives of most people. Previous guidelines have not promoted abdominal thrusts for drowning, but had allowed them if it was suspected that a foreign body was aspirated as part of the drowning. Moreover, abdominal thrusts were not encouraged or promoted as first treatment for drowning in the CPR guidelines. Now the AHA actively discourages abdominal thrusting for drowning/near-drowning resuscitation. I quote the AHA which now states, based on thorough review: "Attempts to remove water from the breathing passages by any means other than suction (e.g. abdominal thrusts or the Heimlich maneuver) are unnecessary and potentially dangerous. The routine use of abdominal thrusts or the Heimlich maneuver for drowning victims is not recommended." "There is no evidence that water acts as an obstructive foreign body. Maneuvers to relieve FBAO [Foreign Body Airway Obstructions] are not recommended for drowning victims because such maneuvers are not necessary and they can cause injury, vomiting and aspiration and delay CPR." The AHA Guidelines are based on a series of referenced articles and critical review of all evidence available. The physiology of choking is simple, and can be deadly. A solid foreign object blocks the trachea. It acts as a ball-valve, letting the victim exhale but not inhale. The lungs gradually lose air and diminish in size, raising the diaphragm. Air exchange stops. Without removal of the object, death can occur. Abdominal thrusts in some people can squeeze the lungs a bit and produce pressure to expel the object, but scientific studies with actual measurements show that chest thrusts are more effective, as one would expect. An already raised diaphragm cannot be raised much further to expel air from the lungs. Squeezing the lungs directly will expel air with more force. Thus chest thrusts are superior—and safer. It is time for him to stop promoting his speculations. Heimlich has also advocated abdominal thrusting for treating asthma attacks. Most asthma attacks are spasmodic, in whole or in part, and use of the thrusting is illogical and medically unsound. No data exist to support abdominal thrusting for asthma. The immediate use of medications and other proven emergency measures in the hands of trained medical personnel is required for treating asthma attacks. Delay in treatment of asthma can be rapidly fatal. Malariotherapy Mischief Heimlich also claims that malaria parasite injections are effective against cancer, Lyme disease, and HIV/AIDS. For more than a decade, he has carried out clandestine human experiments with "malariotherapy" in Third World countries. The U.S. Centers for Disease Control and Prevention and other governmental bodies have disclaimed this bizarre and scientifically unsupportable method. Nevertheless, his Heimlich Institute Foundation, which has funded and sponsored such work, continues to solicit and accept funding for "malariotherapy" research for HIV infections. In 2004, Heimlich engaged Victoria Wells Wulsin, M.D. to review his work on malariotherapy and write a business plan for promoting it. Wulsin concluded that "the preponderance of evidence indicates that neither malaria nor Immunotherapy will cure HIV/AIDS" and that the Heimlich Institute had been too secretive about its work. Despite claims by Heimlich that that no active work on malariotherapy was being done, Wulsin’s report shows that it was. When it became clear that the report would be made public by others, she released it but added an executive summary in which she claimed that her involvement with the Heimlich Institute was "strictly limited" to a research review. However, the original report indicates that she had access to experimental data, knew that something was radically wrong, and was aware of ethical violations that she should have reported to appropriate governmental authorities. The report also indicates that an "American sponsor" was collaborating with Heimlich, but Wulsin has refused to reveal the sponsor's name. Wulsin is is now running for a seat in the U.S. House of Representatives. Association with Dr. Edward Patrick In October 2008, a federal court judge dismissed a libel suit brought by Edward Patrick, M.D. against the Cleveland Scene newspaper and Thomas Francis, a writer whose cover story, "Playing Doctor," had accused Patrick of lying about his professional experience. Patrick is board-certified in emergency medicine, based on a one-year residency program followed by credit for practice. However, critics believe he did not complete residency training. The newspaper article also questioned the veracity of data from Patrick that were used to establish the Heimlich maneuver. as a method for treating choking. The judge concluded that Patrick misrepresented the extent of his medical training and failed to present credible information to rebut other accusations made in the article. Patrick is appealing the dismissal. For Further Information Complaint against Henry J. Heimlich & Edward J. Patrick (Web site of Heimlich's son Peter Heimlich) Outmaneuvered (Four-part series by RADAR Online, November 2005. Playing doctor: Lying on a résumé isn't a crime - except when a doctor does it. Luckily for Edward Patrick, the Ohio Medical Board is forgiving. Cleveland Scene, October 2004 What's wrong with research on Malariotherapy for HI. (Circare Web site) Index of documents related to Heimlich's malariotherapy research (Circare Web site) Anti-quack group demands Wulsin cough up sponsor of Heimlich AIDS experiments Is Heimlich maneuver safe for drowning victims? (Dayton Daily News—registration required for access) Cincinnati Beacon (To access critical comments, search for "Henry Heimlich") Immunotherapy and beyond: Heimlich Institute (Dr. Victoria Wulson's Report) This article was revised on October 23, 2008.

医学

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Kristin was worried. After a summer spent in the sun, she noticed a strange-looking mole on her shoulder. Since she'd just read an article about how more people in their teens and twenties are getting skin cancer, she decided to get the mole checked out. Kristin made a doctor's appointment, but continued to worry in the days before the exam. What if it was cancer? Why hadn't she been more sensible about the sun? Fortunately, her mole was not cancerous. Her doctor reassured her that she'd done the right thing by having it checked — skin cancer is a lot easier to treat if it's caught early. Although there are several different types of skin cancer, most don't become life-threatening because they aren't likely to spread to other parts of the body. Unfortunately, melanoma is different. If it's not caught early, melanoma can spread from the skin to other organs — often with deadly results. If there's any good news about melanoma, it's this: You have the power to substantially lower your risk of getting it. All it will cost you is a little extra time spent protecting yourself from the sun and paying attention to the moles on your skin. What Is Melanoma? Melanoma is a type of cancer that begins in the melanocytes. Melanocytes are skin cells that produce melanin, the pigment that gives skin its color. Melanocytes commonly cluster together to form skin growths called moles (or "nevi," in medical terms). Most people have several moles — maybe even dozens — and they usually don't cause any problems. Moles may be flat or raised, large or small, light or dark, and can appear anywhere on our bodies. Sometimes, though, melanocytes can malfunction. Because of a genetic change, they can begin growing out of control, sticking together to form lesions or tumors, crowding out healthy cells, and damaging surrounding tissue. This condition is known as cancer. Melanoma that's caught early, when it's still on the surface of the skin, can be cured. But if melanoma is ignored or untreated, it can grow downward into the skin until it reaches the blood vessels and lymphatic system. These two systems can act like a highway for the cancer cells, allowing them easy access to distant organs like the lungs or the brain. That's why early detection is so important. How Do People Get It? How does a normal melanocyte become malignant (cancerous)? Researchers believe it's probably a combination of genes and the things we do, like tanning. One of the most important contributors to melanoma is ultraviolet (UV) sun damage. Cells that have been damaged — particularly by short bouts of bad, blistering sunburns during childhood or regular tanning bed use as a teen or young adult — are more likely to become cancerous over time. The jury is still out, but some experts think that factors like the thinning of the ozone layer or clothing styles that expose more skin also may contribute to a person's risk of skin cancer. It's also thought that, as people live longer and become more are aware of the disease, more cases of skin cancer are naturally going to be diagnosed. But more likely today's melanoma rates have as much to do with lingering misconceptions about tanning from generations ago. Back in your parents' and grandparents' day, most people (including doctors) thought it was safe and even healthy to lather up with oil and tan as much as you wanted — just as they thought it was OK to smoke in hospital rooms, which seems crazy now! Even tanning beds and sun lamps were touted as being safer than the sun when they first became popular in the 1980s. Today we certainly know better. Experts know that certain risk factors increase a person's chance of developing melanoma, including: a fair complexion (light skin that freckles or burns easily, blue eyes, or blond or red hair) multiple moles (typically more than 25) UV exposure (whether from the sun or a tanning bed) a history of frequent or severe sunburns a relative with melanoma or a family history of irregular moles age (older people are still at greater risk) a previous melanoma (moles typically don't grow back after being removed, but a person who's had melanoma once is more likely to have a recurrence somewhere else) Although it's less likely, you can still get melanoma even if you're dark skinned, young, and have no family history. It appears that behavior — too much sun exposure and not enough skin protection — can override the other risk factors. How Do People Know They Have It? Many melanomas start out as a mole or a bump on the skin. Of course, not every mole is cancerous — far from it. What's more telling is whether a mole has undergone any kind of recent change, whether in size, shape, or color. That's why it's important to take a mental snapshot of your skin — kind of like a mole roadmap — so you'll know what's normal for you. With that as a baseline, you'll be able to spot any changes early. Keep the ABCDE rule in mind when checking your moles: A for asymmetry: If you were to cut the mole down the middle, would the left and the right sides look different? B for border: Are the edges blurry and undefined? Does it appear to be spreading sideways? C for color: Does the mole look darker or lighter than usual, or does it have an area of new color — perhaps black, blue, purple, red, or white? D for diameter: Is the mole larger than the eraser on a pencil top? E for evolving: Has the size, shape, or color changed over time? If you answered yes to any of these questions about an existing mole — or if you have a new mole, or one that's started to itch or bleed — see your doctor right away. The most common places for melanoma to occur are on the torso, head, and neck for men, and the lower legs for women. African Americans are more likely to get melanoma under the nails, or on the palms and soles of the feet. If a doctor suspects melanoma, he or she will perform a biopsy — removing all or part of the mole in question and examining its cells under a microscope. Not only can a biopsy tell if the cells are cancerous, it can also be used to tell how deeply cancer has penetrated the skin and predict its risk of spreading. Knowing these details will help the doctor map out a treatment plan. How Do Doctors Treat It? What doctors do about melanoma depends on how big and deep the cancerous area (known as a "lesion") is, what part of the body it's on, and whether it has spread to other parts of the body. Treatment for melanoma typically includes surgery to remove the lesion. If doctors suspect that cancerous cells may have traveled to other areas of the body, treatment may also include radiation (high-energy X-rays that are directed at tumors) or chemotherapy (cancer-fighting drugs). Doctors may also use immunotherapy (also known as biologic therapy), a treatment that stimulates the body's own immune system to fight cancer cells, alongside these other treatments. How Can You Prevent It? Although you can't control how fair your skin is or whether you have a relative with cancerous moles, there are several things you can do to lower your risk of developing melanoma. The most important is limiting your exposure to the sun. Take these precautions: Avoid the strongest sun of the day — between 10 a.m. and 4 p.m. Use broad-spectrum sunscreen (SPF 15 or more) whenever you're in the sun. Wear a wide-brimmed hat and cover up with long, loose cotton clothing if you burn easily. Stay out of the tanning salon. The risk of developing melanoma is eight times greater among people who use tanning beds regularly. Also, be sure to check your moles often (you may need to ask a friend to help with those hard-to-reach areas, like your back and scalp). Keep dated records of each mole's location, size, shape, and color, and don't wait to have anything suspicious checked out. Not all skin cancer is melanoma, but every case of melanoma is serious. So now that you know more about it, take responsibility for protecting yourself and do what you can to lower your risk. Reviewed by: Christopher N. Frantz, MD American Cancer SocietyThe American Cancer Society is the nationwide community-based voluntary health organization dedicated to preventing cancer, saving lives and diminishing suffering from cancer through research, education, advocacy, and service. Call:(800) ACS-2345American Academy of DermatologyThis website provides patients with up-to-date information on the treatment and management of disorders of the skin, hair, and nails.The Skin Cancer FoundationThe Skin Cancer Foundation educates people about skin cancer and ways to prevent it. Indoor TanningTempted to try a tanning salon? Read this article to learn about the possible effects of indoor tanning.TanningThe sun can do a lot more than just give you a warm summer glow. Get the facts on sun and skin damage.Dealing With CancerIt's unusual for teens to have cancer, but it can happen. The good news is that most will survive and return to their everyday lives. Learn about how to cope if you or someone you know has cancer.

医学

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Newsletters 03/26/2013 Leading Change, Saving Lives It's early morning and Organizational Systems Alumnus David Williams, PhD is on a virtual meeting coaching hospital teams across the Atlantic. In the Southwest of England, nurses are trying to reduce hospital-associated infections in acute care hospitals. Headset on and consciously listening, he hears stories from frontline staff on the unit. Dr. Williams’ journey to become one of the nation’s leading experts on emergency service and health care efficiency was far from traditional, but today he’s helping hospitals and ambulance services around the world save lives. A guidance counselor convinced David to volunteer as a firefighter with a small town fire department in hopes it would inspire him to go to medical school. Instead, he went on to college and studied in one of the first bachelors programs focused on the management of Emergency Medical Services and worked as a city paramedic nights and weekends. After a decade of frontline experience and a leadership role in quality improvement, he enrolled at Saybrook University. "I started the doctoral program in Organizational Systems while I was the Commander over Quality for the Austin, Texas EMS system,” he said. “One of my courses was on consulting skills and Professor Nancy Southern enabled me to work with an EMS Consulting firm as part of my studies to gain hands on experience and make the learning include pragmatic application." At the end of the semester, the firm offered him a role as a senior consultant and he spent the next six years reviewing and improving EMS systems around North America, training leaders of 911 centers and ambulance services, and conducting industry research on practices and performance. After a major federal report found that EMS system design and operations were lacking, David’s Saybrook dissertation became the first significant study to examine system design holistically and identify the obstacles to a patient-centered approach. His dissertation was honored as the Saybrook dissertation of distinction for 2010. "I was humbled by the recognition of the work and my Mom was very proud." In 2005, Dr. Williams began his own firm – TrueSimple – based in Austin, Texas. In addition to his expertise in EMS system design, he continued to develop his passion for process improvement. Momentum had been building for nearly a decade in healthcare to apply improvement science to enhance patient safety and reduce medical risk. One of the leading champions of the work is the Institute for Healthcare Improvement in Cambridge, MA. In 2009, Dr. Williams was invited to join their faculty and became a member of an elite group of advisors that support EMS improvement collaboratives around the world. "We teach hospitals and healthcare providers about rapid cycle testing and measurement for Improvement and coach teams to test change ideas to improve outcomes," he said. This work has taken him across North America, the United Kingdom, and Portugal working with some of the top patient safety experts in the world. "It's been a great learning curve and wonderful community and I'm excited to know our work is helping to protect patient's and save lives." When he reflects on Saybrook University and the effect it had on his career and life’s work, Dr. Williams says, “I think back to my time at Saybrook University and I’m thankful for the opportunities it enabled, the way faculty like my dissertation chair Dr. John Adams and others pushed me, and the great friends I have to this day.” Accreditors Approve Saybrook University... A Message from the President: Looking Back Helps... Veterans Day Newsletter: supporting soldiers who... Veterans Day Newsletter: Shining a spotlight on... Veterans Day Newsletter: Welcoming Warriors Home

医学

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Stem cells improve visual function in blind mice Columbia University Medical Center An experimental treatment for blindness, developed from a patient’s skin cells, improved the vision of blind mice in a study conducted by ophthalmologists and stem cell researchers. The retina of a patient with AMD (top), and the effect of AMD on central vision, (below). Credit: Stephen Tsang, and the National Eye Institute An experimental treatment for blindness, developed from a patient's skin cells, improved the vision of blind mice in a study conducted by Columbia ophthalmologists and stem cell researchers. The findings suggest that induced pluripotent stem (iPS) cells -- which are derived from adult human skin cells but have embryonic properties -- could soon be used to restore vision in people with macular degeneration and other diseases that affect the eye's retina. "With eye diseases, I think we're getting close to a scenario where a patient's own skin cells are used to replace retina cells destroyed by disease or degeneration," says the study's principal investigator, Stephen Tsang, MD, PhD, associate professor of ophthalmology and pathology & cell biology. "It's often said that iPS transplantation will be important in the practice of medicine in some distant future, but our paper suggests the future is almost here." The advent of human iPS cells in 2007 was greeted with excitement from scientists who hailed the development as a way to avoid the ethical complications of embryonic stem cells and create patient-specific stem cells. Like embryonic stem cells, iPS cells can develop into any type of cell. Thousands of different iPS cell lines from patients and healthy donors have been created in the last few years, but they are almost always used in research or drug screening. No iPS cells have been transplanted into people, but many ophthalmologists say the eye is the ideal testing ground for iPS therapies. "The eye is a transparent and accessible part of the central nervous system, and that's a big advantage. We can put cells into the eye and monitor them every day with routine non-invasive clinical exams," Tsang says. "And in the event of serious complications, removing the eye is not a life-threatening event." In Tsang's new preclinical iPS study, human iPS cells -- derived from the skin cells of a 53-year-old donor -- were first transformed with a cocktail of growth factors into cells in the retina that lie underneath the eye's light-sensing cells. The primary job of the retina cells is to nourish the light-sensing cells and protect the fragile cells from excess light, heat, and cellular debris. If the retina cells die -- which happens in macular degeneration and retinitis pigmentosa -- the photoreceptor cells degenerate and the patient loses vision. Macular degeneration is a leading cause of vision loss in the elderly, and it is estimated that 30 percent of people will have some form of macular degeneration by age 75. Macular degeneration currently affects 7 million Americans and its incidence is expected to double by 2020. In their study, the researchers injected the iPS-derived retina cells into the right eyes of 34 mice that had a genetic mutation that caused their retina cells to degenerate. In many animals, the human cells assimilated into mouse retina without disruption and functioned as normal retina cells well into the animals' old age. Control mice that got injections of saline or inactive cells showed no improvement in retina tests. "Our findings provide the first evidence of life-long neuronal recovery in a preclinical model of retinal degeneration, using stem cell transplant, with vision improvement persisting through the lifespan," Tsang says. "And importantly, we saw no tumors in any of the mice, which should allay one of the biggest fears people have about stem cell transplants: that they will generate tumors." Tsang hopes to begin a clinical trial for macular degeneration patients in the next three years, after more preclinical testing in animal models. Already a similar trial -- testing retina cells derived from embryonic stem cells -- has seen encouraging preliminary results. A paper from this study, published earlier this year, reported that the stem cells are safe and have potential to improve the vision of two patients with macular degeneration. "These results are encouraging, but iPS cells could be a more attractive option than embryonic stem cells," Tsang says, "because patients may not need drugs to prevent rejection of the transplanted cells." Regardless of which cell works better, the prospect of stem cell transplants may mean many people with macular degeneration may never lose their vision. "We have a good idea which patients will eventually lose their vision. In the early stages of macular degeneration we can tell by looking in the eye, and new genetic tests can now predict vision loss with 70 percent accuracy even before those signs emerge," Tsang says. "If the therapy is safe, we could intervene very early to prevent much vision loss." The study was published online in advance of print in the journal Molecular Medicine. The research was supported by NIH grants 5P30CA013696, P30EY019007, and R01EY018213; the Schneeweiss Stem Cell Fund, and the Foundation Fighting Blindness. The above story is based on materials provided by Columbia University Medical Center. The original article was written by Susan Conova. Note: Materials may be edited for content and length. Li, Y., Tsai, Y.T., Hsu, C.W., Erol, D., Yang, J., Wu, W.H., Davis, R.J., Egli, D., and Tsang, S.H. Long-term safety and efficacy of human induced pluripotent stem cell (iPS) grafts in a preclinical model of retinitis pigmentosa. Mol Med., 2012 DOI: 10.2119/molmed.2012.00242 Columbia University Medical Center. "Stem cells improve visual function in blind mice." ScienceDaily. ScienceDaily, 1 October 2012. <www.sciencedaily.com/releases/2012/10/121001141127.htm>. Columbia University Medical Center. (2012, October 1). Stem cells improve visual function in blind mice. ScienceDaily. Retrieved October 22, 2014 from www.sciencedaily.com/releases/2012/10/121001141127.htm Columbia University Medical Center. "Stem cells improve visual function in blind mice." ScienceDaily. www.sciencedaily.com/releases/2012/10/121001141127.htm (accessed October 22, 2014).

医学

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VCA Findlay Animal Hospital Heartworm Disease in CatsPet Info PrintHeartworm Disease in Cats What causes heartworm disease?Heartworms are a blood-borne parasite called Dirofilaria immitis that reside in the heart or adjacent large blood vessels of infected animals. The female worm is 6 to 14 inches long (15 to 36 cm) and 1/8 inch wide (5 mm). The male is about half the size of the female. Heartworm disease is much more common in dogs. "...incidence of heartworms that is far greater than previously thought." However, recent studies of cats with heart and respiratory diseases have found an incidence of heartworms that is far greater than previously thought. Cats are relatively resistant to heartworm infection when compared to dogs, with the infection rate in cats reported to be 5-20% of the rate in dogs in the same location. Approximately 1/3 of infected cats live indoors only. Typically, cats have fewer adult worms than dogs, usually less than 6. How are heartworms transmitted to a cat?The life cycle of the heartworm is complex and requires two host animals in order to complete it. Heartworms require the mosquito as an intermediate host and as many as 30 species of mosquitoes can act as this host and transmit heartworms. Mosquitoes ingest immature heartworm larvae, called microfilariae, by feeding on an infected cat or, more commonly, an infected dog. The microfilariae develop further for 10 to 30 days in the mosquito's gut and then enter its mouthparts. When an infected mosquito bites a cat, it injects infective larvae into the cat. The larvae migrate and mature for several months, ending up in the right side of the heart and the pulmonary arteries. There they mature into adult heartworms capable of reproduction about six months from the time they enter the cat. Shortly thereafter, at around eight months after infection, they begin to produce a new crop of microfilaria that will live in the cat's blood for about one month. Cats are resistant hosts, and few circulating microfilaria are generally found. We’ve Got Positive Cattitude! We help to make cat care easier for you – Get a Free Feline First Exam* (for new clients). "It is necessary for a cat to be bitten by an infected mosquito in order to become infected with heartworms." Because of this life cycle, it is necessary for a cat to be bitten by an infected mosquito in order to become infected with heartworms. Heartworms are not transmitted directly from one cat to another or from a dog directly to a cat. How are heartworms diagnosed?There are several methods used in diagnosing heartworms; unfortunately, none are 100% reliable so a combination of tests is often needed. The diagnostic sequence usually progresses as follows: "The most common signs are a sudden onset of coughing and rapid breathing..." Clinical Signs One of the most challenging aspects of diagnosing feline heartworm disease is that there are no specific clinical signs. The most common signs are a sudden onset of coughing and rapid breathing, signs that can also be caused by several other diseases. Other common non-specific clinical signs include weight loss and vomiting. On occasion, an apparently normal cat may be found dead, or may develop sudden overwhelming respiratory failure and heartworm disease is diagnosed on a post-mortem examination. Sudden death is thought to be due to a reaction within the lungs to the young heartworms, or to a reaction to dead or live heartworms entering the pulmonary arteries and obstructing the flow of blood to the lungs. Acute Clinical Signs Chronic Clinical Signs collapse Coughing dyspnea Vomiting convulsions Dyspnea diarrhea/vomiting lethargy blindness anorexia tachycardia weight loss syncope chylothorax sudden death Blood Tests Several blood tests are used for heartworm diagnosis, but the heartworm antibody test and the heartworm antigen test are proving to be most helpful in diagnosing the disease in cats. 1. The heartworm antibody test determines that the cat's immune system has been exposed to heartworms. A positive test may indicate that an active infection is present. However, cats who have had heartworms but whose heartworms have died will also have antibodies for an unknown time. Currently, it is believed that the antibodies persist for two to four months after the heartworms have died. Cats with late stage larvae that are not yet adults, and cats with adult heartworms in places other than the heart, may also test positive with the antibody test. This test is very sensitive, so it is used first. If it is positive, the next test is performed. 2. The heartworm antigen test detects the presence of adult female heartworms. It is very specific, but not as sensitive as the antibody test. A positive test indicates that heartworms are present, but a negative test does not mean that they are absent. Because the cat must have at least two adult female worms present to make this test positive, a negative test may mean that the cat may only have a small number of worms or that all the worms present are male. "A diagnosis of feline heartworm infection is confirmed when both the antibody and antigen tests are positive." In summary, a diagnosis of feline heartworm infection is confirmed when both the antibody and antigen tests are positive. 3. A blood sample can be tested for the presence of microfilariae. However, less than 20% of cats with heartworms have microfilariae in their blood, and microfilariae are only present for one to four weeks. Although a positive test is diagnostic, a negative test means little. 4. An eosinophil count can be measured in cats suspected of harboring heartworms. Eosinophils are a type of white blood cells that occur in increased numbers when certain parasites are present. They are elevated in the presence of heartworms, but this elevation only occurs for a few months. This test is not specific, since cats with other parasites (intestinal worms, fleas, etc.) or allergies also commonly have increased eosinophil counts. An eosinophil count is often performed with a Complete Blood Cell Count (CBC) and serum chemistries during the initial diagnostic workup. Radiographs (x-rays) permit us to view the size and shape of the heart. They also allow us to measure the diameter of the pulmonary arteries. Many cats with heartworms have an increase in the size of the pulmonary arteries, or the arteries may appear blunted (suddenly come to an apparent stop) on their way to the lungs, due to worms obstructing them. However, many other cats with heartworms have no abnormal findings on their radiographs, especially early in the infection. Cardiac ultrasound or Echocardiography Echocardiography allows the examiner to directly view the internal structures of the heart and surrounding vessels and assess the condition and function of the heart. In some cats, the actual adult heartworms can be seen; this finding confirms the presence of heartworms. However, because most infected cats have a low number of worms this does not occur often. Can feline heartworm disease be treated?There is no drug approved for treating heartworms in cats. One of the drugs for treating dogs has been used in cats, but it causes significant side effects. "There is no drug approved for treating heartworms in cats the reaction to the dead and dying worms can cause sudden death." To complicate things further, when the adult heartworms die during this treatment, they pass through the pulmonary arteries to the lungs where the reaction to the dead and dying worms can cause sudden death. Thus, we have a dilemma when a cat is diagnosed with heartworms. One of two main choices must be made: 1. Treat with the drug designed for dogs. However, this drug can have serious side effects in cats. These side effects include acute pulmonary (lung) failure and death in a small percentage of cats. 2. Treat the symptoms of heartworm disease and hope the cat outlives the worms. Since heartworms live in a cat for about two to three years (as opposed to five to seven years in dogs), several months of treatment are needed. When cats are in a crisis, they are treated with oxygen and corticosteroids ("cortisone") to relieve the reaction occurring in the pulmonary arteries and lungs, and, if needed, drugs to remove fluid from the lungs (diuretics). When they are stable, they are treated continuously or periodically with corticosteroids. However, the threat of an acute crisis or sudden death always exists. 3. Another possible treatment option, surgical removal of the heartworms, is currently being performed in Japan and some parts of Europe. Surgical extraction may become a better treatment option in the future, as the technique improves. Is there a way to prevent heartworms?Veterinarians now strongly recommend that all cats receive year-round monthly heartworm preventative in areas where mosquitoes are active all year round. "There are excellent heartworm preventatives now available for cats, making prevention of heartworm disease safe and easy. " Cats that live in colder areas, where mosquitoes are seasonal, should be on monthly preventative for at least 6 months of the year. There are excellent heartworm preventatives now available for cats, making prevention of heartworm disease safe and easy. The reasons that heartworm prevention is now recommended for all cats are: 1. Diagnostic Difficulty. Diagnosing heartworms is not as easy in cats as in dogs. 2. Unknown Incidence. Heartworms are not nearly as common in cats as they are in dogs. However, they are probably more common than we realize. As we look more aggressively for heartworms in cats with better and better tests, we expect to find that the incidence is greater than previously thought. University studies have shown that up to 15% of all cats in certain locations, regardless of whether they are indoor and outdoor cats, have been exposed to feline heartworm disease. 3. There Is No Treatment. There is simply no good treatment for heartworm-infected cats. Effective drugs are not available, and cats that seem to be doing well may die suddenly. Treating heartworm infections in cats is risky at best, and not treating these cats is just as risky. It will take about two years for the parasitic infection to be eliminated in the cat, and serious clinical signs can suddenly appear at any time during this period. 4. Prevention Is Safe and Easy. Cats given heartworm prevention drugs have not shown signs of toxicity. There is a wide margin of safety, even in kittens as young as six weeks of age. 5. Indoor Cats Get Heartworms, Too. Exposure to mosquitoes is required for transmission. Cats do not have to be exposed to cats or dogs infected with heartworms. Obviously, cats that go outdoors are more likely to be exposed. However, an infected mosquito can easily get into the house and infect the cat. This client information sheet is based on material written by: Ernest Ward, DVM Related Tagsacute, adult, animals, antibody, antigen, arteries, blood-borne, cats, clinical, coughing, crisis, death, diagnosed, diagnosing, diagnostic, died, disease, dogs, drug, drugs, dyspnea, eosinophil, exposed, feline, female, greater, heart, heartworm, heartworms, host, incidence, increased, indoor, infected, infection, larvae, lungs, male, microfilariae, mosquito, mosquitoes, negative, parasite, performed, presence, prevention, previously, pulmonary, rate, reaction, resistant, shown, specific, treated, treating, treatment, vessels, vomiting, weight, worm, worms

