Datasets:

BAAI

/

IndustryCorpus_medicine

like 3

2014-42/1180/en_head.json.gz/2294

Spotlight On Research Fact Sheets Stories of Success NHLBI In The News Frequently Asked Questions E-NEWSLETTERS Submit your email address below to receive email alerts about press releases. Learn more. Embargoed for Release: April 1, 2008, 9:30 AM EDT NHLBI Communications Office nhlbi_news@nhlbi.nih.gov301-496-4236Ask for press officer on duty | PRINT | SHARE Automated External Defibrillators and CPR Are Equally Helpful for Sudden Cardiac Arrest in the Home Study Finds AEDs Underused at Home The first study to explore the use of automated external defibrillator (AEDs) in the home has found that although the safe and easy-to-use devices are effective for certain types of cardiac arrest, they were underused. The Home Automated External Defibrillator Trial (HAT), a randomized international clinical trial, was supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health.Researchers will present their findings from the international study at the 2008 American College of Cardiology (ACC) Scientific Sessions in Chicago April 1. The results are being published online simultaneously by the New England Journal of Medicine and will appear in the April 24 print edition. An editorial by David Callans, M.D., of the University of Pennsylvania accompanies the articleResearchers followed 7,001 heart attack patients at moderate risk of sudden cardiac arrest who had a spouse or other live-in companion who agreed to take conventional steps to respond to a sudden cardiac arrest -- calling emergency medical services (EMS) and performing cardiopulmonary resuscitation (CPR) – with households that were asked to use an AED before taking conventional life-saving steps. After an average of just over three years of follow-up, researchers found that survival rates were about the same between those who had an AED in the home and those who did not. However, there were relatively few sudden cardiac arrests, and only 39 percent of these events were witnessed at home. The study was conducted in 178 clinical sites in the United States, Canada, Britain, New Zealand, Australia, Germany, and the Netherlands."Cardiac arrest is a top killer of Americans, and this study shows that the strategies of placing an AED in the home and of being prepared to give CPR are equally effective at saving lives in a population at risk for sudden cardiac arrest," noted Elizabeth G. Nabel, M.D., NHLBI director. "The important message here is that every minute counts, and quick action is key. Use an AED if one is handy or perform CPR -- and always call for help by emergency medical professionals, such as by dialing 911." Every two to three minutes, someone in the United States goes into cardiac arrest, and at least 95 percent of cases end in death within a few minutes. Three out of four sudden cardiac arrests take place when the patient is at home. During sudden cardiac arrest, the heart suddenly and unexpectedly stops beating effectively; blood stops flowing to the brain and other vital organs, and the individual collapses into unconsciousness and stops breathing. Although sudden cardiac arrest is not the same as a heart attack, which is the result of a loss of blood supply to the heart muscle, a heart attack increases the risk for sudden cardiac arrest. The most common cause of sudden cardiac arrest is ventricular fibrillation, in which a problem in the heart's internal electrical system causes the large pumping sections of the lower part of the heart (the ventricles) to disrupt the normal rhythm. In these cases, an electric shock from an AED within a few minutes of onset can significantly improve a patient's chance of survival by restoring the heart to its normal rhythm. CPR has also been shown to be effective in increasing survival from sudden cardiac arrest. "The long-term survival rates of all of the HAT participants who went into cardiac arrest were significantly higher than what is typically found in the general population, and fewer of the participants than expected had sudden cardiac arrest," noted Gust H. Bardy, M.D., of the Seattle Institute for Cardiac Research, lead author of the study. "We believe that this is because of the optimal medical therapy and coronary revascularization that all HAT participants received following heart attack. Moreover, although the control arm mortality rates in HAT were equal to the AED group, it is not routine practice to train spouses or other companions following a patient's heart attack on why and how to call emergency medical services for help and how to perform CPR. I believe this should be routine practice following a patient's heart attack, regardless of whether they have an AED in the home." AEDs detect the patient's heart rhythm through electrodes that are applied to a patient's chest. If the AED determines that the problem is caused by ventricular fibrillation, the AED instructs the user to hit a button to deliver an electric shock. The AED transmits the shock through the electrodes, then rereads the heart rhythm to determine if another shock is needed. The machine does not recommend or administer a shock if the cause of the abnormal rhythm cannot be treated by the shock. HAT researchers found no evidence of inappropriate uses of the AED by lay users. All HAT participants previously had a heart attack and were at moderately increased risk for sudden cardiac arrest. Participants also had to have a family member or other live-in companion who was willing to follow specific steps to immediately help the participant in cardiac arrest; these steps were described in a training video and through discussions with study personnel. One-half of the companions (control group) was asked to call EMS and perform CPR immediately; the other half of the group was asked to use an AED before calling EMS (or at the same time, if there were two bystanders) and performing CPR. Participants were followed for about 3 years (ranging from 20 months to 56 months). Overall, 450 participants died during the study, with nearly equal numbers of participants in the control group (228 or 6.5 percent) and the AED treatment group (222 or 6.4 percent). Participants were equally likely to die from sudden cardiac arrest (35.6 percent) as from other causes not related to cardiovascular disease (37.8 percent), and 160 deaths during the study were due to sudden cardiac arrest.Of the 117 sudden cardiac arrests that occurred at home, only one-half (58) of them were witnessed by another member of the household."We knew that the vast majority of sudden cardiac arrests would happen at home, but we didn't expect that so few would be witnessed by a spouse or other member of the household," explained Bardy. "This of course dramatically limits the chance that someone would be there to use an AED or to perform CPR. However, when the AEDs were used, they were safe and effective."AEDs were used by at-home bystanders on 32 HAT participants, with ventricular fibrillation detected in 15 participants. Fourteen of these participants were shocked, and ventricular fibrillation was terminated in each case. There were no device failures. Overall, among the participants in the AED group who used the AED for ventricular fibrillation in the home, four of the 14 participants defibrillated (28.6 percent) survived long term – an improvement over the estimated 2 to 6 percent long-term survival rates typically reported. In addition, AEDs were used on seven neighbors or visiting friends, and shock was advised and successfully given in four individuals, of whom two survived long-term.The AEDs used in the study are the same types of devices that are now available in many airports, fitness centers, and other public places, which have been shown to be safely and easily used by bystanders with little training to perform life-saving treatment on individuals in cardiac arrest. "Studies of public access to AEDs have shown that AEDs can be highly effective in helping people survive sudden cardiac arrest," said Eleanor B. Schron, PhD, NHLBI project officer of the study and a coauthor of the paper. For example, in the NHLBI-supported Public Access Defibrillation Trial, nearly twice as many people survived sudden cardiac arrest in communities where volunteers were trained to use AEDs as well as CPR compared to communities where community volunteers learned CPR only. "Today's findings are consistent with other studies that show that bystanders with little training can safely and effectively use AEDs," she noted. "HAT gives us new insight into how AEDs are used in the home, and, unfortunately, we found that AEDs were underused in the home." Philips Medical Systems and Laerdal Medical donated HeartStart Home Defibrillators for use by participants in the AED group. The HeartStart is the only FDA-approved home defibrillator available without a prescription. To interview Dr. Schron, call the NHLBI Communications Office at (301) 496-4236. To speak with Dr. Bardy, please contact the Seattle Institute for Cardiac Research at (206) 529-1117. ### NHLBI News release, "Public Access Defibrillation by Trained Community Volunteers Increases Survival for Victims of Cardiac Arrest," http://www.nhlbi.nih.gov/new/press/03-11-11.htm Part of the National Institutes of Health, the National Heart, Lung, and Blood Institute (NHLBI) plans, conducts, and supports research related to the causes, prevention, diagnosis, and treatment of heart, blood vessel, lung, and blood diseases; and sleep disorders. The Institute also administers national health education campaigns on women and heart disease, healthy weight for children, and other topics. NHLBI press releases and other materials are available online at: www.nhlbi.nih.gov.The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U. S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical, and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov. For the MediaNHLBI Communications Officenhlbi_news@nhlbi.nih.gov301-496-4236Ask for press officer on duty Related Health Topics

医学

2014-42/1180/en_head.json.gz/2295

Font Size Find Health Topic: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z You are here: News & Events 2014 2013 2012 2011 2010 2009 2008 Letter from Dr. Stephen I. Katz: Advances and Insights from Rare Disease Research August 21, 2014 Office of Science Policy, Planning and Communications (OSPPC) Communications and Public Liaison Branch (CPLB) niamsinfo@mail.nih.gov Anita Linde, M.P.P. Director—OSPPC Nancy Garrick, Ph.D. Deputy Director—CPLB Trish Reynolds, R.N., M.S. Media Liaison Colleen Labbe, M.S. Public Liaison Portal en espa�ol Letter from Dr. Stephen I. Katz:Advances and Insights from Rare Disease Research Stephen I. Katz, M.D., Ph.D. Dear Colleagues: The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) conducts and supports basic, translational, and clinical research on some of the most debilitating diseases affecting the Nation�s health. Although a number of these diseases are very common, many of them are rare, affecting only a few thousand people world-wide. In this month�s letter, I will highlight several examples of NIAMS-funded research on rare diseases. The importance of studying these conditions cannot be overstated. Research on rare diseases has tremendous potential to improve the lives of affected individuals. It also substantially advances our understanding of fundamental biology, and therefore often provides insights that can be applied to other diseases that affect larger numbers of people. In July, I had the opportunity to highlight NIAMS support for research on rare heritable connective tissue disorders at a Capitol Hill briefing sponsored by the Marfan Foundation. I discussed NIAMS-funded research on two disorders, Marfan syndrome and epidermolysis bullosa (EB). In Marfan syndrome, the connective tissue found throughout the body is abnormal, affecting many systems adversely, including the skeleton, eyes, heart and blood vessels, nervous system, skin, and lungs, and in some cases, leading to cardiovascular complications that are life threatening. NIAMS supports basic research to improve understanding of the genetic mutations and molecular mechanisms that cause Marfan syndrome. These investigations formed the basis for clinical trials of a new therapy for Marfan syndrome. In EB, individuals lack proper collagen VII fibers, which are key structural proteins in the skin. The condition results in extremely fragile skin and mucous membranes that break and blister easily. The wounds are difficult to heal, and when they do, extensive scarring can occur that, at times, lead to devastating squamous cell carcinomas. The Institute supports basic research on potential therapies that replace collagen, either through topical or intravenous administration, and funds clinical research to determine whether genetically modified skin grafts can be used to treat patients with EB. Results of the research could have broad implications for treating traumatic wounds in the general population. Also last month, a team of NIAMS researchers led by Dr. Raphaela Goldbach-Mansky, Acting Chief of the Translational Autoinflammatory Disease Section, reported the identification of the gene responsible for STING-associated vasculopathy with onset in infancy (SAVI), a rare autoinflammatory disease. SAVI symptoms, which manifest in early infancy, include systemic inflammation, vascular lesions affecting the fingers, toes, nose, and ears, and inflammation and scarring in the lungs. By analyzing the DNA of affected children and their parents, the researchers were able to identify the genetic mutation that causes the disease, and show that it leads to overproduction of interferon, a major driver of inflammation. The research team has now begun testing whether drugs that block interferon signaling can be used to treat patients with SAVI. This research provides important insights about the molecular mechanisms of the immune response that can be applied to other diseases. More information about the study can be found on the NIAMS website. Finally, in my February letter, I wrote about neonatal-onset multisystem inflammatory disease (NOMID). Like SAVI, NOMID is a rare autoinflammatory disease that also was characterized by Dr. Goldbach-Mansky and her colleagues. Now, a short video developed by the Institute provides a more personal view of how rare diseases affect the lives of patients and families. The video tells the story of Kayla, a young NOMID patient who is treated at the NIH Clinical Center. It also features Kayla�s mother and Dr. Goldbach-Mansky. I appreciate their willingness to share their experiences and to convey, in a very powerful way, why we do this work. Thus, research on rare diseases not only brings new knowledge and potentially new treatments to affected patients, but also provides us with a greater understanding of the biological systems that affect human health.

医学

2014-42/1180/en_head.json.gz/2319

Home > Newsletters > Breast Health Aggressive Breast Cancer May Be Triggered by Obesity Obesity in menopause boosts a woman's risk for a type of breast cancer tied to the hormone estrogen. Those excess pounds may also increase the risk for an aggressive breast cancer that's not influenced by hormones. The aggressive type of breast cancer is called "triple-negative," because it lacks not only estrogen, but also progesterone and the protein HER2, which is involved in other types of breast cancer. Although triple-negative breast cancer is less common than other types, it's deadlier because it is so aggressive and because few treatments are available for it. Researchers at the Fred Hutchinson Cancer Research Center in Seattle assessed data on 155,723 women in the Women's Health Initiative, a large-scale study of postmenopausal women that started in 1993. The women ranged in age from 50 to 79 years old. Assessing data The data included participants’ exercise habits, weight, height, and body mass index (BMI). During the follow-up, which lasted an average of eight years, 2,610 women developed estrogen receptor-positive breast cancer, which is fueled by estrogen, and 307 women developed triple-negative breast cancer. The women were divided into four groups, from lowest to highest BMI. Those in the highest group had a BMI of 31 or higher. (A BMI of 30 or higher is categorized as obese.) Women with the highest BMIs had a 35 percent increased risk of developing triple-negative breast cancer, compared with those who had the lowest BMIs. The highest BMI group also had a 39 percent increased risk of developing other breast cancers. Lead author Amanda Phipps, Ph.D., says the association between triple-negative breast cancer and obesity is "borderline" statistically significant, but that’s probably because of the relatively low numbers of cases in the study. More fat, more estrogen Researchers have long recognized the link between obesity and estrogen-positive breast cancer, which has been blamed on higher exposure to estrogen in fat tissue. After menopause, most of a woman's estrogen comes from fat tissue. "The more fat, the more estrogen exposure," Phipps says. But triple-negative cancers aren't responsive to hormones, she says. "The fact that we see such a similar association between the two subtypes [and obesity] tells us it may not just be the hormonal effect of the obesity [driving the risk]." The bottom line for women? Maintaining a healthy weight is vital as women age. "I think people assume fat is inert," says Joanne Mortimer, M.D., at City of Hope Comprehensive Cancer Center in Duarte, Calif. But researchers are finding that fat cells "do more than take up space," she says. American Cancer Society - What are the risk factors for breast cancer? National Heart, Lung, and Blood Institute - Assessing Your Weight and Health Risk Weight -control Information Network - Do You Know the Health Risks of Being Overweight? Focus on Health to Lose Weight Which is more important to you—being able to wear the jeans you wore five years ago, or being able to move better, have more energy, and improve your health? Losing weight for health rather than appearance can make it easier to set reasonable goals. These are goals to aim for: You should achieve or maintain a body mass index (BMI) of 18.5 to 24.9. Your waist should measure less than 35 inches (40 inches if you're a man). Fat stored around your waist increases your risk for chronic diseases. Try not to eat more calories than your body burns each day. Stick to your eating plan, even on weekends, vacations, and holidays. If you eat more calories than you need, the excess calories are stored as fat. Too much stored fat raises your BMI and makes it hard to get back to your goal weight. Remember that number of calories you need each day depends on your age, gender, and activity. Additional ResourcesGenetic CounselingOutcomes in Patients with HER2 Overexpressing and Triple Negative Phenotypes Treated with Partial Breast Irradiation using Mammosite BrachytherapyRadiation OncologyThe Cancer CenterThe Importance of Breast Care Breast Implants May Hinder Breast Cancer DiagnosisWomen in Their 40s Need Annual MammogramStudy Suggests Change in Radiation Guidelines in Older Women Leading NYC Health Care Professionals To Probe Challenges in Diagnosing Breast Cancer in Multiethnic Communities at April 7 Symposium04/02/2009New York Hospital Queens Women’s Imaging Center Designated “Center of Excellence” by American College of Radiology03/30/2009Understanding Breast Cancer Risks & Management09/30/2008

医学

2014-42/1180/en_head.json.gz/2596

Senator Jane Nelson P.O. Box 12068, State Capitol Contact: Chris Ward (512) 463-0112 MANAGED CARE COMMITTEE UNVEILS BILL PACKAGE AUSTIN - State Senator Jane Nelson, R-Flower Mound, and other members of the Senate Interim Committee on Managed Care and Consumer Protections today announced a package of bills to ensure accessible, quality care for Texans enrolled in managed health care plans. "Nothing is more important to Texas families than their health," Senator Nelson said. "These bills will ensure that, as more Texans participate in managed care health plans, the quality of care they receive will not diminish." Nelson is co-sponsoring six bills stemming from recommendations approved by the committee in its December report. Nelson authored legislation relating to patient confidentiality, access to emergency care, and utilization review. Utilization review is the process by which insurers make decisions about what care will be covered. "When you're sick, you don't want to spend 30 minutes on the phone just to hear a data processor at a computer tell you you don't need medical treatment. When my child is gasping for breath in a pool of blood, I know it's an emergency and I'm not going to waste time calling an HMO for approval to get her to the hospital. When my mother goes in for a breast cancer screening, I don't want her to wind up with a mailbox full of silicone implant brochures," Nelson commented. Highlights of Nelson's bill include: More stringent confidentiality protections for patient records; Including a "prudent layperson" standard in the definition of emergency care; and Requiring that personnel performing utilization review procedures be licensed physicians, nurses, or physician assistants. "Managed care is an ever-expanding part of Texas health care." Nelson commented. "There are areas where the doctor-patient relationship is being eroded by third party interference. These safeguards will protect that sacred bond as managed care continues to expand in Texas." Nelson, who is vice Chair of the Senate Health and Human Services Committee, has also filed bills to ensure women direct access to their OB/GYNs and to guarantee 48-hour hospital stays for mothers and newborns. Other members of the Managed Care Committee are: Senators David Sibley, R-Waco (Chair); David Cain, D-Dallas; Chris Harris, R- Arlington; and Frank Madla, D-San Antonio. Detailed bill summaries are available.

医学

2014-42/1180/en_head.json.gz/2608

Lots of TV May Harm Kids' Diet MONDAY, May 7 (HealthDay News) -- Kids who spend lots of time in front of the TV have poorer diets overall, a new study of U.S. middle school students finds.The research doesn't prove that TV watching has anything to do with what kids eat, and other factors -- such as parenting style -- could be more important than time spent with "American Idol" or "SpongeBob SquarePants."Still, "the more TV you watch, the less likely you were to eat fruits and vegetables every day, and the more likely you were to eat things like candy and soda, eat at a fast food restaurant and even skip breakfast," said study author Leah Lipsky, a staff scientist with the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Previous research has linked more TV watching to obesity in kids, she said, perhaps because the children are less active and snack more.But study co-author Ronald Iannotti, also a staff scientist at the institute, said the issue is complicated. In some cases, for example, boys who are more active tend to watch more TV."There's some evidence that TV may be its [own] unique risk factor. It could be because your metabolic rate is so low that it's just worse than doing anything else," Iannotti said.Seeking to better understand how TV watching affects diet, the researchers examined data from a 2009-2010 survey of more than 12,600 U.S. youngsters in grades 5-10, average age 13. The findings appear in the May issue of the Archives of Pediatrics & Adolescent Medicine.The study found that those who watched the most TV were slightly more likely to eat candy and fast food and skip breakfast, even when researchers adjusted their statistics so they wouldn't be thrown off by factors such as computer use and physical activity. Also, eating habits appeared to deteriorate according to age, gender and race. Unhealthy eating habits were more common among older students than younger ones and more prevalent among boys and black or Hispanic students compared to girls and white students."In some cases, the effect is very small. On the other hand, these effects can be huge when you think of even a slight increase in food intake affecting 200,000 sixth graders," Iannotti said.A positive note was that those who snacked the most while watching TV also ate more fruit (in addition to more candy, soda and fast food).So, is TV at fault? The researchers acknowledged that other factors could play a role, such as parents who allow both TV watching and poor diets. The study authors didn't take household rules into account. The authors said that future research should try to tease out the independent contributions of food advertising, TV time and TV snacking to food consumption among children. If it turns out that a cause-and-effect relationship does exist, attempts should be made to limit viewing or improve the nutritional content of foods advertised on TV, they said.Frederick Zimmerman, chair of the health services department at the Fielding School of Public Health at the University of California, Los Angeles, said the study is well-conducted, but "a little behind the current research curve" with regard to food advertising's effects on health and eating behavior."Other research has shown that physical activity tends to make us crave those inputs that are healthiest for us, whether in the realm of food or entertainment," Zimmerman said. "Regular daily physical activity -- especially outdoors -- is what we're designed for and the natural and enjoyable state of human beings. If we can enjoy regular physical activity, we can let go of some of the anxiety on TV and diet, because we'll naturally want what's healthy for us." More informationFor more on obesity in children, visit the U.S. National Library of Medicine. SOURCES: Leah M. Lipsky, Ph.D., and Ronald J. Iannotti, Ph.D., staff scientists, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Md.; Frederick J. Zimmerman, Ph.D., professor and chair, Department of Health Services, Fielding School of Public Health, University of California, Los Angeles; May 2012 Archives of Pediatrics & Adolescent Medicine Related Articles Use Chia Seeds With Caution, Researcher Warns October 21, 2014 Binge Drinking May Boost Blood Pressure in Young Men October 21, 2014 Learn More About Sharp

医学

2014-42/1180/en_head.json.gz/2739

Spaghetti dinner benefits Cancer Caring Center Krista Baker with husband, Jonathan, and children, Nicholas and Sara. Krista Baker said it’s an “honor to be honored” when asked how it felt to be her nursing school class project. Baker, 34, of Carnegie learned in May 2012 that she had breast cancer after discovering a lump in her breast while taking a shower. There is no history of breast cancer in her family. Soon, she was in the midst of chemotherapy while trying to be a wife and mother of two, working full-time at UPMC-Presbyterian and attending classes full time at the Community College of Allegheny County to become a nurse. After six months of chemotherapy, Baker had bi-lateral breast surgery during the holiday break in December. “Then I had four weeks of recuperating,” Baker said. Fellow classmate and friend Aimee Arnold of Whitehall, who is the 2013 day class president, approached Baker about being honored as part of the class’ community service project. “We wanted to do something in honor of her and we’d talked about a spaghetti dinner,” Arnold said. Several of the other classmates have volunteered to assist at the dinner. From 3-7 p.m. Feb. 23, a spaghetti dinner will be held at Arnold’s church, Good Shepherd Lutheran Church, 418 Maxwell Drive, Whitehall. Arnold suggested Baker keep half the money raised from the dinner to help with extra expenses, but Baker declined. All of the proceeds will go to a charity suggested by Baker, the Cancer Caring Center. Baker did not attend programs at the Cancer Caring Center. “Honestly, there was not enough time to go, but I hope to volunteer there when school is over,” she said. “I’ve been to a couple of support groups and they had mainly older women, and I heard the Cancer Caring Center focuses on young women.” Baker and Arnold will graduate from the two-year nursing program in the spring. And before she begins a new job, Baker will have reconstructive surgery. Baker’s husband, Jonathan, will be unable to attend the dinner due to work requirements, but Baker and their two children, Nicholas, 8, and Sara, 5, will attend. As for her family during the past nine months, Baker said they were her “saving grace when I didn’t feel well.” Tickets can be purchased at the door at $5 for adults and $3 for children 12 and under. For more information about the spaghetti dinner, contact the church at 412-884-3232, or email Arnold, Alexis Jenner, Erin Bomeke or Jayme Alter at ccacnursing2013@gmail.com.

医学

2014-42/1180/en_head.json.gz/2746

The Public and Smoking: Fear or Calm Deliberation? A biologist who graduated from Harvard in the famous class of 1910, Clarence C. Little served as president of the University of Maine and then of the University of Michigan before taking up a leading role in cancer research. He is presently scientific director and chairman of the Scientific Advisory Board to the Tobacco Industry Research Committee By Clarence Cook Little We all agree, I am sure, that excess in and abuse of any human activity are undesirable and should be discouraged whether it is the use of alcohol or coffee or tobacco or the function of eating, of exercise or inactivity, of work or recreation. For the vast majority, however, the temperate expression of most of these same activities is an essential part of total health and well-being. When any of these commonplace activities falls under suspicion as being a specific factor in the causation of human disease, we can agree also that this is a matter for serious consideration, but we must be extremely cautious in evaluating the basis for such suspicion and the extent of the supposed risk involved, and in avoiding the creation of fear and panic. This is especially true today, when we are dealing with ailments, such as cancer and heart disease, of people mostly in advanced age groups. These do not, so far as our present knowledge goes, fit into the categories of the old-time pathologists—they are not specific diseases produced by specific causes with specific patterns of injury to specific tissues. It is now generally agreed that they are, at least in part, diseases related in some way to present-day stress, modern environment, and to extension of life into the problem of old age. The worries of home, of business, of driving along highways of crowded living, the search for relaxation and, not the least, the fears of being sick or of catastrophe have an untold effect upon the body and, if sufficiently intense, may certainly lead to illness, if not cause it. As to seeking specific causes of cancer, and also heart disease, science is only now on the threshold of what I hope will be great advances in developing better methods of testing the biologic activity of many, many substances that we all use or are exposed to from day to day and, more important, of assigning to them their relative place in the scale of risks we assume in our daily lives. For it cannot be gainsaid that while there is an absoluteness about the hazards to life, there is no such thing as absolute safety for life. The very things that are essential or important to continued, effective living may be harmful or even fatal under conditions of misuse or abuse. In the field of tobacco use and health, all concerned admit the need for more knowledge and research. Differences exist mainly over the evaluation of our present knowledge or lack of it, and the direction and emphasis of future research. There are some who feel and proclaim that "beyond reasonable doubt" cigarette smoke contains one or more as yet unknown substances that may cause cancer in man. They would concentrate their research on isolating, identifying, or removing these substances even though no such agent has been discovered experimentally. Others believe, however, that the existence in tobacco smoke of substances carcinogenic to the lungs of men has not been and cannot be proved by statistical associations or by painting the skin of mice of certain specific strains with highly concentrated extracts of tobacco smoke. They therefore focus attention on development of more exact and more direct methods of assaying the cancer-inducing powers of suspected substances. In this direction may be found contributions not only to the smoking question but also to the total problem of bio-assay of other substances. FEAR OR CALM DELIBERATION? Generally speaking, the public believes in dicta from scientists or public health groups. Doubt, suspicion, fear, and mental tension can be created and maintained by one type of presentation of a situation. Balance, poise, a judicial attitude and calm deliberation can be engendered by another. For at least four years there have been repeated, sensational, and fear-arousing statements and resultant headlines on the theoretical lethal nature of tobacco smoke. The repeated expression of these views, however, is no measure of their general acceptance by all who are concerned with the problems involved. For instance, the statistical evidence in support of the cigarette theory has not been accepted as proof of generalized conclusions about smoking by a number of distinguished statisticians, among whom may be mentioned especially Dr. Joseph Berkson, Section of Biometry and Medical Statistics of the Mayo Foundation for Medical Education and Research in Rochester, Minnesota. There are certain unfeatured but fundamental contradictions in different statistical papers from which points of agreement have been selected for presentation by advocates of the "cigarette guilt" theory. For example, the implication of the American school of cigarette theorists is that inhalation and, therefore, direct contact of smoke with lung tissue is an important factor in the origin of lung cancer. On the other hand, certain British investigators state that it would appear that inhalation is a "negligible" factor. If this is the case, direct contact is not an important element. In any attempt to identify a suspected agent or agents, these two possibilities are an unsolved complication and are evidence of incomplete knowledge. The clinical pathological data of one American Cancer Society grantee was hailed by the then medical director of that society as "the very evidence skeptics demanded." These same data have not been so evaluated by a considerable number of trained clinical pathologists not affiliated with the American Cancer Society but familiar with much more data of a similar nature. The reports of inducing skin cancer on some mice by smearing highly concentrated tobacco smoke condensates have been countered not only by similar experiments failing to result in cancer but by universally negative carcinogenic results reported by a number of investigators following the inhalation of cigarette smoke or its injection directly into the lungs of rodents. Such contradictions in findings and interpretations could be continued at length, and indeed have been in many authoritative scientific publications, but these few are cited merely as evidence that the status of research into lung cancer involves many unresolved differences in concepts about possible causation and also about its relative incidence and increased frequency. In accepting and carrying out the responsibility of developing a research program in tobacco use and health for the Tobacco Industry Research Committee, my colleagues on the Scientific Advisory Board and I believe the cause of scientific investigation is best served by adherence to our stated position that definitive conclusions or predictions of individual risks are unwarranted by the present state of knowledge in this complex field. INDUSTRY ASSURES FREEDOM IN RESEARCH Some people question, as might be expected, whether the tobacco industry is honest in its efforts to find the whole truth. The conditions under which Tobacco Industry Research Committee grants are made guarantee complete freedom, unhampered conduct of research, and uncensored publication of any and all results. The tobacco industry was and is aware of the seriousness of the implications in the charges against smoking. The industry intends to support research until these charges can be proved or disproved by direct experimental evidence. Even cynics will admit that the industry cannot afford as a practical business matter to offer products which have been so definitely attacked without making every effort to find out the whole truth and, if and when any substance is identified and is shown to be harmful, to do its best to eliminate it. The industry is aiding research for scientific facts and will continue to do so. But it need not accept as final opinions based on incomplete evidence that is challenged by others. Nor does it feel able to "remove" from its products substances the nature, presence, and existence of which are generally admitted to be unknown. In these circumstances, the industry chose a course that is unusual, if not unique, for business-supported research. Scientists were given full responsibility for determining what research is needed and who should do it. The Scientific Advisory Board, of which I am chairman, has complete freedom in allocating the research monies, now amounting to some $2.2 million, to investigators in leading U.S. research, medical, and educational institutions. The board considers proposals for projects on their scientific merits and the prospects of constructive findings. The board may also initiate research ideas and then seek out qualified scientists to develop and conduct the needed lines of investigation. It is important for the public to remember that the members of the Scientific Advisory Board, in their approach to this research responsibility, take the position that smoking has not been proved guilty or guiltless in matters affecting human health. Their attitude is that statistical and indirect evidence does not prove its guilt as a causative agent. The open question of its innocence or its guilt can best be answered through unhampered research for the full facts. THE RIGHT TO LEARN AND TO INFORM The board members do not deny the right of any individual to state his belief in the guilt of smoking. Along with many independent research scientists they do and will as scientists insist on maintaining their right to their own criteria for judgment and for the opportunity to inform the public concerning the reasons for their position. They will do this until they possess evidence which they consider meaningful and conclusive on each and every research step. They will do this in spite of expensive and extensive pressure propaganda, and in spite of personal misinterpretations and attacks. These statements of honest doubt, shared by many scientists, do not constitute a "controversy," and those who feel as does the Scientific Advisory Board will not be driven into admitting it to be such. There has been no organized effort or campaign to claim that tobacco has been proved innocent, because those who, like the Scientific Advisory Board, desire a full and complete analysis of its effects are still in search of the answers. Similarly, there has been little widely publicized presentation of negative evidence relating to tobacco use, such as there has been of reports by those who are already convinced that they have found proof of its guilt. This is not surprising, for it is satisfying to proclaim you have surrounded the enemy and that mopping up activities are all that is needed. But to state that strong enemy forces are still undetected and that a long hard campaign lies ahead is irritating to the generals who are claiming the victory. It seems, however, to those who will have some responsibility for the continued campaign, that the public—the troops on the firing line—deserve to be told what the whole evidence is and of the likelihood that the battle is not won and then be allowed to decide for themselves what the dangers, real or imaginary, may be. About fifteen years ago there were headlines and a propaganda flurry based on statistical evidence that direct exposure to sunlight was a causative factor in skin cancer. This point of view, which was widely accepted, received support from experiments showing skin cancer on the ears of rodents following exposure to ultraviolet light, a component of sunlight. In spite of this, no one asked for legislation to bring back the bathing regalia of the gay nineties, and no one attempted to educate children not to visit beaches or to wear sun suits, nor were farmers and sailors urged to carry umbrellas. From the first charges that tobacco might be a causative factor in lung cancer and cardiovascular disease, there have been repeated efforts by some ardent laymen and some already convinced scientists to activate debate and controversy with those who desire further information before they feel ready to take the trip to Canossa. It may be that some day—perhaps soon, perhaps years from now—we shall know what part or parts various factors play in the etiology of lung cancer in man. When we do, tobacco use may or may not prove to be one of them. Today, while we are making real progress in lifting the cancer curtain, we should not be misled into thinking that one glimpse behind a raised corner of this curtain reveals to us all the knowledge that remains to be unearthed. The public has been heavily propagandized along one definite theory of causation by those convinced by one level of information. Some of us demand a different order and level of knowledge before we accept causation or condone presentation of conclusions to the public. We claim merely the right to pursue knowledge through scientific research, the right to hold our point of view, and the right of the public to be aware of it. http://www.theatlantic.com/magazine/archive/1957/12/the-public-and-smoking-fear-or-calm-deliberation/304764/

医学

2014-42/1180/en_head.json.gz/2844

Home Page - Non-Traumatic Emergencies Home > Online Library > Home Page - Non-Traumatic Emergencies > Glossary - Non-Traumatic Emergencies acetaminophen - a pain-relieving and fever-reducing drug found in many over-the-counter medications such as Tylenol). aneurysm - a saclike protrusion from a blood vessel or the heart. angina pectoris (Also called angina.) - recurring chest pain or discomfort that happens when some part of the heart does not receive enough blood. antivenin (Also called antivenom.) - an antidote to snake venom used to treat serious snake bites. Antivenin is derived from antibodies created in a horse's blood serum when the animal is injected with snake venom. Because antivenin is obtained from horses, snake bite victims sensitive to horse products must be carefully managed. appendectomy - the surgical removal of the appendix (to treat acute appendicitis). appendicitis - an inflammation of the appendix, a finger-like portion of the large intestine that generally hangs down from the lower right side of the abdomen. Although the appendix does not seem to serve any purpose, it can become diseased and, if untreated, can burst, causing infection and even death. arteriosclerosis - commonly called "hardening of the arteries"; a variety of conditions caused by fatty or calcium deposits in the artery walls causing them to thicken. asthma - a chronic, inflammatory lung disease characterized by recurrent breathing problems usually triggered by allergens. Infection, exercise, cold air, and other factors may also be allergic triggers. atherosclerosis - a type of arteriosclerosis caused by a build-up of plaque in the inner lining of an artery. blood pressure - the force or pressure exerted by the heart when pumping blood; also, the pressure of blood in the arteries. brain attack (Also called stroke.) - the sudden disruption of blood flow to the brain. carbon monoxide (CO) - a colorless, odorless gas which can be created whenever a fuel (such as wood, gasoline, coal, natural gas, or kerosene) is burning. cardiac arrest - the stopping of heartbeat. cardiopulmonary resuscitation (CPR) - an emergency method of life-saving. Artificial respirations and chest compressions are used to restart the heart and lungs. central nervous system - the brain and the spinal cord. cerebral embolism - a brain attack that occurs when a wandering clot (embolus) or some other particle forms in a blood vessel away from the brain - usually in the heart. cerebral hemorrhage - a type of stroke occurs when a defective artery in the brain bursts, flooding the surrounding tissue with blood. cerebral thrombosis - the most common type of brain attack; occurs when a blood clot (thrombus) forms and blocks blood flow in an artery bringing blood to part of the brain. cerebrovascular accident - apoplexy or stroke; an impeded blood supply to the brain. cerebrovascular occlusion - an obstruction in the blood vessel in the brain. cholecystectomy - surgery to remove the gallbladder. cholecystitis - inflammation of the gallbladder wall. cholecystography - X-ray that shows the flow of contrast fluid through the intestines into the gallbladder. choledocholithiasis - a condition characterized by gallstones present in the bile ducts. cholelithiasis - a condition characterized by gallstones present in the gallbladder itself. defibrillator - an electronic device used to establish normal heartbeat. dehydration - loss of fluids from the body, often caused by diarrhea. direct fluorescent antibody test (dFA) - a test most frequently used to diagnose rabies in animals. dyspnea - shortness of breath. endoscopic retrograde cholangiopancreatography (ERCP) - an X-ray procedure to look into the bile and pancreatic ducts; an endoscope is inserted through the mouth into the duodenum and bile ducts. E. coli O157:H7 (Also called E. coli. or Escherichia coli.) - a species of bacteria found in the intestines of man and healthy cattle; often the cause of urinary tract infections, diarrhea in infants, and wound infections. epilepsy (Also called seizure disorder.) - a brain disorder involving recurrent seizures. extracorporeal shockwave lithotripsy (ESWL) - a procedure that uses shock waves to break gallstones up into tiny pieces that can pass through the bile ducts without causing blockages. fever (Also called pyrexia.) - an abnormal temperature of the body. A fever generally indicates that there is an abnormal process occurring in the body. food-drug interaction - occurs when food eaten affects the ingredients in a medication being taken, preventing the medication from working the way it should. frostbite - an injury to the body caused by freezing. gallbladder - organ that stores the bile made in the liver. gallstones - solid masses or stones made of cholesterol or bilirubin that form in the gallbladder or bile ducts. heart attack (Also called myocardial infarction.) - occurs when one of more regions of the heart muscle experience a severe or prolonged decrease in oxygen supply caused by a blocked blood flow to the heart muscle. heat stroke - the most severe form of heat illness and is a life-threatening emergency. It is the result of long, extreme exposure to intense heat, in which a person does not sweat enough to lower body temperature. Heimlich maneuver - An emergency first-aid treatment, consisting of a series of under-the-diaphragm abdominal thrusts, used on a person choking on food or a foreign object. hypertension - high blood pressure. hypothermia - an abnormally low body temperature brought on by staying in cold temperatures for a long period of time; a life-threatening emergency. ibuprofen - a nonsteroidal anti-inflammatory drug (NSAID) found in many over-the-counter medications (for instance, Advil or Motrin). indigestion (Also called dyspepsia.) - poor digestion; symptoms include heartburn, nausea, bloating, and gas. influenza (Also called the flu.) - a viral respiratory tract infection. The influenza viruses are divided into three types: A, B, and C. Lyme disease (LD) - a multi-stage, multi-system bacterial infection caused by the spirochete Borrelia burgdorferi, a spiral-shaped bacterium that is most commonly transmitted by a tick bite. magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. methyl-tert-butyl ether - a solution injected into the gallbladder to dissolve gallstones. myocardial infarction (Also called heart attack.) - occurs when one of more regions of the heart muscle experience a severe or prolonged decrease in oxygen supply caused by a blocked blood flow to the heart muscle. peak flow meter - a portable, inexpensive, hand-held device used to measure how air flows from lungs in one "fast blast;" to measure the ability to push air out of the lungs. post-Lyme disease syndrome (PLDS) - a condition, also known as chronic Lyme disease, characterized by persistent musculoskeletal and peripheral nerve pain, fatigue, and memory impairment. rabies - a widespread, viral infection of warm-blooded animals; caused by a virus in the Rhabdoviridae family, it attacks the nervous system and, once symptoms develop, it is 100 percent fatal in animals. seizure - occurs when part(s) of the brain receives a burst of abnormal electrical signals that temporarily interrupts normal electrical brain function. shock - impaired body function due to blood loss or a disturbance in the circulatory system. sphincterotomy - a procedure to open the muscle sphincter - a ring of muscle around a natural opening that acts like a valve - wide enough so stones can pass into the intestine. spirogram - a record of the amounts of air being moved in and out of the lungs. spirometer - an instrument that measures the amount of air moved in and out of the lungs (the amount of inhaled and exhaled air). spirometry - a pulmonary test of the lungs using a spirometer. splints - a device for preventing movement of a joint or holding in place any part of the body. stroke (Also called brain attack.) - the sudden disruption of blood flow to the brain. sunburn - the skin's reaction to overexposure of ultraviolet (UV) radiation, the invisible rays that are part of sunlight. syrup of ipecac - an emetic made from the dried root of a plant called ipecacuanha, which is grown in Brazil. An emetic is an agent that causes vomiting. transient ischemic attack (TIA) - a strokelike event that lasts for a short period of time caused by a blocked blood vessel. trauma - a physical injury or wound caused by an external force of violence, which may cause death or permanent disability. Trauma is also used to describe severe emotional or psychological shock or distress. ultrasound - a diagnostic imaging technique which uses high-frequency sound waves to create an image of the internal organs. vertigo - dizziness. X-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film. Or call 1-888-824-0200UCH1000010 (4)

医学

2014-42/1180/en_head.json.gz/2898

Gulf Bend home services has vacancies as new program is implemented By JR Ortega March 19, 2010 at 5:03 p.m.Updated March 18, 2010 at 10:19 p.m.ARE YOU A CANDIDATE FOR THE RESIDENCE PROGRAM?Must be 22 years and older.Have a determined mental disability.Meet specific level of care criteria.Are in need of active 24-hour treatment in a supervised setting.Must also meet income or resource limit requirements of Social Security or Medicaid.WANT TO LEARN MORE?For more information, please contact Gulf Bend Center at 361-575-0611 or visit www.gulfbend.org. For more information on the specific program, ask for Martha Resendez, Intellectual Development Disability Community Service manager. Space is now available at several of Gulf Bend's community-based homes.In April, Gulf Bend's Intermediate Care Facilities Program, which has four, six-bed facilities, will have five vacancies because of a roll out of people being accepted into another, less restrictive program called the Home and Community Services program. "It is important for families to prepare for the future," said Martha Resendez, Intellectual and Developmental Disabilities Community Service manager. "How is the individual going to be supported if something happens to them in the future? There is too much reliability on the family."Some people have moved from the Intermediate Care Facilities program to the new program because the Home and Community Services program allows people to live in the communities and they can move anywhere in Texas with the services, Resendez said.The Intermediate Care Facilities program gives people diagnosed with intellectual or developmental disabilities or related conditions a place with 24-hour supervision and coordination that fit their individual needs, Resendez said. The community-based residence is another service Gulf Bend offers that the Crossroads area may not know about, said Don Polzin, executive director. "We've got a responsibility," Polzin said. "We want the community to know, because people don't know how to access these services."Polzin is keeping a close watch on both the federal and state level to see how health care reform and funding will be in the next couple of years."We see a tightening of the belt," he said. "We're going to have to learn how to operate under those constraints."Despite what happens on a federal and state level, the need for these services will always be there, Polzin added."We have an aging society and I think that's going to become an increasing need," he said. "Our business isn't going to get any easier."SHAREComments

医学

2014-42/1180/en_head.json.gz/2947

Anti-HIV drugs in pregnancy not linked to children�s language delays WEBWIRE – Thursday, July 18, 2013 The combinations of anti-HIV drugs recommended for pregnant women do not appear in general to increase their children�s risk for language delay, according to a study from a National Institutes of Health research network. Children exposed to HIV in the womb and whose mothers received combinations of anti-HIV drugs during pregnancy were no more likely to have language delays than were children exposed to HIV in the womb and whose mothers did not receive these recommended treatments, the study found. In both groups, about 25 percent of the children had language delays by 2 years of age, suggesting that the delays were not associated with the anti-HIV drugs taken during pregnancy. The findings allay concerns in the medical community that the drug combinations could affect the developing fetal brain in ways that cause language delays. Typically, these combination treatments include three or more drugs from at least two drug classes. For a woman who is HIV-positive and pregnant, recommended combination therapies treat the infection and greatly reduce the chance that the virus will spread to the fetus. Previous studies suggested that the drugs used to treat pregnant women might contribute to language delays in infants and toddlers, even those who remained HIV-negative. However, the researchers concluded that one drug sometimes used in the combination treatments should be monitored. Children whose mothers received combination therapy containing the drug atazanavir were more likely to have language delays at 1 year of age than were the other children in the study. These children appeared to catch up to their peers. The researchers noted that these effects were not seen in children in the atazanavir group at age 2. �Anti-HIV combination therapies do not appear to be linked to language delays, but it�s prudent to monitor children exposed to HIV in the womb for signs of language delay,� said study co-author George Siberry, M.D., of the Maternal and Pediatric Infectious Disease Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), one of the NIH institutes that conducted the study. �Until there is a better understanding of what contributes to the delays, it�s important to monitor the language development of children in this group carefully, and refer them for language therapy at the first sign of a delay.� Dr. Siberry collaborated with first author Mabel L. Rice, Ph.D., of the University of Kansas, Lawrence; Paige L. Williams, Ph.D., of the Harvard School of Public Health, Boston; Howard J. Hoffman, of the National Institute on Deafness and Other Communication Disorders (NIDCD), part of NIH; and colleagues at the National Institute of Mental Health (NIMH), also part of NIH; Albert Einstein College of Medicine, New York City; Northwestern University Feinberg School of Medicine, Chicago; Keck School of Medicine of the University of Southern California, Los Angeles; and Tulane University School of Medicine, New Orleans. In addition to the NICHD, NIDCD and NIMH, seven NIH institutes and funding agencies supported the study: National Institute on Drug Abuse, National Institute of Allergy and Infectious Diseases, Office of AIDS Research, National Institute of Neurological Disorders and Stroke, National Heart, Lung and Blood Institute, National Institute of Dental and Craniofacial Research, and National Institute on Alcohol Abuse and Alcoholism. The findings appear online in the Pediatric Infectious Disease Journal. As part of an ongoing protocol known as the Pediatric HIV/AIDS Cohort Study, the researchers examined the effect of typical combination treatments. Around the time of the children�s first and second birthdays, the researchers administered questionnaires to caregivers, asking them to assess their child�s language development. At age 1, the caregivers indicated whether their children could respond to a list of simple words, and whether they could point with a finger or make other gestures to communicate. The assessment for 2-year-olds asked caregivers to choose words the child had spoken or responded to, as well as other milestones of language use common to children at this age. The researchers evaluated the language skills of nearly 800 children. They were able to collect assessments at study visits at either ages 1 or 2 for 70 percent of the children, and 40 percent were assessed at BOTH ages 1 and 2. The researchers found that 26 percent of the 1-year-olds were significantly behind typical children their age with regard to emerging language skills. Communicating at age 2 requires a different set of skills, as words increasingly replace gestures. Yet, communication among 23 percent of 2-year-olds, too, was significantly delayed, compared with peers, the researchers found. The researchers also conducted an analysis of individual drugs in the combination treatments the mothers received. Atazanavir is among the preferred medications for the treatment of pregnant women, and its use is increasing, the authors noted. Mothers of about 20 percent of the children in the study took this drug as part of their treatment. The researchers found that 1-year-olds who had been exposed to atazanavir were nearly twice as likely to experience language delays as those who were exposed to combination regimens without atazanavirs. However, they did not find evidence of increased language delays among the 2-year-olds whose mothers took atazanavir. About the National Institutes of Health (NIH): NIH, the nation�s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov. Infectious Disease Control Youth / Children

医学

2014-42/1180/en_head.json.gz/3038

KESSLER: Visiting Yale’s brain collection By Zara Kessler It’s in large part thanks to Harvey Cushing that Yale possesses more brains than Harvard. After graduating from Yale in 1891, Cushing, the “father of modern neurosurgery,” headed to Harvard for medical school. He did a stint at John Hopkins University, where, in 1902, the pathology department claimed to have misplaced a pituitary cyst he was studying. Enraged, Cushing vowed that he would henceforth keep track of all his own brain specimens. Three decades and over 2,000 tumor operations later, Cushing returned to Yale, serving as Sterling Professor of Neurology. He offered his collection of approximately 600 jarred specimens to Harvard, but when the university dawdled, Cushing brought his brains back to New Haven. Those jars of formaldehyde — together with copious records, detailed drawings, glass plate negatives and a collection of historically significant medical books — remained at Yale upon Cushing’s death in 1939. And for about 30 years, young neurosurgeons studied his specimens housed in a sub-basement of Brady Memorial Laboratory. But by 1979, no one paid much attention to the jars. The collection was locked in a room near a fall-out shelter in the basement of Harkness Hall and forgotten. Kind of. By the mid 1990s medical students had discovered the collection and, in typical Yale fashion, created a rite of passage and a society around sneaking into it, a process that apparently required removing door panels and picking locks. Those who entered signed a poster-board emblazoned with the words “The Yale Medical School Brain Society” and instructions to “Leave Only Your Name, Take Only Memories.” Mike “Hippocampus” Schlosser, Prem “Queen Amygdala” Bhat, or José “Hole in the Head” Prince, they scrawled. In 1996, Christopher Wahl ’96 MD — among the first to rediscover the room after a night of drinking at Mory’s in 1991 — got permission to write his MD thesis on Cushing’s Brain Tumor Registry. I was sober when I went to see Cushing’s brains (a good thing, considering it was 10 a.m.). I did not crawl through any steam tunnels, duck under pipes, remove door panels or pick locks. I didn’t even get to sign my name on the Brain Society poster. (I think I would have gone with Zara “Medulla Oblongata” Kessler.) Instead, I climbed down two flights of stairs in the Harvey Cushing/John Hay Whitney Medical Library to the Cushing Center, accompanied by Education Services Librarian Jan Glover, who agreed to give me a tour. I signed my name in a guest book. Beginning in the late 90s with the renewed interest in Cushing’s brains, Yale began to explore potential homes for the collection, and in 2008, the sub-basement of the Medical library was chosen. Soon thereafter, a forensic scientist cleaned the jars, replaced the formaldehyde, moving the brains, two-by-two in individual buckets (accompanied by Yale’s Environmental Health and Safety team) from Harkness to the Pathology lab. In June 2010, the Cushing Center opened. There are about 400 jars of brains, still bearing their original labels and tags, in cases along the shelves of the center. The lighting is a bit eerie, and I imagine visiting the spheres of wrinkles might not make the best solo expedition. Underneath the glowing orbs are some highlights of Cushing’s book collection: a 13th century manuscript containing writings by Aristotle, a first edition of Andreas Vesalius’ Humani Corporis Fabrica, a first edition of Nicolaus Copernicus’ “On the revolutions of the heavenly spheres” with a note scribbled in the margin by Edwin Hubble of telescope fame. My favorite non-cranial jar is a tiny one in a display devoted to Cushing’s life. It sits next to a photograph of Cushing and Ivan Pavlov. The two met at the 13th International Physiological Congress in Boston in 1929. Cushing invited an interested Pavlov to come see him do surgery with an electrosurgical knife. Pavlov was so fascinated by the tool that Cushing decided to call down to the hospital kitchen for a piece of liver so Pavlov could play around with the knife. Pavlov used the tool to sign his name in the meat. Cushing, not surprisingly, preserved the liver in the little jar on display. It’s a pretty historic piece of meat (and unlike during my venture to Louis’ Lunch, this time I didn’t even have to eat it). So yes, since June 2010, going to the Brain Room has become a bit more mainstream of a Bucket List activity. But I’d say swallow your pride and go in to look at some of Yale’s most distinguished brains. Of course, if you’ve been paying attention, you’ll realize that there are about 600 jars in the collection, and about 400 are on display. The other 200? Glover and a couple of others who work at the Center say they think that they’re still in the basement of Harkness. Zara Kessler is a senior in Ezra Stiles College. Her column runs on alternate Fridays. Contact her at zara.kessler@yale.edu. GeoJoe Wow! Very informative — thanks for writing about such a cool topic. And here’s another em-dash: —. There was a front page WSJ article on the Yale brains and steam tunnels in the 90’s. That article made the discovery more dramatic than a night after Mory’s. It may have been written by or about the ’96 med student or thesis. I think it said something about Branford; the med student could have been an undergrad in 1991. Thanks for clearing up the mystery, and good research.

医学

2014-42/1180/en_head.json.gz/3172

Wellness Center | Women's Center Home > Health Library > Women on Hormone Therapy May Benefit From Extra Calcium, Vitamin D Women on Hormone Therapy May Benefit From Extra Calcium, Vitamin D WEDNESDAY, June 26 (HealthDay News) -- Although there has been significant debate about whether calcium and vitamin D supplements are beneficial for older women, new research suggests that the answer may be yes for those who are taking hormone replacement therapy. Women using HRT who also took daily supplements of calcium and vitamin D saw a 40 percent reduction in their rate of hip fractures compared to women who took placebo supplements, according to the study. "We found that women who were on hormones had less hip fractures, and women who were on hormones and calcium and vitamin D supplements had even fewer hip fractures," said study author Dr. John Robbins, a professor of medicine at the University of California at Davis. Results of the study were published online June 26 in the journal Menopause. As many as half of all women over 50 will have an osteoporosis-related fracture in their lifetime, according to the U.S. Preventive Services Task Force (USPSTF). Osteoporosis is a condition caused by a loss of bone mass and density, which leaves bones fragile and more susceptible to fractures. Calcium is an important component in bone growth, and vitamin D helps the body absorb calcium. What's not clear is if supplements of these nutrients are as helpful in keeping bones strong as they are from natural sources, such as diet. The USPSTF recently looked at the effect of 1,000 milligrams of daily calcium and 400 international units of vitamin D. In February, they concluded that women shouldn't take calcium and vitamin D supplements because the available evidence wasn't strong enough to show a significant benefit. They added that the benefits of higher doses are unknown. The new study included data from the Women's Health Study on about 30,000 postmenopausal women between the ages of 50 and 79. Many of the women were taking hormone replacement therapy -- either estrogen alone or a combination of estrogen and progesterone. Just over 16,000 women participated in the calcium and vitamin D portion of the study. They were randomly selected to receive either a placebo or 1,000 milligrams of calcium and 400 international units of vitamin D each day. The average follow-up time was about seven years. The hormone therapy and the supplements together were the most effective treatment for reducing hip fracture risk. The researchers found that the combination reduced the risk of hip fracture by 57 percent. Overall, the rate of hip fracture was 11 per 10,000 women per year for those who took both hormones and supplements. Women who took only hormones had a hip fracture rate of 18 per 10,000, while those who took only supplements had a hip fracture rate of 25 per 10,000. Women who received neither therapy had 22 hip fractures per 10,000 women. The researchers weren't able to tease out whether vitamin D or calcium had any benefits on their own. All of the women who took one supplement also took the other. The study also was unable to find an optimal dose to help prevent hip fracture, although it appeared that women with a calcium intake of 1,200 milligrams and higher (from diet and supplements) might garner more benefit, Robbins said. The researchers saw a similar trend in lower hip fracture rates for women with higher vitamin D intake. "In moderation, I think there's relatively little risk of harm from calcium or vitamin D," Robbins said. "If a woman is taking hormones and other bone-enhancing drugs, she should also take calcium and vitamin D supplements in moderation or get them from dietary sources," he said. Dr. Jill Rabin, chief of ambulatory care, obstetrics and gynecology at Long Island Jewish Medical Center in New Hyde Park, N.Y., agreed that there doesn't appear to be a significant downside to taking these supplements if a woman doesn't have side effects, such as constipation, from taking them. "We can get a lot of calcium from our diet, and that's probably the best way to get it," Rabin said. "But if you can take a supplement without ill effects, you can certainly continue. And women considering taking hormone therapy might also want to add supplements." But, she added, the question of whether vitamin D and calcium can provide a significant reduction in fracture risk in women still needs more study. "The question hasn't been answered yet," she said. As for hormone therapy, which is often prescribed for symptoms of menopause, doctors recommend the lowest possible dose for a short period of time. Use of hormone therapy has been linked to a variety of health problems, including risk of breast cancer, stroke and blood clots, according to the USPSTF. Learn more about calcium and where to find it in your diet from the U.S. National Institutes of Health Office of Dietary Supplements. SOURCES: John Robbins, M.D., professor, medicine, University of California at Davis; Jill Rabin, M.D., chief, ambulatory care, obstetrics and gynecology, and head, urogynecology, Long Island Jewish Medical Center, New Hyde Park, N.Y.; June 26, 2013, Menopause, online

医学

2014-42/1180/en_head.json.gz/3242

WHOOPING COUGH EPIDEMIC MAY BE WORST IN 50 YEARS Date: 6/23/2010 Number: 10-041 Contact: Al Lundeen (916) 440-7259 SACRAMENTO Urging Californians to get vaccinated now, Dr. Mark Horton, director of the California Department of Public Health (CDPH), warned today that the state is on pace to suffer the most illnesses and deaths due to pertussis, also known as whooping cough, in 50 years.“Whooping cough is now an epidemic in California,” Horton said. “Children should be vaccinated against the disease and parents, family members and caregivers of infants need a booster shot.”As of June 15, California had recorded 910 cases of pertussis, a four-fold increase from the same period last year when 219 cases were recorded. Five infants — all under three months of age — have died from the disease this year. In addition, 600 more possible cases of pertussis are being investigated by local health departments.Pertussis is cyclical. Cases tend to peak every two to five years. In 2005, California recorded 3,182 cases and eight deaths.Pertussis is a highly contagious disease. Unimmunized or incompletely immunized young infants are particularly vulnerable. Since 1998, more than 80 percent of the infants in California who have died from pertussis have been Hispanic.The pertussis vaccine is safe for children and adults. Pertussis vaccination begins at two months of age, but young infants are not adequately protected until the initial series of three shots is complete at 6 months of age. The series of shots that most children receive wears off by the time they finish middle school. Neither vaccination nor illness from pertussis provides lifetime immunity.Pregnant women may be vaccinated against pertussis before pregnancy, during pregnancy or after giving birth. Fathers may be vaccinated at any time, but preferably before the birth of their baby. CDPH encourages birthing hospitals to implement policies to vaccinate new mothers and fathers before sending newborns home. CDPH is providing vaccine free of charge to hospitals.Others who may have contact with infants, including family members, healthcare workers, and childcare workers, should also be vaccinated. Individuals should contact their regular health care provider or local health department to inquire about pertussis vaccination.A typical case of pertussis in children and adults starts with a cough and runny nose for one-to-two weeks, followed by weeks to months of rapid coughing fits that sometimes end with a whooping sound. Fever is rare.