医学

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Certain Birth Defects More Common Among Hispanics: Report Unfortified corn masa flour may contribute to neural tube defects, March of Dimes says FRIDAY, June 20, 2014 (HealthDay News) -- Hispanic mothers are at especially high risk of having newborns with serious birth defects of the brain and spine called neural tube defects, according to a new report. Also, more babies are born prematurely to Hispanics than women of other ethnicities, the March of Dimes report states. This report, updating a similar 2008 paper by the nonprofit foundation, also highlights the fact that a greater proportion of Hispanic women have babies each year than any other population in the United States, making it the fastest-growing ethnic group in the country. "One of the things that caught our eye was, while Hispanics represent 17 percent of the population, 24 percent of premature babies are Hispanic," said Dr. Edward McCabe, senior vice president and chief medical officer of the March of Dimes, an organization aimed at improving the health of mothers and babies. Hispanic women may be more prone to giving birth prematurely -- defined as before the 37th week of pregnancy -- because of risk factors such as being three times as likely as white mothers to be younger than 17 years old. They are also less likely to have graduated from high school and more likely to lack health insurance. The rate of preterm births among Hispanics was about 12 percent higher than that of white mothers in 2012, the report said. Neural tube defects, which include conditions such as spina bifida and anencephaly, are malformations of the brain and spinal cord that can cause death or disability. Experts suggested that Hispanic mothers are significantly more likely to give birth to babies with these birth defects than white or black women because corn masa flour is a staple of the diet of a majority of Hispanics. Corn masa flour, used to make tortillas and other foods, is not fortified with folic acid, a B vitamin that can help prevent neural tube defects. Wheat flour manufacturers are required by the U.S. Food and Drug Administration to fortify that type of flour with folic acid, also called folate. Also, Hispanic women are less likely to report taking a multivitamin containing folic acid prior to becoming pregnant, according to the report. "This is why the March of Dimes is striving to have masa cornmeal fortified with folate," said Dr. Diana Ramos, an associate clinical professor of obstetrics and gynecology at the University of Southern California Keck School of Medicine in Los Angeles. "Corn masa flour is not part of the standard American diet, so, since 2012, we've been working on this, making progress slowly," added Ramos, co-chair of the newly established March of Dimes Hispanic Advisory Council. McCabe said the March of Dimes has launched a Spanish-language site, Nacersano.org, that offers information about the specific health needs of Hispanics. He said a variety of outreach efforts, including the website and new advisory council, are needed to help raise awareness in the Hispanic community about the need for folic acid consumption and prenatal health. Other health literacy efforts aimed at Hispanics should focus on tackling smoking, obesity and type 2 diabetes, he said. "By 2050, it's projected that 30 percent of the population of women of childbearing age will be Hispanic," he said. "Clearly, it's a growing population." The Nemours Foundation has more about birth defects (http://kidshealth.org/parent/system/ill/birth_defects.html ). SOURCES: Edward McCabe, M.D., Ph.D., senior vice president and chief medical officer, March of Dimes, White Plains, N.Y.; Diana Ramos, M.D., M.P.H., associate clinical professor, obstetrics and gynecology, Keck School of Medicine, University of Southern California, and medical director, family planning and maternal health, Los Angeles County Department of Public Health, Los Angeles, Calif.; June 4, 2014, report, March of Dimes, Maternal and Infant Health in U.S. Hispanic Populations: Prematurity and Related Health Indicators

医学

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/ Article Members with the Pregnancy Help and Information Center are breaking in a new building and lending a helping hand to new parents. Dietra Bradham is holding her three-month-old son Jacob. Bradham already has a 19 and a 23-year-old, but admits after having her first two, there's still a lot she's didn't know about pregnancy, that is until now. "They help me to know what's going on in my body. It's very important for a young lady to know what's going on in their bodies, so they can feel more comfortable with it," says Dietra Bradham. A wall displays success stories of those like Bradham who've come to the Pregnancy Help and Information Center and received help. Now, located in a new building on South Gadsden Street, the center is a "second home" for young mothers and fathers. "Through our educational resources, we're showing them what it's like to actually parent hands on." Connie Moore, the center's director, can personally relate to her clients because Moore herself gave birth at a young age. "Chad would have been 31 years old, this year. Chad only lived for three days because I was a teen mom and I didn't get the care that I needed. Chad was born premature and had not developed his lungs," Connie Moore says. Moore hopes her story serves as a lesson to young parents like Josh Thomas and his wife as they raise their 14-month-old and another child on the way. "They've told us different techniques to raise the babies when they're crying what to do, what to expect and it really prepares you before you have your child," says Josh Thomas. The center serves some 1,200 clients each year, and about 120 of them are young fathers. A grand opening and ribbon cutting ceremony for the new Gadsden Street center will take place Wednesday, February 18 at noon. More Scrutiny for Japanese Maker of Defective Air Bags Most Viewed Woman Killed in Accident on Blountstown Highway

医学

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What Is a Valgus Deformity? A valgus deformity is commonly seen in the hip. Valgus deformities can occur in the knees. View slideshow of images above Daniel Liden Valgus deformity is a term used in orthopedics to describe a condition in which a segment of a joint or bone is angled outward. The opposite of a valgus deformity is a varus deformity, in which a segment of a bone or joint is angled inward. The two terms, however, are often mistakenly interchanged. Such types of deformities are most often present in hips, knees, and feet. When necessary, these deformities can, to some degree, be surgically repaired. Though they are often interchanged, the terms valgus and varus are always supposed to refer to the specific direction in which the distal segment in the joint is facing. The distal segment of a joint is the point farthest away from center of the spot where the separate bones physically join. In Latin, valgas means “knock-kneed” and varus means “bowlegged.” The modern names for these deformities were derived from these Latin terms. A valgus deformity always refers to a condition in which the distal point of the joint points outward, while a varus deformity always refers to a condition in which the distal point of the joint points inward. Ad Genu valgum, a condition colloquially described as “knock-knees,” is a condition in which the knees angle in and, often, touch each other. In this condition, the femur is angled inward in relation to the hip; this is a varus deformity. In the same condition, however, the knees face outward; this is a valgus deformity. Both deformities are present in the same condition, so it is vital to use the proper terms to describe them. There are several different types of valgus deformities depending on the specific joint that is deformed. In the hip, such deformities are known as coxa valga. Typically, the shaft of the femur is angled outward from the neck of the femur. Cubitus valgus describes a deformity in the elbow and results in turned-in elbows. In hallux valgus, the big toe points toward the second toe, and the joint points outward, away from the foot. Valgus deformities can occur at several other joints and bones, such as the knees and ankles. A varus deformity can occur at the same variety of joints and bones that a valgus deformity can occur at. Without treatment, these deformities can place stress on other joints and bones and cause further problems. The main problems associated with a valgus deformity are pain and difficulty of movement. Successful surgery can partially or completely fix these problems. Ad What Is Outtoeing? What Is Intoeing? What Is Metatarsus Varus? What Is Metatarsus Valgus? What Is Genu Recurvatum? What Is the Difference Between Valgus and Varus Deformity? What Is Triple Arthrodesis? In addition to people having valgus deformity, dogs and cats can have this condition, also. The neighbor down the street has a dog with this condition.The owner took him to a specialist, who said his problem was double bone growth in the joints. His paws pointed out and he would bite his paws. Apparently, his case isn't too serious, but he could have surgery. The surgeon would take out some of the bone and then stabilize the rest of the bone. Luckily, he probably will not have any long term effects except arthritis in ten years or so. Lucky dog! view entire post Clairdelune I'm thinking that the valgus deformity and the varus deformity are usually taken care of by surgery these days. I remember back in the 50s, I saw people who were knock-kneed and bow-legged. I recall the cowboys on TV shows were often bow-legged. The condition where the big toe point toward the second toe must be really painful, especially when wearing shoes. It's good to know that this painful deformity that can cause problems with other joints, can, at least, be partially healed by surgery. view entire post

医学

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AACR News The mission of the AACR is to prevent and cure cancer through research, education, communication, and collaboration. Abnormal Circulating Cells in Lung Cancer Patients: Possible New Technique for Identification tags: abnormal cells, American Association for Cancer Research, circulating tumor cells, Clinical Cancer Research, CTCs, FDA-approved, lung cancer, prognosis, survival, test by AACR Communication Staff AACR Hosted Teleconference on July 22, 2010, at 1:00 p.m. ET. (Recording of the teleconference available below) PHILADELPHIA — Researchers at The University of Texas M. D. Anderson Cancer Center are testing a new technique for identifying circulating genetically abnormal cells, which can lead to poor prognosis, in patients with non-small cell lung cancer. These genetically abnormal cells are most likely circulating tumor cells, shed from a malignant tumor. Increased numbers of these cells were associated with relapse of disease and poorer survival, according to study results. Identifying these cells using the current FDA-approved test is quite challenging because the current test, which is based on an antibody that adheres to the surface of circulating epithelial cells, is not very sensitive. In a study published in Clinical Cancer Research, a journal of the American Association for Cancer Research, Ruth L. Katz, M.D., professor of pathology at The University of Texas M. D. Anderson Cancer Center, and her colleagues used a fluorescence in situ hybridization method for detection of genetically abnormal cells, without resorting to antibody capture. They found that patients with non-small cell lung cancer had significantly higher levels of circulating abnormal cells than controls, and the numbers of abnormal cells increased with the stage of disease. The AACR hosted a teleconference to discuss these findings and the wider issue of circulating tumor cells in cancer research on Thursday, July 22, 2010, at 1:00 p.m. ET. Roy Herbst, M.D., Ph.D., chief of the section of thoracic medical oncology at The University of Texas M. D. Anderson Cancer Center, and a senior editor of Clinical Cancer Research, hosted the teleconference. The following panelists participated: Ruth L. Katz, M.D., professor of pathology at The University of Texas M. D. Anderson Cancer Center: “The numbers of genetically abnormal cells in the bloodstream of lung cancer patients were far more than we had originally expected. Similar genetic abnormalities were also found to be present in the malignant cells from the patients’ lung cancers, and there were more abnormal blood cells in advanced-stage disease compared to early-stage disease.” Fred R. Hirsch, M.D., Ph.D., professor of medicine and pathology at the University of Colorado Cancer Center: “Circulating tumor cells, or genetically abnormal cells, are shed from the tumor or its microenvironment and out into the bloodstream. Although this particular technique will need validation in a larger patient subset, these are very encouraging results that provide us with a framework for moving forward.” Minetta Liu, M.D., director of the Translational Breast Cancer Research Program at the Lombardi Comprehensive Cancer Center at Georgetown University: “This paper is an excellent example of our efforts to personalize cancer therapeutics. An increased understanding of the nature and origins of circulating tumor cells will enable us to better assess their significance and impact. This, in turn, will improve our ability to manage patients with malignancies. Listen to a recording of the teleconference: http://media.libsyn.com/media/aacr/CCR_CTC_Cancer_Teleconference.mp3 Download* the mp3 of the teleconference (6.4 MB, 27 minutes and 30 seconds) *On a PC, right mouse click on the “Download” link and select “Save link as…” in Firefox or “Save Target as…” in Internet Explorer. Subscribe to the AACR RSS News Feed Subscribe to the Clinical Cancer Research RSS feed Learn more about circulating tumor cells The mission of the American Association for Cancer Research is to prevent and cure cancer. Founded in 1907, the AACR is the world’s oldest and largest professional organization dedicated to advancing cancer research. The membership includes 31,000 basic, translational and clinical researchers; health care professionals; and cancer survivors and advocates in the United States and more than 90 other countries. The AACR marshals the full spectrum of expertise from the cancer community to accelerate progress in the prevention, diagnosis and treatment of cancer through high-quality scientific and educational programs. It funds innovative, meritorious research grants, research fellowship and career development awards. The AACR Annual Meeting attracts more than 17,000 participants who share the latest discoveries and developments in the field. Special conferences throughout the year present novel data across a wide variety of topics in cancer research, treatment and patient care. The AACR publishes six major peer-reviewed journals: Cancer Research; Clinical Cancer Research; Molecular Cancer Therapeutics; Molecular Cancer Research; Cancer Epidemiology, Biomarkers & Prevention; and Cancer Prevention Research. The AACR also publishes CR, a magazine for cancer survivors and their families, patient advocates, physicians and scientists. CR provides a forum for sharing essential, evidence-based information and perspectives on progress in cancer research, survivorship and advocacy. Media Contact: jeremy.moore@aacr.org Share this:TwitterGoogleLike this:Like Loading... from → Press Releases ← Fish Oil May Reduce Risk of Breast Cancer New Lab Test Could Identify Imatinib Resistance → 2011 AACR Annual Meeting AACR Video App for iPhone and Android Phones Proceedings for Mobile Devices AACR on Twitter:Error: Twitter did not respond. Please wait a few minutes and refresh this page.AACR Journal RSS Feeds Cancer Discovery Cancer Epidemiology, Biomarkers & Prevention Molecular Cancer Research Molecular Cancer Therapeutics AACR News Feeds AACR News AACR Scientific Podcasts Follow the AACR Online AACR Facebook Page AACR Photo Gallery AACR You Tube Channel Follow “AACR News”

医学

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Home :: press ASA Press Releases Contact: Jackie Cooper or Lee HerringE-mail: pubinfo@asanet.orgPhone: (202) 247-9871 August 11, 2008 Married Adults Report Better Health, But Singles Are Catching Up By Amy Sutton, Contributing Writer Health Behavior News Service For years, researchers have known that adults who have swapped rings say they are healthier than their never-married peers are. According to a recent study, though, singles are catching up when it comes to good health. "Married people are better off than never-married people in terms of health status, but the gap has narrowed over time," said lead author Hui Liu, an assistant professor and sociologist at Michigan State University in East Lansing. The authors used 32 years of data from the National Health Interview Survey to analyze trends in marital status and health among about 1.1 million participants: married, widowed, divorced, separated and never-married adults ages 25 to 80. The study appears in the September issue of the Journal of Health and Social Behavior. Liu and her co-author found that over the past three decades, self-reports of overall health among never-married adults improved significantly, making the discrepancy in health between married and never married less pronounced. This narrowing health gap between the married and the never married applies only to men, but not women, Liu said. One reason for this trend is that today's society might offer never-married men "greater access to social resources and support" that were in the past primarily found in a spouse, the authors noted. However, Susan Averett, Ph.D., professor of economics and business at Lafayette College in Easton, Pa., said that the "data cannot tell us definitively if marriage is the cause of the change in self-reported health or some other unobserved factor" is at work. "Given the rise in cohabitation over the time period they study and the lack of evidence on how cohabiting affects health relative to marriage — since cohabiting is generally less stable and shorter term — means that we miss an interesting piece of the puzzle," said Averett, who had no affiliation with the study. Over time, self-reports of health also improved for African-Americans, Liu said. Except for the widowed, all groups reported showed improvements in self-rated health, a reflection of advances in health among African-Americans in the United States in general, she said. In contrast, the study also pointed to an emerging trend toward worsening health in those who had previously been married in comparison to their married peers, especially widows or widowers, who experienced the most significant declines. In 1972, the widowed were about as likely to report being in good health as the married, but in 2003, they were 7 percent less likely to report good health than their married counterparts were. One explanation, Liu suggested, is that the stress of widowhood leads to greater health problems for widowers, compared to their married peers. # # # The Journal of Health and Social Behavior is the quarterly journal of the American Sociological Association. Liu H, Umberson DJ. The times they are a changin': marital status and health differentials from 1972 to 2003. J Health Soc Behav 49(3), 2008. About the American Sociological AssociationThe American Sociological Association (www.asanet.org), founded in 1905, is a non-profit membership association dedicated to serving sociologists in their work, advancing sociology as a science and profession, and promoting the contributions to and use of sociology by society.

医学

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Charitable group helps with kids’ medical costs Susan Minuk Special to The CJN, Friday, February 1, 2013 Tags: Health Comments Aaron Maresky and his mom, Mandy, co-founders of Aaron’s Apple. Aaron’s Apple, a charitable organization started by a child to help other children, funds the high costs of medication and treatment for families whose children suffer from chronic illnesses. At the age of seven, Aaron Maresky was determined to make a difference in the lives of other children, while simultaneously battling his own chronic illness. “I was taken to the hospital with terrible stomachaches, and I stayed in the hospital for two weeks,” Aaron, now 11, said. “I had many, many needles and tubes put everywhere. Sometimes I was really sore and it was very scary. I missed three months of school and I lost 30 pounds. “The doctors told my parents that I had Crohn’s disease, and I would require a very special medicine given to me by infusion every six to eight weeks. My medicine costs more than $40,000 every year,” explained Aaron, co-founder of Aaron’s Apple. For many children suffering from chronic conditions such as Crohn’s, ulcerative colitis, rheumatoid arthritis and pediatric cancer, the only option to ease their suffering comes in the form of high-priced medical treatments. Aaron’s family had a plan that covered his medication, but he recognized the harsh reality that not everyone was so fortunate, and that many parents had no choice but to stand by helplessly and watch their child suffer. “Every time Aaron went to the hospital, he would give a donation, in efforts to help make another child feel better. From this grew the charity called Aaron’s Apple,” said Aaron’s mother, Mandy Maresky, co-founder of the charity. Aaron’s Apple will host its second annual Caring to the Core Gala on March 2, at The Warehouse Event Venue in Downsview Park, 35 Carl Hill Rd., where guests will enjoy New York-inspired cuisine and entertainment, including celebrity appearances and a silent auction. “Aaron’s Apple’s tag line is, ‘Take a bite and change a life.’ New York is also known as the Big Apple. We want people to ‘Take a bite out of the Big Apple’ and change a life,” Mandy said. The charity is run solely by volunteers and works with the Hospital for Sick Children. “Everyone involved is dedicated to helping as many children and families as possible. Aaron’s Apple has recently been approached by physicians of children suffering with cancer to assist with the costs of their chemotherapy treatments,” Mandy said. Having raised more than $220,000 to date, Aaron’s Apple continues to help families cope with overwhelming medical costs. The inability to afford the required treatment for their child places enormous stress on them. To purchase tickets for the gala, go to caringtothecore.com. For more information about Aaron’s Apple, go to www.aaronsapple.com.

医学

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Foreign Policy In Focus Killing Libya in Order to Save It: Gulf War Syndrome Modern battlefields tend to be toxic nightmares, and depleted uranium is one of the main culprits. By Conn Hallinan, April 2, 2011. Print There were two images from the Libyan war that are likely to spell real trouble in the coming years. One was of several U.S. A-10 attack planes, ungainly looking machines ugly enough to be nick named “Warthogs,” taxiing down a runway. The other was of several rebel fighters dancing on top of a burning tank. That tank, an old Russian-era T-72, was likely knocked out by one of those A-10s, which means those rebels fighters are almost certainly going to be in a world of hurt. Because, while they were celebrating, they were also breathing in the residue from the shell that killed that tank, a 30 mm depleted uranium munition (DUA). DUA is the weapon of choice when it comes to killing armored vehicles, and A-10s are specialists at using it. The U.S. used 320 tons of it in the first Gulf War, 10 tons in Kosovo, and over 1,000 tons in the invasion of Iraq. It is lethal to tanks, but it also damages anything that comes into contact with it. Common photos back in 1991 were of U.S. soldiers climbing on top of knocked-out Iraqi tanks to have their pictures taken or to look for souvenirs. When they did, they inhaled uranium oxide or impregnated their uniforms with it. The soldiers didn’t know better because the U.S. Defense Department (DOA) told them DUA was harmless, even though the DOA knew better. In 1991 the U.S. Army’s Armament Munitions and Chemical Command concluded that “any system struck by DUA penetrator can be assumed to be contaminated with DU,” and instructed soldiers to wear protective masks, clothes and respirators “as a minimum,” and dispose of the clothing afterwards. The only problem was that the Army never told the troops, even those whose job it was to deal with vehicles hit by DUA. No one said a word to the 144th National Guard Supply Company of the 24th Infantry Division which picked up 29 U.S. armored vehicles hit by DUA “friendly fire” to ship them home. When the tanks and armored personnel carriers arrived in South Carolina, they were interned in a radioactive waste dump. If the soldiers didn’t know the objects were “hot,” the brass did. Many of those members of that National Guard company subsequently came down with the “Gulf War Syndrome” (GWS) that afflicted at least 118,000 out of the 700,000 soldiers who served in the 1990-91 conflict. Veterans suffer from chronic fatigue, headaches, muscle spasms, joint pains, memory loss, anxiety and balance problems; were twice as likely to develop amyotrophic lateral sclerosis (Lou Gehrig Disease); and between two and three times more likely to have children with birth defects. DUA is one of the most deadly anti-tank weapons around. The enormous weight of the DUA “arrow” in each shell can penetrate four inches of armor as if it were margarine. It then explodes in a 10,000-degree fireball that reduces up 70 percent of the munition to powder. The powder can travel up to 25 miles from the initial blast site. Depleted uranium is not highly radioactive, but it has a half-life of 4.4 billion years, and, if it gets into your system, it can be very dangerous. According to the U.S. Environmental Policy Institute, DUA “has the potential to generate significant medical consequences.” “People have always assumed low doses are not much of a problem,” Alexander Miller of the U.S. Armed Forces Radiobiology Research Institute told the Guardian (British), “but they can cause more damage than people think.” A study by the Institute found that DUA could damage bone marrow chromosomes. Not all of the Gulf War butcher bill can be laid at the feet of DUA. After 11 years of denying there was anything to GWS, the Pentagon finally admitted that at least 130,000 soldiers had been exposed to chemical weapon residue when the Iraqi arms depot at Kamisiyah was blown up. Modern battlefields tend to be toxic nightmares, and that was doubly so in Iraq. But there is no question that DUA was a major contributor to the syndrome, particularly for those who developed immune related diseases. A standard effect of radiation is suppression of the immune system. The effects of low-level radiation are hard to track, because many “hard” cancers take 16 to 24 years to develop. Iraqi medical authorities claim that the cancer rate in Basra—an area that was saturated with DUA in the Gulf war and the Iraq War—has jumped ten fold, and birth defects are much higher than in the rest of the country. DUA is also used in 25 mm cannon shells, and 105 MM and 120 MM tank shells. The Army is using it to manufacture 50-caliber machine gun ammunition and is experimenting with using it for standard issue infantry weapons. It is also used to coat armored vehicles, making them almost impervious to non-DUA shells. The U.S. is selling DUA to Israel, Egypt, Pakistan, some of our NATO allies—Germany and Italy won’t use it—Sweden, Taiwan, Saudi Arabia, Pakistan, Thailand, and other countries that the Pentagon will not reveal in the name of “national security.” Depleted uranium is also a highly toxic metal and can damage the liver and kidneys, particularly if it gets into the water supply. If a DUA round misses a target, its “penetrators” are so heavy that they tend to go deep into the soil. “A major concern of the potential environmental effects of intact [DUA] penetrators or large penetrator fragments,” notes the World Health Organization, “is the potential contamination of ground water after weathering.” Because of the dangers associated with DUA, in August 2002 a subcommittee of the United Nations found that the weapons violated seven international agreements, including the UN Charter and the Geneva Conventions. Efforts to ban it, however, have been vetoed by the U.S., France and Britain. In 2009 Belgium became the first country to ban the use of DUA, and in the same year the Latin American Parliament voted for a moratorium on its use. The International Coalition to Ban Uranium Weapons that includes 120 non-governmental organizations is currently lobbying to get the weapons eliminated. There are other rough beasts being visited on the Libyans these days as well, including cluster weapons, highly explosive canisters that can shred everything from people to tanks. U.S. warplanes have been dropping CBU-103, 104, 105, and AGM-154 A and B, all of which have a failure rate of anywhere from 5 to 23 percent. These unexploded “bomblets” can kill for decades. During the bombing of Laos from 1964 to 1973, 90 million cluster munitions were dropped, killing more than 12,000 civilians. The bomblets continue exact a yearly toll of 100 to 200 people. More than 50 million clusters were dropped during the 1991 Gulf War, and in the two years that followed the war’s end, they killed 1,400 Kuwaiti citizens. A U.S. company hired to clear cluster weapons from a small area in Kuwait found 95,700 unexploded MK-118 submunitions from the notoriously unreliable CBU-99 “Rockeye” cluster bomb. Unexploded clusters are still causing problems in Kosovo, and they take a steady toll of civilians in Afghanistan. Libya has no-go areas dating back to the Second World War, when Italians, Germans and British seeded their fronts with land mines. Whatever government emerges in Libya today will have to deal with the aftermath of yet another war, this time created by DUA and cluster weapons. “The problem in defense is how far you can go without destroying from within what you are trying to defend from without,” Dwight Eisenhower once remarked. A problem indeed. One hopes Libya manages to avoid what a village in Vietnam experienced, the one that was destroyed in order to save it. More of Conn Hallinan’s work can be found at Dispatches From the Edge. Issues: Health, War & PeaceRegions: Libya, Middle East & North AfricaTags: depleted uranium, gulf war syndrome, Libya

医学

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UN: 21 nations take up polio ’emergency’ By JOHN HEILPRIN (AP) GENEVA - Some 21 nations in the Middle East and nearby regions have jointly made the eradication of polio an emergency priority and recognized that Pakistan is a key part of the problem, the World Health Organization said Wednesday. The joint resolution by nations who are part of the U.N. health agency’s Eastern Mediterranean region have called on Pakistan to urgently vaccinate all of its children to prevent the virus from spreading internationally. Pakistan also approved the resolution, which the Geneva-based agency says includes Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, the United Arab Emirates, and Yemen. The problem is particularly challenging in Pakistan, where a U.N.-backed eradication campaign has suffered from violence and mistrust directed against polio workers and people who want their children vaccinated. Earlier this week, WHO officials said the polio virus has now been confirmed in 13 of 22 children who became paralyzed in a northern Syrian province. The health agency said the Syria outbreak comes from a strain that originated in Pakistan, where, along with Afghanistan and Nigeria, it is endemic _ and has been spreading across the Middle East. It said the virus has been detected in Egypt, and closely related strains of Pakistani origin turned up in sewage samples in Israel, the West Bank and Gaza Strip, but higher immunization rates in those places have helped keep the virus in check. A third of the nations in the WHO’s Eastern Mediterranean region are conducting mass polio vaccination programs, the agency said, and more such campaigns are planned for December. The nations in those regions also said they are trying to improve access for health workers to reach children who have not yet been vaccinated. WHO said its emergency "outbreak response" to polio in Syria and the region is expected to continue at least six to eight months more. In Syria, WHO and UNICEF, the U.N. children’s agency, are trying to work with other humanitarian agencies to reach more of the millions of people affected by the civil war including unvaccinated children. The two agencies "are coordinating the vaccination campaign with all concerned parties to make sure that all children are vaccinated no what where they are located," said Dr. Jaouad Mahjour, head of communicable diseases prevention and control for WHO’s regional office. Pakistan, which had 198 confirmed polio cases in 2011 _ the highest number of any nation in the world that year _ cut that number down to 58 in 2012 through an aggressive vaccination program. But the program has been marred by violence carried out by militants who oppose the U.N. and government-led vaccinations, claiming it is meant to sterilize Muslim children. In October, in a village outside the provincial capital of Peshawar, a bomb explosion killed a police officer and a member of a volunteer peace committee when it went off next to van carrying Pakistani security guards who were protecting workers carrying out an anti-polio drive in the country’s northwest. In May, Pakistani authorities had to suspend a four-day vaccination program after gunmen shot dead a female polio worker and wounded another. The militants’ suspicions stem from the CIA’s use of a Pakistani doctor from an immunization program in the hunt for Osama bin Laden two years ago. The militants also accuse polio workers of spying for the U.S. government, and two Pakistani Taliban militants banned the polio work from two tribal regions due to opposition to U.S. drone strikes. Those suspicions were reinforced by the disclosure that the CIA also used a Pakistani doctor for a hepatitis vaccination program to try to get blood samples from bin Laden’s family before U.S. commandos killed him in May 2011. (Copyright 2013 by The Associated Press. All Rights Reserved.)