医学

2014-42/1180/en_head.json.gz/3441

Department of Medicinal Chemistry and Pharmacognosy Alumni Department of Medicinal Chemistry & Pharmacognosy People Faculty Staff and Assistants Faculty in the Department of Medicinal Chemistry and Pharmacognosy Bolton, Judy L.: Professor and Head, Department of Medicinal Chemistry and Pharmacognosy, Ph.D. (1988) University of Toronto Research interests: Chemical toxicology. The toxic effects elicited by dietary constituents often involves oxidative metabolism to electrophilic intermediates. We utilize chemical and biological approaches to study the cytotoxic/genotoxic mechanism including synthesis, spectroscopy, chromatography and enzymology. Metabolites and metabolic intermediates are identified, and their effects on various biochemical parameters studied. judy.bolton Bruzik, Karol S.: Associate Professor, Department of Medicinal Chemistry and Pharmacognosy, Ph.D. (1980) Polish Academy of Sciences Research interests: Bioorganic chemistry. Investigation of mechanisms of inositol-related enzymes and their function in cell signaling events. Synthesis of analogs of biophosphates as inhibitors and probes of enzyme mechanisms. Real-time, live-cell assay of enzymatic activities in response to receptor stimulation. Isolation, structure determination and synthesis of novel phosphoinositide second messengers. kbruzik Burdette, Joanna E.: Associate Professor, Department of Medicinal Chemistry and Pharmacognosy; Associate Dean for Research and Graduate Education, College of Pharmacy. Ph.D. (2003) University of Illinois at Chicago Research interests: The Burdette lab is interested in biological questions that are important for women’s health. We integrate imaging, drug discovery, and basic biology to try and understand how and where ovarian cancers originate. Our research primarily uses mouse models to understand early events in ovarian cancers. We are also using natural products to uncover new progestins and anti-cancer molecules. joannab Che, Chun-Tao: Norman R. Farnsworth Professor of Pharmacognosy, Department of Medicinal Chemistry and Pharmacognosy. Ph.D. (1982) University of Illinois at Chicago Research interests: Interested in natural drugs and Chinese medicine, including: 1. Natural products chemistry: isolation, characterization, and structural elucidation of secondary metabolites from medicinal plants and other natural sources. 2. Biologically active natural substances. 3. Chemical/biological standardization and quality assessment of herbal drugs and herb-based preparations. 4. Development of analytical techniques for herbal drug analysis. 5. Development of evidence-based Chinese medicine and other natural products chect Federle, Michael J.: Associate Professor, Department of Medicinal Chemistry and Pharmacognosy, Ph.D. (2002) Emory University, Atlanta Research interests:Research focuses on discovering and understanding how bacteria communicate among themselves as a means for organizing group behaviors, especially behaviors facilitating the initiation and progression of disease in humans. Cell-to-cell communication in bacteria, termed Quorum Sensing, relies on a language of small, secreted signaling molecules called autoinducers. Bacteria detect and respond to autoinducers through various types of receptor proteins sitting atop gene regulatory networks. it is my goal to identify and describe the production and structure of new autoinducers and their cognate signal-transduction networks that contribute to the pathogenic state of the microorganism. Our lab will use classic bacterial genetic and molecular biology techniques combined with conventional genomic, proteomic, and metabolomic analyses to identify components and targets of these signaling systems. Structural analysis of autoinducers and receptors, as well as screening for inhibitory compounds, will also be a focus of our work. I am concentrating my efforts on Gram-positive pathogens, as these organisms pose the most current threat in developing resistance to multiple antibiotic treatments. It is my hope that our research will lead to the development of new therapies that exploit and confuse communication systems bacteria use to organize attacks on the body. mfederle

医学

2014-42/1180/en_head.json.gz/3513

Sovaldi Approved for Chronic Hepatitis C MONDAY, Dec. 9, 2013 (HealthDay News) -- Sovaldi (sofosbuvir) has been approved by the U.S. Food and Drug Administration to treat chronic infection with Hepatitis C. It's considered a breakthrough medication since it's the first such drug that does not require same-time administration of interferon, the agency said in a news release. Infection with the hepatitis C virus causes liver inflammation that can lead to liver failure. Most infected people have no symptoms for years until the onset of liver failure, the FDA said. Complications may include a yellowing of the eyes and skin called jaundice, liver cancer, bleeding or fluid accumulation in the abdomen. Some 3.2 million Americans are infected with hepatitis C, the agency said. Sovaldi is designed to inhibit a protein that the virus needs to replicate. The drug's safety and effectiveness were evaluated in clinical studies involving 1,947 people who hadn't responded to other hepatitis C treatments, who hadn't been treated previously, or who couldn't tolerate the standard treatment of interferon, the FDA said. The most common side effects of Sovaldi included fatigue and headache. The drug is marketed by Gilead, based in Foster City, Calif. The National Library of Medicine has more about hepatitis C. Hepatitis Pediatric Diseases and Conditions Hepatitis in Children Hepatitis Quiz Q and A on Generic Drugs FDA OKs Once-a-Day Drug for Chronic Hepatitis C Olysio Approved as Hepatitis C Treatment Impavido Approved to Treat Tropical Parasitic Disease Northera Approved For Rare Blood Pressure Condition Aptiom Approved to Treat Seizures Avastin Approved for Late-Stage Cervical Cancer Beleodaq Approved for Aggressive non-Hodgkin Lymphoma Belsomra Approved for Insomnia Bionic Prosthetic Arm Approved Blood Test for Yeast

医学

2014-42/1180/en_head.json.gz/3612

Qualfon has plans to grow in Liberty Lake Rebranding of Center Partners facility part of transition In Biz Send items for In Biz Valley Hospital names new CEO From Staff Reports Tim Moran was named Valley Hospital's new chief executive officer, effective Aug. 26, the hospital announced in a press release. Moran, who had served as interim CEO at Valley since early July, brings more than 35 years in health care management. He spent most of his career in California, but has also worked for hospitals in Oregon, South Carolina and Saudi Arabia. "We're thrilled to have such an experienced, dynamic professional to lead this next phase of growth at our hospital," said Frank Tombari, chairman of the Valley Hospital board of trustees. "Tim is a hands-on leader, who believes in collaboration and financial and operational discipline. His focus on patient care, high performance teams and physician integration will help advance Valley Hospital and the entire Rockwood Health System." Moran said he is looking forward to "quickly becoming familiar with the community, and working with the leaders, employees and Medical Staff to accelerate the growth, quality and services Valley offers to meet the community's needs." Moran replaces Dennis Barts, who left earlier this summer to take a similar position in Colorado.

医学

2014-42/1180/en_head.json.gz/3665

Of mice and mental models: Neuroscientific implications of risk-optimized behavior in the mouse by Stuart Mason Dambrot Enlarge The experimental environment. In the switch task, a trial proceeds as follows: 1: Light in the Trial-Initiation Hopper signals that the mouse may initiate a trial. 2: The mouse approaches and pokes into the trial-initiation hopper, extinguishing the light there and turning on the lights in the two feeding hoppers (trial onset). 3: The mouse goes to the short-latency hopper and pokes into it. 4: If, after 3 s have elapsed since the trial onset, poking in the short-latency hopper does not deliver a pellet, the mouse switches to the long-latency hopper, where it gets a pellet there in response to the first poke at or after 9 s since the trial onset. Lights in both feeding hoppers extinguish either at pellet delivery or when an erroneously timed poke occurs. Short trials last about 3 s and long trials about 9 s, whether reinforced or not: if the mouse is poking in the short hopper at the end of a 3-s trial, it gets a pellet and the trial ends; if it is poking in the 9-s hopper, it does not get a pellet and the trial ends at 3 s. Similarly, long trials end at 9 s: if the mouse is poking in the 9-s hopper, it gets a pellet; if in the 3-s hopper, it does not. A switch latency is the latency of the last poke in the short hopper before the mouse switches to the long hopper. Only the switch latencies from long trials are analyzed. Copyright © PNAS, doi: 10.1073/pnas.1205131109 (Medical Xpress) -- Regardless of an organism’s biological complexity, every encephalized animal continuously makes under-informed behavioral choices that can have serious consequences. Despite its ubiquity, however, there’s a long-standing question about its neurological basis – namely, whether these choices are made through probabilistic world models constructed by the brain, or by reinforcement of learned associations. Recently, however, scientists in the Department of Psychology at Rutgers University found that reinforcement cannot account for the rapidity with which mice modify their behavior when the chance of a given phenomenon changes. The researchers say this indicates that mice may have primordially-evolved neural capabilities to represent likelihood and perform calculations that optimize their resulting behavior – and therefore that such genetic mechanisms can be investigated and manipulated by genetic and other procedures. In conducting their research, Prof. Randy Gallistel and doctoral student Aaron Kheifets had to first address a key challenge in identifying estimates of stochastic parameters versus reinforcement-driven processes as the behavior-optimizing mechanism in the laboratory mice studied (the c57bl/6j strain of Mus musculus, the common house mouse, from Jackson Labs). “Because both processes can lead to approximately optimal behavior in the long run,” Gallistel tells Medical Xpress, “one has to focus on the short run – that is, on the course of the transition in behavior. The problem in this case is that the transition is a change in the distribution of switch latencies.” A distribution of switch latencies is composed of a great many temporal discriminations on the part of the subject observed over a long sequence of trials, so this distribution can be used to prove that the process generating the distribution changed abruptly. “Fortunately,” Gallistel continues, “it was obvious from simple inspection of the raw data that there was an abrupt change. The challenge was to develop a mathematical analysis that confirmed this. Meeting this challenge required the use of Bayesian methods, which are just now beginning to be applied to behavioral data. In addition, we had to develop analyses showing that differential reinforcement could not explain the transition.” The team therefore applied Bayesian methods of analysis to the determination of the parameters of a transition function for a 4-parameter mixture distribution. “Also,” Gallistel adds, “a graphical means of displaying the raw data in such a way as to make the basic phenomenon visually apparent was required. To this end, we devised a figure with a huge number of bits per square centimeter – that is, it shows an enormous amount of readily graspable information in a small space.” There are several ways the researchers are augmenting their current investigation. “We’re working on automating the process of decision-making during the experiment,” Gallistel illustrates, “so as to improve the efficiency.” They’re also adding external temporal noise by varying the objective pay-off latencies (the durations between which the mouse must discriminate) to see how external uncertainty (random variation in the objective intervals) and internal uncertainty (uncertainty about the timing of the experienced intervals) interact. The scientists state that their findings suggest that neural mechanisms for estimating probabilities and calculating relative risk are phylogenetically ancient. “Mice and humans have not shared a common ancestor since before the extinction of the dinosaurs,” notes Gallistel. “Thus, the fact that both mice and humans have well-developed brain mechanisms for calculating risk indicates that those mechanisms were present in their common ancestor.” This also suggests, he says, that this finding means that such mechanisms may be explored through genetic and other invasive procedures in genetically manipulated mice and other laboratory animals. “A common strategy in modern mechanism-oriented biological research,” says Gallistel,” is to use the enormous power of combined classical and molecular genetics to discover the molecular, cellular and systems realization of basic mechanisms. A classic illustration of such use comes from the pioneering work of Seymour Benzer1 and his students on the circadian clock. By the 1970s, a great deal of behavioral and physiological evidence had accumulated that organisms of all kinds, even bacteria, have an internal clock that regulates their physiology and, in animals, their behavior – for example, the sleep-wake cycle, the ingestion cycle, and, indeed, almost every aspect of physiology and behavior.” However, until Benzer's work, no one had the faintest idea what the actual mechanism of such a clock might look like or where to look for it. “What this mechanism might possibly be was so mysterious that many scientists did not believe that there really was a clock,” Gallistel points out. ”They thought it was an emergent phenomenon, which is scientific jargon for a phenomenon that does not have a mechanism in any simple sense of the term, but rather emerges from mysterious and ineffable interactions between many different mechanisms. Many contemporary neuroscientists see memory as such a phenomenon." “When I was a graduate student,” Gallistel recalls, “I became familiar with the extensive behavioral evidence of an internal clock in, for example, bees, and I argued to some of my fellow graduate students that there had to be an honest-to-God clock in the brain. I well remember one of them saying in sarcastic disbelief, ‘You mean if you took the top of the skull off, you could see the hands going around?’” Benzer searched for fruit flies that had heritable genetic malfunctions so that they either did not have a clock, or had an abnormal clock that ran too fast or too slow. “Some very eminent colleagues of his – such as the Nobelist Max Delbruck – thought he was crazy to embark on such a wild goose chase, but he and his students soon found what they had set out to look for,” Gallistel continues. “They then used classical genetic techniques to localize these genes to small regions of certain chromosomes and that made it possible to use molecular genetics techniques to find the exact location of these genes and to establish the base-pair sequences in these genes. That, in turn, enables molecular biologists to identify the protein coded for by these genes and to fashion all kinds of every more sophisticated molecular tools that have enabled legions of other scientists to establish what is by now a quite detailed and constantly improved story about this molecular clock and where it is located and how it works. This is now in all the textbooks and it is a great triumph of reductionist biology.” Gallistel adds that because Benzer’s strategy has proven so powerful, there are now techniques for inducing mutations in mice for the express purpose of finding mice with heritable malfunctions in any of the thousands of different physiological and behavioral processes about whose underlying mechanisms we’re still ignorant. The general strategy is to test hundreds or even thousands of these mutant mice, looking for mice with a heritable malfunction in the phenomenon one is interested in. “In our case,” explains Gallistel, “this would be a heritable malfunction in risk assessment – either an inability to assess risk at all, or, more interestingly, a systematic inaccurate estimation of risk. One exploits the vast knowledge we have accumulated about mouse genetics and the thousands of genetically distinct inbred strains of mice to localize the gene whose mutation produces the heritable anomaly. One then uses molecular techniques, which have become radically more efficient and fast than they were in Benzer's day, to sequence the gene. One can then use an incredible array of tools and techniques that have been developed over the last several decades by molecular biologists to locate the cells where the gene is expressed, thereby opening up the investigation of the cellular and systems biology. One also can manipulate the gene itself in order to alter the functioning of the mechanism in ways that enable us to understand how the mechanism works at the molecular level.” Gallistel notes that this strategy only works if the phenomenon being investigated is robustly present and readily measured in animals like the mouse, the zebra fish, or the fruit fly – the species chiefly used in the pursuit of this strategy. “If you think only humans – and maybe only college trained humans – can correctly estimate probabilities and correctly calculate risks, then there is no way you can use this strategy. However, we’ve shown that mice can correctly estimate probabilities and correctly calculate risks – and that their ability to do so can be assessed in completely automated behavioral tests that require very little human labor, and that can be run on hundreds of mice simultaneously. In other words, there is now a way to apply Benzer's strategy to the mechanisms that mediate the brain's ability to estimate probabilities and calculate risks – and the molecular and cellular bases of these abilities are as mysterious to us at this time, as were the molecular and cellular bases of the daily clock in the 1970s.” Gallistel adds that other research and application areas might benefit from their findings. “Probabilities are simple quantities and the calculation of risk requires the application of arithmetic operations to these quantities,” he concludes. “The ability to represent quantities and apply arithmetic operations to them is a foundation of mental activity. Pursuit of these avenues could lead to an understanding of the physical bases for our ability to think.” More information: Mice take calculated risks, PNAS May 16, 2012, Published online before print May 16, 2012, doi: 10.1073/pnas.1205131109 1Related: Clock Mutants of Drosophila melanogaster, PNAS September 1, 1971 vol. 68 no. 9 2112-2116 Copyright 2012 Medical Xpress All rights reserved. This material may not be published, broadcast, rewritten or redistributed in whole or part without the express written permission of PhysOrg.com. Spatial configuration can spark deja vu, psychology study reveals (Medical Xpress) -- Déjà vu - that strange feeling of having experienced something before - is more likely to occur when a scene's spatial layout resembles one in memory, according to groundbreaking new research ... Brain oscillations reveal that our senses do not experience the world continuously (Medical Xpress) -- It has long been suspected that humans do not experience the world continuously, but rather in rapid snapshots. Device helps with Sudden Infant Death Syndrome detection University of Texas at Arlington researchers have obtained a patent for a device aimed at saving babies’ lives through improved and rapid detection of Sudden Infant Death Syndrome. Dreamless nights: Brain activity during nonrapid eye movement sleep (Medical Xpress) -- The link between dreaming and rapid eye movement (REM) sleep are well understood – but the fact that consciousness is reduced during nonrapid eye movement (NREM) sleep is not. Recently, ... Friendly Fungi: Elucidating the fungal biosynthesis of stipitatic acid (Phys.org) -- In a tale worthy of Sherlock Holmes, scientists in the School of Chemistry at the University of Bristol, UK have solved a biochemical mystery that had previously proven elusive for 70 years: ... New ALS associated gene identified using innovative strategy Using an innovative exome sequencing strategy, a team of international scientists led by John Landers, PhD, at the University of Massachusetts Medical School has shown that TUBA4A, the gene encoding the Tubulin Alpha 4A protein, ... Bariatric surgery may be a risk factor for a condition that causes severe headaches, according to a study published in the October 22, 2014, online issue of Neurology, the medical journal of the American Academy of Neurol ... Bipolar disorder discovery at the nano level A nano-sized discovery by Northwestern Medicine scientists helps explain how bipolar disorder affects the brain and could one day lead to new drug therapies to treat the mental illness. Mathematical model shows how the brain remains stable during learning Complex biochemical signals that coordinate fast and slow changes in neuronal networks keep the brain in balance during learning, according to an international team of scientists from the RIKEN Brain Science ... Brain simulation raises questions What does it mean to simulate the human brain? Why is it important to do so? And is it even possible to simulate the brain separately from the body it exists in? These questions are discussed in a new paper ... Scientists have described a way to convert human skin cells directly into a specific type of brain cell affected by Huntington's disease, an ultimately fatal neurodegenerative disorder. Unlike other techniques ...

医学

2014-42/1180/en_head.json.gz/3666

Debilitating eyesight problems are on the decline for older Americans By Erin White (Medical Xpress) -- Today’s senior citizens are reporting fewer visual impairment problems than their counterparts from a generation ago, according to a new Northwestern Medicine study. Improved techniques for cataract surgery and a reduction in the prevalence of macular degeneration may be the driving forces behind this change, the researchers said. “From 1984 until 2010, the decrease in visual impairment in those 65 and older was highly statistically significant,” said Angelo P. Tanna, M.D., first author of the study. “There was little change in visual impairments in adults under the age of 65.” The study, published in the journal Ophthalmology, shows that in 1984, 23 percent of elderly adults had difficulty reading or seeing newspaper print because of poor eyesight. By 2010, there was an age-adjusted 58 percent decrease in this kind of visual impairment, with only 9.7 percent of elderly reporting the problem. There was also a substantial decline in eyesight problems that limited elderly Americans from taking part in daily activities, such as bathing, dressing or getting around inside or outside of the home, according to the study. “The findings are exciting, because they suggest that currently used diagnostic and screening tools and therapeutic interventions for various ophthalmic diseases are helping to prolong the vision of elderly Americans,” Tanna said. Tanna is the vice chairman of ophthalmology at Northwestern University Feinberg School of Medicine and an attending physician at Northwestern Memorial Hospital. Stephen Kaye, of the Institute for Health & Aging and Disability Statistics Center, University of California, is the second author of the study. The study used self-reported data collected from 1984 to 2010 through two major population-based surveys, the National Health Interview Survey and the Survey of Income and Program Participation. Survey questions revealed how vision problems can impact the daily activities and quality of life of Americans and helped researchers analyze trends in the prevalence of visual impairment of adults in the United States. While this study didn’t identify any of the causes of the change in the prevalence of visual impairment, Tanna said there are three likely reasons for the decline: -- Improved techniques and outcomes for cataract surgery -- Less smoking, resulting in a drop in the prevalence of macular degeneration -- Treatments for diabetic eye diseases are more readily available and improved, despite the fact that the prevalence of diabetes has increased Future studies should identify which treatment strategies help prevent vision in older adults and then make those treatments available to as many people as possible, Tanna said. More information: www.sciencedirect.com/science/… ii/S0161642012003612 Journal reference: Ophthalmology Provided by Northwestern University Vision loss more common in people with diabetes Visual impairment appears to be more common in people with diabetes than in those without the disease, according to a report in the October issue of Archives of Ophthalmology, one of the JAMA/Archives journals. Routine glaucoma screening program may benefit middle-age African-American patients Implementing a routine national glaucoma screening program for middle-age African American patients may be clinically effective; however its potential effect on reducing visual impairment and blindness may be modest, according ... Visual impairment may be associated with higher suicide risk Visual impairment may be associated with an increased risk of suicide through its indirect negative effect on health, according to a report in the July issue of Archives of Ophthalmology. Study predicts 40 percent increase in blindness in Nigeria by 2020 By 2020, 1.4 million Nigerians over age 40 will lose their sight, and the vast majority of the causes are either preventable or treatable, according to the Nigeria National Blindness and Visual Impairment Study Group. Study evaluates prevalence of age-related macular degeneration in the United States An estimated 6.5 percent of Americans age 40 and older have the eye disease age-related macular degeneration, a lower rate than was reported 15 years ago, according to a report in the January issue of Archives of Ophthalmology. Smartphone approach examining diabetic eye disease offers comparable results to traditional method A smartphone-based tool may be an effective alternative to traditional ophthalmic imaging equipment in evaluating and grading severity of a diabetic eye disease, according to a study released today at AAO 2014, the American ... 3-D printed facial prosthesis offers new hope for eye cancer patients following surgery Researchers have developed a fast and inexpensive way to make facial prostheses for eye cancer patients using facial scanning software and 3-D printing, according to findings released today at AAO 2014, the 118th annual meeting ... iPads detect early signs of glaucoma in Nepal eye screening Using a tablet screening app could prove to be an effective method to aid in the effort to reduce the incidence of avoidable blindness in populations at high-risk for glaucoma with limited access to health care, according ... Could reading glasses soon be a thing of the past? A thin ring inserted into the eye could soon offer a reading glasses-free remedy for presbyopia, the blurriness in near vision experienced by many people over the age of 40, according to a study released today at AAO 2014, ... iPhones for eye health: Capturing ocular images in difficult-to-photograph patients Smartphone technology is a widely available resource which may also be a portable and effective tool for imaging the inside of the eye, according to results of a study released today at AAO 2014, the 118th annual meeting ... Bono reveals glaucoma forces him to wear sunglasses U2 frontman Bono revealed Friday that the real reason he wears sunglasses is because he suffers from glaucoma.

医学

2014-42/1180/en_head.json.gz/3668

Quantity of sugar in food supply linked to diabetes rates, study says Does eating too much sugar cause diabetes? For years, scientists have said "not exactly." Eating too much of any food, including sugar, can cause you to gain weight; it's the resulting obesity that predisposes people to diabetes, according to the prevailing theory. But now the results of a large epidemiological study suggest sugar may also have a direct, independent link to diabetes. Researchers from the Stanford University School of Medicine, the University of California-Berkeley and the University of California-San Francisco examined data on sugar availability and diabetes rates from 175 countries over the past decade. After accounting for obesity and a large array of other factors, the researchers found that increased sugar in a population's food supply was linked to higher diabetes rates, independent of obesity rates. Their study will be published Feb. 27 in PLOS ONE. "It was quite a surprise," said Sanjay Basu, MD, PhD, an assistant professor of medicine at the Stanford Prevention Research Center and the study's lead author. The research was conducted while Basu was a medical resident at UCSF. The study provides the first large-scale, population-based evidence for the idea that not all calories are equal from a diabetes-risk standpoint, Basu said. "We're not diminishing the importance of obesity at all, but these data suggest that at a population level there are additional factors that contribute to diabetes risk besides obesity and total calorie intake, and that sugar appears to play a prominent role." Specifically, more sugar was correlated with more diabetes: For every additional 150 calories of sugar available per person per day, the prevalence of diabetes in the population rose 1 percent, even after controlling for obesity, physical activity, other types of calories and a number of economic and social variables. A 12-ounce can of soda contains about 150 calories of sugar. In contrast, an additional 150 calories of any type caused only a 0.1 percent increase in the population's diabetes rate. Not only was sugar availability correlated to diabetes risk, but the longer a population was exposed to excess sugar, the higher its diabetes rate after controlling for obesity and other factors. In addition, diabetes rates dropped over time when sugar availability dropped, independent of changes to consumption of other calories and physical activity or obesity rates. The findings do not prove that sugar causes diabetes, Basu emphasized, but do provide real-world support for the body of previous laboratory and experimental trials that suggest sugar affects the liver and pancreas in ways that other types of foods or obesity do not. "We really put the data through a wringer in order to test it out," Basu said. The study used food-supply data from the United Nations Food and Agricultural Organization to estimate the availability of different foods in the 175 countries examined, as well as estimates from the International Diabetes Foundation on the prevalence of diabetes among 20- to 79-year-olds. The researchers employed new statistical methods derived from econometrics to control for factors that could provide alternate explanations for an apparent link between sugar and diabetes, including overweight and obesity; many non-sugar components of the food supply, such as fiber, fruit, meat, cereals and oils; total calories available per day; sedentary behavior; rates of economic development; household income; urbanization of the population; tobacco and alcohol use; and percentage of the population age 65 or older, since age is also associated with diabetes risk. "Epidemiology cannot directly prove causation," said Robert Lustig, MD, pediatric endocrinologist at UCSF Benioff Children's Hospital and the senior author of the study. "But in medicine, we rely on the postulates of Sir Austin Bradford Hill to examine associations to infer causation, as we did with smoking. You expose the subject to an agent, you get a disease; you take the agent away, the disease gets better; you re-expose and the disease gets worse again. This study satisfies those criteria, and places sugar front and center." "As far as I know, this is the first paper that has had data on the relationship of sugar consumption to diabetes," said Marion Nestle, PhD, a professor of nutrition, food studies and public health at New York University who was not involved in the study. "This has been a source of controversy forever. It's been very, very difficult to separate sugar from the calories it provides. This work is carefully done, it's interesting and it deserves attention." The fact that the paper used data obtained over time is an important strength, Basu said. "Point-in-time studies are susceptible to all kinds of reverse causality," he said. "For instance, people who are already diabetic or obese might eat more sugars due to food cravings." The researchers had to rely on food-availability data for this study instead of consumption data because no large-scale international databases exist to measure food consumption directly. Basu said follow-up studies are needed to examine possible links between diabetes and specific sugar sources, such as high-fructose corn syrup or sucrose, and also to evaluate the influence of specific foods, such as soft drinks or processed foods. Another important future step, he said, is to conduct randomized clinical trials that could affirm a cause-and-effect connection between sugar consumption and diabetes. Although it would be unethical to feed people large amounts of sugar to try to induce diabetes, scientists could put participants of a study on a low-sugar diet to see if it reduces diabetes risk. Basu was cautious about possible policy implications of his work, stating that more evidence is needed before enacting widespread policies to lower sugar consumption. However, Nestle pointed out that the findings add to many other studies that suggest people should cut back on their sugar intake. "How much circumstantial evidence do you need before you take action?" she said. "At this point we have enough circumstantial evidence to advise people to keep their sugar a lot lower than it normally is." More information: dx.plos.org/10.1371/journal.pone.0057873 Blood sugar diabetes risk for South Asians A new diabetes study at the University of Leicester has discovered that South Asians (people of Indian, Pakistani, Bangladeshi and Sri Lanka origin) have higher levels of blood sugar than white Europeans independent of risk ... Sweetened beverage consumption increases in the US Over the past two decades, the number of adults consuming sugar-sweetened beverages such as soft drinks, fruit drinks and punches has increased dramatically, according to a study led by researchers at the Johns Hopkins Bloomberg ... New evidence in fructose debate: Could it be healthy for us? A new study by researchers at St. Michael's Hospital suggests that fructose may not be as bad for us as previously thought and that it may even provide some benefit. UK public underestimating sugar levels in popular drinks (Medical Xpress) -- People in the UK are significantly misjudging the amount of sugar in popular drinks, particularly those perceived as “healthy” options according to research revealed today by ... U.S. kids still eat too much added sugar: CDC (HealthDay) -- Added sugar in drinks and foods makes up almost 16 percent of the calories U.S. children and teens consume, federal health officials report. Recommended for you

医学

2014-42/1180/en_head.json.gz/3670

New genetic cause of children's liver disease discovered (Medical Xpress)—The discovery of a 'faulty gene' in children with liver disease could pave the way for new treatments for children with a range of serious and life-threatening liver conditions. The findings – published on Sunday, 9 March in Nature Genetics – follow two years of research by doctors and scientists at King's College London and King's College Hospital, both part of King's Health Partners AHSC. Cholestatic liver disease (CLD) describes a number of conditions caused by impairment of bile formation, or bile flow. Normal bile production is essential for absorption of food and the body's ability to dispose of waste. CLD can be fatal, and many patients require liver transplantation. At least 12,000 people suffer from CLD in the UK. Using the latest gene sequencing technology, the team at King's discovered that 12 patients with CLD had a mutation in both copies of the TJP2 gene, which means it doesn't produce the TJP2 protein. This discovery of a new disease, called 'TJP2 deficiency', is a significant breakthrough. Crucially, it now means liver experts understand the mechanism underlying the disease, and can start treatment earlier and in a targeted fashion. Dr Richard Thompson, a paediatric liver specialist at King's who led the research, said the findings should increase our understanding of the way other types of liver disease develop. He said: 'This is extremely exciting. By understanding the disease better, we are a step closer to one day finding a cure. In the short-term, it also makes the disease much easier to diagnose –we have gone from basic science discovery to routine diagnostic testing in less than a year, which is amazing. Crucially, this means we can start logical treatment for the disease sooner. The basic principles of the discovery could also be applied to other, more common forms of liver disease, which is also very exciting.' King's, a major centre for the treatment of adult and paediatric liver disease, is one of three centres currently trialling a new drug for the treatment for CLD in children. Explore further: Novel potential approach to prevent infection in patients with liver failure More information: "Mutations in TJP2 cause progressive cholestatic liver disease." Melissa Sambrotta, et al. Nature Genetics (2014) DOI: 10.1038/ng.2918. Received 21 September 2013 Accepted 14 February 2014 Published online 09 March 2014 Journal reference: Nature Genetics Novel potential approach to prevent infection in patients with liver failure Findings published in the American Association for the Study of Liver Diseases journal, Hepatology, indicate that infection, the commonest cause of mortality in patients with acute liver failure (ALF), may be decreased by inh ... Toxic bile damages the liver Researchers at the Heidelberg University Hospital have discovered a new genetic disease that can lead to severe liver damage. Because a protective component of the bile is missing, the liver cells are exposed to the toxic ... British team perform new 'warm' liver transplants British surgeons said Friday they have performed successful liver transplants on two patients using a revolutionary technique which keeps the organ warm and functioning while outside the body. NSAID use linked to reduced hepatocellular carcinoma risk and mortality due to chronic liver disease Researchers found that aspirin use is associated with a decreased risk of developing hepatocellular carcinoma and death from chronic liver disease (CLD), according to a study published November 28 in the Journal of the Na ... FDA reports Samsca may cause liver damage (HealthDay)—After reviewing data from recent large clinical trials, the U.S. Food and Drug Administration has determined that Samsca (tolvaptan) should not be used for longer than 30 days and should not ... New genome-editing technique enables rapid analysis of genes mutated in tumors Sequencing the genomes of tumor cells has revealed thousands of genetic mutations linked with cancer. However, sifting through this deluge of information to figure out which of these mutations actually drive ... Advances in muscular dystrophy treatments from targeting endogenous stem cells In the past few months significant insights into the molecular controls of damaged tissue and how to manipulate them for better regeneration has been revealed for treating rare muscular disorders, which also extends to the ... The effect that genes have on our brain depends on our age. These are the findings of a group of researchers from the MedUni Vienna. It has been known for a number of years that particular genetic variations ... Most respond well to genetic testing results, according to study (Medical Xpress)—People at high risk for psychological distress respond positively to receiving results of personalized genetic testing, according to new research at Washington University School of Medicine ... Diet for your DNA: Novel nutrition plan sparks debate around data protection Personalised diet plans will not be widely accepted by the public until regulations are in place to protect information about our DNA, new research has shown. Loss of Y chromosome associated with higher mortality and cancer in men Age-related loss of the Y chromosome (LOY) from blood cells, a frequent occurrence among elderly men, is associated with elevated risk of various cancers and earlier death, according to research presented ...

医学

2014-42/1180/en_head.json.gz/3707

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

医学

2014-42/1180/en_head.json.gz/3708

My Left BreastMy WordPress Blog I Found a Lump Breast Cancer Posts Breast Cancer Resources How the Site Works You are here: Home / Uncategorized / The Rock ‘n Roll Hall of Fame Induction CeremonyThe Rock ‘n Roll Hall of Fame Induction Ceremony On Saturday we watched the 2014 Rock ‘n Roll Hall of Fame Induction Ceremony. It was filled with a gold mine of icons from my youth like Peter Gabriel, Linda Ronstadt, Cat Stevens, Hall & Oates, The E Street Band and Nirvana. OK, so Kiss was also inducted, but I’ve never been too big on Kiss. Man, those guys are getting old! Peter Gabriel acknowledged all of the many other musicians he’d collaborated with over the years, saying, ” Music should come with a health warning; it can be so dangerous; it can make you feel so connected, and can make you think the world could and should be a much better place. And it can occasionally make you very, very happy.” He brought out Youssou N’Dour to perform “In Your Eyes” and they both brought a sweet, ethereal passion to the stage. Cat Stevens seemed a bit embarrassed to be honored, but watching his performance reminded me of how much his music spoke to me when I was in my teens. I wrote a paper on “But I Might Die Tonight” in High School and had a long discussion with my English teacher at the time about the meaning of life, which I can still remember fondly. Linda Ronstadt is ill with Parkinson’s disease which is a huge loss and she wasn’t able to attend but the all star group of women performing her songs sounded awesome: Stevie Nicks, Sheryl Crow, Emmy Lou Harris, Bonnie Raitt and Carrie Underwood. Carrie sang her heart out, impressive for someone so young, collaborating with such a group of heavy hitters. It gave me a new found respect for her. These women have all weathered life as older rockers pretty well, considering the smoking, drinking and hard partying rock ‘n roll lives I’m sure they’ve all experienced, their voices are still strong and full of emotion. Hall & Oates were great with their Philly soul sound, as always, although I had no idea that John Oates was quite that short. He’s an eloquent and gracious speaker, more so than Daryl Hall. The E Street Band was, of course, wonderful and stupendous. I’m a long time fan of Bruce Springsteen, ever since my younger brother turned me on to his poetic lyrics in my 20’s. Bruce gave an honest and moving speech about the controversy behind his initial induction without the band and then they showcased each of the members of the band solo, against a backdrop of “Kitty’s Back.” The most intense moments in their set were when they talked about missing Clarence Clemmons, and how he would have loved being inducted into the Hall of Fame. His widow gave a sweet little speech about how he was known for being “the Big Man” for many reasons, which brought the house down. The Nirvana set was really fun. I thought I’d hate it, it’s sort of the antithesis of what Kurt Cobain stood for, but the young performers who joined Dave Grohl and Krist Novoselic on stage were fantastic and you could tell they were all having the time of their lives. Dave Grohl has become one of my favorite performers, his honesty and obvious passion for what he does comes through and he was a beast on those drums! Novoselic reminded me of a big bear, playing away soulfully on the accordion, of all instruments, for “All Apologies.” Lorde sang a version of it that gave me goosebumps. I suspect Kurt would have been happy to have her do the honors. And of course, Courtney Love had to show up, spewing inanities into the mike and trying to get everyone on the stage to hug her. Dave and Krist graciously, but uncomfortably, hugged her back. Man, she’s still a wreck. I love the music of that time, it made such an impression on me growing up. The passion and rebellion were so linked to my own life as I grew up rebelling against my parents and my Catholic upbringing. Last night reminded me of how much music meant to me at that age, and still does. I hope you all get a chance to watch it! To subscribe to My Life Breast, enter your email address in the box below: June 1, 2014 | By Claudia | Filed Under: Uncategorized 6 Comments Comments Diane Tolley says June 1, 2014 at 9:22 pm A reminder to me that we’re all ageing. But we don’t ever have to get old! I’d love to have seen it! Claudia Schmidt says June 1, 2014 at 9:28 pm It was nice to see that even though they’re getting older, they all still had lots of passion for the music. It reminded me of my own passion about music and brought me back in touch with that time – hope you get to see it – you might be able to find it online or on demand. Carol Cassara says June 2, 2014 at 1:07 am Enjoyed your take on the event and the “greats”…hard to imagine all that time has passed…. Claudia Schmidt says June 2, 2014 at 3:57 pm I know, isn’t it? I don’t feel that old……. Nancy's Point says June 4, 2014 at 2:58 pm Hi Claudia,I was going to watch this, but I forgot! That happens a lot… But thanks to this post, it’s almost like I did watch. Thanks! And yes, we’re all getting older aren’t we? But growing older is a good thing, a very good thing. Claudia Schmidt says June 8, 2014 at 10:17 pm I hope you have a chance to watch it, Nancy, it was a lot of fun! And yes, growing old is a good thing….. Claudia Schmidt, a working mom with two cool, but snarky teens, writes about life after her breast cancer experience in February of 2010. Claudia’s work has been featured on BlogHer, BA50 and Midlife Boulevard. She lives in bucolic Clinton, New Jersey with her husband, two teens, their dog (Tucker) and cat (Maverick). Follow her on Twitter @claudoo , Facebook or Pinterest. Copyright © 2014 · Tricked out by Fabulous Blogging · WordPress · Log in

医学

2014-42/1180/en_head.json.gz/3715

Home : About NCADD : Our Founder Our Founder - Marty Mann | | NCADD Founder - Marty Mann Marty Mann was an alcoholic. Plain and simple. She admitted it and once sober she dedicated the rest of her life to help others who suffered from the same crippling, often fatal, disease. Educating an ignorant public drove her every day to eradicate the stigma of addiction. Marty knew what is meant to feel despair and what it was like to be alone. When her health returned and friends noticed her new radiance, she simply remarked, “You let God in and He comes out of you.” Marty came from privilege, born in 1905 into a wealthy Chicago family and attended the best private schools. Married at 22, divorced at 23, Marty was a drunk at 24, around the same time her father lost his fortune. Marty moved to NYC and soon enjoyed an admired reputation for handling her drink; she developed a high tolerance for alcohol consumption, often an early symptom of alcoholism. Attractive, intelligent, engaging with a sharp wit and a flair for parties, things came easy for Marty and drinking was increasingly part of the picture. Life events soon took her deeper into alcoholism. She quit her job as an editor and moved to London after her grandmother died and left her a small inheritance. Marty was even more the life of the party in a new city across the Atlantic. However, soon she experienced memory blackouts and got drunk on lesser and lesser amounts of alcohol. Marty became frightened. Despite her strong will power, she could not stop drinking. Then, in 1934, Marty fell from a small balcony during a party. She never knew if she fell or jumped. A fractured leg, a broken jaw and traction for six months did not stop her from continuing to drink. Out of money, jobs gained and lost, Marty wound up in a secluded corner of Hyde Park in London, sipping booze from a bottle. She was close to hitting her bottom. Read more... Marty Mann’s Birthday Reminds All of Her Contribution to the World | | Marty Mann was born October 15, 1904. In reality, Marty Mann is scarcely a household word, yet she is arguably one of the most influential people of the 20th century and her influence continues into the 21st century. Marty rose to a triumphant recovery that powered a historic, unparalleled change in our society. Through her vision and leadership, the attitude of America toward alcoholism was changed from a moral issue to one of public health. This was a tremendous shift, especially considering America's long temperance history that culminated in the Prohibition Amendment of 1920. What the Alcoholic Owes to Marty Mann | | Out of Her Suffering Has Been Born a Network of Hope and Help for Thousands. by Floyd Miller In January 1963, Reader's Digest published a story by Floyd Miller titled "What the Alcoholic Owes to Marty Mann. Out of her suffering has been born a network of hope and help for thousands. The article is available at Silkwood.net, a website that provides historical writings, documents, letters, events, people, places and references through-out the history of Alcoholics Anonymous. Read more... | | Will The Real Marty Mann Please Stand Up ? About twenty five years ago, a popular television show called "To Tell the Truth," introduced three people, each of whom claimed to be Marty Mann, described as a recovered alcoholic who had founded the National Council on Alcoholism (now the National Council on Alcoholism and Drug Dependence- NCADD). A panel of celebrities proceeded to question the three. Only the real Marty Mann told the truth - the others lied to fool the panel. When "the real Marty Mann" stood, the panel of celebrities and the audience were astounded to learn that the only woman among the three, this handsome, poised, articulate, dignified woman, was Marty Mann, a former drunk. Read more... About NCADD OverviewVision, Mission & LogoOur FounderOur HistoryOur BoardOur AffiliatesOur StaffAwards and RecognitionContact UsAnnual Reports and 990sUpcoming Events Looking for Assistance Call: 1-800-622-2255 or Enter your Zip Code below to identify an NCADD affiliate near you: Welcome and Thank You for your interest in supporting the mission and activities of the NCADD and its local affiliates. 6th International Conference on Fetal Alcohol Spectrum Disorder Coming March 4 – 7, 2015

医学

2014-42/1180/en_head.json.gz/3791

Department of Orthopaedics and Rehabilitation, Yale University School of Medicine Peter G Whang, MD About Peter G Whang, MD Welcome Specialties Anatomical Low Back, Neck, Spine Arthritis, Deformity, Disability, Joint Replacement, Metabolic Bone Disease, Osteoporosis, Pain, Rehabilitation, Trauma/Fractures, Tumor/Oncology, Motion sparing and minimally invasive surgery More about Specialties » My approach to treating patients Dr. Whang is an Associate Professor in the Yale Department of Orthopaedics and Rehabilitation. He is a fellowship-trained surgeon who specializes in treating diseases of the cervical, thoracic and lumbar regions of the spine including the following pathologic conditions: neck and arm pain/numbness/weakness, lower back and leg pain/numbness/weakness (sciatica), spondylosis (degenerative arthritis), inflammatory arthritis, degenerative disc disease, disc herniations, spinal stenosis, spinal fractures, cervical whiplash, osteoporosis/compression fractures, spinal deformities, scoliosis (adult and adolescent), spondylolysis (pars defects)/spondylolisthesis, spinal tumors, and spinal infections. Dr. Whang received his undergraduate degree in biochemistry from Harvard University and his medical degree from the Duke University School of Medicine. He completed his residency in orthopaedic surgery at the University of California, Los Angeles and received specialized fellowship training in orthopaedic and neurosurgical spinal surgery at the Rothman Institute at Thomas Jefferson University in Philadelphia, PA. Dr. Whang is particularly interested in novel spinal technologies including minimally invasive surgeries and motion-sparing/nonfusion procedures. He regularly performs the following surgeries: spinal fusions, spinal decompressions, microscopic discectomies, artificial disc replacements, X-Stop (for spinal stenosis), minimally invasive spinal procedures including lateral interbody fusions (XLIF), and kyphoplasty (for compression fractures) Dr. Whang is actively involved in clinical and basic science research with a focus on the biology of spinal fusion and bone healing, bone grafting substitutes, and evidence-based medicine. He continues to present the results of his studies at a number of national and international meetings. He is also involved in the development of new spinal implants and techniques. At this time he is currently an investigator for various clinical trials. Dr. Whang is on the editorial staff of several publications and serves on multiple committees for the National Association of Spine Surgeons (NASS). In addition to his research pursuits, Dr. Whang devotes much of his time to the teaching of residents and medical students in the Yale School of Medicine. Dr. Whang welcomes the opportunity to work closely with patients and referring physicians alike and is readily available for consultations regarding any type of spinal concerns. He sees patients at the Yale Physicians Building in New Haven as well as satellite offices in Guilford, Milford, and Fairfield County. He may be contacted through his office at (203) 785-2584. More About Peter G Whang, MD » Yale Department of Orthopaedics and Rehabilitation - New Haven Office Yale Physicians Building - 1st Floor 800 Howard Avenue New Haven, CT USA 06520-8071 View map Other staff in my practice My clinical staff includes my administrative assistant, Carolina Dejesus, as well as several experienced orthopaedic nurses in the Yale Department of Orthopaedics and Rehabilitation. Peter G Whang, MD Department of Orthopaedics and Rehabilitation, Yale University School of Medicine Home

医学

2014-42/1180/en_head.json.gz/3843

What Is a Classical C-Section? The classical C-section has been used by physicians as the standard way of performing a C-section, but recently it has been superceded in use by the Low-Transverse uterine incision (see next section). In a classical C-section, the physician makes an incision or cut in the upper or contractile portion of the uterus. This gives much more access to the baby. It traditionally has been done under emergency circumstances, so many doctors thought this was the quickest and easiest way to deliver the baby. However, as doctors discovered later, this type of incision subjected both the mother and baby to additional risks, as will be discussed later. While we're on the subject, don't confuse the way your skin is cut and the way your uterus is cut. We're talking about the cutting of the uterus here, not the incision in the skin that you see – confusing, but important differences. Just because a doctor cuts your outer skin up and down or a bikini cut (sideways) doesn't mean that he cuts your uterus that same way. You can't tell from the outer skin incision how your uterus was cut, and it does matter later if you plan on having subsequent births. The old dictum was once a C-section, always a C-section, which usually applied to the classical Cesarean section and meant that you always had to have C-sections for later deliveries. However, that dictum does not always apply to a low-transverse C-section. Risks of a Classical C-Section When a classical C-section is performed, the area that is cut tends to be muscular so that when a scar forms, the scar is found to be weaker when laboring with a future pregnancy. This does not bode well for a mother's attempt at a vaginal delivery in subsequent births, for fear that the scar might tear while in labor. Thus, there is a risk in future deliveries for the uterus to rupture. If a rupture occurs, the mother could bleed internally, and the baby could work its way through the previous incision or scar. In that case, the placenta would be compromised, and the baby could die. The mother could also die. The overall risk of a uterine rupture occurring is less than one percent in women who have never had surgery of the uterus (for example, a previous baby born by this type of C-section). However, in women who have had a classical C-section in a previous birth, the risk for rupture elevates to 20-25 percent in subsequent pregnancies and births attempted vaginally. For this reason, most doctors recommend that subsequent births also be delivered via C-section. In contrast, the risk for rupture in subsequent pregnancies for a woman with one low-transverse C-section is less than one percent. And that's the real reason that OBs prefer the low-transverse C-section procedure. Uncovering Statistics How did doctors figure this out? Dr. John said that there is an unfounded story that the difference between these two types of C-sections in subsequent births was first noticed in the UCLA parking lot, of all places! One day the parking lot was literally full of women having babies at the County Hospital because the hospital was full, and there weren't enough rooms. Because many of the women were Hispanic and possibly there weren't enough interpreters or time to get full histories or data before the births, it wasn't until after the births occurred that doctors discovered that many of the women were having a third or fourth child delivered vaginally, but they had previously had low-transverse incisions and C-sections. Bells started ringing and people started asking questions. The result: The discovery that low-transverse incisions are safer for vaginal deliveries after C-sections. (Hey, it's a good story whether it's true or not.) Next: Low transverse C-section; the surgery >>

医学

2014-42/1180/en_head.json.gz/3915

Contribute Thoughts | Search Serendip for Other Papers | Serendip Home Page Biology 202 1998 Second Web Reports On Serendip Rage Disorder Ingrid Katz The study of the relationship between the mind and the brain can be traced back to 1895, when a little known Viennese neuro-psychiatrist named Sigmund Freud wrote a relatively unnoticed piece titled "A Project for a Scientific Psychology". In it, he proposed that the cognitive mechanisms of normal and abnormal mental phenomenon could be explained through an orderly study of brain systems. Throughout contemporary philosophy and psychology, the relationship between mind and brain has been extensively studied without a decisive resolution. One proposed solution has been to adopt the position that the mind is an expression of the activity of the brain and that these two are separable for purposes of analysis and discussion but inseparable in actuality. Thus, mental phenomenons arise from the brain, but mental experience also affects the brain. This is demonstrated by the many examples of environmental influences on brain plasticity. Mental illness can be categorized as reflecting abnormalities in the brain/mind interaction with the surrounding world. (1) In the following paper, an assessment shall be made of how biology/neurobiology has impacted the study and diagnosis of mental illness. Two general conclusions will be drawn from this presentation. The first of these conclusions is that with time, money, and increased research, there will be an ever-expanding ability to discern biological and material identifiers of mental illness. The second conclusion that shall be drawn is that there will be a continued trend towards "blurring" the border between "normal" and "abnormal" behavior as mental illness is increasingly better understood. Each of these conclusions raises new issues that shall be addressed in the body of this paper. It was not before the 1950s that mental illness was considered worthy of major study in medicine. Even today, the mode of recognizing brain and mind linkages most often occurs across several disciplines. Thus, the challenge of developing a scientific psychopathology through integration of these cross-disciplines still remains an arduous task. The study of the mind has primarily fallen under the jurisdiction of the cognitive psychologists, while the study of the brain has generally fallen into the domain of neurologists (further subdivided within this discipline). Given this current state of affairs, how does one honestly come to understand that which dictates the manifestation of mental illness? Currently, there are no known biological makers for any mental illness other than dementias such as Alzheimer's disease. (1) In the absence of pathological markers, the current definitions of mental illnesses are syndromal and based on a pattern of behavior and familial aggregation. (2) Locating the neural mechanisms involved in producing mental illness is an iterative process, requiring a methodological approach, much like other diseases. Still, the task of defining what constitutes "normal" and what constitutes "mentally ill" is not necessarily an objective one. Thus, such research can be challenging and potentially mired down in ethical issues over neurological ones. Lingering myths, concerning such illnesses as schizophrenia, have gradually yielded to new treatments and understanding of what constitutes mental illness. Still, a myopic view of such an illness has often been accepted as the norm. For decades, schizophrenia was blamed on bad parenting or even on the individual him or herself. (3) Recently, however, the disease has been found to have genetic links, where subtle deformations in the brain can occur as early as in the womb. In two reports published in the Lancet (June, 1997), researchers were able to identify that positive symptoms related either to the over-perfusion or the under-perfusion of blood in the prefrontal cortex region of the brain. (4) Further studies by researchers at the National Academy of Sciences have linked impaired functioning of the cerebellum to the onset of schizophrenia. (5) As this research progresses, a better understanding of neural mechanisms underlying such mental illnesses as schizophrenia has been obtained through an analysis of the underlying cognitive function that is injured and the underlying neural circuitry of that cognitive function. (5 and 6) Similar data has been gathered on individuals experiencing violent episodic outbursts. (7 and 8) The two pieces of research presented above on schizophrenia exemplify the increasing trend and interest towards the advanced and integrated study of mental illness. Thus, as research continues, it will become increasingly likely that further biological markers will be developed to better identify and adequately diagnose various forms of mental illness. This raises the further issue of what factors trigger human behavior. Is the way one behaves simply biologically based, or do environmental causes play a role in impacting the "output" of behavior? If one assumes that the nervous system is, on the whole and at the level of the neuron itself, a collection of input/output devices, then one is capable of monitoring inputs and outputs entering the brain. Likewise , it can be stated that the specific inputs and outputs are not only dependent upon environmental stimuli, but also upon the very make up of the neuron itself. (9) Research on the topic so far has supported both an environmental and physiological role in the outcome of an individual's mental state. Given this assertion, one must briefly address the notion of "free will". Can an individual ever act "freely" and if so, how much control does one's own "biology" have over the environment in which one exists? (10) Given the intrinsic variability in input/output boxes at all levels of organization, the state of the nervous system at a given time depends not only on its inputs at that time but also on the history of its past inputs as well. (9) Thus, the notion of what constitutes "free will" is not limited to a given individual's outputs, but rather through a constant exchange of information between the environment and the biological makeup of the individual. As the notion of free will and the relation of brain and mind are further explored, it remains essential to continue to actively define what constitutes "normal" vs. "abnormal" behavior. This ongoing reassessment of "normalcy" is of pressing importance for both economic as well as humanitarian reasons. As noted in the New York Times in 1996, approximately one-fifth of American adults experience some form of disorder affecting emotions, thoughts, personality or behavior during the course of a year. Of these, approximately 3%, or 5 million adults, are considered severely mentally ill. Expenditures for these individuals have run over $150 billion in annual costs. (5) Thus, a definition of a "boundary" between "normal" and "abnormal" cognitive processes is of primary importance in identifying neural substrates of mental illness. Still, it continues to be an arduous task. Many of the symptoms defining mental illness run in a continuum with normal behavior. At what point does extreme depression turn into a psychopathological disease? When does a rambunctious child have a severe enough condition to be labeled as attention deficit disorder? Thresholds of severity or duration are generally the measure used to resolve such a problem. (11) Still, these remain boundaries of convenience, not ones with inherent biological meaning attached. Thus, as research progresses, one can assert that there will be a continued blurring of the border between "normal" and "abnormal" behavior. This ongoing process of defining mental illness through what appears to be somewhat subjective boundaries may seem imprecise. Certainly, the biomedical paradigm that prevails throughout the Western world of medicine generally considers disease to be distinct from normalcy. One either has cancer or one does not. Still recent findings concerning the genetic risk factors associated with developing a disease (through measurements premorbidly of the BRCA1 and ApoE lipoproteins) raises similar questions about the discontinuity requirement involved in defining a disease process. Thus, current models of mental illness may, in fact, share a closer etiology with cancer than was previously imagined. (1) The creation of a scientific and testable model of mental illness may be generated from a variety of disciplines, such as neurobiology, neuropsychology, cognitive psychology, or psychiatry. For neurobiologists, the underlying linkage between brain and behavior has been the assumption that behavior and the nervous system are one in the same. Likewise, it has been presumed that an understanding of the nervous system structure and function would confer an advantage in understanding human behavior. (9) With the neurological model of an "input/output" system of information exchange, neurologists have been able to consider mental illness at both the level of systems as well as a more acute biological level of information exchange (where axons and dendrites synapse as input and output affect one another). Cognitive psychologists tend to consider behavior manifestations at a more macro level n potentially examining more psycho-social issues defining mental illness and what is considered "normal" and "abnormal". Whatever the point of origin, these models converge on one common pathway to lead to a set of shared characteristics. It is only through the use of cognitive modeling that mental illness can be categorized and properly examined in a modern scientific era. These models must essentially share three characteristics to be useful: first, they must provide a general definition of the disease that is consistent with the biomedical model that is currently implemented in medical settings; second, they must offer a theory that is testable in human beings; and third, they must provide a theory that is able to be modeled and tested in animals. (1) With these three criteria in place, there is a greater possibility for advanced screening as well as improved biomedical understanding of the link between mind and brain, shattering conceptual barriers of what constitutes mental illness. (1) Andreasen, Nancy C. "Linking Mind and Brain in the study of Mental Illnesses: A Project for a scientific Psychopathology," Science. 14 March 1997. Vol 275, No. 5306 p.1586-1592. (2) Robins, E. and Guze, S.B. American Journal of Psychiatry. 126, 983 (1970). (3) "Quieting the voices" (4) "Researchers zooming in on the brain in schizophrenia patients" (5) "Erasing the line between Mental and Physical Ills" (6) "Mood disorders: Pharmacological prevention of recurrences" (7) "Organic reason for behavior isn't likely" The Inquirer, February 8, 1996 (8) "Research on Violence and Traumatic Stress" (9) "Variability in Brain Function and Behavior" (10) "Free will?" (11) Feighner, J.P. et al. Archives of General Psychiatry. 26, 57, 1972. A) "That Fine Madness" Discover Magazine, October, 1996 B) "Alcohol, Violence and Aggression" C) "Rage Disorder" D) "Epileptic Violence and Criminal Behavior"

医学

2014-42/1180/en_head.json.gz/3963

Contact Us | Add to Calendar | Newsletter Sign Up | Home Home Summit Preview 2014 | Medical Innovation Summit Now, it's Personal Cancer Treatment and Personalized Medicine October 27-29, 2014 Cleveland, Ohio Things to Do in CLE 2013 Summit Recap Attendee FAQs Past Summits Sponsor FAQs Challenge Round 1 Participants Challenge Finalists Innovation Base Camp Ground Waves Top 10 for 2014 Top 10 for 2014 (1) HomeSummit PreviewAgendaSpeakersSponsorsFeaturesTop 10 Innovations Download Our FREE Mobile AppStay connected. Download today! Sponsor Innovation Why Sponsor the Medical Innovation Summit? Access over 1,500 healthcare decision makers Lead the conversation when it comes to innovation in healthcare Partner with us to initiate collaborative ideas for advancing healthcare. Cleveland Clinic is searching the globe for the next early stage Health IT companies that will disrupt the market and streamline the delivery of better care to patients everywhere. | View All Speakers Maria Bartiromo Anchor & Global Markets Editor FOX Business Network Maria Bartiromo | Anchor & Global Markets Editor , Maria Bartiromo joined FOX Business Network (FBN) as Global Markets Editor in January 2014. She is the anchor of Opening Bell with Maria Bartiromo on FBN (9-11 AM/ET) and hosts Sunday Morning Futures with Maria Bartiromo, a Sunday business program (10 AM/ET) on FOX News Channel (FNC). Bartiromo has covered business and the economy for more than 25 years and was one of the building blocks of business cable network CNBC. During her 20-year tenure as the face of CNBC, she launched the network’s morning program, Squawk Box; anchored The Closing Bell with Maria Bartiromo; and was the anchor and managing editor of the nationally syndicated On the Money with Maria Bartiromo, formerly The Wall Street Journal Report with Maria Bartiromo. Bartiromo has been a pioneer in her industry. In 1995, she became the first journalist to report live from the floor of the New York Stock Exchange on a daily basis. She joined CNBC in 1993 after five years as a producer, writer and assignment editor with CNN Business News, where she wrote and produced some of CNN's top business programs. She has received numerous prestigious awards, including two Emmys and a Gracie Award. Her first Emmy was for her 2008 News and Documentary coverage of the 2007-2008 financial collapse and her “Bailout Talks Collapse” coverage was broadcast on NBC Nightly News. She later won a second Emmy for her 2009 documentary, “Inside the Mind of Google,” which aired globally on CNBC. Bartiromo won a Gracie Award for “Greenspan: Power, Money & the American Dream,” also broadcast globally on CNBC. In 2009, the Financial Times named her one of the “50 Faces That Shaped the Decade,” and she was the first female journalist to be inducted into the Cable Hall of Fame Class of 2011. Bartiromo is the author of several books, including The Weekend That Changed Wall Street, published by Portfolio / Penguin, and The 10 Laws of Enduring Success, published by Random House; both were released in 2010. Bartiromo writes a monthly column for USA Today. She has also written weekly columns for Business Week and Milano Finanza magazines, as well as monthly columns for Individual Investor, Ticker and Reader’s Digest magazines. She has been published in the Financial Times, Newsweek, Town and Country, Registered Rep and the New York Post. Bartiromo is a member of the Board of Trustees of New York University, the Board of Directors of the Young Global Leaders of the World Economic Forum, the Council on Foreign Relations, the Economic Club of New York and the Board of Directors of The National Italian American Foundation (NIAF). She graduated from New York University, where she studied journalism and economics. She also served as an adjunct professor at NYU Stern School of Business for the fall semesters of 2010 through 2013. She has become part of pop culture during her career, having had cameos in several motion picture movies, playing herself in “Wall Street Two” with Michael Douglas and “Arbitrage” with Richard Gere, among others. In 1999, Joey Ramone of the Ramones rock band wrote a song about her, titled “Maria Bartiromo,” which was on his final album. Twitter Handle: @MariaBartiromo Christopher Connor Sherwin Williams Christopher Connor | Chairman & CEO , Christopher M. Connor is Chairman and Chief Executive Officer of The Sherwin-Williams Company, a $10 Billion Global Leader in the Paint and Coatings Industry. Mr. Connor was elected Chief Executive Officer by the Company’s Board of Directors on October 25, 1999 and added the title of Chairman on April 26, 2000. Mr. Connor, 58, began his employment with The Sherwin-Williams Company in 1983 as Director of Advertising for the Paint Stores Group. Over his 31-year career with Sherwin-Williams, Mr. Connor has held a number of increasingly important assignments in many different functional areas of the Company. In every one of these assignments he has been privileged to work with the outstanding men and women of Sherwin-Williams as they have prospered and grown the Company together. Today, Sherwin-Williams operates over 3,900 paint stores in the United States, owns many of the paint and coatings industry leading brand names, and sells products in over 115 countries around the world. Sherwin-Williams’ culture of excellence has created an environment where outstanding technology, strong marketing, operational excellence and engagement all continue to play a role in the Company’s growing success. Sherwin-Williams has been recognized by many business publications for financial excellence, integrity of business practices, strong track record of dividend payments and notably, by Fortune Magazine, as one of our nation’s top 100 companies to work for on three separate occasions. In addition to The Sherwin-Williams Company Board of Directors, Mr. Connor serves on the board of the Eaton Corporation and the Federal Reserve Bank of Cleveland. His many civic and community board engagements include the Rock and Roll Hall of Fame and Museum, The Playhouse Square Foundation, University Hospitals Health System, United Way Services of Greater Cleveland, Fisher College of Business at The Ohio State University, the National Association of Manufacturers, The American Coatings Association and the Greater Cleveland Partnership. Mr. Connor is a 1974 graduate of Walsh Jesuit High School and a 1978 graduate of The Ohio State University. He and his wife, Sara, have three adult children. Jeff Arnold Sharecare Jeff Arnold | Chairman & CEO , Jeff Arnold is Chairman and CEO of Sharecare, a health and wellness engagement platform he founded with Dr. Mehmet Oz, in partnership with Harpo Productions, Sony Pictures Television and Discovery Communications. Sharecare helps people maximize their human potential by connecting them to personalized health resources including high-quality information from experts, clinical decision support tools, interactive programs and local healthcare providers. Previously, Arnold was Chairman and CEO of HowStuffWorks.com, an award-winning online resource used by millions of people each month, which he sold to Discovery Communications, where he served as Chief Digital Strategy Officer, and Chief Architect of The Curiosity Project until December 2011. At the age of 28, he founded and served as CEO of WebMD Corporation, the first healthcare company to harness the power of the Internet to create a destination for consumers, healthcare institutions and physicians to find trustworthy medical information. He was inducted into the Honor Society of Nursing, Sigma Theta Tau International, as an Honorary Member in recognition of his superior achievements and contributions to the advancement of nursing and health care at national and global levels. Arnold also has been honored by the World Economic Forum; inducted into the Technology Hall of Fame of Georgia; named Entrepreneur of the Year, Southeast Region by Ernst & Young; and received the prestigious Phoenix Award, which recognizes companies and individuals who embody strength, tenacity and leadership in Georgia's healthcare information technology industry. Currently chairman of Forbes Travel Guide, Arnold also has served on numerous boards for public, private and charitable organizations over the years. Twitter Handle: @SharecareNow The Medical Innovation Summit provides an unrivaled perspective on the newest medical innovations and the financial drivers behind those innovations. The conference is recognized for providing singular insights, networking opportunities and actionable take away for all participants. The content is designed for: Senior executives in the healthcare industry Clinical, medical affairs, regulatory and business development executives Venture capitalists and angel investor groups Buy-side and sell-side researchers Consulting, legal and other service providers Agenda Highlights Sunday | October 26th Monday | October 27th New Ventures Healthcare Challenge Cleveland Clinic Tours The State of Healthcare Innovation Dinner and One-on-One with Jeff Immelt, Chairman and CEO, General Electric Tuesday | October 28th The Business of Cancer Risks Personalized Medicine Today Healthcare Transformer Showcase Lunch and One-on-One with Robert Bradway, Chairman and CEO, Amgen Imaging and Health IT Networking Recepton Wednesday | October 29th The Next Generation of Drug Development Top 10 Medical Innovations for 2015 Lunch and One-on-One with Ginni Rometty, Chairman, President and CEO, IBM View Full Agenda | View All Past Sponsors Cleveland Clinic 2014 © All Rights Reserved Innovations Press Kit Contact Us Site Map

医学

2014-42/1180/en_head.json.gz/4042

(http://utsystem.edu) Federal grant furthers skin cancer prevention studies Blog Author: UT System Thursday, November 7, 2013 A UT Health Science Center San Antonio researcher at the Regional Academic Health Center (RAHC) is studying a potential mechanism to prevent skin cancer, thanks to a recently awarded federal grant. Future discoveries could enable development of drugs to complement existing cancer treatment, especially in skin cancer. The Rio Grande Valley is a hot spot for ultraviolet B (UVB) radiation, one of the chief causes of skin cancer, which is diagnosed in more than 1 million Americans annually. “Because skin cancer is more prevalent than any other cancer in the United States, preventing it and producing clinically effective treatments is very important,” said Dae Joon Kim, Ph.D., assistant professor of pharmacology in the School of Medicine of the UT Health Science Center at San Antonio. Dr. Kim received a five-year, $1.6 million Research Project Grant (RO1) from the National Institute of Environmental Health Sciences to study “The Role of TC-PTP in Skin Carcinogenesis.” This is the first new investigator RO1 grant awarded to a UT Health Science Center faculty member at the RAHC Medical Research Division at Edinburg. TC-PTP, a protein originally found in blood, may be a novel target for the prevention of UVB-induced skin cancer, Dr. Kim said. His lab team discovered that the protein deactivates an oncogenic protein called Stat3 in response to UVB radiation. An oncogenic protein is a protein associated with cancer initiation and formation. “We think TC-PTP may protect skin cells against UVB radiation by preventing Stat3’s oncogenic activity,” Dr. Kim said. To prove this concept, Dr. Kim has genetically engineered two types of mice — one with high levels of TC-PTP in skin cells and another mouse with low levels in skin cells. In both sets of animals, other tissues are unaffected. The federal grant will fund these investigations. Paula K. Shireman, M.D., vice dean for research in the School of Medicine of the UT Health Science Center, said Dr. Kim’s grant is historic for the RAHC. “Obtaining an RO1 grant is an important milestone in establishing an independent laboratory and represents a significant investment in Dr. Kim’s research program at Edinburg,” she said. “We are extremely proud of Dr. Kim’s accomplishments and look forward to the outstanding scientific contributions that he and the rest of the faculty of the RAHC at Edinburg will make.” The RAHC’s campuses at Edinburg and Harlingen are under the auspices of the School of Medicine while the new University of Texas medical school in the Valley is being established. UT Health Science Center San AntonioContact: Will Sansom, (210) 567-2579, sansom@uthscsa.edu [1] Links:[1] mailto:sansom@uthscsa.edu

医学

2014-42/1180/en_head.json.gz/4117

AARP VIVA AUTO BUYING PROGRAM KEEP BRAIN ACTIVE! Get expert advice on planning for your own or a relative’s future care needs. Q&A Tool Health Care Costs Calculator Drug Savings Tool See All Health Tools » Learn From the Experts Sign up now for an upcoming webinar or find materials from a past session. See All Webinars » Get smart strategies for managing health conditions. See All Learning Centers » What does the health care law mean to you? Your story is important. We read and learn from every story and it helps us in our educational efforts. We may even use your comments (with permission) to brief legislators, inspire readers and more. Please share your story with us. Do »Tick Tock: Wake Up to ... Tick Tock: Wake Up to the Signs of Heart Disease by: Kim Fernandez, from: AARP VIVA, Spring 2009 Nauseated. Lightheaded. Short of breath. Did you know that these are all signs of heart disease? A majority of Hispanics ages 40 and older say they think they know the signs of heart disease, according to two exclusive AARP Segunda Juventud studies. The problem is, they don't. And that can be deadly: heart disease is the number one killer in the United States, and five out of six victims are 65 and older. But knowledge and prevention, experts say, can reduce those numbers. Yet too often, the public lacks that knowledge, says Altagracia Chavez, M.D., of the Cleveland Clinic Heart and Vascular Center, "and I include my own family in that." Despite respondents' seeming confidence in recognizing warning signs, in the 2007 AARP study, only 45 percent of Hispanics recognized the symptoms of chest pain or discomfort; 22 percent recognized pain or discomfort in one or both arms, the back, neck, jaw, or stomach; and just 4 percent knew that nausea could indicate heart problems. But there's good news: in a 2008 follow-up study, the numbers were 55 percent, 31 percent, and 6 percent, respectively—a significant jump in the first two groups. When it comes to prevention, says Chavez, "Hispanics aren't as familiar with the things that are important to do. We tend not to take as good care of ourselves. And often we don't have access to health care as readily as other population groups." But again, the surveys found some positives: Hispanics say they are willing to change their lifestyle to ward off heart disease. In both surveys, more than 90 percent of Hispanics without a diagnosed heart condition said they were willing to exercise and eat a heart-health diet. And in the 2008 follow-up, more respondents said they are willing to try preventing or controlling high blood pressure and diabetes, lower cholesterol, moderate alcohol use, and quit smoking. Ariel E. Reboyras, a Chicago alderman, has already adopted some of those changes. Because his mother and aunt suffered from diabetes—a major risk factor—he focuses on diet, exercise, and heart-health checkups. "Heart disease scares me," he says. "But I believe you have to practice what you preach, and I'm an avid bicyclist because of it." Reboyras teamed up with the National Alliance for Hispanic Health, the Chicago Department of Public Health, and others to offer free heart-health screenings. To emphasize the importance of diet and exercise, he challenges constituents to join him on an annual bike ride. Reaching Women "Women are under the misconception that heart disease is a man's disease," says Cristina Rabadan-Diehl, at the National Heart, Lung, and Blood Institute. "Heart disease is the number one killer of women." Uncontrolled high blood pressure—the leading risk factor for heart disease and stroke—has been increasing among women. Between the early 1990s and early 2000s, its prevalence jumped from 17 to 22 percent. But Hispanic women tend to be unaware of the dangers. Only 29 percent of Latinas, compared to 68 percent of non-Hispanic white women, say they know about heart disease. Family history led Alona Muñoz, 61, of San Antonio, Texas, to the doctor when she became fatigued—another possible warning sign. Muñoz knew heart disease was hereditary: it had killed her father when he was 37, and most of her aunts and uncles had had heart attacks or bypass surgery. Still, it was a shock when, at age 38, she developed multiple blocked arteries. She survived a quadruple bypass and stroke, and now the semiretired Mexican American housekeeper tries to exercise daily and eat well. Among those diagnosed with a heart condition, 90 percent of the 2008 AARP survey respondents said they are trying to prevent or control high blood pressure, and more than eight out of 10 said they were working to manage their cholesterol levels, weight, or diabetes—all risk factors. 1

医学

2014-42/1180/en_head.json.gz/4118

AAUW’s Cancer Education Campaign Today, we are aware of the many benefits of preventive screening for cancer. When detected in its early stages, many forms of cancer are treatable and patients can resume their lives. Modern medicine has given us remarkable advances for which we should all be thankful. Kathryn McHale In the 1930s, AAUW women also realized the importance of early cancer detection. During a time when the topic of cancer was still considered unmentionable, AAUW Executive and Educational Secretary Kathryn McHale worked alongside Dr. Joseph Colt Bloodgood, a physician who was determined to educate women about the early detection of cancer. In 1913, Bloodgood founded the American Society for the Control of Cancer, which became the American Cancer Society in 1945. In 1930, Bloodgood received $1,000 from John Sims, a carpenter from West Virginia whose wife had died of cervical cancer. With those funds, Bloodgood created the Amanda Sims Memorial Fund, a campaign to educate women about the early detection of cancer of the cervix. At the time, cervical cancer did not receive much attention but was claiming an alarming number of lives. Bloodgood was smart and realized he needed women on his side, or else his message would not get far. So, he enlisted the help of women’s organizations such as AAUW, the General Federation of Women’s Clubs, and the Young Women’s Christian Association. He also hired a female nurse, Florence Baker, to serve as the official voice for the campaign. Dr. Joseph Colt Bloodgood According to McHale, the decision to partner with Bloodgood was logical; it was “entirely in keeping with [AAUW’s] whole notion of adult education.” The doctor contributed to AAUW publications and wrote informational letters that were distributed to branches. In a June 1932 issue of the AAUW Journal, Bloodgood sang the praises of AAUW members: “University women, because of their educational opportunities, are in a better position than untrained women to understand the principles and details of preventive medicine.” In another AAUW publication, The Month’s Work, he also urged women who were unable to afford a personal physician to find a “proper clinic to go to for prenatal care and periodic pelvic examinations.” Dr. Bloodgood knew that early detection of cancer saved lives, and that it also made good economic sense. A true pragmatist, he said that if “what we know of preventive methods should really be applied, the people would actually be saved in taxes, fewer hospitals would be needed, [and] there would be a tremendous reduction in the care of people crippled by chronic disease.” I am amazed by how remarkably advanced, even by today’s standards, AAUW’s 1930s cancer-education campaign seems. Open, frank language was not the norm in the 1930s. Using the word “cancer” was a taboo, let alone acknowledging it as a real problem and suggesting a potential solution. Thankfully, there have been many medical advances since the 1930s, but I think we could still use more McHales and Bloodgoods working together to urge women, who too often take care of others before themselves, to visit their physicians and schedule those important annual examinations and screenings. Suzanne Gould | Issue: Community | Tags: AAUW History | October 01, 2013

医学

2014-42/1180/en_head.json.gz/4160

Antioxidants and Free Radicals Related TopicsAntioxidants for Sports & FitnessAll About Vitamin CCancer Prevention & DietTop Anti-Aging Supplements Antioxidants are nutrients that help minimize free-radical damage to the body. Free radicals are highly reactive compounds that are created in the body during normal metabolic functions or introduced from the environment, such as by exposure to pollution and other toxins. Inherently unstable, free radicals contain “extra” energy which they try to reduce by reacting with certain chemicals in the body, which interferes with the cells’ ability to function normally. Antioxidants combat free radicals in several ways: they may reduce the energy of the free radical, stop the free radical from forming in the first place, or interrupt an oxidizing chain reaction to minimize the damage caused by free radicals. ANTIOXIDANTS Consuming a wide variety of antioxidant enzymes, vitamins, minerals, and herbs may be the best way to provide the body with the most complete protection against free-radical damage. The body produces several antioxidant enzymes, including superoxide dismutase, catalase, and glutathione peroxidase, that neutralize many types of free radicals. Supplements of these enzymes are available for oral administration. However, their absorption is probably minimal at best. Supplementing with the “building blocks” the body requires to make superoxide dismutase, catalase, and glutathione peroxidase may be more effective. These building block nutrients include the minerals manganese, zinc, and copper for superoxide dismutase and selenium for glutathione peroxidase. In addition to enzymes, many vitamins and minerals act as antioxidants in their own right, such as vitamin C, vitamin E, beta-carotene, lutein, lycopene, vitamin B2, coenzyme Q10, and cysteine (an amino acid). Herbs, such as bilberry, turmeric (curcumin), grape seed or pine bark extracts, and ginkgo can also provide powerful antioxidant protection for the body. An increasing number of antioxidant-rich "superfoods" are available, including mangosteen, kombucha, açaí, pomegranate, goji berry, and chia seed. FREE RADICALS Free radicals are believed to play a role in more than sixty different health conditions, including the aging process, cancer, and atherosclerosis.1 Reducing exposure to free radicals and increasing intake of antioxidant nutrients has the potential to reduce the risk of free radical-related health problems. Oxygen, although essential to life, is the source of the potentially damaging free radicals. Free radicals are also found in the environment. Environmental sources of free radicals include exposure to ionizing radiation (from industry, sun exposure, cosmic rays, and medical X-rays), ozone and nitrous oxide (primarily from automobile exhaust), heavy metals (such as mercury, cadmium, and lead), cigarette smoke (both active and passive), alcohol, unsaturated fat, and other chemicals and compounds from food, water, and air. ReferencesCloseCopyright © 2014 Aisle7. All rights reserved. Aisle7.comLearn more about Aisle7, the company.Learn more about the authors of Aisle7 products.The information presented in Aisle7 is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires June 2015.

医学

2014-42/1180/en_head.json.gz/4354

CAP Advocacy STATLINE – CAP’s Biweekly Federal and State Advocacy E-Newsletter Statline Archives STATLINE � February 2, 2012 STATLINE — CAP’s Bi–Weekly Federal and State Advocacy E–Newsletter February 2, 2012 • Volume 28, Number 3 Next Issue: February 16, 2012 © 2012 College of American Pathologists Registration Is Now Open for 2012 CAP Policy Meeting PTO Seeks Public Input on Genetic Diagnostic Testing Congress Returns to Work on SGR, Other Key Issues PCORI Releases Draft Priorities For Comparative Effectiveness Research AMA Lobbies to Delay ICD-10 Implementation Engage, Learn, Advocate. Network. Registration is now open for the 2012 CAP Policy Meeting in Washington, DC, May 7 – 9, 2012. The 3-day meeting is a must-attend for CAP members who want to be part of the CAP’s advocacy effort. It is a rare chance to hear from and engage with nationally recognized health policy experts, key decision makers, and CAP’s own leadership and advocacy team on today’s top issues impacting pathologists. Find out what opportunities and threats policies on ACOs, HIT, and personalized medicine pose to pathologists, earn CME, and take this opportunity to meet with your member of Congress as part of the CAP Hill Day. Meeting registration is free and includes all meeting materials, CME, breakfasts, lunches, and cocktail receptions during the meeting. Attendees will be responsible for their travel, hotel and other expenses. Seating is limited. Visit the 2012 CAP Policy Meeting page for more information and registration. The United States Patent and Trademark Office (PTO) last week invited public comment on the issue of independent second opinion genetic diagnostic testing, and published specific questions it hopes to answer through comments and public hearings in February and March this year. The PTO announcement which appeared in the Federal Register on January 25, 2012, said the public input will be used to prepare a report to Congress by June 15, 2012, as mandated in the America Invents Act, regarding independent second opinion genetic testing where patents and exclusive licenses exist that cover primary genetic diagnostic tests. Among the questions the public is asked to address are: The impact that the current lack of independent second opinion testing has had on the ability to provide the highest level of medical care to patients and recipients of genetic diagnostic testing, and on inhibiting innovation to existing testing and diagnoses; The effect that providing independent second opinion genetic diagnostic testing would have on the existing patent and license holders of an exclusive genetic test; The impact that current exclusive licensing and patents on genetic testing activity has on the practice of medicine, including but not limited to: the interpretation of testing results and performance of testing procedures; and The role that cost and insurance coverage have on access to and provision of genetic diagnostic tests. The College is a plaintiff in the gene patent case against Myriad Genetics, and has been an active opponent of gene patents, particularly when such awards block patients’ access to critical care and medical second opinions. The CAP will submit written comments before the March 26 deadline. The CAP believes gene patent restrictions on genetic testing infringe on the practice of medicine, particularly for pathologists. “Pathologists are obligated to evaluate, understand, and interpret the biological processes responsible for disease including their genetic underpinnings,” said Jan Nowak, MD, PhD, FCAP, a member of the CAP Personalized Healthcare Committee, and Director of the Molecular Diagnostics Laboratory at North Shore University Health System in Evanston, IL. “Restriction of that professional responsibility is, at best, bad medicine, and at worst, not medicine at all.” “Independent, second opinion diagnostic testing would assure the quality of test results and improve testing in terms of biological understanding and technical modification,” Dr. Nowak said. “It will expand the usage of existing tests to other clinical conditions where they may be useful, and stimulate increased research and innovation to remain competitive and improve quality and reduce costs.” The first of two public hearings will be held Thursday, February 16, 2012, 9 am to 5 pm, in Alexandria, VA. The second hearing will be held on Friday, March 9, 2012, 9 am to 5 pm, in San Diego, CA. See the Federal Register announcement for more details as well as testimony and written comment submission deadlines. Contact Saurabh Vishnubhakat, Attorney Advisor, Office of Chief Economist, (571) 272-9300. Congress Returns to Work on SGR, Other Key Issues Late last year, Congress passed the Temporary Payroll Tax Cut Continuation Act of 2011, which extends 2011 Medicare physician pay rates and the Technical Component (TC) “Grandfather” provision through February 2012. After passing the temporary legislation, Congress formed a conference committee, charged with fashioning a bill to be considered by the full House and Senate, hopefully before the February 29th deadline. There are just four weeks until the Temporary Payroll Tax Cut Continuation Act of 2011 is set to expire, and unless Congress passes legislation to replace it, physicians will see their Medicare payments cut by nearly 28% effective March 1, and 160 million workers will face smaller paychecks and another 20 million will lose their unemployment benefits. Members of Congress from both parties say they want to extend the payroll tax cut and long-term unemployment benefits, and will identify ways to pay for them. Physician payment provisions like fixing the Medicare Sustainable Growth Rate (SGR) formula and extending the technical component (TC) “grandfather” provision are also part of these deliberations. Congress has passed a series of short term fixes to the SGR in the past few years, in effect compounding the debt as it accrues each year. It is now costly enough that replacing the SGR will take significant political will as well as capital. It doesn’t help matters that the Congressional Budget Office this week revised its estimate for replacing the SGR, from $290 billion in November 2011, to $316 billion in 2012. The American Medical Association, the CAP, and other physician groups continue to urge Congress to bite the bullet and replace it now while there are unspent savings from other programs, such as the Oversees Contingency Operations (OCO) fund to offset it. The OCO fund refers to the nearly $900 billion in discretionary funds previously allocated for the wars in Afghanistan and Iraq, which could be used to offset retiring the SGR debt. A permanent fix would be unlikely without a budget offset to pay for it. Many in Washington see this as the last major piece of legislation to be considered by Congress before the November elections, making lawmakers wary of decisions that could cost them the election. Despite assurances from Congressional leaders that they will pass a doc fix before the current extension expires, details of a possible fix have not yet been made public. The TC “grandfather”, which costs $80 million per year to support patient care in rural and underserved areas, is in danger of being eliminated because it is one of many provisions bundled into what is known as the Medicare “extenders”, which House Republicans have scrutinized for maximum savings. The House bill passed in December 2011 did not extend this program, which would have expired on December 31, 2011. This is the first time the House hasn’t recommended extending the program, raising the alarm that Congress might end the independent labs’ ability to bill Medicare for the technical component. As a result, CAP grassroots have continued meeting with their Members of Congress to advocate their support. Last week, CAP Governor Patrick Godbey, MD, FCAP, of Southeastern Pathology Associates in Brunswick, Georgia, met with a half-dozen members from the Georgia House and Senate delegations, including Rep. Tom Price, MD (R-GA), a conferee on the congressional conference committee appointed to draft the Medicare legislation. “The conference committee is looking for a fiscally responsible way to pay for the programs and the extenders,” Godbey said. “Lawmakers were receptive to learning more about the issue.” Godbey works with 19 rural hospitals in Georgia and northern Florida. His message to lawmakers: “This is a relatively small program but it is crucial for small and rural hospitals. Many of these small and rural hospitals depend on the ability of independent labs to bill the technical component. Eliminating this program will present a burden that some hospitals won’t be able to bear, and if allowed to expire, we’re going to see many of those hospitals stop providing these services.” Congress has until February 29 to reach agreement and pass a bill that will fund the entitlement programs, set Medicare physician pay, and decide the fate of the Medicare extenders, including the TC Grandfather. Statline will continue to closely monitor this legislation and the actions of the conference committee. PCORI Releases Draft Priorities For Comparative Effectiveness Research The newly launched Patient-Centered Outcomes Research Institute (PCORI), created to help determine the most effective medical treatments, released its draft National Priorities for Research and Research Agenda, last week. The document, which is open for public comment through March 15, identifies five areas where comparative effectiveness research is needed to support decision-making: Assessment of Options for Prevention, Diagnosis, and Treatment Improving Health Care Systems; Communication and Dissemination Research; Addressing Disparities; and Accelerating Patient-Centered Outcomes Research and Methodological Research. These areas encompass the patient-centered research that the independent PCORI institute intends to fund, and are inclusive of all diseases and health conditions. PCORI’s draft Research Agenda outlines more specific areas of research for each of the five priorities. The work PCORI will fund has the potential to impact health care delivery for generations. Some of PCORI’s research priorities align closely with the central, transformational role the CAP envisions pathologists will pursue over the next decade, namely improving patient diagnosis and treatment through outcomes data analysis. “This type of research and the development of clinical decision support tools will come from a partnership between pathologists as medical test information experts, and the health system informatics team,” said Dr. Emily Volk, MD, FCAP, Chair of the CAP Working Group on Measures & Performance Assessment. “If this program is to be successful, it must support this type of research by community pathologists as well as research pathologists in academic settings.” Under guidelines outlined the 2010 Patient Protection and Affordable Care Act (PPACA), PCORI’s governing board comprises a broad cross-section of health-care stakeholders, including representatives of drug and device makers, insurers, consumers, researchers and government agencies that will control an estimated $3 billion over the next decade to help fund and oversee comparative effectiveness research. Part of its funding will come from a new $1 to $2 per-person annual fee on Medicare and most health insurance policies, and the law prohibits its findings from being “construed as mandates for practice guidelines, coverage recommendations, payment, or policy recommendations.” During the public comment period, PCORI hold will a series of focus groups and sponsor a national forum on Feb. 27 in Washington, DC. Based on the comments it receives, PCORI will update its research priorities and issue a revised statement of its priorities in April. After that it will invite researchers to propose specific studies with the goal of committing up to $120 million in funding this year. The American Medical Association sent a letter to Speaker of the House John Boehner earlier this month, asking Congress to halt implementation of the ICD-10 coding system. The changeover to ICD-10 will increase the current billing codes by five-fold from 13,000 in ICD-9, to over 68,000 in ICD-10. According to Madara, it could cost a single medical practice anywhere from $83,290 to more than $2.7 million to make the change. The AMA’s letter argues that implementing ICD-10 will be costly and burdensome for physician practices, and transition to ICD-10 could temporarily threaten their cash flow at a time when physicians must invest in health IT, and Medicare rates are falling. Plus, physicians face added pressure from potential penalties for non-compliance with the e-prescribing, Meaningful Use, and PRQS programs. “The timing of the ICD transition that is scheduled for October 1, 2013, could not be worse,” wrote AMA Executive Vice President James L. Madara, MD. The letter includes a table and timeline to illustrate the volume of financial penalties associated with various federal programs that physicians will be facing if they do not successfully participate in these programs. STATLINE Archive Contact: statline@cap.org 202-354-7100 • 202-354-7155 (fax) • 800-392-9994

医学

2014-42/1180/en_head.json.gz/4408

Home » Latest Articles and News » Chinese Herb Kudzu May Reduce Binge Drinking, Alcoholism Source: http://www.emaxhealth.com/1275/chinese-herb-kudzu-may-reduce-binge-drinking-alcoholism Kudzu is an annoying weed to some people, while others use it as animal feed, an ingredient in a variety of recipes, and to make fabric and soap. But researchers at McLean Hospital and Harvard Medical School are partial to another use for this Chinese herb�as a way to fight binge drinking and alcoholism. One man�s weed is another�s binge drinking buster Kudzu (Pueraria lobata) is a climbing vine that is native to China and Japan, but which was reportedly introduced to the United States in 1876. Today kudzu is largely considered to be a nuisance, especially in the southeastern states, because it spreads quickly and overtakes other plants, cutting off their access to sunlight. But kudzu may also prove helpful in cutting something else�alcohol consumption. Studies of the impact of kudzu on drinking alcohol have been conducted in the past, and this new study focused on puerarin, a specific component of the Chinese herb, to determine if it could reduce the amount of alcohol individuals consumed. Ten twenty-something men and women participated in the study, which consisted of four 90-minute sessions. The sessions took place in simulated "apartments� which were equipped with a TV, DVD player, and a refrigerator stocked with the participant�s favorite beer and non-alcoholic beverages. The participants were allowed to consume as many beers as they wanted (up to six) during the first session. After the session, they were each given either placebo or a pill containing puerarin and told to take it daily. They then returned for a second session. Two weeks later, the subjects completed a third session, but after this occurrence they were given the pill they did not get the first time. After they took their assigned pills for one week, they returned for the fourth and final session. When the subjects took puerarin, they drank significantly fewer beers (decline from 3.5 to 2.4). In addition, "we noted that their rate of consumption decreased, meaning they drank slower and took more sips to finish a beer,� explained lead author David Penetar, PhD, of the Behavioral Psychopharmacology Research Laboratory at McLean Hospital, which indicated an impact on binge drinking. Previous studies of kudzu and alcohol In a study published in the November 2009 issue of Alcoholism, Clinical and Experimental Research, investigators reported on the ability of three isoflavones in kudzu�puerarin, daidzin, and daidzein�to reduce the amount of alcohol consumed by animals. In this study, the focus was on daidzin, which is the most potent of the isoflavones. The investigators synthesized a drug based on daidzin and made a kuzu-like compound called CVT-10216 and tested is on rats bed to drink lots of alcohol. The CVT-10216 increases levels of acetaldehyde, which causes an ill feeling and in turn makes people much less likely to want to drink. This is the basis of the drug Antabuse� (disulfiram), which is a treatment option for alcoholism. Another study of kudzu and alcohol was published in the Journal of Alternative and Complementary Medicine and reported on the impact of the Chinese herb on the sleep/wake cycle of moderate drinkers. The double-blind, placebo-controlled study revealed that moderate drinkers who took kudzu did not experience any problems with sleep, and so kudzu root as a treatment option for alcoholism appears free of sleep side effects. Alcoholism and binge drinking Alcoholism is a significant problem in the United States. The National Institute on Alcohol Abuse and Alcoholism reports that 17.6 million Americans abuse alcohol or are alcohol dependent. The majority of those who try to quit are not successful, as 80% of alcoholics relapse within one year of becoming abstinent. Binge drinking also is a significant concern. A January 2012 report from the CDC (Centers for Disease Control and Prevention) noted that more than 38 million adults in the United States binge drink about four times a month, and that the largest number of drinks per binge is an average of eight. Perhaps surprisingly, it�s not just young people who are binge drinkers. The CDC report shows that the age group 18 to 34 years has the most binge drinkers, but that the age group that binge drinks the most often includes people age 65 and older. Although the researchers noted their findings do not indicate the kudzu ingredient will make people stop drinking altogether, the study "is further evidence that components found in kudzu root can reduce alcohol consumption and do so without adverse side effects,� noted Penetar. Kudzu could be an effective way to manage binge drinking and alcoholism.Source Arolfo MP et al. Suppression of heavy drinking and alcohol seeking by a selective ALDH-2 inhibitor. Alcohol Clin Exp Res 2009 Nov; 33(11): 1935-44 Bracken BK et al. Kudzu root extract does not perturb the sleep/wake cycle of moderate drinkers. J Altern Complement Med 2011 Oct; 17(10): 961-66 Back To Latest Articles and News The Treatment of Premature Ovarian Failure Using Traditional Chinese Medicineby Li Qin Zhao Compendium of Materia Medica (Bencao Gangmu)by Li Shi Zhen C&G CQ Needles without guide tubes (200)C&G CQ Needles without gu... Gua Sha Jade - Cosmetic Roller AgateGua sha jade cosmetic rol... Constitutional Types within the Ten Key Formula Familiesby Michael Max

医学

2014-42/1180/en_head.json.gz/4414

CNS FORUM CNS FM CNS FRIENDS Pope’s Address To Life Academy On Infertility By vijay on Feb 29, 2012 in Speeches “Where Science Cannot Find an Answer, the Answer That Brings Light Comes From Christ” VATICAN CITY,-Here is a translation of the address Benedict XVI gave Saturday when he received some 200 scientists and members of the Pontifical Academy for Life, which is currently celebrating its 18th general assembly on the theme: “The diagnosis and treatment of infertility.” Lord Cardinals, venerable Brothers in the Episcopate and in the Priesthood, I am happy to meet with you on the occasion of the XVIII General Assembly of the Pontifical Academy for Life. I salute and thank all of you for your generous service in defense and on behalf of life, in particular, Monsignor Ignacio Carrasco de Paula, for the words that you spoke to me also on your behalf. The shape that you have given your work manifests that confidence that the Church has always placed in the possibility of human reason and in a scientific undertaking rigorously conducted, which always keep the moral aspect in view. The topic that you chose this year, “Diagnosis and Therapy of Infertility,” besides being humanly and socially relevant, possesses a special scientific value and expresses the concrete possibility of a fruitful dialogue between ethics and biomedical research. With respect to the problem of a couple’s infertility, in fact, you have chosen attentively to recall and to consider the moral dimension, researching paths toward a correct diagnostic evaluation and a therapy that corrects the causes of infertility. This approach is guided not only by the desire to give the couple a child but to restore to the couple their fertility and all of the dignity of being responsible for their procreative choices, of working together with God in the generation of a new human being. The pursuit of a diagnosis and of a therapy represents the most scientifically correct approach to the question of infertility, but also that which is most respectful of the integral humanity of the subjects involved. In fact, the union of the man and woman in that community of life that is matrimony constitutes the only dignified “place” in which a new human being, which is always a gift, may be called into existence. Thus, it is my desire to encourage intellectual honesty in your work, which is the expression of a science that keeps the spirit of the pursuit of truth alive, in the service of man’s authentic good, and that avoids the danger of being a merely functional practice. The human and Christian dignity of procreation, in fact, does not consist in a “product,” but in its connection with the conjugal act, the expression of the love of the husband and wife, of their union that is not only biological but also spiritual. The instruction “Donum vitae” reminds us in this regard, that by its “intimate structure, the conjugal act, while most closely uniting husband and wife, capacitates them for the generation of new lives, according to laws inscribed in the very being of man and of woman” (n. 126). The legitimate parental aspirations of an infertile couple must, for this reason, with the help of science, find a response that fully respects their dignity as persons and spouses. The humility and precision with which you deal with these questions — seen as obsolete by some of your colleagues fascinated by artificial fertility technologies — merits encouragement and support. On the occasion of the 10th anniversary of the encyclical “Fides et Ratio,” I recalled how “easy gain or, worse still, the arrogance of taking the Creator’s place, sometimes play a decisive role. This is a form of the hubris of reason, which can take on dangerous characteristics for humanity itself” (Discorso ai Partecipanti al Congresso Internazionale promosso dalla Pontificia Università Lateranense, October 2008: AAS 100 [2008], 788-789). Indeed, scientism and the logic of profit seem today to dominate the field of infertility and human procreation to the point of limiting other areas of research. The Church pays much attention to the suffering of infertile couples, it cares for them and, because of this, encourages medical research. The science, nevertheless, is not always able to respond to the desires of many couples. I would like again to remind the spouses who experience infertility that their vocation to marriage is not frustrated because of this. The husband and wife, because of their baptismal and matrimonial vocations themselves, are always called to work together with God in creating a new humanity. The vocation to love, in fact, is a vocation to the gift of self and this is a possibility that cannot be impeded by any organic condition. Therefore, where science cannot find an answer, the answer that brings light comes from Christ. I would like to encourage all of who have gathered here for these study days and who work in a medical and scientific context where the dimension of truth is often obscured: Continue to follow the path that you have taken of a science that is intellectually honest and that always ardently seeks the good of man. In your intellectual pursuits do not disdain dialogue with the faith. I address to you the anxious appeal of the encyclical “Deus Caritas Est”: “if reason is to be exercised properly, it must undergo constant purification, since it can never be completely free of the danger of a certain ethical blindness [...] Faith enables reason to do its work more effectively and to see its proper object more clearly” (n. 28). On the other hand, it is precisely the cultural matrix created by Christianity — rooted in the affirmation of the existence of Truth and of the intelligibility of the real in the light of the Supreme Truth — that made the development of modern scientific reason possible in the Europe of the Middle Ages, a knowledge that in the previous cultures had not progressed beyond embryonic form. Illustrious scientists and all of you members of the Academy committed as you are to the promotion of life and the dignity of the human person, keep always in view also the fundamental cultural role that you play in society and the influence that you have in forming public opinion. My predecessor, Blessed John Paul II observed that scientists, “precisely because they know more, are called to serve more” (Discorso alla Pontificia Accademia delle Scienze, November 11, 2002: AAS 95 [2003], 206). People trust you, who serve life, they trust in your commitment to helping those who are in need of comfort and hope. Never give into the temptation of reducing the good of persons to a mere technical problem! The indifference of conscience before the true and the good represents a dangerous threat to authentic scientific progress. I would like to conclude renewing the greeting that the Second Vatican Council addressed to men of thought and science: “Happy are those who, possessing the truth, continue to seek it, to renew it, more deeply to understand it, to give it to others” (Messaggio agli uomini di pensiero e di scienza, 8 dicembre 1965: AAS 58 [1966], 12). It is with these wishes that I impart to all of you who are here and to your loved ones the Apostolic Blessing. Alternate Home Page Wide Featured Content © 2009-2012 Churchnewssite. All rights reserved. Editor in Chief : VIJAY ALMEIDA | Published by : VIGBYOR LLC

医学

2014-42/1180/en_head.json.gz/4430

Sally Poston: Serving the world’s community near and far KAYLA DARNLEY Banner Intern Apr 20, 2014 | 981 views | 0 | 50 | | Sally Poston Becoming a veterinarian, running a thriving business and finding time to volunteer for charitable organizations may sound overwhelming to most people, but not to Sally Poston.The Oak Ridge native moved to Cleveland in 1995 to become the proud owner of an animal clinic and much more. Poston has made her mark as the sole owner of the Animal Medical Center, a doctor of veterinary medicine and a charitable resident of Bradley County. She studied premed at the University of Tennessee at Knoxville, went into veterinary school and then she went on to the Army for five years. Her pre-med background was what sparked an interest in medical care for animals. She has now been in practice since 1995 and purchased her own practice in 2001.“I realized I wanted to own my own business after the Army. I enjoy medicine and decided this would be a better avenue to own my own practice and do medicine,” Poston said.Beyond her work at AMC, Poston, 51, is involved with many charitable projects through the Rotary Club of Cleveland as the secretary and through Broad Street United Methodist Church.“This is the second year I have gone on a mission trip to Honduras. We are seeing improvement. This past trip we tried to see how we could further help. We trained the community on why it is important that they need clean water. The next time I may be able to use my medical and vet skills,” Poston said.While in Honduras, Poston worked on the water system. They installed better water systems so that the people of the community could have clean water and ultimately better health. They also trained one Honduran man to maintain the system so that their progress in health can be seen over time.The water runs through the infrastructure, goes through a series of filters and is stored in 5-gallon jugs that are sold for 50 cents at most for when the people need it. At the top of the building are two 300-gallon water containers as well as a sand filter and an ozonator, which filters out viruses into very small particles. “This system has a really high chance of working. The Hondurans are committed to wanting clean water, learning the system and maintaining it,” Poston said.While Poston works with the water system, this trip produces many projects that help the Honduran community. They work with Habitat for Humanity to build and maintain housing, sponsor around 30 children and provide a means for clean water. Maintenance is done on the local school and medical clinics are available to improve the health of Hondurans.“I am a changed person,” Poston said. “This is a great way to help people. They already believe (in God) so what we are really doing is showing them that there really are people out there who care and want to help. We are showing God’s love in a real, visible way.”The Rotary Club of Cleveland celebrated 90 years of service to the Cleveland community and to Rotary International projects on March 20. As a member, Poston has helped with many projects in Cleveland as well as internationally. The Rotary Club of Cleveland began working alongside Habitat for Humanity and has branched out to helping the Salvation Army, as well as working with Angel Flight under Robert Anderson, who flies needy people to places for specialized medical care.Poston said, “I love seeing it all come together and connect. We are pairing with people no matter the religious background and creating sustainability for others.” ‘Make a Difference Day’ participants are needed United Way pledges are at 58 percent of goal Reflections on the International Cowpea Festival INKSPOTS: RICK NORTON Associate Editor Dr. Palmer is rehab director at Bradley Healthcare

医学

2014-42/1180/en_head.json.gz/4457

Specialized Information Services Division Alaska Medical Library Disclaimer Notices: Copyright & Privacy State Puts Routine TB Screening on Hold March 14th, 2013 by cgarrett In the 1940s and 1950s, medical ships cruised the waters of southwest Alaska, trying to end an epidemic of tuberculosis that infected as many of 90 percent of the region’s population. Doctors now face shortages of tuberculosis detection and treatment medicines even as the aftershocks of that 70-year-old epidemic infect Alaskans anew. “What we’re having to do due to the national shortage is to ask people to put on hold some of the routine screening of at-risk people,” said Dr. Michael Cooper, Alaska’s deputy state epidemiologist. Alaska has the highest tuberculosis rates in the country, partly due to the mid-20th century epidemic, Cooper explained. Anchorage Daily News Working Together to Understand and Predict Arctic Change The United States Executive Office of the President’s National Science and Technology Council has released a five-year Arctic Research Plan that outlines key areas of study the Federal government will undertake to better understand and predict environmental changes in the Arctic. The Plan was developed by a team of experts representing 14 federal agencies, based on input from collaborators including the Alaska Governor’s Office, indigenous Arctic communities, local organizations, and universities. Seven research areas are highlighted in the Plan as both important to the development of national policies and well-poised to benefit from interagency collaboration, including among them: regional climate models, human health studies, and adaptation tools for communities. The Report Emerging Research Questions in the Arctic February 14th, 2013 by cgarrett The Polar Research Board, of the National Research Council (part of National Academy of Sciences) announced a study activity designed to provide guidance on future research questions in the Arctic over the next 10-20 years, identifying the key scientific questions that are emerging in different realms of Arctic science and exploring both disciplinary realms (e.g., marine, terrestrial, atmosphere, cryosphere, social sciences, and health[1]) and cross cutting realms (e.g., integrated systems science and sustainability science). Based on the emerging research questions, the study will also help identify research infrastructure needs (e.g., observation networks, computing and data management, ship requirements, shore facilities, etc.) and collaboration opportunities. Attention will be given to assessing needs where there may be a mismatch between rates of change and the pace of scientific research. Although it is understood that there is no one answer, the committee is asked to explore how agency decision makers might achieve balance in their research portfolios and associated investments (e.g., what are some of the challenges of trying to do both problem-driven research and curiosity-driven research?). The goal is to guide future directions in U.S. Arctic research so that research is targeted on critical scientific and societal questions and conducted as effectively as possible. The study will include a community workshop to be held in Alaska in late spring of 2013, and the Committee’s report is expected to be released by spring 2014. Further information about the project, including the study scope and the provisional committee slate, and public comments, can be submitted here. State and Native Health Consortium Continue Work to Assess Health Needs in Alaska January 24th, 2013 by cgarrett The Alaska Department of Health and Social Services and the Alaska Native Tribal Health Consortium have launched their second survey in an effort to assess Alaskans’ wants, needs and vision for the future of health and health care in Alaska. The initial survey ran between Sept. 17 and Oct. 22, 2012. More than 1,500 Alaskans responded to the survey, listing such health priorities as alcohol use and abuse; the cost of health care; and diet, exercise and obesity as their principal health concerns. The second survey is designed to shorten the current list of 71 health indicators to the top 25 Alaskans feel are most important. The Healthy Alaskans 2020 initiative will track the state’s progress in meeting these top health priorities between now and 2020. Anchorage Daily News Though Still High, Alaska’s Homicide, Suicide Rates Drop a Bit A new study conducted by the Alaska Division of Public Health shows a decline in violent deaths in Alaska during the past five years, an indication that some of Alaska’s most persistent and serious problems could be improving. The data comes from the Alaska Violent Death Reporting System (AKVDRS), a federally funded program established in 2004. Alaska is one of 18 states receiving federal funding for the program, which has collected data for two five-year periods, 2004-2008 and 2007-2011. Alaska DispatchAlaska Violent Death Reporting System 2003 – 2008 New Film Highlights Alaska Native Suicide Prevention A feature length documentary film about Alaska Native journeys through heartbreak and hope. In a landscape as dramatic as its stories, Alaska Native people face staggering suicide rates, yet remain determined to heal & thrive! In We Breathe Again, a movie in production about Alaska Native suicide-prevention work, a man talks about his suicide attempt. “I wanted to hunt. I wanted to put food aside, but I couldn’t do it without a vehicle and gas money.” He began drinking and finally turned a gun on himself. The last thing he remembers saying to his family before the gun went off was, “By god, I love you all.” The people in the film were courageous, willing to talk about moments of anguish as well as triumph, so that others can learn from their experiences, says director and cinematographer Marsh Chamberlain. “Listening to them has been such a privilege. We Breathe Again is about serious issues, but it’s also uplifting-a healing journey. Whatever our characters have been through, they’re all living healthy lives now, so that hasn’t been hard to do.” Indian Country Today Nunavut research projects clean up at first-ever Arctic Inspiration Prize December 14th, 2012 by cgarrett Nunavut came up trumps at the first-annual Arctic Inspiration Prize at the ArcticNet Annual Scientific Meeting in Vancouver, B.C. Dec. 13. The prize is awarded to four research projects that “address pressing issues facing Canada’s Arctic and its Peoples.” All four get a selected chunk of a $1-million prize given by the S. and A. Inspiration Foundation. The winning Nunavut projects include: The Arctic Food Network — $360,000: The Arctic Food Network won its money by creating a scheme to build regional food cabins along a network of “food highways” or snowmobile trails across the territory. The Nunavut Literacy Council — $300,000: The Nunavut Literacy Council won its $300,000 with its three-year research project about embedding literacy skills into traditional programs. Inuit elders writing a book on Inuit Qaujimajatuqangit — $240,000: Ten elders from across Nunavut, along with a subset of many other elders, are writing a book about traditional knowledge and culture, What Inuit Have Always Known to be True. UIHI Launches Native Generations Campaign to Protect Native Babies For every 1,000 American Indian and Alaska Native babies born in U.S. cities, as many as 15 die before their first birthday. To raise awareness and share valuable health and prevention messages about this problem, the Urban Indian Health Institute (UIHI) has launched Native Generations, a campaign addressing the high rates of infant mortality among American Indians and Alaska Natives. The campaign was made possible by funding from the U.S. Department of Health and Human Services’ Office of Minority Health. Native American Times Indigenous Russians May Lose Arctic Council Association November 16th, 2012 by cgarrett The Association of Indigenous Peoples of the North, Siberia and the Far East (RAIPON), Russia’s largest indigenous rights group and one of six indigenous Permanent Participants on the world’s Arctic Council, is in serious danger of being permanently dissolved. The non-governmental organization has received an official six-month “activities suspension order” from Russia’s Ministry of Justice restricting the group from protesting or gathering. The federal Ministry of Justice accused the organization of noncompliance with federal law. Rodion Sulyandziga, RAIPON’s first vice president, told the French news agency AFP, “This is a political decision. They want to remove us as a barrier and active participant in international law.” RAIPON represents an estimated 30,000 indigenous people and 41 member groups throughout Russia and, in some cases, is the only mouthpiece for indigenous Russians. Because of the suspension, RAIPON has stopped all international projects, but the association isn’t going to give up without a fight. RAIPON plans to appeal the ministry’s decision. However, if the appeal is unsuccessful, RAIPON will be ordered to completely shut down operations within six months, leaving the indigenous people of Russia’s Arctic without a voice on the Arctic Council. Alaska Dispatch U.S. Census and American FactFinder Workshop October 29th, 2012 by cgarrett The Alaska Native Epidemiology Center and the Alaska Division of Public Health are hosting a U.S. Census and American Factfinder Workshop. This is a two-day workshop featuring beginner and intermediate/advanced training sessions for the American FactFinder. Mark your calendars and register early for this event! Session topics will include American Factfinder basics, Margin of Error, PUMS files, Alaskan exercises, and more. Space is limited and registration is required. Conference will be held in Anchorage, AK. Specific location details will be available upon completed registration. Completed registration forms are due before 5:00 pm on November 1, 2012. Applications may be submitted via email to anepicenter@anthc.org, or by fax at: (907) 729-4569. Posted in Events | Comments Off Categories climate change (2) Alaska Native Tribal Health Consortium (ANTHC) Store Outside ANTHC Digital Stories UAAINNOVATE

医学

2014-42/1180/en_head.json.gz/4476

Cleveland Clinic researcher receives a four-year, $600,000 award for brain cancer research CRAIN'S HOME | CRAIN'S BLOGS | ALL SCOTT SUTTELL POSTS STAFFING AND WORKPLACE BLOG -- SCOTT SUTTELL Ohio's workers' comp bureau enters the 21st century The Ohio Bureau of Workers' Compensation is trying to make things a little easier on employers.The bureau has launched an online tool that helps employers navigate and manage the details of their workers' compensation insurance policy. The “My Policy Page” at the bureau's website allows most employers to view policy, rating plan and claims information instantly. It also displays each employer's program eligibility to highlight any premium-saving opportunities they may be missing, according to the bureau.Employers without an online profile can create one at the website, OhioBWC.com.“We've made a priority of improving service to better meet the needs of our customers, and that includes simplifying the process of communicating and conducting business with us,” said BWC administrator/CEO Steve Buehrer in a statement.Employers will be directed automatically to the page after logging in to their BWC e-account. They then can report payroll and pay premium, reprint coverage certificates, check balances outstanding, update demographic and contact information, and receive updates on deadlines.Among the other features they can view: Current program participation and eligibility for other premium discount programs. Claims history and details about specific claims. (A search function allows an employer to look up claims by date of injury, status, or benefit type.) Quarterly claims costs, as well as any costs associated with claims that occur during a specified range of dates. This function also allows the creation of a downloadable report in Microsoft Excel. Streamlining is in order Ohio Gov. John Kasich wants to bring order to the state's mashup of job-training programs.Columbus Business First reports the Kasich administration “will take some immediate steps to improve Ohio's work force development system, including a rebranding of the one-stop employment centers scattered around the state.”The centers — essentially, entry points for people trying to find jobs — will be tied to the OhioMeansJobs brand within the next 30 days, says John Weber, a deputy director at the Ohio Department of Job and Family Servcies.Columbus Business First reports that Mr. Weber on Monday told Gov. Kasich's new Executive Workforce Board that the rebranding strategy will create consistency across the state for the 90 one-stop centers and OhioMeansJobs, a partnership between Job and Family Services and the resume services of Monster Worldwide Inc.The agency will encourage the use of OhioMeansJobs.com as the sole source for job searches and as a resource for applying for unemployment benefits, according to the story.At present, the state's work force development system has about 90 programs scattered across 13 state agencies. Good career move CNNMoney.com profiles Twitter's president of global revenue, who turns out to have Cleveland roots.Adam Bain, 39, “started his career in news at one of the first regional city guides, Cleveland.com, and then spent two years as a web producer at the Los Angeles Times before he joined News Corp. in 1999,” according to the story.He joined Twitter in August 2010, when the microblogging platform “had a $3.7 billion valuation but no obvious business model.”Today, with 140 million active users, Twitter has “become a staple for advertisers,” Fortune says. “It is expected to pull in $288 million in ad revenue this year, according to eMarketer, a 107% jump over 2011, and is now valued at $8 billion.”CNNMoney.com says Mr. Bain's next move is a “self-service tool for small businesses,” but as with the company's slow-to-emerge ad products, “he is taking his time to learn from competitors before releasing it widely.” A company called Bolt Insurance has issued a report, ”Wasting Away: The State of Workplace Productivity,” that estimates the country experiences an annual payroll loss of $134 billion from employees spending time on tasks that are not work-related. (So, my Internet time spent to find this little gem — not a waste!)You'd probably think the Internet is the big time-waster, but this report claims that's not so: Meetings are the No. 1 source of wasted time, followed by office politics and annoying coworkers. $1.1 billion per week is lost because of time spent by employees on fantasy sports. Only 1 in 5 workers kill time on the job because they are underpaid. Usually, it's because they do not have enough responsibility.I have no idea if these numbers are remotely accurate, but they're fun. (And there are a lot more of them in Bolt's spiffy graphic.)Now, back to work …You also can follow me on Twitter for more news about business and Northeast Ohio.

医学

2014-42/1180/en_head.json.gz/4523

Oral Cancer: The Forgotten Disease Brittney F. Jerred Oral Cancer: Early Detection and Prevention Esthetics: The Intermediate Layer Douglas A. Terry, DDS, Karl Leinfelder, Hien Ngo Restorative Dentistry: The Esthetic Management of Multiple Missing Anterior Teeth Frank M. Spear, DDS, MSD January 2007, Volume 3, Issue 1 Industry Insider Aetna® Launches Dental/medical Integration Program That Includes Specialized Pregnancy Benefits Aetna® (Hartford, CT) has launched a new dental/medical integration program, effective January 1, 2007, that offers enhanced dental benefits to members who are pregnant or have diabetes, coronary artery disease, or cerebrovascular disease (stroke). It also offers educational outreach about dental care. These changes come on the heels of a published research analysis from Aetna and the Columbia University College of Dental Medicine that found that high-risk individuals who sought earlier dental care lowered the risk or severity of their condition and subsequently lowered their overall medical costs. The enhanced benefit program for pregnant women includes one additional cleaning visit and non-surgical removal of tartar, bacteria, and rough surfaces, among others. In partnership with the Columbia University College of Dental Medicine, Aetna conducted a two-year educational outreach pilot with 500,000 members starting in 2003, which found approximately 57% of those at-risk members who received education sought subsequent dental care. Aetna is offering the outreach program free of charge to all plan sponsors with an existing Aetna fully-insured medical plan in conjunction with any of Aetna’s insured or self-insured dental plans (DMO, DPPO, or Dental Indemnity). Aetna has also incorporated this educational component with existing disease management programs supporting pregnancy and targeted chronic conditions, making it available to plan sponsors and their employees who have both Aetna Medical and Aetna Dental. For more information, visit www.aetna.com. LED Dental Inc Hosts International Symposium to Promote Oral Cancer Awareness LED Dental Inc, a Vancouver-based medical device company, hosted an international oral cancer symposium at Tufts University School of Dental Medicine in Boston, Massachusetts. The session, titled “The Inside Summit on Oral Cancer Discovery and Management: The Technologies and the Role of the Dental Clinician 2006,” was moderated by Gerard Kugel, DMD, MS, PhD, professor at Tufts University School of Dental Medicine. The audience of dental clinicians was provided with the latest information on direct tissue fluorescence visualization technology and the benefits of incorporating it into a daily routine examination. During the symposium, an international group of experts from the fields of dentistry, medicine, technology, and academia spoke to an equally diverse audience to promote oral cancer awareness and ensure better patient outcomes. “The outcome we’re hoping for is to increase the number of practices actively screening for oral cancer and then treating it comprehensively,” said Dr. Kugel. To help accomplish this, LED Dental is planning on publishing the entire proceedings of the symposium and roundtable later in the year. Novlar’s Positive Phase 2 Pediatric Study Results Support Recent Pivotal Data in Adolescents and Adults NV-101, a local dental anesthetic reversal agent, met its safety and efficacy endpoints in a Phase 2 study for pediatric patients, according to Novalar Pharmaceuticals, Inc (San Diego, CA). In this study, the time to normal sensation was reduced by 55.6%, a clinically and statistically significant (p<0.0001) acceleration of the return to normal sensation. In the Phase 3 studies, NV-101 continued to be well tolerated with no serious adverse events reported in the pediatric population studied. If approved by the Food and Drug Administration (FDA, NV-101 will be the only local anesthetic reversal agent available for use in pediatric, adolescent, and adult (including geriatric) patients that accelerates the return to normal sensation and function following restorative and periodontal maintenance procedures. Phentolamine mesylate (a vasodilator), the active ingredient in the investigational agent NV-101, has been approved and has been in use in specific medical indications at significantly higher doses for over 50 years. The National Museum of Dentistry Opens The Narwhal: A Whale of a Tooth The National Museum of Dentistry (NMD) opened its new exhibit The Narwhal: A Whale of a Tooth on December 9 and 10. The exhibition features a 13 ft., life-size model of a male Narwhal with its more than 5-foot long tusk that grows through the upper jaw and lip. The exhibition will remain at NMD through August 2007. NMD exhibition’s Narwhal model (Monodon monocerous or “one tooth”), documentary photographs, interviews, and educational facts bring to life this curious creature. Small for a whale, adults reach lengths of 13 to 15 feet and weigh between 2,200 and 3,500 lbs. Narwhals are the only animals that grow an essentially straight tusk, which can achieve a length of 9 feet. Their home range includes the Atlantic portion of the Artic Ocean and the Greenland Sea. NMD, an affiliate of the Smithsonian Institution, is located at 31 South Greene Street, Baltimore, Maryland. Dr. Steven Offenbacher Receives 2006 Norton M. Ross Award for Excellence in Clinical Research OraPharma, Inc. (Warminster, PA), manufacturer of ARESTIN® (minocycline hydrochloride) Microspheres, 1 mg, announced that Dr. Steven Offenbacher, the OraPharma Distinguished Professor of Periodontal Medicine at the University of North Carolina at Chapel Hill School of Dentistry, has been named the recipient of the 2006 Norton M. Ross Award for Excellence in Clinical Research. The Ross Award, sponsored by the American Dental Association (ADA) through the ADA Foundation, is given in memory of Dr. Norton M. Ross, a dentist and pharmacologist who contributed significantly to oral medicine and dental clinical research. Dr. Offenbacher’s research focuses on several areas, including the relationship of periodontal disease to premature birth, heart disease, diabetes, and atherosclerosis. Offenbacher is the principal investigator on a 5-year, multisite study focusing on whether or not tooth cleaning performed on expectant mothers decreases the rate of preterm deliveries at fewer than 37 weeks, and also what effect maternal tooth cleaning may have on the birth weight of infants born at fewer than 37 weeks gestation. Oral Health America to Hold 17th Annual Gala Oral Health America, a non-profit organization that has been dedicated to improving oral health for all Americans for 50 years, will be holding its 17th Annual Gala Dinner and Silent Auction on February 22, 2006, at Navy Pier in Chicago, Illinois. The event will raise funds to support educational and service programs designed to improve oral health. The Oral Health America 17th Annual Gala Dinner and Silent Auction will run from 7 pm to 11 pm. Tickets are $250 each; a table for 10 can be purchased for $2,200. Oral Health America is also seeking event sponsors at the Gold ($2,000+) and Platinum ($5,000+) levels. For tickets or information on sponsorships and donations please contact Joe Donohue by calling (312) 836-9900 or e-mail him at joe@oralhealthamerica.org. King of Thailand Celebrates 80th Birthday with Oral Health Care Initiative In celebration of King Bhumibol Adulyadej’s 80th birthday, the citizens of Thailand will receive an unusual gift�oral health. The initiative, coordinated through Thailand’s Ministry of Public Health with training and support provided by 3M ESPE (St. Paul, MN), plans to provide complete dentures to 80,000 edentulous patients by 2007. Faculty members of several universities and dental schools across Thailand are currently conducting training courses for dental professionals on impression technique for edentulous patients using 3M ESPE products. Training facilities are equipped with Impregum™ Penta™ Soft Medium Body Polyether Impression Material and Impregum™ Penta™ Medium Body Polyether Impression Material. Dentists also are training on Pentamix™ 2 Mixing Units, which continue to rotate throughout the country for use in small hospital clinics where patients receive their dentures along with instruction on proper oral health care. In 2006, more than 1,300 dentists in Thailand completed training with the Pentamix 2 mixing units, which continue to rotate throughout the country for use in small hospital clinics where patients receive their dentures along with instruction on proper oral health care. A complete collection of scientific research and product ratings for Impregum polyether impression materials is available online at www.3MESPE.com/impregumsoft,or for more information call 1-800-634-2249. Ultradent’s Podcast Heats Up the Digital Airwaves Ultradent Products Inc. (South Jordan, UT) has produced the first weekly dental podcast. The Ultradent Products podcast presents topics from the anti-caries benefits of tooth whitening to minimally invasive endodontics. Ultradent’s free podcast provides subscribers with relevant information on industry trends every week. Ultradent’s podcasters include experts such as Dr. John Kanca, Dr. Jaimee Morgan, and Dr. Van Haywood. Because podcast audio files are accessible at any time and place, subscribers can pull from a growing library of over 20 episodes at their convenience. For more information about how to subscribe to the Ultradent Products Podcast, please visit podcast.ultradent.com. For questions or ideas about future podcasts, call 1-800-268-9010. National Board Dental Test Construction Accepting Applications There are 11 vacancies on the National Board Dental Test Construction Committees and two vacancies on the National Board Dental Hygiene Test Construction Committees for appointment in 2008. Applicants will be selected March 2007 at the Joint Commission on National Dental Examinations annual meeting. The dental vacancies are for: a gross anatomy expert, a physiology expert, a full-time dentist practitioner with expertise in biochemistry and physiology, a general pathology expert, a dental anatomy and occlusion expert, two operative dentistry experts, two orthodontic experts, a behavioral science expert, and a pharmacology expert. The dental hygiene vacancies are for an oral histology and embryology expert and a community dental health expert. For criteria and application information, go to: http://www.ada.org/prof/ed/testing/construction/index.asp. The deadline for applications is Jan. 22, 2007. DentalAEGIS

医学

2014-42/1180/en_head.json.gz/4617

Contact: Anne DeLotto Baier abaier@health.usf.edu University of South Florida (USF Health) Non-dopaminergic drug preladenant reduces motor fluctuations in patients with Parkinson's disease Study reports 'off time' reduced in those receiving standard dopamine therapy Tampa, FL (Feb. 10, 2011) -- Preladenant, a non-dopaminergic medication, reduces off time in patients with Parkinson's disease receiving standard dopamine therapy, an international study led by the University of South Florida found. Results of the double-blind, randomized clinical trial are reported online today in the journal Lancet Neurology. The findings suggest that preladenant may offer a new supplemental treatment for Parkinson's disease without some of the complications of levodopa and other standard dopamine treatments. "The goal of treatment is to provide the best possible function and quality of life to patients over time," said lead author Dr. Robert A. Hauser, director of the Parkinson's Disease and Movement Disorders Center at USF. "After a few years, many patients find that their traditional Parkinson's disease medications wear off after a few hours leading to a re-emergence of symptoms. In this study, preladenant was shown to reduce off time, thereby affording patients more time through the day with better function." Dr. Hauser and colleagues evaluated the safety and effectiveness of a range of doses of preladenant in 253 patients experiencing "wearing off" symptoms from their levodopa therapy. The patients were also receiving other available anti-parkinsonian drugs, such as dopamine agonists and/or entacapone. The 12-week study found that the addition of 5 and 10 mg of preladenant twice daily significantly reduced "off time" -- the re-emergence of troublesome motor symptoms such as slowness, stiffness, tremors, and immobility � when compared to patients receiving similar doses of placebo. Futhermore, preladenant significantly increased "on time" � the period during which patients' Parkinson's symptoms were adequately controlled --.without significantly worsening dyskinesia (involuntary twisting, turning movements). The doses were well tolerated, and the incidence of treatment-related adverse effects was similar for patients receiving preladenant and placebo. In Parkinson's disease, the brain's dopamine-producing cells falter and die, leading to movement-related or motor symptoms such as tremors, stiffness, slowness, and balance problems. Levodopa, a compound converted into dopamine in the brain, is still the gold standard therapy for Parkinson's, but as the disease advances this standard drug works for increasingly shorter time periods. As a result, patients begin to experience impaired movement before their next scheduled dose of medication. The re-emergence of symptoms accompanying this "off-time" can make it difficult for patients to perform even the most basic functions, such as walking and dressing. In addition, over time patients tend to develop a sensitivity to levodopa therapy during "on-time" resulting in involuntary twisting, turning movements known as dyskinesia. Currently available drugs widely used to treat Parkinson's disease correct for the loss of the neurotransmitter dopamine � either by boosting available dopamine in the brain or directly stimulating dopamine receptors. New ways to treat the disease that better address motor fluctuations without adverse side effects continue to be sought. Preladenant is a non-dopaminergic medication that targets adenosine A2A receptors in the motor control areas of the brain. It may offer advantages over dopamine medications, possibly including fewer side effects. The clinical trial was conducted at 44 sites in 15 countries. Preladenant is an investigational medicine and is not approved for use. ### Funding for the study was provided by Schering-Plough, a subsidiary of Merck. Dr. Hauser has done consulting for Schering-Plough. Parkinson's disease is an age-related, degenerative brain disease that affects one out of 100 people over age 60. USF Health is dedicated to creating a model of health care based on understanding the full spectrum of health. It includes the University of South Florida's colleges of Medicine, Nursing, Public Health and Pharmacy, the School of Biomedical Sciences and the School Physical of Therapy and Rehabilitation Sciences; and the USF Physician's Group. With more than $394.1 million in research grants and contracts in FY2009/2010, the University of South Florida is a high impact global research university.