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Access to the members-only section of this site is restricted. If you are interested in being a member of this site, please send your professional affiliation and contact information to: who@ilaimh.org. About ILAIMH Established in 1982, the Illinois Association for Infant Mental Health (ILAIMH) is a membership organization of diverse professionals working with infants, toddlers and their families. Members come from the fields of education, social work, psychology, medicine, academia, public policy, child development, physical and occupational therapy, and other allied disciplines. With over 200 members, the diverse and multidisciplinary scope of our members reflects the nature of infant mental health practice. Though developed as a clinical specialty, infant mental health practice is infused into every setting where practitioners work with or on behalf of very young children and their families. ILAIMH is structured to facilitate collaboration and the exchange of information among members and others concerned with the health and well-being of infants, toddlers, and their families. Chief among the Association’s activities is an annual professional conference held in the fall followed by a seminar series through the winter and spring focusing on topics related to the conference theme. In addition, the Association has developed training modules related to infant mental health issues such as attachment, feeding and sleeping difficulties that are available to early childhood programs and practitioners around the state. The Association has also become involved in infant mental health-related advocacy efforts in recent years. Most noteworthy perhaps has been the Association’s influence in establishing the Early Intervention (EI) System’s Social and Emotional Pilot Project in 2002, which was recently rolled out statewide, as well as its involvement in the passage of the Illinois Children’s Mental Health Act of 2003. The Association continuously strives to find new ways to reach out to and support early childhood professional in Illinois. Suggestions and comments related to the work of the organization are always welcome, as are new members. Current information and activities related to the work of the Association are available in our quarterly newsletter. To see our privacy policies for the web site, click here. Please contact us with questions, comments, or requests for membership information at: Illinois Association for Infant Mental Health c/o Erikson Institute 451 N. LaSalle Street HomeAbout ILAIMHBoard of DirectorsOfficersCommitteesSeminars & ConferencesIllinois InitiativesLinks & Resources Listserv Interact with your colleagues online. ILAIMH Members receive: • Significant discounts on conferences and seminars• Emailed quarterly newsletter with articles of note about the Infant Mental Health field• Opportunities to network and connect with colleagues across the state, joining a strong community of professionals AboutJoinContact Seminars & ConferencesProjectsIllinois InitiativesLinks & ResourcesILAIMH News Archive Copyright © 2014. Illinois Association for Infant Mental Health. Designed by Rokusek Design

医学

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The Lariam Debate…Continues By Mark Thompson @MarkThompson_DCDec. 05, 20120 Share Army photo / Staff Sgt. Marcus J. QuartermanThe rate of malaria among U.S. troops in Afghanistan, like these, has dropped sharply since the Pentagon stopped routinely giving them an Army-developed medicine, a former Army doctor says. Email The use of the drug mefloquine – also known by its trade name, Lariam – has been controversial for years. Developed by the U.S. Army in the 1970s, it was the standard medication to fight malaria provided to U.S. troops headed to Afghanistan, Iraq, and Somalia. But soldiers complained that taking Lariam in pill form once a week made them feel strange. There were reports of mental ailments – including anxiety, hallucinations, depression and suicidal thoughts – associated with its use. Yet the Army marched on to the beat of its own drug. “Military personnel will die of malaria if MQ not available,” the science director of the Walter Reed Army Institute of Research – the outfit that developed the drug – warned in 2004. But reports of problems with the Army-invented drug proved significant enough that its civilian manufacturer, the Swiss company F. Hoffman-La Roche, stopped producing it in the U.S. in 2009. That same year, the U.S. military returned to daily doses of doxycycline, the U.S. military’s pre-Lariam anti-malarial choice, as its primary drug for fighting the mosquito-borne tropical disease, estimated to kill more than 1 million people a year. So what has happened now that soldiers no longer routinely take Lariam? Are they dying of malaria more often, as the science director of the Walter Reed Army Insitute of Research predicted eight years ago would happen if they didn’t use it? A recent article in the American Journal of Tropical Medicine and Hygiene reported that 61% of soldiers complied with doxycycline’s daily dosing, while only 38% given Lariam took it once a week as directed. That caught the eye of Remington Nevin, a former Army public-health doctor now pursuing graduate work at the Johns Hopkins University in Baltimore. “By conventional wisdom these results appear counterintuitive, and they stand in contrast to earlier findings among civilian travelers and military personnel that suggest observed compliance should be higher with weekly dosing,” he noted in a letter published in the latest issue of the journal. Even more strikingly, Nevin says that malaria cases dropped dramatically since troops switched to doxycycline. “Among U.S. military personnel in Afghanistan, over these past three years, and co-incident with the shift away from mefloquine as a preferred chemoprophylaxis, the rate of malaria has actually fallen over 70%,” Nevin said. “Today in Afghanistan, malaria affects only about 1 U.S. service member per 1,000 per year; this rate is extremely low by historical standards, particularly as compared with rates during prior operations in areas of comparable endemicity, including Somalia, where they were nearly ten times higher.” It seems that no matter how well a medicine may be in controlled trials, it won’t work if people don’t take it as prescribed in the real world. “Today’s soldiers may be less likely to adhere to mefloquine chemoprophylaxis because of growing awareness of its strong association with psychiatric symptoms and its potential to induce neurotoxicity,” Nevin concluded. “Senior U.S. military medical officials now acknowledge that the neuropsychiatric side effects caused by mefloquine may confound the diagnosis and management of post-traumatic stress disorder and traumatic brain injury, making its routine use less desirable.” Nevin, who recently testified before a Senate panel on the chronic effects of mefloquine, said the Food and Drug Administration has convened a panel of neurotoxicologists and other experts to review the safety of the drug, based on recent reports of brainstem damage. These reports, Nevin suggests, represent “the tip of the iceberg” and that “thousands of veterans may suffering from the neurologic and psychiatric effects of mefloquine toxicity”

医学

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CDC to bring HIV testing to pharmacies, retail clinics Nurse.com News The U.S. Centers for Disease Control and Prevention has announced a pilot project to train pharmacists and retail store clinic staff at 24 rural and urban sites to deliver confidential and rapid HIV testing.The goal of the initiative is to extend HIV testing and counseling into the standard, everyday services offered by pharmacies and retail clinics. The CDC will use the results of the pilot effort to develop a model for implementation of HIV testing in these settings across the country. The project is part of the CDC�s efforts to support its 2006 testing recommendations, which call for all adults and adolescents to be tested for HIV at least once as part of routine healthcare. It coincides with this year�s National HIV Testing Day, which has taken place every June 27 since 1995."We know that getting people tested, diagnosed and linked to care are critical steps in reducing new HIV infections," Kevin Fenton, MD, director of the CDC�s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, said in a news release. "By bringing HIV testing into pharmacies, we believe we can reach more people by making testing more accessible and also reduce the stigma associated with HIV."The CDC estimates that 1.1 million people are living with HIV in the United States, yet nearly one in five remains unaware of the infection. In addition, a third of those with HIV are diagnosed so late in the course of their infection that they develop AIDS within a year, missing ample time in which they could have received life-extending medical care and treatment, and potentially reduced transmission to partners.Community pharmacies and retail clinics, with their convenience and easy accessibility, can play a critical role in ensuring more Americans have access to an HIV test, the CDC said. Millions of Americans enter pharmacies every week, according to estimates, and an estimated 30% of the U.S. population lives within a 10-minute drive of a retail clinic. Compared to healthcare settings and conventional HIV testing sites, these locations may provide a more accessible environment for people who may be anxious about seeking an HIV test."Our goal is to make HIV testing as routine as a blood pressure check," said Jonathan Mermin, MD, director of the CDC�s Division of HIV/AIDS Prevention. "This initiative is one example of how we can make testing routine and help identify the hundreds of thousands of Americans who are unaware that they are infected."Throughout the two-year initiative, the CDC will provide training for staff in community pharmacies and retail clinics in 12 urban areas and 12 rural areas with high HIV prevalence or significant, unmet HIV testing needs. Training will focus on how to deliver rapid HIV testing and counseling and link those who are diagnosed with the virus to care and treatment.The CDC will use the pilot project to develop a comprehensive toolkit for pharmacists and retail clinic staff around the country to use in implementing HIV testing. Send comments to editor@nurse.com or post comments below.

医学

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Top Stories in Health and Wellness​ Ebola Still Weighs on Texas Hospital Virtual Reality Therapy Shows New Benef... Pine-Nut Oil: Appetite Suppressant Up? DNA Shown to Protect Latinas From Breas... New Online Media, Old Human Behavior The Trouble With Background Noise Email Ann Lukits Dec. 3, 2012 10:20 p.m. ET Everyday background noise, whether it is a neighbor's television or passing aircraft, can have a disruptive effect on people's cognitive learning and unconscious physiological processes, says a study in the International Journal of Hygiene and Environmental Health. The health hazards of loud noise are well studied, but low-intensity background noise has received less attention, researchers said. The study tested the computer learning abilities of 59 Austrians in their mid-20s in a room with varying background noise. Each was required to study three computer texts for 15 minutes and then were tested on their knowledge. Enlarge Image Everyday background noise, whether it is a neighbor's television or passing aircraft, can have a disruptive effect on people's cognitive learning and unconscious physiological processes, says a study in the International Journal of Hygiene and Environmental Health. Matt Collins One group of 20 was exposed to low-level noise of 36 decibels during the tests. (Normal conversation is 50 to 60 decibels.) A second group of 20 was exposed to 45 decibels of garbled noise from a comedy CD played backward in an adjacent room. A third group, with 19 subjects, was exposed to the simulated noise—about 46 decibels—of a distant aircraft approaching an airport at a rate of one per minute. Heart rate and galvanic skin responses, both autonomic indicators of stress, were measured throughout the learning period for the three tests. Memory scores were higher in the control group than in both the aircraft- and neighborhood-noise groups. In one test, it was significantly higher than the three aircraft-noise tests. Skin conductance rates in the aircraft-noise group were significantly higher than in control subjects throughout most of the study, and higher than the neighborhood-noise group in the final five minutes of text learning. Heart rates in the aircraft group also increased significantly in these last five minutes. Aircraft noise may place a higher demand on attention and sympathetic physiological responses such as heart rate and perspiration than other types of noise, researchers said. Caveat: The aircraft noise had a broader spectrum compared with the other noise sources and may have been perceived as louder, triggering psychological effects, such as thoughts of an attack from above, researchers said. Some people are more sensitive to background noise than others, they said. Title: Effects of low Intensity noise from aircraft or from neighbourhood on cognitive learning and electrophysiological stress responses Medication errors: A study in the Journal of Pediatric Health Care found that 25% of parents were unable to correctly measure a dose of children's cough syrup, but the wording of the instructions had little effect on accuracy. Research has shown that dosing errors are common with liquid medications, often because of ambiguous instructions and the type of measuring device used. The study involved 193 U.S. women in their late 20s. About a third were college educated and 80% had children. Health literacy, the capacity to understand medical-related information, was adequate in 99, marginal in 58 and inadequate in 36, tests showed. The subjects received identical medication bottles with instructions to shake well before measuring 6 milliliters of the liquid. In 96 cases, the instructions were implicit, or indicated the medication should be given every 12 hours. For 97 subjects, the instructions explicitly stated the medication be given at 7 a.m. and 7 p.m. A 10-milliliter needleless syringe was used by 86% of subjects, a 5-milllimeter syringe by 8.3% and a kitchen teaspoon by 5.7%. Women with children were three times more likely to measure the medicine correctly than women without children, results showed. Dosing accuracy was higher in better-educated subjects and those with higher health literacy. Instruction type had no effect. Dosages were most accurate when the 10-milliliter syringe was used. Use of a kitchen teaspoon, which isn't an equivalent measure, could have serious health ramifications related to dosing errors, researchers said. They recommended pharmacies provide standard measuring devices with pediatric medications. Caveat: Subjects were recruited from a medical clinic and some may have been stressed due to impending appointments, researchers said. The study didn't assess how parents would administer medication over a standard course of treatment involving several days. Title: Women's Understanding of Different Dosing Instructions for a Liquid Pediatric Medication Chronic cough: Taking daily iron supplements dramatically improved chronic dry, tickly cough in healthy, nonsmoking women with below-normal iron levels—a condition that affects nearly 20% of child-bearing women—compared with treatments targeting only cough symptoms, according to a small study in the International Journal of Clinical Practice. Cough is more frequent and severe in women than men, and often starts after puberty, researchers said. Iron deficiency may affect areas of the brain involved in the neurological control of cough, they said. The study involved 22 women in their late 30s from northern Italy. All had low iron levels and coughs lasting approximately 12.8 months. Their cough severity was rated 3.9 on a scale from 0 (no cough) to 5 (worst cough). Tests showed the subjects had normal lung function and none had asthma. Histamine challenge tests, which measure airway response to allergens, found all 22 had easily irritated, or hyper-responsive, airways. The study involved two 60-day treatments separated by a month of no treatment. In one, subjects received 10 milligrams of antihistamine once a day and 20 milligrams of proton-pump inhibitor twice a day. In the other, they received two 330-milligram iron sulphate tablets daily. Iron supplementation significantly improved cough and histamine hyper-responsiveness compared with antihistamine and proton-pump inhibitor treatment, results showed. Iron levels returned to normal in all but two patients, who were found to have a genetic blood disorder, researchers said. Caveat: More than 1,000 men were screened for the study but none had chronic cough and low iron, researchers said. The study lacked a control group because administering iron to patients with no iron deficiency would be unethical, they said. Title: " target="_new" class="icon none" >Effect of iron supplementation in women with chronic cough and iron deficiency Helpful bacteria: A common bacterium linked to the appearance of peptic ulcers and other stomach disorders may have beneficial properties that help to prevent complications from acid-reflux disease, says a report in Digestive Diseases and Sciences. Helicobacter pylori are found in about half the world's population, often with no discernible symptoms. Higher rates of H. pylori and lower rates of gastroesophageal reflux disease (GERD) are reported in African Americans, compared with white populations, but the association between H. pylori and GERD isn't clear, researchers said. The study involved 2,020 African Americans, 1,219 women and 801 men, who underwent upper endoscopy, a diagnostic procedure, at a Washington, D.C., hospital from 2004 and 2007. Results showed that 77.1% had gastritis, an inflamed stomach lining, and 2.9% had esophagitis, inflammation caused by stomach acid leaking into the esophagus. Both conditions were found in 18% of subjects, while 2% had normal results and served as controls. Stomach biopsies showed 38% of subjects had H. pylori. H. pylori were present in 3.8% of patients with esophagitis and 34.4% of controls, but the bacterium didn't result in significant differences between controls and subjects with gastritis or gastritis and esophagitis, the study found. H. pylori may reduce stomach-acid secretions by suppressing ghrelin, a hormone linked to obesity, which is a risk factor for GERD, researchers said. Aggressive efforts to eradicate H. pylori in the general population may explain why African Americans are experiencing a dramatic increase in esophageal cancers, they said. Caveat: The prevalence of H. pylori infection was found in African American patients treated in a hospital and may not be the same in the general population, researchers said. The control group was small. Title: Helicobacter pylori Protection Against Reflux Esophagitis Denial and delay: Up to one-third of women diagnosed with inoperable breast cancer initially put off seeing a doctor, often for several months, despite noticeable breast changes, says a report in Acta Oncologica. Public-awareness campaigns stress the importance of mammography screening and early diagnosis to a favorable breast-cancer prognosis. Despite this public focus, cancers are well advanced in many women because of delays contacting the medical system. To understand those delays, researchers reviewed data from 157 Danish women diagnosed with inoperable or metastatic breast tumors from 2006 to 2011. The data showed 12.1% had waited three to six months after the first symptoms appeared before contacting a doctor, while a wait of six to 12 months was reported by 3.8%. Longer waits of more than one or two years were reported by 18%. A third of subjects had abnormal breast symptoms, including ulcerated tumors and skin changes. Other health problems, such as depression and anxiety, were reported in 14.6% of subjects and may have overshadowed breast-tumor symptoms, researchers said. About 12% lived in nursing homes and 7.6% had dementia. But 42% of subjects had none of these factors and more than half had neglected obvious symptoms, researchers said. Denial must play a role in their behavior, though improving early detection efforts may not succeed in reaching these women, they said. Caveat: The study was small and the findings may not apply to women in other countries. Title: Women with inoperable or locally advanced breast cancer—what characterizes them? A retrospective review of 157 cases. Seeking an Alternative Treatment for Age-Related Eye Conditions A new compound developed from a fetal-growth protein may provide an alternative to two common treatments for age-related macular degeneration and other eye conditions, and have fewer side effects, researchers said. Drugs that target angiogenesis, the abnormal growth of blood vessels inside the eye, are the mainstay of therapies for a growing number of eye conditions. The latest issue of Acta Ophthalmologica reports on the study, conducted in China, which involved experiments with a human placenta growth factor molecule called ZY1 that plays a role in gestation. The growth factor is part of a family of such factors that includes vascular endothelial growth factor (VEGF), a protein that stimulates angiogenesis. Bevacizumab (Avastin) and ranibizumab (Lucentis), the drugs most commonly used to treat angiogenesis, target VEGF, but adverse side effects have been reported with both, researchers said. Experiments showed that ZY1 significantly inhibited VEGF-induced angiogenesis and the formation of vessel-like tubular structures in cell cultures. Higher concentrations have a greater effect. A control compound, ZY1-S, didn't demonstrate any inhibitory properties. ZY1 also suppressed blood-vessel formation by 50% to 80% in mice with corneas implanted with micropellets loaded with VEGF and ZY1, compared with micropellets containing either a placebo or only VEGF. Eye injections of ZY1 resulted in no adverse effects in mice compared with a placebo. Placental growth factor doesn't affect healthy organs, suggesting it could be used in developing safe antiangiogenic drugs for vision loss, the researchers said. Caveat: The compound hasn't been tested on human eyes. Title: Inhibition of ocular neovascularization by a novel peptide derived from human placenta growth factor-1 —Ann Lukits

医学

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New research confirms potential deadly nature of emerging new monkey malaria species in humans Sep 09, 2009 Researchers in Malaysia have identified key laboratory and clinical features of an emerging new form of malaria infection. The research, funded by the Wellcome Trust, confirms the potentially deadly nature of the disease. Malaria kills more than a million people each year. It is caused by malaria parasites, which are injected into the bloodstream by infected mosquitoes. Of the four species of malaria that commonly cause disease in humans, Plasmodium falciparum, found most commonly in Africa, is the most deadly. P. malariae, found in tropical and sub-tropical regions across the globe, has symptoms that are usually less serious. Recently, researchers at the University Malaysia Sarawak, led by Professors Balbir Singh and Janet Cox-Singh, showed that P. knowlesi, a malaria parasite previously thought to mainly infect only monkeys - in particular long-tailed and pig-tailed macaques found in the rainforests of Southeast Asia - was widespread amongst humans in Malaysia. Subsequent reports in neighbouring Southeast Asian countries have led to the recognition of P. knowlesi as the fifth cause of malaria in humans. Now, in a study published in the journal Clinical Infectious Diseases, Professors Singh and Cox-Singh, together with colleagues from University Malaysia Sarawak, Kapit Hospital and the University of Western Australia, have published the first detailed prospective study of the clinical and laboratory features of human P. knowlesi infections. "P. knowlesi malaria can easily be confused with P. malariae since these two parasites look similar by microscopy, but the latter causes a benign form of malaria," says Professor Singh. "In fact, because the P. knowlesi parasites reproduce every twenty four hours in the blood, the disease can be potentially fatal, so early diagnosis and appropriate treatment is essential. Understanding the most common features of the disease will be important in helping make this diagnosis and in planning appropriate clinical management." The researchers initially recruited over 150 patients admitted to Kapit Hospital in Sarawak, Malaysian Borneo, between July 2006 and January 2008 who had tested positive with a blood film slide for Plasmodium species. Using molecular detection methods, P. knowlesi was found to be by far the most common infection amongst these patients, accounting for over two-thirds of all cases. As with other types of malaria in humans, P. knowlesi infections resulted in a wide spectrum of disease. Most cases of infection were uncomplicated and easily treated with chloroquine and primaquine, two commonly used anti-malarial drugs. However, around one in ten patients had developed complications and two died. Complications included breathing difficulties and kidney problems (including kidney failure in a small number of cases), which are also common in severe P. falciparum cases. Although the researchers saw a case fatality rate of just under 2%, which makes P. knowlesi malaria as deadly as P. falciparum malaria, they stress that an accurate fatality rate is hard to determine given the relatively small number of cases studied so far. All of the P. knowlesi patients - including those with uncomplicated malaria - had a low blood platelet count. In other human forms of malaria, this would only be expected in less than eight out of ten cases. In addition, the P. knowlesi platelet counts tended to be significantly lower than for other malarias. However, even though blood platelets are essential for blood clotting, no cases of excessive bleeding or problems with clotting were identified. The researchers believe the low blood platelet count could be used as a potential feature for diagnosis of P. knowlesi infections. Recently, there have been cases of European travellers to Malaysia and an American traveller to the Philippines being admitted into hospital with knowlesi malaria following their return home. "The increase in tourism in Southeast Asia may mean that more cases are detected in the future, including in Western countries," says Professor Singh. "Clinicians assessing a patient who has visited an area with known or possible P. knowlesi transmission should be aware of the diagnosis, clinical manifestations, and rapid and potentially serious course of P. knowlesi malaria." Source: Wellcome Trust (news : web) Explore further: Where Ebola battles are won Monkey malaria widespread in humans and potentially fatal A potentially fatal species of malaria is being commonly misdiagnosed as a more benign form of the disease, thereby putting lives at risk, according to research funded by the Wellcome Trust and the University Malaysia Sarawak. Genome sequences of 2 malaria parasites defined Professor Alan Cowman, Professor Brendan Crabb, Dr Paul Gilson and Dr Toby Sargeant are WEHI members of international research teams that have made significant discoveries about two deadly malaria parasites, Plasmodium kn ... Protein plays key role in transmitting deadly malaria parasite The protein MAEBL is critical for completing the life cycle of malaria parasites in mosquitoes, allowing the insects to transmit the potentially deadly infection to humans, a University of South Florida study has shown. The ... FDA approves quick malaria test The U.S. Food and Drug Administration has approved the Binax NOW Malaria Test, the first rapid test authorized for laboratory use in the United States. Plasmodium vivax -- challenging the dogma of being 'benign' Plasmodium. vivax can cause severe malaria associated with substantial morbidity and mortality, show two studies published in PLoS Medicine this week. These findings challenge the current dogma that P. falciparum can be sev ... Discovery of key malaria proteins could mean sticky end for parasite Scientists funded by the Wellcome Trust have identified a key mechanism that enables malaria-infected red blood cells to stick to the walls of blood vessels and avoid being destroyed by the body's immune system. The research, ...

医学

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Amniotic Fluid Leak –The Growing Threat in Pregnant Women Every year approx 13 million premature babies are born worldwide out of which almost 11 million are born in Africa and Asia. In 2005, WHO estimated that 12.9 million births, or 9.6 per cent of all births worldwide, were preterm. An average of 10 % of births worldwide occur before 37 weeks gestation and an estimated 28% of the 4 million annual neo-natal deaths are due to pre-term births. However, this rate ranges between 3.8 % for countries in central Asia and 17.5 per cent in southern Africa. In fact, Amniotic Fluid Leak is one of the major causes of Pre-term delivery. Amniotic Fluid Leak is the most commonly faced problem by pregnant women. If not treated on time, could pose a serious threat to both mother and baby. Amniotic fluid is the baby’s ‘Life Support System’ along with Placenta and Umbilical Cord. It is the liquid that protects the baby and aids in the development of muscles, limbs, lungs and digestive system. This fluid is generated soon after the Amniotic sac is formed i.e. about 12 days after conception. However, initially the fluid is made up of water provided by mother but post 20 weeks into pregnancy; it primarily forms into fetal urine. Amniotic fluid not only facilitates the growing baby’s movement in the womb but also enables the baby to breathe and swallow the liquid in the second semester. Furthermore, Amniotic fluid levels increases regularly until about 32-33 weeks gestation, and then they level off. In some cases the Amniotic fluid may measure too low i.e. Oligohydramnios or too high i.e. Polydramnios. A normal fluid level ranges about 800-1000 ml and may vary. The Amniotic Sac grows and begins to fill, mainly with water, approx two weeks after fertilization; 10 weeks later the liquid comprises of proteins, carbohydrates, lipids and phospholipids, urea and electrolytes, all of which aids in the fetus growth. Amniotic fluid is produced by exudation of fluid through the skin of the fetus until 14th week of pregnancy at which point keratinization of skin occurs. During weeks 8–11, the fetus begins to swallow and urinate, which is why the Amniotic fluid contains fetal urine in the later stages of gestation. Furthermore, the volume of Amniotic fluid increases as the fetus grows. The amount of Amniotic fluid is greatest approx 34 weeks after conception or 34 weeks ga (gestational age). At 34 weeks ga, the amount of Amniotic fluid is approx 800 ml. The amount of fluid declines to roughly 600 ml at 40 weeks ga, which is usually when the baby is born. Complications of Pregnancy are health problems that occur during pregnancy which could involve the mother's health, the baby's health, or both. Some women have health problems before they become pregnant that could lead to complications and other issues arise during pregnancy. One of the most commonly ignored problems among pregnant women is Amniotic Leak. The forewaters i.e. bag of water in front of baby’s head are released when the amnion ruptures. This is commonly known as the time when a woman's "water breaks". When this occurs during labour at term, it is known as "spontaneous rupture of membranes" (SROM). If the rupture precedes labour at term, however, it is referred to as "premature rupture of membranes" (PROM). The majority of the hindwaters i.e. bag of water around the body remain inside the womb until the baby is born. Artificial rupture of membrane (ARM), a manual rupture of the Amniotic sac, can also be performed to release the fluid if the amnion has not spontaneously ruptured. Amniotic fluid leakages can cause severe complications and therefore it is imperative that the expectant mother receives medical guidance and the proper treatment. However, there are times, when the Amniotic sac may develop a tear or may rupture causing the Amniotic fluid to leak before term. When this occurs 37 – 38 weeks before term, it is referred to as ‘Preterm Premature Rupture of Membrane’ or PPROM. When either of these cases occurs, the fluid either gushes or leaks out in a continuous trickle resembling a discharge. When premature rupture of the Amniotic sac occurs, it is necessary to determine the cause of the leaking Amniotic fluid. However, if the leaking Amniotic fluid is a result of a severe rupture of the membranes of the Amniotic sac, then labor may begin within 48 hours. When this happens, the mother-to-be must receive treatment in order to avoid causing an infection to the fetus. But, this is easier said than done especially when the leak is occurring at unearthly hours like midnight. Over time, innovation in science and developments in technology may provide an easy solution to such a potential problem, enabling both the affected patient and the doctor to breathe easy. Factors Causing Amniotic Fluid Leak – - A bacterial infection, an injury or trauma or a defect in the Amniotic sac can trigger off this problem including amniocentesis, which is a specialized test that involves taking a sample of Amniotic fluid through a needle from the womb and examining it in the laboratory to check for congenital abnormalities. - Depending on the severity of the problem, there may be excessive discharge of fluid or a slight trickle. - This is a serious problem that needs to be addressed as soon as possible as this may cause Oligohydramnios or low levels of Amniotic fluid which in turn increases the chances of a premature delivery. - Moreover a tear in the Amniotic sac can cause infection in fetus within 24 hours of such a leak. - The growth of the fetus can also be restricted especially if the tear happens early in pregnancy. - Stress and other psychological issues could act as a precipitating factor towards the leak. - Sometimes the tear is quite insignificant and will heal itself after a couple of days. Detection & Diagnostics – A general rule of thumb to identify Amniotic Fluid Leak is to ask the mother-to-be to lie down for 30 minutes and once she sits up, there is a gush that occur it may be the result of the broken water bag. There is no other way for a pregnant woman to detect Amniotic fluid leak especially if it is a small one. Moreover in certain cases of pregnancy especially in the last trimester, a woman may have excessive vaginal discharge. This could be urine, the cervical mucus or a combination of both. Hence it is extremely imperative to ascertain the cause of the wetness and evade any confusion to be sure and safer. Thus, routine monitoring of Amniotic Fluid level should be mandatory for preventing pre-term delivery. Some Remedial Steps to be taken once the leak has been detected – - In minor leaks, especially if the patient is dilated, the fluid would continue to leak out, even if the patient is up and moving around. It wouldn't be only some nights and only at night but all nights and day long. - It is important that the attending Doctor is consulted as soon as possible to discern the actual nature of discharge as the Doctor alone is empowered with various options to ascertain the cause of the fluid leak. Currently there is no non-invasive method available to detect the Amniotic fluid leak. Due to lack of any accurate method available, most commonly, Urine leakage may be mistaken for Amniotic leak. 60% of such complaints are usually false alarm and may cause paranoia in the patient and the family. The best thing to do in such a scenario is to consult your doctor immediately. - Authored Article by Dr. B. K. Iyer Family Physician, Mumbai Googles offices awesome images Amazing 9 slips fielding in Cricket History Cricket and fielding Positions Vasu Recipes - Indian Delicacies Carrot Stuffed Idlis a favorite breakfast of Indians which is the key food for easy digestion will more delicious if you take with chutney Eat eggs for breakfast To lose weight Eggs are the best way to start the day for those who want to lose weight Hypertension on the high? Here are top 10 tips to get it down and keep it down.