医学

2014-42/1180/en_head.json.gz/4619

Contact: Marjorie Montemayor-Quellenberg mmontemayor-quellenberg@partners.org Research gets real � Public votes determine winner of $100,000 research prize Robert Green, M.D., M.P.H. accepts his BRIght Futures Prize award. Boston, MA � Robert Green, MD, MPH, has been named the winner of the $100,000 BRIght Futures Prize, after a unique competition in which nearly 6,500 online votes from people across the globe determined the winning project. Dr. Green's project, which will explore the genome sequencing of newborns, emerged as the winner after six weeks of public voting. "I am grateful for BWH for creating this competition and I am delighted to win. At the same time all three finalists were fantastic and worthy of funding," said Dr. Green. "And I hope we can keep this momentum going so more and more people can get their creative pilot projects funded in this kind of way." In this unique competition, BWH placed the power to determine what vital medical research gets funded in the hands of those who will eventually benefit from it�the public. For the first BRIght Futures prize, the BWH Biomedical Research Institute (BRI) wanted to award a prestigious seed grant to support research that is compelling and promising, but too preliminary or new to receive conventional external funding. It was intended to generate excitement and motivation within the research community and engage the public around these specific research projects as a way to educate the community about the vast array of innovative research taking place at BWH and to involve the public and patients in a more meaningful way in the process of research. To initiate the BRIght Future's Prize process, the leadership at the BRI asked researchers to submit proposals for projects that fell into two major categories: Using genetics in clinical care and better using what we know about the immune system across diseases. From the project proposals submitted, two sets of peer reviewers selected three proposals they felt proposed equally outstanding projects to compete for the public's vote. Green's project focuses on a randomized survey of new parents to find out if DNA sequencing of their newborns would be perceived as useful to them and why. If the expected enthusiasm of the new parents is confirmed, the research team will then conduct a pilot project to obtain sequencing in a small number of newborn babies, and integrate genomic information into their medical care. In addition to Dr. Green's project the other finalists included a project jointly led by Drs. Phil DeJager and Elizabeth Karlson, whose proposal focused on using genetics and electronic health records to treat multiple sclerosis and a project led by Dr. Robert Plenge, whose proposal focused on the use of technology to unravel the mysteries of the immune system. The award was announced at the inaugural Brigham and Women's Hospital (BWH) Research Day on November 15. The day-long celebration featured a discussion on the importance of research; presentations open to the public on today's hottest health topics such as obesity, healthy aging and personalized medicine by world-renowned experts; more than 150 posters illustrating some of the most promising work coming out of BWH's leading labs. A keynote address was provided by Dr. Atul Gawande, award-winning writer and BWH surgeon, entitled "The Century of the System." ### Brigham and Women's Hospital (BWH) is a 793-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare. BWH has more than 3.5 million annual patient visits, is the largest birthing center in New England and employs more than 15,000 people. The Brigham's medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in patient care, quality improvement and patient safety initiatives, and its dedication to research, innovation, community engagement and educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving nearly 1,000 physician-investigators and renowned biomedical scientists and faculty supported by $640 million in funding. BWH continually pushes the boundaries of medicine, including building on its legacy in organ transplantation by performing the first face transplants in the U.S. in 2011. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies, OurGenes and the Women's Health Initiative. For more information and resources, please visit BWH's online newsroom.

医学

2014-42/1180/en_head.json.gz/4823

About Hypnotherapy Home Welcome to the Institute of Clinical Hypnotherapy & Psychotherapy Summer Foundation Class Dates Cork 2014 Summer Foundation Class Dates Dublin 2014 Late Summer Foundation Class 2014 Diploma Class Dates 2014/2015 Supervision Class Dates 2014/2015 Upgrade Class Dates 2014/2015 January Foundation Class Dates 2015 Summer Foundation Class Dates 2015 Late Summer Foundation Class Dates 2015 The Institute of Clinical Hypnotherapy and Psychotherapy (ICHP) was founded in 1979 to establish a national organisation for independent Hypnotherapy-Psychotherapy practitioners. The ICHP is a totally autonomous association of like-minded therapists, Post-Graduate members and suitably qualified ethical Hypnotherapists /-Psychotherapists. The I.C.H.P. is dedicated to the professional and ethical use of eclectic Hypnotherapy-Psychotherapy, allied to the practice of psychoanalysis, hypno-analysis, and psychotherapy, for the treatment of nervous disorders and emotional problems. Mission Statement The primary purpose of the ICHP Institute is the advancement of the art, science and practice of Ethical Hypnotherapy-Psychotherapy as a technique for the relief and rehabilitation of persons suffering from nervous disorders and emotional problems. The ICHP exists to promote widespread personal empowerment through therapeutic techniques, and to promote the training of its members and education for the general public. Guiding Principles In keeping with the ICHP Mission Statement and the historical legacy of the pioneers of Clinical Hypnotherapy-Psychotherapy, the Institute has developed the following guiding principles to focus the members and students, teachers and board to follow: - Develop and deliver quality programmes that are responsive to the needs of both students and the caring and helping professions.- Build a community of skilled caring professionals which is person/client centred and accessible to people who are in need of assistance with mental, physical, spiritual and emotional problems.- To integrate Hypnotherapy-Psychotherapy into the Medical model of health, especially mental health.- Develop undergraduate programmes incorporating international best practice in all areas of Clinical Hypnotherapy-Psychotherapy.- Promote the recognition of Hypnotherapy-Psychotherapy as a separate and distinct profession, including Hypno-analysis, Hypno-counselling, etc.- Promote the ethos of ICHP as the most ethical, professional and educational body in its field.- Provide a strong element of Hypnotherapy-Psychotherapy training, practical training and clinical placements in all ICHP modules.- To teach all relevant health providers both the practice and benefits of Clinical Hypnotherapy-Psychotherapy. Directors LetterAs Course Director of the Institute of Clinical Hypnotherapy & Psychotherapy Training & Accreditation Institute it gives me great pleasure to welcome you to the ICHP and I wish you every success on your journey to becoming a professional Hypnotherapist-Psychotherapist.This programme is designed to equip you, the student, with the necessary expertise to assist clients in the caring and helping profession.It was W.B. Yeats that wrote “Education is not the filling of a pail, but the lighting of a fire”. The ICHP programme in Hypnotherapy is one of the most exciting and fascinating careers available in modern society. All facets of human behaviour involves the use of the mind and the subconscious in every sphere of contemporary life.Modern scientific Hypnotherapy-Psychotherapy has a history of some 250 years although its pre-scientific origins date back some 5000 years. Hypnotherapy is today experiencing an unprecedented boom in growth and expansion and in Ireland, Europe and globally.I know you will find the course both stimulating and rewarding as there is great emphasis on self-development combined with Supervision. As you progress through the ICHP Programme you will be exposed to a wide variety of experts in the field with a vast repertoire of approaches and styles to prepare you to consult with an array of mental health symptoms.Finally, the programme is designed to be taught by professionals in the field and combine clinical based practice with a theoretical underpinning and promotes a good working relationship between tutors, students, supervisors and work placement personnel. This close relationship is an inherent part of the ICHP culture and prepares our graduates for a professional career in the field of Hypnotherapy-Psychotherapy.I wish you every success in your studies with the Institute of Clinical Hypnotherapy & Psychotherapy. ICHP Video Guide Like Us On Facebook

医学

2014-42/1180/en_head.json.gz/4980

"Brain on Fire: My Month of Madness" - In Conversation with Susannah Cahalan By Andrew DeCanniere Late last year, I came across what is, in my opinion, one of the most important books of 2012, Brain on Fire: My Month of Madness by Susannah Cahalan (Free Press, 2012). In it, the New York Post reporter chronicles her harrowing battle with a rare autoimmune disease known as anti-NMDA Receptor Encephalitis, first discovered in 2007 by Dr. Josep Dalmau at the University of Pennsylvania. In fact, she was only the 217th person in the world to be diagnosed with the condition. Recently, I had the opportunity to speak with Susannah about her experience. Read on to see what she had to say… The author and her mother at her Summit, NJ home (c. 2004/05) Andrew DeCanniere (AD): Getting to your story, the thing that was most striking to me about the condition you were diagnosed with is that all the symptoms are so disconnected from one another that you wouldn’t think that it is symptomatic of anything in particular. Susannah Cahalan (SC): Right. The beginning stages were just kind of so disparate. It was just behaviors that are a little bit abnormal and then some numbness in my hand that didn’t seem at all related. AD: No one would really think that it is anything more than your garden-variety illness. SC: Right. They thought that it was Mono at first. And they didn’t really connect the behavioral changes, because I didn’t really communicate my behavioral changes to anybody in the beginning. I just felt off. I didn’t really tell anyone about that. I remember talking to one of my friends and saying like “I’m all weird about my boyfriend.” I’m acting all strange. I had just gone on birth control, so I thought maybe that was part of it, or maybe I was just not feeling like myself, so I didn’t connect the two at first at all. AD: Now so many people turn to WebMD when they suspect something is wrong, but back in 2009 when you were diagnosed -- and certainly not two or three years before -- there wouldn’t have been all this information that would have been readily available about the disease [anti-NMDA Receptor Encephalitis], so it’s not as if that would have been an option. SC: I mean the disease itself was discovered in 2007. So, when I finally knew what was wrong with me, and looked it up, it was basically just medical journals and very abstract things that I couldn’t at all understand at the time. AD: Right. Apart from that, I don’t think any information on it would have been readily accessible. SC: There was one Diagnosis column in the New York Times -- if you’re familiar with that column -- where they cover these kinds of crazy illnesses and they talk about how a doctor figures it out. Anti-NMDA Receptor Autoimmune Encephalitis was in the New York Times Diagnosis column in 2008 or something. So that was the only mass media that had ever covered the illness prior to my getting sick. AD: And I don’t know about you, but I certainly don’t delve into the medical journals on a regular basis. Another thing that struck me is that even with the support system that you have -- with your family at your side -- it seems that at first it was really difficult to get the proper care yourself. SC: Definitely. But without them fighting for me -- because I couldn’t fight for myself at that point -- I don’t think I would have found a diagnosis on my own. The author and her boyfriend, Stephen (2012) AD: The first doctor that you went to, Dr. Bailey, seems to have been so adamant about his initial diagnosis. It seemed he truly believed these symptoms were simply the result of excessive alcohol consumption, and he couldn’t be convinced that it might be something else. SC: Oh yeah. He was convinced. He was really convinced that I was drinking too much and that I was stressed out. He almost couldn’t be convinced otherwise. AD: It’s like he was going with some sort of stereotype. SC: Definitely. AD: It seems to have been something along the lines of here’s another young, hard drinking, hard partying twenty-something professional. Then, more shockingly, you go back to him with your mom and, though someone had been with you at all times because of your illness – which means you would have been observed at all times -- and your mom tells him that you haven’t had a drop of anything to drink, he still thought that he was right. SC: Right. My mom was able to push him and say this just doesn’t make any sense. Eventually he said “Fine. We’ll do it your way,” but he was very hesitant about it and he wasn’t very convinced. AD: He really had to be pushed to even get you admitted to the hospital. SC: She had to throw a list of my symptoms at him to actually admit me to the hospital. AD: Possibly the only more incredible thing to me about this whole thing is when you went back to him, after you were back at work, was his reaction. I would have been angry. SC: I was at first. I was. It took me a while to come to terms with it and be okay with it in a way, and kind of forgive him and be a little bit more journalistic in my approach as opposed to emotional. So my first draft of the book was very tough on him, but as I grew as a person and a writer and I was able to maintain a journalistic distance, I realized that he was representative of a broken system. He himself was wrong, but he was also part of a bad system. AD: I think it definitely points to shortcomings. Obviously in this country [when it comes to healthcare] we are in a much better position than in a number of other countries. We have access to much better care than in many parts of the world, for example. But I think there’s still so far to go. SC: I agree with you completely. I read something in the Times today about for-profit medicine. It’s really scary when you take all of that into account. AD: I certainly know that he doesn’t represent everybody, but there are definitely things that need to be ironed out. That’s the most diplomatic way that I can think of putting it. Another point that stuck out to me is that though now there is an established series of test to diagnose your condition, back when you were admitted this really wasn’t a known thing, so they had to do a whole bunch of tests to determine what it could be. There was a whole bunch that they had to rule out first. SC: Exactly. That was a big thing. The ruling out of everything. Author Susannah Cahalan and her father at Graceland in 2006 AD: I know that at first there was just a whole series of diagnoses, basically. That’s obviously changed, but I think you said it cost something like a million dollars? SC: Yes. A million dollars in tests. AD: I can’t even imagine what would happen without insurance. SC: Yeah. They wouldn’t have been able to see Dr. Najjar, most likely, without insurance. AD: Now that’s supposedly changing. Everyone’s supposed to be insured, in theory. SC: I don’t know how much is changing really, and I think that even if you have very terrible insurance, I’m not sure you’re going to be at NYU’s epilepsy center because it is very expensive to be there per day. If insurance isn’t covering it, most people cannot afford that kind of care. AD: The recovery part of it in and of itself seems to have been the most difficult part for you. There’s so much that goes into the recovery alone. SC: I think it was the most difficult for me to go through and the most difficult part for me to write. AD: For example, there’s this part in your book where this woman comes up to your mom, and she begins to speak as if you’re not aware of what’s going on or as if you’re not there, when in reality, you are there. You’re just not necessarily being able communicate what you want to communicate, which seems to have been lost on that woman. SC: Right. You’re kind of there. You’re still kind of cognizant of your inabilities. It’s not like you’re completely there. It’s not like you’re sitting there without any clue of what’s going on. It’s that you do have a clue and you understand how much you are not yourself. And I think that was just really painful to go through and hard to recount as well. It’s hard to write about yourself at 90 percent yourself or 80 percent yourself. You know what I mean? It’s a hard thing to communicate to a reader as well… especially to someone who hasn’t gone through something like that. AD: I can only imagine. Especially when you can’t necessarily share how you’re feeling. SC: You can’t really communicate. You can experience, but you can’t really communicate. AD: It surprised me that something so low-tech is used to diagnose the condition. SC: That’s what’s amazing about it. The actual diagnosis was helped by a relatively simple test, the clock test. Then it was confirmed through a spinal tap. Spinal taps have been around forever. It’s a combination of intelligent, smart thinking and simple thinking and cutting-edge neuroscience. So, you can’t just say we can just go back to simple times because that doesn’t really work, either. It’s the combination of working simply and having these cutting edge tools at your fingertips as well. The real cutting-edge part was Dr. Dalmau and the discovery of the new disease, and how he did that. It was also very much trial-and-error and intelligent -- kind of smart, simple thinking as well. It just shows you that with all of the technology we have, it still takes a creative thinker to make it all work. AD: It’s not all about the new technology that’s available. That alone is not going to do it, obviously. When it comes to this sort of research, it almost seems like the more we know, the more you become aware of how little we know and how far we have to go. SC: Very much so. That was a kind of a shock for me while researching this. I’d think I’d be asking a stupid question, but then these amazing doctors wouldn’t have an answer for me. So I realized “Wow. We really are still in the dark ages.” AD: Just goes to show, you’d think we progressed so far, and to a certain extent we have, but I think that the more we learn the more apparent it is that there’s so much further to go and so much more to understand. It’s almost seems never ending. I think that part of what’s so great about the book is that you really do a wonderful job of explaining a lot of this stuff. I think that if people think of a medical mystery novel -- if you want to call it that -- which can involve a lot of medical jargon, it is easy to get lost in a lot of that sort of stuff. Yours explains it wonderfully, in such a way that the reader can easily follow along. SC: Thank you so much. That’s wonderful to hear, because that was important to me. The author at NYU Medical Center (2009) AD: The condition that you were diagnosed with, anti-NMDA Receptor Encephalitis --you said basically that part of what it does is it targets much of that which makes you who you are, higher functions, your personality. I think that’s a good way of explaining it? SC: I think that’s a good way of explaining it, definitely. AD: To me that would be a scary thing. It seems like before you enter the hospital, when you are writing in your computer diary, through the series of Word documents you type up on your computer, it seems like you were very aware of losing your self. SC: Yeah. I think so. I was in such a frenzied rush writing those -- I don’t really remember writing them that much, that coherently. Looking back now I can sense that there’s definitely a foreboding there. AD: That would’ve had to be just a really difficult position to be in. SC: Oh, definitely. It’s very strange reading something that you hardly remember writing. You know, you were in a different mind state. It’s just very strange. AD: I know that you said that what ended up being the cover photo was taken while this was all going on? SC: I did. I took the photo right before I went into the hospital, when I was home from work for one of those weeks where I took off a bunch of days. For some reason I took all these photos of myself and my cat. They were just very strange pictures and that was one of them. I totally forgot about that until my publisher asked me if I had any pictures of myself during that time, and I looked through my MacBook Photo Booth and so that is where they originate. AD: To me, being in that sort of position where you kind of realize what is going on and don’t really know what to do about it, would be frightening. In the book you also touch on that just two years or three years separate you from those who went undiagnosed, or were potentially misdiagnosed, and ultimately ended up in a facility never knowing that they have this condition, which would potentially have been treatable. SC: I’m hoping that changes, but it’s still happening. AD: I don’t know how common it is now for people to be tested for it, or if there’s anything that can be done for them after the fact. It does seem like, for someone who does indeed have the condition, it is time sensitive. SC: Very much. I have had calls from people who think that they have it, and it was in the 80’s, and they have cognitive difficulties or disabilities following that. But it is, it’s very much time-sensitive. AD: The longer it goes on, the more damage that can be done, and the bigger the risk that the damage may be permanent. SC: Yes. Exactly. Basically it can affect the receptors in the brain in a long-term way. AD: And what fascinates me is that this has been around forever basically. I know you write that in the late 80’s, a French Canadian pediatrician treated a number of kids who had a similar sort of pattern of symptoms, and were diagnosed with the generic “encephalitis of an unknown origin.” They could have had this disease, for example. A lot of people have also been misdiagnosed with Autism, and in reality they have this condition. One doctor you cite in your book actually says that out of five million people diagnosed with Autism, about 100,000 could actually have been misdiagnosed and indeed be afflicted with this condition instead and they just don’t know it. SC: That’s kind of a conjecture thing. Even if it’s just five percent or one percent, that’s still a good, sizable chunk. There’s this possibility that they have been misdiagnosed and that they have something else. AD: That’s alarming. That’s why it is so good that it is being recognized, that the word is getting out there with this book. Because maybe there still is something that could be done for some of these people, they can still be treated. Not to over politicize the book, but what do you feel needs to change about the healthcare system? SC: I think that doctors need to be rewarded for time they spend with patients, as opposed to being rewarded for the number of tests that they issue to patients. I don’t know how that’s possible to do, but you know doctors aren’t paid per hour. Right? So, the doctor who spent five minutes with me, who diagnosed me with alcohol withdrawal, gets the same amount of money as Dr. Souhel Najjar who spent an hour of his time with me. Doctors aren’t rewarded for their time and diligence and consideration. Instead they’re rewarded for the number of tests that they give. So, I think something in that needs to change. I don’t know how to change it, but something needs to change there. AD: I think part of that mindset or culture -- when it comes to ordering many tests, often more than are needed to diagnose the problem -- is that they also want to make sure they’re protected from any sort of lawsuit as well. So that if one test is good, well then, ten must be better. SC: Exactly. AD: And then, as you say, they are often overscheduled. SC: Definitely. That’s just to make money. That’s how they make money, which is terrible. AD: And then you try to squeeze everyone in. SC: I know. It’s just not the way it should be. It’s a calling instead of a career. They are patients, they’re not clients. You know? Susannah Cahalan is the author of the New York Times bestseller Brain on Fire: My Month of Madness and a reporter at the New York Post. You can find out more about Susannah and her book by logging onto her website, www.susannahcahalan.com and on Facebook at www.facebook.com/brainonfirebook. Photos: Susannah Cahalan Published on Feb 19, 2013

医学

2014-42/1180/en_head.json.gz/4983

Concussions Should be Treated on Case-By-Case Basis, Says Neurology Group By Erik Derr (staff@latinospost.com) | First Posted: Mar 19, 2013 12:44 PM EDT Tags Concussions (Photo : Creative Commons/Erik Derr) 0 Subscribe to the latinospost newsletter! Treating concussions in athletes should be done on a case-by-case basis. That's the new primary recommendation from the American Academy of Neurology, which says athletes need to be treated according to their individual conditions, not a predetermined approach. The guidelines do recommend, however, that any athlete suspected of having a concussion should be immediately removed from play.Like Us on Facebook "If in doubt, sit it out," Jeffrey S. Kutcher, a doctor at the University of Michigan Medical School, told the New York Times. "You only get one brain; treat it well." The new guidelines brings the group in line with practices followed by the National Football League and other leagues and associations, which acknowledge concussions are too variable to fall into any generalized categories. "We've moved away from the concussion grading systems we first established in 1997 and are now recommending concussion and return to play be assessed in each athlete individually," said Christopher C. Giza, a doctor at the David Geffen School of Medicine and Mattel Children's Hospital at the University of California Los Angeles and one of the lead authors for the new guidelines. "There is no set timeline for safe return to play," he said. The revised recommendations, unveiled at the academy's annual meeting in San Diego earlier this week, have been published in Neurology, the medical journal of the academy. The study noted more than a million American athletes experience concussions each year, with the greatest risk in football and rugby, followed by hockey and soccer. Concussion risk is greatest for young women and girls in soccer and basketball. The authors of the study said they didn't find any "clear evidence that one type of football helmet can better protect against concussion over another kind of helmet." According to the new guidelines, signs and symptoms of a concussion include: headaches, sensitivity to light and sound, changes in reaction time, balance and coordination, changes in memory, judgment, speech and sleep, and loss of consciousness or blackouts. Contribute to this Story:

医学

2014-42/1180/en_head.json.gz/5005

« Hospital leader assures no c... Increase penalties for gambl...» Community shows strong support for the arts Save | To the editor: The mural depicting the history of theater in downtown Lewistown was dedicated on Nov. 1 on the site facing the west wall of Wilson's Gifts and Jewelry next to the Juniata Valley Bank. Members of the community gathered to honor local muralist Dwight Kirkland for creating and painting this massive piece of historic art, one of eight murals completed during the past seven years. Mr. Kirkland donated his services and asked that donations be made for the restoration of the Embassy Theater. Jim Tunall, Chamber Executive Director, served as emcee, local author and historian Paul Fagley traced the history of theater in Lewistown, Mayor Deb Bargo presented Mr. Kirkland the key to the city, Angela Niman, Director of the Arts Council, talked about arts becoming a major attraction in the community and Jim Zubler, Executive Director of Downtown Lewistown Inc., expressed thanks for Dwight's generous donation of time and talents. The project involved many organizations, citizens and patrons. The research and design was a collaboration between Paul Fagley, Mayor Bargo and the Mifflin County Historical Society. Thank-yous were extended to the Wilson family for the use of their wall, the Juniata Valley Bank for closing their parking lot during the weeks of painting, Penn Equipment for the use of the lift with help from Sacred Heart Parish, Francis and Paul Stumpf, whose father was one of the Embassy ushers depicted. Also, The Trolley Car Restaurant, Friends of the Embassy, the Pennsylvania Council of the Arts, Community Partnerships RC&D, Sherwin Williams Paints, Ed and Cathy Forsythe of Ed's Trains and the Juniata River Valley Chamber of Commerce and Visitors Bureau and Downtown Lewistown Inc. Following the dedication a reception was held at the Mifflin Juniata Council of the Arts Gallery on West Market Street where an exhibition of paintings by Dwight Kirkland is currently on display. A tour brochure detailing all eight murals by Kirkland is available at the chamber office in the historic courthouse, on the square, in downtown Lewistown. Thanks to Dwight Kirkland and the entire community for supporting the arts in the Juniata River Valley. Jim Tunall, Executive Director Juniata River Valley Chamber of Commerce & Visitors Bureau Save | Subscribe to Lewistown Sentinel I am looking for:

医学

2014-42/1180/en_head.json.gz/5015

DepressionDiabetesDiabetic Foot UlcersDigestive HealthHypertensionPainSmoking CessationType 1 DiabetesType 2 Diabetes More beans, less white rice tied to less diabetes Published September 01, 2011 New York (Reuters Health) -- Beans and rice are a classic combination throughout the western hemisphere, but a study in Costa Rica finds that the bean half of the equation may be better for health.Among nearly 2,000 men and women, researchers found that people who regularly swapped a serving of white rice for one of beans had a 35 percent lower chance of showing symptoms that are usually precursors to diabetes. "Rice is very easily converted into sugar by the body. It's very highly processed, it's pure starch and starch is a long chain of glucose," said Frank Hu, a professor of nutrition and epidemiology at the Harvard School of Public Health in Boston, who was part of the study team. "Beans compared with rice contain much more fiber, certainly more protein and they typically have a lower glycemic index -- meaning they induce much lower insulin responses," he told Reuters Health. Hu's group looked at the diets of nearly 1,900 Costa Rican men and women participating in a study of risk factors for heart disease between 1994 and 2004. None of the participants had diabetes at the start of the study.As Costa Rica has become richer and more urbanized, rice consumption has risen while intake of beans has fallen, Hu said. Meanwhile, the rate of diabetes in the country has soared.The extra rice might be at least partly to blame, the Harvard group concludes. They found that people who ate more white rice over time had higher blood pressure and elevated levels of sugar and harmful fats in their blood as well as lower levels of "good" cholesterol.Those factors, along with a high waist circumference, are all elements of the so-called metabolic syndrome, which is a major risk factor for both type 2 diabetes and heart disease. People who ate at least two servings of beans for every serving of white rice tended to be at lower risk for metabolic syndrome. In those who substituted a serving of beans for a serving of white rice the risk of metabolic syndrome was reduced by 35 percent, the researchers report in American Journal of Clinical Nutrition. Although rice may be a larger part of diets outside the U.S., the findings have important implications in this country, Hu said. Americans are consuming more rice than ever, up from 9.5 pounds per person in 1980 to 21 pounds per person in 2008, government figures show. Consumption of dry beans is markedly lower, at about seven pounds a year per person, according to the U.S. Department of Agriculture. That's a bad trend, said Hu, especially if people are eating white rice rather than brown rice. From the body's perspective, a serving of white rice "is like eating a candy bar - the fiber and other nutrients are stripped away," said Hu, who added that the trend "will have long-term metabolic effects.""It would be useful to introduce more legumes, including beans, into our diet to replace white rice and some of the red meat," he told Reuters Health.The Harvard team's findings do not prove that white rice raises diabetes risk or that beans lower it. In previous research, Hu and his colleagues have found that eating brown rice may protect against type 2 diabetes. "It doesn't surprise me that you get better health outcomes in bean eaters," said David Jenkins, a nutrition researcher at the University of Toronto who developed the concept of the glycemic index to help diabetics gauge the effect various foods would have on their blood sugar. "Beans are notable among plant foods" for having a modest effect on blood sugar, he explained.Although Jenkins said the health benefits of different beans might vary, "as a class they hang together pretty well, and much more uniformly than other foods." Sources: http://bit.ly/njnqdi American Journal of Clinical Nutrition, online August 3, 2011. Rate This Article

医学

2014-42/1180/en_head.json.gz/5119

Home | About Us | Counseling | MBSR Online | Classes | Retreats | Corporate Wellness | Resources | Store | Contact Us Overview What is MBSR? MBSR in Medicine Meditation Research What is Mindfulness? Schedule and Fees MBSR CME's and CEU's Meditation Research Roundup By Richard Mahler Western science continues to train its investigative focus on the relationship between meditation and the human body. Each month it seems that one or more articles are published in scientific journals describing the results of rigorous studies involving some form of meditative or contemplative practice. Inquiries in recent years have documented apparent effects from meditation that include lowered blood pressure, decreased heart and respiratory rates, increased blood flow, and other measurable signs of the relaxation response. Other reported benefits include enhancement of immune function and relief of perceived chronic pain due to arthritis and other disorders. Here’s a round-up of some of the more recent clinical study results: As reported in June 13, 2006, editions of the Washington Post, heart disease patients involved in a small government-funded study who practiced transcendental meditation for four months showed slight improvements in blood pressure and insulin levels. Cited in the article is a report published in the Archives of Internal Medicine. Participating patients who learned TM did better on blood pressure and insulin measures than those who spent the same amount of time on lectures, discussions, and homework about the effects of stress, diet, and exercise on the heart. The 103 patients in the study received regular medical care as well, including drugs to lower cholesterol and blood pressure. Adding meditation had "a strong enough effect that we could show a benefit over traditional health care," said co-author Noel Bairey Merz of Cedars-Sinai Medical Center. The new study is believed the first to show an effect of meditation on insulin function. In a separate report, issued on May 8, 2006, by ScienCentral News (www.sciencentral.com), Massachusetts General Hospital psychologist, Sara Laza, is quoted as saying she can see measurable physical changes in the brains of people who routinely meditate. "Meditation can have a serious impact on your brain long beyond the time when you're actually sitting and meditating, and this may have a positive impact on your day-to-day living," said Lazar, an instructor at Harvard Medical School. Her research was funded by the National Institutes of Health and the Centers for Disease Control. As she outlined in the Nov. 15, 2005, issue of NeuroReport, Lazar and her team used MRI brain scans to compare the brains of people who practiced insight (vipassana) meditation every day with those of non-meditators. "These are not monks,” she emphasized, “these are just people who choose to meditate for about 45 minutes a day every day." Lazar and her research team found that certain areas of the cortex — the outer layer of the brain that contains our thinking, reasoning, and decision-making functions — were significantly thicker in the meditators. "One of them is right up in the front of your brain right above your right eye, and this is an area that's involved in decision making and in working memory [as well as] short term memory," she explained. Lazar also saw thickening in another region of the brain, called the insula, that she considers "a central switchboard of the brain." The insula connects the primitive limbic cortex and the more advanced cortex, which is highly developed in primates and humans. Lazar said this region is thought to be "involved in coordinating the brain and the body and the emotions and thoughts," she explained. "It helps us better make decisions." The researchers think this thickening might help to counteract the natural thinning of the cortex that occurs as we get older. The brain's cortex starts getting thinner from about age 20 and continues to thin throughout life. “It's not a cure-all, but it perhaps can help prevent the loss of some functions," Lazar said. "One small part of the front of the brain does not get thinner with age… [suggesting] that this part of the brain is not affected by age. This part of the cortex is involved in short term working memory and cognitive decision-making." Results also suggest that ongoing meditation would continue the thickening process. "The thickness is strongly correlated with the amount of experience. So the more they sat, the thicker it was," Lazar noted. The Massachusetts researcher plans to further study how meditation might affect mental ability by testing people "at multiple time points and to test their cognitive ability to see if cognitive ability correlates with thickness and if that changes as the brain gets thicker.” The Dalai Lama has long advocated that neuroscientists investigate the effect of spiritual traditions, such as meditation, on the brain. In 1991, the exiled Tibetan leader asked University of Wisconsin professor Richard Davidson whether he would like to study the effect meditation had on the brain. The neuroscientist’s assent led to the groundbreaking discovery that activities like meditation can in fact “train” the mind to react to situations with positive emotions. Last May, Time magazine named Davidson one of the most 100 influential people “who shape our world.” The director of UW’s Waisman Laboratory for Brain Imaging and Behavior was labeled a “pioneer in the exciting frontier of mind-body medicine.” Davidson told the university’s Badger Herald that meditation “changes circulations in the brain that are critical for the development of emotion. [Thus,] characteristics like happiness and compassion are skills that can be trained.” Building on his research on the connection between meditation and mental health, Davidson said he is now studying how meditation and other spiritual practices relate to physical health. “We’ve shown that those circuits [that can be affected by meditation] are also related to parts of the body that are important for physical health,” Davidson said. Richard Mahler is an independent editor, writer, and teacher. He has published 11 books and written for publications such as the Los Angeles Times, Chicago Tribune, Los Angeles Daily News, Alternative Medicine, Miami Herald, San Francisco Chronicle, Albuquerque Journal, Toronto Globe and Mail, Houston Chronicle, and E/The Environment Magazine.

医学

2014-42/1180/en_head.json.gz/5164

Green Healthcare Institutions: Health, Environment, and Economics, Workshop Summary ( 2007 ) / 2 Sustainable Healthcare Facilities Prev ChapterPrev Page Next PageNext Chapter Prev ChapterPrev Page Next PageNext Chapter Print Front Matter R1-R12 1 Introduction 1-5 2 Sustainable Healthcare Facilities 6-17 3 Economics, Ethics, and Employment 18-27 4 The Health Aspects of Green Buildings 28-37 5 The Process of Change 38-44 6 Champions for Change 45-52 7 General Workshop Discussion 53-58 Presentation Abstracts 59-100 References 101-106 Appendix A Workshop Agenda 107-111 Appendix B Speakers and Panelists 112-113 Appendix C Workshop Participants 114-116 2 Sustainable Healthcare Facilities In 2004 the healthcare industry in the United States constituted 16 percent of the country’s gross domestic product. Today, the United States is experiencing one of the largest healthcare facility building booms since the Hospital Survey and Construction Act, commonly referred to as the Hill-Burton Act, was passed in 1946 (Public Law 79-725). New technologies and new competitive pressures affect health care as more people are moving to the suburbs and older city hospitals are becoming obsolete. Hospital design transformation requires looking for new ways to improve healthcare quality and recognizing the relationship between medical services, environment, and diseases. Visionary thinking, connecting sustainability to health, and pollution prevention are important for the future of the healthcare industry. The first session of the workshop is summarized in this chapter and includes presentations by Craig Zimring, Robin Guenther, and Knut Bergsland. This portion of the workshop explored the agendas involved in green health care and provided examples of sustainable healthcare facilities and the methods and tools employed in their design and operation. The information provided is drawn from the insights and experience of the presenters, and some of the current standards and best practices being implemented in green healthcare institutions today. GREEN BUILDING AND HEALTH AGENDAS: POINTS OF CONVERGENCE Because modern healthcare facilities are large consumers of resources, they provide an opportunity to make changes or reduce the consumption of these resources. Despite financial pressures, they are dedicated to helping people and can be models for other institutions, said Craig Zimring of the Georgia Institute of Technology. According to Zimring, there are two agendas for green health care: the green agenda and the design-as-quality-support (DQS) agenda. The Front Matter R1-R12 1 Introduction 1-5 2 Sustainable Healthcare Facilities 6-17 3 Economics, Ethics, and Employment 18-27 4 The Health Aspects of Green Buildings 28-37 5 The Process of Change 38-44 6 Champions for Change 45-52 7 General Workshop Discussion 53-58 Presentation Abstracts 59-100 References 101-106 Appendix A Workshop Agenda 107-111 Appendix B Speakers and Panelists 112-113 Appendix C Workshop Participants 114-116 Close 2 Sustainable Healthcare Facilities ." Green Healthcare Institutions: Health, Environment, and Economics, Workshop Summary . Washington, DC: The National Academies Press, Green Healthcare Institutions Health, Environment, and Economics: Workshop Summary green agenda is a multilevel analysis of socioeconomic health impacts at multiple scales, ranging from a building’s occupants to society as a whole. The DQS agenda converges with the green agenda but differs, according to Zimring, in some important ways. Similar to the green agenda, the DQS agenda advances social and economic goals, but it focuses on using design to improve quality and safety outcomes, such as error and infection reduction, staff turnover, length of stay, and patient and family satisfaction. In this agenda, design is viewed as a tool that can affect healthcare outcomes for patients, staff, and the institution as a whole. Relationship Between the Two Agendas The green agenda is based on the notion of a virtuous cycle explained Zimring. Designing, constructing, and managing a hospital in accordance with principles of sustainable development can benefit the local community, the economy, and the environment. It can improve public health as well as reduce the demand for health services. In contrast, the DQS agenda approaches construction from a slightly different perspective. Similar to evidence-based medicine, in which healthcare decisions can be made based on the best evidence about the outcome of those decisions, evidence-based design decisions are based on the best predictions about their outcome, asserted Zimring. Evidence-based design is the conscientious, explicit, and judicious use of current best evidence in making design decisions that advance an organization’s goals. DQS involves a process in which one understands the evidence, makes hypotheses, tests the outcomes, and works back into decision making. Part of the DQS agenda is based on two Institute of Medicine (IOM) reports: To Err Is Human: Building a Safer Health System (IOM 2000) and Crossing the Quality Chasm: A New Health System for the 21st Century (IOM 1999). In To Err Is Human, the IOM extrapolated that as many as 98,000 people die each year from preventable medical errors. Furthermore, there are approximately 2 million hospital-acquired infections in the United States, and as many as 88,000 people die from those infections (CDC, 2000). Zimring observed that even at the lower end of these numbers, more people in the United States die from hospital-acquired preventable adverse events than from other leading causes of death, such as AIDS, breast cancer, and motor vehicle accidents (IOM, 2000). One of the reasons why these safety problems occur is that the most experienced caregivers in hospitals—nurses—have a very high turnover rate, noted Zimring. Concern about safety, quality, and nursing turnover has contributed to a “quality revolution” and the belief that healthcare institutions can make a dramatic improvement in healthcare quality and safety through better information and strategic action. This initiative is led by such organizations as the Institute for Healthcare Improvement, the Center for Health Design, and others. Role of the Physical Environment in Green Building and Health Zimring observed that there is a large and growing body of evidence demonstrating the role of the physical environment in achieving healthcare quality and safety. For example, a recent meta-analysis of more than 600 primarily peer-reviewed studies found associations between the physical environment and patient and staff outcomes in four areas: reduced staff stress and fatigue and increased effectiveness in delivering care; improved patient safety; reduced patient stress and improved health outcomes; and improved overall healthcare quality (Ulrich et al., 2004). For example, access to views and natural light in healthcare facilities can have important stress-reducing effects, as well as reduce pain and the length of stay at the hospital (Ulrich, 1991). In their meta-analysis review, the authors observe that hospitals are complex systems in which it is difficult to isolate the impacts of individual factors and suggest that design-based evidence parallels evidence-based medicine for improving health care. Zimring recommended additional research in the area of evidence-based design to understand how hospital design affects health. In conclusion, he described the green agenda as encompassing ecological health on multiple scales. It credits environmental initiatives, such as reduced resource use, and it aims for improved patient outcomes. The green agenda does not guarantee that recycled floor surfaces or less outgassing of chemicals from products will result in better care or more rapid recovery, cautioned Zimring. In reinventing hospitals and transforming their design, design is a tool to improve quality, safety, and experience. HIGH-PERFORMANCE HEALING ENVIRONMENTS As construction technology advanced during the past century, the design of hospitals changed from daylit, naturally ventilated, pavilion-style buildings to high-rise buildings with mechanically conditioned air, said Robin Guenther of Guenther 5 Architects. Bellevue Hospital in New York City is a prime example of this change. It was built on a site near nature, overlooking the East River, before the expertise was available to build high-rise buildings or provide mechanical ventilation. At that time, hospitals needed access to clean air and fresh water to heal people. The facility has continued to expand and based on blueprint calculations, Guenther reported that Bellevue Hospital now has 60,000 square feet of floor space, an acre and a half footprint, and less than 10 percent of the building has a window. Because projections for construction in the healthcare sector are for approximately 100 million square feet per year, Guenther suggested that architects need to identify new models for healthcare facilities. Today’s healthcare facilities are buildings that are low in thermal mass—they heat up too quickly and cool down too rapidly—and are heavily dependent on artificial systems, such as lighting, FIGURE 2-1 Healthcare facilities annually consume nearly twice the energy of an average commercial building. SOURCE: Energy Information Administration, 1995 Commercial Buildings Energy Consumption Survey. ventilation, and interior environments. Healthcare facilities consume nearly twice the annual energy of an average commercial office building (Figure 2-1).* Even with healthcare expenditures constituting roughly 16 percent of the GDP, healthcare facilities are unable to keep up with demand and upgrade older facilities. Many of the structures built in the United States during the Hill-Burton Act era, particularly urban medical centers, are challenged by real estate and capital issues and are in need of replacement, said Guenther. Leadership in Energy and Environmental Design In the past two decades, the link between buildings and health has received considerable attention. Many media reports have highlighted the problem of indoor air toxins in sealed buildings. The October 2003 issue of Metropolis magazine was entitled “Architects Pollute,” and placed a large share of the responsibility for contributing to global warming on the shoulders of architects. An article within the issue asserted that architects and the construction industry are responsible for half of America’s energy consumption and half of its green-house gas emissions produced by burning coal, gasoline, and other fossil fuels (Hawthorne, 2003). Americans’ growing concern that buildings do impact their health has influenced the federal government’s decision to support green building. In its report The Federal Commitment to Green Building: Experiences and Expectations, green buildings are defined as “the practice of (1) increasing the efficiency with which buildings and their sites use energy, water, and materials, and (2) reducing building impacts on human health and the environment through better siting, design, construction, operation, maintenance, and removal—the complete building life cycle” (OFEE, 2003). The U.S. Green Building Council developed Leadership in Energy and Environmental Design (LEED) as “a nationally accepted benchmark for the design, construction, and operation of high performance green buildings. The LEED rating system is the current best practice standard for the building sector. LEED gives building owners and operators the tools they need to have an immediate and measurable impact on their buildings’ performance. LEED promotes a whole-building approach to sustainability by recognizing performance in five key areas of human and environmental health: sustainable site development, water savings, energy efficiency, materials selection, and indoor environmental quality” (U.S. Green Building Council, 2006). Initially, LEED was created as a tool for the for-profit sector, which needed motivation to use emerging green building technologies, and was based on the premise that the nonprofit sector would embrace green building technologies as a component of their mission. LEED certification is given to the top 25 percent of green-performing buildings in the United States. With levels that include Certified, Silver, Gold, and Platinum, certification is achieved based on a third-party checklist of strategies for building, design, and construction. Of the approximately 1,800 registered projects in the LEED system in 2004, only 2 percent of these projects were in the healthcare industry (Kozlowski, 2004). Examples of LEED Construction in Health Care A few noteworthy LEED projects in health care include Emory University’s Winship Cancer Institute in Atlanta, Georgia; the Dell Children’s Medical Center in Austin, Texas; Boulder Community Foothills Hospital in Boulder, Colorado; and the Patrick H. Dollard Health Center in Harris, New York. Emory University’s Winship Cancer Institute is a research and clinical facility for cancer patients that formally received certification in the U.S. Green Building Council’s LEED program in 2005. Input from patients influenced the design of the Infusion Center, which has more intimate clusters of space for four patients each and hip-high walls that personalize the space for family members while maintaining visibility for good nursing care. The building design seeks to create an atmosphere of life, health, and the ultimate hope for a cure. Dell Children’s Medical Center in Austin, Texas, is a LEED-registered project that is pursuing certification at the Platinum level. A redevelopment located at the old Austin Municipal Airport, it is pursuing green strategies across the board; most notably, the integration of a combined heat and power facility that doubles the efficiency of electricity generation by utilizing waste heat for thermal energy. It is scheduled for occupancy in late 2007. Boulder Community Foothills Hospital is a replacement women’s and children’s hospital. It is a green-field hospital built on previously undeveloped, degraded wetlands that were home to a large prairie dog colony. The hospital returned 32 restored acres of the 49-acre site to the community as permanent open space. The city of Boulder then built the hospital sustainably as a way to gain community support for development of the site, explained Guenther. The hospital architects focused on local and regional low-emitting materials, reduction of water use through xeriscaping (landscaping that does not require supplemental irrigation), low-flow fixtures, and energy reduction. Another sustainable healthcare facility is the Patrick H. Dollard Discovery Health Center in upstate New York. It is a residential facility for developmentally disabled children and adults, and the medical staff has a keen interest in the impact of the environment on developmental disabilities. The Dollard Health Center construction strategies included high-reflectance roofing, reliance on local and regional recycled-content low-emitting materials, and elimination of polyvinyl chloride in finish materials and plumbing. By using ground source heat pumps, energy demand was reduced by 42 percent and onsite fossil fuel combustion was eliminated. In addition, the facility opted to purchase green power, said Guenther. Green Guide for Health Care First released in 2003, The Green Guide for Health Care filled a need in the marketplace for green building tools specifically for health care. According to its website, The Green Guide for Health Care is “the healthcare sector’s first quantifiable sustainable design toolkit integrating enhanced environmental and health principles and practices into the planning, design, construction, operations and maintenance of their facilities. This guide provides the healthcare sector with a voluntary, self-certifying metric toolkit of best practices that designers, owners, and operators can use to guide and evaluate their progress toward high performance healing environments” (GGHC, 2006). The document has an explicit health-based focus. Before this connection, healthcare administrators often dismissed green building as having no relevance to health, viewing it as purely about saving the environment, noted Guenther. In 2002, the American Society for Healthcare Engineering (ASHE) developed the Green Healthcare Construction Guidance Statement, which articulated the need to protect health on three scales: building occupants, the surrounding local community, and the global community and resources (ASHE, 2002). The core structure and content of The Green Guide for Health Care is based on existing tools, such as LEED, transferred and modified for health care. The document encourages best practices without certification and regulatory thresholds, and it bridges design and construction with operational considerations. The Green Guide for Health Care is a web-based, downloadable, free, open-source tool. In January 2006, the website registrants numbered approximately 6,800, with diverse geographic distribution; about 10 percent of the registrants are from outside the United States. With more than 60 projects actively based in the pilot program, a critical mass of healthcare projects are engaging in this work, noted Guenther. The healthcare industry is beginning to recognize the relationship among medical services, the environment, and diseases. The first step was taken in 1998 when the American Hospital Association signed a voluntary memorandum of understanding with the U.S. Environmental Protection Agency pledging reductions in solid waste; avoidance of persistent, bioaccumulative, and toxic compounds; and virtual elimination of the use of mercury by 2005 (AHA, 1998). Guenther concluded by noting the responsibility of the healthcare industry to build and operate sustainable buildings, if for no other reason than for the health of the building’s occupants. The healthcare industry has the opportunity to be a model for health-based, sustainable approaches to construction, food service, active living, and waste management. It should lead creative thinking and draw inspiration from such visionaries as the early environmentalist David L. Lawrence. As mayor of Pittsburgh, Lawrence implemented a dedicated urban renewal plan connecting sustainable buildings to health and pollution prevention. Kaiser Permanente is another visionary in health care; the company’s leadership in the industry is further discussed in Chapter 6. BUILDING GREEN AND INTEGRATING NATURE: RIKSHOSPITALET UNIVERSITY HOSPITAL IN OSLO Building green requires a big picture approach. At its core, planning and building green hospitals require that little harm be done to the macro- and micro-environments, noted Knut Bergsland of SINTEF Health Research. This approach should be taken throughout the life cycle of the building and should include all support systems during its useful life. Healthcare facilities need to find the most important indicators for green hospital building. To establish a culture for green building, commitment must come from the top down, noted Bergsland. Without this leadership, it will be difficult to establish environmental values in hospitals. The crucial, priority elements in hospital buildings are those that are Access to nature is important to wellbeing. It is a deep-rooted human need that may even transcend cultural barriers. —Knut Bergsland most beneficial to health and require the least effort and use of resources. For example, access to nature is important to well-being. It is a deep-rooted human need that may even transcend cultural barriers, noted Bergsland. The importance of nature as a stress-reducing factor is long established (Ulrich, 1991). Thus, planning for maximum daylight and integrating nature into hospital design by as many means as possible are the right things to do in both the patient and work environments, asserted Bergsland. Success Story of Green Hospital Building in Norway Norway is a small country on the outskirts of Europe with 4.6 million inhabitants (approximately the population of Colorado) and a population density similar to that of Maine. Norway’s per capita gross domestic product is similar to that of the United States at approximately $48,000 (CIA, 2007), and 10 percent of it is spent on health care (Johnsen, 2006). According to Bergsland, the healthcare system in Norway is driven by the same forces as in most other Western countries—demographic change, new information and technologies, and demands for efficiency. Health care in Norway is delivered through a national system based on equal access to and distribution of services as the main principle. The Norwegian healthcare system is 90 percent public and tax based. Hospitals are owned by the state and run as trusts, inpatients do not pay for their stay, and physicians are employed by the hospital. Rikshospitalet University hospital in Oslo has 1.5 million square feet of floor space and is located next to woodlands with views of the city and the Oslo fjord, noted Bergsland. It is a tertiary teaching hospital providing world-class medical services, such as transplant surgery. The hospital covers all clinical specialties except for geriatrics and psychiatry; it has 585 beds, excluding intensive-care beds. The hospital has 4,000 full-time-equivalent staff members, 35,000 inpatients, 20,000 day patients, and 160,000 outpatients per year. Between 2000 and 2004, inpatient activity in the Rikshospitalet increased by 22 percent, and outpatient activity increased by 66 percent (Bergsland, 2005). The Rikshospitalet site—on cultivated land next to the existing medical fac- ulty—was selected by the Norwegian Parliament over protests from environmental activists. The Rikshospitalet counters the notion that hospitals should be built on a flat site, noted Bergsland. Because the site is sloping and saucer shaped, it effectively hides the substantial building structure; big volumes can be hidden in the bottom of the saucer and make the hospital appear as a 3- to 4-story building, while it actually is 6 to 7 stories high. The hospital sits on 87 acres of land, the footprint for the entire construction is 430,560 square feet, and the main building is 322,920 square feet, noted Bergsland. The architects’ vision for the physical environment of the hospital was a village-like horizontal layout with daylight in all spaces. The architects sought to reduce anxiety and build dignity for both patients and personnel, using natural materials whenever possible (Figure 2-2). The hospital planning process started in 1990 and involved 800 people, more than 15 percent of the total workforce, including medical staff. Because of the village concept, the hospital is seen as a town rather than a building: it has a main street, a square, and a landmark tower. The main street facilitates way finding because intersections are unique, not identical, as they tend to be in most modern hospitals. The Rikshospitalet’s curving main street is a device for patients to draw a mental picture of the route to their destination. The curvature hides the length of the corridor—280 meters long—and the traffic hierarchy minimizes the need for signage. The art and nature at the intersections help people remember their location and aid recognition. Recognition facilitates the trip, and the shortest distance to one’s destination is not a straight line, but the most beautiful route. The main street is also a place of positive distractions; for example, concerts are held on the street at least once a month. Art is an integrated part of the building; 0.9 percent of the total building budget was earmarked for art in the hospital. Art may have similar effects on stress reduction as nature, noted Bergsland. The main plaza of the hospital faces south, creating sunny spots along the perimeter. Norway is a cold country with a low sun, and the extra light is welcome. Integrating nature was part of the hospital design; there is a walking trail next to the site, with a creek running between the trail and the hospital (Figure 2-3). Some patients use the woods next to the hospital as part of their therapy, said Bergsland. Natural stone was used in the main street, the floors, and street furniture; wood was used in benches, chairs, reception desks, and the cafeteria. Great care was taken to preserve existing trees. Views to the outside from the main street open up to green spaces and courtyards, and there are places for contemplation. This feature also illustrates that Rikshospitalet is a friendly, non-frightening building. It is very distinct from the big clinical machines that are commonly seen, noted Bergsland. The main entrance of the central plaza is a tower that creates the first impression of the hospital. According to Bergsland, the first impression of a building plays a disproportionate role in the conception of what comes after, such as com- FIGURE 2-2 The village structure of the main street at Rikshospitalet aids recognition and facilitates way finding. Integrated art serves as a stress reducer. Natural daylight creates space efficiency and evokes a positive response from patients and staff. SOURCE: Rikshospitalet Information Department, unpublished (2005). Reprinted with permission. FIGURE 2-3 This hospital’s architects focused on designing a humanizing environment, not minimizing the footprint. The main street is the backbone of the hospital and encourages informal meeting between staff. Walkways connect patient units with treatment facilities. munication with a doctor. The staff cafeteria is located next to the main entrance, which facilitates informal meetings among staff members. Walkways on three levels connect the patient units with treatment facilities across the main street. Inpatients are taken to treatment across the street in their beds. The hospital is accessible by public transportation. Oslo city authorities extended an existing rail track when the hospital was planned, and today connections to central Oslo run every eight minutes. For those who drive to the hospital, the parking structure is a 4-minute walk to the main entrance. Bicycle parking is located outside the hospital, under the main plaza. Energy Use in the Rikshospitalet In terms of energy use, the Rikshospitalet is not an exemplar project, noted Bergsland. It uses more energy per square meter than most other Norwegian hospitals. Increased clinical demand has resulted in a need for extra capacity and ventilation, and some system limits have been passed. However, the glassed roof brings Norwegian winter light into the main street of the hospital, and the extra energy that is required to keep the street at 17°C in the winter is more than outweighed by the positive effect on staff morale, said Bergsland. The hospital tries to be environmentally conscious about its energy use, and, despite a 20-percent increase in clinical services in 3 years, it reduced its energy use by 10 percent (Bergsland, 2005). The positive feedback from the people who are using the building more or less corroborates the concept that the architects suggested, said Bergsland. A preliminary study on the effects of hospital design on patient attitudes, activity patterns, productivity, and staff morale at the Rikshospitalet was performed in 2004. The results showed that people liked the building because it was interesting and nonfrightening, and they thought the main street was perfect for interaction (Bergsland, 2005). Among other positive factors cited was daylight in working and patient spaces and good functional proximities between related departments. Also, the art made staff feel proud of their environment. Patients ranked the Rikshospitalet highly. Furthermore, productivity measures increased, and absenteeism and turnover rates decreased. The average sick leave in Norwegian hospitals is approximately 8 percent. After moving to the new building, the Rikshospitalet personnel’s sick leave rate declined from 8 to 6 percent (Bergsland, 2005). The building concept may have played a role in achieving patient and staff satisfaction, said Bergsland, but is difficult to determine the role of design on activity, productivity, or medical outcomes. Such factors as the Hawthorne effect,† moving into new premises, organizational changes, and staffing levels may influence outcomes to a degree that is difficult to establish. An increase in worker productivity produced by the psychological stimulus of being singled out and made to feel important.