医学

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1 in 3 Seniors Now Dies with Dementia Hugh Pickens writes writes "Serena Gordon reports that new report finds that one in every three seniors now dies while suffering from Alzheimer's or another form of dementia. Even more concerning is that the Alzheimer's Association estimates that by 2050, nearly 14 million people will have Alzheimer's disease up from 5 million today. "Alzheimer's disease is a public health crisis that is here," says Beth Kallmyer. "One in three seniors is dying with Alzheimer's or another dementia. For other major diseases, the death rate is going down because the federal government funds and invests in research. We have not seen that same commitment for Alzheimer's disease." The US government currently funds about $500 million in Alzheimer's research, according to Kallmyer. In comparison, heart disease receives about $4 billion in research funding and cancer gets about $6 billion (PDF). Dr. Brian Appleby says while current treatments won't cure or reverse the disease, they can increase the amount of time until someone needs nursing home care. Right now, he says, the focus is on trying to prevent Alzheimer's disease from occurring. Alzheimer's disease is really a chronic illness. It starts decades before we see the symptoms," Appleby says. The best advice to potentially prevent Alzheimer's disease is to keep your heart healthy. That means quitting smoking, eating healthy, maintaining a healthy weight and getting regular exercise. It also means staying active mentally, Appleby added."

医学

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Home | Contact Us | Locations & Directions | Resources Foundation / Donate Controlling Infections Flu Update Hand Hygiene Campaign Improving Medication Safety Patient Safety External Reports Protecting Health Information Safe Care Goals Speak Up Campaign STAT Team Boulder Sports Medicine Boulder Center for Sports Medicine Events Childbirth & Parenting Classes Registering Now Childbirth & Parenting Additional Classes & Services Lectures & Special Events Online Lecture Library Pool Classes Therapeutic Gym Classes Integrative Therapies for Cancer Patients Resources & Links for Other Clinical Services National Center forInfectious Diseases National Institutes of Health on Ear, Nose & Throat Society for Endocrinology Eye Care America Family Doctor American College ofGastroenterology American College ofGynecologists American College ofPhysicians Enlarge Boulder Community Health and its physicians offer a wide range of first-rate clinical services. Listed below are links to physicians and other clinicians who practice in some key areas. AIDS & Infectious Diseases The Beacon Center for Infectious Diseases offers a comprehensive range of diagnostic and treatment services for patients and treatment services for patients with infectious diseases, including HIV/AIDS. Ear - Nose and Throat The medical specialty of Otolaryngology encompasses medical and surgical treatment of ear, nose and throat disorders. Several board-certified specialists are affiliated with BCH. An endocrinologist treats complicated and serious medical conditions such as diabetes, thyroid and adrenal gland malfunctions, and hormone disorders. These physicians have training in internal medicine and several years of specialty training in endocrinology and metabolism. Endocrinology is a branch of medicine dealing with disorders of the endocrine system and its specific secretions called hormones. Eye Care Ophthalmology is the branch of medicine that deals with diseases of and injuries to the visual pathways, including the eye and areas surrounding the eye, such as the lacrimal system and eyelids. Several board-certified specialists are affiliated with BCH. They can provide both medical and surgical care. Family practice physicians handle a wide variety of medical problems and care for patients of all ages, often as a family group. This approach allows for continuity of care for the individual and integrated care for the family as a whole. Training for family practice doctors includes obstetrics, gynecology and pediatrics, among other areas. Gastroenterologists are specially trained in the management of disorders of the digestive system -- the esophagus, stomach, small and large intestines (colon), pancreas and liver. After finishing their general medical education, gastroenterologists complete several years of additional training in internal medicine and conditions of the digestive tract. Gynecologists are trained in the medical and surgical treatment of disorders affecting a woman's female reproductive system. Several board-certified specialists are affiliated with BCH. Hearing Services Hearing loss is an invisible and usually painless disability that has a tremendous impact on a person’s quality of life. Boulder Community Hospital’s experienced and professionally certified audiologists can provide a comprehensive range of diagnostic services, along with expert help in choosing and properly fitting hearing aids and other assistive devices. Our audiologists are specialists in treating infants and young children. Holistic medicine is the conscious pursuit of the highest level of functioning and balance of the physical, environmental, mental, emotional, social and spiritual aspects of human experience, resulting in a dynamic state of being fully alive. This creates a condition of well-being regardless of the presence or absence of disease. Holistic medicine focuses on education and responsibility for personal efforts to achieve balance and well being. Infertility specialists are board-certified physicians who provide a range of specialized diagnostic and treatment services for women, men and couples who are not able to get pregnant after at least one year of trying or women who are able to get pregnant but then have repeated miscarriages. Internal medicine physicians are concerned with the complete non-surgical care of adults – from adolescents to the elderly. Internists have undergone special study and training so they are experts in medical diagnosis and treatment of adult disorders, including treatment of severe chronic illnesses. Return to Top Inside Medical Services HomeCare Imaging HOME | PRIVACY NOTICE | SITE MAP | FEEDBACK © 2014 Boulder Community Health | Website by Your Perceptions, Inc Left mouse button enlarges typeRight mouse button decreases type Eliminate graphics and print content

医学

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TrovaGene, Inc. to Introduce First Urine-Based Molecular Diagnostic Test for Transrenal Cancer Mutation Monitoring 11/28/2012 8:34:54 AM SAN DIEGO, Nov. 28, 2012 /PRNewswire/ -- Trovagene, Inc. (NASDAQ: TROV) today announced successful development of its first molecular diagnostic test capable of detecting KRAS mutations from a urine specimen. Transfer of the transrenal KRAS test to the company's CLIA lab is expected to be completed in December 2012 with commercial availability expected in January 2013.(Logo: http://photos.prnewswire.com/prnh/20120620/LA28014LOGO)"Our scientific team has developed the first commercially viable process for quantitative detection of KRAS mutations in transrenal DNA isolated from a simple urine specimen," said Charlie Rodi, Ph.D., chief technology officer of Trovagene. "This represents a breakthrough in cancer monitoring, and will provide oncologists and surgeons with the ability to frequently check mutation status before, during, and after therapy."Cell-free nucleic acids originate from both normal and diseased cells, circulate through the bloodstream, cross the kidney barrier, and can be detected in urine as transrenal DNA. As interest in this technology grows among leading academic cancer centers, Trovagene continues to engage with new collaborators to develop a series of transrenal molecular diagnostic tests to detect and monitor cancer mutations. Trovagene's initial oncogene mutation tests will include KRAS, BRAF and PIK3CA. Potential uses of this non-invasive technology include monitoring for recurrence of disease, determining response to therapy and disease detection.Solid tumors represent more than 90% of all cancers, and approximately 24% of these are KRAS mutation positive. Based on current cancer incidence rates in the US, each year an estimated 360,000 newly diagnosed patients are expected to have KRAS mutation-positive cancers."Over the next six months, we plan to introduce a variety of assays that may offer significant clinical benefits for physicians and patients, as well as potential savings for the healthcare system," stated Antonius Schuh, Ph.D., chief executive officer of Trovagene. "The ability to test, detect and confirm cancer mutation status non-invasively represents an enabling technology that can be used across a variety of clinical applications." Clinicians interested in utilizing the transrenal KRAS test should contact Trovagene Client Services at 888-391-7992.About Trovagene, Inc.Headquartered in San Diego, California, Trovagene is developing its patented technology for the detection of transrenal DNA and RNA, short nucleic acid fragments, originating from normal and diseased cell death that cross the kidney barrier and can be detected in urine. Trovagene has a strong patent position as it relates to transrenal molecular testing. It has U.S. and European patent applications and issued patents that cover testing for HPV and other infectious diseases, cancer, transplantation, prenatal and genetic testing. In addition, it owns worldwide rights to nucleophosmin-1 (NPM1), an informative biomarker for acute myelogenous leukemia (AML) and mutations in the SF3B1 gene, which have been shown to be associated with chemotherapy response in chronic lymphocytic leukemia (CLL) patients.Certain statements in this press release are forward-looking within the meaning of the Private Securities Litigation Reform Act of 1995. These statements may be identified by the use of forward-looking words such as "anticipate," "believe," "forecast," "estimated" and "intend," among others. These forward-looking statements are based on Trovagene's current expectations and actual results could differ materially. There are a number of factors that could cause actual events to differ materially from those indicated by such forward-looking statements. These factors include, but are not limited to, substantial competition; our ability to continue as a going concern; our need for additional financing; uncertainties of patent protection and litigation; uncertainties of government or third party payer reimbursement; limited sales and marketing efforts and dependence upon third parties; and risks related to failure to obtain FDA clearances or approvals and noncompliance with FDA regulations. As with any medical diagnostic tests under development, there are significant risks in the development, regulatory approval and commercialization of new products. There are no guarantees that future clinical trials discussed in this press release will be completed or successful or that any product will receive regulatory approval for any indication or prove to be commercially successful. Trovagene does not undertake an obligation to update or revise any forward-looking statement. Investors should read the risk factors set forth in Trovagene's Form 10-K for the year ended December 31, 2011 and other periodic reports filed with the Securities and Exchange Commission.ContactTrovagene, Inc.Investor RelationsAmy CaterinaInvestor RelationsTrovagene, Inc.858-952-7593acaterina@trovagene.comSOURCE Trovagene, Inc.

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This content requires the Adobe Flash Player and a browser with JavaScript enabled. International Patient ServicesOur International Patient Services Program is designed to offer international patients state-of-the-art medical care in an environment tailored specifically for the most discriminating individual. International patients choosing our program for their healthcare needs will experience world-renowned physician expertise, superior nursing care and cutting-edge technology found in only the most advanced medical centers. International Services also recognizes the unique needs of individuals from other countries and provides a spectrum of personalized services designed to make for a most extraordinary patient experience. Boca Raton Regional Hospital is an advanced, tertiary medical center with 400 beds and more than 800 primary and specialty physicians on staff. The Hospital is a recognized leader in oncology, cardiovascular disease and surgery, minimally invasive surgery, orthopedics, women’s health and emergency medicine, all of which offer state-of-the-art diagnostic and imaging capabilities. The Hospital is a designated Comprehensive Stroke Center by the Florida Agency for Health Care Administration (AHCA). Boca Raton Regional Hospital is the recipient of the 2014 Distinguished Hospital Award for Clinical Excellence™ by Healthgrades® for the 10th year in a row. Only 24 of the nation’s 4,500 hospitals have earned such a consecutive distinction. The Hospital has also been recognized by Healthgrades as one of America’s 50 Best Hospitals in 2011, 2012 and 2013 and as one of the 2013 America’s Best 100 Hospitals for Cardiac Care and Gastrointestinal Care. Healthgrades has also awarded the Hospital with the 2013 Women’s Health Excellence Award™ for the fourth consecutive year and the 2012 Emergency Medicine Excellence Award™ for the third year in a row. Boca Raton Regional Hospital was also recognized for the third consecutive year in U.S. News & World Report’s 2013-2014 Best Hospitals listing as a top-ranked hospital in the South Florida metropolitan area.Need more information?Call 561.955.INTL (4685) or 800.535.BOCA (2622) or use the Contact Form HEART & VASCULAR INSTITUTE The Christine E. Lynn Heart & Vascular Institute opened at Boca Regional in 2006, which made it the first open-heart program started in Palm Beach County in over 22 years. The Institute has performed over 1,000 open-heart procedures – the majority of which are performed off-pump – more than 15,000 cardiac catheterizations and over 800 angioplasties.Diagnostic Testing ServicesCardiac Catheterization EchocardiographyElectrocardiogram (ECG or EKG)Electrophysiology StudiesExercise Stress Tests (Treadmill Tests)Holter MonitorMyocardial BiopsyTilt Table TestTransesophageal EchocardiographySurgical Services AngioplastyCoronary Bypass SurgeryEndoscopic Vein HarvestingMinimally Invasive Heart SurgeryValve Replacement/RepairSurgical AblationsTreatment for Atrial Fibrillation: including state-of-the-art mini-maze surgeryEndovascular Aortic SurgeryFacilities Cardiac Catheterization Lab: state-of-the-art rooms for diagnostic and interventional procedures, placement of pacemakers and implantable cardioverter defibrillatorsNew, Cardiovascular ICU for patients recovering from open-heart, vascular and thoracic surgeriesPost Coronary Intervention UnitCardiac Step Down UnitCardiac Telemetry Unit: provides continuous monitoring of heart patients who are having complications or are recovering from a cardiac event/procedure; a radio-frequency telemetry monitor in each bed sends a signal to the central nursing stationPost-Surgical Cardiac Rehab: programs designed for faster, fuller recoveries and improved quality of life under direction of specially trained staffAdvanced Arrhythmia CenterHybrid OR Center of Excellence for Heart Failure CareClick here to visit the Christine E. Lynn Heart & Vascular Institute The Eugene M. & Christine E. Lynn Cancer Institute is revolutionizing the treatment of cancer and patient care. The Eugene M. & Christine E. Lynn Cancer Institute at the Harvey & Phyllis Sandler Pavilion opened in November 2008. The state-of-the-art, award winning $73 million, 98,000 square-foot facility houses the Hospital’s imaging, radiation, chemotherapy and cancer support services, as well as its clinical research capabilitiesOne of the largest cancer programs by patient volume in the state of FloridaInternationally renowned physicians in cancer treatmentSpecialized physician expertise in breast, urological, head and neck, thoracic, gastrointestinal, hepatobiliary (liver and bile ducts) and bloodborne cancersDedicated Multimodality Center where patients are seen by multiple sub-specialists in genetics, surgery, radiation oncology, medical oncology, pathology and imaging at the same location on the same visitThe latest technological advancements and the most sophisticated diagnostic services and treatment availableMost advanced imaging technology availableThe Center for Hematology-OncologyOnly facility in south Florida with AccuBoost™ technologyNovalis Tx™ – image guided radiosurgery – the most precise treatment availableOncology Social Workers guide patients, offering support and education through group and individual counselingCindy Bertuch Rosencrans Life Expression Program (The CINDY Program) addresses questions, emotions, decisions and challenges that arise for the cancer patient and their loved onesPatients benefit from the Lynn Cancer Institute’s affiliations with major academic cancer centers including Moffit Total Cancer Care™Research nurses improve patient access to clinical trials and facilitiesPain and symptom management, genetic testing and specialized diagnostic servicesClick here to visit the Eugene M. & Christine E. Lynn Cancer Institute WOMEN’S HEALTH & WELLNESS INSTITUTE The Christine E. Lynn Women’s Health & Wellness Institute – The Center for Breast Care, offers a full range of comprehensive services including screening, diagnostic care and treatments. Internationally renowned physicians in breast imagingSame-day mammography results and consultationClinical breast exams and high-risk evaluationPerform over 90,000 diagnostic procedures a yearNo prescriptions needed for screening mammograms (over the age of 40)State-of-the-art imaging technologyGenetic testing for high-risk patientsBreast MRI, breast PEM (Positron Emission Mammography), breast ultrasound and bone densityBreast cancer risk assessment/genetic counselingAccess to leading clinical imaging trialsWorld-class breast cancer programStereotactic biopsyMobile digital MammoVanRated in the top 5% in the nation for Women’sHealth ExcellenceTM by Healthgrades®\Click here to visit the Christine E. Lynn Women’s Health & Wellness Institute Boca Raton Regional Hospital’s Orthopedic Institute offers care in a variety of sub-specialties, including arthritis treatment, hip and knee replacement, spinal surgery, shoulder surgery and sports medicine. The dedicated team of physicians, nurses, physical therapists and other healthcare professionals is focused on improving the lives of patients by alleviating pain, promoting speedy recoveries and returning patients to a state of independence. Boca Raton Regional Hospital performs anterior hip replacement, providing patients with a faster recovery, less pain and enhanced mobility. We specialize in joint resurfacing, an alternative to total joint replacement. Our state-of-the-art navigation system gives our orthopedic surgeons added precision in the operating room. The Hospital’s orthopedic unit provides a host of patient amenities including private rooms, WiFi and flat screen televisions.Click here to visit the Orthopedic Institute PATIENT & GUEST SERVICES The BocaCare International Patient Services Program is dedicated to meeting the needs of patients and their families who come to Boca Raton Regional Hospital from all around the world. Our International Patient Center prides itself on providing highly personalized care, with compassionate and knowledgeable staff members who are attuned to the particular needs of all cultures and strive to make the experience of all patients and family members as pleasant and comfortable as possible. In order to meet the diverse needs of all our patients, Boca Raton Regional Hospital provides personalized liaison services, which include the following: Coordination of hospital, physician and diagnostic services appointmentsPhysician referral services24-hour emergency services, including air ambulance coordination servicesAssistance in finding physicians/specialists within your insurance network24-hour translation services in 180 languagesTravel arrangement assistanceTransfer of medical records to and from your primary physicianFulfilling any special nutritional or spiritual needs The International Patient Center also provides assistance with financial concerns, such as:Coordination with primary insurance and travel assistance companiesEstimates and discounted package pricing for uninsured, self-paying patientsCoordination of advance deposit payments (wire transfers, etc.)In addition to providing our patients with the best possible clinical care, Boca Regional collaborates with the Boca Raton Resort & Club, a Waldorf Astoria Resort, to provide patients and their families with accommodations that are second to none. The Boca Raton Resort & Club is world renowned for its elegance and the many amenities it provides to each of its visitors. ABOUT THE CITY OF BOCA RATON Boca Raton Regional Hospital is located in Boca Raton, Florida, one of south Florida’s most premier and idyllic oceanside destinations. It is home to many of America’s most successful business people, as well as a haven for celebrities, philanthropists and members of society. Whether our international patients are traveling alone or with companions, Boca Raton provides renowned dining, entertainment and recreational experiences. The City is also rich in cultural diversity and enjoys a longstanding reputation for being a most welcoming community for international visitors. © 2005 - 2014 Boca Raton Regional Hospital Ask the Doctor Videos BRRH.com Davis Therapy Centers Emergency Medicine Employee Email - OWA Home Health Imaging Services Lab Services Making Rounds: - Physician Interviews Managed Care Plans Privacy and Patient Rights Secure Link Boca Raton Regional Hospital Contact Form Fields marked with * are required.. CPR Course Inquiries Education Inquiry Foundation/Benefactor Info Medical Staff Inquiry Toppel Family Place Patient Satisfaction/Comments/Concerns Volunteer Office Privacy Officer * First Name: * Last Name: Mailing Info: 800 Meadows Road Main Telephone Number 561.955.7100 Sending...

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Music Therapy - Children's Healthcare of Atlanta In the News Articles Stop Childhood Cancer William G. Woods, M.D., Chair, Hematology/ Oncology, leads a specialized team dedicated to caring for children and young adults with cancer and blood disorders. To make an appointment, call 404-785-1112 or 888-785-1112. See if our Second Opinion Services are right for your family.International Services Though our International Patient Services, we help meet the unique needs of families traveling from outside of the United States. Home Services Cancer & Blood Disorders Resources Newsroom In the NewsMusic Therapy Easing a Child's Pain with the Sound of Music By Giannina Smith @ Atlanta Business Chronicle Therapists Beth Collier and Cori Snyder are using their musical gifts as a way to heal and motivate. From using the rhythm of a song to help a child take a first step in rehabilitation to singing a song to divert a patient's focus away from the side effects of chemotherapy, Collier and Snyder are helping patients at Children's Healthcare of Atlanta get through a difficult time. For their work with young patients in music therapy, Collier and Snyder are the winners of the 2010 Health-Care Heroes Allied Health Professional award. "Each day I realize I am fortunate to do work I love to do and I get to meet so many people and have such unique experiences." said Collier, therapist at Aflac Cancer Center and Blood Disorders Center of Children's Healthcare of Atlanta. 'The tough stuff?seeing kids feel so sick and talking to parents who have lost a child to cancer?will never be easy. Watching them find ways to cope with music is one thing that is slightly redeeming in the process." Joining Children's in 1998, Collier first discovered the benefits of music therapy while volunteering at a nursing home in high school, where she used the piano to bring out the personality of residents. Serving first as a music therapist in the Inpatient Rehabilitation Program at Children's, Collier saw a need for a music therapy program at the Aflac Cancer Center for children battling cancer or a blood disorder. "I was trying to develop the program at the hospital and talked to different units and said this is how music therapy can be effective with your patients and, of course, they said that's great, but where is the money?" she said. The money to fund the music therapist position at the Aflac Cancer Center eventually came from Rock Against Cancer, a nonprofit that funds music therapy for pediatric cancer patients. "Being a cancer survivor and seeing what kids go through, it's amazing what music does to take your mind off the pain you're going through," said Jean Murphy, Rock Against Cancer Atlanta fundraising chair. 'We've just been overwhelmed from the reception we've gotten from the kids and the parents that Beth helps. She is just truly amazing." Splitting her time between Children's at Egleston and Scottish Rite campuses, Collier spends her days visiting children with a music cart and engaging them in songwriting, guitar lessons and other music-related projects. 'We had a dance party after lunch one day. They did everything from the chicken dance to break dancing." Collier said. "I don't know exactly what is going to happen until I know who is up and ready to go because they are very sick." Sometimes the patients are too sick to do anything. In those cases, Collier tries various methods to ease the pain or nausea associated with chemotherapy. 'They may not want to do anything active, but I can sit at the bedside." She said. "I can't stop someone from vomiting, but at least their focus shifts away fromhow horrible they are feeling." Collier has sung children to sleep and even been asked by parents to sing fortheir child at the end of their lives or at their funerals. "A lot of kids don't survive and the death can be tough, but at the same time if the family is willing to use music, it is an honor for me to be involved with that," she said. For those children that do make it through the fight, Collier hopes she has given them a way to cope with difficulties beyond their illness. "So many kids tell me they come out of the battle with cancer feeling like they are better for it. I hope having a tool like music to cope with pain and anxiety lasts far beyond the illness," she said. In October 2008, when Collier began providing music therapy to patients at the Aflac Cancer Center, Snyder was hired as music therapist in inpatient rehabilitation at Scottish Rite, essentially doubling the size of the music therapy program. Using music to help infants and young adults recover from stroke and brain injury, Snyder first discovered her interest in music therapy in high school. "I wanted to do something to help people in my life," she said. "I started reading books about psychology and music and the impact of music on the brain. By the time I was a junior or senior in high school I knew music therapy was definitely what I wanted to do." Through the use of guitars, pianos, drums and singing, Snyder uses patients' preferred music to help them recover their speech, language abilities and cognitive skills. Rather than using weights or exercise, Snyder's sessions consist of learning to play instruments or utilizing the rhythm in a familiar song to help them walk again. "Oftentimes music can really be the breakthrough point for them to get them started and it might open up that pathway to being able to talk again or it might help organize their body muscles enough to get those first steps in again," she said. Snyder often works alongside other therapists and when she isn't available to participate in sessions she puts together individual music programs on an iPod system that patients can use in her absence. "Music isn't unique ... music covers speech areas, the music stimulates neuronsin motor areas so you can use the music to stimulate those areas to give them a jump-start for therapy," Snyder said. "I've had patients who can only speak clearly when singing for several weeks before they are able to actually speak on their own again." Even for low-level patients, like those still in a coma, Snyder is able to use music to decrease their heart rate and stabilize their breathing. Snyder said the most rewarding part of her work is seeing patients recover and come back to visit?some even playing music for the hospital's Sunday chapel service. "I think the best part is just seeing the impact of music on everyone's lives and seeing how it can open the door for a child to being able to speak or walk again and seeing them smile because of it," she said. Beth Collier Age: 38 Years in business: 15 Top career achievement: Starting new music therapy program now serving five areas of the hospital that didn't have access to music therapy just two years ago Career highlights: Brook Run (Georgia Retardation Center), provided music therapy services to adults with severe delays; Elaine Clark Center; Wesley Woods Geriatric Center; Children's Healthcare of Atlanta, music therapist inpatient rehabilitation Hobbles: Morning walks with bull mastiff, Maggie, and playing violin with the Cobb Symphony Orchestra. Also, listening to live music. Cori Snyder Age: 31 Years in business: Eight years as a board-certified music therapist Top career achievement: Helped lead design, setup and use of a music therapy multi-sensory room for adolescents and adults in skilled nursing care at Georgia Regional Hospital and receiving certification for Neurologic Music Therapy, NICU Music Therapy, and Brain Injury Specialist Certification Career highlights: Music therapist, Tallahassee Memorial Healthcare Hospital and Behavioral Health Center; Memory Impaired Assisted Living Center; Georgia Regional Hospital, Atlanta; Children with Autism and Aflac Bone Stem Cell Transplant Study; Children's Healthcare of Atlanta at Scottish Rite Hobbles: Bicycling, reading, movies, playing with my two cats and going tothe park or lake

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News and Announcements Search - Children's Healthcare of Atlanta Patients & Families Medical Professionals Donors & Volunteers Job Seekers Home About Us Newsroom News and Announcements News and Announcements Search News and Announcements Search Search by related service Foundation Results since 11/28/2011 Children’s Healthcare of Atlanta Foundation Appoints New Trustees to Help Raise $61 Million in 2014 The Children’s Healthcare of Atlanta Foundation is pleased to announce the addition of nine new members to its Board of Trustees. Under the leadership of Chairman Thomas M. Holder, the Children’s Foundation Board is charged with raising critical funds to help meet the growing needs of one of country’s leading, not-for-profit pediatric healthcare LexisNexis® Joins Safe Kids Georgia for Fifth Annual "Simpler Solutions, Safer Communities" Awards Safe Kids Georgia, a statewide network led by Children’s Healthcare of Atlanta dedicated to preventing unintentional injuries, has announced that LexisNexis® Risk Solutions will be the presenting sponsor of the organization's fifth annual awards breakfast, "Simple Solutions, Safer Communities." Aflac Honors Leaders in Fight Against Childhood Cancer Aflac, the number one provider of supplemental insurance in the United States, announced today that the company is honoring two heroes in the fight against childhood cancer with their first ever Aflac Duckprints Award. The first awards will be presented to former Atlanta Braves pitcher John Smoltz and Aflac Cancer Center of Children's Healthcare of Atlanta Director Dr. William G. Woods. Children’s Healthcare of Atlanta Kicks Off “Share the Hope” Campaign with Compelling Video to Raise Awareness In an effort to convey the authentic, emotionally charged stories of their patients, parents and staff, Children’s has teamed up with local advertising agency BKV, as well as the Verizon Foundation, to launch a digital campaign of social sharing during this holiday season. Barnes & Noble Annual Holiday Book Drive Barnes & Noble stores across the country invite customers to give the gift of reading to children in need during its annual Holiday Book Drive, taking place from November 1, 2011 to January 1, 2012. Third Annual DI Dash Outpaces Previous Fundraising Record Children’s Healthcare of Atlanta is excited to announce that the third annual 5K DI Dash road race on August 27 -- organized by Atlanta-based Digital Insurance -- generated a $35,000 charitable donation to Children’s and drew some 700 registered participants. Aflac and Carl Edwards Unveil Racecar for Childhood Cancer Awareness Aflac, the number one provider of supplemental insurance in the United States, and Carl Edwards, NASCAR driver of the No. 99 Aflac Ford Fusion, are teaming up to support this year’s National Childhood Cancer Awareness Month, recognized annually in September. Aflac’s “Friends of a Feather” Campaign Invites Americans to Join its 16-Year Fight Against Childhood Cancer Aflac, the number one provider of supplemental insurance in the United States, kicked off its “Friends of a Feather” campaign today, the same day that marks the start of National Childhood Cancer Awareness Month. Kids II Strong Legs Run Returns to Downtown Atlanta Nov. 5, Benefits Children’s Healthcare of Atlanta Join Kids II and Children’s Healthcare of Atlanta Saturday, Nov. 5, 2011, for the 27th annual Kids II Strong Legs Run. As one of Atlanta’s largest and most popular road races, the event includes a 10K qualifier for the 2012 Peachtree Road Race. SurvivorLink Helps Childhood Cancer Survivors and Health Care Providers Link for Better Quality of Life Care The Aflac Cancer Center and Blood Disorders Service of Children's Healthcare of Atlanta announced today the successful launch of the SurvivorLink information technology system—a crucial tool to help physicians, clinical staff and patient families ensure childhood cancer survivors have optimal health and quality of life. Steve Smith Launches Twitter-based Campaign to Benefit Children's at Hughes Spalding Now through June 10, former NBA player and current studio analyst for NBA TV, Steve Smith, will host “Count Me In for Kids” to benefit Children’s Healthcare of Atlanta at Hughes Spalding. Blank Family Announces $3 Million Gift to Children's Healthcare of Atlanta Arthur M. Blank, co-founder of The Home Depot and owner of the Atlanta Falcons, announced a $3 million gift through The Arthur M. Blank Family Foundation to honor his wife Stephanie Blank’s support of the Child Protection Center at Children’s Healthcare of Atlanta and her service on the Children’s Foundation Board of Trustees. Radiant Systems, Children’s Healthcare of Atlanta Team Up to Sprint for Cancer April 16 Usher in spring, shape up for summer and support pediatric cancer research at the ninth annual Radiant Systems Sprint for Cancer 5K,10K and Fun Run road race, a qualifier for the Peachtree Road Race. WWE Superstars Unveil Artistic Talents to Benefit Children’s Healthcare of Atlanta Tickets are now on sale for WrestleMania® Art, a special, one-night event featuring artwork created by WWE Superstars and Divas, to be held at the Fox Theatre Wednesday, March 30 at 6:30 p.m. with Red Carpet arrival at 5:30 p.m.