医学

2014-42/1180/en_head.json.gz/5220

Skip Navigation | En EspañolSearch this site: Disorders A - Z: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z You are here: Home » News From NINDS » News Articles » Skip secondary menu HomeDisorders A - ZNews From NINDSNINDS News ArticlesGrantees in the NewsEvents2015 President's BudgetCalendar of EventsProceedingsFunding InformationResearch ProgramsTraining & Career AwardsEnhancing DiversityFind PeopleAbout NINDS From Touchpad to Thought-pad? Follow NINDSnews For release: Wednesday, October 27, 2010 NIH-funded research shows that digital images can be manipulated with the mindMove over, touchpad screens: New research funded in part by the National Institutes of Health shows that it is possible to manipulate complex visual images on a computer screen using only the mind.The study, published in Nature,* found that when research subjects had their brains connected to a computer displaying two merged images, they could force the computer to display one of the images and discard the other. The signals transmitted from each subject’s brain to the computer were derived from just a handful of brain cells.“The subjects were able to use their thoughts to override the images they saw on the computer screen,” said the study’s lead author, Itzhak Fried, M.D., Ph.D., a professor of neurosurgery at the University of California, Los Angeles. The study was funded in part by the National Institute of Neurological Disorders and Stroke (NINDS), and the National Institute of Mental Health (NIMH), both part of NIH.The study reflects progress in the development of brain-computer interfaces (BCIs), devices that allow people to control computers or other devices with their thoughts. BCIs hold promise for helping paralyzed individuals to communicate or control prosthetic limbs. But in this study, BCI technology was used mostly as a tool to understand how the brain processes information, and especially to understand how thoughts and decisions are shaped by the collective activity of single brain cells. “This is a novel and elegant use of a brain-computer interface to explore how the brain directs attention and makes choices,” said Debra Babcock, M.D., Ph.D., a program director at NINDS.The study involved 12 people with epilepsy who had fine wires implanted in their brains to record seizure activity. Recordings like these are routinely used to locate areas of the brain that are responsible for seizures. In this study, the wires were inserted in the medial temporal lobe, a brain region important for memory and the ability to recognize complex images, including faces. While the recordings from their brains were transmitted to a computer, the research subjects viewed two pictures superimposed on a computer screen, each picture showing a familiar object, place, animal or person. They were told to select one image as a target and to focus their thoughts on it until that image was fully visible and the other image faded away. The monitor was updated every one-tenth of one second based on the input from the brain recordings.As a group, the subjects attempted this game nearly 900 times in total, and were able to force the monitor to display the target image in 70 percent of these attempts. Subjects tended to learn the task very quickly, and often were successful on the first try.The brain recordings and the input to the computer were based on the activity of just four cells in the temporal lobe. Prior research has shown that individual cells in this part of the brain respond preferentially – firing impulses at a higher rate – to specific images. For instance, one cell in the temporal lobe might respond to seeing a picture of Marilyn Monroe, while another might respond to Michael Jackson. Both were among the celebrity faces used in the study. Dr. Fried’s team first identified four brain cells with preferences for celebrities or familiar objects, animals or landmarks, and then targeted the recording electrodes to those cells. The team found that when subjects played the image-switching game, their success appeared to depend on their ability to power up cells that preferred the target image and suppress cells that preferred the non-target image.“The remarkable aspects of this study are that we can concentrate our attention to make a choice by modulating so few brain cells and that we can learn to control those cells very quickly,” said Dr. Babcock. Prior studies on BCIs have shown that it is possible to perform other tasks, such as controlling a computer cursor, with just a few brain cells. However, the task here was more complex and might have been expected to involve legions of cells in diverse brain areas needed for vision, attention, memory and decision-making.*Cerf M et al. “On-line, voluntary control of human temporal lobe neurons,” Nature, October 28, 2010.NINDS (www.ninds.nih.gov) is the nation’s leading funder of research on the brain and nervous system. The NINDS mission is to reduce the burden of neurological disease – a burden borne by every age group, by every segment of society, by people all over the world. The mission of the NIMH (www.nimh.nih.gov) is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure.NIH — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.Reporters: For more information, call 301-496-5924 or go to www.ninds.nih.gov/PressRequest/. Last Modified November 29, 2010 National Institute of Neurological Disorders and StrokeHome | About NINDS | Disorders A - Z | Research Funding | News From NINDS | Find People | Training | Research | Enhancing Diversity Careers@NINDS

医学

2014-42/1180/en_head.json.gz/5248

FDA Approves Botox for Overactive Bladder When patients don't respond to standard treatments TUESDAY, Jan. 22 (HealthDay News) -- U.S. Food and Drug Administration approval of Botox (onabotulinumtoxinA) has been expanded to include adults with overactive bladder who don't respond to anticholinergics. In a clinical study, people treated with Botox after 12 weeks had urinary incontinence 1.6 to 1.9 times less per day than people treated with a placebo, the FDA said. The most common adverse reactions recorded during the study included urinary tract infection, painful urination, and urinary retention. People who develop urinary retention may have to use a catheter until the situation resolves, the agency said. Botox has been approved for several other uses, notably to treat facial wrinkles. The product is made by Allergan Inc., based in Irvine, Calif. Categories: Urology Nephrology Family Practice Nursing OBGYN & Women's Health Pharmacy Powered by jQuery UI Accordion - Default functionality

医学

2014-42/1180/en_head.json.gz/5261

8 More of the Craziest Plastic Surgeries To Look Like Someone Else 1The Brazilian man who spent nearly $170,000 to look like real-life Ken doll A Brazilian-born flight attendant who wants to live in a Barbie world has undergone 20 cosmetic procedures to look like a human Ken doll. 30-year-old Rodrigo Alves, a self-proclaimed plastic surgery addict, has spent £100,000 (about $168,850) on his obsession.His numerous surgeries include three nose jobs, jaw liposuction, calf shaping, pectoral implants and a six-pack sculpting operation. He also goes for Botox twice a year and takes collagen tablets, anti-water retention pills and hair growth supplements.Alves, who lives in London and describes himself as a “worldwide socialite” on his Instagram page, said Barbie's beau is the “ideal man.” (Source) 2The Japanese man who spent $150,000 on plastic surgery to look like Michelangelo's David Alan, a 20-year-old from Japan, spent $150,000 on plastic surgery in the span of just one year. After being teased in school for his effeminate looks, he wanted to permanently change his face. He chose to model himself after Michelangelo's Renaissance masterpiece, David. Alan wanted look "foreign" and have an "ageless face" and felt "the ideal is the Statue of David."I'm not sure how much Alan face resembles that of David's, but he certainly looks nothing like his former self. He has had various surgeries – two on his nose, one on his eyes, several lift-and-tuck procedures to remove and prevent wrinkles, and injections to alter the shape of his chin. Alan left home and moved to Tokyo at the age of 16. Once there, he became involved with at least five older women who have sponsored all his beauty treatments.Alan is consumed by his own appearance. He constantly monitors his face by taking at least 1,500 selfies a month – he has 4,000 pictures of himself on his smartphone. He has said that he wants to use plastic surgery to become more beautiful than anyone else and doesn't care if he's respected or not – he just wants to look good. 3The woman who spent $15,000 to look Photoshopped Like millions of Americans, Triana Lavey loves taking selfies, but the 37-year-old television producer from Los Angeles didn't really how she looked in her Facebook photos or Skype chats. So in 2012, she decided on plastic surgery for the perfect selfie look. Triana was not always happy with her selfies and would use popular iPhone apps with filters that gave her the perfect airbrushed look. Regardless, she began to notice flaws in her face that she felt needed more permanent fixing.She had an implant inserted into her chin at Dr. Richard Ellenbogen's clinic in Beverly Hills. While working on her chin, the doctor suggested a few other changes, like fat grafting and a nose job. Triana was soon convinced she needed those procedures and ended up spending $15,000 on her face.Triana believes in presenting the best of herself online. “Your social media presence is just as important as your real life presence,” she said. (Source | Photo) 4The South Korean twin sisters who got plastic surgery that turned them into totally different twin sisters These twin sisters were participants on the Korean reality show "Let's Beauty." The premise of the show is to help people that think their looks hold them back look better and feel more confident. These lucky twin sisters got a chance to change their look and their lives when they were sponsored by this show.While the twins still look identical, the shape of their mouths, eyes, chins and the overall contour of their faces has completely changed. The show also changed their clothes and hairstyles for a complete makeover experience. 5The woman who spent $25,000 on plastic surgery to look like Jennifer Lawrence Like many, Kitty is a huge Jennifer Lawrence fan, but unlike many, the 30-year-old is such a big fan she decided to go under the knife to resemble the young American Hustle star.As Lawrence's star has risen, so has the frequency with which Kitty is compared to the Academy Award winner.The married dog trainer and mother of a 5-year-old daughter went on a month long plastic surgery journey in February 2014 to look more like Jennifer Lawrence.At First Surgical Hospital in Houston, Kitty underwent liposuction to her face and body, a breast augmentation, rhinoplasty, and fat grafts to her cheeks and behind which took six hours and cost $25,000, minus a discount for appearing on TV. 6The woman who spent $8,000 on plastic surgery to look like a drag queen 21-year-old Collagen Westwood has admired drag queens ever since she was a little girl and is now doing everything she can to look like one. The young Londoner was bullied as a child and had always wanted to change her appearance. An aspiring singer (whose childhood idols were Boy George, Lily Savage and Dead or Alive singer Pete Burns), Collagen says she grew up around drag queens and had always wished she was as glamorous as they seemed to be. Now she's living her dream, dressing up as a drag queen when she goes out and spending her savings on collagen injections and nose jobs to make her look more like those she idolized.Collagen says she loves looking plastic and can't wait until she raises enough for more cosmetic surgery. She intends to have breast augmentation and have some of her ribs removed so she can wear tighter corsets. 7The Singaporean girl who had 10 surgeries to look like anime girl 29-year-old Singapore based fashion designer Jacqueline Koh underwent an astonishing ten surgeries to have her face completely transformed into an anime character.Koh was committed to completely changing the way she looked and spent a whopping $136,000 on cosmetic surgery over the past several years. She underwent liposuction and a body reshaping procedure which then led to various face surgeries including chin implants, eyelid adjustments, rhinoplasty and even flattening her ears. She maintains a rigid and expensive maintenance regime that includes daily facemasks, weekly skin rejuvenation, massages, Botox and other fillers.Koh claims to be satisfied with all of the procedures and says she is happy and the “same person on the inside.” She says she receives hundreds of emails daily from people seeking advice on cosmetic procedures and enjoys steering them in the right direction. 8The woman who wants plastic surgery to look ugly A young woman from Chongqing is seeking plastic surgery to make her face less attractive, after being dumped. The 23-year-old woman's sweetheart left her to for another woman. Although the two had been together for six years, her ex feared that her too-beautiful face might attract too many other men and he didn't feel safe staying with her. Though she has been courted by many others men, she came to hate all of them, prompting her desire for the surgery. The doctors, however, refuse to cooperate and believe she has a mental disorder and needs therapy instead. (Source) 10 Craziest Plastic Surgeries to Look Like Someone Else 11 Worst Makeup Disasters 12 Most Embarrassing Family Portraits 12 of the Best Instagram Accounts To Follow 10 Cases of Inappropriate Cleavage Another 10 Hilarious TV Photobombs 10 Incredibly Bizarre Death Statistics

医学

2014-42/1180/en_head.json.gz/5290

Febrile infection-related epilepsy syndrome ORPHA163703 AERRPSAcute encephalitis with refractory repetitive partial seizuresAcute non-herpetic encephalitis with severe refractory status epilepticusDESC syndromeDevastating epileptic encephalopathy in school-aged childrenFIRESFever-induced refractory epileptic encephalopathy in school-aged childrenIdiopathic catastrophic epileptic encephalopathySevere refractory status epilepticus owing to presumed encephalitis 1-9 / 100 000 G40.5 SummaryFebrile infection-related epilepsy syndrome (FIRES) describes an explosive-onset, potentially fatal acute epileptic encephalopathy that develops in previously healthy children and adolescents following the onset of a non-specific febrile illness.FIRES has an estimated European prevalence of 1/100,000 children and adolescents and an annual incidence of 1/1,000,000.FIRES usually presents in 3-15 year olds that have previously been healthy and developmentally normal. It always comes after a simple febrile illness. Manifestations include the sudden onset of convulsive and recurrent focal seizures. This is followed by refractory focal epilepsy along with a decline in memory, cognition and behavior. Psychiatric disorders and occasionally motor disability can be present in some cases. In serious cases, the disease progression can lead to a vegetative or semi-conscious state or even death.At present the etiology is unknown. An infection-related pathogenesis is suspected but no direct causes have been established. There may be a genetic etiology for the disease, as seen in Dravet syndrome (see this term), but as yet, no causative genes have been identified. An immune basis for FIRES has also been speculated as certain autoimmune antibodies (such as VGKC, anti-GAD and anti GluR-3) have been found to be elevated in some patients. However, most FIRES patients are mainly autoantibody-negative and immunotherapy-resistant. A metabolic disorder (e.g. mitochondrial encephalopathy) is being discussed as a possible etiological factor.FIRES should be suspected when the acute onset of refractory seizures follows a few days after a simple febrile illness in previously healthy children. Analysis of cerebrospinal fluid shows normal findings or mild pleocytosis but no presence of pathogens. Tests for metabolic diseases are usually performed with negative results. MRI usually shows no specific abnormalities.Differential diagnoses include Dravet syndrome, Alpers syndrome, female restricted epilepsy with intellectual disability (due to PCDH19 mutations), infectious or limbic encephalitis (e.g., with VGKC antibodies or NMDA receptor antibodies) and metabolic diseases (e.g., biotin-responsive basal ganglia disease, citrullinemia) (see these terms).Patients with FIRES require immediate hospitalization. Antiepileptic drugs are given to treat seizures but are often ineffective. High-dose phenobarbital and clobazam are most likely to be effective. In severe cases, barbiturates (titrated to burst suppression) are the only treatment for refractory status epilepticus, however, treatment by inducing a prolonged burst-suppression coma has been asociated with a worse cognitive outcome. A ketogenic diet has been beneficial in some cases, especially if initiated early.FIRES often has a poor prognosis but a few patients have fully recovered.Expert reviewer(s) Dr Andreas VAN BAALEN Last update: July 2012

医学

2014-42/1180/en_head.json.gz/5376

The Brain & Behavior Research Foundation Names 10 Recent Discoveries Funded by its NARSAD Grants That Will Help Understand, Treat and Cure Mental Illnesses The Brain & Behavior Research Foundation names 10 recent discoveries funded by its NARSAD Grants. (PRWEB) February 12, 2014 The Brain & Behavior Research Foundation Names 10 Recent Discoveries Funded by its NARSAD Grants That Will Help Understand, Treat and Cure Mental Illnesses The Brain & Behavior Research Foundation has named 10 recent discoveries, funded by its NARSAD Grants, that provide new insight into the mysteries of the brain and potential treatments for people with depression, anxiety, schizophrenia, PTSD and panic disorder. “We are entering the golden age of brain research,” says Jeffrey Borenstein, M.D., President & CEO of the Brain & Behavior Research Foundation, which funds cutting-edge research for the understanding, early detection, treatment, prevention and cure of mental illness. Through its NARSAD Grants, it has awarded over $300 million to more than 3,700 scientists around the world since 1987. “These 10 recent discoveries highlight the kind of scientific work that will help us understand, treat and cure the mental illnesses that affect one in four people,” he says. “Because federal funding for research is steadily declining, private funding is required to drive the kind of high risk, high reward research that changes lives.” Steady Stream of New Neurons in the Brain May Keep Depression at Bay: NARSAD Grantee Kirsty Spalding, Ph.D., and a team at the Karolinska Institutet in Stockholm quantified for the first time the number of new neurons generated in adult brains, finding that approximately 1,400 new neurons are added each day during adulthood. New Biological Depression Trigger and Treatment Target: Leading a team of researchers at Yale, NARSAD Grantee Marina Picciotto, Ph.D. has linked acetylcholine, a signaling chemical or neurotransmitter, with depression, opening the possibility to treat a root cause of the illness rather than only its symptoms. Unlocking Mystery of how Antidepressants Work Offers Hope for Improved Depression Treatment: NARSAD Grantee Hongjun Song, Ph.D., and researchers at the Institute for Cell Engineering at Johns Hopkins University School of Medicine discovered a specific protein that helps electroconvulsive therapy (ECT) and antidepressant medications work. New Technology Enables Discovery of Novel Way to Reduce Anxiety Symptom: NARSAD Grantee Rene Hen, Ph.D., of Columbia University Medical Center led a group of researchers who may have found a way to reduce anxiety in people with post-traumatic stress disorder (PTSD) and panic disorder without negatively affecting the ability to learn. 3D Imaging Technology Promises Breakthroughs in Brain Research: NARSAD Grantee Karl Deisseroth, M.D., Ph.D., led a team at Stanford in developing CLARITY, a new imaging technology that provides high-resolution, 3D images of the brain that offer new insights into brain structure and function, and could shed light on the underlying causes of psychiatric disorders. Early Warning Signs of Schizophrenia: NARSAD Grantee Scott A. Schobel, M.D., of Columbia University Medical Center’s Department of Psychiatry discovered that elevated levels of the neurotransmitter glutamate in the hippocampus region of the brain may cause the transition to psychosis in people at high risk for developing schizophrenia. Behavioral Therapy Program Helps People with Mental Illness Lose Weight: NARSAD Grantee Gail L. Daumit, M.D., of Johns Hopkins University, led Project Achieve, the first weight loss clinical trial with people with serious mental illnesses. She found that people with bipolar disorder, schizophrenia and depression can lose weight and keep it off through a modified lifestyle intervention program. Potential Breakthrough for Schizophrenia: Working with mice that were genetically engineered to have very low N-methyl-D-aspartate (NMDA) receptor activity in the brain, NARSAD Grantee Joseph T. Coyle, M.D., and his team of researchers at Harvard Medical School were able to reverse schizophrenia-like symptoms by giving the mice D-serine, one of two molecules required to activate NMDA receptors. Brain Scans May Guide Choice of Antidepressants vs. Cognitive Behavioral Therapy to Treat Depression: NARSAD Grantee Helen S. Mayberg, M.D., and colleagues in the Department of Psychiatry at Emory University identified specific activity in the right anterior insula of the brain that can potentially predict whether people with major depressive disorder (MDD) will better respond to an antidepressant medication or psychotherapy MRI Brain Scans May Help Diagnose Depression in Preschoolers: NARSAD Grantees Joan L. Luby M.D., and Deanna M. Barch, Ph.D., at the Washington University School of Medicine in St. Louis found that preschoolers with depression showed more activity (blood flow) in the amygdala—the region of the brain that controls emotional processing and regulating—providing the earliest evidence yet of changes in brain function in young children with depression. About NARSAD Grants from the Brain & Behavior Research Foundation Research projects funded by NARSAD Grants are selected by the Foundation’s Scientific Council comprised of 146 leading experts in brain and behavior research, including two Nobel Prize winners. The Foundation invests 100% of donor contributions for research directly into its NARSAD Grants. For more information, visit bbrfoundation.org. Nadine Woloshin Brain & Behavior Research Foundation 212-843-8041

医学

2014-42/1180/en_head.json.gz/5469

Biomolecule Studied For Medical Uses Duke University Chemistry Department researchers are creating unique polymers out of naturally occurring building blocks that don't provoke immune reactions and in some cases also biodegrade in the body. The tree-like, globular-shaped substances are being evaluated for a variety of medical uses. Share This DURHAM, N.C. -- Duke University Chemistry Department researchers are creating unique polymers out of naturally occurring building blocks that don't provoke immune reactions and in some cases also biodegrade in the body. The tree-like, globular-shaped substances are being evaluated for a variety of medical uses. Called biodendrimers, these structures are prepared by systematically reacting acids with alcohols to form what chemists call "esters." The results are branching molecular chains with finger-like ends that can form sticky and tenacious links with other substances. These characteristics make them "ideal candidates for medical and tissue engineering applications," said Mark Grinstaff, the assistant chemistry professor who heads the Duke team. One potential application, which Duke Medical Center eye researchers are beginning to test, is a glue that could "close a wound and then be dissolved as new tissue grows in to repair the wound site," he added in an interview. "It could really potentially change the way we do corneal surgery," added Dr. Terry Kim, associate director of the Corneal and Refractive Surgery Service at the Duke Eye Center and a medical center assistant professor of ophthalmology. Another possibility, which biomedical researchers at Duke's Pratt School of Engineering have also started investigating, would be using such biodendrimers as scaffolding to help induce cells to repair damaged human joints. "Biodendrimers appear to interact with cells in completely novel manners," said Lori Setton, assistant professor and Harold L. Yoh Faculty Scholar in the Pratt School's Department of Biomedical Engineering. Because of its promise, Grinstaff's research just received $250,000 in funding from the Johnson & Johnson Focused Giving program, established to stimulate exploration in medical science. Other funding sources include the Pew, Sloan and Dreyfus foundations. In a spring 2001 issue of the Journal of the American Chemical Society, Grinstaff and graduate student Michael Carnahan described the synthesis and characterization of one of these dendrimers, made from glycerol and lactic acid. He, Carnahan and other graduate students also discussed research on several dendrimers during the American Chemical Society's national meeting in Chicago Aug. 26-30. "It's an exciting time," he said. "We've finally gotten to the point where we're able to make the molecules, characterize them and understand their physical properties. Now we're exploring opportunities for applications." Almost all prior work of this type has involved simpler chain-like molecules called linear polymers. Those "constitute a class of materials well suited for research and clinical applications ranging from drug delivery to tissue engineering," Grinstaff and Carnahan noted in their Journal of the American Chemical Society article. Linear polymers already are being used as surgical sutures that can be degraded and absorbed by the body, their article added. They are candidates for orthopedic applications such as screws, pins and scaffolds, for pharmaceutical uses such as drug delivering hollow spheres, and for surgical applications like staples and dressings. However, the new compounds offer potential advantages to linear polymers, notably because of biodendrimers' large surface areas and their many finger-like projections, called "end-groups." They are also easily dissolved and mixable, flow easily and can be sticky. And their thickness and degree of solidification can be controlled with laser light. At Duke Medical Center, Kim's research group is currently evaluating biodendrimers as possible protective sealants for painful perforation wounds to the cornea, the eye's clear protective cover. These perforations represent "full thickness holes in the cornea," Kim said. "Currently as corneal surgeons we have a lot of limitations on how to repair these. They can be very difficult to close with conventional suturing." Fast and complete wound closure is important to curb pressure-reducing fluid loss and infection, Kim noted. Corneal perforations can also lead to "cataract formation, among other things," he said. "And you can potentially lose the eye if its structural integrity is not restored promptly." Currently, physicians may use tight-bonding cyanoacrylate glue to seal small perforations, which then heal on their own. But when that glue dries "it gets very hard and can be very difficult to apply on corneal wounds," Kim said. It also becomes opaque. Even though that hard and cloudy coating eventually drops off, it can be uncomfortable in the meantime. In contrast, solidification rates of biodendrimer glues can be controlled by using an argon laser beam. "We can control how hard we want it," Kim said. "It's a glue that's very soft. And it's very easily put into the wound." This glue also remains clear as it dries. "So far our work looks very encouraging," continued Kim, who also envisions the possibility of using biodendrimer glues to reduce or even eliminate the need for sutures in corneal transplant surgery. While evaluations at the Pratt School of Engineering are at an earlier stage, Setton's soft tissue engineering group is already finding that Grinstaff's biodendrimers present cells with "a different chemical surface and overall three-dimensional topography" than other polymers do, she said. Setton hopes further investigation will show that, when applied to damaged joints, these biodendrimers will serve as an effective scaffolding for a matrix of new repair tissue to grow on. "It's too early to tell," she noted. Grinstaff's group has been creating these biodendrimers by reacting the alcohol glycerol with not only lactic acid but also caproic and succinic acid. "The way we synthesize these is we start from the center and we grow the shell outward," he said. The biodendrimer thus builds up in step by step increments. In each increment, Grinstaff's team makes additional molecular bonds by freeing some glycerol to interact with acid in an "esterification" reaction. Meanwhile, the rest of the alcohol is kept under chemical lock and key. After more alcohol is freed through a "deprotection" reaction, the next esterification reaction proceeds, making yet more chemical bonds. Story Source: The above story is based on materials provided by Duke University. Note: Materials may be edited for content and length. Duke University. "Biomolecule Studied For Medical Uses." ScienceDaily. ScienceDaily, 31 August 2001. <www.sciencedaily.com/releases/2001/08/010831081113.htm>. Duke University. (2001, August 31). Biomolecule Studied For Medical Uses. ScienceDaily. Retrieved October 22, 2014 from www.sciencedaily.com/releases/2001/08/010831081113.htm Duke University. "Biomolecule Studied For Medical Uses." ScienceDaily. www.sciencedaily.com/releases/2001/08/010831081113.htm (accessed October 22, 2014). Botulinum toxin (cosmetic treatment)

医学

2014-42/1180/en_head.json.gz/5632

The State of the Chiropractic Profession Cover Stories Written by TAC Staff Wednesday, 25 November 2009 00:00 Read : 2641 times As The American Chiropractor celebrates its 30 Year Anniversary, our panel of leaders look back on just how far the chiropractic profession has come and what lies ahead. Dr. Louis Sportelli President of NCMIC Dr. Sportelli has served in many capacities throughout his 47-year career in chiropractic. He is currently serving as President of NCMIC Group Inc., which provides malpractice insurance and financial services to doctors of chiropractic. Another area of interest has been patient education, and he has written a book, Introduction to Chiropractic™, which is widely used by doctors of chiropractic across the world and is now in its 12th edition. TAC: The past thirty years have been controversial for chiropractic. What would you say have been the milestones that have occurred and how have they impacted chiropractic? There have been several that have happened in the past 30 years. A few years earlier than 1979, the most significant achievement occurred and that was the recognition of CCE by the United States Department of Education. That single event changed the entire educational process for the profession, established one standard, provided loans for prospective students and removed a stigma from the profession that chiropractic education was inferior. Following that event, the long awaited success of the Wilk v AMA litigation, which essentially provided information from the legal discovery process which enabled the profession to fully understand the events of the past and pave the way for future advancement based on the AMA conspiracy. Then, the starting of the World Federation of Chiropractic (WFC) in 1988, the AHCPR recognition of spinal manipulation and the most current accomplishment with the publication of the proceedings of the Bone and Joint Decade–Neck Pain Task Force, which was the most comprehensive research consortium ever assembled from around the world. The significance of that research and scientific collaboration has yet to be fully realized. These events have continued and will continue to change the public, private and professional view of chiropractic. TAC: What is the most pressing issue of the moment for the profession? Without question, The Health Care Reform, and whether or not chiropractic will be included and in what fashion. This new health care model will change the direction of chiropractic availability for decades. This issue is far more difficult to expound upon because no one knows precisely where the debate will take us and upon what the reform will focus. Without a doubt, however, the health care debate will provide the most significant challenge to the profession ever. Dr. James Winterstein President of National University Health Sciences Dr. James Winterstein is a 1968 graduate of National University of Health Sciences. He completed his residency in diagnostic imaging in 1970 and became a diplomate of the American Chiropractic Board of Radiology in May of 1970. Dr. Winterstein has been a member of the Board of Directors of the Federation of Illinois Independent Colleges and Universities for the past 18 years and also serves as a board member for Alternative Medicine Integrated Inc. TAC: What would you say was the largest missed opportunity for Chiropractic? During the past 30 years, the chiropractic profession, which prior to 1970, saw itself and practiced as a diagnostically, therapeutically conservative primary care profession, had the opportunity to demonstrate its potential as a source of conservative primary care providers–the necessity for which has become very clear in the past several years, as the deficiency of primary care providers becomes ever more evident. Unfortunately, the chiropractic profession chose to restrict itself almost completely to musculoskeletal disorders, primarily because of reimbursement opportunities provided by the insurance industry during the 80’s and 90’s. It sold its true value for the sake of increased income. As this took place, the third party payer industry took note through its actuaries and, gradually but consistently, contained and further restrained the chiropractic profession, by virtue of its own profile of practice to limited musculoskeletal therapeutics. The missed opportunity has resulted in a boxed in profession and, except for some small future opportunities, it might well never recover from this error of professional judgment. TAC: What, in your opinion, was the most significant event that unfolded in the past 30 years? The most significant event to have unfolded in the past 30 years was the development of the Journal of Manipulative and Physiological Therapeutics, which, until recently, was the only peer reviewed and fully indexed scientific journal of the profession. Prior to this, the development of educational accreditation by the Council of Chiropractic Education as a true watershed event. Also of true significance for the profession has been the development and federal funding of basic and clinical research at a high level of scientific attainment. These three accomplishments, which actually cover the period from 1974 to the present, are, in my estimation of greatest significance to the development and recognition of the chiropractic profession. Dr. Joseph Brimhall President of Western States Chiropractic College Joseph Brimhall, D.C., President of Western States Chiropractic College in Portland, Oregon, since 2003, was in private practice for twenty-two years. He has extensive experience in regulation, professional testing, chiropractic accreditation (national and international), and regional accreditation. Dr. Brimhall was CCE President, CCE-COA Chairman, and is President-Elect of CCEI. TAC: What has been the single biggest deterrent to unity within the profession? The question, itself, reveals the restraint—the perception that the profession lacks unity may actually be the principal dilemma. Second to that quandary is the illusory notion that somehow "unity" is a necessary or desirable attribute for the profession. The chiropractic profession is unified where it counts, with recognized educational requirements, dependable evaluation processes, professional licensure and regulation in jurisdictions around the world, and strong ethical values. Yes, we disagree about practice scope and philosophy and techniques and many other things. We have a variable mixture of attitudes and a broad dissimilarity of professional philosophies. Is that a bad thing, or is the diversity of thought a strength? My view is that the range and assortment of clinical and philosophical approaches is an asset—that we benefit from having multiple views and opinions, because it forces us to persistently assess and evaluate our direction and our values. I’m not talking about those that use the profession for unethical purposes—we need to continue to weed those elements out in order to protect our patients and our professional integrity. However, I believe that honest disagreements provide grist for the mill in advancing the profession. Otherwise, we become a profession of homogenous zombies that are unable to make new discoveries or adapt to changing environments. Our disagreements need to continue as great debates. As changes occur and health care evolves, we can discover our direction and our identity only through open dialogue, mindful deliberation, and decisive action. It is not the lack of unity that binds us; it is the failure to engage. A critical majority of the profession is willing to simply sit on the side-line and observe, too lazy or too afraid to take a stand and work for the greater good. If we expect the profession to develop and thrive, we need to be willing to ask the difficult questions, to fight for what we believe in, and to grapple with our differences until we find accord. This is a continuous and necessary pattern. If we expect to grow, the process must repeat itself over and over. There is no easy path to success, and advancement of the profession cannot be accomplished by spectators. Dr. Gerry Clum President of Life Chiropractic College West Gerard W. Clum, D.C., is president of Life Chiropractic College West in Hayward, California, and is the most senior chiropractic college president in the world today. He will begin his 30th year as president of Life West in January 2010. He has served in the leadership of the ICA, ACC, WFC and the Foundation for Chiropractic Progress. TAC: What is the Most Pressing Issue of the Moment for the Profession? Perspective. We are in a moment of great fluidity in our culture. Further, we are in a moment where the focus of this fluidity has the potential to greatly impact our circumstances. I am not naïve. I understand there is a great deal at stake in the current discussions regarding health reform. But I also understand that this focus on health reform has brought conversations forward that would have been hard for us to imagine months ago. When the President of the United States predicates a dialogue about health care reform with the premise that we do NOT have a health care system, we have a sickness care system, something we have longed for has arrived. When policy makers and pundits alike agree that health care reform will not reform health, something we have longed for has arrived. When the great "answer" for health reform is not big pharma, but clean living, something we have longed for has arrived. If we can gain a perspective on how the thinking of large and powerful portions of society is aligning with our viewpoints and understandings, we can begin to further appreciate how the firmament is being prepared for a transition that will be far more welcoming to our practices than we ever dreamed possible. Joseph Campbell was fond of remarking that, to change a culture, one must first change the metaphor of the culture. The metaphors of health and health care have changed and the culture is changing accordingly. The culture wants and needs a new model of health care—and we are in remarkable alignment with what they are seeking. Our task today is to gain a broader view of our world and its directions and express our views in language and metaphors that are consistent and synchronous with their view, so that we may be more easily heard and more fully appreciated for our contribution. We are on target. We do not need to change our path. Rather, we need to appreciate the alignment of the hearts and minds of our society with our thoughts and practices. Dr. Sid Williams often quoted Columbus’ log, "Today, we sailed due West, because it was our course." Stay the course, but do so in the language and with the cultural understandings of the day. Dr. Scott Haldeman Chairman of the Research Council of the World Federation of Chiropractic. Scott Haldeman, D.C., M.D., Ph.D., is a Clinical Professor of the Department of Neurology, UC, Irvine; Adjunct Professor of the Department of Epidemiology, UCLA; and Past President of the North American Spine Society and the American Back Society. He is chairman of the Research Council of the World Federation of Chiropractic. He has published over 185 articles or book chapters and has authored or edited 7 books. TAC: What are the challenges that face the chiropractic profession in the 21st century, in the next decade, and beyond? How could the growth and progress of chiropractic be advanced or stymied during this time period? The past 20 years has seen a marked increase in the amount of research into the epidemiology, diagnosis, and treatment of disorders associated with the spine, especially back and neck pain. The therapeutic benefit of spinal manipulation for back and neck pain is no longer seriously questioned and there are growing research efforts to look into the impact of this treatment approach on other conditions. The research support for spinal manipulation has resulted in the situation where chiropractors are generally accepted as valuable members of the health care team. The acceptance of chiropractic has resulted in a debate within the profession concerning the future role it wishes to play within this team. The potential future roles for chiropractors include 1) a limited practice to that of a skilled practitioner of spinal manipulation; 2) a wellness/holistic clinician focusing on preventative health care therapies; or 3) the primary spine care clinician. Recent publication of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders and a special issue of The Spine Journal on Evidence Informed Management of Chronic Low Back Pain emphasized the fact that many of the treatments that have been demonstrated to be effective in the management of back and neck pain, such as exercise, education, mobilization, manipulation and NSAID’s, are neither high tech nor expensive and could easily be offered by chiropractors. The position that offers the greatest opportunity for chiropractors is that of primary spine care clinician. This position assumes that the chiropractor will become the most knowledgeable clinician in the field. A decision to strive for this role in the health care system will require a change in the culture of the profession. Practicing chiropractors will be expected to attend the major chiropractic research meetings, such as the World Federation of Chiropractic and the RAC conferences. They will have to participate in greater numbers in the inter-professional spine research meetings, such as the North American Spine Society Congress. They will also be required to subscribe to and read the major spine journals in order to achieve the knowledge necessary to become the authority on the spine. Chiropractic colleges will have to change the curriculum to train students to accept this role. Graduate continuing education programs will have to include a strong scientific component. It is not yet clear whether individual chiropractors, the colleges or the state and national associations have made the decision as to which of these roles would serve the profession the best. It will be very interesting to see what role the chiropractic profession will decide to assume in this very exciting evolution of health care. David Chapman-Smith, LL.B, F.I.C.C. Secretary-General of the World Federation of Chiropractic Mr. Chapman-Smith, a Toronto attorney, is Secretary-General of the World Federation of Chiropractic and editor/publisher of The Chiropractic Report. His introduction to chiropractic was as legal counsel for the New Zealand Chiropractors' Association before the famous New Zealand Commission of Inquiry into Chiropractic in 1977/78. TAC: If you could have your wish to change the profession, what would be the thing you would change? Nothing fundamental to the profession should change–such as its philosophy of health and its central focus on skilled assessment and treatment, by hand, of subluxation/dysfunction in the spine and the neuromusculoskeletal system. The profession that so many of us admire, and to which I have devoted my last 30 years, will have lost its way, if new generations of chiropractors are not skilled and confident in joint adjustment–spine, pelvis and extremities. Two of the major issues for the profession today, related to each other, are its relative isolation within health care and the lack of public funding for education, research and practice that it needs and deserves. On isolation, a chiropractic friend of mine who holds qualifications in both chiropractic and medicine is an executive in a large Canadian health services corporation. This employs many MD’s, DC’s, PT’s and others. It seeks contracts with large employers, insurers and others for the health plans it offers. He sees much more of the health care world as it actually is than you or me. His conclusion, after watching all the above professions at work with NMS patients, and seeing which services are most in demand and how they are priced–"chiropractic is the best kept secret in the world. DC’s offer such a superior service but nobody knows." What would I change in the profession? It would be something key to bring about more rapid knowledge, acceptance and, therefore, use, funding and support of chiropractic services within mainstream healthcare. I would like to see all chiropractic students having at least part of their clinical training in a multidisciplinary setting that includes medical services and, ideally, medical students. This is already happening in many chiropractic schools internationally. In Denmark, chiropractic students complete most of their clinical training in a major spine care hospital. In Mexico, all graduates complete a first clinical year in state hospitals. In the US, eleven chiropractic colleges now have some students doing rotations in VA and DOD hospitals, but this exposure to broader clinical training and other professions and healthcare students should be available for all. This will strengthen clinical training. However, my point here is that it will continuously educate others influential in health care about chiropractic—and this will lead to the greatly increased community acceptance and funding that the profession and its patients need and deserve. Dr. Vernon Temple President of the National Board of Chiropractic Examiners Dr. Vernon R. Temple is the president of the National Board of Chiropractic Examiners. A 1977 graduate of Palmer College of Chiropractic, he is past president of the Vermont Board of Chiropractic and past chair of the Federation of Chiropractic Licensing Boards. Dr. Temple is a diplomate of the American Board of Chiropractic Orthopedists.He continues to practice in Bellows Falls, Vermont. TAC: If you had one piece of advice for new graduates starting into practice in 2010, what would it be? The most important piece of advice I can provide to the new practitioner is to develop a Patient-Centered (PC) practice. This means that the full intent of doctor and staff regarding all patient contact is always to be focused on the best interest of the patient. Some of the key areas where the practitioner can incorporate PC include: 1. Patient Education Patients come into your office with the same four basic questions: "What’s wrong with me?" "Can you help?" "How long will it take?" "How much will it cost?" To meet patient’s needs, the doctor will completely answer these questions; but, to truly have a PC practice, the doctor should also educate the patient about their role as a partner in their health care. The PC doctor ensures patients understand how chiropractic will relieve their current condition and contribute to long-term health. 2. Patient Services As the new practitioner develops office procedures, both the doctor and staff must put patients’ needs first. From the initial phone call, to the first time a patient comes in to fill out forms, to the initial consultation, to the report of findings, through the final staff encounter, all processes must be convenient for the patient and must make the patient feel cared for. Having a doctor and staff who demonstrate a sincere and genuine passion for the patient’s well being will build a lifelong successful practice. Empathy for the patient’s suffering gives the patients confidence that their health is in the hands of caring people. Not only will these patients return, but they will refer their family, friends and loved ones to receive that quality of care. 4. Financial arrangements Payment for services will always be a consideration, but should never take priority over patient needs. A PC practice dictates that patient contact and care always remain in the best interest of the patient. Ensure that all financial arrangements are based upon the needs of the patient and then billed appropriately. The fruits of an ethical practice are a waiting room full of patients appreciative of a doctor they know is working in their best interest. 5. Continuing Education for the Doctor and Staff Doctors of Chiropractic should always continue to learn, to expand their knowledge, to continue to invest their time in order to enhance their abilities to meet their patients needs. Ongoing staff training regarding procedures and patient interactions represents another avenue to meet the goals of a PC practice. If all doctors incorporate the philosophy of patient-centered care, they will be rewarded with a comfortable living, an enjoyable career and, most important of all, the satisfaction of helping thousands of patients in their community live healthier lives. Dr. William Morgan Champion for Chiropractic Integration Dr. William Morgan, a champion for chiropractic integration, has been credentialed in four hospitals, including Bethesda and Walter Reed. He is the resident chiropractic consultant to the government clinics that care for our nation’s leaders in Washington, D.C., and is on faculty of three chiropractic colleges and one medical school. TAC: Where do you see the next great challenge to face chiropractic? Cultural Relevance. Contrary to what other futurists may predict, I do not see chiropractic’s next big challenge to be attacks on our market share by competing professions or insurance companies, nor do I see it as exclusion from Congress’ health care bill. I do, however, see chiropractic’s next big challenge to be more fundamental: the loss of cultural relevance. Cultural relevance is maintained by being embedded in the popular culture; to speak the same language, to understand the culture, and to have a position in the culture that is valued. In the current congressional healthcare debate, no adversary is seeking to confine us, because we aren’t even mentioned. Have we lost our impact on the debate? Is society becoming indifferent towards chiropractic? If these are indicators of a trend, chiropractic will gradually ebb. The danger of this type of challenge is in its insidious nature, slowly eroding our niche; so slowly, that it is hardly recognized. The vertebral subluxation is neither the cause nor the solution to our problems. Certainly, I can use this term when engaged in discussions in chiropractic circles, or I can speak with more standardized neurological/biomechanical terminology when engaged with medical specialists. To most of our culture, whose goals are pain relief and health, the word subluxation is simply jargon. To establish our relevance, we need to move past jargon, beyond practice management schemes, past intra-professional disagreements, and emerge with a higher degree of professionalism and maturity. If chiropractic attains cultural relevance (some would say cultural authority), then our other concerns should take care of themselves. With relevance, chiropractic will be in demand and, whether or not we are included in government health care plans or covered by insurance, will not matter. Patients will seek us regardless of coverage or competition. Think of dentists or optometrists. Whether covered by third party payers or not, our culture will continue to utilize dentistry and optometry. These professions have cultural relevance. What will it take to attain strategic cultural relevance? We need to align our profession with the needs of the culture. We need to develop a realistic sense of self-awareness and, instead of trying to bring the culture around to our way of thinking, we need to listen to the culture, learn what the culture values, strive to fill a niche that is valued by the culture, and communicate to the culture in the predominant forums of the day.

医学

2014-42/1180/en_head.json.gz/5644

Understanding the Conundrum of Immune Activation in HIV/AIDS Why is it that chronic activation of the immune system during HIV infection actually leads to disease progression? By Regina McEnery and Kristen Jill Kresge From International AIDS Vaccine Initiative In most circumstances, the body's deployment of the immune system (both the innate and adaptive arms) allows it to conquer an invading pathogen (see VAX July 2008 Special Issue, Understanding the Immune System and AIDS Vaccine Strategies). But HIV is unique in that it directly attacks the cells of the immune system, slowly breaking down the body's defenses. Once the adaptive immune system is alerted to an HIV infection, it responds by producing HIV-specific CD4+ T cells, which orchestrate the function of CD8+ T cells, also known as killer T cells because of their ability to kill virus-infected cells. While these T cells are beneficial in suppressing HIV, they are also preferentially targeted and destroyed by the virus. As more CD4+ T cells are generated in response to HIV, there are also more cells for the virus to infect and kill, setting off a destructive cycle. Once the virus destroys a critical number of these immune cells, the body's ability to control HIV is severely compromised. A person is diagnosed with AIDS once their number of CD4+ T cells declines below a certain level (fewer than 200 cells in a milliliter of blood). When the immune system is compromised to this degree, a person also becomes susceptible to many other bacterial and viral infections. In a person with AIDS, these are referred to as opportunistic infections. Many T cells are lost during the course of HIV infection because they are directly infected and killed by the virus. However researchers suspect that HIV also uses other mechanisms to induce immune dysfunction. These mechanisms are not fully understood but some scientists believe that the presence of HIV overstimulates the immune system. HIV is a chronic infection and there is little or no evidence that any HIV-infected individual has ever been able to clear the virus from their body. As long as HIV is present, the immune system is in a constant state of activation or high alert -- struggling to produce immune responses that could control the rapid spread of the virus. There is a broad consensus among researchers that this chronic state of immune activation contributes to the virus's ability to cause disease, an idea referred to as pathogenesis. However, while there are some hypotheses about how HIV causes chronic immune activation, the precise mechanisms are still under investigation. Clues from nonhuman primates AdvertisementStudies in nonhuman primates infected with simian immunodeficiency virus (SIV), the monkey equivalent of HIV, suggest that chronic immune activation may play a crucial role in pathogenesis. Rhesus macaques, which are most often used in AIDS vaccine research, develop an AIDS-like disease following SIV infection. However there are some species of nonhuman primates, including sooty mangabeys and African green monkeys, which do not develop AIDS-like symptoms or any deleterious consequences following SIV infection (see VAX Sept. 2008 Primer on Understanding Control of Virus Replication). Although SIV-infected sooty mangabeys have high levels of virus circulating in their blood, they are able to maintain normal levels of CD4+ T cells. Interestingly, researchers have also observed that the immune systems of SIV-infected sooty mangabeys are not chronically activated, as they are in SIV-infected rhesus macaques or HIV-infected individuals. This may be partly why they are able to avoid developing AIDS. Researchers plan to do additional studies to see if artificially increasing the level of immune activation in these animals will trigger disease progression. Causes of immune activation Studies in HIV-infected humans have shown that during the very early stages of infection, the virus rapidly infects and kills T cells in mucosal tissues, with the greatest depletion of CD4+ T cells occurring in the intestine, or gut (see VAX April 2006 Primer on Understanding the Early Stages of HIV Infection). In most people, the numerous immune cells in the gut that are lost early in infection are never restored, even following initiation of highly active antiretroviral therapy. Some researchers propose that this massive depletion of T cells in the gut allows disease-causing bacteria that normally live in the intestine to leak out and circulate more widely in the body, further burdening the immune system. This is one factor that researchers think may contribute to the high level of immune activation in HIV-infected individuals. HIV may also interfere with a subset of T cells that are responsible for dampening immune responses and keeping the immune system in check. These so-called regulatory T cells play an important role in suppressing immune responses once an infection is eliminated, and also prevent the immune system from becoming overzealous and attacking the body's own cells. Little is known about the function of regulatory T cells in HIV infection, but this is an active area of investigation and may provide additional insights about the role of immune activation in HIV pathogenesis. Although the ideal goal is to develop an AIDS vaccine that could prevent HIV infection entirely, a partially effective vaccine that could control the virus in the early days of infection might help prevent severe damage to the immune system and allow the body to better control HIV. This could alleviate some of the causes of chronic immune activation and might help delay disease progression in individuals who may become HIV infected through natural exposure to the virus, despite vaccination. HAART Reduces Inflammation in the Blood But ... Understanding Innate Immunity and HIV This article was provided by International AIDS Vaccine Initiative. Visit IAVI's website to find out more about their activities, publications and services.

医学

2014-42/1180/en_head.json.gz/5753

Malaria, microscopic view of cellular parasites Mosquito, adult feeding on the skin Mosquito, egg raft Mosquito, larvae Mosquito, pupa Malaria, photomicrograph of cellular parasites Malaria is a parasitic disease that involves high fevers, shaking chills, flu-like symptoms, and anemia. Quartan malaria; Falciparum malaria; Biduoterian fever; Blackwater fever; Tertian malaria; Plasmodium Malaria is caused by a parasite that is passed from one human to another by the bite of infected Anopheles mosquitoes. After infection, the parasites (called sporozoites) travel through the bloodstream to the liver, where they mature and release another form, the merozoites. The parasites enter the bloodstream and infect red blood cells. The parasites multiply inside the red blood cells, which then break open within 48 to 72 hours, infecting more red blood cells. The first symptoms usually occur 10 days to 4 weeks after infection, though they can appear as early as 8 days or as long as a year after infection. The symptoms occur in cycles of 48 to 72 hours. Most symptoms are caused by: The release of merozoites into the bloodstream resulting from the destruction of the red blood cells Large amounts of free hemoglobin being released into circulation after red blood cells break open Malaria can also be transmitted from a mother to her unborn baby (congenitally) and by blood transfusions. Malaria can be carried by mosquitoes in temperate climates, but the parasite disappears over the winter. The disease is a major health problem in much of the tropics and subtropics. The Centers for Disease Control and Prevention estimates that there are 300 to 500 million cases of malaria each year, and more than 1 million people die of it. Malaria is a major disease hazard for travelers to warm climates. In some areas of the world, mosquitoes that carry malaria have developed resistance to insecticides . In addition, the parasites have developed resistance to some antibiotics. These conditions have led to difficulty in controlling both the rate of infection and spread of this disease. Bloody stools Convulsion During a physical examination, the doctor may find an enlarged liver or enlarged spleen . Malaria blood smears taken at 6 to 12 hour intervals confirm the diagnosis. A complete blood count (CBC) will identify anemia if it is present. Malaria, especially falciparum malaria, is a medical emergency that requires a hospital stay. Chloroquine is often used as an anti-malarial medication. But chloroquine-resistant infections are common in some parts of the world. Possible treatments for chloroquine-resistant infections include: Artemisinin derivative combinations, including artemether and lumefantrine Atovaquone-proguanil Quinine-based regimen, in combination with doxycycline or clindamycin) Mefloquine, in combination with artesunate or doxycycline Choice of medication depends in part on where you were when you were infected. Medical care, including fluids through a vein (IV) and other medications and breathing (respiratory) support may be needed. The outcome is expected to be good in most cases of malaria with treatment, but poor in falciparum infection with complications. Brain infection (cerebritis) Destruction of blood cells (hemolytic anemia Respiratory failure from fluid in the lungs (pulmonary edema Rupture of the spleen leading to massive internal bleeding (hemorrhage) Call your health care provider if you develop fever and headache after visiting the tropics. Most people who live in areas where malaria is common have developed some immunity to the disease. Visitors will not have immunity and should take preventive medications. It is important to see your health care provider well before your trip, because treatment may need to begin as long as 2 weeks before travel to the area, and continue for a month after you leave the area. Most travelers from the U.S. who contract malaria fail to take the right precautions. The types of anti-malarial medications prescribed will depend on the area you visit. Travelers to South America, Africa, the Indian subcontinent, Asia, and the South Pacific should take one of the following drugs: mefloquine, doxycycline, chloroquine, hydroxychloroquine or atovaquone-proguanil. Even pregnant women should consider taking preventive medications because the risk to the fetus from the medication is less than the risk of catching this infection. Chloroquine has been the drug of choice for protecting against malaria. But because of resistance, it is now only suggested for use in areas where Plasmodium vivax, P. oval, and P. malariae are present. Falciparum malaria is becoming increasingly resistant to anti-malarial medications Recommended medications include mefloquine, atovaquone/proguanil (Malarone), and doxycycline. Prevent mosquito bites by wearing protective clothing over the arms and legs, using mosquito netting while sleeping, and using insect repellent. For information on malaria and preventive medications, visit the CDC website: www.cdc.gov/malaria/travelers/index.html Fairhurst RM, Wellems TE. Plasmodium species (Malaria). In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa.: Elsevier Churchill-Livingstone; 2009:chap 275. Patel SS. Malaria. In: Auerbach PS. Wilderness Medicine. 6th ed. Philadelphia, Pa.: Elsevier Mosby; 2011:chap 49. Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

医学

2014-42/1180/en_head.json.gz/5938

HEALTHDAY - KIDS HEALTH Aug 21, 2013 9:00 AM by By Alan MozesHealthDay Reporter 'Fat Letters' Take the Stage in Childhood Obesity Debate WEDNESDAY, Aug. 21 (HealthDay News) -- If their kids are frequently tardy, truant or failing to turn in homework, parents of U.S. schoolchildren expect to be notified. And in some districts, they might be contacted about yet another chronic problem: obesity. The "fat letter" is the latest weapon in the war on childhood obesity, and it is raising hackles in some regions, and winning followers in others. "Obesity is an epidemic in our country, and one that is compromising the health and life expectancy of our children. We must embrace any way possible to raise awareness of these concerns and to bring down the stigmas associated with obesity so that our children may grow to lead healthy adult lives," said Michael Flaherty, a pediatric resident physician in the department of pediatrics at Baystate Medical Center in Springfield, Mass. About 17 percent of U.S. teens and children are obese -- three times the number in 1980, according to the federal Centers for Disease Control and Prevention. And one in three is considered overweight or obese. Being overweight or obese puts kids at risk of developing serious health problems, such as heart disease. Too much weight can also affect joints, breathing, sleep, mood and energy levels, doctors say. Massachusetts -- which has had a weight screening program since 2009 -- is one of 21 states that have implemented statutes or advisories mandating that public schools collect height, weight, and/or BMI (body mass index) information. Some states further require that parents receive confidential letters informing them of the results, advising that they discuss the findings with a health care provider. But some parents in the Bay State and elsewhere consider such policies an unwelcome intrusion into private family matters. Other objectors say "fat letters," as they are sometimes called, have the potential to trigger bullying or eating disorders among the very children they're trying to help. In Massachusetts, where parents are letter-informed of BMI results for students in grades 1, 4, 7 and 10, the state department of public health is currently debating a possible repeal of the letter portion of its screening protocol. This would be a grave mistake, Flaherty believes. "The growing number of children and adolescents seen day in and day out in our clinics with hypertension, high cholesterol, diabetes, and musculoskeletal issues secondary to weight do not lie," he said. Flaherty, a clinical associate at the Tufts University School of Medicine, outlines his thoughts in a "perspective" piece published online Aug. 19 in Pediatrics. While acknowledging that the effectiveness of such programs remains to be determined, Flaherty notes that school screenings are nothing new, with many states having done so for many years. And in 2005, the U.S. Preventive Services Task Force determined that calculating a child's BMI -- a calculation of body fat based on height and weight -- should be considered the "preferred measure" for tracking weight issues. What's more, he suggests that parental fears that BMI assessments may accidently identify healthy muscular children as overweight is a misplaced concern over a relatively rare phenomenon. "Additionally, no studies have shown any increased risk in bullying, eating disorders or unhealthy dieting patterns," Flaherty noted. "While these risks exist, they have not been proven in states where these programs have existed for several years." The very point is to have a "confidential way of mailing letters directly home to parents where these issues can be addressed in the privacy of the home without any other students being aware of other children's BMI," he said. Other specialists are less enthusiastic about school BMI screenings. Dr. David Dunkin, an assistant professor of pediatric gastroenterology at the Icahn School of Medicine at Mount Sinai in New York City, cautions that simply legislating parental notification of school screening results will not help curb the obesity crisis without comprehensive and well-designed follow-up. "While I feel that the intention is good [to] raise awareness among parents about their children being obese, and thus instilling motivation for behavioral changes or lifestyle modifications, this is unlikely to have effects in and of itself," Dunkin said. To bring about change, notifications should include referrals to programs that could help parents make lifestyle modifications for their children, he added. But Dunkin would prefer to see weight issues addressed by a family's pediatrician. "I think it is the primary responsibility of the pediatrician to discuss obesity on a case-by-case basis with the child and the family, and try to help them with life changes," he said. "As a pediatrician I often speak to the family about this, and can assist them with advice on what to do to improve their child's health." While Flaherty agrees that pediatricians should measure a child's BMI at every child's well-care visit, he said these check-ups are only performed annually. "Pediatricians have 15 to 20 minutes per year to deal not only with BMI, but a variety of other preventive health issues," Flaherty said. "The public school system is a universal organization that has been used as a forum to reach children and parents for a variety of other issues: vaccinations, dental exams, and hearing and vision screening." More information For more on childhood obesity, visit the U.S. National Library of Medicine. »Comments Top Videos

医学

2014-42/1180/en_head.json.gz/6228

Pacific Health PerspectivesChristian ScienceHome Notes from Don Ingwerson Notes from The Mother Church The Brain: Is it the Source of Health? December 10, 2012 By Don Ingwerson © GLOW IMAGESmodel used for illustrative purposes by Don Ingwerson As a life-long educator, I get excited when new discoveries are made that show how to maintain health and be freer from physical and mental limitations. My most recent encouragement came from the new book Super Brain, which supports the idea that the brain is important to our health in a number of newly discovered ways. These new research findings, about how the brain functions under stressful situations that affect health, are almost surreal. They show that the mind has great power to maximize health, happiness, and spiritual wellbeing. The use of these findings could go a long way towards preventing illnesses that have plagued humans for centuries – such as aging, Alzheimer’s, and memory loss – and they point to something many researchers have been saying for some time: that the mind-body connection is more than theory. What authors Deepak Chopra and Rudolph E. Tanzi do in Super Brain is take the data of mind-body connections to another level. Through scientific evidence they show how the brain functions and how this functioning affects health. In contrast to the “baseline brain” that fulfills the tasks of everyday life, they suggest that through increased self–awareness the brain can be taught to reach far beyond its present limitations. Beliefs about the brain that tend to be limiting can be overcome by combining cutting-edge research with spiritual insights. One reason scientists continue to search for the source of consciousness, or this higher brain function, is that qualities of thought like forgiveness, humor, and love have a positive impact on the body. Yet to date the search to find the material source for these healing qualities has been unsuccessful. Limiting consciousness research to laboratory analysis of brain tissue (where measurements are more quantifiable) could be inhibiting a full exploration and understanding of consciousness. But many top scientists continue to search for answers about consciousness. Australian researcher David J. Chalmers, in a video called The Conscious Mind, asks, “How does the water of the brain turn into the wine of consciousness? How is it that all of this matter adds up to something as complex, as interesting, and as unique as consciousness?” And evolutionary biologist Richard Dawkins was asked, “What is the one question you most want to see answered?” He replied, “How does subjective consciousness work? How does it evolve?” Is it possible there’s value in looking in a different direction than biomedical and body-based research to areas that are more subjective and metaphysical? “In the areas of health and wellbeing, research shows that how we express ourselves spiritually definitely matters. Whom we affiliate with…whether we make time for regular devotion, what we believe, the strength of our faith…these things contribute to whether we become ill or stay well,” claims Jeff Levin in God, Faith and Health: Exploring the Spirituality-Healing Connection. This idea that spiritual thought affects health was shown recently when a friend of mine, who was suffering from terror dreams, decided to use prayer as his alternative medicine. The biblical statement, “Preserve me, O God: for in thee do I put my trust” (Psalms 16:1) was very meaningful and helpful. This spiritual thought, along with, “The divine Mind that made man maintains His own image and likeness,” expressed in the book, Science & Health with Key to the Scriptures, gave him the prayerful strength to overcome this mental suffering. He was healed f

医学

2014-42/1180/en_head.json.gz/6423

Home / Newsroom / 2006 News Releases / News Release News Archived Press ReleasesUC San Diego Health System In The NewsNews FeaturesContacts for JournalistsMedia GuidelinesSubscribe to NewsletterRSS Feed Translate: News Release May 01, 2006 T Cell "Brakes" Lost During Human Evolution Study may explain many human diseases, and severe human reaction to recent clinical trial using T cell-activating antibody A significant difference between human and chimpanzee immune cells may provide clues in the search to understand the diverse array of human immune-related diseases. Researchers at the University of California, San Diego (UCSD) School of Medicine have uncovered a a specific type of molecule expressed on non-human primate T cells, but not human T cells. T cells are important orchestrators of the immune system. In an NIH-funded study to be published on-line in advance of publication in Proceedings of the National Academy of Sciences the week of May 1-5, UCSD researchers report that – unlike T cells from chimpanzees, bonobos, and gorillas (the “great apes” which are human’s closest evolutionary relatives) – human T cells lack expression of certain “Siglec” molecules. Siglecs are immune-dampening proteins that bind to sialic acids, the complex sugars found on the outside of cells. Siglec molecules seem to regulate T cell activation in chimpanzees by restricting the degree of signaling from the T cell receptor, which normally triggers the response of T cells in the immune system. “Siglecs are like ‘brakes’ that can slow down the activation of an immune cell upon stimulation,” said Ajit Varki, M.D., UCSD Professor of Medicine and Cellular and Molecular Medicine and co-director of UCSD Glycobiology Research and Training Center. “During human evolution, we seem to have shut off these brakes on our T cells, allowing them to become hyper-active.” Human T cells respond much more robustly than chimpanzee cells do, a disparity that could be explained by the absence of human T cell Siglecs. The explanation for this human-specific evolutionary loss of Siglecs is currently unknown. The UCSD scientists speculate that this may have been due to a selective pressure by a microbe that once drove human ancestors to require a high level of T cell activation. Another possibility is that this phenotype was secondarily acquired, during the adjustment to the human-specific loss of the sialic acid Neu5Gc some three million years ago, and that the phenotype has been carried by all humans ever since. The study raises warning flags about the stimulatory and potentially destructive potential of the absence of Siglec molecules in human T cells, compared to chimpanzees and other nonhuman primate counterparts. This may explain some major differences in susceptibility to certain diseases between humans and great apes. One example is the lack of progression to AIDS in the great majority of chimpanzees infected with HIV virus. It could also account for the rarity of T-cell mediated liver damage, such as chronic active hepatitis, cirrhosis and cancer, following Hepatitis B or C infection in chimpanzees. In addition, several other common human T cell-mediated diseases, including bronchial asthma, rheumatoid arthritis and type 1 diabetes, have, so far, not been reported in chimpanzees or other great apes. The study suggests that the expression of Siglecs on chimpanzee T cells in essence puts the brakes on the cells during chronic HIV infection, preventing progression to AIDS in chimpanzees. In contrast, the onset of human AIDS occurs more rapidly due to the loss of T cells, which are essentially “unprotected” by the regulatory Siglecs. This study may also explain the severe human reactions observed in a recent clinical trial using a T cell activating anti-CD28 antibody produced by TeGenero, Inc. All six healthy volunteers who received doses at 500 times lower than what was tested in nonhuman primates became severely ill, requiring hospitalization. “In retrospect, the absence of natural restrictions on activation, such as that provided by Siglecs, could have predicted this striking disparity between humans and nonhuman primates,” said Varki. The human volunteers could have experienced rapid activation of T cells and a resulting “cytokine storm.” The research team asked for a sample of the anti-CD28 antibody from TeGenero in order to test it on chimpanzee blood, but the company declined their request. While this family of molecules displays a striking difference between humans and nonhuman primates, the researchers point out that there may be other undiscovered factors that also contribute to the observed differences in immune function. As our closest evolutionary cousins, chimpanzees share more than 99% identity in typical protein sequences with humans. For that reason, the common chimpanzee has long been assumed to be an effective animal model for human diseases. “In fact, chimpanzee diseases may be much more disparate from human diseases than previously envisioned,” said Varki. “The good news is that the loss of this brake system is not permanent, as we still have the Siglec genes in our genomes, and do continue to express them in other blood cell types,” said Varki. “It is reasonable to hope that drugs can be found to turn the Siglec brakes back on again in human T cells, to slow the T cells down when they become hyper-active and cause disease.” Additional contributors to the paper include Dzung H. Nguyen, Nancy Hurtado-Ziola and Pascal Gagneux, also in the UCSD Glycobiology Research and Training Center and Departments of Medicine and Cellular and Molecular Medicine. This study was funded by grants from the National Institutes of Health, the American Heart Association and the G. Harold and Leila Y. Mathers Charitable Foundation. The researchers also wish to acknowledge the Zoological Society of San Diego, the Yerkes National Primate Research Center, Atlanta, and the Lincoln Park Zoo, Chicago for the blood samples from great apes, which were collected in the course of routine health checks. Media Contact: Debra Kain, 619-543-6163, ddkain@ucsd.edu UCSD Health Sciences Communications HealthBeat: News Follow @UCSDHealth Related Specicialties

医学

2014-42/1180/en_head.json.gz/6597

Vol 1, No. 1Latest IssueBack IssuesGo to Issue 2 of 45Aug/Sept 2005, March 2013, Michael Simons, a leading researcher on the role of arteriogenesis in cardiovascular diseases, directs the Yale Cardiovascular Research Center (YCVRC). The YCVRC’s collaborative spirit and unique scientific climate has attracted top cardiovascular scientists to the School of Medicine and has opened up new research directions and avenues of funding. (Photo by Harold Shapiro) Getting to the heart of disease Scientist works toward molecular therapies for cardiovascular diseases Born in Leningrad (now St. Petersburg), Russia, to Jewish parents before the fall of the Soviet Union, Michael Simons, M.D., says a medical career was “sort of a default.” Anti-Semitism barred Jews from many scientific pursuits, so his parents, both doctors, encouraged his interest in medicine as the basis for a strong natural science education. Simons’ family immigrated to Boston in 1978. Simons had begun a 6-year medical program immediately after high school in Russia, so he was admitted to Boston University School of Medicine as a third-year student, but he chose instead to start anew, as an undergraduate. “I thought, if I continue in a medical program, I’ll forever have an inadequate undergraduate education,” he says, speaking with a mild accent and an understated intensity. Knowing nothing about the nearby Massachusetts Institute of Technology (MIT), Simons walked inside and introduced himself. “I figured it’s probably a state school, so it can’t be too expensive,” he says, laughing. He applied and was offered a spot and a scholarship. After graduating, Simons went to medical school at Yale, where he began to explore cardiology, crossing paths with influential figures in the field such as Barry L. Zaret, M.D., now professor emeritus of medicine, and S. Evans Downing, M.D., professor emeritus of pathology, an adviser for his thesis research in coronary physiology. In 1993 Simons joined the faculty at Harvard Medical School and Boston’s Beth Israel Hospital (now Beth Israel Deaconess Medical Center), whose chief of cardiology was William Grossman, M.D., whose success in recruiting leading molecular cardiologists soon transformed the program into one of the world’s best. “I never knew if it happened by design or by accident, but we were able to do what nobody else could do,” Simons says. By that time, physicians were routinely using procedures like balloon angioplasty and stenting to treat coronary artery disease, but Simons was interested in doing so by stimulating the growth of new arteries, a process known as arteriogenesis. To that end, he began studying whether recently discovered angiogenic growth factors might be used to accomplish that goal. Animal research had shown promise, but studies in humans were inconclusive. To better understand arteriogenesis, Simons studied the molecular controls that determine blood vessel growth. He continued this research for seven years as the A.G. Huber Professor of Medicine at Dartmouth Medical School, uncovering new and unexpected mechanisms controlling how the signals of growth factors are processed in their target cells. Returning to Yale in 2008, Simons succeeded Zaret as the Robert W. Berliner Professor of Medicine and chief of the medical school’s Section of Cardiovascular Medicine, and he launched the Yale Cardiovascular Research Center, which has become a research powerhouse under his direction. Simons’ work holds great promise beyond the treatment of coronary disease. “There are distinct signals that control cell fate and thus the type of vasculature that’s formed,” says Simons, also professor of cell biology. By manipulating these signals, his work suggests, the growth of arteries, veins, and lymphatic vessels can be stimulated in a targeted way to treat arterial, venous, and lymphatic diseases—and he also believes that manipulating the vessels that supply blood to tumors may one day lead to new possibilities for treating cancer. Michael Simons, MD Barry Zaret, MD Berliner Professor studies how blood flow stimulates the formation of new arteries Ensign Professor has unveiled mechanisms shared by the vascular and nervous systems Cardiovascular science as social network Berliner Professor envisions blood vessel growth as therapy Looking at RNA to get to the heart of cardiovascular disease

医学

2014-42/1180/en_head.json.gz/6695

DR. BASIL ISAAC HIRSCHOWITZ HIRSCHOWITZ, DR. BASIL ISAAC The course of modern medicine took a dramatic change when Dr. Basil Isaac Hirschowitz and two colleagues created the first fully flexible fiberoptic endoscope in 1957. Dr. Hirschowitz, along with Larry Curtis and C. Wilbur Peters, developed a technique for coating and bundling hair-thin glass fibers in such a way as to allow viewing over long distances and around bends. This gave him an illuminated and unobstructed view inside hollow organs such as the esophagus, stomach and colon and the means for minimally invasive surgery. The invention, which revolutionized the practice of gastroenterology and provided the basis for optical fiber communication in multiple industries, is arguably one of the most important developments of the 20th century. The original instrument resides in the permanent collection of the Smithsonian. Dr. Hirschowitz, who died on January 19, 2013 at age 87, received recognition and awards from organizations around the world, including a Nobel Prize nomination. Much more than an inventor, Dr. Hirschowitz was a gifted and caring physician, a research scientist and a teacher. He dedicated his career to the study of physiology, pharmacology and diseases of the upper GI tract and published more than 350 papers, many related to ulcer disease. Much of his time was spent as a Professor at the University of Alabama School of Medicine in Birmingham, where he founded and served as director of the Division of Gastroenterology for 29 years. The Basil I. Hirschowitz Endowed Chair in Gastroenterology was established at UAB in 1997 and upon his retirement in 2008, he was awarded the University's President's Medal. He received worldwide recognition for his contributions to medicine. He was honored by a Mastership in the American College of Physicians, the Royal Society of Medicine in England, and received an honorary Doctor of Medicine Degree from University of Götenborg, Sweden. Among his many awards were the Julius Friedenwald Medal from the American Gastroenterological Association, the Charles F. Kettering Prize presented by the General Motors Cancer Research Foundation, and in the Spring of 2010, the Castle Connolly National Physician of the Year Award for Lifetime Achievement, which recognized Dr. Hirschowitz as a leader in health care whose research, skills and dedication have improved the lives of people throughout the world. Basil Isaac Hirschowitz was born in 1925 in Bethal, South Africa. He was the first son of the late Morris and Dorothy Hirschowitz, a progressive Jewish farming family who had fled the pogroms in Lithuania at the turn of the century. He excelled at school, and received his undergraduate degree at Witswatersrand University at age 18 and his graduate degree in medicine when he was 22. He continued his medical training in London under Sir John McMichael at Hammersmith Hospital, followed by studies in gastroenterology at the Central Middlesex Hospital under Sir Francis Avery Jones. In 1953, he moved to the United States where he continued his focus on gastroenterology, first at the University of Michigan then at Temple University in Philadelphia. In 1959 he joined an elite group of pioneer medical faculty being recruited to the University of Alabama School of Medicine in Birmingham. Their task was to develop the burgeoning medical school's various specialties. In his capacity as Director, Dr. Hirschowitz founded the department of gastroenterology only two years after he and his associates had done their groundbreaking work on the fiberoptic endoscope. He spent the rest of his career at UAB, performing research, treating patients and, through his fellowship program, training several generations of promising gastroenterologists who would, in turn, become leaders in their field. Shortly after arriving in the United States, he met Barbara Louise Burns, an occupational therapist at the University of Michigan. They were married in Ann Arbor in 1958. He became a naturalized citizen in 1961 and made a permanent home in Birmingham, Alabama, where they raised their four children. The family traveled frequently, both to South Africa for family visits as well as to many other countries as part of his extensive lecture schedule. He was an avid photographer and a keen gardener, with a particular love for cultivating roses. He was a collector; of African art, geological specimens and stamps. In 1992, he was named a Fellow of the Royal Philatelic Society of London. But above and beyond all of these pursuits was his overriding passion for science. In one of his final addresses to a graduating class of medical students, he commented, "We who are leaving, envy you the opportunities that the rush of science is about to offer you. Defend it and make good use of it." Dr. Hirschowitz is survived by his wife of fifty-five years, Barbara, his children David Hirschowitz, Kaaren Hirschowitz Engel, Dr. Edward Hirschowitz (Alison), Vanessa Hirschowitz (Nick Kouchoukos), and seven grandchildren - Zoe, Simon and Iris Engel; Maxwell, Sophie and Sydney Hirschowitz; and Alexander Kouchoukos. A funeral service was held at Johns-Ridouts on Monday, January 21st at 2:00. Contributions can be made to: UAB; the Birmingham Museum of Art; the Birmingham Botanical Gardens. Funeral Home Johns-Ridout's Funeral Parlors 2116 University Blvd Birmingham, AL 35233 (205) 251-5254 Published in The Birmingham News from Jan. 22 to Jan. 23, 2013 - ADVERTISEMENT -

医学

2014-42/1180/en_head.json.gz/6846

SomaSimple Discussion Lists > WWW The Wild Wise World > The Wind Rose Mo's Neurophilosophy blog Welcome to the Somasimple forums. You are currently viewing our boards as a guest which gives you limited access to view most discussions and access our other features. By joining our free community you will have access to post topics, communicate privately with other members (PM), respond to polls, upload content and access many other special features. Registration is fast, simple and absolutely free so please, join our community today! If you have any problems with the registration process or your account login, please contact us. The Wind Rose Other forums all around the Planet. Opened to all readers. Human Primate Social Groomer and Neuroelastician Location: Weyburn Sask. I can't figure out why I never started a Wind Rose thread for Mo's blog, Neurophilosophy, before today - I certainly love to point out his blogposts. Well, it's never too late.. This post is a very nice one, pointing out 6 dogmas about the nervous system that have been destroyed by new waves of science. The dogmas that are gone are: 1: The adult human brain is not plastic. ...the brain is capable of reorganizing itself extensively, particularly in response to experience and injury. Learning is now thought to occur as a direct result of the modification of synaptic connections in the brain; reorganization of the brain's wiring is widely believed to take place following injury, and to underly phenomena such as phantom limb syndrome in amputees. 2: The adult human brain cannot regenerate. ... it is now well established that the adult human brain contains small populations of neural stem cells, which are capable of dividing to generate new neurons throughout adulthood. The function of these new cells is still unclear, and researchers have so far had little success in coaxing them to divide in vivo. Nevertheless, once they do so, stem cells can potentially be used to develop treatments for neurological conditions such as stroke, epilepsy and Alzheimer's, Parkinson's, and Huntington's diseases. 3: Neurons are the functional elements of the nervous system. In the 19th century, the discovery of the neuron was quickly followed by the realization that the nervous system contains another cell type: the glial cell. Glial cells were quickly relegated to a secondary role in which they provide neurons with structural and nutritional support. In recent years, however, this view has begun to change. Glial cells are now known to regulate communication between neurons and to control blood flow through the capillaries in the brain. They can also communicate with neurons, with each other, and with blood vessels, and a study published in April of this year shows that glial cells can generate action potentials. Rather than being mere support cells, glia may yet be shown to be the main players in brain function. I would like to point out that glial cells arise from neural crest, which comes off the ectoderm layer just before what's left of it turns into skin. 4: Neurotransmitters are released from the nerve terminal. According to the conventional view, neurons receive inputs from other nerve cells on their dendrites, integrate these signals in the cell body, and generate an action potential which is propagated along the axon. When the action potential reaches the nerve terminal, it triggers the release of neurotransmitters, which diffuse across the synaptic cleft and elicit a response in the postsynaptic membrane. However, several studies published published last year show that neurotransmitters can also be released from axons in the white matter of the corpus callosum. Wow. Quote: 5: Neurons are binary switches. In other words, a nerve cell is either on or off: at any given time, it is either generating an action potential, or it is not. The action potential was regarded as an "all or nothing" response. That is, a minimum amount of stimulation is required before a neuron will produce a nervous impulse, and a sub-threshold stimulus (one that is smaller than the minimum stimulus amplitude) will not produce a response. It has long been known that cells of the invertebrate nervous system produce graded potentials, whereby the amount of transmitter released is proportional to the intensity of the stimulus. We now have evidence that mammalian neurons can generate graded potentials as well - they are not simple on/off switches, and the action potential is not all or nothing. 6: Neurons communicate with each other by propagating action potentials. Neurons evolved to communicate with each other, and they do so by generating nervous impulses which are propagated along the nerve fibres. But because this electrical activity cannot cross the synapse, it is converted to a chemical signal which transmits the signal from one cell to the next. Although all neurons communicate in this way, we now know that some cells in the nervous system can convey signals by the propagation of a secondary messenger cascade. These biochemical signalling cascades can travel along the nerve fibre, and can elicit the release of neurotransmitters from the nerve terminal, in the absence of electrical activity. www.dermoneuromodulation.com SensibleSolutionsPhysiotherapy HumanAntiGravitySuit blog Neurotonics PT Teamblog Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts) Canadian Physiotherapy Association Pain Science Division Facebook page @PainPhysiosCan WCPT PhysiotherapyPainNetwork on Facebook @WCPTPTPN Neuroscience and Pain Science for Manual PTs Facebook page @dfjpt SomaSimple on Facebook @somasimple "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley �Comment is free, but the facts are sacred.� ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial �If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire Send a private message to Diane Visit Diane's homepage! Find More Posts by Diane

医学

2014-42/1180/en_head.json.gz/6851

Spinal ependymoma A personal forum for people diagnosed with a spinal ependymoma, which is a rare, generally benign tumor of the spinal cord. Spinal ependymoma: a personal account By Bill Anschell (blog moderator)(NOTE: Although this is published in the form of a blog, I would prefer that readers not post comments. It is intended as a documentation of my surgery for, and subsequent recovery from, an ependymoma of the spinal cord. The "comments" that follow my initial post are updates from me detailing various points in the recovery process. If you would like to give me feedback or ask for advice, please email me directly at billanschell@mindspring.com. Above all, as I do throughout this blog, I encourage you to join the community of spinal cord tumor patients - both pre- and post-surgery - at www.spinalcordtumor.org, which is an enormously valuable resource.)The fact that you found your way here probably means that you or someone close to you has been diagnosed with a spinal ependymoma, or perhaps an as yet unknown spinal cord tumor. That was my situation in early August of 2005, when MRIs indicated a probable ependymoma, with a lesser chance of an astrocytoma.I immediately began doing the same thing you’re in the midst of: Searching the internet for articles that might help me understand exactly what I was facing. And I discovered what you’ve no doubt found as well: Spinal cord tumors are so uncommon that there are no user-friendly, comprehensive and conclusive articles on them. With no apparent centralized database or controlled scientific studies in place, the best you can do is to read the many (sometimes contradictory) clinical articles by neurosurgeons and other doctors around the world, and piece together your own best interpretation.That’s what I did, as exhaustively as my unprofessional research skills allowed. It left me with a pretty good understanding of spinal ependymomas (or, at least, my particular tumor, which was an intramedullary thoracic one at T10 – 11). It also revealed that there are apparently no published personal accounts of the experience – from diagnosis, to surgery, to rehabilitation and beyond. Nor are there any websites specifically devoted to the subject. Knowing how much I would have appreciated those resources when I was in the thick of it, I decided to put together this blog. (NOTE: I subsequently have discovered www.spinalcordtumor.org, a very helpful resource. I discuss it more in my follow-up postings).So, I’ll start by telling my own story in full gory detail, and hope that others will follow suit. The disclaimers should be obvious: I’ve assimilated the articles I’ve read, augmented by brief discussions with the surgeons involved in my case, and reached conclusions that in some instances may be simply my best guess. I’ve tried to be clear about which of my points are “greyer” than others. So please view my word for no more than what it is: a fellow patient’s unscientific attempt to make sense out of a complex and under-researched – at least in terms of availability to the lay reader - subject.I would particularly welcome specialists in the field to join in with corrections and other insights.1) Symptoms/DiagnosisMy first symptom crept up about five years prior to the diagnosis: My outside toes very gradually were becoming numb to the touch. I mentioned this to a couple of different physicians during my physical exams over that period, and they were not concerned. Then the numbness slowly became more pronounced and spread across all my toes. By the end, I would try to entertain my wife by making a fist, splaying my toes out, and pounding them into the ground, hammer-like. She wasn’t amused…Starting about a year before the diagnosis, more symptoms developed, again very gradually. I was having to urinate very frequently, and sometimes couldn’t take a two-mile walk (my exercise routine) without a bathroom break. Bowel movements sometimes also became very urgent. And from there it gets even more personal; suffice to say, if you’re dying for details, you’ll have to email me.I also had some episodes where, out of the blue, I would become very lightheaded and feel a pressing sensation down each arm, lasting about a minute, leaving me feeling weak and panicked (the latter because I thought I might be having a heart attack). I can’t say for sure that these were related to my tumor, particularly since involvement of the arms would usually point to a higher location in the spine, but they have ceased since the operation. Around the same time, I began having intense low back pain in the middle of the night. I would wake up feeling a stabbing pain, but all I had to do to ease it was to walk around for a few minutes. I began taking Advil every night before bed to help me sleep through.At my next physical exam, hearing of the latter two symptoms, my physician referred me for a variety of tests. First I had a chest x-ray (negative), then an ultrasound (looking for an aneurism; negative), then I met with a heart specialist (all tests negative). Next, in January, 2005, I was referred for an MRI.At that point, I made a big mistake. For years I had suffered problems with my neck: herniated discs were causing me a lot of pain and stiffness. I’d had a couple of cervical MRIs, five years apart, each with the same outcome: surgeons advising me that I should live with the pain unless it was completely unbearable, because surgery was a last resort that was best avoided if possible. With that in mind, I didn’t want to spend $2,000 for a low back MRI that I expected would tell me the same thing. The pain had subsided somewhat, I had concluded that my problems were from a new, lower herniated disc (which had been my primary suspicion all along), and I decided I would skip the MRI and live with the symptoms unless I couldn’t stand it anymore. Seemed sensible at the time…But by July the nighttime pain had returned with a vengeance, and I went ahead with the MRI in early August. By sheer coincidence, the attending diagnostic radiologist the night of my MRI was a friend, and he pulled me aside afterwards to give me a heads-up on what he saw: A large tumor inside my spinal cord; probably an ependymoma, possibly an astrocytoma. He copied some relevant pages from a medical book, and I used them as a starting point for my research, grateful to have a head start on the process.2) Choosing a NeurosurgeonSeveral days later, I met with a surgeon who is part of my HMO’s well-respected neurosurgical team. From my reading to date I knew that I wanted the tumor to be an ependymoma – NOT an astrocytoma, which carries a relatively discouraging prognosis. Looking at my MRI, the neurosurgeon told me that it was “almost certainly” an ependymoma. That was particularly reassuring because the MRI itself indicated “inhomogeneous enhancement,” which normally tilts the diagnosis toward astrocytoma. Apparently it was the actual shape and location of the tumor that indicated ependymoma.He conducted some minor tests to check out any neural deficits that might have already been created by the tumor, testing my ability to feel a safety pin touching various parts of my leg. He also checked my reflexes and gait, and found me to be in very good shape, with minimal existing symptoms: just some missing sensation and a little spasticity in my left leg.Those favorable findings were significant, because there seems to be a consensus among articles I’ve read that the single biggest predictor of a patient’s post-surgery recovery is his/her pre-surgery status. These articles say that function lost prior to surgery is rarely regained, though there can be some minor improvement in strength. Other predictors were not on my side; they include location of the tumor (better cervical than thoracic) and ratio of the tumor mass to spinal cord thickness (the tumor may grow large enough to compact the spinal cord from within, as mine had). More on this later.The neurosurgeon was confident that he could successfully remove the tumor, but he was leaving town and would be unavailable for almost two months. He felt that there would be no harm in waiting (unlike most neurosurgeons he believes that ependymomas are so slow-growing that they’re actually present from birth), but suggested that if I wanted the surgery sooner, I could meet with his partner, another very well-respected member of the HMO team.I didn’t see any advantage to waiting, so I scheduled a meeting with the second neurosurgeon. In between, I continued to read as much material as I could find, and I was able to ask the second neurosurgeon some very specific questions about his approach.I found him to have a conservative surgical philosophy, inclined to err on the side of leaving residual tumor rather than risking surgical damage to the spinal cord. This is, of course, an entirely reasonable and responsible position, but it wasn’t what I wanted. The risk of recurrence is much higher if a tumor isn’t fully resected. And a tumor recurrence is much harder to treat than the first occurrence, with scar tissue clouding the delineation between tumor and spinal cord. I felt I would rather risk living with a new deficit than raise the odds of a recurrence, with its consequent repeat surgery, radiation, and worsened prognosis.I was also very concerned by his comment that if he discovered that tumor to be an astrocytoma (which he, too, considered a 20% possibility), he would simply close me back up rather than attempt to remove it. Astrocytomas, which integrate themselves into the spinal cord itself rather than just pressing against it as ependymomas do, are more difficult and risky to resect. However, the most current articles I had read recommended treating astrocytomas as aggressively as possible.When I expressed my concerns to him, he said that knowing my preferences, he would act more aggressively, but always erring on the side of safety. Again, while this is entirely reasonable, it didn’t instill confidence that he was the right surgeon for me.I asked if he had access to the most state-of-the-art equipment for the surgery; I wanted assurance that I wasn’t compromising myself by staying within the HMO. He mentioned that the only relevant equipment I might find at a different hospital was motor-evoked potential (MEP) monitoring technology, which he didn’t consider to be significant. We set the surgery date for two weeks later, and I began reading as much as I could on MEP monitoring.MEP monitoring technology is a relatively recent addition to the spinal surgery arsenal, having been in use for about 15 years, gradually becoming a more common surgical aid. Surgeons who use it generally do so in conjunction with sensory-evoked potential (SEP) monitoring. While the details are far beyond me, my lay understanding is that the former monitors motor impulses from the brain down through the spinal cord, whereas the latter triggers and monitors sensory stimuli from the feet or ankles upward. In both cases, a monitor technician scans a read-out during the surgery, making sure the signal intensity doesn’t drop below a certain threshold. If/when it does, it is an indication that the surgeon is in danger of causing damage to the nerves (in the worst case, paralysis). Sometimes the signals give the warning too late, and the damage has already been done. But in many instances the surgeon is able to try a different approach, or give the nerves some “rest time” before probing further.I found 12 different articles on MEP monitoring, almost all written by practicing neurosurgeons and neurosurgical teams. Eleven of them recommended it as an important surgical aid, more effective alone than SEP monitoring alone, and ideally used in tandem with SEP monitoring. The other one was simply neutral. My neurosurgeon was planning on using only SEP monitoring, and that didn’t sound good to me. When I emailed him about it, he replied that the MEP technology was unproven, and wasn’t considered a “surgical standard” (which would constitute grounds for referring me to a hospital that had the technology in place). This did nothing to make me feel better. How could a technology be “proven,” when its only effect was to prevent errors? With such a small universe of ependymoma surgeries (250 per year in the U.S., according to one article), when would a controlled study ever be able to take place? And, in lieu of that, wouldn’t the hands-on experience of neurosurgeons who regularly use the technology be the best indicator of whether or not it is helpful?I decided I should get an opinion from a neurosurgeon outside my HMO. But I found it impossible to get an appointment prior to my surgery date, which was less than two weeks away. Through sheer good luck, it turned out that a friend of mine had worked professionally with a doctor considered by many to be the area’s top brain and spine neurosurgeon. She sent him an email on my behalf, and he took a personal interest in me because of my vocation (I’m a jazz pianist). I met with him two days later.He concurred with the diagnosis (80% chance ependymoma, 20% chance astrocytoma), and spoke highly of the surgeon I’d been assigned. But from talking with him I could tell he was clearly more aggressive in his surgical approach (even with astrocytomas) than my surgeon, and he also performed this particular surgery far more often, perhaps more than anyone else in the region. His prognosis was more optimistic (predicting I’d end up at least as well off as before the surgery, and probably better), and I connected much better with him personally. He used MEP monitoring (along with SEP monitoring) as a regular practice, and vouched for its value in surgery.On the basis of the more aggressive approach and use of MEP monitoring – both of which were supported by strong majorities of neurosurgeons in the articles I’d read – I asked my HMO to refer me to the third neurosurgeon. There was some nerve-wracking back-and-forth as the original surgery date approached, but eventually the referral came through. Undoubtedly, there were all kinds of political and personal dimensions to this episode, but I can only speculate. Was the original surgeon under pressure NOT to refer me? (Instead of covering the surgery in-house, my HMO had to pay a lot of money to the hospital where it took place). Were there professional relationships to consider? (The referring surgeon told me I had created stress between him and the surgeon I was referred to; the latter said they are good professional acquaintances, and it hadn’t been a problem. For my part, I had raised all my questions as respectfully and diplomatically as possible).In a perfect world, the referral would have been quick and painless for all concerned. Despite the uncertainties about MEP monitoring, the mere fact that it would likely help, and couldn’t hurt, would constitute grounds for referral, particularly in light of the seriousness of the procedure and its potentially life-altering complications. One thing is certain: Even at the top of the medical profession, doctors are people, HMOs are businesses, and their various interrelationships can’t be overlooked.Meanwhile, I had undergone SEP baseline testing (to establish my normal levels as a frame of reference during the surgery), and it hadn’t gone well. My ankle clenched so badly that they weren’t able to get readings through the spasms (which I much later found out were probably a symptom of the tumor), so I had to repeat the testing after taking Valium. Then the technician found a delay in the signal, which she said could turn out to be problematic in surgery.My new neurosurgeon scheduled me for surgery a week-and-a-half later. I mentioned to him that in the two weeks since the original diagnosis, my symptoms seemed to be escalating. I was fully aware that I was probably scrutinizing myself more closely, and noticing relevant symptoms that I might have missed before, but even in light of that there seemed to be a real progression. My left knee was buckling sometimes, my legs got more fatigued after walks (though I was still able to walk two miles), and my ankles felt stiff. While the other two neurosurgeons had been skeptical about the idea of rapid symptom progression, my new neurosurgeon said that – despite the slow-growing nature of ependymomas – my tumor might have reached a critical mass after which the onset of symptoms would take place quickly. He prescribed steroids to reduce the swelling over the remaining days.During the week prior to the surgery, I had various tests and meetings, stopped taking unrelated medications, and filled out a form acknowledging the risks I was voluntarily taking. Heading the list: possible permanent loss of bowel and bladder function, and possible paralysis.3) Surgery/hospital stayEarly in the morning on the scheduled date, I reported for surgery, which was expected to take around four hours. As I was being prepped, the surgeon pulled my wife aside and let her know that I would probably have to spend a couple of weeks in rehab once I was released from the hospital. The location of my tumor meant that he would need to cut through the dorsal column, which would pretty much eliminate most sensation below my waist, so I would need to learn to walk again virtually from scratch.Needless to say, I don’t remember anything from the surgery itself. As I went under, I was trying to chant “ependymoma, ependymoma, ependymoma,” not as a mantra but as a final vote against an astrocytoma. When I came to, I immediately asked my wife the two big questions: “Was it an ependymoma?” (yes) “Am I paralyzed?” (no). Good news all around.I learned that the surgery had been more challenging and risky than anyone had expected. The tumor was so large that it had compressed the surrounding spinal cord to the thickness of a piece of paper. As a result, removing it - without damaging the spinal cord itself – became extremely difficult. The procedure had gone on for six hours and – according to the neurosurgeon – “taken ten years” off his life. Most significantly, the SEP monitoring had failed; apparently the tumor’s encroachment had rendered that form of monitoring useless. Only the (controversial) MEP monitoring had worked, and its signals twice dropped to levels that forced my surgeon to halt the procedure.I honestly believe that had I not made the case for my referral, based on the importance of MEP monitoring, I’d probably still be carrying around a chunk of tumor (likely to recur) or have suffered neurological damage during the surgery. Instead, for the most part, all seems to have gone well. Lesson: When the stakes are high, do your research, and take charge of your own care.Although I feel that I did all I could on my own behalf once I was diagnosed, my one regret is that I had postponed the January MRI. Given how large the tumor was, how challenging it was to remove, and some concerns that have come up in my recovery process (below) I’m wondering if the results would have been even better if I’d had the surgery six months earlier. My surgeon’s theory about the tumor reaching critical mass and provoking a sudden rush of symptoms seems to have been validated. He later told me that if I’d waited a few more weeks for surgery I might have already been in a wheelchair.I was in the hospital for a week, and although I’m told I was lucid, I remember it through a narcotic haze. As promised, I had virtually no feeling below the waist, and couldn’t move myself around the bed at all, even on my back. When my surgeon checked up on me, he was very pleased by my strength (which apparently is the most critical post-surgery function), and not at all disturbed by my lack of sensation. In addition to being numb, I had lost virtually all of my proprioception, which is the body’s awareness – independent of touch - of each of its parts’ location; its sense of position. I couldn’t tell where my legs lay in the hospital bed without looking, or which way my toes were bent when they were tested. This would contribute greatly to the challenge of walking again, and would return only very gradually, along with the sensation.Part of the surgical procedure is a laminectomy, which involves removing a section of the spine to gain access to the spinal cord. The bone is cut in two places and literally removed for the duration of the surgery, then put back in place. The size of the piece removed mirrors the length of the tumor, and larger blocks may require permanent reinforcements inserted into the spine itself. I was fortunate in that regard, having a tumor that spanned fewer than three segments. Laminectomies are serious in themselves, even when comprising the primary part of a surgery (e.g., treating a herniated disc). I am very fortunate, undoubtedly due to the handiwork of my surgeon, that the laminectomy has caused me only minor pain and no complications to date.The worst aspect of my hospital stay was the bladder/bowel component. While my pain threshold is pretty high, the catheter just killed me, and it was always there. Anytime the nurses shifted me in the bed, I would get a searing reminder. And while I’m sure they had good reason, the nurses’ obsession with bowel movements hit me somewhere between tragedy and comedy. The bowel program was its own self-contained, self-perpetuating world: Narcotics that make patients constipated, stool softeners to loosen them up, anti-constipation pills, and – all else failing – suppositories and enemas. Add the nightly wake-ups to check my vital signs, and you’ll understand why I was soon aching to leave.A couple of days before my hospital stay ended, a very chipper occupational therapist (picture a young Katy Couric in uniform) and a physical therapist visited me from the hospital’s rehab wing. Their goal was to get me up on my feet. Step One was for me to swing my legs over the side of the bed and sit up for the first time. That alone left me dizzy and sweating heavily. From there they helped me to a standing position, most of my weight supported by a walker. I closed my eyes to stop from vomiting; when I opened them, Katy Couric’s smiling face was inches from mine. “You look great!!!”she said, even as I sagged back to the bed, feeling perhaps more wretched than at any other time in my life. There were witnesses. The hospital stay in five words: Prepare to lose your dignity.4) Inpatient RehabNext I was transported to an inpatient rehab clinic at a separate institution, where I would spend the following two-and-a-half weeks. I pretty quickly weaned myself of the narcotics, broke the cursed bowel cycle, and managed to lose the catheter. Life got much better, and it was actually a fairly relaxing period. It also helped that I had tremendous support from my family throughout my rehab stay, just as I had in the hospital.It’s worth mentioning that doctors, residents, therapists, and nurses in both the hospital and the rehab clinic were less optimistic about my recovery than my neurosurgeon. Prior to the surgery, my neurosurgeon had virtually assured me that I’d be good as new, and even after the surgery proved more challenging than he’d expected, he continued to predict a full recovery. The others were more cautious, not wanting to get my hopes up for what they saw as an uncertain future. I asked my neurosurgeon why his outlook for me was so much rosier than theirs. “It’s because they don’t see the recovery curve of these tumors from beginning to end, and I do.” He had a point: I was thrown in with victims of serious accidents with resultant major spine trauma, whereas my operation was controlled, with a more predictable outcome. Spinal tumors are so rare that they are not part of most rehab workers’ experience base. In their frame of reference, accident victims and tumor patients alike progress to the point of discharge, but beyond that, further recovery would be unknown.So I continued to believe my neurosurgeon, and this put me in an unusual position within the rehab program. Much of what the therapists showed us – particularly on the occupational therapy side – was intended to help us deal with disability in day-to-day situations. And many of the patients were coping with the realization that their lives might never again be the same. I was actually somewhat buoyed by the success of my surgery, optimistic about my prognosis, and eager to get on with my life.In spite of that, progress was slow. Everyone including my neurosurgeon repeatedly reminded me that recovery could take up to a year. It simply takes that long for nerves to regenerate, whether severed during the surgery or impacted by the tumor. Consequently, sensation below the waist returns only gradually, as does proprioception. Lacking those two forms of feedback, learning to walk was a major challenge. Rehab consisted of one to two hours each of occupational therapy (day-to-day strategies) and physical therapy (exercises related to balance, strength and – ultimately – walking) plus plenty of bed rest.My first assignment was learning to transfer myself from my bed to a wheelchair (sounds simple, but trust me…). Then, when I was finally able to get up on my feet, I worked on using a walker. From there I made it to forearm crutches before I was discharged, taking a walker and set of crutches home with me. The therapists were thrilled with my progress, though I found it disturbing that my left leg lagged so far behind my right. It was in keeping with my surgeon’s prediction (the functions most affected prior to surgery take longest to recover), but even today it remains a source of concern.Once I got home, I was self-sufficient enough to stay alone during the day. My wife had set up the house so that I could travel from room to room safely on crutches and reach everything I needed. We bought lots of take-out food, which I was able to microwave and serve myself using the walker with a basket on it for transport. My wife also set up a tub transfer bench in the shower, which I continue to use today.I was visited at home twice a week by a physical therapist, who helped me graduate from crutches to a cane. She got me started on an exercise regimen that evolved as my function improved. After a couple of weeks, I was able to drive myself to a nearby rehab facility, where I continued with weekly appointments. Two weeks ago (three-and-a-half months after the surgery), I was able to meet my most recent therapist’s goal of being able to walk without a cane in public (it’s much easier in a familiar house, with walls to bounce off). My gait isn’t pretty, but I’m happy to be in the final stage of the recovery process. We’ve now reduced the schedule to one meeting per month, and I continue to do the exercises she gave me (now primarily stretches) daily.5) Real Life/PrognosisMy goal from the beginning was to play my first gig one month after the surgery, and I was able to do so. It wasn’t pretty - moving around the club I leaned heavily on the forearm crutches and had to be helped on and off the stage - but it helped me get back into the normal pattern of my life. I am fortunate that my left leg, which has turned out to be my biggest problem, is the one limb I don’t need to use in playing piano. My reduced sensation and proprioception in my right foot and leg make pedaling a bit of a issue, but it’s not enough to really affect a gig; I just have to keep my eye on my foot to make sure it’s sitting where I need it. I’m able to drive an automatic, and we’ve shuffled around the family cars to make that possible (I used to drive a stick, but I quickly found that to be a bad idea, given my left leg’s reluctance to get with the program).As I’ve come to understand it, there are several factors that play into the recovery process. Any neurological deficits in place prior to the surgery are likely to get worse before they get better, and as my neurosurgeon explained to me, they are the last things that will actually heal. On top of that, the complications from the surgery itself – numbness and proprioception as an inevitable consequence of severing the dorsal columns, plus any incidental damage to the spinal cord – also have to heal. As I mentioned earlier, all of these problems can take up to a full year to mend to their final level, and according to the various sources I’ve read, recovery typically doesn’t even begin until the third or fourth month.Today, four months after the surgery, I’m living my life pretty much as it had been prior to the surgery, though I still have much recovery ahead, and I hardly go a minute without thinking about my status and prognosis. My biggest issue, which no one had predicted, is spasticity (aka “tone”) in my hips, knees, ankles, and toes. I’m experiencing it far more in my left (bad) leg than in my right. Essentially, the muscles are flexing when I don’t want them to, causing my legs to feel stiff and heavy, my toes to curl a little, and my knees and ankles to feel stiff and sometimes painful.Strangely, this problem has been playing out on a strictly every-other-day pattern: Good days (relatively little spasticity) always alternate with bad ones (serious ankle pain, major stiffness from the knees down). On the good days, I feel a little weaker (since the spasticity actually helps my legs to bear my weight better, albeit clumsily), but I much prefer that weakness to the awkwardness and pain of the bad days. Most troubling to me is the fact that this problem has not improved at all, and may still be getting worse. In fact, it didn’t really kick in hard until around the third month, though it’s possible I was simply unaware of it prior to that because of my lack of sensation. It doesn’t seem to be related to the amount of stress I put on the legs via walking.I have read about spasticity as a symptom of spinal cord trauma, but not as a post-op complication. My surgeon assures me that it will go away, though a rehab doctor I met with was less certain. For now, I’m doing lots of stretches, as my surgeon and physical therapist recommend, and hoping I won’t be living with it forever.Other than that, everything is getting better. My left knee, which used to buckle a lot, has strengthened, and my right leg can go forever. The main impediments to my walking are the spasticity and the fact that feeling in my feet has been returning patchily, so I don’t sense their full contact with the ground, especially when I walk without shoes. But sensation continues to come back, particularly in my feet, ankles, and the backs of my legs. I can go up and down stairs one at a time (good leg leading up, weak one leading down), and I can handle about 1/2 mile of walking over the course of a day. Doesn’t sound like much, but considering I’m just four months into the year-long recovery process, it feels like I’m doing well. My surgeon and therapists are all impressed with the progress, and I’m happy to take their word.While the spasticity has got my immediate attention, my biggest concern, by far, is the possibility of a recurrence. I’m trying not to dwell on it. Both the MRI taken immediately after my surgery and my three-month follow-up MRI are clean, with no evidence of residual tumor (thus my surgery is considered a “gross total resection”). According to my surgeon and the various articles I’ve read, this puts my chances of a recurrence at just 10% - 20%; not bad odds at all. But the recurrence itself would be a daunting development. As I mentioned earlier, the scar tissue from the first surgery makes it hard for the surgeon to find a delineation between the tumor and spinal cord, which in turn makes it very difficult to get a total resection the second time around. Additionally, according to a radiation oncologist I met with, a tumor that recurs has “declared itself to be more aggressive” than the original, with an increased likelihood of growing faster and/or spreading. For that reason, radiation is almost invariably used in conjunction with the second surgery, and that carries risks of its own.6) RadiationI’ve found that radiation oncologists and neurosurgeons will look at the same situation from very different perspectives, directly related to their craft. Although my surgeon and his team viewed my immediate post-op MRI as clean, the radiation oncologist was less convinced (from what I understand, the post-op MRI inevitably contains blood and stray tissue that cloud the picture, leaving it open to interpretation). For that reason, my case was brought before the tumor board as a possible candidate for radiation. Ultimately, the radiation oncologist took my surgeon’s word that, even through the operating microscope, he saw no residual tumor by the end of the surgery.The same radiation oncologist (a well-respected doctor at a good hospital) requested that I meet with him shortly after the surgery so he could present my options. I couldn’t understand why we were even meeting, because every article I’d read recommended against radiation in the event of a gross total resection, and the jury seemed to be split even in the case of partial resections. Spinal ependymomas are considered somewhat resistant to radiation treatment, and the spinal cord is susceptible to radiation damage. The radiation oncologist explained that he was actually recommending a watch-and-wait approach, but that he wanted me to know my options because some people in my shoes might choose radiation to be safe against the possibility of the tumor spreading, and to further reduce the odds of recurrence.This sounded reasonable, but hardly appealing: the radiation used was based on a standard he described (if I remember correctly) as 5/5: It would carry a 5% chance of producing paralysis within five years, with the odds going up beyond that period. That, to me, sounded no better than the 10% - 20% chance of a tumor recurrence over my lifetime, particularly considering that even if I did undergo radiation, there was no guarantee that the tumor wouldn’t recur. And I hadn’t read of a single incident where an ependymoma in the thoracic area (as opposed to lower down the spinal cord) had metastasized. As a friend of mine put it, “consider the hammer they’re holding.” A radiation oncologist is more inclined to believe in radiation as a cure; a neurosurgeon is more likely to believe in surgery. Even as I acknowledge that most of the articles I’ve read are by neurosurgeons, I’m choosing to believe that point of view.At my three-month follow-up, my neurosurgeon, in presenting me with the 10% - 20% probability of a recurrence, added, “But that’s long-term; ten, twenty years or more.” He continued, “This is considered a malignant tumor by a lot of people, but we believe we can cure it.” Again, the idea that some doctors – but not others - consider a spinal ependymoma malignant seems to be a matter of perspective: All the articles I had read described it as a slow-growing, benign tumor, with an infrequent tendency to recur. But these articles were written by neurosurgeons. Perhaps neurosurgeons consider it benign because they feel that if they truly get every microscopic bit, they can cure it; it’s understandable that a surgeon would embrace that as a goal. And perhaps a radiation oncologist, who is equipped to tackle malignancies, sees the ependymoma as always ready to grow back, and thus a suitable candidate for radiation even following surgery that is declared a gross total resection. Or maybe I just think too much…7) PainOne final note: If you’re about to undergo the surgery, no doubt you are interested in how painful the process is. I can only speak from my own experience, and here’s how it played out…Prior to the surgery, my only pain was the nightly searing low back wake-up call. Other than that, my symptoms were principally numbness and weakness.Immediately following the surgery in the hospital, I was heavily medicated (morphine at first, which gave me some bad reactions; other narcotics over time). I remember some minor back pain, but mainly – strange as it sounds – I took the medicine to help me deal with the pain of the catheter and the bowel program. Once I got rid of the catheter (my first few days in rehab), I was able to wean myself from the narcotics, which in turn allowed me to go without the bowel program. From then on, I was able to get by on strong doses of conventional painkillers like Ibuprofen and Acetaminophen. The primary pain at that point was in my back, which was sore but not at all unbearable.When I got home I immediately switched to over-the-counter medication: a couple of Advil tablets every eight hours, and extra-strength Tylenol overnight. That continues to be my regimen to date, but my pain has actually gotten worse rather than better over time. Beginning around the third month after surgery, the stiffness in my knees and pain in my ankles from spasticity became a constant source of discomfort; it has yet to improve. My back remains a little sore from time to time, but considering how much time I spend seated (at the piano and computer), the laminectomy has been surprisingly easy on me. I consider that a tribute to my neurosurgeon’s good work, as was his complete removal of a very difficult tumor.--Bill Anschell, January 2006If you click on the "comments" link below, you'll find additional information, including detailed updates on my recovery written seven months, one year, and two (+) years after surgery. posted by Bill Anschell @ 9:27 PM 19 comments Name: Bill Anschell View my complete profile

医学

2014-42/1180/en_head.json.gz/6868

Donor Registry Online Donations Offline Donations Mail to: StopLeukemia.org PO Box 438 Hingham, MA 02043 All donations are tax deductible. Helpful Leukemia Links • Leukemia Facts • The Leukemia and Lymphoma Society • The National Bone Marrow Transplant Link • Cure Magazine follow us: SundayAug072011 Rose M. (Valzania) Cohen My grandmother, Rose M.(Valzania) Cohen died on December 11, 2008 at the age of 96. She was the head of the family and an inspiring, independent presence in our lives. She was born in Italy in 1912 and in 1915 came to this country with her mother and sister on the last ship before the beginning of World War I. They joined her father and lived in New Hampshire. When he died in the flu epidemic of 1918, her mother and the three siblings moved to Dorchester, MA. She came from humble beginnings - the first houses that they lived in were without indoor plumbing or electricity. She attended a one room school house and only completed the 8th grade before she had to go to work to help the family. She married my grandfather in 1936. While he was in Europe during World War II, she worked with her sisters at the retail store the extended family had started in the North End. After the war, they started a family, raised two daughters and moved to Milton, MA where she resided for 58 years. She was very active in the community and in her children’s lives, and was a Girl Scout leader and PTA mother. She loved working outside and took pride in her vegetable and flower gardens. She lost her husband after celebrating their 40th anniversary in 1976. This was a devastating loss, but she was determined to stay independent and to continue living in her house that held their life memories. Over the next 32 years, she returned to work in retail until the age of 90, kept her license and drove until 92, and independently stayed in her house until 96 - only several months before her death. Her health remained good despite her arthritis and back problems. She exercised daily, ate well, cooked for herself and was determined to stay in her house until the end. Unfortunately, at age 95 her years of anemia turned into multiple myeloma. Although this disease had started to weaken her, she was determined not to let it slow her down. She wanted to try a mild treatment of chemotherapy to see if it would slow down the disease. Always positive and never complaining through all the various doctor visits and treatments, it unfortunately failed to slow down the progress of the myeloma. She celebrated her 96th birthday at home and then in September an infection started the downward spiral of her health. Her mind was sharp and her fighting spirit was strong, but her body was weakened by age and disease. She could not recover and passed away with family at her side December 11, 2008. She leaves behind a simple philosophy of life - be the best that you can be and be good to one another. We would like to thank everyone that donated in Grandma Rose's memory. StopLeukemia, Inc. is recognized as a 501(C)(3) tax-exempt charitable organization with the IRS. All donations are deductible for income tax reporting purposes. All Rights Reserved , StopLeukemia.org | info@stopleukemia.org | PO Box 438 Hingham, MA 02043 creative by fantabul.us

医学

2014-42/1180/en_head.json.gz/6875

Driving Ability May Falter With Age in HIV-Positive Adults Small study looked at mental skills, simulator testing FRIDAY, April 4, 2014 (HealthDay News) -- Middle-aged and elderly people with HIV may have deficits in their mental skills that affect their ability to drive, according to a small new study. The study included 26 adults with HIV (the virus that causes AIDS), aged 40 and older, who were given mental performance and driving simulator tests. The level of the virus in the HIV-positive patients' blood did not affect their driving performance, but being older was associated with poorer driving skills and slower visual processing speed, the researchers said. The study was published recently in the Journal of the Association of Nurses in AIDS Care. This area requires further research because by 2015, nearly half of the people with HIV in the United States will be 50 or older, said principal investigator David Vance, associate director of the Center for Nursing Research at the University of Alabama at Birmingham. "Driving is perhaps one of the most [mentally] complex everyday activities, involving the ability to successfully negotiate one's environment on the road by making quick decisions and attending and reacting to various stimuli," he said in a university news release. "The most pronounced and prevalent [mental] deficits in HIV are found in measures of speed and processing -- functions essential to safe driving," Vance said. Although the study found that older HIV-positive people showed signs of impaired driving, it did not prove a cause-and-effect relationship. "Previous research shows 29 percent of adults with HIV have indicated a decreased driving ability. That alone means it's an area that requires further examination," Vance said. The U.S. National Institute of Allergy and Infectious Diseases has more about HIV/AIDS (http://www.niaid.nih.gov/topics/hivaids/understanding/Pages/Default.aspx ). -- Robert Preidt SOURCE: University of Alabama at Birmingham, news release, April 2, 2014

医学

2014-42/1180/en_head.json.gz/6960

New Center for Integrative Health to focus on alternative medicine research, education October 2002 The Health Science Center has opened the doors its new Center for Integrative Health. The center is the first in the area to focus on alternative medicine research and education. Nearly half of all Americans now say they use herbal remedies like St. John�s Wort, Ginseng and Ginkgo biloba. But because herbal substances don�t require U.S. Food and Drug Administration approval, little is known about the possible side effects or drug interactions of the remedies. "Traditionally, alternative therapy has not been a part of medical students' curriculum," said Roberto Villarreal, M.D., M.P.H., director of the center. "However, in recent years, the use of alternative medicines and therapies by the general population has become quite widespread. Doctors and patients need to be aware of how effective, non-effective or harmful some of these alternative medications or therapies can be." Representatives from all five schools of the Health Science Center and local practitioners sit on the center�s advisory board. The general public can access free information in English and Spanish about complementary and alternative therapies from the center's Web site at http://cih.uthscsa.edu/heading.html. Share: More stories: Read current stories Current Issue (PDF) HSC News UT Health Science Center 7703 Floyd Curl Dr. © 2002 - 2014 UTHSCSA Links provided from UTHSCSA pages to other websites do not constitute or imply an endorsement of those sites, their content, or products and services associated with those sites. Updated 7/30/14

医学

2014-42/1180/en_head.json.gz/7089

Chagas Disease Symptoms and Pictures Symptoms of Chagas Disease How is The Disease Transmitted Chagas Disease Chagas Disease This site is devoted towards educating the public, health care professionals, and veterinarians about Chagas disease and its deadly progression. Caused by a parasite, Trypansoma cruzi, a single celled organism that burrows its way into the heart muscle, it is not a disease to be taken lightly, nor is watching someone you love die from the disease a pleasant prospect. In February, 2006 I had never heard of the word, “Chagas” and had no idea that in this day and age of technology and medical advancements, that a disease that causes 50,000 deaths per year and threatens over 120 million at risk people in twenty-one countries could be so “concealed”. My knowledge of the disease and its effects would grow as I slowly and painfully watched my beloved Mastiff’s body become ravaged from the microscopic, single celled parasites as they waged war on his heart, nerves, muscles and brain and left his tissues filled with dead and dying cells. Why Is Learning About This Deadly Blood-Borne Parasite So Important? In Latin America Chagas Disease is the fourth leading cause of death, and as populations of both people and insects migrate, the disease is becoming more prevalent in the United States and a risk to our blood supply. How could it be that in the United States it is largely unknown to the general public? Did you know that our blood supply is not screened for Chagas’ disease, and it is estimated that up to 370,000 patients with Chagas disease reside in the US? No routine testing of donated blood units for the presense of T. cruzi, the organism that causes Chagas, is done by U.S. blood banks. (Update: Back in 2006 when this site was first published, there was no routine screening for Chagas Disease that was done by US blood banks. Now, in 2012, screening is done by a majority of the blood banks, although in the United States, there is still not 100% screening of blood donors for antibodies to Trypansoma cruzi.) At least three cases of Chagas’ disease in the U.S. have resulted from patients receiving Chagas’ infected organs from a Chagas’ positive organ donor, and at least 7 patients have been reported to have been infected by receiving Chagas’ tainted blood transfusions. It is difficult to obtain accurate statistics either on deaths caused by Chagas disease or on infections themselves. Most victims of the disease are unaware that they are even infected, as are their doctors. Testing is rarely done in the US, even in patients with cardiac disease which is one of the leading causes of death in the country. T. cruzi infections are often missed, more than they are diagnosed, both in animals and in humans. Canine Infections At least 400 dogs have died from Chagas disease in Texas, yet these are only the cases that were discovered and reported. How many animals with cardiac disease or heart attacks are actually sent for extended testing following their death? In Texas alone it is estimated that the insects which transmit the disease are infected at a rate of 17-48%. Other states may not even do any testing for the disease in insects, thus it is difficult to say exactly how many insects are positive for the disease in your area. Ask your veterinarian to do a Chagas disease test on your animals, and you will likely be told that it’s “not necessary”. Tell that to Nan whose cheerful, one year old Laborador Retriever, died in their front yard near San Antonio, one morning soon after been diagnosed with Chagas disease. Or perhaps you may not know that Becky and Wendell Oliver’s 3 month old Labrador “went from a bundle of energy to a limp, wheezing wreck in less than 24 hours. After a rushed trip to the vet, the puppy died next to his water bowl in the Oliver’s garage.” The disease destroys the heart muscle and may also target the esophagus, colon and brain. A sonogram done on my Mastiff showed a flabby, overstretched, dilated heart muscle, quivering and fluttering. His heart would try to compensate for the lack of pumping ability by adding in extra beats, then racing out of control. The next few weeks saw my dog age years and even the simple act of going outside became laborious for him. As the disease progressed, each night I’d hear “crackles” in his breathing and have to give diuretics to keep him from drowning in the fluids that were beginning to back up in his lungs. My goals for this site are simple. To bring the disease of Chagas out in the open so that you, the readers of the site, and the public are aware of the disease. My hope is that you’ll gain useful information and will be prepared to protect your home, children, and pets from this disease to the best of your ability. And when the public is armed with additional knowledge, then hopefully there will be a push for better diagnosis and treatments for Chagas’. If we do not act upon this disease soon, my fear is that it will progress to a point where it may be extremely difficult to control. Early detection, vector elimination or reduction, and better testing can only be helpful in a disease of this nature. Please pass this site onto your friends, family and anyone you know who may be interested in spreading the word about Chagas disease. May you never have to experience the pain of losing a loved one to Chagas’. Photo Credits for Logo: Special Thanks to Glen Seplak (gauchocat), photographer extraordinaire, for his photos which I’ve used in the logo for this site. Chagas – Kiss of Death Disease Information (4) How is The Disease Transmitted (1) Reducing Your Risk (1) Symptoms of Chagas Disease (1) © 2014 Chagas. All Rights Reserved. Chagas Disease

医学

2014-42/1180/en_head.json.gz/7092

The four common bioethical principles Respect for autonomy Respect for autonomy The four common bioethical principles The word autonomy comes from the Greek autos-nomos meaning “self-rule” or “self-determination”. According to Kantian ethics, autonomy is based on the human capacity to direct one’s life according to rational principles. He states, “Everything in nature works in accordance with laws. Only a rational being has the capacity to act in accordance with the representation of laws, that is, in accordance with principles, or has a will. Since reason is required for the derivation of actions from laws, the will is nothing other than practical reason.” (In Korsgaard, 2004)Rationality, in Kant’s view, is the means to autonomy. Autonomous people are considered as being ends in themselves in that they have the capacity to determine their own destiny, and as such must be respected. For John Stuart Mill, the concept of respect for autonomy involves the capacity to think, decide and act on the basis of such thought and decision freely and independently. Mill advocated the principle of autonomy (or the principle of liberty as he called it) provided that it did not cause harm to others: “That the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant. ... Over himself, over his own body and mind, the individual is sovereign” (Mill, 1968, p. 73). The principle of not causing harm to others (known as Mill’s “harm principle”) provides the grounds for the moral right of a patient to refuse medical treatment and for a doctor to refrain from intervening against the patient’s wishes. Nevertheless, Mill believed that it was acceptable to prevent people from harming themselves provided that their action was not fully informed. Nowadays, an autonomous decision might be described as one that is made freely/without undue influence, by a competent person, in full knowledge and understanding of the relevant information necessary to make such a decision. It should also be applicable to the current situation or circumstances. Many people see dementia as a humiliating disease involving a deterioration of mental power, the loss of one’s former personality and identity and eventually becoming a burden to others. Many dread the prospect of being deprived of the chance to decide their own fate and thus exercise their right to self-determination. Fears linked to this perception of dementia may include the fear of under-treatment (on the grounds that dementia cannot be cured) and the fear of over-treatment, thereby prolonging the suffering that accompanies dementia (Hertogh and Ribbe, 1996). Self-determination is a central principle in health care, which is gradually moving away from a paternalistic approach towards a more individualistic, client-centred approach where the patient plays a more active role in his/her own health and well-being. Such an approach requires that patients take responsibility for making their own decisions and also that they bear the consequences of those choices. However, it should be borne in mind that not everyone agrees with the emphasis that is currently placed on autonomy. For example, although the Danish Council of Ethics (2003) appreciates individuals taking responsibility for their own lives, it points out that the ideal of personal autonomy is based on extreme individualism and that this viewpoint takes the focus away from the fact that people are always influenced and to some extent dependent on others. They are what they are as a result of interactions with others and a particular history. Similarly, the Finnish National Advisory Board on Health Care Ethics - ETENE - (2001) cautions against concentrating almost exclusively on the principles of autonomy and self-determination. Whilst these principles may serve to protect patients from abuse and give them an active role in their treatment, ETENE states, “…it is important to understand that help for a human being cannot be based on just a single, isolated principle – and far less on its mechanical application. Alongside self-determination, the principles of the common good, community and equity, among others, demand to be taken just as seriously.” Nevertheless, the possibility to exercise some degree of autonomy, through advance consent or refusal of medical treatment and/or care, could be beneficial to many people with dementia. Last Updated: Friday 09 October 2009 Alzheimer Europe gratefully acknowledges the support of the German Ministry of Health for the implementation of the Dementia Ethics Network.