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Nov-Dec 2005 Front PageAnnouncementsFocus on FoodGet MovingGet Up & GoHealthy GivingMessagePersonal StoriesPhysician ProfileRoundtableSpotlightTechnology Table of Contents Arnold Palmer Prostate Center Garnering International Acclaim Nurse Coordinator Cindy Huff confers with Eisenhower patient Mike Adams.When the Arnold Palmer Prostate Center opened in January 2005, its goal was to provide skilled, coordinated and compassionate treatment to the men of the Coachella Valley and beyond – perhaps to the entire nation. But what the organizers and professionals behind the Center did not realize at the time was the degree to which the Center would garner international acclaim. Today, nearly 50 percent of the cancer patients seeking treatment at the Arnold Palmer Prostate Center come from outside of California, with more than 30 percent coming from outside the United States, some as far away as Germany and Sweden. “It’s primarily through the advice and suggestion of friends,” says Cindy Huff, RN, Nurse Coordinator for the Arnold Palmer Prostate Center. “People are hearing about the great service that we provide here from other people, and that we’re part of a 100 Top Hospital®.They’re then finding out more about us through our informative Web site.” The Center, which is located in the $65 million Eisenhower Lucy Curci Cancer Center, boasts a unique mix of state-of-the-art technology and a highly qualified and caring medical team.That team includes radiation oncologists, urologists, medical oncologists and – something quite unique to cancer programs – a nurse coordinator, who helps facilitate the process from diagnosis to treatment to after care. “For three or four months, I take personal responsibility for our patients as nurse coordinator, providing educational information, arranging all the tests, and even helping them with lodging,” Huff exclaims. “And, it’s not just me, but the rest of the team as well.We get them the information they need to make the decisions they need to make.” Perhaps what’s most surprising is that this cornucopia of support services, which would not typically be covered by Medicare, is provided free to the patient and their families – perhaps another reason cancer patients are flocking from near and far to access these services. “We have many patients from Canada and Britain,” Huff says. “There’s often a waiting list in Canada for the medical services that we provide, and these men do not want to, or sometimes, can’t wait six months to a year for treatment.” Many of the medical services and procedures offered at the Center are not available outside of the country. Services like Brachytherapy (radioactive seed implants), External Beam Radiation Therapy and Stereotactic Radiosurgery, are either not available or offered on a limited basis in Canada and Britain. Additionally, when patients do find these specialized services elsewhere, they often return to Eisenhower Medical Center and the Arnold Palmer Prostate Center for the quality of care and the personal touch that Eisenhower is able to deliver. “We have people call and say,‘I see that Arnold Palmer’s name is on this Center and I know that he wouldn’t attach his name to anything other than a quality program,’” Huff explains. “It’s a huge responsibility for the people who work here to continually deliver such a high degree of quality care. But we do it. Others say, ‘I want someone who will take care of me…look after my best interest,’ and that’s what we do here. My personal motto is ‘Five minutes of worry is five minutes too long.’With the support of the community, the donors, and Arnold Palmer, this program will be able to reach out to men with prostate cancer around the world for a long time to come.” Healthy Living Magazine is a publication of Eisenhower Medical Center · © Copyright 2014 All Rights Reserved · Email the Webmaster

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Contact: Sue McGreevey smcgreevey@partners.org New joint replacement material developed at MGH put to first clinical use New form of polyethylene will allow stronger, more versatile joint replacement Massachusetts General Hospital (MGH) surgeons have performed the first total hip replacement using a joint socket lined with a novel material invented at the MGH. An advance over first-generation highly crosslinked polyethylene, which was also developed at MGH and significantly reduced a serious complication of early hip implants, the new material may be applied in replacements for a wider variety of joints in a more diverse group of patients. �We think this material could be used for any joint in the body and in any implant design, even those demanding higher flexion and more mobility,� says Orhun Muratoglu, PhD, co-director of the Harris Orthop�dics Biomechanics and Biomaterials Laboratory (OBBL) at MGH, who developed the new material in collaboration with scientists at the Cambridge Polymer Group. Total replacements for hips and other joints were developed in the late 1960s, but it soon became apparent that hip implants could start loosening about 5 years after surgery and would eventually fail completely. A team led by William Harris, MD, DSc, now director emeritus of the MGH OBBL, investigated this complication and found that long-term friction of the implant�s head against the polyethylene-lined joint socket would break off small particles of polyethylene. The body�s immune system reacted against these foreign particles, eventually destroying adjacent bone tissue and causing the implant to loosen � a condition called periprosthetic osteolysis. Harris and his colleagues, working with polymer chemists from MIT, found that high doses of radiation would �crosslink� the polyethylene, bonding molecules together to produce a much more durable material. The procedure also generates free radicals that could lead to oxidization and degradation of the implant, but the research team found that melting the material would eliminate free radicals. The first-generation highly crosslinked polyethylene was approved by the FDA for use in implants in 1999 and has been licensed to Zimmer, Inc. However, the MGH researchers knew that the first-generation material had limitations in strength that made it unsuitable for some types of joint replacement implants. Subsequently, Muratoglu found that oxidation could be blocked by diffusing the antioxidant vitamin E throughout the polyethylene material. Both mechanical testing and animal studies have shown that the new material resists wear as well as the first generation and is much stronger. Vitamin-E-stabilized, highly crosslinked polyethylene has also received FDA approval for use in joint implants and has been licensed to both Zimmer and to Biomet, Inc., which made the implant used in the first surgical procedure on July 16. �This material will allow us to offer our patients very long-term, high-performance joint replacements,� says Andrew A. Freiberg, MD, chief of the Arthoplasty Service in the MGH Department of Orthop�dics, who performed the first implant with the new material. �It should be suitable for higher-stress applications in younger patients, those who are more active and those who are heavier.� MGH orthop�dic surgeons are running an international study in 7 countries to study the new material, with a focus on measuring long-term performance of the Vitamin-E stabilized bearing surfaces. Patients can be enrolled as part of this study if they meet the entrance requirements and are able to follow up at MGH or another participating hospital for at least five years. Those interested in the program should call Janet Dorrwachter at (617) 726-2939. Massachusetts General Hospital, established in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH conducts the largest hospital-based research program in the United States, with an annual research budget of more than $500 million and major research centers in AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, human genetics, medical imaging, neurodegenerative disorders, regenerative medicine, systems biology, transplantation biology and photomedicine. MGH and Brigham and Women's Hospital are founding members of Partners HealthCare HealthCare System, a Boston-based integrated health care delivery system.

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Ministry thanks medical experts Salaseini Moceiwai THE Ministry of Health has conveyed its gratitude to a team of medical specialists from the Sahyadri Group of Hospitals in India for taking time out to conduct free screening for patients in the country. Addressing more than 200 people at a live Bollywood music show in Labasa on Friday, Health Minister Doctor Neil Sharma said it had always been a difficult task to bring specialist care to Fiji in the past."With government's move to partner with an internationally-recognised specialist group, we now have the capabilities to undertake necessary specialist level care in orthopaedics, cardiac surgery and neurosurgery," Dr Sharma said."These opportunities give doctors and nurses in Fiji a chance to upskill their knowledge and improve their service to another standard."Such relations, he said were very important in the move to grow our nation's health care system."We thank the specialists for their effort and tremendous assistance in trying to improve the lives of those Fijians who are suffering from cardiac, joint and brain-related problems."The hospital's director, Doctor Charudutt Apte, said the ministry was doing a marvellous task in helping the people of the country.He said they were more than happy to return and operate on the patients identified for surgery.

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Learning About Holoprosencephaly (HPE) What do we know about holoprosencephaly? Is there a test for holoprosencephaly? Is there a treatment for holoprosencephaly? What is the prognosis for holoprosencephaly? NHGRI Clinical Research on Holoprosencephaly Additional Resources for Holoprosencephaly Holoprosencephaly (HPE) is a relatively common birth defect of the brain, which often can also affect facial features, including closely spaced eyes, small head size, and sometimes clefts of the lip and roof of the mouth, as well as other birth defects. Holoprosencephaly is a disorder caused by the failure of the prosencephalon (the embryonic forebrain) to sufficiently divide into the double lobes of the cerebral hemispheres. The result is a single-lobed brain structure and severe skull and facial defects. In most cases of holoprosencephaly, the malformations are so severe that babies die before birth. In less severe cases, babies are born with normal or near-normal brain development and facial deformities that may affect the eyes, nose and upper lip. This birth defect occurs soon after conception. It has a prevelance of 1 in 250 during early embryo development, and 1 in 10,000 to 1 in 20,000 at term. There are three classifications of holoprosencephaly: Alobar, in which the brain has not divided at all, is usually associated with severe facial features. Semilobar, in which the brain's hemispheres have somewhat divided, causes an intermediate form of the disorder. Lobar, in which there is considerable evidence of separate brain hemispheres, is the least severe form. In some cases of lobar holoprosencephaly the baby's brain may be nearly normal. The milder craniofacial characteristics of HPE include microcephaly, midface flattening, hypotelorism (closely spaced eyes), flat nasal bridge, and single maxillary central incisor. Approximately 80 percent of severe HPE have characteristic facial features. The least severe of the facial anomalies in holoprosencephaly is the median cleft lip (premaxillary agenesis). The most severe is cyclopia, an abnormality characterized by a single eye located in the area normally occupied by the root of the nose, and a missing nose or a proboscis (a tubular-shaped nose) located above the eye. The least common facial anomaly is ethmocephaly, in which a proboscis separates closely-set eyes. Cebocephaly, another facial anomaly, is characterized by a small, flattened nose with a single nostril situated below incomplete or underdeveloped closely-set eyes. Not all individuals with HPE are affected to the same degree, even in families where more than one individual has this predisposition. This is why it is often helpful to discuss these issues with a professional in genetics who is trained to recognize features that might suggest that HPE is, or is not, likely to occur again in a family. The risk of reoccurrence is small in most families. There are a number of causes of HPE, including genetic alterations and environmental effects. The cause of HPE in any individual family is often unknown. The best diagnostic procedure is a brain scan (CT or MRI). Molecular testing for several HPE genes are available. Each child has a unique degree of malformations. Treatment must be individualized, although common problems occur. In general, treatment is largely symptomatic and supportive. Involvement in support groups and HPE Conferences are helpful (See: Additional Resources). Top of page The prognosis for individuals with the disorder depends on the severity of the brain and facial malformations and associated clinical complications. The older literature suggested that the prognosis was uniformly poor. Recent studies show a broader range of outcomes than previously assumed. Clinical and Genetic Studies on Holoprosencephaly [clinicaltrials.gov] The purpose of the present study is to increase our understanding of the genetic and clinical manifestations of HPE through detailed physical, psychological, developmental, neurologic endocrinologic, and radiologic studies. We also plan to examine the spectrum of clinical characteristics of HPE to facilitate early diagnosis and clinical management, including genetic counseling. Finally, we plan to assess the psychosocial impact of HPE on the family as a unit. To accomplish this, we plan to enroll approximately 60-80 affecteds and family members each year, with an enrollment ceiling of 250. Most patients and their families will be seen at the NIH Clinical Center. A subset may be examined outside the NIH, and a further subset, for the psychosocial studies, may be interviewed by phone. Current NHGRI Clinical Studies Search Clinical Trials.gov [clinicaltrials.gov] Clinical Research FAQ About Holoprosencephaly NINDS Holoprosencephaly Information Page [ninds.nih.gov]From the National Institute of Neurological Disorders and Stroke Carter Centers for Research in Holoprosencephaly [ninds.nih.gov]Collaborative initiative created to gather, analyze, and share information about HPE. Holoprosencephaly Conferences: 1st NIH Conference on Holoprosencephaly April 3-6, 2000 2nd NIH Conference on Holoprosencephaly April 8 & 9, 2002 Third NIH Conference on Holoprosencephaly April 18-20, 2004 Carter Centers for Brain Research in Holoprosencephaly and Related Malformation [stanford.edu] Alliance of Genetic Support Groups [geneticalliance.org] Association of Birth Defect Children [birthdefects.org] National Organization for Rare Disorders (NORD) [rarediseases.org] The Arc of the United States [thearc.org] Holoprosencephaly [rarediseases.nih.org]Information from the Genetics and Rare Diseases Information Center. March of Dimes Birth Defects Foundation [marchofdimes.com] Finding Reliable Health Information OnlineA listing of information and links for finding comprehensive genetics health information online.

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> State Health Department Addresses Questions on Radiation Impact from Japan Nuclear Plants State Health Department Addresses Questions on Radiation Impact from Japan Nuclear Plants ALBANY, N.Y. (March 17, 2011) - In the wake of last Friday's major earthquake and ensuing tsunami that damaged several nuclear power plants in Japan, State Health Commissioner Nirav R. Shah, M.D., M.P.H., is reassuring New Yorkers today that no U.S. states are expected to experience harmful levels of radiation. In addition, the New York State Department of Health (DOH) is providing the following information to address concerns about health and safety related to radiation. What is the expected impact in the United States? A number of federal agencies, including the Department of Energy (DOE), the Environmental Protection Agency (EPA), and the Nuclear Regulatory Commission (NRC) are continually monitoring radiation levels of air, drinking water, milk and precipitation across the country. This nationwide monitoring network, RadNet, will alert the agencies to any changes in radiation levels. Additional monitoring sites in Hawaii, Alaska and Guam have also been added in the wake of the evolving situation in Japan. At this time, no U.S. states are expected to experience harmful levels of radiation. DOH also conducts routine air monitoring for radioactivity and will be able to detect any changes in radiation levels in New York State. Should people take potassium iodide (KI) for protection? Elevated levels of radiation are not expected in the United States. Therefore, DOH advises that there is no reason to purchase or take potassium iodide (KI). The NRC also has issued guidance stating that taking KI is not recommended. KI is a chemical compound that can be used to protect the thyroid gland from exposure to radioactive iodine, only one of many radioactive materials that may be released from a nuclear power plant. KI is only effective at protecting a person's thyroid gland from airborne or ingested radioiodine if taken within a relatively narrow timeframe prior to or after exposure. It does not protect any other organs in the body. It is important to note that taking KI will not provide long-term protection for a person against radioactivity. Also, KI should not be used as a general health precaution unless high-level radiation exposure is expected and is recommended by health officials. Potassium iodide can also be harmful to people who have certain medical conditions, including iodine sensitivity or allergies. In many cases, people who have shellfish or seafood allergies or certain skin conditions may have anaphylactic reactions to KI intake. Should people take other precautions? Because of the low threat of radioactivity exposure in New York and other U.S. states, the federal government is not advising people to take any special protective measures at this time. Staying informed is the best step for people to take. Anyone planning on traveling to Asia should check the website for the U.S. Department of State, http://www.state.gov/, to see if there are any travel restrictions in place. How harmful is radiation? Radiation is always present in our environment, usually at very low levels known as background radiation. In addition, people who undergo certain medical tests or procedures such as an x-ray are exposed to low-level radiation that is generally not considered harmful. The levels of radiation being released from the damaged nuclear power plants in Japan are constantly being assessed; however, based on the information available at this time, it is not expected to occur in New York State or impact public health. DOH will continue to communicate with various federal agencies to determine appropriate steps to take as the situation in Japan evolves, and will issue additional guidance if necessary. http://www.health.ny.gov/environmental/radiological/potassium_iodide/ http://emergency.cdc.gov/radiation/ http://www.nrc.gov/

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Home > Health News > Health Highlights: April 28, 2014 Scientists Use Cloning to Create Stem Cells Super Arthgold Capsules Recalled Side Effects of Chantix to be Reviewed in Fall: FDA Health Care Law Payment Policies Unfair: Report Physical Therapists Paid $1.8 Billion by Medicare in 2012 Using cloning technology, researchers created stems cells from a woman with type 1 diabetes that are genetically identical to the woman and her disease, a new study says. It may someday be possible to use such cells in transplants to treat or even cure the condition, which affects millions of people. Currently, there are few treatment options for patients, other than the use of insulin and careful diet, NBC News reported. The study, published in the journal Nature, is the second this month to report successful use of cloning technology to create human embryonic stem cells. Scientists want to find ways to use these cells to treat a wide variety of health problems, ranging from diabetes and Parkinson's disease to injuries that cause organ damage or paralysis. "I think this is going to become reality," study author Dr. Dieter Egli, of the New York Stem Cell Foundation, told journalists, NBC News reported. "It may be a bit in the future but it is going to happen." He and his colleagues used a technique called somatic cell nuclear transfer. The nucleus is removed from a normal skin cell and human egg, and the nucleus from the skin cell is injected into the egg. In this case, the researchers used DNA from the women with type 1 diabetes. The egg was tricked into growing as if fertilized by sperm. Cells from the growing egg were removed and prompted to grow into pancreatic cells that make insulin, but are destroyed in diabetes. These cells matched the women's DNA, including the genetic errors that caused her diabetes, NBC News reported. "These stem cells could therefore be used to generate cells for therapeutic cell replacement," the study authors wrote. This is only the third time that scientists have successfully created human embryonic stem cells. Earlier this month, researchers made cells by cloning two men. Last year, another team created cells from babies. "I think these papers show conclusively it's possible," Dr. Douglas Melton of the Harvard Stem Cell Institute, told NBC News. He who was not involved in the research. Some batches of Super Arthgold -- a dietary supplement marketed as a treatment for joint pain and arthritis -- are being recalled because they may contain undeclared drug ingredients that can pose serious health risks, the U.S. Food and Drug Administration said Monday. The recalled 500-milligram capsules may contain chlorzoxazone, diclofenac and indomethacin and could be deadly for certain people including: those who are allergic to these drugs; have heart, liver, kidney and gastrointestinal conditions; or have recently had heart bypass surgery. The recall by Nano Well-being Health Inc. is for bottles that contain 120 capsules and have the following lot numbers and expiry dates: L1P1-6100/Expiration date June 25, 2016 and L1P2-6000/Expiration date September 16, 2016, the FDA said. The bottles were distributed nationwide. Consumers who have recalled bottles should stop using the product and return it to the place of purchase. If you've experienced any problems that may be related to taking the capsules, contact your doctor, the FDA said. Psychiatric Side Effects of Chantix to be Reviewed in Fall: FDA The mental health risks associated with the anti-smoking drug Chantix will be reviewed at a public meeting scheduled for October, the U.S. Food and Drug Administration says. The meeting will feature a panel of experts who will discuss the psychiatric and behavioral side effects of the pill and how best to manage them, the agency announced Friday, The New York Times reported. In 2009, the FDA ordered drug maker Pfizer to add a black box label -- the strongest safety warning -- to Chantix after it was linked to hostility, aggression, depression and suicidal thoughts. There were dozens of reports of suicide and suicidal behavior among people taking the drug. Pfizer was also told to conduct further studies to assess the extent of these side effects. The company recently provided the FDA with new data about the anti-smoking drug. "Pfizer has proposed an update to the Chantix labeling based on these new data, which, we believe, would better reflect the product's safety profile as it pertains to neuropsychiatric symptoms," company spokeswoman Victoria Davis said in a statement, The Times reported. The findings submitted to the FDA include data from a number of Pfizer studies, as well as findings from two studies conducted by the U.S. Department of Defense and the Department of Veterans Affairs. The government studies were released in 2011 and found that Chantix users did not have a higher rate of psychiatric hospitalizations than those who used nicotine patches or other treatments to help them stop smoking. However, the study authors said only mental health problems that resulted in hospitalization were included, which means many such problems likely went unreported, the Times said. U.S. sales of Chantix began in 2006 and the FDA began investigating the drug's potential side effects in 2007. The pill's labeling tells patients to stop using it if they develop agitation, depression, suicidal thinking and other behavioral changes. Chantix works by blocking nicotine from binding to certain locations in the brain and triggering the release of the "feel-good" chemical dopamine. Hospitals and doctors that treat large numbers of poor Americans are unfairly penalized under payment policies in the federal health care law that reward high-quality health care, a new report says. The measures of quality in those rules are flawed because they do not take into account that it is often more difficult to successfully treat patients who are poor or have little education, according to the White House-commissioned draft report by a 26-member expert panel, The New York Times reported. For example, poor people may not be able to afford prescribed medications or transportation to doctor's offices or clinics. People with low levels of education or literacy may have trouble understanding or following written instructions for home care and medication use. The expert panel added that hospitals and clinics used by these patients may not have the resources or equipment needed to properly diagnose and treat health problems, The Times reported. The current payment policies inadvertently widen health disparities between poor and rich Americans by shifting money away from doctors and hospitals that care for low-income patients, the document said. The panel recommended that measures of health care quality of performance be adjusted for various "sociodemographic factors," The Times reported. The panel was created by the nonprofit, nonpartisan National Quality Forum, which endorses health care standards. "Factors far outside the control of a doctor or hospital -- patients' income, housing, education, even race -- can significantly affect patient health, health care and providers' performance scores," said Dr. Christine Cassel, president of the forum, The Times reported. "The administration's current policy on adjustments for socioeconomic status are quite inadvertently exacerbating disparities in access to medical care for poor people who live in isolated neighborhoods. I'm sure that's not what President Obama intended with the Affordable Care Act," panel member Steven Lipstein, president of BJC HealthCare in St. Louis, said. One change suggested by the panel would be to compare doctors and hospitals who provide care for a similar share of low-income patients, The Times reported. Physical therapists working in offices were paid $1.8 billion by Medicare in 2012, making them the 10th-highest among 74 types of health care specialists, according to an analysis of government data by The New York Times. The highest paid physical therapist was Wael Bakry of Brooklyn, who received $4.1 million in Medicare payments that year. His practice treated 1,950 Medicare patients in 2012 and was paid by Medicare for 94 separate procedures for each patients. That works out to a total of about 183,000 treatments a year, 500 a day, 21 an hour, according to The Times. While Bakry did not dispute the $4.1 million figure, he suggested that the Medicare data could be "deceiving," and noted that one person could not provide all of that care alone. "I'm not Superman," Bakry told The Times. Medicare has never questioned his billing practices nor denied payments to his practice, he said. Bakry is not listed in a database of providers who are currently excluded from Medicare. The Medicare data released this month also revealed that Brooklyn was the address listed by half of the 10 physical therapists nationwide who were paid the most by Medicaid in 2012. Two others had addresses on Long Island, one in Queens, one in California, and one in Texas. Federal officials say that Brooklyn is a national hot bed of Medicare fraud, particularly scams linked to physical therapy. Dishonest members of that profession bill for treatments or procedures they never gave patients. This is often easier for physical therapists to do than specialists in fields such as cardiology or oncology,The Times reported.

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HomeFood TechnologyDaily NewsFDA issues proposed rule on sanitary transportation of food FDA issues proposed rule on sanitary transportation of food The U.S. Food and Drug Administration has proposed a rule that would require certain shippers, receivers, and carriers who transport food by motor or rail vehicles to take steps to prevent the contamination of human and animal food during transportation. Part of the implementation of the Sanitary Food Transportation Act of 2005, the proposal marks the seventh and final major rule in the FDA Food Safety Modernization Act’s (FSMA) central framework aimed at systematically building preventive measures across the food system. The proposed regulation would establish criteria for sanitary transportation practices, such as properly refrigerating food, adequately cleaning vehicles between loads, and properly protecting food during transportation. The proposed rule would apply to shippers, carriers, and receivers who transport food that will be consumed or distributed in the United States and is intended to ensure that persons engaged in the transportation of food that is at the greatest risk for contamination during transportation follow appropriate sanitary transportation practices. The requirements in the proposed rule would not apply to the transportation of fully packaged shelf-stable foods, live food animals, and raw agricultural commodities when transported by farms. The FDA intends to hold a public meeting on the rule on March 20 in College Park, Md. The proposed rule is available for public comment until May 31, 2014.