医学

2014-42/1180/en_head.json.gz/7175

I.F.T.: Need for guidance on whole grain, fiber Jeff Gelski ANAHEIM, CALIF. — The 2010 Dietary Guidelines for Americans no doubt will promote the consumption of whole grains and fiber, but the upcoming Guidelines also could enlighten consumers on how fiber content varies in different whole grains. A lot of fiber confusion exists among consumers, said Dr. Theresa A. Nicklas, Ph.D., a professor in the Department of Pediatrics at the Baylor College of Medicine in Houston. She spoke June 7 during the presentation "Fiber: The heart of whole grain" at the Institute of Food Technologists’ annual meeting and food expo in Anaheim. The level of fiber may vary significantly in products containing whole grains, she said. She thus added the creators of the Guidelines for 2010 may want to alter the guidance about eating 3 servings of whole grains a day from the 2005 Guidelines. They may want to consider change it to "fiber-containing whole grains." "This is not my recommendation," said Dr. Nicklas, who served on the 2005 Dietary Guidelines committee. "It’s something I’m throwing out there that they may want to consider." The fiber content of whole grains may vary from 3.4% for brown rice to 17.3% for hulled barley, said another speaker, Dr. Michael Falk, Ph.D., executive director of Life Sciences Research Office, Inc., which is based in Bethesda, Md., and provides scientific analysis and advice to government and industry. Fiber content, the kind of fiber and phytochemical content all vary widely in whole grains, he said. Because of this nutrient variability, the beneficial health effects of one whole grain may not be the same for another whole grain. Such variance makes it difficult to achieve a wide-ranging health claim for whole grains and has implications for national healthy policy and guidelines, Dr. Falk said. A stronger body of evidence for health claims exists with fiber, he said. "If you are focusing on the whole grain part, you may be missing the fiber issue," he said. Dr. Joanne R. Lupton, Ph.D., of Texas A&M University, Texas A&M, professor, said science and government should continue to promote whole grain intake because enough scientific information exists to show independent health effects of both whole grains and fiber. "We should not be putting down whole grains if they are not high in fiber," she said at the I.F.T. session. "Yes, we should be promoting good and excellent sources of fiber, but at the same time we should be promoting whole grains." Dr. Lupton, who served on the 2005 Dietary Guidelines committee, added guidance should focus on obtaining whole grains and fiber from nutrient-dense sources, including high-fiber cereals, legumes, vegetables and fruit. She said the biggest source of fiber from vegetables is french-fried potatoes for Americans while the biggest source of fiber from grain is hamburger buns and hot dog buns. "One is getting a lot of calories along with this," Dr. Lupton said.

医学

2014-42/1180/en_head.json.gz/7182

Search Health Information Sinuses Near Nose Not Just 'Evolutionary Leftover' New study finds they help give nose shape and get air to the lungs more quickly FRIDAY, March 15 (HealthDay News) -- If people think about their sinuses at all, it's usually because they are blocked or infected. But, according to a new study, the so-called maxillary sinuses play an important role in the shape and function of the nose. The findings dispel the long-held belief that these sinuses -- bulbous pouches located on either side of the nose -- are evolutionary leftovers with little useful function in modern humans. In the University of Iowa-led study, researchers studied the faces of 20 people of African origin and 20 people of European origin. The investigators concluded that the maxillary sinuses change their size in order to "allow the nose to change shape without affecting other areas of the face," lead author Nathan Holton, a biological anthropologist, said in a university news release. This is important because different nose shapes evolved based on climate conditions. Among people in colder areas, the nose became narrower and longer in order to better trap air in the nasal passage and warm and moisten it before it reaches the lungs. Among people in warmer regions, the nose is broader and shorter because the air is already warm and moist. The main goal of the nose is to get air to the lungs as quickly as possible, the study authors pointed out in the news release. On average, the maxillary sinuses in the people of European origin were 36 percent larger than those of African origin, in faces of roughly the same size. This is because the narrower noses of Europeans allows more room for maxillary sinuses, the researchers explained. "Essentially, by having these sinuses, that's what allows the nose to change its shape, at least in terms of width and independently from other parts of the face," Holton said. The study was published in the March issue of The Anatomical Record. The Nemours Foundation has more about sinuses and sinus problems. SOURCE: University of Iowa, news release, March 12, 2013

医学

2014-42/1180/en_head.json.gz/7272

Thousands of records may have been lost or damaged at VA hospitals in Buffalo, Batavia Four whistle-blowers initially complained about shoddy record-keeping at the Buffalo VA Medical Center on Bailey Avenue. Harry Scull Jr./Buffalo News file photo , updated May 22, 2013 at 10:21 PM Tweet WASHINGTON – Thousands of patient records at the VA hospitals in Buffalo and Batavia have likely been misplaced or damaged, according to federal officials who have been prodding the facilities to improve their record-keeping.VA officials uncovered the problem after the associate director of the Buffalo medical center initially dismissed worker complaints about shoddy record-keeping, according to officials at the Office of Special Counsel, which presses federal agencies to address complaints brought by whistle-blowers. Four medical records technicians in Western New York “disclosed that medical files – including cardiac records, dental records and Agent Orange registry records – were randomly thrown in boxes rather than kept in any order, that many Social Security numbers were not properly attributed to the correct veteran name, and that mold-infested files were not handled properly to prevent further contamination and to ensure their restoration,” the Office of Special Counsel said. “As a result, veterans’ medical records were often deemed unavailable.” Word of the lost and damaged records, coming just four months after reports that the Buffalo VA hospital potentially exposed hundreds of diabetic patients to contaminated insulin pens, prompted Rep. Chris Collins, R-Clarence, to call for the resignation of Veterans Affairs Secretary Eric Shinseki.“I continue to be outraged” by the VA’s repeated problems, Collins said on Wednesday. “We’re coming up on Memorial Day, and here’s the VA, which is supposed to provide benefits that all of our veterans have earned in protecting our freedom, and what we have here is a bunch of bureaucrats in Washington and the district offices who seem content to collect a paycheck and not serve the public.”While it’s impossible to know exactly how many patient records have been misplaced or damaged, it’s likely that thousands were, said Ann O’Hanlon, a spokesman for the Office of Special Counsel.That’s because the internal VA investigation unveiled systemic problems with record-keeping in Buffalo and Batavia that would have affected not only the records of hospital patients, but also veterans who visited VA facilities for outpatient services, O’Hanlon said.A spokesman for the VA in Buffalo, Evangeline Conley, noted that the hospital system had used electronic medical records since 1997. But that explanation didn’t sit well with O’Hanlon, who noted that the VA did not even mention electronic records in its report of the records problems.“Clearly by the record and their response there were extensive paper records,” she said. “We don’t know how many there are, but there are both paper and electronic records.”In a letter explaining its findings to President Obama, Special Counsel Carolyn N. Lerner said the four local whistle-blowers initially complained about 160 boxes of records, each containing 40 files, that had been stored for at least eight years at the facility in Batavia.While the boxes were labeled according to medical categories such as “Cardiac,” “Dental” and “Agent Orange,” records were actually randomly filed in those boxes. That meant all the boxes had to be searched whenever a doctor wanted to see any one patient’s records. As a result, “the four whistle-blowers personally know of at least 15 instances where veterans’ records were requested and deemed unavailable because the records could not be located,” Lerner wrote.Later, in the midst of a “record retirement project” involving approximately 240 boxes of records, the whistle-blowers found five boxes contaminated with mold.They then told Elizabeth M. Kane, Health Information Management System manager in Buffalo, about the moldy files, and she ordered the workers to put the moldy files in new boxes and ship them to a storage facility in Missouri.Believing that the handling of all those files violated agency rules, the whistle-blowers complained to David J. West, director of VA Health Care Upstate New York Medical Center. In response, on Jan. 27, 2012, West asked Jason Petti, associate medical center director of the VA hospitals in Western New York, to investigate.Later that very same day, Petti informed his boss that he had completed his investigation and that “the review did not substantiate any of the concerns” identified by the whistle-blowers.Exasperated, the whistle-blowers complained to the Office of Special Counsel, which contacted Shinseki, the VA secretary, who asked the undersecretary for health to investigate.“The investigation team substantiated most of the allegations and made seven recommendations regarding the steps that need to be taken” to correct the problem, Shinseki said in a letter to Lerner, the special counsel.Those recommendations include developing a strategic plan for managing patient records, following existing VA policies and procedures, processing all the boxed records stored in Buffalo and Batavia to determine if they need to be electronically scanned and stored and evaluating all on-site record storage locations.The VA then acted on those recommendations, said Conley, the local VA spokesperson.“As a result of this second review, an improvement plan for storage and disposition of records was put in place as well as enhanced training for employees,” Conley said.In addition, the VA’s lawyers gave Kane, the woman in charge of record-keeping, a “written counseling” to make sure she understood the severity of the problems. But the VA exonerated Petti, saying he responded quickly to the problems and provided appropriate oversight – a finding that flabbergasted Collins.“The administrators congratulated him for doing well,” Collins said. “He did anything but.”While Collins demanded Shinseki’s resignation, Rep. Brian Higgins, D-Buffalo, wrote a letter seeking a meeting with the VA secretary.“There is a distinct pattern of mismanagement” at the VA in Western New York, Higgins said. “There are systemic problems that need to be addressed by the VA secretary.”Officials at the Office of the Special Counsel, meanwhile, lauded the four whistle-blowers – Leon Davis III, Cathleen A. Manna, Tracy Harrison and Pamela G. Hess-Wellspeak – for taking the matter into their own hands and demanding change.“They experienced pushback at every level,” O’Hanlon said. “They went out of their way to get someone to look at this issue, but no one would until they came to our office. We really admire their courage and fortitude.”email: jzremski@buffnews.com

医学

2014-42/1180/en_head.json.gz/7328

HomePublic Health Threats and PandemicsH1n1's Teachable Moment Connect With Us: Op-Ed H1N1's Teachable Moment Authors: Peter Navario, Fellow for Global Health, and Scott Rosenstein, Eurasia Group January 11, 2010 Huffington Post Much of the domestic discourse on preparedness for the second wave of H1N1 has focused on the speed with which a vaccine has been produced, which ignores a striking fact: ninety percent of H1N1 vaccine stocks will be distributed to individuals in the U.S., and eleven other wealthy countries, while the rest of the world must make due with the remains. As the 95 poorest countries wait for vaccine donations from the U.S. and elsewhere to arrive, which will only allow them to vaccinate just two percent of their populations, the Netherlands has begun to sell off surplus vaccine stock. This inequality in access has sparked criticism from public health and human rights advocates, who argue that there is an epidemiologic and moral imperative to ensure vaccine availability in poor countries. Though these criticisms may be valid, they fail to address a more politically persuasive point that lack of access to vaccinations in low and middle-income countries imperils domestic public health and national security. Ad hoc vaccine sharing is not only an incomplete strategy for managing global health threats, but it also leaves the U.S. population vulnerable. There are several reasons why it is in the interests of the United States to enhance global vaccine access and pandemic response capacity in low and middle-income countries. First, the current vaccine allocation arrangement ensures that countries with the least capability for managing a pandemic also have the least access to life-saving vaccines and medicines, thereby perpetuating the cycle of illness and poverty in poor countries, and creating fertile ground for new or re-emerging viruses to replicate, mutate and eventually spread back to the United States. Moreover, during a more virulent outbreak, the U.S. could be exposed to broader economic risks due to disruptions to the "just-in-time" global economy. In 2003, the poorly managed SARS outbreak halted travel and trade in Southeast Asia and cost an estimated $50 billion in that region alone. Finally, the majority of vaccines (including H1N1), as well as essential medical supplies such as facemasks and ventilators, are manufactured abroad. A severe pandemic with high rates of illness and death could lead to rampant absenteeism from work, or worse, hoarding in countries that produce and manufacture these goods. The risk of hoarding is increased if there is a persistent perception that wealthy countries act according to narrow self-interest during global health emergencies. Unfortunately, this has already happened. Indonesia has refused to share virus samples and report cases of the deadly H5N1 flu virus to the World Health Organization (WHO) for fear that wealthy countries would use this information to produce costly drugs and sell them back to poor countries at a profit. While the reasoning is severely flawed and endangers the health of people all around the world, it reveals the potential consequences of persistent inequality in access to essential medicines. The H1N1 experience has taught us that a more robust U.S. response must address the inadequate global supply of vaccine during pandemic emergencies, often called "surge capacity," and enhance low and middle-income countries' domestic response capabilities. Work on expanding the supply and domestic production capacity is underway, and the U.S government should continue to support newer production approaches, such as cell-based or DNA-based vaccines, which can help to mitigate current surge capacity shortfalls. To complement these efforts, the U.S. FDA should expedite the review of safety and efficacy data of adjuvant-boosted vaccines. Adjuvants serve as a multiplier, exponentially increasing the number of people who can be immunized by a given amount of vaccine, and they have been extensively tested and used in Europe and Canada safely for years. Contrary to the spurious rhetoric from the anti-vaccine movement, adjuvant use in the U.S. would enable the demand for domestic vaccine to be met rapidly and safely. It would also enhance our ability to supply vaccine to poorer countries. In addition to stimulating vaccine production, the U.S. should devote additional financial and technical resources to building disease surveillance and response capacity in developing countries. Most importantly, the world needs a formal governance mechanism for pandemic emergencies that procures, stockpiles and distributes vaccines and supplies for developing countries to replace the current system of ad hoc donations. The G7 plus Mexico recently met to discuss equitable vaccine distribution; the United States should ensure that such a mechanism is part of ongoing discussions. H1N1 will not be the last or worst pandemic humanity will face. It should therefore serve as a "teachable moment" for the U.S. and other donor nations. Poor countries' inability to manage pandemic emergencies poses a threat to health everywhere. International solidarity on pandemic management guided by enlightened self-interest is not only the right thing to do and good foreign policy, it is essential to ensuring the health and security of the U.S. citizenry. This article appears in full on CFR.org by permission of its original publisher. It was originally available here. More on... Public Health Threats and Pandemics, United States, Pharmaceuticals and Vaccines Non-Therapeutic Use of Antibiotics in Animal Agriculture, Corresponding Resistance Rates, and What Can be Done About It Authors: Laurie Garrett and Kammerle Schneider Laurie Garrett and Kammerle Schneider discuss the use of antibiotics in feed animals, and its contribution to the rise of antibiotic... Must Read George Mason University:Vaccine Prioritization During an Influenza Pandemic Author: George Mason University School of Law The collection of essays focusing on different concerns about vaccine prioritization. Op-Ed How to Keep Ebola Out of Your Neighborhood Author: Laurie Garrett As American politicians encourage the use of fever checks at airports and travel bans to stem the global spread of Ebola, Laurie Garrett... Op-Ed Obamacare May Hold the Key to Saving the U.S. from Ebola The 43.3 million uninsured Americans are the country's greatest vulnerability when it comes to stopping the world's scariest virus. Facebook

医学

2014-42/1180/en_head.json.gz/7345

Children’s Hospital Researchers Find Vitamin D May Treat and Prevent Severe Allergic Response to Common Mold in Patients with Cystic Fibrosis Pittsburgh, PA - August 25, 2010 - Vitamin D may be an effective therapy to treat and even prevent allergy to a common mold that can cause severe complications for patients with cystic fibrosis and asthma, according to researchers from Children’s Hospital of Pittsburgh of UPMC, the University of Pittsburgh School of Medicine and Louisiana State University School of Medicine. Results of the study, led by Jay Kolls, M.D., Ph.D., a lung disease researcher at Children’s Hospital and professor of pediatrics at the University of Pittsburgh School of Medicine, are published in the September 2010 issue of the Journal of Clinical Investigation. Aspergillus fumigatus, is one of the most common airborne molds and while it does not cause illness in the vast majority of those who inhale it, it can cause life threatening allergic symptoms in patients with cystic fibrosis. As many as 15 percent of patients with cystic fibrosis will develop a severe allergic response, known as Allergic Bronchopulmonary Aspergillosis (ABPA). Some patients with asthma also can develop ABPA. The research team led by Dr. Kolls studied cystic fibrosis patients from the Antonio J. and Janet Palumbo Cystic Fibrosis Center at Children’s Hospital who had A. fumigatus infections. One group had developed ABPA, while the other hadn’t. The researchers found that the ABPA patients had a heightened response by immune cells known as type 2 T helper (Th2) cells, and that a protein known as OX40L was critical to this heightened response. The heightened Th2 response correlated with lower levels of vitamin D as compared with the non-ABPA patients. Adding vitamin D to these cells in the laboratory substantially reduced the expression of OX40L and increased the expression of other proteins critical to the development of allergen tolerance. “We found that adding vitamin D substantially reduced the production of the protein driving the allergic response and also increased production of the protein that promotes tolerance,” said Dr. Kolls, who also is professor and chair of genetics at LSU Health Sciences Center New Orleans. “Based on our results, we have strong rationale for a clinical trial of vitamin D to determine whether it can prevent or treat ABPA in patients with cystic fibrosis.” Cystic fibrosis is an inherited chronic disease that affects the lungs and digestive system of about 30,000 children and adults in the United States (70,000 worldwide), according to the Cystic Fibrosis Foundation. A defective gene and its protein product cause the body to produce unusually thick, sticky mucus that clogs the lungs and leads to life-threatening lung infections and obstructs the pancreas and stops natural enzymes from helping the body break down and absorb food. “These important findings by Dr. Kolls’ team add to the growing body of evidence showing that vitamin D may play a critical role on immune responses and allergic diseases,” said Juan Celedón, M.D., Dr.P.H., chief of the Division of Pulmonary Medicine, Allergy and Immunology at Children’s Hospital. Last UpdateAugust 25, 2010 Kolls, Jay, MD Celedon, Juan, C., MD, DrPH Pulmonary Medicine, Allergy & Immunology Cystic Fibrosis Center Search:

医学

2014-42/1180/en_head.json.gz/7349

News Release Shore Medical Center Announces Affiliation with The Cancer Institute of New Jersey (CINJ) Shore’s Cancer Center Becomes the 16th member of the CINJ Network Somers Point, NJ – Shore Medical Center is pleased to announce it has entered into an affiliation agreement with The Cancer Institute of New Jersey - the state’s only National Cancer Institute-designated Comprehensive Cancer Center. Shore and its nationally-recognized Cancer Center become the 16th member of the CINJ Network and the first in Atlantic County to provide patients facing a cancer diagnosis with access to The Cancer Institute of New Jersey’s state-of-the-art clinical and research capabilities. As an affiliate, Shore Medical is able to offer its patients enrollment in Cancer Institute of New Jersey clinical trials while having them receive care and treatment locally at the Somers Point facility. Shore’s patients also will receive access to community education, outreach and other services provided by The Cancer Institute of New Jersey that complement the medical center’s comprehensive cancer program. “Shore is proud to become an affiliate of The Cancer Institute of New Jersey,” said Shore President and CEO Ron Johnson. “This groundbreaking organization has a demonstrated history of clinical and research excellence, so members of our community can feel confident that they are receiving the very best in cancer care. This partnership represents the natural evolution of Shore as the premier cancer care provider in southern New Jersey.” “The Cancer Institute of New Jersey is proud to welcome Shore Medical Center into our statewide network of hospitals that provides patients access to the very latest clinical trials and cancer care right in their own communities,” said Cancer Institute of New Jersey Director Robert S. DiPaola, M.D. “Shore’s Cancer Center has distinguished itself as a leader in providing exceptional cancer care, and we look forward to working closely with the Shore team in delivering cutting-edge therapies to patients in southern New Jersey and beyond.” One third of all newly diagnosed cancer patients in New Jersey choose The Cancer Institute of New Jersey or one of its affiliate hospitals for treatment. “Through this affiliation with the state’s National Cancer Institute-designated Comprehensive Cancer Center, I am pleased that we are expanding our exceptional cancer resources to the southern part of our state,” said New Jersey Health Commissioner Mary E. O’Dowd, M.P.H. “By pairing Shore’s cancer program with The Cancer Institute of New Jersey’s vast clinical and research capabilities, residents in this region will now have access to a wider array of cancer care resources.” As one of Shore Medical Center’s six Centers of Excellence, the Cancer Center’s state-of-the-art radiation and medical oncology programs, under the respective direction of Dr. Vasthi Wilson and Dr. Julianne W. Childs, enable patients to receive all of their care and treatment under one roof. Since 1987, the Cancer Center has been recognized by the American College of Surgeons Commission on Cancer for meeting that organization’s stringent standards for patient care. The Cancer Center at Shore Medical Center was conceived, designed and built specifically to support the special needs of cancer patients, their families and friends. It represents the new face of 21st century cancer care, featuring a comprehensive approach combining exceptional clinical treatment with patient comfort and convenience. A highlight of the Cancer Center’s multi-disciplinary approach to patient care is the weekly roundtable sessions which bring together surgeons, oncologists, radiologists, nurses and nurse navigators to determine a patient’s best treatment plan. In July of 2012, the Cancer Center introduced the Advanced Pulmonary Diagnostic Center. Under the direction of leading pulmonologist Dr. Bennett Ojserkis, it is the first center in southern New Jersey to address the growing number of patients being diagnosed with lung nodules and abnormal findings in the chest. The center offers a one-stop approach to providing patients with a fast, convenient, comprehensive and minimally invasive way to have their nodules evaluated and monitored by the region’s most passionate and highly skilled pulmonary team. “As the Cancer Center grows, we are committed to exploring every avenue in order to provide the best possible care for our patients and their families,” said Cancer Program Administrative Director Donna Cericola, B.S.N., R.N., O.C.N. “In The Cancer Institute of New Jersey, we have found a partner perfectly aligned with our patient-centered philosophy, and are excited about the future of cancer care in our region.” The affiliation became effective late last month. About Shore Medical Center At Shore Medical Center, kindness complements an extraordinary level of clinical sophistication. Our people are the foundation of this modern medical center where advanced technology harmonizes with compassionate care. Shore Medical Center attracts the area’s best physicians, nurses and clinicians. It is also the most favored among these professionals for their own personal healthcare needs. Shore Medical Center is home to six Centers of Excellence for Cancer, Cardiovascular, Neurosciences, Spine and Orthopedic, Emergency and Maternity and Pediatric care. Our passion drove us to develop affiliations with Penn Medicine, the Cancer Institute of New Jersey, Onsite Neonatal Partners and Advanced Radiology Solutions, become a member of The Jefferson Neuroscience Network and have physicians on staff from the Rothman Institute. Shore opened its Pediatric Care Center, the first of its kind in New Jersey, in July of 2011 and its state-of-the-art Surgical Pavilion and Campus Expansion in September of 2011. The Shore Medical Center Foundation creates and implements dynamic philanthropic programs that support the mission of Shore Medical Center. The Cancer Institute of New Jersey (www.cinj.org) is the state’s first and only National Cancer Institute-designated Comprehensive Cancer Center dedicated to improving the detection, treatment and care of patients with cancer, and serving as an education resource for cancer prevention. Physician-scientists at The Cancer Institute of New Jersey engage in translational research, transforming their laboratory discoveries into clinical practice, quite literally bringing research to life. The Cancer Institute of New Jersey is a Center of Excellence of the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School. The Cancer Institute of New Jersey Network is comprised of hospitals throughout the state and provides the highest quality cancer care and rapid dissemination of important discoveries into the community. Flagship Hospital: Robert Wood Johnson University Hospital. System Partner: Meridian Health (Jersey Shore University Medical Center, Ocean Medical Center, Riverview Medical Center, Southern Ocean Medical Center, and Bayshore Community Hospital). Major Clinical Research Affiliate Hospitals: Carol G. Simon Cancer Center at Morristown Medical Center, Carol G. Simon Cancer Center at Overlook Medical Center, and Cooper University Hospital. Affiliate Hospitals: CentraState Healthcare System, JFK Medical Center, Robert Wood Johnson University Hospital Hamilton (CINJ Hamilton), Shore Medical Center, Somerset Medical Center, The University Hospital/UMDNJ-New Jersey Medical School*, and University Medical Center of Princeton at Plainsboro. *Academic Affiliate

医学

2014-42/1180/en_head.json.gz/7404

Cleveland Clinic wins raves as an innovator Blog Entry: December 27, 2012 10:59 AM | Author: SCOTT SUTTELL Even institutions at the very top of their field have room to innovate significantly.Case in point: The Cleveland Clinic, which “is gaining new renown for innovation in improving the quality of care while holding down costs,” according to this editorial from The New York Times.“In its most fundamental reform, the Clinic in the past five years has created 18 “institutes” that use multidisciplinary teams to treat diseases or problems involving a particular organ system, say the heart or the brain, instead of having patients bounce from one specialist to another on their own,” the newspaper writes.On a recent visit to the Clinic, The Times says, its staff observed a team of a neurosurgeon, a neurologist, a neuroradiologist, a neurologist with advanced training in intensive care, a physical and rehabilitation doctor, a medical resident, a physical therapist and a nurse.“As they made rounds from patient to patient, they had a portable computer that displayed electronic medical records so that the whole team could see how the patient was doing and plan the course of care for the day,” according to The Times. “This team approach can improve the quality of care because all the experts are involved in deciding the best treatment option, which can save time and money.”As others have pointed out, the Clinic “ has strong leverage to drive such reforms because its staff physicians are salaried and are granted only one-year contracts and subjected to annual performance reviews.” The Times says the Clinic also sets the pace in data analysis to evaluate how well treatments work.“For instance, the Clinic analyzed outcomes for heart surgery patients and found that those who had received blood transfusions during surgery had higher complication rates afterward and a lower long-term survival rate,” according to the editorial. “As a result, it has adopted strict guidelines that limit the use of transfusions.”The Clinic's progress in restructuring itself, says Michael Porter, a Harvard professor who analyzes health care delivery and organizational change, is “light speed” compared with other institutions. He tells The Times that the Clinic is “a model of where we need to go. Not perfect, not done, but far along.” It's only fair, after linking yesterday to a CNNMoney.com list that named Cleveland-based Cliffs Natural Resources Inc. as one of the worst-performing Fortune 500 stocks of 2012, to follow up with a link to this Barrons.com post that notes the mining company is having a nice end to a tough year.Cliffs led the Standard & Poor's 500 index on Wednesday, and the price has risen 18% in December, according to Barrons.com. (Even with the late-year bounce, though, Cliffs is still off 42% this year.)One reason for Cliffs' decline is concern about China's economy, Barrons.com notes, but “the good news is that China's slowdown won't last forever. When it awakens, so will the sector.”And the website points out that Cliffs pays dividends exceeding 5%. “That means you'll be paid while you wait for the rebound,” according to the post. Microsoft, with its new Windows 8 operating system and Surface tablet to sell, opened 51 retail stores in 2012, and its next batch of six stores will include one at Beachwood Place in Beachwood.Jonathan Adashek, Microsoft's general manager of communications and strategy, announced on the company's official blog that the first new stores in 2013 will be in malls in Beachwood, Miami, Salt Lake City, San Antonio, San Francisco and St. Louis. (Microsoft currently has just a kiosk in the Beachwood mall.)“We look forward to opening the doors of these stores, and many others, where our direct connection with customers will be built one interaction and one relationship at a time,” Mr. Adashek wrote.No details yet on store opening dates. Forbes.com generally takes a dim view of Cleveland in its various lists — jobs here are scarce, all our houses are in foreclosure, the air is filthy, etc. — so here's your chance to take a dim view of Forbes.com.Eagle-eyed reader Ken Prendergast, executive director of All Aboard Ohio, an advocacy group for rail travel in the state, points out that the website's data page includes the following description of our city:Cleveland is home to several industries, including household cooking equipment, textiles, furniture, pharmaceuticals, chemicals and automotive parts. Cleveland State Community College and Lee University are also based in Cleveland. Cleveland is the location for the corporate headquarters of Life Care Centers of America, the largest privately held nursing facility company in the U.S. Its location provides numerous tourist attractions including whitewater rafting, mountain climbing and shopping within the urban parts of town.That doesn't sound like the Cleveland you know, does it? Well, it would if the Cleveland you knew was Cleveland, Tenn., which is indeed home to Cleveland State Community College, Lee University, Life Care Centers of America and other institutions.Sounds like a fun place. It's just not our place.You also can follow me on Twitter for more news about business and Northeast Ohio.

医学

2014-42/1180/en_head.json.gz/7505

Home Health & Wellness A-Z Health & Wellness A-Z Health & Wellness A-Z Health Illustrated Encyclopedia Multimedia - multimedia Search Health Information Head injury If you do not see our video content, you need to install an updated Flash Player. The latest Flash Player 9,0,115,0 is available for download @ adobe.com. You've fallen and hit your head. It hurts a little, but you're not bleeding and you feel okay. Do you have a head injury, or are you fine? Knowing how to tell a minor head injury from a serious one could literally save your life. Let's talk about head injuries. Millions of people get head injuries every year. They get into car accidents or fights, they fall, or they get hit in the head while playing sports or working on the job. Most head injuries are minor, because your head comes equipped with its own natural hard hat, a protective skull that surrounds and protects your brain. But sometimes that protection isn't enough. More than a half-million people each year get head injuries severe enough to send them to the hospital. The most common type of head injury is a concussion. That's when a hit in the head makes your brain jiggle around in your skull. You can also get a bruise on your brain, called a contusion. Brain contusions are a lot more serious than bruises from a bump on the arm or leg. Other types of head injuries include a fractured skull or a cut on your scalp. If you get hit in the head or fall and you don't bleed, you've got a closed head injury. If an object enters your brain, like glass from a windshield during a car accident or a bullet from a gunshot, then you have an open head injury. It can be very hard to tell if you've got a minor closed head injury or a serious one. Your head might look perfectly fine from the outside, when you actually have bleeding or swelling inside your brain. To tell the difference, look for other signs of a serious head injury, such as a severe headache; Clear or bloody fluid coming from your nose, ears, or mouth; Confusion, drowsiness, or a loss of consciousness; Changes in the way you hear, see, taste, or smell; memory loss; mood changes or strange behaviors; slurred speech or recurrent vomiting. If you or someone else has any of these symptoms, call for medical help right away. If you don't have these symptoms and you think it's just a minor head injury, you probably don't need to be treated. Just ask a friend or family member to keep an eye on you. If it's your child or someone else with the head injury, wake them up from sleep every 2 or 3 hours to ask questions like, "Where are you?" and "What's your name?" just to make sure they're alert. If you're in any doubt about whether a head injury is serious, play it safe and get medical help. To play it even safer, protect your head during any activities that could lead to an injury. Wear a helmet whenever you skateboard, roller skate, ski, snowboard, or ride a bike or motorcycle. Put on your seatbelt whenever you're in the car. And put kids in an age-appropriate car seat or booster seat.

医学

2014-42/1180/en_head.json.gz/7547

Contact: Keely Savoie ksavoie@thoracic.org COPD? Eat your veggies You know it's good for you in other ways, but could eating your broccoli also help patients with chronic lung disease? It just might. According to recent research from Johns Hopkins Medical School, a decrease in lung concentrations of NRF2-dependent antioxidants, key components of the lung's defense system against inflammatory injury, is linked to the severity of chronic obstructive pulmonary disease (COPD) in smokers. Broccoli is known to contain a compound that prevents the degradation of NFRP. The findings were published in the second issue for September of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society. COPD is the fourth-leading cause of death in the U.S. and affects more than 16 million Americans. In this study, researchers examined tissue samples from the lungs of smokers with and without COPD to determine if there were differences in measured levels of NRF2 expression and the level of its biochemical regulators, including KEAP1, which inhibits NRF2, and DJ-1, which stabilizes it. Dr. Biswal had previously shown that disruption in NRF2 expression in mice exposed to cigarette smoke caused early onset of severe emphysema. When compared to non-COPD lungs, the lungs of patients with COPD showed markedly decreased levels of NRF2-dependent antioxidants, increased oxidative stress markers, a significant decrease in NRF2 protein with no change in NRF2 mRNA levels (indicating that it was expressed, but subsequently degraded), and similar KEAP1 levels, but a marked decrease in the level of DJ-1. "NRF2-dependent antioxidants and DJ-1 expression was negatively associated with severity of COPD," wrote principle investigator, Shyam Biswal, Ph.D., an associate professor in the Bloomberg School's Department of Environmental Health Sciences and Division of Pulmonary and Critical Care at the Johns Hopkins School of Medicine. "Therapy directed toward enhancing NRF2-regulated antioxidants may be a novel strategy for attenuating the effects of oxidative stress in the pathogenesis of COPD." While clinical trials to date of antioxidants have been disappointing in improving the clinical course of patients with COPD, this study points to a possibility of benefit from restoring NRF2 levels in damaged lungs by reducing the action of KEAP1, which is an inhibitor of NRF2. "[I]ncreasing NRF2 may also restore important detoxifying enzymes to counteract other effects of tobacco smoke," wrote Peter Barnes, D.M., of the National Heart and Lung Institute in London, in the accompanying editorial. "This has been achieved in vitro and in vivo by isothiocynate compounds, such as sulforaphane, which occurs naturally in broccoli and [wasabi]." Sulforapane has been shown to be able to restore antioxidant gene expression in human epithelial tissue in which DJ-1 has been reduced. Isothicyanate compounds such as that found in broccoli inhibit KEAP1, and thus prevent it from degrading NRF2, according to Dr. Barnes. "Future studies should target NRF2 as a novel strategy to increase antioxidant protection in the lungs and test its ability to decrease exacerbations and improve lung function in patients with COPD," concluded Dr. Biswal. John Heffner, MD, past president of the ATS, commented that "mounting evidence over several decades underscores the importance of oxidant-mediated damage for the development of COPD in addition to other lung diseases. This study adds greater precision to our understanding of the specific antioxidants that may protect the lung against emphysema to allow clinical trials based on valid pathophysiologic principles."

医学

2014-42/1180/en_head.json.gz/7548

Contact: Nancy Solomon solomonn@slu.edu Commentary: Obese pregnant women should gain less weight than currently recommended Saint Louis U. obstetrician criticizes new guidelines in medical journal ST. LOUIS -- Recent recommendations by the Institute of Medicine (IOM) call for women who are overweight or obese to gain more weight than they should, a Saint Louis University obstetrician wrote in a January commentary for Obstetrics & Gynecology. Joined by several colleagues, Raul Artal, M.D., chair of the department of obstetrics, gynecology and women's health at Saint Louis University, who has conducted extensive research on weight gain during pregnancy, did not endorse the IOM's May 2009 recommendation. The IOM, a non-governmental, independent, nonprofit organization, provides advice that is designed to improve health to national decision makers and the public. "The recently published IOM recommendations for gestational weight gain are virtually identical to those published in 1990 with one exception: obese women are now recommended to gain 11-20 pounds compared to the previous recommendations of at least 15 pounds," Artal said. "Recommending a single standard of weight gain for all obese classes is of concern since higher BMI levels are associated with more severe medical conditions and have long-term adverse health implications." Artal recommended obese women eat a nutrient-rich diet of between 2,000 and 2,500 calories a day, which would cause them to cap their weight gain at 10 pounds, and in some cases, lose weight. Under a doctor's guidance, he said, obese pregnant women can safely engage in physical activities and modify their diets to successfully limit their weight gain with no harmful effects on the fetus. When obese women reduce the amount of weight they gain, they also cut their risk of developing complications such as gestational diabetes and preeclampsia. By contrast, obese women who gain too much weight increase their risk of developing these conditions who affect both mother and fetus. Artal called excessive weight gain during pregnancy a significant contributor to the obesity epidemic. "Excessive gestational weight gain has been implicated in an intergenerational vicious cycle of obesity as overweight and obese mothers give birth to big daughters who are more likely to become obese themselves and deliver large infants," he said. Pregnancy is an ideal time for women who are obese to exercise and watch what they eat, Artal said. These lifestyle changes are safe and carry benefits that last long after they have given birth, Artal added. "Similar to smoking cessation programs, pregnancy provides a unique and ideal opportunity for behavior modifications given high motivation and enhanced access to medical supervision," he said. "Limited weight gain in obese pregnant women has the added potential for setting the foundation for a healthier lifestyle over a woman's lifespan." Artal led the team of obstetricians who drafted the American College of Obstetricians and Gynecologists' guidelines for exercise during pregnancy. He was joined in writing the commentary by Charles Lockwood, M.D., chair of the department of obstetrics, gynecology and reproductive sciences at Yale University School of Medicine and Haywood Brown, M.D., chair of obstetrics and gynecology at Duke University Medical Center. Popularly known as "The Green Journal," Obstetrics & Gynecology is the official publication of the American College of Obstetricians and Gynecologists. Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first medical degree west of the Mississippi River. The school educates physicians and biomedical scientists, conducts medical research, and provides health care on a local, national and international level. Research at the school seeks new cures and treatments in five key areas: cancer, infectious disease, liver disease, aging and brain disease and heart/lung disease.

医学

2014-42/1180/en_head.json.gz/7702

Atlanta Hearing Associates Atlanta: (770) 574-4819Decatur: (404) 549-6788 FAQ's HearingResources How Hearing Works HearingAids Lyric Widex Hearing and Ear Protection Ringing In TheEars OurAudiologists Joy Pritchett, Au.D. Carmen Wright, Au.D. Rita Chaiken, Au.D. Susie Fages, M.S. Melissa Wikoff, Au.D. Stephanie Collins, Au.D. Top TenReasons OurLocations What is a cochlear implant? A cochlear implant is a small, complex electronic device that can help to provide a sense of sound to a person who is profoundly deaf or severely hard-of-hearing. The implant consists of an external portion that sits behind the ear and a second portion that is surgically placed under the skin (see figure). An implant has the following parts: A microphone, which picks up sound from the environment. A speech processor, which selects and arranges sounds picked up by the microphone. A transmitter and receiver/stimulator, which receive signals from the speech processor and convert them into electric impulses. An electrode array, which is a group of electrodes that collects the impulses from the stimulator and sends them to different regions of the auditory nerve. An implant does not restore normal hearing. Instead, it can give a deaf person a useful representation of sounds in the environment and help him or her to understand speech. A cochlear implant is not an easy fix to loss of hearing, it involves intense auditory therapy to be successful. How does a cochlear implant work? A cochlear implant is very different from a hearing aid. Hearing aids amplify sounds so they may be detected by damaged ears. Cochlear implants bypass damaged portions of the ear (the outer and inner hair cells) and directly stimulate the auditory nerve. Signals generated by the implant are sent by way of the auditory nerve to the brain, which recognizes the signals as sound. Hearing through a cochlear implant is different from normal hearing and takes time to learn or relearn. However, it allows many people to recognize warning signals, understand other sounds in the environment, and enjoy a conversation in person or by telephone. A cochlear implant recipient will periodically need to have adjustments made to the device. Cochlear implant mapping (the programming and adjusting of the cochlear implant) is performed by an audiologist who specializes in cochlear implants. Who gets cochlear implants? Children and adults who are deaf or severely hard-of-hearing can be fitted for cochlear implants. According to the Food and Drug Administration (FDA), at the end of 2006, more than 112,000 people worldwide had received implants. In the United States, roughly 23,000 adults and 15,500 children have received them. Adults who have lost all or most of their hearing later in life often can benefit from cochlear implants. They learn to associate the signal provided by an implant with sounds they remember. This often provides recipients with the ability to understand speech solely by listening through the implant, without requiring any visual cues such as those provided by lipreading or sign language. Cochlear implants, coupled with intensive postimplantation therapy, can help young children to acquire speech, language, and social skills. Most children who receive implants are between two and six years old. Early implantation provides exposure to sounds that can be helpful during the critical period when children learn speech and language skills. In 2000, the FDA lowered the age of eligibility to 12 months for one type of cochlear implant. How does someone receive a cochlear implant? Use of a cochlear implant requires both a surgical procedure and significant therapy to learn or relearn the sense of hearing. Not everyone performs at the same level with this device. The decision to receive an implant should involve discussions with medical specialists, including an experienced cochlear-implant surgeon. The process can be expensive. For example, a person's health insurance may cover the expense, but not always. Some individuals may choose not to have a cochlear implant for a variety of personal reasons. Surgical implantations are almost always safe, although complications are a risk factor, just as with any kind of surgery. An additional consideration is learning to interpret the sounds created by an implant. This process takes time and practice. Speech-language pathologists and audiologists are frequently involved in this learning process. Prior to implantation, all of these factors need to be considered. What does the future hold for cochlear implants? With advancements in technology and continued follow-up studies with people who already have received implants, researchers are evaluating how cochlear implants might be used for other types of hearing loss. NIDCD is supporting research to improve upon the benefits provided by cochlear implants. It may be possible to use a shortened electrode array, inserted into a portion of the cochlea, for individuals whose hearing loss is limited to the higher frequencies. Other studies are exploring ways to make a cochlear implant convey the sounds of speech more clearly. Researchers also are looking at the potential benefits of pairing a cochlear implant in one ear with either another cochlear implant or a hearing aid in the other ear. Where do I go for help? If you or a loved one feel you may benefit from cochlear implant technology, or would like additional information, please contact your physician for a referral to be tested at our clinic. We do pre-testing to determine if you are a candidate to be seen by a cochlear implantation center. The closest implantation centers to our area are in Salt Lake and Boise. We are fortunate to now have a cochlear implant mapping center at Idaho State University in Pocatello, Idaho, allowing patients to have their adjustments done more locally. It has been our pleasure to allow ISU to make special arrangements to use our facility to service local cochlear implant patients. For more information or to schedule an appointment please contact us at 208-529-1514. state of the art treatments procedures for better health Schedule testing and Audiology Services Atlanta Hearing Associates - Dunwoody/Sandy Springs 1713 Mt. Vernon Road, Suite 3, Atlanta, GA 30338 (770) 574-4819 http://hearatlanta.com Atlanta Hearing Associates - Toco Hills/Emory 1991 N. Williamsburg Dr., Suite A, Decatur, GA 30033 (404) 549-6788 Hearing Associates - Lake Sinclair 111 Field Stone Dr., Suite 106, Milledgeville, GA 31061 (478) 387-4186 http://oconeehearingassociates.com Hearing Associates - Lake Oconee 1051 Parkside Commons, Suite 103, Greensboro, GA 30642 (706) 623-4425 http://oconeehearingassociates.com Atlanta Hearing Associates © 2013 Privacy Policy Powered By EducatedPatients.com

医学

2014-42/1180/en_head.json.gz/7717

Healthcare Law Opponents Are Conceding President Obama's re-election and the Senate remaining under Democratic control have dashed Republican hopes of axing the healthcare law, observers said. While maintaining that fully implementing the Affordable Care Act will be disastrous, the law's opponents finally are acknowledging it will, in fact, go into effect, The Hill reported. "Repeal of the whole thing, I just don't see now how that's possible," said Grace-Marie Turner, president of the Galen Institute, a conservative healthcare think tank. States, meanwhile, face a Nov. 16 deadline to tell the Obama administration whether they plan to run part of their own health insurance programs, the new state-based marketplaces that will make available subsidies for low- and middle-income individuals and small businesses to buy coverage. Eventually, states also will have to decide whether they'll accept a larger expansion of Medicaid that would include a liberal match from the federal government along with the requirement that states kick in some of their own money, Politico said. While most Republican states said they were waiting for the elections before making a formal decision, a number have been quietly planning to run their own if options for the ACA's demise ran out. "I think you'll see a large number of states that have been waiting to begin to move more aggressively to implement," said David Merritt, managing director at Leavitt Partners, which advises GOP-led states on exchange implementation. So far, 13 states and the District of Columbia have told the Department of Health and Human Services they plan to control their own exchanges. Two-thirds of states could be ready to run at least part of an exchange when they open for enrollment in October, Joel Ario, former HHS director of exchange planning, told Politico. At least five GOP governors have rejected setting up their own exchange. "My best guess is that every other state is in some state of preparedness," Ario said, including states where governors have been outspoken against the law. Plenty of questions remain on key rules governing exchanges, benefits health plans must cover, employer requirements and the Medicaid expansion, Politico said. Stakeholders, including health insurers, also face tight deadlines to prepare for core coverage expansions and consumer protection to go into effect in 2014. "We're hoping to see proposed rules as soon as possible," said Justine Handelman, vice president of legislative and regulatory policy for the Blue Cross and Blue Shield Association. "We're now less than a year from open enrollment." Source: Copyright United Press International 2012 Governors Accept Obamacare, Despite GOP Rhetoric Covered California Begins Renewals for 1.1 Million Westgate Resorts Joins $10 Wage Trend Dems See Senate Hopes in South Jobs, the Debate That Candidates Fear the Most Are Health Waivers Too Complicated to Claim?

医学

2014-42/1180/en_head.json.gz/7780

Healthcare // Patient Tools 4/2/201205:10 PMMarianne Kolbasuk McGeeNewsConnect Directly1 CommentComment NowLogin50%50% Mobile App Helps Consumers Shop For HealthcareCastlight Health mobile app lets consumers use their smartphones to look up cost and quality information about their healthcare providers, an especially helpful tool for patients with high-deductible plans. Is That Healthcare Website Making You Sick? (click image for larger view and for slideshow) For a lot of patients, just the thought of asking their doctor how much a check-up, X-ray, or lab work costs can feel awkward. But a new mobile app makes it easy for many patients to find that information without confronting their doctors or their staff. Castlight Health, which provides an online shopping platform for healthcare, recently introduced a new mobile app that lets consumers use their smartphones to access healthcare pricing and quality data about their providers. Castlight Mobile is available as a native application on Apple iOS and Google Android devices, and is also accessible to Blackberry and other smartphone users via an optimized mobile Web offering. The application is free to all employees of Castlight's employer customers. Those customers include Regis Corp., which operates 8,000 corporate-owned hair salons, including Supercuts, nationwide. Regis in March rolled out Castlight, which employs 50,000 workers in the U.S., including 17,000 full-time employees who are eligible for health benefits. [ Read 11 Telemedicine Tools Transforming Healthcare. ] Most of Regis Corp.'s health plans from Aetna have high deductibles, ranging from $2,500 to $5,000, while the average Regis employee is 27 years old and female, said Allison Brown, Regis' director of employee services. Although many of those employees work in salons, others are field managers who often are on the road. "When someone has an illness or an accident when they're away from home, panic sets in," said Brown. The mobile app allows Regis' traveling employees to use their smartphones to find providers in their health plan network who are located near their hotel and "gives them cost information, and a map and play-by-play directions to get there," she said. "It's been really helpful." The mobile app is also convenient for employees in other industries, including field salespeople, grocery clerks, truckers, and manufacturing workers, who are often on the road or don't have desk jobs providing easy access to computers or the Web, said Ethan Prater, VP of products at Castlight, a venture-backed company whose investors include the Cleveland Clinic and Morgan Stanley Investment Management. Castlight has an interesting family tree. The San Francisco-based company was co-founded in 2008 by CEO Dr. Giovanni Colella, who also co-founded RelayHealth, which was acquired by McKesson. Castlight's other co-founder was Todd Park, former chief technology officer of the U.S. Dept. of Health and Human Services, who was recently named CTO of the U.S., replacing the nation's first CTO, Aneesh Chopra. The "secret sauce" of Castlight's offering is the company's "data sources," including employer healthcare claims, data about negotiated rates, and quality data from centers of excellence, on which Castlight applies algorithms to calculate cost and quality information about providers, said Prater. The company provides its services to self-insured employers, including companies in the retail, manufacturing and financial services industries, who often offer employees high-deductible health plan choices, he said. This "healthcare transparency" is delivered to Castlight's client's employees via a Web-based portal that allows consumers to shop for healthcare and make their choices based on quality ratings of healthcare providers in their networks, as well as cost information, such as out-of-pocket expenses. For many Castlight clients such as Regis, the service replaces stodgy, static books that were mailed to employees annually to inform them about providers in their health plan networks. But even that information didn't contain price data, said Brown. "When people go into their doctor's office for a routine annual check-up, there are often services, like tests that show up as itemized costs on their bills later, and some of those things aren't covered," said Brown. The Castlight service allows Regis employees to check out this cost information for tracking their out-of-pocket expenses before making an appointment. The mobile app can help Regis workers find healthcare info on the fly when they're ill and looking for care from providers who might include nearby retail or workplace clinics. "The information is easy to find and easy to use for a lay people," she said. Regis is in the midst of rolling out wireless networks in its salons nationwide so employees can have easier access to this health information from work, she said. Some Regis employees already have been saving out-of-pocket costs by using Castlight's services, Brown said. That includes one employee whose doctor billed her a higher fee than what was listed for that doctor on the Castlight portal. The employee successfully requested a fee correction from the doctor's office, she said. Castlight is helping Regis employees be more educated healthcare consumers by filling an information gap, Brown said. "Doctors often can't talk about price," she said. And at the same time, "there's something about doctors' white coats that have patients saying yes to everything," she said. The 2012 InformationWeek Healthcare IT Priorities Survey finds that grabbing federal incentive dollars and meeting pay-for-performance mandates are the top issues facing IT execs. Find out more in the new, all-digital Time To Deliver issue of InformationWeek Healthcare. (Free registration required.) CISUS000, re: Mobile App Helps Consumers Shop For Healthcare it's Park. Todd Park. You probably want to spell his name right, you being IT experts and him being CTO of the USA and all.

医学

2014-42/1180/en_head.json.gz/7886

Scottsdale woman gets implanted, invisible hearing aid Pilar Arias/KTAR | December 24, 2012 @ 7:48 am TUCSON, Ariz. - LoriAnn Harnish, 53, of Scottsdale has become the first person in the Southwest to get an implanted and invisible hearing device called Esteem. Harnish suffered from hearing loss since she was five years old. She wore hearing aids for many years but often times they would cause irritation and infection. Dr. Abraham Jacob, an associate professor from the University of Arizona Department of Surgery Division of Otarlaryngology said Harnish received the surgically implanted device on Sept. 27. "With this device your hearing can be on potentially at night, if you jump in the swimming pool, if you get in the shower," Dr. Jacob said. "The device can not only be left on for 24 hours but has an adjustable volume. The battery needs to be replaced every five to nine years, depending on the amount of use." According to Dr. Jacob, the device uses a person's own ear as a microphone, picking up sounds through the ear canal and using the body's natural anatomy to reduce the background noise, distortion and acoustic feedback that people experience with conventional hearing aids. It also addresses several sources of dissatisfaction with conventional hearing aids such as discomfort and being unable to wear them around water. With the growing number of older Americans, Dr. Jacob said Esteem could improve the lives of many with hearing impairment, like it did with Harnish. Dr. Jacob said she enjoys the device so much that she's planning on having surgery on her other ear within the year. Insurance companies in Arizona do not currently cover Esteem, but Dr. Jacob believes with sufficient pressure from patients hopefully they will soon.

医学

2014-42/1180/en_head.json.gz/7942

How to Cut Your Child's Asthma Risk By Reuters Health Incense burning tied to asthma risk in some kids Study calls antibiotic-asthma link into question EU backs stroke prevention drug despite 256 deaths Other Treatments for Allergic Rhinitis Pollution, pets, too little vitamin D or even too many hamburgers can raise your child's risk of breathing problems. We compiled the latest breakthroughs to help you prevent attacks... Kids’ ER visits for asthma rise with air-pollution levelsAs daily levels of ozone and pollutants from vehicle exhaust climb, so do children’s emergency-room visits for asthma attacks, according to a 2010 study published in the American Journal of Respiratory and Critical Care Medicine.Researchers at Emory University in Atlanta used detailed air-quality data to look at the relationship between daily pollution fluctuations and the number of children seen at city ERs for asthma attacks. In general, the rate of ER visits rose along with increases in ground-level ozone and certain pollutants directly released from motor vehicles, including carbon monoxide and certain types of fine particles small enough to be inhaled deeply into the lungs. Ground-level ozone forms when sunlight reacts with pollutants from cars, factories and other sources, and is the main component of smog. Ozone levels are typically highest in the summer.Studies like this could help in refining local color-coded systems used to alert the public as to whether the day’s air quality is “good,” “moderate,” unhealthy for people with lung disease or other chronic conditions, or potentially unhealthy for all, according to epidemiologist Matthew J. Strickland, Ph.D., an assistant professor in Emory’s Department of Environmental Health.The study also found that the link was stronger during warmer months than colder ones. One explanation, Strickland said, is that the absolute concentrations of certain pollutants were higher in warmer weather; another is that kids typically spend more time outside during warmer months.For parents, the bottom line is that they should be aware that air quality can affect their children’s asthma. “I would encourage parents to pay attention to the local air-quality index,” Strickland said. Children with a history of asthma flare-ups during high-pollution days may be better off staying inside when levels are in the unhealthy zone.Local news outlets generally provide daily air-quality indices; they’re also available on the government Web site AIRNow. Dogs plus pollutants may raise risk in kidsKids who grow up with a dog in the house may be at higher risk of developing asthma if they’re also exposed to secondhand smoke or nitrogen dioxide, according to research published in the June 2010 European Respiratory Journal.Children exposed to the toxic gas and to dog allergen during their first year of life were nearly five times as likely to have asthma at age 7 compared to kids with neither exposure, while dog allergen plus secondhand smoke nearly tripled the risk.Most studies of asthma in children have looked at single risk factors, but in the real world, people often face multiple exposures.Researchers at Vancouver General Hospital in Canada looked at 380 children considered to be at high risk because they had at least one close relative with asthma, or at least two close relatives with allergies.The researchers compared children’s exposure to dog allergens, secondhand smoke (measured by checking their urine for the nicotine byproduct cotinine, as well as their umbilical cord blood at birth) and nitrogen dioxide, which is found in car exhaust and produced by other types of fuel burning. At age 7, 19% of the children had asthma, while almost 41% had “bronchial hyperreactivity” – twitchy airways in which the tiny tubes of the airways tighten up in response to a given stimulus (for example, cold air). Owning a dog was the only factor that independently increased asthma risk, the researchers found; individual exposure to air pollutants didn’t up risk.However, combinations of exposures did sharply increase risk. For example, 7-year-olds exposed to dogs in infancy as well as to nitrogen dioxide were 4.8 times as likely to have asthma as children with neither exposure, while the combined risk for dog and secondhand smoke exposure was 2.7 times greater. Insufficient vitamin D tied to severe attacksAsthmatic children with relatively low vitamin D levels in their blood may have a greater risk of suffering severe asthma attacks, research published in the June 2010 Journal of Allergy & Clinical Immunology suggests.The Harvard Medical School study, which followed more than 1,000 children with asthma for four years, found those with vitamin-D “insufficiency” at the outset were more likely to have an asthma attack that required a trip to the hospital.When researchers considered other factors – including the severity of the children’s asthma at the study’s start, their weight and their family income – vitamin D insufficiency was linked to a 50% increase in the risk of severe asthma attacks. People are considered to have an overt deficiency in vitamin D when blood levels drop below 11 nanograms per milliliter (ng/mL). But there’s debate over how the optimal vitamin D level should be defined.For their study, the researchers considered children with vitamin D levels of 30 ng/mL or lower to be insufficient in the vitamin.The effects of vitamin D on the immune system, which include the inflammatory response to infections, might help explain why higher levels were linked to a lower risk of severe asthma exacerbations, according to the researchers. They said it’s also possible that the vitamin enhances the effects of anti-inflammatory steroid hormones – both the body’s natural supply and the synthetic corticosteroids used to treat asthma.In this study, the beneficial association between vitamin D and asthma attacks was mainly seen in children who were on budesonide, a corticosteroid. The American Academy of Pediatrics recommends that infants, children and teenagers get 400 IU of vitamin D each day. But in November 2010, an expert panel from the Institute of Medicine raised its own recommendations for kids 1 and older to 600 IU. Milk, breakfast cereals and orange juice fortified with the vitamin are the main food sources, though some fatty fish naturally contain high amounts. Experts recommend vitamin pills for children who don’t get enough from food. Vitamin D is naturally synthesized in the skin when exposed to sunlight, but long winters and sun avoidance in the summer mean that many kids may not get enough this way. Overweight children and adults also appear to be at elevated risk of deficiency because vitamin D is stored in body fat. The more it gets sequestered into fat tissue, the less active vitamin there is in the blood. Burger diet linked to higher childhood asthma riskChildren who eat three or more burgers a week may be at a higher risk of asthma and wheezing. But a healthy diet rich in fruit and fish seems to stave off the risk, according to a large international study published in the journal Thorax in June 2010.Researchers from Germany, Spain and Britain who studied data on 50,000 children across the world found the link between burgers and asthma was strongest in rich nations, where diets with high levels of junk food are more common.A meat-heavy diet itself has no bearing on the prevalence of asthma, according to the scientists who conducted the study. Yet frequent burger eating could be a signal for other lifestyle factors that raise asthma risk.“This is a sign that the link is not strongly related to the food itself, but that burgers are a proxy for other lifestyle and environmental factors like obesity and lack of exercise,” said study leader Gabriele Nagel, Dr. Med., of the Institute of Epidemiology at Ulm University in Germany.She added, however, that there were “biologically plausible” links for the positive effects of a healthier diet itself, such as the antioxidants found in fruit and vegetables and the omega-3 polyunsaturated fatty acids in fish, which have anti-inflammatory properties.In particular, she said, foods rich in vitamin C have been linked to better lung function and fewer asthma symptoms.Fever reducer may be linked to allergies and asthmaThe use of paracetamol for infants may be linked to the development of allergies and asthma later on, according to a November 2010 report in Allergy & Clinical Immunology.But more research is needed to clarify this, and the benefits of paracetamol use for fever control still outweigh the potential of later allergy development, said author Julian Crane, a professor at the University of Otago in Wellington, New Zealand. “The major finding is that children who used paracetamol before the age of 15 months were more than three times as likely to become sensitized to allergens and twice as likely to develop symptoms of asthma at 6 years old than children not using paracetamol,” Crane said in a statement. “However, at present we don’t know why this might be so. We need clinical trials to see whether these associations are causal or not, and to clarify the use of this common medication.” Crane said there were few other options for fever control in young children, noting that aspirin has dropped out of favor over about the last 30 years due to links between aspirin use and the potentially fatal illness Reye’s syndrome in children. “That timing fits quite well with the rise in the prevalence of allergies, but that may just be coincidence,” he said. He added that in the absence of other options and studies establishing a firm causal link, paracetamol should still be used for now. Half of “untreatable” cases may be treatableSome kids with “treatment-resistant” asthma may actually be treatable, according to a September 2010 report in The Lancet medical journal. Approximately 1 in 10 kids in the United States has asthma, and about 1 in 20 has a severe form that doesn’t respond to standard therapies. But after thoroughly evaluating the evidence to date, researchers at the Imperial School of Medicine in London think the true number of problematic cases may be far lower. A lot of children carry a misdiagnosis of severe asthma or are simply not taking their medications correctly, they said.They found that many patients either weren’t using their inhaler properly or weren’t taking the right dose of medication each day. Researchers also found that less than half of patients picked up more than 80% of their prescriptions, and that many of the drugs sitting in patients’ medicine cabinets were past their expiration dates. About a quarter of the kids were exposed to tobacco smoke, which exacerbates symptoms.To limit obstacles to proper asthma diagnosis and treatment, the researchers urged doctors to go back to the basics: first re-evaluate patients to confirm the diagnosis and ensure these fundamental management strategies are met. Symptoms should then be carefully assessed before a tailored therapy plan is made for each child based on individual patterns of airway inflammation, potentially utilizing new and future powerful options. Promising new asthma therapies are currently in the works, researchers said. Still, evidence suggests that conventional therapies, if used correctly, would suffice for more than half of these kids. “If the asthma is bad, get referred to a multidisciplinary pediatric respiratory team who can reassess the whole problem from the beginning,” said professor of pediatric respirology Andrew Bush, M.D., who co-authored the study.What’s Your Allergy IQ?Ignorance may be bliss, but not when it comes to a stuffy, sneezy, scratchy problem like allergies. Maybe you suffer from seasonal allergies. Or perhaps the bed bugs really are biting. Do you know what’s making you itch? Find out with this allergy quiz.Check out Health Bistro for more healthy food for thought. See what Lifescript editors are talking about and get the skinny on latest news. Share it with your friends (it’s free to sign up!), and bookmark it so you don’t miss a single juicy post!Talk to us on Facebook and Twitter! The information contained on www.lifescript.com (the "Site") is provided for informational purposes only and is not meant to substitute for advice from your doctor or healthcare professional. This information should not be used for diagnosing or treating a health problem or disease, or prescribing any medication. Always seek the advice of a qualified healthcare professional regarding any medical condition. Information and statements provided by the site about dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease. Lifescript does not recommend or endorse any specific tests, physicians, third-party products, procedures, opinions, or other information mentioned on the Site. Reliance on any information provided by Lifescript is solely at your own risk. Next: Is your dog causing asthma? Next: Vitamin D deficiency can lead to attacks... Next: What hamburgers have to do with asthma... Next: The truth about "treatment-resistant" asthma... Next: Doctors are going back to basics...