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Support ISMP Survey results: Community liaison programs to decrease hospital readmissions ISMP would like to thank more than 250 healthcare professionals, primarily pharmacists and nurses, who completed our survey on community liaison programs in November and December 2012. We conducted the survey to learn more about these relatively new programs in which one or more dedicated health professionals serve as a liaison between the hospital and post-hospital setting, particularly in regards to the patient’s pharmaceutical care plan and follow-up appointments. Now that penalties enacted with the Affordable Care Act are being levied against hospitals with high readmission rates for patients with heart failure, heart attack, and pneumonia, the stakes have never been higher to prevent readmissions within 30 days. Given that medication discrepancies contribute largely to readmissions,1 a community liaison program can help reduce this risk while improving the quality of life for the patient. Survey Results One in three (31%) respondents to our survey has established a community liaison program in their hospital; of these, 78% are hospital-run programs that utilize internal staff; 10% are vendor-run programs operated by an external pharmacy organization; 12% are a combination of hospital- and vendor-run programs. Hospital-Run Programs Respondents offered a variety of reasons for developing a hospital-run community liaison program rather than using an outside vendor to provide this service. Respondents thought an internal program was most convenient for patients and less likely to result in delays in filling prescriptions prior to discharge. They felt inpatient pharmacists could provide better transitional care to patients due to familiarity in navigating through a patient’s medical record, knowledge of complications that may have occurred during the hospitalization, and ease of communicating with in-house physicians and other caregivers. Respondents felt that internal staff would be better able to advocate for the needs of the patients. Respondents with internal programs also felt it was an advantage to the hospital both clinically and financially to keep the program in-house. They already had qualified staff that could provide the service, and/or they expressed a desire to invest in their existing staff and expand the pharmacists’ services beyond the hospital stay. Many felt that an internal program had greater flexibility to adapt to the changing needs of the hospital and its patients. Several respondents also felt that patient satisfaction scores, which are linked to the financial stability of the hospital, were best maintained or improved by offering the service internally. Respondents in hospitals with an outpatient pharmacy suggested that an internal program seemed like a rational expansion of pharmacy resources. The most important goals of respondents’ hospital-run programs, listed in rank order, included preventing or reducing readmissions, facilitating safe medication use in the home, and coordinating pharmaceutical care upon discharge. The vast majority (80%) of hospital-run community liaison programs utilize hospital pharmacists to provide the service either alone or as part of a team that provides the service; others utilize a nurse/nurse practitioner (29%), community pharmacist (18%), or physician (6%) either alone or as part of a team. In at least half of respondents’ hospitals, community liaison professionals directly interact with the patient’s primary care physician, hospital pharmacists, and other members of the patient’s care team, most often by phone, email, or mail. About three-quarters (78%) interact with the patient at the bedside but less than half interact with the patient’s physician specialist or community pharmacist. While one might expect a hospital-run program to include interaction with all patients or caregivers before discharge from the hospital, only about three-quarters (78%) of respondents reported this; many (65%) contact the patient or caregiver by phone. Likewise, only 41% of respondents interact with patients and caregivers in the home or post-hospital setting. Vendor-Run Programs Respondents who utilized a vendor-run community liaison program reported several reasons for outsourcing this service. According to respondents who have employed vendor-based community liaison programs, the goals of the program were very similar to those mentioned by respondents with hospital-run programs. Believing that additional staff might need to be hired, respondents said convenience and lower cost were the most common reasons for using a vendor-run program. Respondents also suggested that vendor-run community liaison programs have been shown to increase patient satisfaction scores related to explaining possible drug side effects. Respondents who utilize a vendor-run community liaison program reported that both community pharmacists and pharmacy technicians provide the service. Direct interaction between patients and a community liaison professional occurs at the bedside with all (100%) patients/caregivers, and three-quarters (75%) are contacted by phone and visited in the home or other post-hospital setting. Respondents also reported that vendor-run programs include more face-to-face contact with the primary care physician (50%) than hospital-run programs (25%). However, no interaction was reported between the community liaison professional and hospital pharmacists, and little interaction was reported between the liaison professional and the patient’s community pharmacist. Respondents who reported a combination of vendor- and hospital-run programs were mostly large health systems in which hospitals with a fully owned retail pharmacy on-site provided a hospital-based program, and hospitals without an on-site retail pharmacy used a vendor-based program. Future Plans for Pharmacy Liaison Programs More than three-quarters (79%) of respondents without a program told us they plan to provide a community liaison program in the future. Of these, 84% said they would prefer to develop a hospital-run program. The frequently cited reasons for this choice have been compiled in Table 1 (page 2 in PDF). About 5% of respondents without a community liaison program said the hospital has been approached by an external vendor to provide this service, most often by phone or email, although several respondents reported face-to-face meetings between the vendor and corporate executives, such as the chief financial officer. Among the 16% of respondents who said they would prefer a vendor-run program, many provided the same reason: to ensure adequate resources dedicated to this purpose given that the hospital pharmacy was currently understaffed and busy. One respondent suggested that an outside perspective might be an added bonus if the liaison is able to bring a broader view of lessons learned to the hospital. Studies cited in our November 15, 2012, newsletter article (www.ismp.org/sc?id=164) clearly suggest that community pharmacy liaison programs can help reduce hospital readmissions and other types of harm and wasted healthcare resources associated with preventable adverse drug events. Thus, hospitals should not be tentative in their pursuit of such a program, be it hospital- or vendor-run. Although these programs may not yet be widespread, they are proving to be a valuable resource that may improve patient outcomes while reducing healthcare costs. With the new financial penalties associated with readmissions alone, now is an opportune time to garner interest and support for the program from hospital leadership. During the survey, health professionals asked us if we could provide contact information for hospitals that have implemented a community liaison program so they could get a sense of what has worked or not worked. If your hospital has implemented a community liaison program and would be willing to talk to others, please send your contact information to ismpinfo@ismp.org. Reference 1) Coleman EA, Smith JD, Raha D, et al. Posthospital medication discrepancies: prevalence and contributing factors. Arch Intern Med. 2005;165:1842-7. Acute Care Main Page Current Issue Past Issues Highlighted articles Action Agendas - Free CEs Special Error Alerts Subscribe Newsletter Editions Community/Ambulatory Long Term Care Consumer Home | Contact Us | Employment | Legal Notices | Privacy Policy | Help Support ISMP Med-ERRS | Medication Safety Officers Society | For consumers ISMP Canada | ISMP Spain | ISMP Brasil | International Group | Pennsylvania Patient Safety Authority 200 Lakeside Drive, Suite 200, Horsham, PA 19044, Phone: (215) 947-7797, Fax: (215) 914-1492 © 2014 Institute for Safe Medication Practices. All rights reserved

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Cost Squeeze Raises Concerns About Health Benefits Package Topics: Health ReformBy Jordan Rau and Eric PianinKHN Staff WritersJul 27, 2009 As Congress continues to try to scale back the costs of health care legislation, some patient advocates, health care policy analysts and lawmakers fear the plan may be pared to the point of leaving millions of Americans with either inadequate benefits or large out-of-pocket costs. Since June, leading lawmakers have been trying to lower the pricetag on legislation that would provide affordable coverage to 47 million uninsured Americans. After an initial estimate for a Senate plan came in at $1.6 trillion over a decade, lawmakers vowed to prune the cost to no more than $1 trillion. Now, with President Barack Obama encouraging House and Senate leaders to find even more in savings, some health care advocates question whether lawmakers can preserve the core principles of the Democrats’ plan — including near-universal coverage, ample insurance subsidies for low-income families and a cap on out-of-pocket costs. "We are very concerned that [lawmakers] have that fixed and arbitrary total dollar amount and this is it," said Stephen Finan, senior director of policy for the American Cancer Society Cancer Action Network. "Either it's not going to be enough to pay for adequate insurance or we just dumb down the level of benefits. We are concerned we could wind up with a package that is neither adequate nor affordable coverage." From the beginning, Obama and his allies on Capitol Hill have stressed the importance of slowing health care spending, but now the push to save money has begun to divide the Democrats, with moderates and conservatives saying that tough spending constraints are critical to prevent further growth in the federal deficit, and liberals fretting that their ambitions for overhaul may be fatally compromised. "People have got to be realistic about what is possible” to accomplish, said Senate Budget Committee Chairman Kent Conrad, D-N.D, a prominent deficit hawk. “We’ve got to live in the real world. We can’t do everything we’d like to do and pay for it and bend the cost curve the right way." The effort to trim the costs of the legislation has come partly at the behest of the Blue Dog Coalition, a group of fiscal conservatives in the House. Rep. Mike Ross, D-Ark., a leader of the group, said that unless the U.S. manages to slow the increase in health care costs to the overall inflation rate, "it's going to bankrupt this country and it’s going to cost 160 million people…who have health care today their health care in the future, perhaps as early as 10 or 15 years from now." But liberal lawmakers see it differently. Rep. Eliot L. Engel, D-N.Y., a senior member of the Energy and Commerce Committee, said, “There is a certain amount of money that has to be spent, and I will be loath to vote for something that doesn’t do the job. At some point you’re better off not doing it at all than doing a job that’s incomplete.” Karen Pollitz, a research professor at the Health Policy Institute at Georgetown University, says she's already worried that under the current legislative drafts, a person with a serious illness such as cancer or diabetes could quickly run up charges for thousands of dollars in deductibles, co-payments and co-insurance. Bill drafters are trying to protect people from such catastrophic costs by setting a maximum amount they would have to pay each year out of pocket—$5,000 a person and $10,000 a family in the House bill and a bit more in the Senate Health, Education, Labor and Pensions Committee version. But Pollitz said that even those levels may be too high for low-income people. “It may be fine for families that don't need too much care, but God forbid somebody gets into a motorcycle accident," Pollitz says. "They're going to hit the $5,000 limit quickly. People with limited incomes, and particularly families, can easily drown in bills, even if there are co-pays." Indeed, a report released last December by the Center for Studying Health System Change, a Washington research group, said that families experience substantial financial strain once they are paying more than 2.5 percent of their annual incomes on medical bills. For a family of three earning two-and-a-half times the federal poverty level, or $45,775 a year, that threshold would be reached once they spent more than $1,144 on health expenses. But Congress appears to be moving toward more cost sharing by patients. In a bill recently approved by the Senate health committee, insurers would be required to cover at least 76 percent of health care expenses incurred by the average plan member, and the Senate Finance Committee is considering setting the requirement at 65 percent. The House Democratic bill would set the ratio, technically known as "actuarial value," at 70 percent. That would be less than the standard health care plan available to federal employees and on par with what Medicare and high-deductible Health Savings Accounts pay, according to a recent report by the Congressional Research Service. Moreover, a typical private employer preferred-provider plan pays between 80 percent and 84 percent, and the typical health maintenance organization pays 93 percent, according to CRS. A secondary concern of advocates is what benefits these plans would actually cover. The bills identify broad categories, including hospitalization, emergency treatment, outpatient services, doctors and nursing, prescription drugs, rehabilitative services, mental health and substance abuse, maternity care and preventive services. Yet dental coverage for adults is not guaranteed in either the House or the Senate health bills, and maximum out-of-pocket limits do not appear to apply to medical services obtained from a provider outside an insurer's preferred network. Under the bills, the legislation would delegate to federal regulators the decisions about what specific procedures must be covered. The approach – similar to what Massachusetts did when it passed a statewide overhaul in 2006 -- is considered politically wise. It's intended to avoid setting off a feeding frenzy of interests lobbying Congress for the inclusion of their favored drug or medical treatment. But the vagueness makes it harder to clarify what Americans will be getting for their money, some consumer groups say. Patient advocates are pressing lawmakers to give them a broader role in advising the officials who would ultimately decide specific benefits. "You look at mental health and substance abuse and the question is, is this just for a certain set of clinical conditions like schizophrenia, or marriage counseling for couples who are having a hard time?" said Sabrina Corlette, director of health policy programs at the National Partnership for Women & Families, a nonprofit group based in Washington. "These are questions that families are going to have." President Bill Clinton's 1993 health care proposal spent dozens of pages spelling out the services to which patients were entitled. For instance: People in their 40s would have been guaranteed cholesterol tests every five years. Those needing prosthetics would have been assured of artificial legs, arms and eyes, and children under three years old would have been provided rubella and eight other immunizations. That plan, however, became bogged down in Congress. An additional concern of some about the bills is the level of subsidies that will be offered to low-income families to cover the cost of health care premiums. While both the Senate health and House plans have set that level at four times the federal poverty level—about $88,000 for a family of four—members of the Senate Finance Committee have been discussing dropping the threshold to 300 percent of poverty, which translates to about $66,000 for a family of four. That would be a substantial savings to taxpayers. However, if if fewer subsidies mean fewer people could afford insurance, it could make it harder for lawmakers to justify requiring that almost everyone have coverage. And that raises other issues, according to the insurance industry and others. Unless most people, including the healthy as well as the sick, are part of the insurance pool, it would be harder to restrain rising health costs. That, in turn makes it harder for the government to require insurers to guarantee coverage to everyone, even those likely to need costly care. Because of that domino effect, Congress is not planning to make it easy to get a hardship exemption from the requirement that individuals have health coverage. The Senate health bill proposes exempting people from buying insurance if the premiums are more than 12.5 percent of their adjusted gross incomes, while the House bill sets that threshold at 11 percent. But Senate Finance is considering requiring people to buy insurance even if premiums amount to as much as 15 percent of their incomes. “As Congress keeps lowering the money level of subsidies they're willing to provide, that by definition makes affordability a bigger problem," said Finan of the cancer society. "If they cut the subsidies too much, their promise won't be kept." We want to hear from you: Contact Kaiser Health News

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Back Pain Treatment for 9 Different Triggers Screening for Scleroderma Why Does Your Head Ache? 10 Tools to Ease Joint Pain Yerba santa is a sticky-leafed evergreen that is native to the American Southwest. It was given its name ("holy weed") by Spanish priests impressed with its medicinal properties. The aromatic leaves were boiled to make a tea to treat coughs, colds, asthma, pleurisy, tuberculosis, and pneumonia, and a poultice of the leaves was applied to painful joints.Unlike many medicinal herbs, yerba santa actually has a pleasant taste. It has been used as a general food flavoring and in cough syrups to disguise the bad taste of other ingredients.What Is Yerba Santa Used for Today? Yerba santa is often used for the treatment of the , as well as chronic respiratory problems such as . Unfortunately, there is no meaningful scientific evidence to indicate that it is effective. About the most that can be said scientifically is that one of its constituents, eriodictyol, might have mild expectorant properties. Topical yerba santa has been recommended as a treatment for poison ivy. 2DosageYerba santa tea may be made by adding 1 teaspoon of crushed leaves to a cup of boiling water and steeping for half an hour. However, many of its resinous constituents do not dissolve in water, and for that reason alcoholic tinctures of yerba santa are commonlyh used. Yerba santa is on the FDAs GRAS (generally recognized as safe) list for use as a food flavoring. There have been no reports of significant side effects or adverse reactions, except for the inevitable occasional allergic reaction. Nonetheless, safety in young children, pregnant or nursing women, or those with severe liver or kidney disease has not been established. How Much Do You Know About Home Remedies?Chicken soup for a cold? Holding your breath to halt your hiccups? Friends and family swear by these common cures. But you're not so sure. You've heard all the age-old remedies, but can you decipher fact from fiction? Find out how much you really know in this home remedy quiz.Find out how much you really know in this home remedy quiz.References1. Review of Natural Products . St. Louis, MO: Facts and Comparisons; 1991: Yerba Santa monograph. 2. Tierra M. The Way of Herbs . New York, NY: Pocket Books; 1990:254. 3. Review of Natural Products

医学

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Uncertainty surrounds death of Cumbrian hospital fall victim By James Broadhurst Last updated at 10:15, Saturday, 28 June 2014 A coroner says he couldn’t be certain whether a man who died after falling from a hospital toilet window was trying to escape or attempting to kill himself. Deividas Sereika Related: Inquest verdict due after man's death fall at Cumbrian hospital Deividas Sereika, 40, of Edinburgh Road, Maryport, died on May 8 last year after the fall from a third-storey window at Whitehaven’s West Cumberland Hospital. He broke a window in one of the hospital bathrooms and squeezed himself out head-first. Mr Sereika died a couple of hours later at about 10pm from his injuries after going into cardiac arrest twice. Earlier that day he was taken to hospital after being found in a distressed state complaining that aliens were talking to him through a chip in his wrist. Doctors and the mental health liaison team at the hospital determined that Mr Sereika, who had previous problems with alcohol, needed to be treated medically first because his hallucinations were likely caused by alcohol withdrawals from drink. Assistant coroner Robert Chapman recorded a narrative verdict. He said: “Taking into account his history of escaping from the hospital whilst in treatment, the state of his mental health, the attempted exit through the fire escape, it is uncertain whether, when exiting the window, he was trying to escape from the hospital ward or to kill himself.” Mr Sereika had previously run away from hospital in April 2012. Moments before Mr Sereika’s fall on May 8, Lianne Bartlett-Lowrey, a health care assistant at the hospital, saw him trying to get out of the fire exit. When she went up to him, he asked her where the toilet was. After showing him and returning to the nurse’s station she heard glass shattering and Mr Sereika had squeezed himself out of the bathroom window. One of the issues that had arisen during the inquest was whether the mental health liaison team should have carried out an assessment on Mr Sereikas. Dr Andrew Morgan, a consultant psychiatrist for the Cumbria Partnership NHS Foundation Trust, believed it was a missed opportunity, but Mr Chapman was satisfied that even if a mental health assessment had been carried out, it wouldn’t have affected the outcome. First published at 10:02, Saturday, 28 June 2014

医学

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InicioTemas de SaludProgramasCentro de PrensaPublicacionesDatosPaíses y CentrosAcerca de OPS Questions and Answers on Post-Pandemic Post-pandemic 1. What does post-pandemic mean? How do we know that the pandemic is over? The H1N1 pandemic was characterized by the emergence of a new influenza virus to which many people had no pre-existing immunity. It caused unusual and extensive outbreaks of disease in the summer months in many countries and very high levels of disease in winter months. It was also characterized by an almost complete dominance of the pandemic virus over other seasonal influenza viruses, and by unusual clinical patterns where the most severe cases were occurring most often in younger age groups. We are now moving into a situation where many people in all age groups in many countries have some immunity to the new virus, and where no unusual summer outbreaks have occurred in either the Northern or Southern Hemispheres, and where seasonal influenza A (H3N2) and influenza B viruses are being reported in many countries. Based on these criteria we see an overall picture where pandemic patterns have been replaced by seasonal patterns of influenza. However, it is important to realize that individual influenza seasons themselves can be highly variable. In some years, the impact can be mild while in other years it can be quite severe. In the post pandemic period, cases and outbreaks due to the H1N1 virus will continue to occur. In addition, it is most likely that younger age groups, including pregnant women, will continue to be affected disproportionately by cases of severe disease from H1N1, including viral pneumonia. It is impossible to predict if younger people will remain at higher risk or whether this will change over time. Given this picture, it will remain important for people to take prudent steps to protect themselves from influenza infection such as through use of vaccines, hand and respiratory hygiene and other steps. Pandemic Influenza Preparedness and Response Guidelines 2. Does the end of the influenza pandemic mean that fewer people will become sick and die of the H1N1 virus? The future impact of the H1N1 virus is not possible to predict. On the one hand, the H1N1 virus is expected to continue to circulate as a seasonal influenza strain for the foreseeable future and because of this, more people will develop immunity to this current version of the virus. On the other hand, the virus is also expected to change over time as a result of antigenic drift and these changes may mean that the immunity that has developed to this version of the virus may become less protective against future versions. In addition, there may well be areas of some countries that were less severely affected in earlier periods of transmission that could experience more severe disease in a second season. 3. Why did WHO take so long to declare the end of the pandemic? WHO has been monitoring epidemiological and virological evidence from all parts of the world, including both Northern and Southern Hemispheres, to determine when the pandemic is over. In particular, WHO has waited until the picture in the Southern Hemisphere and tropical countries has become clearer. 4. What does the end of the pandemic mean for individuals? For most individuals, there will not be much impact on their daily lives. Regardless of whether the world is in a pandemic situation or not, many individuals are always susceptible to severe infection by influenza viruses. Therefore, individuals should take prudent steps to reduce their risk of infection, including use of influenza vaccine when available and especially if they are in group at high risk for severe illness. Most individuals who become ill can be treated safely at home but caretakers and family members should be aware that if an individual develops symptoms suggesting more severe disease, such as prolonged high fever, trouble breathing, or confusion, then professional medical care should be sought. 5. Will the pandemic flu virus continue to cause severe illness among the same higher risk groups? Based on available evidence, the virus currently continues to pose a higher risk for severe illness in some groups, including young children, pregnant women and those with respiratory or chronic health conditions. This will likely continue to be the case as these same groups were known to be at higher risk of severe disease with the previously circulating seasonal influenza strains Related links: Who is more at risk to severe illness? What about other risks? 6. What can individuals do to protect themselves from the H1N1 flu virus? Individuals can continue to protect themselves from the virus through preventive measures such as practicing good respiratory etiquette including covering sneezes and coughs. WHO also continues to recommend vaccination against the virus through a monovalent (single virus) pandemic vaccine, or a trivalent (three viruses) seasonal influenza vaccine, depending on whichever is available locally. Additional measures such as respiratory etiquette (for example, covering your mouth when you cough) and good hand hygiene practices also have roles in preventing spread and acquisition of infection. 7. What major public health measures are recommended to countries now? Even as we move out of the pandemic period, it is important for countries to remain vigilant and alert for infections and outbreaks and to continue to take steps to protect their populations against influenza. WHO recommends that countries: • Monitor for unusual patterns of influenza disease, including any changes suggestive of potential changes in the severity of the H1N1 virus. • Continue routine monitoring of respiratory disease surveillance and reporting through pre-established channels. • Continue vaccination against influenza, including using either the pandemic monovalent H1N1 vaccine or the seasonal vaccine containing the new H1N1 virus, when influenza vaccine is available and according to national health authorities. The H1N1 pandemic provided a significant challenge to all countries and WHO encourages countries to assess their experience and identify lessons that can be applied to strengthen their preparedness and response to future pandemics. 8. What is the possibility of this virus drifting or mutating into a more virulent form? Flu viruses are predictable in the fact that they all change over time, but are unpredictable as to the direction in which they will change. As the human population develops immunity to this version of this virus, it is anticipated this virus will change to evade the immunity through a process of mutations known as antigenic drift. What we do not know is what the changes may be. It is possible for the virus to become milder, or possibly, more pathogenic and severe. It may develop new properties such as antiviral drug resistance. This is one of the reasons why global monitoring is used to follow changes in influenza viruses and why influenza vaccines must be updated each year. . Antigenic drift WHO decision-making regarding the pandemic 1. Did pandemic preparedness waste resources since many vaccines and antivirals were not used and have to be destroyed? Countries and WHO undertook broad efforts to be better prepared for the pandemic because being unprepared is always less desirable. The overall effort to better prepared for this pandemic had enormous benefits that will continue into the future and that will broadly help countries to be better prepared for other disease threats. For example, because of the passage of the International Health Regulations, one of the critical preparations, countries now report disease threats and important information quicker than ever. This will strengthen the world's alertness and responsiveness. Within this broad context, vaccines and antivirals can be seen to be one part of a larger overall effort to be better prepared. Although minimizing waste is important. their availability helped to mitigate the health impact of the pandemic . Over the course of the pandemic, increasing clinical data have been published in peer-reviewed medical journals confirming that prompt use of antivirals correlates with improved recovery from illness and fewer deaths. Evidence shows that antivirals have been especially effective for treating patients at increased risk of developing complications from H1N1. Similarly, the H1N1 vaccine has been demonstrated through world wide monitoring efforts to be safe and in studies to be effective. Now the pandemic H1N1 virus has been incorporated into the seasonal vaccines. Finally, it must be stressed that in a future pandemic, we could face a situation where not enough vaccines and antiviral drugs will be available. The big issue is not remaining stocks, but how to make sure that the world's populations can have enough vaccines and antiviral drugs when needed. That is still an unmet challenge. Related link:

医学

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Home/Beautypedia Product Reviews/Expert Reviews/High Performance Balancing Cleansing Oil High Performance Balancing Cleansing Oil (Discontinued) by Shu Uemura Price:$28 - 5 fl. oz. High Performance Balancing Cleansing Oil is very similar to the Cleansing Beauty Oil Premium A/O, only with fewer bells and whistles (none of which have much, if any, impact on skin). Otherwise, the same review applies. The original Shu Uemura cleansing oil. Two-in-one cleanser and makeup remover helps maintain the skin's integral balance while thoroughly rids skin of impurities. Leaves skin smooth and soft without stripping skin of its natural oils. Removes waterproof makeup. Mineral Oil, Corn Germ Oil, Polysorbate 85, Safflower Seed Oil, Cetyl Ethylhexanoate, Sorbitan Trioleate, Jojoba Seed Oil, Sea Water, Squalane, Macadamia Ternifolia Seed Oil, Glycerin, Linalool, Tocopherol, Rosemary Leaf Extract, Canola Oil, C12-15 Alkyl Benzoate, Dicaprylyl Carbonate, Isopropyl Myristate, Ethyl Oleate, Fragrance Shu Uemura (pronounced "ooo-ee-moo-ra") has been a makeup artist for over 50 years, and is said to still be involved with his namesake company. The line is based in Japan but has an international presence; L'Oreal obtained a 35% stake in the company in 2000, and gained management control in 2004. L'Oreal's involvement with this line explains why many of the previous foundations have either been discontinued (rightly so) or retooled for the better, and undoubtedly must have something to do with the dismissal of other lackluster products and the line's expanded presence in department stores. They've done a good job giving this already-trendsetting group of products an valuable breath of fresh air while at the same time keeping several of the classic products the line has become known for. We also want to applaud the new tester units; most are sensibly labeled, and they're very accessible. Also a plus is that this line tends to draw salespeople who are adept at makeup and have a penchant for being experimental with color (which can be great for those looking to get out of a makeup rut).We suppose the best thing we can say about Shu Uemura's skin care is that the cleansing oils (which are recommended only for dry to very dry skin) do a thorough job of removing all types of makeup. Beyond that, the unreasonable prices, dubious claims, and overall average formulas don't add up to a justifiable reason to assemble a full skin-care routine from this line. Color and brushes are where Shu Uemura excels, and their reputation in this area is well earned.The selling point of almost all of the Shu Uemura skin-care products is deep sea water and algae, neither of which is unique to this line or essential for any skin type. Deep sea water does not have any research backing up the claims for its anti-aging benefit for skin. One study examined a species of deep sea urchin whose skin was infected with a bacteria present in the water, while another illuminated the fact that deep sea water contains pathogenic bacteria that can cause skin problems, as seen in humans who dive to such depths. So much for deep sea water being helpful.Other published studies have demonstrated that drinking the stuff had benefits for a sampling of people with atopic eczema/dermatitis syndrome (AEDS). But drinking deep sea water isn't the same as slathering or spraying it on skin, and since this was not a comparison study, who knows if the eczematic patients involved may have had a similar response if they had been drinking green tea, or eating more omega-3 rich foods, such as salmon instead? (Sources: European Journal of Clinical Nutrition, September 2005, pages 1093–1096; and Diseases of Aquatic Organisms, February 2000, pages 193–199). In short, there is no convincing evidence that seawater, whether bottled near the shore or from leagues below, is superior water for skin.Shu Uemura hypes water as the best source of hydration for skin, but that is also far from the truth. It takes much more than water to create healthy skin. In fact, too much water is bad for skin! Excess water actually impairs and disrupts the skin's protective outer barrier and can cause irritation, dryness, and an impaired immune response (Sources: Journal of Investigative Dermatology, December 1999, pages 960–966; and Wound Care Journal, October 2004, pages 417–425). What's in short supply in the skin-care products below are antioxidants, cell-communicating ingredients, or skin-identical ingredients, types of ingredients that are much more essential to healthy skin functioning than any kind of seawater.For more information about Shu Uemura, owned by L'Oreal, call (888) 748-5678 or visit www.shuuemura-usa.com.Shu Uemura MakeupAs you'll see from the reviews below, Shu Uemura does several categories exceedingly well. His powder blush and eyeshadow textures aren't in a class by themselves anymore thanks to other companies improving their formulas, but they are still amazingly smooth and a pleasure to work with. The loose powders are wonderful, too, and the latest foundations improve on their predecessors with even better shades and higher sunscreen ratings. Of course, the brushes from this line also deserve mention. Other than M.A.C. and possibly Trish McEvoy, you won't find a more extensive selection anywhere, though you'll want to keep in mind that the prices are all over the map, and mostly on the high side.We'd ignore most of the pencils, which tend to be expensive and ordinary, as are the lipsticks. Considering L'Oreal's influence you'd think that this line would’ve become stronger with their mascara offerings (as L'Oreal did when it purchased Maybelline a few years ago), but that hasn't happened yet. Perhaps that improvement is yet to come.Note: Shu Uemura is categorized as a brand that tests on animals because its products are sold in China. Although Shu Uemura does not conduct animal testing for its products sold elsewhere, the Chinese government requires imported cosmetics be tested on animals, so foreign companies retailing there must comply. This requirement is why some brands state that they don’t test on animals “unless required by law.” Animal rights organizations consider cosmetic companies retailed in China to be brands that test on animals, and so does the Paula’s Choice Research Team. Resist C15 Super Booster + Resist Super Antioxidant Concentrate Serum Resist Optimal Results Hydrating Cleanser Item #:

医学

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For Many Women, Hot Flashes Last 10 Years or More After Menopause FRIDAY, Jan. 31, 2014 (HealthDay News) -- Many women continue to have hot flashes for years after menopause, a new study finds. Researchers looked at 255 older women and found that 80 percent of them had moderate-to-severe hot flashes during menopause, 17 percent had mild hot flashes and 3 percent had no hot flashes. Obese white women and black women (whether obese or not) were most likely to have moderate-to-severe hot flashes, while non-obese white women had the lowest risk. Women who had more than a high school education had a 34 percent lower risk of hot flashes, a finding that calls for additional study, the University of Pennsylvania Perelman School of Medicine researchers said. They also found that moderate-to-severe hot flashes continued for an average of nearly five years after menopause. And more than one-third of women had moderate-to-severe hot flashes for 10 years or more after menopause, according to the study published online this week in the journal Menopause. Hormone replacement therapy is the primary medical treatment for hot flashes, according to the researchers. Current guidelines recommend that the treatment be used for no longer than five years. But the Penn researchers said there's a lack of evidence to support the recommended three- to five-year limits on the use of hormone therapy. They noted that concerns about health issues linked to hormone therapy -- such as cancer and cardiovascular problems -- make some doctors reluctant to prescribe it, or they stick to the recommended time limits on its use. "Our findings point to the importance of individualized treatments that take into account each woman's risks and benefits when selecting hormone or non-hormone therapy for menopausal symptoms," study author Ellen Freeman, a research professor in the department of obstetrics and gynecology, said in a university news release. "While leading non-hormone therapies such as Paxil or Escitalopram may provide some relief of menopausal symptoms for some women, for others, they may not be as effective as hormone-based therapy," she added. The U.S. Office on Women's Health has more about menopause. SOURCE: University of Pennsylvania, news release, Jan. 30, 2014 Adjusting Your Attitude About Menopause Periods, Pregnancy, Menopause—And Sleep Drug Reference Belladonna Alkaloids; Ergotamine; Phenobarbital Black Cohosh, Cimicifuga racemosa Menopause Quiz Antidepressant Eases Menopause-Related Symptoms, Study Finds Bleeding Irregularities Common in Menopause, Study Finds Home Page - Gynecological Health Introduction to Menopause Hot Flashes: You Don’t Have to Take the Heat

医学

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Proclamation 5544 -- National Spina Bifida Month, 1986 the President of the United States of Spina bifida strikes one to two of every one thousand babies born in the United States. It is the most common crippler of newborns. When this disease occurs, the baby's spinal cord forms abnormally and the arches of the vertebrae, the bones that surround the cord, fail to develop. The spinal cord or its protective tissue may be displaced outside the spinal canal. Nerves supplying the legs, bladder, and bowel are incompletely developed or damaged. nerve damage resulting from this disease can have devastating consequences, including muscle paralysis, loss of sensation in the skin, and spine and limb deformities. Most babies with spina bifida also develop hydrocephalus -- a potentially dangerous buildup of fluid pressure within the brain. thanks to important advances in neurosurgery and antibiotic therapy, a baby born with spina bifida today has between an 80 and 95 percent chance for survival. And the development of new surgical and bracing procedures and devices to compensate for lost function have made it possible for patients to lead more active and normal lives. now under way in the Nation's scientific laboratories is aimed at improving our understanding the cause of this disease and developing methods to prevent it. Much of this work is being done by scientists supported by the Federal government's National Institute of Neurological and Communicative Disorders and Stroke and the National Institute of Child Health and Human Development. Voluntary agencies like the Spina Bifida Association of America, the National Easter Seal Society, and the March of Dimes Birth Defects Foundation also promote vital research and provide essential services and encouragement to families. In the work of these agencies, and that of the researchers and clinicians they sponsor, lies the hope that we will one day conquer spina bifida. enhance public awareness of the problem of spina bifida, the Congress, by Senate Joint Resolution 368, has designated the month of October 1986 as ``National Spina Bifida Month'' and authorized and requested the President to issue a proclamation in observance of this event. Therefore, I, Ronald Reagan, President of the United States of America, do hereby proclaim the month of October 1986 as National Spina Bifida Month, and I call upon the people of the United States to observe this month with appropriate observances and activities. Witness Whereof, I have hereunto set my hand this 8th day of Oct., in the year of our Lord nineteen hundred and eighty-six, and of the Independence of the United States of America the two hundred and eleventh. Ronald [Filed with the Office of the Federal Register, 12:08 p.m., October 9, 1986] The proclamation was released by the Office of the Press Secretary on October

医学

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4 Eating Habits May Help Older Women Maintain Weight Loss TUESDAY, Aug. 28 (HealthDay News) -- Older women who want to keep off weight -- no small feat for many after menopause -- might consider four specific eating behaviors, according to new research."Losing weight and maintaining a weight loss is incredibly difficult," said Bethany Barone Gibbs, an assistant professor of health and physical activity at the University of Pittsburgh.She looked at both short-term and long-term changes made by nearly 500 overweight or obese women, all in their late 50s.She found specific eating habits linked with weight loss -- or no weight loss.Long-term, those who decreased desserts, sugary beverages and cheeses and meats (which were grouped together) and increased fruits and vegetables did best.The study is published in the September issue of the Journal of the Academy of Nutrition and Dietetics.Barone Gibbs looked at two time points -- six months and four years. The behavior changes at the six-month mark linked with weight changes were not the same as those linked with weight control at the four-year mark.At six months, eating fewer desserts, eating fewer fried foods, drinking fewer sugary beverages, eating more fish and eating out less were linked with more weight loss.However, at the four-year mark, not all those behaviors were still linked with weight loss. This finding suggests that some behaviors aren't typically maintained long-term, she said.For instance, the link between reducing fried foods and weight control dropped out at the four-year mark. "Maybe you can say no French fries for six months," she said, but not forever.Long term, those who ate more fruits and vegetables and less meat and cheese were more likely to sustain weight loss.The changes in diet and weight were small. "If you increased your fruits and vegetables by two servings a day [over whatever you ate before], that was associated with a three-pound weight loss at the end of four years," she said.Decreasing sugary beverages by 16 ounces daily was also linked with about a three-pound loss after four years.Those strategies that worked at the four-year mark seem worth adopting if women want to lose weight and maintain the loss, Barone Gibbs said. She mined the data from an earlier study of women, activity and nutrition. In that original study, researchers evaluated how lifestyle interventions affected heart health.Barone Gibbs took the information collected and determined which eating habits were linked with more weight loss.In the earlier study, the 481 women were assigned at random to a lifestyle-change group or a health-education group. Those in the lifestyle-change group met with experts throughout the study and aimed to follow healthier habits, such as boosting fruits and vegetables. The health-education group was offered seminars on women's health, but not specifically weight-loss advice.Barone Gibbs found an association between the eating habits and weight control, but the research did not prove cause and effect.More than one-third of Americans are obese, according to the U.S. Centers for Disease Control and Prevention. Among older women, natural declines in energy output -- that is, many become sedentary -- could make long-term weight loss more challenging, according to Barone Gibbs. Some older women blame weight gain on a slower metabolism, but the process is more complicated than that. As people age, their amount of muscle declines and their amount of body fat rises, so they burn fewer calories. It is ultimately not your metabolism speed that determines if you are too heavy, experts say, but the amount you eat and how much activity you get."This study provides a glimpse at why changes in eating patterns must be maintainable for weight loss to be sustainable," said Connie Diekman, director of university nutrition at Washington University in St. Louis."The study supports the fact that diets don't work but small steps in behavior change can help with weight loss," Diekman said.However, this study is not the final word on the subject, she said. "Since the study did not set out to establish cause and effect, more studies would be helpful," she said.More informationTo learn about weight and health, visit the Academy of Nutrition and Dietetics.SOURCES: Bethany Barone Gibbs, Ph.D., assistant professor, health and physical activity, University of Pittsburgh; Connie Diekman, R.D., director, university nutrition, Washington University in St. Louis; September 2012 Journal of the Academy of Nutrition and Dietetics Related Articles Y Chromosome Loss May Predict Earlier Death for Men October 22, 2014 Dieters May Be Thwarted by Absence of Healthy Foods October 18, 2014 Learn More About Sharp

医学

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Resource Center Current & Past Issues eNewsletters This copy is for your personal, non-commercial use only. To order presentation-ready copies for distribution to your colleagues, clients or customers, click the "Reprints" link at the top of any article. Employer Health-Care Delay May Goose Exchange Enrollment Increased use of exchanges could bolster Obama’s health-care overhaul. By Alex Wayne, Bloomberg July 16, 2013 Freeing companies from a U.S. government mandate to offer employees health care is setting off a chain of events that may enlarge the pool of uninsured Americans. That may be good for President Barack Obama’s health-care overhaul. The success of the 2010 Affordable Care Act is largely dependent on how many people are willing to buy subsidized health plans through government exchanges. Most of the people affected by Obama’s decision this month to delay the employer mandate to provide health care will now be eligible to use the exchanges when they open Oct. 1. The law’s creation of state-by-state marketplaces had targeted about 26 million of the more than 50 million uninsured Americans for coverage. “A few million” more may now be made eligible by the delay, said Larry Levitt, senior vice president at the nonprofit Kaiser Family Foundation research group. “This administration needs people to enroll in health insurance, and they want them to enroll in health insurance through the exchanges,” said Chris Condeluci, a lawyer at Venable LLP in Washington who helped write the Affordable Care Act while working as a Senate Finance Committee aide. Obama, a Democrat, has been stymied by Republicans in his effort to implement the law. The employer-mandate delay has emboldened Republicans, who have three House committee hearings scheduled this week on the Affordable Care Act, and have set plans to vote on legislation to scale back two major provisions. “Each provision you delay continues to demonstrate that the entire law is unworkable,” U.S. House Speaker John Boehner, a Republican from Ohio, said in a July 9 letter to Obama. Boehner demanded additional information about the employer-mandate delay, including estimates on “the change in the number of individuals receiving subsidies through” the exchanges. The July 2 announcement by the Obama administration lets employers with 50 or more workers wait until 2015 to comply with a mandate to provide full-time workers with health insurance. Former Democratic Party Chairman Howard Dean said increased enrollment in the exchanges will be “an unintended effect” of the employer-coverage delay. “What this means is that if you don’t have insurance, the exchange is your default position, not the employer,” Dean, who is a medical doctor and served as Vermont’s governor from 1991 to 2003, said in a phone interview. “This will drive more people into the exchanges, and that’s good.” If the exchanges are to benefit, it will be as a result of many separate decisions by large employers affecting small numbers of workers. For athletic apparel retailer Foot Locker Inc., the delay may affect “a few hundred” people out of its 38,000-person workforce, said Ken Hicks, the New York-based company’s chairman and chief executive officer. “For larger companies, it’s not that big a deal,” he said in a phone interview. In 2012, 95 percent of companies with at least 50 workers offered health benefits to at least some of their workers, according to Menlo Park, California-based Kaiser, which has been tracking implementation of the health law. That leaves a thin margin for exchange enrollment beyond what was already projected, said Kevin Counihan, the executive director of Connecticut’s exchange. The effect of the employer-mandate delay is probably “more symbolic than substantive,” and it’s up to the exchanges to get word out that the programs are available, he said. The affected Foot Locker employees work 30 to 40 hours a week. Instead of immediately reducing their hours to less than 30 -- the threshold that triggers the health law’s requirement for employers to offer health care -- companies will see the delay as something that “allows you time to get them situated properly,” Hicks said. “We now have time to get them to the 30 hours or make a determination whether we want to make them full time,” he said. Wegmans Food Markets Inc., a supermarket chain based in Rochester, New York, said in a statement that the health law means “eligibility requirements will change” for part-time employees, though it didn’t say if anyone would lose their company-sponsored coverage and be eligible for the exchanges. At least 14 states are building their own exchanges, and the federal government is setting up the rest for the remainder of the 50 U.S. states. About 7 million people are expected to get coverage through their state exchanges in 2014, according to the Congressional Budget

医学

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Health System > Giving > Young and Butani recognized for outstanding achievement and ... All Leading Initiatives Comprehensive Cancer Center and Programs Children’s Hospital and Programs Informatics and Telehealth Stem Cell and Transplantation Student Scholarships and Support Emergency, Trauma and Surgical Services All Ways to Give Gifts of Stock, Real Estate, Other Why Support UC Davis? Your Giving Matters Health System Leadership Health System Strategic Plan UC Davis School of Medicine Learn more about UC Davis Health System’s major awards and honors UC Davis Health System Annual Report (PDF) The campaign for UC Davis Major gifts Memorial and tribute gifts Gifts of stock, real estate, etc. Events Employee giving NEWS | May 21, 2012 Young and Butani recognized for outstanding achievement and teaching Two UC Davis Health System faculty were recognized with the Hibbard Williams Extraordinary Achievement Award and the C. John Tupper Prize for Excellence in Teaching during the School of Medicine commencement ceremony on May 19, 2012. The Williams Award went to J. Nilas Young, professor and chief of cardiothoracic surgery, and the Tupper Prize was given to Lavjay Butani, professor and chief of pediatric nephrology.J. Nilas YoungNamed for the second dean of the medical school, the Williams Award recognizes exceptional faculty contributions beyond traditional teaching and research roles. Young has brought international distinction to UC Davis through his leadership of the cardiothoracic surgery team and as medical director of the Heart to Heart International Children's Medical Alliance. In 1989, he co-founded the organization to bring surgical expertise to children worldwide whose congenital heart defects cannot be repaired in their own countries. He has since made yearly humanitarian visits to Russia to provide critical medical services and physician training.Young has been with UC Davis since 2001, where he is recognized for his expertise in surgical treatments for high-risk cardiac patients. His research focuses on improving patient outcomes, including investigating the potential of microRNAs to regenerate injured myocardium tissue, perfecting complex aortic surgery procedures and defining pre-operative therapies to reduce post-operative complications. As director of the cardiothoracic surgery residency program, he is known for recruiting superior surgeons-in-training to the university and for his skilled, approachable mentorship style.Created by the founding dean of the medical school, the Tupper Award recognizes sustained and enduring contributions to medical education. An important factor in the selection of award recipients is widespread recognition as an outstanding teacher.Lavjay ButaniButani, who has been with UC Davis since 1999, is a thoughtful, inspiring educator who encourages critical thinking and humanism among medical residents and students. He is known for inspiring confidence and trust among those he teaches while leading them to achieve the highest standards in family-centered, evidence-based pediatric care.Butani leads the only pediatric nephrology program in the region and a team that is nationally recognized for advanced care and research to improve outcomes and quality of life for children with kidney disease. He has particular interests in treating kidney transplant recipients and children with advanced chronic kidney disease. The UC Davis School of Medicine is among the nation's leading medical schools, recognized for its research and primary-care programs. The school offers fully accredited master's degree programs in public health and in informatics, and its combined M.D.-Ph.D. program is training the next generation of physician-scientists to conduct high-impact research and translate discoveries into better clinical care. Along with being a recognized leader in medical research, the school is committed to serving underserved communities and advancing rural health. For more information, visit medschool.ucdavis.edu. Giving | UC Davis Health System | 4900 Broadway, Suite 1150 | Sacramento, CA 95820 | Phone: 916-734-9400 | FAX: 916-451-2637

医学

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Holly Auer (215) 349-5659 Department of Communications Gene Therapy Improves Vision in Patients with Congenital Retinal Disease Press Kit: Gene Therapy Improves Vision in Patients Department of Opthamology, University of Pennsylvania School of Medicine BEHIND THE HEADLINE Labs, Love, and . . . a Vision Penn Doctors’ Enduring Partnership Leads to Sight for the Blind The collaboration that paved the way for this week’s announcement of a breakthrough gene therapy treatment for blindness began more than 20 years ago in a medical school lab. As a young Jean Bennett and Al Maguire – now both faculty members in the department of Ophthalmology at the University of Pennsylvania School of Medicine -- carefully tunneled through a human brain together during their first-year anatomy class, chemistry sparked between the pair. Jean Bennett and Al Maguire Click on thumbnail to view full-size image He made her laugh, with a brainy, dry wit that left others wondering when he was telling a joke and when he was being serious. Two years later, the pair married, and they capped off their Harvard Medical School careers with a special project – the birth of their first child. During those early years together, the two doctors dreamed big about their plans for the future. Maguire focused on building a career in ophthalmology, specializing in retinal degeneration. And Bennett, who also earned a doctorate in cell and developmental biology at the University of California at Berkeley, turned toward her background in basic science. Intrigued by animal models of these eye diseases, and early gene therapy work she’d seen in a mentor’s lab at the National Institutes of Health, she and Maguire began to ask “what if?”, thinking of ways to combine their respective passions. It was still a pie-in-the-sky fantasy -- this notion of somehow delivering corrected genes to make the blind see -- but soon, the roots of the science began to spread. “In the next couple years, it became clear that it even though it was still fantasy, it was becoming more and more realistic,” Bennett says. By 1992, the couple landed at Penn, where Maguire combined his clinical work with the genetic research they built during a year Bennett spent working in a makeshift lab filled with improvised tools at the Michigan hospital where Maguire completed a fellowship. In 2001, they hit a huge milestone in their pursuit, by leading a team that developed a gene therapy protocol to restore sight in a dog afflicted with a severe retinal degeneration that, in humans, renders infants permanently blind. Now, the latest breakthrough Bennett, Maguire and their colleagues have demonstrated shows that this gene therapy can be used to safely restore vision in human subjects. They detail their success in three young adults this week in the New England Journal of Medicine. Despite the research’s huge imprint on their professional lives, the couple says they try to limit shop talk at home – the dinner table, for one, is sacred space reserved for other topics – and they also share a love of outdoor pursuits and the arts. Bennett plays the piano, and Maguire is an oil painter, and they count among their family members an adopted seeing eye dog and the tiny birds that hatch in their aviary. The couple has three children, ages 22, 21 and 18. In all things, however, their shared passion for helping the visually impaired propels them forward. The ups and downs of bench science don’t deter Bennett, and Maguire continually poses new ideas of how to measure progress in their work. When it’s slow-going, there’s the wonder of seeing their patients cope with incredible adversity – to photograph tiny items in a museum, blow the images up and hold them close to their face to see, for instance, or behold the spectacular colors of floral blooms at the Philadelphia Flower show despite failing conventional tests for color vision – that keeps them focused on the dream that ignited so many years ago.

医学

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Bribing People To Lose Weight Works, Says Study By: AP (Posted by Melissa Brunner) Posted: Thu 2:08 PM, Mar 07, 2013 / Article (AP) Willpower apparently can be bought. The chance to win or lose $20 a month enticed dieters in a yearlong study to drop an average of 9 pounds - four times more weight than others who were not offered dough to pass up the doughnuts. Many employers, insurers and Internet programs dangle dollars to try to change bad habits like smoking or not exercising, but most studies have found this doesn't work very well or for very long. The new study, done with Mayo Clinic employees, was the longest test yet of financial incentives for weight loss. Doctors think it succeeded because it had a mix of carrots and sticks - penalties for not losing weight, multiple ways to earn cash for succeeding, and a chance to recoup lost money if you fell off the "diet wagon" and later repented. Incentives are "not like training wheels where people learn healthy habits and then will continue them on their own" -- you have to keep them up for them to work, said one study leader, Dr. Steve Driver of Mayo in Rochester, Minn. And if you're looking to set up a system like this at work or among friends, the key is to make it self-sustaining, Driver said. The Mayo one did that by having people who didn't lose weight put penalties into a fund that paid rewards to those who did. It's also a good idea to make people pony up in advance. One woman flew into a tizzy when she stepped on a scale at a weigh-in and was told she'd have to pay. "She headed for the door" but later came back and paid, Driver said. "People in Minnesota are pretty honest." Driver will discuss the study this weekend at an American College of Cardiology conference in San Francisco. The group released results Thursday. Mayo paid for the study and Driver owns stock in Gympact, a company with an Internet program that gives financial incentives for exercising. The diet study involved 100 obese employees at Mayo Clinic but was not a workplace wellness program. Half were given weight-loss counseling, monthly weigh-ins and a three-month gym membership. The others had those things plus financial incentives. The aim was to lose 4 pounds a month up to a goal that depended on their starting weight. If they failed, they paid $20 into a kitty. If they succeeded, they got a voucher to collect $20 when the study ended. Part of the kitty was used to pay the rewards. The rest was put into a lottery that anyone could win, whether they had made their weight-loss goals or not. "People saw that if they stuck with it, they had a chance at winning more than they had lost," Driver said. Participants in the financial incentives group also earned $10 a month and lottery "tickets" for coming to monthly weigh-ins and texting their weights to study leaders each week, said Dr. Don Hensrud, preventive medicine chief at Mayo. So people could have lost as much as $240 or won as much as $360, plus what built up in the lottery fund. After a year, 27 of the 50 financial incentive participants came out ahead moneywise. About 62 percent of them completed the study versus 26 percent of the other group. The incentives group lost a little more than 9 pounds on average, compared to 2.3 pounds for the others. The results are promising, but people may need to lose more than 9 pounds to make a big difference in health, said Dr. Kevin Volpp, director of the University of Pennsylvania's Center for Health Incentives and Behavioral Economics. "There's been an explosion of interest in this" and 86 percent of large employers now provide incentive programs like this, he said. The cash was a big motivator for one study participant -- Audrey Traun, 29, a lab training specialist who dropped 40 pounds, from 215 pounds to 175. "I was impressed. I didn't think I was quite capable of that," said Traun, who lives in Kellogg, Minn. As the study went on, though, the cash became less important, and "it was actually more motivating to see my progress -- pounds lost and how my clothes were fitting," she said. Traun used the nearly $400 she earned in the study on a family vacation. In England, there was big enthusiasm a few years back for campaigns using cash or gift certificates to convince people to make healthier choices, like getting vaccinated, quitting smoking and losing weight. But after a few limited trials, the programs have mostly petered out. The most successful were those that offered pregnant women vouchers if they stopped smoking; several of those programs are still in place. "You have to prove these schemes work otherwise it's just money down the drain," said Eleni Mantzari, who studies financial incentives in health at King's College London. People often revert to unhealthy habits once the financial motivation is gone, she said. Over 57,000 Kansans Signed Up For ACA Coverage Comments are posted from viewers like you and do not always reflect the views of this station.

医学

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Stemedica/Dr. Art Tucker letter Jump to: navigation, search 02 September 2007 The Royal Gazette newspaper in Bermuda has recently reported in a number of articles the proposal to create a Stem Cell laboratory and treatment centre in Bermuda (1). The clinic is proposed to be sited in a converted private dwelling in Smith’s Parish. The articles pertain to a joint press release by the current Bermudian Premier Dr Ewart Brown, his wife, Mrs Wanda Brown and Stemedica Cell Technologies Incorporated (2). The articles describe the origin of Stemedica Inc as a Russian company based in California. Stemedica Inc is reported to have existing facilities in Moscow, Seoul, Paris, Mexico and Switzerland. The disclosed targets of Stemedica Inc are the treatment of neurodegenerative diseases by the use of adult stem cells (possibly autologous: a situation in which the donor and recipient are the same person). The company seeks to gain credibility by linking to a National Institute of Health Website which outlines stem cell developments (3) and NIH information sites, together with groups like www.michaeljfox.org, www.alz.org and www.strokecentre.org. It is unknown if Stemedica Inc is acknowledged or supported by these organisations. A search of these linked sites provides no reference to Stemedica Inc, thereby suggesting an opportunist association. Review of the Stemedica Inc website clearly indicates that their activities are focussed upon clinical Trials, principally in the areas of Neurodegenerative disease, ophthalmology, Urology and Tissue regeneration (ulcerative wounds and burns). This is further emphasised by Dr Brown’s press release which confirmed that “To begin with it [the clinic] will focus solely on research, but eventually hopes to be able to treat one or two stem cell patients per week”. Claims for ‘successful outcomes’ of stem cell therapy in every category by Stemedica Inc are not defined or reported. A search of the NIH Clinical Trials website identifies 773 currently registered stem cell studies associated with the USA. I was unable to find reference to Stemedica in any of these clinical Research Studies. The vast majority of studies are associated with cancer therapy utilising bone marrow transplantation. Following a scientific literature search via Medline®, I was unable to identify any peer reviewed papers associated with Stemedica Inc to support their claims of breakthrough technologies. In particular with reference to the Senior Management: · The President & Chief Medical Officer, Nikolai I. Tankovich, I was only able to identify nine papers in Russian, none of which were related to the stem cell keywords. · Vice President, Medical Research, Alex Kharazi, two papers, none of which were related to the stem cell keywords. · Vice President Global Research, Eugene Baranov, twenty-seven papers, none of which were related to the stem cell keywords. After performing a search on the Board of Advisors, I note a surprising lack of Peer-reviewed Scientific Publications and a complete absence of such publications related to the stem cell keywords. Finally a similar search on Dr Ewart Brown was hampered by the commonality of the name “Brown E”, but there was complete absence of such publications related to the stem cell keywords. Neither was I able to identify any intellectual property linked to Stemedica Inc registered with the US Patent & Trademark Office or the European Patent Agency. However, the IP position may be pending at this time, prior to publication or held within shell or parent companies. "I wish to voice my extreme concerns as detailed below in relation to this proposed development as attempts by Bermudians to raise questions and concerns on this issue have apparently gone unanswered by Dr. Brown." Stem Cell Overview Stem-cell-based therapies have existed since the first successful bone marrow transplant in 1968. The recent development of techniques to grow human embryonic stem cells in culture and an increasing understanding of the pathways of cell differentiation have expanded the horizon of likely therapeutic uses. This letter is focused on a sub-group of these applications – the use of embryonic pluripotent or adult multipotent stem cells to create human tissues for ex vivo transplantation into patients with medical conditions caused by the degeneration or injury of cells, tissues or organs. Stem cells have two main characteristics that distinguish them from other types of cells. First, they are unspecialized cells that may replicate for long durations via normal cell division. The second is that under certain conditions, they can be induced to differentiate into specialised cells such as myocardium or the insulin-producing cells of the pancreas. Currently there are two types of stem cell available for research: embryonic stem cells and adult stem cells. Human embryonic stem cells were the first area of study derived from embryos created by in vitro fertilization therapy. These embryos were no longer suitable or required for that purpose, and were donated for research. Clearly the use of such materials remains highly emotive for religious and moral reasons. An alternative is adult stem cells which may be collected via the bone marrow or more recently isolated from the general circulation via apheresis cell separation. Stem cells are important for many reasons. In the 3- to 5-day-old embryo (a blastocyst), stem cells in developing tissues may give rise to the multiple differentiated cell types that make up discrete tissues and organs. In some adult tissues, such as bone marrow, muscle, and brain, discrete populations of adult stem cells can generate replacements for cells that are lost through normal wear and tear, injury, or disease. These observations have prompted some in the scientific community to hypothesise that stem cells may, at some point in the future, become the basis for treating diseases such as Parkinson's disease, diabetes, and heart disease. Central to this proposal is a clear comprehension that the medical and scientific community does not possess the knowledge base or experience at this time to manipulate stem cells for therapeutic purposes. · Immaturity of the scientific field of stem cell therapy. The most advanced model of stem cell applications in the human is the heart; in which clinical research has been undertaken and is evolving. However, current reported developments have been contradictory and of modest benefit. This was very eloquently summarised in a 2006 Editorial in the New England Journal of Medicine (NEJM) by Rosenzweig (4). “Recent randomized studies of cell therapy for heart disease represent a milestone in this rapidly developing filed while serving as a cogent reminder that many important clinical and fundamental questions have yet to be addressed. We should guard against both premature declarations of victory and premature abandonment of a promising therapeutic strategy. The ultimate success of this strategy is likely to depend on continued and effective coordination of rigorous basic and clinical investigations. In the interest of public safety, (as will the MHRA in the United Kingdom), the FDA in the United States of America has jurisdiction over the production and marketing of any stem-cell-based therapy involving the transplantation of human cells into patients (5). An excellent report summarising these requirements may be found in a 2006 NEJM article by Halme & Kessler (6). Usefully the authors provide specific recommendations about how scientists should address the inherent safety and efficacy issues with these therapies. What oversight or regulatory framework is present or proposed in Bermuda? · Clinical Research and Medical Ethics Review Origin and History o 1927 Food Drug and Insecticide Administration formed o Death of 107 people from elixir of sulphanilamide containing solvent diethylene glycol o Federal (Food Drug & Cosmetics) Act - approval of new drugs before marketing Nuremberg Doctor’s Trial 1946/7 (United States of America v. Karl Brandt, et al.) Twenty three physicians and scientists were tried for crimes against humanity. Five were acquitted, seven received death sentences; the remainder received prison sentences ranging from 10 years to life

医学

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Parents on alert for "Whooping Cough" outbreak By: Tim Johnston Email Updated: Fri 2:55 AM, Nov 16, 2012 By: Tim Johnston Email Home Anderson County Health Department Facebook ANDERSON COUNTY, Ky. (WKYT) - There are five cases of the "Whooping Cough" confirmed by the Anderson County Health Department, and they say that's enough to consider it an outbreak of the infectious bacteria. Health Director Tim Wright said all of the cases can be traced to a fifth grade classroom at Emma B. Ward Elementary, in Lawrenceburg. "The first case we had was October 22nd. We got the confirmation that it was positive, I think it was on November 8th, and it escalated from there," said Wright. Wright added that one of the cases even included a toddler with ties to a fifth grader at the school, showing just how contagious this infection can be. "The incubation period is six to 21 days, so you can have the bacteria and not have symptoms yet. So that's why it's very important for us to get on top of this." Wright said students are required to get immunized before entering the first grade, a second round of the immunization is given to students before entering the sixth grade. Wright said it's as if the immunity wore off. Parents at the school say they are concerned about the outbreak after getting a letter, and in some cases a phone call, from the school. "I don't really know a whole lot about it but it's crazy how it spreads so easily," said Jimmie Hawkins, a parent of a third grader, who was hoping to have lunch with his child but had to cancel because of the health concern. Gail Hoskins, a mother of a first grader added, "That really scares me knowing that there's five. They said it wasn't in the end of the school where my son is in, but he has a low immune system and he catches everything." The school board said the building will be cleaned multiple times a day, and Friday after school, free vaccines will be offered to all fifth graders, staff, and even the bus drivers. The immunizations will be done at the elementary school from 4-5:30 pm. "When you're dealing with elementary school aged kids, it's pretty serious," stated Wright. According to a fact sheet handed out by the Anderson County Health Department, after five days of treatment the "whooping cough" is no longer considered contagious. Wright said his department has notified doctors in the area to treat anyone who may have come into contact with the infection, regardless of any symptoms being shown. More information on the "Whooping Cough" can be found on the Anderson County Health Department's facebook page below.

医学

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11 chemicals that may be causing the ‘pandemic’ of autism, ADHD and other disorders GRN Reports: Public health experts have identified 11 industrial chemicals as “developmental neurotoxicants” that are likely contributors to the rise of neurological disorders and deficits among young people worldwide, including... Public health experts have identified 11 industrial chemicals as “developmental neurotoxicants” that are likely contributors to the rise of neurological disorders and deficits among young people worldwide, including autism and Attention Deficit and Hyperactivity Disorder (ADHD). The chemicals are mainly toxic pollutants and byproducts such as arsenic and lead, which are released into the environment by coal plants and many other industrial operations, according to the report published in The Lancet Neurology on Friday. Studies show too much fluoride — evidenced here by teeth mottling — can have cognitive consequences. One compound, fluoride, stood out from the list because it’s treated as a desirable health supplement. Fluoride is deliberately added to the drinking water in hundreds of cities in the US and in other countries to help prevent dental decay. The public health experts added fluoride to their list of 11 neurotoxicants because of studies showing excess consumption depresses IQs in children. This prompted the Fluoride Action Network, the leading American group opposed to fluoridation, to call for a reconsideration of fluoridation. “In light of the new classification of fluoride as a dangerous neurotoxin, adding more fluoride to American’s already excessive intake no longer has any conceivable justification,” said FAN executive director Paul Connett. “We should follow the evidence and try to reduce fluoride intake, not increase it.” Dozens of American cities, from Oneida, NY, to Davis, CA, have rejected fluoridation in recent years. And many more, including Austin and New York City, have groups actively trying to roll back what they see as the potentially harmful fluoridation of their city water systems. These groups argue that the risk of neurological or other health damage from ingesting fluoride is not worth it, now that fluoride toothpastes and topical treatments can be used to protect teeth. Fluoridation proponents say the risk is small, and the return, stronger teeth, still justified. The report’s authors, Drs. Phillippe Grandjean, an adjunct professor of Environmental Health at the Harvard School of Public Health and Philip J. Landrigan, Dean for Global Health at the Icahn School of Medicine at Mount Sinai in New York, decided upon their list of 11 neurotoxicants because each has been found to contaminate food, water or soil and to interfere with the vulnerable neurological systems of children. That makes these chemicals likely suspects for triggering the autism, attention-deficit disorder, dyslexia and other “cognitive impairments” that affect millions of children and are increasing in frequency. In addition, many of these chemicals are known to cross the “blood-brain barrier” affecting the fetuses of expose mothers. Studies indicate that both types of exposure – prenatal and direct — can be harmful even at low levels because the developing human brain is especially sensitive to these chemicals prenatally and in early childhood. The doctors acknowledge that it will be difficult to pinpoint the exact causes of the “pandemic” of cognitive difficulties besetting children around the world, but argue for the precautionary approach, which would reduce chemicals of concern even in the absence of “absolute proof” that they cause a specific health issue. While genetics play a role in autism and other cognitive issues, “genetic factors seem to account for no more than perhaps 30-40 percent of all cases of neurodevelopmental disorders,” the doctors wrote. “Thus, non-genetic, environmental exposures are involved in causation, in some cases probably by interacting with genetically inherited predispositions.” A CLOSER LOOK AT THE NEUROTOXICANTS Acute arsenic poisoning produces spots on the hands; early life exposure could impair intellectual abilities in children. Five of the 11 chemicals cited in the Lancet review – the report is a compendium of the current science — had been identified in an earlier review by the team and published in 2006. Those were lead, methylmercury, polychlorinated biphenyls (PCBs), arsenic and toluene, and Grandjean and Landrigan updated their findings on those. Lead is well known for causing cognitive deficits and behavior problems in children who are exposed to high levels, which is why it was removed from gasoline and paint decades ago. However, it continues to enter the environment via industrial pollution. Recent international studies confirm the new thinking that “no safe level of exposure to lead exists,” the Lancet article authors wrote. Similarly, methylmercury, which accumulates in the food chain as animals and marine live consume lead contaminated food and water, has been well documented to affect fetuses, even at low levels, which is why pregnant women are warned to limit their seafood and fish consumption. Prenatal exposures to methylmercury have been detected in children as old as 14, and have been shown to cause abnormal sensory stimulation responses in a child’s brain, the researchers wrote. PCBs are found in hydraulic fluids, plasticizers, fire retardants and pesticides and can get into drinking water. The EPA reports that chronic exposure can affect the thymus gland and harm the immune and nervous systems. Arsenic gets into drinking water from treated wood, paints, mining and other industrial processes (or breakdowns, such as the recent coal ash containment leaks in to the Dan River in North Carolina). Long-term exposure “may have an increased risk of cancer,” according to the EPA and studies show it can impair cognitive function in children. Toluene, a solvent found in paints, varnishes, lacquers and glues, has been associated with the development of asthma and acts on the central nervous system. Acute toxic exposure can cause seizures and a loss of balance; chronic exposure can decrease cognitive abilities, damage skin, cause anemia and impair bone formations. The new report, Neurobehavioural Effects of Developmental Toxicity, added six more chemicals that interfere with brain development: manganese, fluoride, chlorpyrifos, dichlorodipenyltrichloroethane (DDT), tetrachloroethylene and polybrominated diphenyl ethers (PBDEs). Manganese is a metal that’s a useful dietary ingredient, but only at low doses. While it’s a naturally occurring metal, excess amounts get into food and water from the runoff of manganese-containing pesticides, industrial waste and landfill leaching. Studies show that excessive consumption by children correlated with reduced achievement in math and increased hyperactivity. One study found that school-aged children living near manganese mining and processing facilities with airborne manganese concentrations showed diminished intellectual function and impaired motor skills. Fluoride, another naturally occurring compound, is consumed in excess when children get it in treated drinking water and also in certain foods and fruit juices, that have recently been found to contain higher levels of fluoride. The US Centers for Disease Control and the American Dental Association endorse adding fluoride to drinking water because it strengthens tooth enamel. But in 2011, the US Health and Human Services lowered its recommended level of fluoride in water after a study found many American children showed mottling on their teeth, indicating they were getting too much fluoride. The Lancet researchers included fluoride because a meta-analysis of 27 studies of children exposed to high levels of fluoride in drinking water, mainly in China, found that it lowered their IQs by an average of seven points. Critics of fluoridation in the US and around the world have been fighting to stop the practice, arguing that modern science shows it does more harm than good and that children’s teeth can be adequately protected with topical fluoride applications from toothpaste and at the dentist’s office. One way to avoid chlorpyrifos and other pesticides is to buy Organic-certified produce. Chlorpyrifos, an organophosphate pesticide, has been shown to lead to a small head circumference in babies born to exposed mothers. This indicates that the chemical affects brain growth, and “neurobehavioural deficits that have persisted to at least 7 years of age,” the Grandjean and Landrigan wrote. DDT and its related metabolite, DDE, continue to cause problems in the environment. Even though the highly toxic DDT was banned in the US and other developed nations decades ago, it is still used in other parts of the world, such Africa where it is sprayed to fight mosquito-borne malaria. Furthermore, it persists in the environment for decades. One study cited linked DDE to delayed development in toddlers. Tetrachloroethylene (TCE) is a solvent, which studies show has been correlated with hyperactivity and aggressive behavior in children born to mothers who were exposed while pregnant and working as operating room nurses or on the factory floor. It’s no longer used as an anesthetic, though its use as an industrial degreaser has contributed to groundwater contamination in certain areas. It is present at hundreds of Superfund sites and has been found seeping into buildings from contaminated soil. TCE also is an acknowledged carcinogen. Polybrominated diphenyl ethers (PBDEs) have been used as flame retardants in upholstered furniture, TV and computer casings and dozens more products. Epidemiological studies in Europe and the US “have shown neurobehavioral deficits in children with increased prenatal exposures to these compounds.” The research is emerging, the scientists wrote, but PBDEs “should be regarded as hazards to human neurobehavioral development, although attribution of relative toxic potentials to individual PBDE cogeners is not yet possible. [i.e., they cannot draw a definite line from one type of PBDE to a specific disorder]” Some types of PBDEs have been phased out, but have been replaced by related chemicals. Environmentalists are highly concerned about these synthetic chemicals because they persist in soils, house dust and landfills. Discarded TVs and computers carry PBDEs to the landfill, one reason it’s important to recycle them. “To control the pandemic of developmental neurotoxicity, we propose a global prevention strategy,” Grandjean and Landrigan wrote. “Untested chemicals should not be presumed to be safe to brain development, and chemicals in existing use and all new chemicals must therefore be tested for developmental neurotoxicity.” They proposed an international clearinghouse could test chemicals, share data, develop protective policies and identify new chemicals that pose a threat to the human brain. (Top photo: Harvard.edu)

医学

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In this site In all PAHO In WHO Director's Corner Global Calendar About PAHO Countries and Centers PAHO in maps PAHO in One Click Bulletins Portal Institutional Memory Virtual campus of Public Health Priority Countries PAHO's Communities The PAHO Headquarters Library The PAHO Headquarters Library and Information Services supports the work of the Organization and provides a wide variety of professional and technical reference and information services covering a broad range of subject areas within the biomedical and public health field, including, historical information. It also collects, organizes, preserves and disseminates regional information produced by PAHO, both bibliographic and in full text, besides offering a selected collection on related health subjects affecting the people of Latin America and the Caribbean. The Library's collections are referenced in its electronic PAHO/HQ Online Library Catalog, accessible through the Web. The PAHO Institutional Memory The PAHO Institutional Memory Database (IM) is the official registry of the Pan American Health Organization's intellectual production collected at the Organization's Headquarters. It offers users access to the PAHO bibliographical records and digital collection dating from the Organization's inception in 1902. The database currently holds over 38,766 bibliographic references, of which around 23,627 represent selected full text materials. The system provides access to print and online materials, as well as other media formats. The database is maintained by the PAHO Library and is intended to preserve and disseminate current and historical documents of the Organization. The Virtual Health Library The Virtual Health Library promotes an equitable, universal, modern, and efficient access to relevant information generated by dynamics of public health in the Region. The Virtual Campus of Public Health The Campus is a public service of continuing education and information. Its main objective is to contribute to the development and improvement of the efficiency of public health management through the resolution of cases closely related with professional practice, as well as to promote the exchange of experiences among professionals in the sector and among public health institutions of various countries. The HINARI program, set up by WHO together with major publishers, enables developing countries to gain access to one of the world's largest collections of biomedical and health literature. Over 3300 journal titles are now available to health institutions in 113 countries, benefiting many thousands of health workers and researchers, and in turn, contributing to improved world health. Headquarters Library - Institutional Memory - Virtual health Library - Virtual campus of Public Health - HINARI

医学

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Subjects & KeywordsAll > Public Health, Innovation, Intellectual Property and Trade > Technology Transfer and Local ProductionKeywords > biomedical technologyKeywords > diagnosisKeywords > innovationKeywords > local manufacture of pharmaceuticalsKeywords > local pharmaceutical industryKeywords > local productionKeywords > local production - medical technologiesKeywords > policy developmentsKeywords > technology transferLocal Production for Access to Medical Products: Developing a Framework to Improve Public Health (2011; 78 pages) Abstract This report forms part of the project entitled “Improving access to medicines in developing countries through technology transfer and local production”. It is implemented by the Department of Public Health Innovation and Intellectual Property of the World Health Organization (WHO/PHI) in partnership with the United Nations Conference on Trade and Development (UNCTAD) and the International Centre for Trade and Sustainable Development (ICTSD), with funding from the European Union (EU). The aim of this work was to develop a framework that could bring together and guide policy-makers and others from all these relevant fields. The framework presented here provides an entry point for supporting the local production of medicines, vaccines and diagnostics in a manner that should improve access to those medical products maximizing the potential to improve public health. The project itself is in two phases. Phase 1 of the project concentrated on identifying the main challenges and obstacles to local production and related technology transfer in developing and least-developed countries. The project involved commissioned literature reviews to describe the current landscape and historical and current trends; regional workshops with a broad range of stakeholders; and in-country work to investigate and describe a series of company-focused case studies from low- and middle-income countries. This document seeks to provide an overview of these findings in a style that is accessible to all readers and summarizes the issues at a high level. It is based on the ongoing work and wider evidence on the issues of local production and access to medical products from the wider literature available on the topic. For a more detailed discussion of the trends in local production, and the methods, analysis and findings from Phase 1, readers should be guided by the references throughout this document and the series of reports available for free download from the WHO web site. In phase 2, the framework, as it develops, will be used to guide the actions of WHO and its partners in support of local production within developing and least developed countries. Related documentsIncreasing Access to Diagnostics Through Technology Transfer and Local ProductionLocal Production and Access to Medicines in Low- and Middle-income Countries: A Literature Review and Critical AnalysisLocal Production of Pharmaceuticals and Related Technology Transfer in Developing Countries: A Series of Case Studies by the UNCTAD SecretariatTrends in Local Production of Medicines and Related Technology TransferPharmaceutical Production and Related Technology Transfer: Landscape ReportLocal Production for Access to Medical Products: Developing a Framework to Improve Public Health (Policy Brief) View the PDF document

医学

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HomeThis is the archived site - Click here for the new site A Major Victory for Reason Swift Written by Brandon K Thorp The World Health Organization [WHO] has responded to a call from young medics and said that it DOES NOT recommend the use of homeopathy for treating HIV, TB, malaria, influenza and infant diarrhea. In an open letter to the WHO in June of this year, the group of early career medics and researchers from the UK and Africa asked the body to make clear that homeopathy cannot prevent or treat these serious diseases despite its growing promotion by manufacturers and practitioners. The Director General's office has confirmed that the responses from WHO departments (below) "clearly express the WHO's position." Today the Voice of Young Science [VYS] network, who coordinated the letter, has written to the health ministers of all countries to publicise the WHO's position, asking them to combat the promotion of homeopathy for these dangerous diseases. Comments from the WHO: Dr Mario Raviglione, Director, Stop TB Department, WHO: "Our evidence-based WHO TB treatment/management guidelines, as well as the International Standards of Tuberculosis Care (ISTC) do not recommend use of homeopathy." Dr Mukund Uplekar, TB Strategy and Health Systems, WHO: "WHO's evidence-based guidelines on treatment of tuberculosis...have no place for homeopathic medicines." Dr Teguest Guerma, Director Ad Interim, HIV/AIDS Department, WHO: "The WHO Dept. of HIV/AIDS invests considerable human and financial resources [... ] to ensure access to evidence-based medical information and to clinically proven, efficacious, and safe treatment for HIV... Let me end by congratulating the young clinicians and researchers of Sense About Science for their efforts to ensure evidence-based approaches to treating and caring for people living with HIV." Dr Sergio Spinaci, Associate Director, Global Malaria Programme, WHO: "Thanks for the amazing documentation and for whistle blowing on this issue... The Global Malaria programme recommends that malaria is treated following the WHO Guidelines for the Treatment of Malaria". Joe Martines, on behalf of Dr Elizabeth Mason, Director, Department of Child and Adolescent Health and Development, WHO: "We have found no evidence to date that homeopathy would bring any benefit to the treatment of diarrhoea in children...Homeopathy does not focus on the treatment and prevention of dehydration - in total contradiction with the scientific basis and our recommendations for the management of diarrhoea." In one way, it's remarkable that statements like these need to be made. As one of the scientists associated with VYS pointed out, it's one thing for homeopaths to go after gullible people on Park Avenue with a case of the sniffles. Repugnant, sure, but at least they're not interfering with the medical treatment of dying children in developing nations. That's a whole other kind of bad, and massive kudos are due to the brave young brains of VYS for recognizing an outrage when they see one. But how could they not? Many of the VYS scientists are entrenched in those developing nations, doing their damndest to help people while dealing with those superstitions already extant in the populace. They do not need the added distractions of homeopaths pushing their wares and worldviews, promising miracle cures with no ill effects. Unlike in the United States or Europe, where even skeptics can afford to regard alternative "medicine" and fringe scientists as semi-urgent problems, bad science in the developing world can result in disasters of world-historic scope. As the great Raymond Tallis said in a comment attached to the VYS' letter: The catastrophic consequences of promoting irrational and ineffective treatments for serious illnesses have been demonstrated in South Africa, where Thabo Mbeki's policies have led to an estimated 365,000 unnecessary premature deaths. The prospect of replicating this reckless behaviour elsewhere in developing countries by advocating homoeopathic treatments for AIDs and other potentially lethal conditions is appalling. I hope that the timely intervention by the Voice of Young Science Network will help to pre-empt a public health disaster. It illustrates the importance of young scientists, torchbearers for a better future, taking a stand and speaking out. Tallis' allusions to Mbeki's disastrous AIDS denialism are entirely appropriate, given the size of the problem the young scientists are confronting. According to their letter to WHO: In Kenya, the largest homeopathic supplier, the Abha Light Foundation sells homeopathic medicines for malaria, diarrhoea and influenza. It now runs 20 health centres, 25 mobile clinics and five HIV/AIDS clinics. In Tanzania, Jeremy Sherr and Sigsbert Rwegasira run three homeopathic clinics and claim to have government support to establish a school of homeopathy. Rwegasira claims to treat "no less than 100 malaria patients per day." According to Sherr's promotional material, "conventional medicine only supplies temporary relief, often at a great cost financially, and with many severe side effects". In Ethiopia, the Amma Resonance Healing Foundation, run by Peter Chappell, offers to treat AIDS patients with "resonance healing in the form of homeopathy", as "an ideal alternative and complement for the treatment of HIV/AIDS in developing countries" because of "the very low costs of producing the remedy" and because it has "no side effects". In Ghana, the Senya/Tamale Homeopathy Project treats malaria patients with homeopathy. In Botswana, the Maun Homeopathy Project offers homeopathic treatment in several locations and mobile clinics for HIV related complaints such as herpes and diarrhoea "for those people who are HIV+ but who are not taking anti-retroviral drugs". We at the JREF enthusiastically support and congratulate the Voice of Young Science network for having won such a resounding victory for reason. Unfortunately, some of the less-young scientists at the WHO seem determined to hurt as few homeopaths' feelings as possible. Note the carefully neutral language being used in the top segment of their response, and even in the comments below. The strongest statement anyone will make explicitly against homeopathy is noting its inability to effectively combat dehydration. Ironically, this is one of the few things some homeopathic remedies can treat, since it's all water...! Some of the endorsements are luke-warm, as if the writers are trying to be politically correct by not even mentioning the word "homeopathy," and even stating that this quackery can be somewhat useful in some applications. It is not, and it represents one of the many pieces of misinformation that we at the JREF have battled for years now. Homeopathy is 100% nonsense, it doesn't work, and it costs lives. We must add that we're very satisfied with the WHO censure of South Africa's official government support of quackery and their denial of facts - a stance that has cost some 365,000 lives in that country. Unfortunately - and inexplicably, given points one through for of WHO's explicitly stated agenda - the World Health Organization has not yet deigned to publish its statement on its own website.

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Posts tagged with MEDICAL LOSS RATIO RULE Sep 18, 2012Sep 18, 2012 A Business Owner Expects the Worst From Health Insurance OverhaulBy Robb Mandelbaum The AgendaHow small-business issues are shaping politics and policy. PhotoKurt Summers: It's about fear.Credit Courtesy of Austin Generator Services The Supreme Court decision upholding most of the Affordable Care Act came as a blow to Kurt Summers, a small-business owner in Austin, Tex. Soon after the decision was announced, he warned his fellow citizens, through the auspices of The Washington Post, that unless “we elect officials to both Congress and the White House who understand the importance of small business and who will return some sanity to Washington” — and repeal the health law — he will most likely have to postpone his considerable ambitions for his company. In the short-term, today’s ruling will force me to pause and rethink my immediate hiring, acquisition and expansion plans. In order to plan ahead, I need to know what future costs and regulations I will be facing. With the law intact, I expect the cost of doing business to increase and new regulations to be delivered by a federal government that doesn’t appreciate the daily challenges of running a business. Like many small companies, our business is largely dependent on the prosperity of larger business; if the economy begins to fail, and if our business customers suffer as a result of this law, the ripple effect will force us to hunker down and perhaps even to let people go. In our first two profiles of business owners struggling with health care decisions, those owners did not have such strong feelings about the Affordable Care Act — they had hoped they would benefit from it, but they didn’t know much about it. Mr. Summers, our third profile, is obviously in a different situation, and we wanted to understand why. Aug 7, 2012Aug 7, 2012 The Affordable Care Act Rebate Checks Are in the Mail: Now What?By Robb Mandelbaum The AgendaHow small-business issues are shaping politics and policy. Some small businesses were among the most strident opponents of the Affordable Care Act, but by Wednesday, many of these businesses will have received checks totaling $321 million from their health insurance providers, courtesy of the health care overhaul that became law in 2010. The checks are rebates from insurers that did not spend at least 80 percent of the premiums they collected from small group plans on either actual health care expenses or improving the quality of health care, a provision known as the medical loss ratio rule. Small businesses in 38 states, the District of Columbia and three United States territories are receiving checks on behalf of their employees, according to the Department of Health and Human Services. (In the remaining 12 states and in the Northern Mariana Islands, insurance companies in the small group market spent at least 80 percent of collected premiums on health care-related expenses.) The typical subscriber, which could be either an individual or a family, will receive a $174 rebate. Average rebates are highest in Georgia, at $811 per subscriber, and lowest in Utah, at $7 per subscriber.

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Israeli, Canadian hospitals unite to raise $1.1M Sunday, November 25, 2012 Tags: Health Comments New Generation Building under construction A partnership between the Canadian Shaare Zedek Hospital Foundation and the North York General Hospital Foundation will help to transform pediatric facilities in Toronto and Jerusalem. The Bridging Children’s Health campaign was created to unite the two hospitals in a shared commitment to improving health care for children, teens and their families, they said in a statement. The campaign culminated in an event presented by First Capital Realty that featured keynote speaker Rudy Giuliani, former mayor of New York City. The campaign raised $1.1 million toward the redevelopment of North York General Hospital’s child and teen program facility and the construction of the New Generation Building, which houses the Wilf Children’s Hospital at the Shaare Zedek Medical Center in Jerusalem. Lisa Colt-Cotler, national executive director of the Canadian Shaare Zedek Hospital Foundation, said “what started as a small seed of an idea between a member of our board and North York General’s executive vice-president of philanthropy grew into a successful fundraising initiative. We knew that our donors and friends in the community would embrace this partnership to support pediatric facilities at both hospitals.” The Shaare Zedek Medical is in the final stage of its $60-million campaign to complete the construction of the New Generation Building housing the Wilf Children’s Hospital, the most active maternity hospital in the western hemisphere with approximately 15,000 births each year. The existing pediatric facilities were built nearly 30 years ago and, since 1979, the number of children treated as in-patients has risen by 400 per cent. The New Generation Building is one of the most significant and ambitious projects in Israeli medicine, with its focus on providing maternal, infant and pediatric care together in one facility, she said. Colt-Cotler said that the $150-million campaign for North York General is the largest comprehensive campaign ever undertaken by a Canadian community hospital and will provide it with the resources to remain a centre for exceptional care and teaching in a diverse community of more than 400,000 people. The campaign hopes to raise $5 million to redevelop the hospital’s child and teen program facility, which will include a greater number of private in-patient rooms, and will provide greater comfort and convenience for children, teens and their families. The Bridging Children’s Health campaign honoured two doctors who have provided extensive contributions to heath care. Dr. Ofer Merin is a cardiothoracic surgeon, lieutenant colonel in the Israel Defence Forces and deputy director general at Shaare Zedek. He has close ties to Toronto and North York General, having completed his fellowship in Toronto and having led grand rounds at North York General on a recent visit. He was given responsibility for emergency readiness at Shaare Zedek in 2007, and was subsequently appointed as director of the hospital’s trauma unit. As commander of the IDF field hospital over the last 10 years, he has also served as the director of surgical operations in the field hospital that has performed emergency relief in Haiti and Japan following natural disasters. The second honoree, Dr. Noah Forman, began his career in emergency medicine at North York General Hospital and also serves as medical director for the Toronto Maple Leafs and Toronto Fire Services.

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Myanmar’s “red angel” midwives prepare to bring care to displaced women in Rakhine A "red angel" midwife cares for a mother and her newborn in Yangon, Myanmar. Photo credit: UNFPA/Benny Manser YANGON, Myanmar – Twenty-three-year-old Ma Thae Ei Phyu is one of five “red angel” midwives who participated in a recent UNFPA-supported intensive training programme at a maternity ward on the outskirts of Yangon, Myanmar. The programme prepared the red angels – named for their red ‘longyi’ garments – to carry out life-saving work in camps for displaced people in the Sittwe and Myebon townships of Rakhine State. Myanmar has an estimated 200 maternal deaths per 100,000 live births, well above the regional average of 160, according to UNFPA's State of the World Population report from 2013. And women in the displacement camps in Sittwe and Myebon are particularly vulnerable. They have poor access to routine health care, and often rely solely on mobile health workers like the red angels. Midwives are undergoing training in a clinic in South Dagon, Yangon, before being deployed in Rakhine State. Photo credit: UNFPA/Benny Manser Many of the midwives participating in the training had already been deployed to the camps, but were evacuated following the outbreak of communal unrest in late March. They used their time in Yangon as an opportunity to sharpen their skills while awaiting redeployment. Going where the needs are greatest UNFPA spends about US$207,500 a year training midwives in Myanmar and deploying them in areas where the needs are greatest. These include hard-to-reach rural areas and the displacement camps in Rakhine and Kachin states, where health facilities and midwives are in short supply. Ms. Ma Thae Ei Phyu has been deployed in Rakhine several times through the Myanmar Nurses and Midwife Association (MNMA). In 2012, she provided antenatal care to pregnant women in the displacement camps, providing check-ups and immunizations, and giving health and hygiene lessons. She was deployed in Rakhine again in early 2014, but was evacuated because of the unrest. With her recent training – which took place at an MNMA clinic in Yangon’s South Dagon Township in early May – she will be even better equipped to serve displaced people in Rakhine. The programme covered antenatal care, delivery assistance and post-natal services, as well as emergency obstetric care, voluntary family planning, post-abortion care and the prevention of the mother-to-child transmission of HIV. “I have learned… what the potential risks are during the first, second and third stages of delivery," said Ms. Ma Thae Ei Phyu. "From the practical part of the training, I understand more, such as if there are complications during or after the birth, such as bleeding, so I can refer the mothers to the hospital." The training also covered the minimum initial service package for reproductive health, a standard of care for providing reproductive health care in crisis situations. “It was much safer” But even in bustling Yangon, the red angels’ services have proven essential. Thirty-six-year-old Ma San Mu gave birth to a boy at the South Dagon clinic on 1 May. Mawi Zun Khim (left) is training five midwives, including Ma Thae Ei Phyu (right). Photo credit: UNFPA/Benny Manser Her first two children were born at home, but for her last two deliveries, she chose to give birth in the maternity clinic. “I felt it was much safer for me to deliver the baby in the clinic,” she said. “My age also played a factor, in case there would be complications connected to the birth. My third child was also born right here in the clinic, and I was very happy with the service I received also this time around.” First-time mother Ma Moe Moe echoed these sentiments. She gave birth to a healthy boy on 30 April. “It was safer for me to have the baby here in the clinic. Many still prefer to give birth at home. The midwife was very helpful and told me about what to expect during the birth, as well as how to take care of the baby,” she said. UNFPA has provided support for reproductive health commodities and equipment in seven states or regions of Myanmar. The organization has allocated $300,000 to help upgrade equipment and refurbish 10 maternity wards in Yangon, Magwe, Shan State and Ayeyarwady. Additionally, UNFPA supported MNMA’s deployment of 10 midwives in the underserved townships of Sittwe, Pauktaw and Myebon. They have provided services to about 4,700 people, both male and female. UNFPA also supports a static clinic in Rakhine and two mobile clinics managed by the Myanmar Medical Association. – By Malene Arboe-Rasmussen and Benny Manser

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Home > Departments & Institutes > Department of Neurology About UsDivisionsResidency, Fellowships, and ResearchFaculty and StaffNewsVideo Nervous System Disorders CME Mount Sinai is hosting Advances in Neurology: Diagnosis and Practical Management of Patients with Nervous System Disorders on October 25, 2014. Register now for this full-day symposium The Estelle and Daniel Maggin Department of Neurology at Icahn School of Medicine at Mount Sinai is built around the nation’s oldest Neurology Department with more than 100 years of history. Our neurology residency program is designed to provide residents with a broad base of knowledge in neuroscience, and the clinical abilities to recognize and treat the full spectrum of neurologic diseases. Our fellowship and internship opportunities give students the chance to specialize and find their ideal clinical, or research focus, with NIH funded research opportunities and excellent physician-instructor support. The Mount Sinai Hospital ranks 15th in the nation for Neurology in the 2014-2015 “Best Hospitals” issue of U.S. News and World Report Our researchers receive more than $30 million annually in NIH research grants Icahn School of Medicine ranks 19 out of 153 accredited medical schools nationwide, according to the 2015 U.S. News & World Report annual survey. Stuart C. Sealfon, MD, is the Glickenhaus Professor and Chair, Department of Neurology; Director, Center for Genomics, Proteomics, and Bioinformatics; Director, Center for Translational Systems Biology; Professor, Neurobiology; and Professor, Pharmacology and Systems Therapeutics. Read more We offer clinical fellowships in numerous areas, including headache, multiple schlerosis, neuro-AIDS and neuromuscular medicine. Learn more Neurology Residency Program Current and past Neurology residents from Icahn School of Medicine at Mount Sinai discuss their experiences and talk about why they chose Mount Sinai and what sets it apart. Neurology Research Residency Program Recipient of NIH funding, Sam Horng, MD, PhD, and PGY3 resident, is studying the role of astrocytic mechanisms of lesion limitation relevant to multiple sclerosis (MS). Learn more about Dr. Horng’s work in the John Multiple Sclerosis Research Laboratory Friedman Brain Institute Alzheimer’s Disease Research Center

医学