医学

2014-42/1180/en_head.json.gz/7976

Search Lessons America Should Learn From a Land of 'Free' Health Care MANAGED CARE January 1997. © MediMedia USAA Personal ViewLessons America Should Learn From a Land of 'Free' Health CareThis British-trained, San Diego-based family physician says today's managed care reminds him of what his homeland went through 48 years ago — and points out lessons the British experience can teach.Eric G. Anderson, M.D. MANAGED CARE January 1997. ©1997 Stezzi Communications A Personal View This British-trained, San Diego-based family physician says today's managed care reminds him of what his homeland went through 48 years ago — and points out lessons the British experience can teach. Eric G. Anderson, M.D. Imagine a land of physician entrepreneurs. They own their offices, decide which hours they'll work and choose their patients. And, yes, get paid pretty well. They've never worked for a third party, never had to offer a discount, and never had to justify or explain anything to anybody except maybe to their own consciences. They're seldom in accord with each other — indeed the cliché is "three doctors, four opinions" — but on one thing they agree: This is the good life for physicians. Let's not change it. America before the mid-1980s? No, Britain in the year 1948. The parallels are striking, although the British National Health Service's version of managed care had an easier start than its business-style counterpart in this country. If we consider the experience of the United Kingdom, we can learn from its successes — and its problems. Three years before left-winger Aneurin Bevan started the Great Experiment of socialized medicine, the British people had struggled to the end of World War II — the war that followed the Great War that was going to end all wars. The country was impoverished. The servicemen and women returning to civilian life were used to corporate-style military medicine and had lost contact with their prewar private physicians. The nation was prepared to be frugal, ready for a simpler, more structured health care system. What came forth was essentially the most mammoth managed care system in the entire world. Capitation was set at £1 per patient per year, a fee considered by the planners to be appropriate because low-key, stiff-upper-lip British patients were not thought likely to abuse the system. The capitation fee, equal then to about $2.80, was often described by physicians as "one pound sterling per skull." Small additional sums were paid for a few items of service such as immunizations and Pap smears. The 'low-key' hordes arrive Actually, in many ways Britain's nationalized health service has worked fairly well for several decades. But the pent-up demand broke upon physicians like waters from a bursting dam. I remember being tested for my first aid badge in the Boy Scouts in 1948 and asking my longtime family doctor, the examiner, why he was moving his magnificent burgundy red leather chairs out of his waiting room and replacing them with wooden benches. "Ah, Eric," he said wistfully and, as it turned out, presciently, "I'm King Canute getting ready for the flood." It came. Demand for medical services jumped so fast once they were "free" that the National Health Service became a national sickness service. It still is. It's never had the resources to prevent disease and so ensure the nation's health. The demand for treatment for real and imagined disease virtually broke the bank. For the last 48 years, the British government has tried in several ways to balance the books by reducing this demand: It increased the modest cost of prescriptions — several times. The public responded by visiting the doctor even more for trivial illness because, despite the increase, a big bottle of antacid on prescription for simple dyspepsia was still cheaper than pharmacies' over-the-counter charge for the same bottle. To reduce demand for night house calls for overworked primary care physicians, the government created a cutoff time in the evening and appealed to the public not to telephone after that time unless it was a true emergency. What happened? Of course! Lots of requests for instant house calls for nonemergencies came during the 15 minutes before cutoff time. It built barriers to reduce requests for durable medical supplies, and yet, when the dust settled, it seemed every bedside cabinet had its hearing aid, its set of eyeglasses — and for a while, even its wig. These objects were not necessarily worn, but they were obtained because the patient was "entitled." Patient demand remains insatiable. Asked the biggest challenge faced by one of the few new hospitals in Great Britain, the award-winning Queen Margaret Hospital in Fife, Scotland, Paul M. White, its chief executive, replied: "the management skills to meet the sustained pressure of inexhaustible demands on scarce resources. Ahead lie many challenges: demands for new services, medical 'breakthroughs,' new technologies, an aging population and a national shortage of trained staff." Doctors in the front line see overuse as a problem, too. At my 35-year medical school reunion in 1993 I asked an old friend, one of Britain's GPs, why their waiting rooms were always full. Hadn't we finally got them all healthy after nearly a half century? "Yes, but you can't stop 'em coming," he said. "They know there is such a thing as a free lunch. Health care here in Britain is a banquet, and every bugger in this country thinks he's starving." His dispirited response reminded me of the cliché that in America patients hate their doctors, but in Britain doctors hate their patients. If you make it free, they will come I'm surprised by those experts in the United States who don't seem to understand that if medical care has low or no copayments people will use the service more. If there were no charge for going to the movies, wouldn't we go more often? If we could get a baby sitter at little or no cost, wouldn't she be in our house all the time? Similarly, when my San Diego group added 17,000 Medicare HMO patients in 1986, we found a very high percentage of frail, elderly, ill patients amongst those joining. The patients who flocked to us then were not vital, healthy souls with little previous medical expense; they were, in contrast, those who had been overwhelmed by constant visits to their doctors and were bewildered by the paper work of Medicare Part B. Of course, not all demands on medical services are unwarranted. Still, my sense of déjà vu prompts the questions: What can the British experience teach the United States? What might help U.S. managed care executives and their doctors reduce unfair demand? First, we require a consistent national policy to educate the public on what is proper use of the medical professional's time. This will not be easy given the sophistication of the American consumer, the pervasive influence of pharmaceutical advertising, the "hot news!" stories constantly on television and the public's fascination with science-by-anecdote. Second, society urgently needs to set up panels to take a long, hard look at the aging demographics of America and make decisions about what is appropriate medical treatment for a nation whose source of medical funding, like that of all other nations, is not infinite. We don't have to declare, like the British, that we can't afford to cover dialysis in end-stage renal disease in patients over the age of 55. But we do have to decide, for example, that if we're going to spend $500 million for the latest method of diagnosing osteoporosis — DXA, dual energy X-ray absorptiometry — then we have to drop something else that's costing us money. I would have said "like doing so many cholesterol levels in the healthy elderly," except that treating cholesterol has become another New Deal. Third, patients have to take some responsibility for their own health. If patients want to be covered for extras like the right to rove far afield late in their pregnancy so that they end up being delivered by physicians outside their plan, let them pay extra for the privilege. If a person wants to be covered for bone marrow transplant for breast cancer at a time when the procedure truly is experimental, let her pay an extra premium and, if she doesn't, let's find a way to silence the lawyers. Fourth, we need to find a way to make patients and the popular press think that they are part of the team, that we need to conserve resources and, if we do, that we all benefit. We have to explain the trade-offs — publicizing, for example, that because we don't cover futile care for every brain-damaged infant we can afford to offer all kinds of supportive counseling for many dysfunctional families. We have to help our patients realize that those choices are their decisions, not ours. Society has to confront those issues. Individual physicians can't and won't. Yet indulgent, soft-hearted America has never been good with hard choices — not in politics, not in health care, not in life. There's a lot to lose, however. This is the nation that 74 Nobel prize winners in physiology and medicine have called home (vs. Britain's respectable 22). Yet if it swamps its physicians with a flood of excessive demands, those in the front line in the trenches will drown. Before their last breath they'll have become the equivalent of the overwhelmed British GP — like the one my American neighbor called on recently in England when he went, by appointment, to inquire about his aged mother still living there. He sat down opposite the desk. The busy doctor looked up and said, "Yes?" His hand, holding his pen, was poised above the prescription pad. Forgetting that this was a patient's relative, the doctor was all set to do what he often must do to handle the immense demands on his time: scribble a prescription without even examining the patient. The author, a semiretired family physician and freelance writer in San Diego, attended medical school in Edinburgh, Scotland, in the 1950s and began his medical career in Britain. Following Great Britain's Lead on EMR and (Maybe) OTC StatinsA Look at Kaiser CEO's Legacy: Faith in Quality Never WanedEDTUs: Last Line of Defense Against Costly Inpatient StaysMaking the Case for a 'Health Care Fed': Should Uncle Sam Decide What Works?Could German Drug Price Transparency Come to the U.S.? Meetings

医学

2014-42/1180/en_head.json.gz/7978

search UK's Bad Medicine: Why US Has Better Odds vs. Cancer David Gratzer Rudy Giuliani's presidential campaign released a radio ad last week in which the candidate praised American health care for curing him of prostate cancer and wondered what might have happened to him under the socialized medicine practiced in the United Kingdom, where survival rates for that condition are far lower. In the ad, now running in New Hampshire, Giuliani says: "I had prostate cancer five, six years ago. My chance of surviving prostate cancer - and thank God I was cured of it - in the United States: 82 percent. My chances of surviving prostate cancer in England: only 44 percent under socialized medicine." He drew those statistics from an article I wrote for the summer 2007 issue of City Journal. The ad has already aroused intense criticism, most of it claiming that survival rates in Britain aren't nearly so low. ABC News's Rick Klein, in a blog entry titled "Rudy's Fuzzy Healthcare Math," writes: "The data Giuliani cites comes from a single study published eight years ago by a not-for-profit group, and is contradicted by official data from the British government." Kevin Drum, blogging at CBS News and Ezra Klein of American Prospect argue that England and America have "virtually the same mortality rates from prostate cancer." Let me be very clear about why the Giuliani campaign is correct: The percentage of people diagnosed with prostate cancer who die from it is much higher in Britain than in the United States. The Organisation for Economic Co-operation and Development reports on both the incidence of prostate cancer in member nations and the number of resultant deaths. According to OECD data published in 2000, 49 Britons per 100,000 were diagnosed with prostate cancer and 28 per 100,000 died of it. This means that 57 percent of Britons diagnosed with prostate cancer died of it; consequently, just 43 percent survived. Economist John Goodman, in "Lives at Risk," arrives at precisely the same conclusion: "In the United States, slightly less than one in five people diagnosed with prostate cancer dies of the disease. In the United Kingdom, 57 percent die." None of this is surprising. In the United Kingdom, only about 40 percent of cancer patients see an oncologist and, histori- cally, the government has been reluctant to fund new (and often better) cancer drugs. So why do the critics think that Britain's survival rates are as high as America's? The main reason is that they are citing overall mortality rates, which are indeed, as Ezra Klein writes, similar across various countries. That is, the percentage of all Americans who die from prostate cancer is similar to the percentage of all Britons who do. But this misses the point, since a much higher percentage of Americans than Britons are diagnosed with prostate cancer in the first place. If you are a patient already diagnosed with prostate cancer, like Rudy Giuliani, your chances of survival - as Giuliani correctly said - are far higher in the United States. Likewise, though Rick Klein is right that official U.K. data differ from mine, those data look at five-year survival rates - that is, they track cancer patients for five years and report on their survival. Their approach is different from mine. They don't examine what we might call a snapshot, as my data do: that is, examining how many people with a particular disease die during a given interval of time, say, a year. And, true, the OECD data are seven years old, as Rick Klein also points out. However, newer studies show a similar trend: Americans do better when diagnosed with cancer than their European counterparts. Since the publication of my City Journal essay, the prestigious journal Lancet Oncology has released a landmark study on cancer-survival rates. Its findings: * The American five-year survival rate for prostate cancer is 99 percent, the European average is 78 percent, and the Scottish and Welsh rates are close to 71 percent. (British data were incomplete.) * For the 16 types of cancer examined in the study, American men have a five-year survival rate of 66 percent, compared with only 47 percent for European men. Among European countries, only Sweden has an overall survival rate for men of more than 60 percent. * American women have a 63 percent chance of living at least five years after a cancer diagnosis, compared with 56 percent for European women. For women, only five European countries have an overall survival rate of more than 60 percent. These data, recently released, are now the best available. They too confirm Giuliani's point: He was fortunate to be treated here. I'm not denying that American health care has its problems. On the contrary, I've just written a book advocating reform. And the Giuliani campaign isn't denying it, either - the mayor has advocated reforms of his own. But as Americans consider how to improve our health-care system, we should understand what we do well and what other countries do poorly. Failing to do so would be the public-policy equivalent of malpractice. Original Source: http://www.nypost.com/seven/11052007/postopinion/opedcolumnists/uks_bad_medicine_901295.htm

医学

2014-42/1180/en_head.json.gz/8048

News | MS in the Media | Supporter news | MS Trust Blog | Keeping in touch Where am I? Home › News › Will personal health budgets really give people greater choice and control of personalised health care? Author: MS Trust Angela Coulter of the King's Fund questions whether personal budgets are the best way to give people control of their own health care. The Health Secretary, Andrew Lansley, plans to roll out personal health budgets to all those receiving NHS continuing care in England by April 2014. NHS continuing care (also known as fully funded NHS care) is care provided outside hospital that is arranged and funded solely by the NHS. It is only available for people who need ongoing health care and meet certain eligibility criteria, for example a complex medical condition that requires a lot of care and support. People with personal health budgets will be able to make their own decisions about how to spend the NHS funds allocated for their care in line with an agreed care plan. The scheme will enable people to access services not available through the NHS and have greater choice and control over the provision of care. The budget for this plan can be held by a health professional; by an independent third party on behalf of the individual or by the individual. However Angela Coulter, visiting Fellow at the King's Fund and former Chair of the Picker Institute, questions in her blog whether these shared budgets are the best way to achieve greater responsiveness to individual needs, believing the scheme may be too complex and may hamper the choice of the people rather than enhancing it. Concern has been raised that the scheme may start to shift resources into complementary therapies or non-health care items; if the clinical benefits are complex, those involved in underwriting the personal health budgets may lose enthusiasm; and the scheme may enable choices only for those people who have the confidence and capacity to take on individual budgets at the expense of those who do not. A pilot scheme for personal health budgets is currently underway and the fourth interim review was recently published. This found that many of those who were offered personal health budgets responded positively to the offer of greater choice and more control, but the prospect of budget-holding caused confusion and anxiety for others. This was made worse by the lack of information both before and during planning. An alternative scheme, the Year of Care Programme, is investigating the potential of personalisation of care for people with long-term conditions without the use of personal budgets. By incorporating shared decision-making and self-management support, the programme aims to enhance annual health checks and ensure that people are offered a choice of local NHS and community services through responsive commissioning. Overall, people involved are clear about the benefits: producing a better experience for people involved and real changes in self-care behaviour; improved knowledge and skills for professionals; greater job satisfaction, better organisation and team work, and improved productivity. Direct payment scheme for social care - A to Z of MS MS Trust news item Personal health budget pilot MS and me - self-management guide to living with MS King's fund blog Picker Institute Year of Care Programme (RCGP) Personal health budget pilot - Department of Health website Everything you need to know about personal health budgets Information on NHS continuing care Sign up to news alerts To keep up to date with news about MS sign up to receive News Alerts by email when new items are added. Please complete all marked * fields MS Trust Information Service For more information contact the MS Trust's personal information service on 0800 032 3839 or by email More about the Information Service Other ways to keep in touch with news about MS

医学

2014-42/1180/en_head.json.gz/8077

| | � NAMI APPLAUDS SURGEON GENERAL�S REPORT AS A FOUNDATION FOR ACTION Laurie Flynn, Executive Director, National Alliance for the Mentally Ill (NAMI) FOR IMMEDIATE RELEASE Contacts: Mary Rappaport 703-312-7886 Monday, December 13, 1999 Bob Carolla 703-516-7963 The Surgeon General�s Report on Mental Health is an important step forward, building on the vision of the White House Conference on Mental Health which earlier this year identified the crisis in mental illness treatment in the United States. The Report provides a national baseline for understanding mental illness and the gap between what we know and what we do in treating mental illness. It describes a system that is fragmented, with critical gaps and barriers. Mental illnesses are biological brain disorders. Treatment exists, if you can get it, but too many Americans cannot. Every year, one out of every five Americans�adults and children alike�experience a mental disorder. No one is immune. The direct cost to the nation is approximately $70 billion. Indirect costs total almost $80 billion. Mental illnesses kill. They ruin lives and destroy families. The Report�s single, explicit recommendation is that anyone with symptoms of mental illness should seek help. But in the face of a public health crisis, Americans must demand that treatment and services be made available. The Report provides a foundation for action. Ultimately, however, the President and Congress, and leaders at the state and local levels, are the ones who have the power to help. In spite of laws in over half the states, many health insurance programs continue to discriminate against people with mental illness. In spite of overwhelming need, many public programs also do not give priority to those who are most in need. The Report recognizes the importance of a quiet scientific revolution that has generated greater understanding of the nature of mental illnesses and effective treatments. But what the Report does not explicitly say is that the federally declared Decade of the Brain must not end. As America enters the new millennium, we must redouble and triple commitments to scientific research�and commit to finding a cure for schizophrenia and other severe brain disorders. The Report recognizes that mental illness cannot be treated as separate and unequal to physical illnesses. In the 1950s, Brown v. Board of Education overturned the principle of separate but equal in America�s race relations and fueled a great civil rights movement. Today, this report must be used to fuel a broad national movement to end stigma and discrimination based on mental illness�and equally uphold the principle of individual dignity for those who suffer through no fault of their own. As a society, we must commit to restoring the lives of Americans affected by mental illness and renewing the promise of an American Dream that includes all our people.

医学

2014-42/1180/en_head.json.gz/8083

Uninsured Americans: How Many, and How Do We Help? Matt at the Center for Faith in Politics blog disagrees with me on health care issues I raised when criticizing a New Republic editorial that makes this claim: Government isn't the best way to provide all Americans with health security. It's the only way. Matt discusses the large number of Americans (he puts the figure at under 46 million) who do not have health insurance.As Michael Cannon points out in this 2004 Cato Institute publication, a couple of things need to be understood about the number of uninsured.First, quite a few of uninsured individuals are eligible for Medicaid. Thus, they do have coverage (although I concede they are failing to earn it by themselves, this is hardly a problem we can expect a "universal system" to solve). In fiscal year 2006, according to Nina Owcharenko of the Heritage Foundation, Medicaid is expected to provide services for 46 million individuals and cost taxpayers $338 billion.Second, these figures include people who are without health insurance only part of a year. Cannon says: In addition to those eligible for Medicaid, for instance, [the figure given for the number of uninsured] includes people who lose their health insurance for only a brief period, such as when they graduate from college or change jobs. Over 3 million such people will regain coverage within four months, and another 6 million will regain coverage within 12 months. Various studies suggest that one-fourth (10 million) of this group decline coverage that is offered by their employers, and one-fifth (8 million) live in households making more than $50,000 per year. Cannon also notes: Moreover, the persistently uninsured are mostly young (39 percent are under age 25, and another 22 percent are under age 35) or healthy (86 percent report their health to be "good," "very good," or "excellent"). Matt also links to Josh Kidd at Larameekidd, who links to New Yorker author Malcolm Gladwell's blog. Gladwell says: "Canadians now spend on health care -- and I'm not sure of the exact figure here -- something like 60 percent of what Americans spend. If that were increased to, say, 65 percent, many of the rationing and wait-time problems would be alleviated."In the early 1990s, my husband David took a look at widely-touted figures from that era showing Canadians spending 55 percent of what Americans spent, per capita, on health care annually. Government-run medicine advocates of that era were arguing that Canada's ability to deliver health care more inexpensively was evidence of socialized medicine's superior efficiency. David demonstrated that the figures being used were comparing apples to oranges. U.S. figures included dental care, prescriptions, ambulance services, cosmetic surgeries, private hospital rooms and vision care, while Canadian figures did not. David also noted that the medical expenses of Canadians who had crossed the U.S.-Canadian border to escape that country's waiting lines would have been counted as part of the U.S.'s per capita figures. When apples were compared to apples, the per capita expenditures of the two nations, at least at that time, were roughly equivalent.Nonetheless, Gladwell wonders if perhaps Canada's chronic and serious problem with waiting lines could be alleviated if the Canadians would open their purses a little wider."If" is a big word. In government-run systems, health budgets are set by politicians, who have a vested interest in minimizing expenditures (so taxes/deficits can be minimized). So even if health care bureaucracies have perfect knowledge about the best way to allocate funds within government health budgets (another big if), the budget-setting incentives inherent in government-run plans are something other than the health of each individual patient.Conservative-backed consumer choice systems, however, are designed so the budget-setter is also the consumer. Premium support (paying premiums for low-income citizens) makes the system equitable (in the rich vs. poor sense); the fact that consumers are empowered pushes the system to allocate resources efficiently, according to health care needs. Thus, conservative proposals, properly understood, offer the same opportunities for universal care as do the largely liberal-backed government care proposals, but do so in a manner more likely to get appropriate health care services to the patients who truly need them.The point, after all, is not to provide health care insurance coverage, the provision of which is the government-run model's strong suit, but actual medical services. Given a choice between universal care (offered by the conservative-backed consumer choice model) and universal coverage (what government-run systems actually offer), I submit the public will opt for care.As the whole of human history shows, governments are great at making promises, but the delivery of goods and services tends to be done best in a competitive marketplace.Addendum, March 21: Josh Kidd has written to ask our thoughts on the Massachusetts health care debate. I have not followed it closely, but we did address it in this post.In a March 21 blog post here we add the thoughts of John Graham of the Pacific Research Institute. Posted by Amy Ridenour at 1:01 AM

医学

2014-42/1180/en_head.json.gz/8093

Nobel Scientist Discovers Scientific Basis of Homeopathy Tuesday, October 05, 2010 by: Tony IsaacsTags: homeopathy, scientist, health news (NaturalNews) At a time when the British Medical Association is calling for an end to national funding for homeopathy and detractors are describing it as "nonsense on stilts", a Nobel prize-winning scientist has made a discovery that suggests that homeopathy does have a scientific basis after all. In July, Nobel Prize winning French virologist Professor Luc Montagnier shocked fellow Nobel prize-winners and the medical establishment by telling them that he had discovered that water has a memory that continues even after many dilutions.Until Montagnier's research, the bulk of mainstream doctors and scientist had maintained that there was no scientific way that multiple dilutions used in homeopathy could possibly work. In part, such views stemmed from lack of understanding. In larger part, such views likely stemmed from a desire to stem the rising popularity of homeopathy and eliminate it as a competition to mainstream medicine - much the same as happened in the United States a century ago.One of the foundations of homeopathy maintains that the potency of a substance is increased with its dilution. Montagnier discovered that solutions containing the DNA of viruses and bacteria "could emit low frequency radio waves" and that such waves influence molecules around them, turning them into organized structures. The molecules in turn emit waves and Montagnier found that the waves remain in the water even after it has been diluted many times. To a lay person, that may not mean much, but to a scientist is highly suggests that homeopathy may have a scientific basis.In Britain the market for homeopathy is estimated to be growing at around 20% a year. Over 30 million people in Europe use homeopathic medicine. Homeopathy is supported in Britain by Prince Charles and the physician to the Royal Family has been a homeopathic physician since the late 1800s.While homeopathy is also experiencing a resurgence of popularity in the United States, it is far more popular in much of the rest of the world. In India, approximately 130 million people use homeopathy. In Brazil, homeopathy is a recognized medical specialty where 15,000 medical doctors are certified as homeopathic specialistsThe latter half of the 19th century was homeopathy's heyday in the United States. Regular physicians could hardly compete. By 1902 homeopaths did seven times the business of allopaths and there were 15,000 practicing homeopathic physicians in the US. During the 1849 cholera epidemic, homeopaths from Cincinnati kept rigorous records showing that they lost only 3% of their patients, while allopathy lost 16 to 20 times more.Many highly accomplished individuals past and present have chosen homeopathy as their therapy of choice, including several U.S. Presidents. Many of America's literary greats advocated for and often wrote about homeopathy, including Ralph Waldo Emerson, Henry Wadsworth Longfellow, Louisa May Alcott, Nathaniel Hawthorne, and Mark Twain - as did European greats such as Goethe, Sir Arthur Conan Doyle, Lord Alfred Tennyson, and George Bernard Shaw.At the turn of the 20th century, the AMA came right out and admitted that competition was destroying physicians' incomes. Thanks to funding from John D. Rockefeller and the Carnegie Foundation, the AMA was able to repress and ultimately eliminate homeopathy and other natural and alternative competition. The 22 homeopathic medical schools that flourished in 1900 dwindled to just 2 in 1923. By 1950 all schools teaching homeopathy were closed.Ironically, John D. Rockefeller believed strongly in homeopathy. He referred to it as "a progressive and aggressive step in medicine." Rockefeller lived to the ripe old age of 99 using only homeopathy in the latter part of his life.Sources included:http://www.theaustralian.com.au/news/health-...http://www.wddty.com/nobel-scientist-discove...http://www.guardian.co.uk/society/2010/feb/2...http://www.scnm.edu/homeopathy.htmlhttp://www.tbyil.com/Managed_Illness.htmAbout the authorTony Isaacs, is a natural health author, advocate and researcher who hosts The Best Years in Life website for those who wish to avoid prescription drugs and mainstream managed illness and live longer, healthier and happier lives naturally. Mr. Isaacs is the author of books and articles about natural health, longevity and beating cancer including "Cancer's Natural Enemy" and is working on a major book project due to be published later this year. He is also a contributing author for the worldwide advocacy group "S.A N.E.Vax. Inc" which endeavors to uncover the truth about HPV vaccine dangers.Mr. Isaacs is currently residing in scenic East Texas and frequently commutes to the even more scenic Texas hill country near Austin and San Antonio to give lectures and health seminars. He also hosts the CureZone "Ask Tony Isaacs - featuring Luella May" forum as well as the Yahoo Health Group "Oleander Soup" and he serves as a consultant to the "Utopia Silver Supplement Company". More news on homeopathy The disinformation myths against homeopathyHomeopathy for pets - safer and more effective than toxic drugsLife-threatening infectious disease responds better to homeopathy than allopathic medicineSwiss government report declares homeopathy is 'cost effective' in treating patientsResource list: Find qualified homeopathic practitioners and reliable long-distance homeopathic pharmacies for hard-to-find remediesTreat pain with homeopathyThe Swiss government's exceedingly positive report on homeopathic medicine Take Action: Support NaturalNews.com by linking back to this article from your website http://www.naturalnews.com/029940_homeopathy_scientist.html

医学

2014-42/1180/en_head.json.gz/8094

Search ArticlesSearch Recipes Four Clinical Trials Further Clarify The Role Of Physical Activity In Cognitive Function And Dementia Resistance Training Emerging as Particularly Valuable for Older Adults Four studies reported today at the Alzheimer's Association International Conference 2012 (AAIC 2012) describe the ability of targeted exercise training to promote improved mental functioning and reduced risk for cognitive impairment and dementia in cognitively healthy older adults and those with mild cognitive impairment (MCI). The reports, from six- and 12-month randomized controlled clinical trials, depict the beneficial effects of different types of exercise – resistance training, aerobic training, and balance-stretching training – on a variety of cognitive abilities, brain structure, functional neural plasticity, growth factors, and risk factors for cognitive decline such as depression and sleep quality. "Currently, the strongest data for lifestyle-based Alzheimer's risk reduction is for physical activity, yet this data is generally observational and considered preliminary, said William Thies, PhD, Alzheimer's Association Chief Medical and Scientific Officer. "These new intervention studies are taking place over longer periods of time to begin to clarify exactly which types of physical activity are most effective, how much needs to be done, and for how long. In particular, where previously we had seen positive associations between aerobic activity, particularly walking, and cognitive health, these latest studies show that resistance training is emerging as particularly valuable for older adults." It is generally accepted that regular physical activity is essential to healthy aging; it also may prove to be a strategy to delay or prevent the onset of cognitive impairment and dementia. "It is very important to learn more about factors that actually raise and lower risk for cognitive decline and Alzheimer's. To do that, we need long-term studies in large, diverse populations, and we need the research funding to conduct those trials. For example, we have learned very practical lifestyle risk factors for heart disease from long-term research like the Framingham Study. Alzheimer's now needs its version of that research," Thies added. "By midcentury, care for people with Alzheimer's will cost the US over $1 trillion. This will be an enormous and unsustainable strain on the healthcare system, families, and federal and state budgets. The first-ever US National Plan to Address Alzheimer's was unveiled in May, and now this plan must be speedily and effectively implemented. An additional $100 million is needed now for Alzheimer's research, education, outreach and community support," Thies said. Moderate walking may grow brain region related to memory; increase nerve growth factor According to Kirk Erickson, PhD, of the University of Pittsburgh, "There is growing interest in lifestyle factors and interventions that enhance the cognitive vitality of older adults and reduce the risk for cognitive impairment. However, very little is understood regarding the molecular processes that contribute to enhanced brain health with exercise, or the impact that greater brain volume has on cognitive function." Erickson and colleagues randomized 120 older adults without dementia who have been sedentary for the previous six months to a moderate intensity walking group or a stretching-toning group for one year. MRI was used to measure the size of a brain region associated with memory, known as the hippocampus, both before and after the exercise intervention. Blood was drawn to measure concentrations of brain-derived neurotrophic factor (BDNF), and a cognitive testing battery was conducted before and after the intervention. The researchers found that, in this study group, one year of exercise training increased the size of the hippocampus by two percent (2 percent) in the walking group compared to the stretching-toning group. (Significant shrinking of the hippocampus is characteristic of Alzheimer's disease.) The increase in hippocampal volume was correlated with similar changes in BDNF. "Our findings suggest that the aging brain remains modifiable, and that sedentary older adults can benefit from starting a moderate walking regimen," Erickson said. Resistance training may improve thinking and memory in older adults with MCI Exercise and regular physical activity may prove to be promising intervention strategies to postpone or prevent Alzheimer's dementia, but perhaps not all types of training are equally effective. PhD student Lindsay Nagamatsu, of University of British Columbia, Vancouver, Canada, and colleagues with the EXCEL (EXercise for Cognition and Everyday Living) study compared the effects of both twice-weekly resistance training (weight lifting) (n=28) and twice-weekly aerobic training (walking) (n=30) with twice-weekly balance and tone exercises (n=28) on executive cognitive function in women aged 70-80 with probable MCI in a 6-month randomized controlled trial. Teresa Liu-Ambrose, PhD, PT, of the University of British Columbia and Vancouver Coastal Health Research Institute, was the principal investigator of EXCEL and supervises Nagamatsu. Compared with the balance and tone group, the resistance training group significantly improved performance on the Stroop Test, which measures selective attention and conflict resolution, and a memory task. Resistance training also led to functional changes in three brain regions involved in memory. In contrast, the aerobic training group did not show similar improvements. "MCI is a critical window to intervene against dementia," Liu-Ambrose said. "We found that twice-weekly resistance training is a promising strategy to alter the trajectory of cognitive decline in seniors with MCI." "Furthermore, we found that the aerobic training group had improved performance on a different memory task called the Rey Auditory Visual Learning Test. So both exercise groups improved their memory scores, but on different types of memory. More research is needed to determine the differential effects of these two types of exercise training," Nagamatsu added. Higher functioning older adults may be more likely to show cognitive benefits from resistance training Nader Fallah, PhD, and colleagues at the University of British Columbia, Vancouver used multi-state modeling* to investigate: 1) the simultaneous effect of exercise training and baseline factors on changes in executive cognitive function, and 2) the effect of exercise training on an individual's probability for cognitive improvement, maintenance, or decline. *Multi-state models are models for processes that at any time occupy one of a few possible conditions or situations. For example, this model can be used to estimate the impact of physical activity on the individual probabilities of cognitive improvement, stability or decline. It allows analysis of changes in all directions, especially improvement – which has had relatively little attention but appears to be essential to understanding how neurodegenerative disease occurs. Specifically, they performed a secondary analysis of a 12-month randomized, controlled clinical trial conducted in Vancouver of 155 community-dwelling women aged 65 to 75 years old who were randomly assigned to either resistance training or balance and tone training. The primary outcome measure was performance on the Stroop Test, an executive cognitive test of selective attention and conflict resolution. Teresa Liu-Ambrose, PhD, PT, of the University of British Columbia and Vancouver Coastal Health Research Institute, was the principal investigator of this study and supervises Fallah. The scientists found that: The probability of improving or maintaining results of the test were higher with resistance training among the study participants with higher function at beginning of the study. Resistance training and balance and tone exercises had similar effect among those with lower function at baseline. Overall, those in the balance and tone group demonstrated a significantly lower probability for improved performance on the Stroop Test, and a significantly higher probability of decline. "To our knowledge, this is the first study to demonstrate that an individual's baseline self-regulatory capacity impacts the amount of cognitive benefit the person will reap from targeted exercise training," Fallah said. "Before our study, we had no appreciation of the simultaneous impact of targeted exercise training and other factors, such as baseline cognitive status, on cognitive change in older adults. By using a multi-state transition model, we demonstrated that the probability of improving selective attention and conflict resolution in older adults is most evident among those with higher baseline cognitive status – which is different from the current general opinion," Liu-Ambrose said. Combination training (aerobic + strength + balance) may improve memory in people with MCI Hiroyuki Shimada, PhD, and colleagues at the National Center for Geriatrics and Gerontology, Obu, Aichi, Japan, conducted a randomized trial to test the impact of a 12-month, supervised, multicomponent exercise on cognitive function among older adults with amnestic (memory-related) MCI. The exercise program included aerobic exercise, muscle strength training, and postural balance retraining. "Previous reviews suggested that combined aerobic exercise and strength training improved cognitive and physical functions more than aerobic exercise alone," Shimada said. The final study population consisted of 47 older adults with amnestic MCI, 65 to 93 years old. Participants were randomized either to multicomponent exercise (n = 25) or an education control group (n = 25). People in the multicomponent exercise group exercised under the supervision of physiotherapists for 90 minutes/day, two days/week, 80 times for 12 months. People in the control group attended three education classes about health during the 12-month period. Measurements of cognitive function (Logical Memory II subtest of the Wechsler memory scale-revised, letter and category fluency, digit symbol coding, and Stroop color word test) were administered after six and 12 months. The scientists found that the multicomponent exercise and educational program improved performance on Logical Memory II subtest of the Wechsler memory scale-revised. Additionally, there was a significant interaction effect for letter fluency test between groups. "In other words, the ability to use language of the multicomponent exercise group improved significantly compared with the educational program group," Shimada said. "Our findings suggest that an exercise intervention can, at least partly, improve or maintain cognitive performance in older adults with amnestic MCI."

医学

2014-42/1180/en_head.json.gz/8279

Yorkshire Ambulance Service staff will go on strike later today Ambulance staff are due to go on strike again this afternoon. Members of the Unite Union, who work for the Yorkshire Ambulance Service, will walk out between 3pm and 8pm.It claims its members will go 10 hours without a meal break and be forced to work 12-hour shifts by changes to working patterns introduced last month.People are being urged to use the emergency service wisely and only dial 999 in an emergency.David Whiting, chief executive for the Yorkshire Ambulance Service NHS Trust, said: “Our plans to maintain high standards of patient care and minimise any impact from previous episodes of strike action have been effective and we have taken steps to ensure our service remains just as resilient this time.“We would like to reassure members of the public that our contingency plans continue to focus on providing a safe, responsive and high-quality emergency service which remains the Trust’s top priority.Mr Whiting said 999 should only be used for ambulances when someone has a life-threatening or serious illness or injury. Anyone requiring advice or treatment for a non-emergency situation or minor ailment should consider things like self-care, a visit to a local pharmacist, contacting the NHS 111 urgent care service or going to their GP, a walk-in centre or minor injuries unit.”To find your nearest non-emergency service, visit http://www.nhs.uk/service-search or call 111. Comments

医学

2014-42/1180/en_head.json.gz/8327

Your E-mail: My AccountContact Us Despite Warnings, Tanning Remains PopularPosted May 23, 2012 The link between too much sun and possibly lethal skin cancers is well established. So is the connection between cancer and indoor tanning. That knowledge understandably has prompted a rash of messages and advice about the wisdom of judicious exposure to the sun and indoor tanning as well as the need for the liberal application of sunscreen. Not a lot of people, it seems, are listening. That's the report from the Centers for Disease Control and Prevention. A new survey indicates that half of U.S. adults under 30 say they've had a sunburn at least once in the previous year. That's ominous. Almost all physicians agree that even a single blistering burn can double the risk of developing melanoma, an often deadly form of skin cancer. There's more. The CDC survey also indicates that indoor tanning remains popular. About 6 percent of all adults in the country said they had tanned indoors in the previous year. The percentage was significantly higher -- 32 percent -- among white women between 18 and 21, and women in their 20s said they tanned indoors more than 20 times in the same time frame. Those numbers frighten dermatologists, other physicians and public health officials. The link between indoor tanning and cancer is pretty definitive. A World Health Organization analysis found that the risk of melanoma rose 75 percent in people who began indoor tanning before the age of 30. Indeed, indoor tanning was deemed so dangerous by the WHO that the organization classified tanning devices as carcinogenic in 2009. More frightening still is the fact that earlier gains made in the campaign to inform the public about the dangers of natural and indoor tanning have eroded in recent years. The number of those who reported a blistering burn dropped to 45 percent in 2005 after widespread public service announcements. The CDC report indicates the number rose to 50 percent in 2010. It seems safe to say, then, that if people are listening to reports about the dangers of the sun and indoor tanning, they are certainly not learning from them. Failure to heed that information can be costly. The incidence of melanoma has been rising for about three decades. Among whites, who have the highest incidence of the disease, it climbed from 10 per 100,000 in 1975 to 24 per 100,000 in 2009. The pain and suffering those numbers reflect is immense. About 76,000 cases of melanoma will be diagnosed in adults this year. About 9,200 will die. Other skin cancers linked to sun exposure and indoor tanning also are on the rise. The quest for the perfect tan, it seems, never ends, especially among youngsters and young adults eager to win the approval of their peers. The search can be dangerous. About a third of those seeking that golden glow routinely fail to use sunscreen. The result is sadly predictable in many cases. "It's the sunburn you got when your were 18 that leads to the cancer that you get when you're 40. That sunburn will come back to haunt you," says Dr. Zoe Draelos, vice president of the American Academy of Dermatology. The belief that a great tan always reflects good health is simply wrong. That mindset must change if the United States is to avoid an epidemic of deadly skin cancers. �2012 the Chattanooga Times/Free Press (Chattanooga, Tenn.) Visit the Chattanooga Times/Free Press (Chattanooga, Tenn.) at www.timesfreepress.com Distributed by MCT Information Services Printable Version E-mail a Friend Kamut® Chili The large kamut grain has a chew to it similar to ground beef.

医学

2014-42/1180/en_head.json.gz/8359

Idaho Eye Care and Retina Care Retina Specialists of Idaho Retina Conditions Doctor Roberts DENTON R. ROBERTS, M.D. Dr. Roberts is a vitreoretinal surgeon specializing in diseases of the retina, vitreous, and macula. He completed his undergraduate training at Brigham Young University and thereafter attended the University of Utah School of Medicine. His internship was completed at Bassett Hospital in Cooperstown, NY followed by residency training at the University of Alabama in Birmingham. He completed a two-year vitreoretinal fellowship with Robert Morris, M.D., Doug Witherspoon, M.D., and Ferunc Kuhn, M.D. known leaders and innovators in retinal surgery. His residency and fellowship training boast some of the highest clinical and surgical volumes in the nation. Dr. Roberts has had extensive training in ocular trauma and reconstruction as well as the latest techniques in vitreoretinal surgery. He has received awards for outstanding research during residency and continues to participate in clinical research. He is board certified with the American Board of Ophthalmology and is a member of the American Academy of Ophthalmology, American Society of Retina Specialists, International Society of Ocular Trauma, American Medical Association, the Helen Keller Foundation for Research and Education, and the Idaho Medical Association. Referring Doctors | About Doctor Roberts | Idaho Eye Care | Retina Conditions | Patient Info | Office Location | Sitemap | Contact Us | red olive © 2009 Retina Specialists of Idaho, PLLC | 13923 W. Wainwright Dr., Suite 301 Boise, ID 83713

医学

2014-42/1180/en_head.json.gz/8390

Donate Salk News Release Home > News & Media > Salk News > The genome guardian's dimmer switch: regulating p53 is a matter of life or death News & Media The genome guardian's dimmer switch: regulating p53 is a matter of life or death Salk Institute scientists show how regulation of a key damage response protein can make the difference between survival and death after radiation LA JOLLA, CA—Scientists at the Salk Institute for Biological Studies have found clues to the functioning of an important damage response protein in cells. The protein, p53, can cause cells to stop dividing or even to commit suicide when they show signs of DNA damage, and it is responsible for much of the tissue destruction that follows exposure to ionizing radiation or DNA-damaging drugs such as the ones commonly used for cancer therapy. The new finding shows that a short segment on p53 is needed to fine-tune the protein's activity in blood-forming stem cells and their progeny after they incur DNA damage. "It's like a dimmer switch, or rheostat, that helps control the level of p53 activity in a critical stem cell population and the offspring they generate," says Geoffrey M. Wahl, professor in the Salk Institute's Gene Expression Laboratory, and senior author of the study, which appears online in the journal Genes & Development on July 1, 2011. "In principle, controlling this switch with drugs could reduce the unwanted effects from DNA-damaging chemotherapy or radiation treatment, allowing higher doses to be used." The protein p53 is an important tumor suppressor because it can destroy or halt the growth of cells that develop potential cancer-causing DNA mutations. But as Wahl's lab and others have shown over the past several years, p53 has much broader importance in the life and death of cells. "It's critical for determining whether a cell survives stress and continues to function in a variety of situations," says Wahl. One problem with p53 is that it apparently evolved to protect the integrity of the genome for future generations, rather than to prolong the lives of individual cells or animals. From the point of view of an animal, p53 sometimes goes too far in killing cells or suppressing growth. Experiments in mice have suggested that even modest reductions in p53's activity greatly increases survival after exposure to radiation, without raising the long-term cancer risk to unacceptable levels. Scientists therefore are eager to find out how cells naturally regulate p53, so that they can target these mechanisms with drugs. One clue uncovered by recent studies is that regulatory molecules can alter p53 activity by chemically modifying some key amino acids. In the current study, Wahl and colleagues set out to illuminate the function of a stretch of regulatory amino acids at one end of the protein by creating "designer" mice with other amino acids in this region, thereby rendering it inoperative. The mutant mice had somewhat higher p53 activity than normal mice, at least in some tissues. Based on other studies, Wahl's team expected the mutants to age faster. To their surprise, however, the mutant mice lived about as long as ordinary, "wild type" mice. A second surprise came when Wahl's team exposed the mice to ionizing radiation, of the sort that nuclear power plants may emit. While all the normal mice survived, half the mutant mice died within four weeks. To understand why the mutant mice died so readily, Vivian Wang, a postdoc in Wahl's lab, collaborated with the Salk veterinarian, Mat Leblanc, and hematologists at UCSD and noted that the irradiated mutant mouse hearts became enlarged and pale, as if they had been starved of oxygen. "Eventually, we found the reason for this," Wahl explains. "We found that irradiation and the ensuing p53 response significantly damaged the blood-forming cells of their bone marrow, but other parts of their bodies seemed quite normal. We followed up these studies with stem cell transplantation experiments to show the mutant p53 really affected the stem cells and their descendents that make the blood." These results led the team to conclude that the loss of function of p53's normal "dimmer-switch" segment had allowed the protein to become too active in the hematopoietic stem cells of the mutant mice, arresting the stem cells' proliferation and preventing them from replacing the blood cells lost to irradiation. "If the stem cells and their descendants are arrested for too long, they can't recover fast enough, and the mice eventually die of the effects of insufficient oxygenation of critical tissues," Wahl says. The team then studied how p53 activation could cause these cells to arrest for too long. Using sophisticated new techniques, they found that p53 lacking its "dimmer switch" turned on too much of a gene called p21, which acts as a brake to halt cells from dividing. "To confirm the significance of that finding, we created mice that expressed the mutant p53, but had only one instead of the normal two copies of p21," Wahl says. "This reduced p21 levels after irradiation. Remarkably, this was enough to significantly reduce the mortality of the 'dimmerless' p53 mice. They were much less sensitive to radiation when they just had one less copy of p21." The study underscores the importance of an evolutionarily conserved regulatory segment of p53 and the importance of p53 activity in the response to conditions that produce DNA damage. "Our study indicates that the amount of damaged DNA caused by radiation or toxins, isn't the sole determinant of life or death," says Wahl. "The extent to which p53 is also very important." One implication of this research is that drugs to lower p53 levels, or to reduce its transcription of other growth-stopping genes such as p21, might be used temporarily to reduce unwanted tissue damage from DNA-altering drugs or radiation. Another implication is that p53-boosting drugs, which are currently being tested in cancer patients, could have dangerous side effects if used in combination with other drugs that cause DNA damage. "Our mouse model suggests that if you use a p53-activating agent, the last thing you should do is combine it with a general DNA-damaging chemotherapy or radiotherapy," Wahl says. The lead author of the study was Yunyuan ("Vivian") Wang, PhD, at the time a postdoctoral researcher in Wahl's lab, and now a project scientist at the University of California, Irvine. The other coauthors were Mathias Leblanc, Kurt Krummel and Danielle Engle, of the Salk Institute's Gene Expression Laboratory; Norma Fox and Kenneth Kaushansky, MD, of the University of California, San Diego; Jian-Hua Mao and Allan Balmain of the Helen Diller Family Comprehensive Cancer Center, at the University of California, San Francisco; and Kelsey L. Tinkum, David Piwnica-Worms and Helen Piwnica-Worms of the Mallinckrodt Institute of Radiology at Washington University Medical School in St. Louis. Funding provided by the National Cancer Institute. About the National Cancer Institute (NCI): as part of the National Institutes of Health (NIH), one of 11 agencies that compose the Department of Health and Human Services (HHS), the NCI, established under the National Cancer Institute Act of 1937, is the Federal Government's principal agency for cancer research and training. The National Cancer Act of 1971 broadened the scope and responsibilities of the NCI and created the National Cancer Program. Over the years, legislative amendments have maintained the NCI authorities and responsibilities and added new information dissemination mandates as well as a requirement to assess the incorporation of state-of-the-art cancer treatments into clinical practice. NCI coordinates the National Cancer Program, which conducts and supports research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer, rehabilitation from cancer, and the continuing care of cancer patients and the families of cancer patients. About the Salk Institute for Biological Studies: The Salk Institute for Biological Studies is one of the world's preeminent basic research institutions, where internationally renowned faculty probe fundamental life science questions in a unique, collaborative, and creative environment. Focused both on discovery and on mentoring future generations of researchers, Salk scientists make groundbreaking contributions to our understanding of cancer, aging, Alzheimer's, diabetes and infectious diseases by studying neuroscience, genetics, cell and plant biology, and related disciplines. Faculty achievements have been recognized with numerous honors, including Nobel Prizes and memberships in the National Academy of Sciences. Founded in 1960 by polio vaccine pioneer Jonas Salk, M.D., the Institute is an independent nonprofit organization and architectural landmark. Get Involved

医学

2014-42/1180/en_head.json.gz/8432

A Heart Disease Veteran at Just Age 12 FRIDAY, May 4 (HealthDay News) -- Even youngsters who seem to be in perfect health can be at risk for heart disease. Just ask Heather Link.When she was 12, Heather was the picture of health as a competitive swimmer. But, several weeks after a dental checkup, she was suddenly engaged in the fight of her life.She had a condition known as infective endocarditis, which develops when bacteria enter the bloodstream and infect the lining of the heart, a blood vessel or the heart's valves. In Heather's case, a small cut that had occurred during her dental checkup gave the bacteria a way in. At first, she had no idea she was even sick. But, after some time, she started to feel as if she might have the flu. She had a fever, felt achy and had chills. Her fever spiked to 104 degrees Fahrenheit at one point. Her mother repeatedly took her to the doctor, but it seemed as if Heather just had a viral infection, such as the flu. But when her condition worsened, Heather's mother took her to an emergency room in Buffalo, N.Y. There, she recalled, a spinal tap revealed the bacteria that were infecting her heart. The infection had seriously damaged her heart's aortic and mitral valves, and she needed immediate open heart surgery to repair the damage. Though just a kid then, Link recalled not being scared before the surgery. "I was so weak and so sick at that point, that I don't really remember much of what was going on," she said. Several weeks later, she started to have symptoms of heart failure, such as severe shortness of breath, and she had another surgery to fix the repairs that had come undone. But her symptoms continued."I couldn't keep any food in," she recalled. "I was losing weight. All I could do was lie on the couch and watch TV," she said, noting the sharp contrast to how she had been living before the surgeries.Ultimately, she had a third surgery, this time at Brigham and Women's Hospital in Boston, and felt better for a while. She went home and started seventh grade, but by December she was having chest pains. Not taking any chances, her parents took her back to Boston, and she went into cardiac arrest when she got to Brigham and Women's Hospital. By now, her heart had been under so much stress that her doctors decided to put her on a ventricular assist device. For about a week, the device took over the work of her heart and lungs, allowing them to rest. Then there was one last surgery, to remove it."The ventricular assist device allowed my own heart to recover and saved me from needing a heart transplant, which would have changed my life dramatically," Link said.Instead, she was back in the pool about nine months after the device was removed. And doctors told her that she probably owed her life to swimming. "They told me that competitive swimming saved my life because I was in such good shape and had a strong heart," Link said. "If I were just a normal kid, they said I probably wouldn't have made it."However, Link said, her heart never completely recovered. It works at about 70 or 75 percent of what it once did, she said, but she's had no more surgeries and is as active as she wants to be. She's 26 now and teaches first grade. She also works to raise awareness of ventricular assist devices through Abiomed, the company that manufactured her device. She wants people to know that there are viable options to heart transplants.And for others who might find themselves in a similar situation, Link stressed the importance of being aware of all options and not being afraid to ask questions."If my mom hadn't pushed so hard for me to see the doctors in Boston, I wouldn't be here," she noted. "As much as I hate what happened to me at the time, people have learned from it, and in our area, things have changed now that the doctors are more aware that this can happen."More informationA companion article explains more about heart disease and children.SOURCE: Heather Link, Buffalo, N.Y. Related Articles

医学

2014-42/1180/en_head.json.gz/8555

« PI deputies follow up tip on... A day of remembrance and of...» ARMC approves nurses contract Save | Post a comment | ALPENA -The Alpena Regional Medical Center Board of Trustees approved the Michigan Nurses Association contracts at its meeting on Tuesday while in closed session. "We are pleased to have completed these complex negotiations with two groups of nurses covered under the Michigan Nurses Association union which include registered nurses in Home Care and the management group - consisting of about 30 nurses in total," Diane Shields, vice president of human resources and support services, stated in a press release after the meeting. "ARMC's top priority continues to be patient care with highly skilled staff to provide the best care for patients. With technology that rivals that of larger facilities, ARMC is committed to providing the region with high quality compassionate care from the staff, who are a part of the community. The building and grounds committee has been pursuing the renovation of the emergency department with a cost of approximately $7.5 million. Other projects are the pain clinic and inpatient rehab, 3 Central ADA compliance update and staff lockers. The total for all of these projects is $10 million. The building and grounds committee recommended moving forward with the emergency room project, including the additional projects, to the finance committee for review. "The building and grounds committee recommended to finance that the emergency room project be approved, and that was presented at finance in detail," finance committee chair James Arbuckle said With the approval of the expenditure for the project, the certificate of need process started immediately following the meeting, with a 30 day window for the letter of intent to be submitted, and a maximum 120 day cycle to respond. The hospital hopes to have the bids back by the end of September, with the whole project expected to take up to 2016 to finish. "I think we've talked enough in many, many different meetings over the months about the need for this," Trustee Georgene Hildebrand said. "We, on one hand, really need to be careful about our expenses, but on the other hand, have a need to update. This area is just not meeting the patients' needs any more." In other business: © Copyright 2014 The Alpena News. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

医学

2014-42/1180/en_head.json.gz/8651

Center for AIDS Research (CFAR) CFAR Working Groups HIV Host Defense HIV Host Defense Scientific Working Group The objective of this Scientific Working Group is to enhance and grow research in HIV Host Defense, integrating the research of its CFAR member labs. The group brings together researchers who are internationally recognized studying diverse aspects of host defense and the innate and adaptive human immune system. Priority research areas are: • Identification and characterization of HIV restriction factors • Elucidating the interplay of the Innate and Adaptive Immune system with HIV • Developing HIV vaccines • Developing novel targets for potential therapeutics David L. Freelander Memorial Chair in HIV Research, Dr. Jeremy Luban is an internationally distinguished physician-scientist who has been working on HIV/AIDS and related cellular issues in infectious disease for nearly thirty years. He was recently recruited to UMass Medical School from the University of Geneva. One of his most significant contributions to the field is the discovery of cellular factor TRIM-5a that is important for HIV-1 replication or which confer immunity to this deadly virus. Jeremy Luban, MD Dr. Shan Lu is a leader in novel vaccine development against a wide range of human pathogens. He designed and conducted the world’s first DNA prime-protein boost AIDS vaccine study in humans, which showed cross-reactive neutralizing antibody responses in volunteers—a major progress in AIDS vaccine development. In addition to HIV vaccines, he has worked on vaccines against emerging infectious disease and bio-defense targets. Dr. Lu is the current President of the International Society for Vaccines (ISV), an organization of the world's leading vaccine scientists. Shan Lu, MD, PhD Dr. Kate Fitzgerald has made major contributions to our understanding of how the innate immune response recognizes and responds to microbial challenge. She has published several high impact papers on the recognition of RNA viruses by innate sensors RIG-I and TLR7 and the role of the inflammasome in defense against fungal infections. Katherine Fitzgerald, PhD

医学

2014-42/1180/en_head.json.gz/8661

Decreasing Toxins in Brains of Alzheimer’s Patients Keep Cognitive Deficits at Bay Pilot Study Shows that Selectively Draining Isoprostanes from Cerebrospinal Fluid Stabilizes Cognitive Decline (Philadelphia, PA) – The ever-slowing capacity to clear the build-up of such toxins as isoprostanes and misfolded proteins that accumulate in the brains of Alzheimer’s disease patients causes the death of cells involved in memory and language. Domenico Pratico, MD, Associate Professor of Pharmacology at the University of Pennsylvania School of Medicine, and colleagues have shown in a preliminary study that reducing the levels of isoprostanes, which specifically reflect oxidative damage in the brain, by draining cerebral spinal fluid (CSF) can stave off future reductions in cognitive abilities. This work appears in the August issue of the Journal of Alzheimer’s Disease. As measured by a paper-and-pencil cognitive test, the researchers found that scores of the eight patients who had the specially designed shunt continuously operating for one year stayed stable. However, the scores of the patients who did not get the shunt declined by 20 percent after 12 months. “What’s interesting is that the patients without the shunt didn’t stop taking their regular Alzheimer medication, such as anti-cholinesterase,” says Pratico. Over 12 months, the isoprostanes were reduced by about 50 percent compared to Alzheimer’s patients taking standard anti-Alzheimer oral medications alone. “We were very happy to see this amount of reduction,” says Pratico, who adds that the research team predicted reductions only half that size. Additionally, the normal components of CSF like glucose and immunoglobulins did not change after the shunt was placed in patients. The shunt has a selective capacity to filter out toxins of a specific molecular weight and size, in this case isoprostanes. Applying a treatment for hydrocephalus to Alzheimer’s disease, the microns-wide shunt, or catheter, is placed subcutaneously in a space at the base of the cerebellum. It runs under the skin to the peritoneum, a space in the belly where body fluids accumulate before flowing to the kidney to be filtered and eventually eliminated in the urine. The shunt is put in once, drains continuously, and is cleaned out periodically by a neurologist. The eight patients still have their shunts and there are now almost 100 patients recruited into the next phase of the study, which is being conducted at Stanford University. Other collaborators on this paper are: Yuemang Yao from Penn; Joshua Rokach, Florida Institute of Technology; Gerald G. Silverberg, Stanford University School of Medicine; Martha Mayo and Dawn McGuire, University of California, San Francisco Medical Center and Enroe Inc. This study was funded in part by the Alzheimer’s Association. Pratico has no financial interest in Enroe Inc. ### PENN Medicine is a $2.5 billion enterprise dedicated to the related missions of medical education, biomedical research, and high-quality patient care. PENN Medicine consists of the University of Pennsylvania School of Medicine (founded in 1765 as the nation’s first medical school) and the University of Pennsylvania Health System (created in 1993 as the nation’s first integrated academic health system). This release is available online at http://www.uphs.upenn.edu/news/News_Releases/aug/Alzheimersshunt.htm

医学

2014-42/1180/en_head.json.gz/8668

UPMCMedia RelationsNews Releases2001Pagesuniversity-pittsburgh-school-medicine-establishes-residency-training-program-japan Right Content​Our Experts Jeffrey RomoffBiography Arthur S. Levine, M.D.Download high resolution version Main Content​ University Of Pittsburgh School Of Medicine Establishes Residency Training Program In Japan PITTSBURGH, July 31, 2001 — The University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center have signed an agreement to assist Teine Keijinkai Hospital in Sapporo, Japan, to establish and operate a U.S.-style residency training program in internal medicine. "This program is the culmination of two years of work and becomes one of only a handful of programs in Japan to use a U.S. model. It puts the University of Pittsburgh at the forefront of international medical education," said Arthur S. Levine, M.D., senior vice chancellor for the health sciences and dean, school of medicine. Historically, the Japanese philosophy of educating and training physicians has been based on students learning both from didactic experiences and from closely observing the words and actions of a senior mentor and professor. This philosophy has extended into residency training, which tends to follow an apprenticeship model through which Japanese residents have relatively less direct patient care experience than their counterparts in the United States. By contrast, U.S. programs work with a formal curriculum that identifies specific skills and knowledge areas that graduates must master, with a mandatory evaluation process. In addition, there is a greater expectation for direct hands-on learning. Progressive autonomy is encouraged by increasing patient-care responsibility, beginning in the first year of residency. Under the agreement, the school of medicine and University of Pittsburgh Medical Center will advise program facilitators at Teine Keijinkai Hospital on goals, staffing and teaching materials. The program will be co-directed by Asher Tulsky, M.D., assistant professor of medicine at Pitt, and Hironori Murakami, M.D., at Teine Keijinkai Hospital. Six students will participate in the first year of the program. During and after completion of the program, they will have the opportunity to participate in additional residency training programs at UPMC member and affiliated hospitals. “We are pleased and proud to be Teine Keijinkai’s partner in this educational voyage of discovery. We hope, and expect, that the students will develop skills that will directly be passed on to their patients in the form of better care and treatment,” said Mark L. Zeidel, M.D., professor and chairman of the department of medicine at the school of medicine and general consultant to the program. The pilot program will run for three years, after which it will be formally evaluated by a team from the University of Pittsburgh School of Medicine. Dr. Levine and Jeffrey Romoff, president of University of Pittsburgh Medical Center, signed the agreement on behalf of the University of Pittsburgh and UPMC. Hospital director Hiroshi Maekubo, M.D., Ph.D., signed on behalf of Teine-Keijinkai Hospital.

医学

2014-42/1180/en_head.json.gz/8757

ScienceHumans Lobotomy Victims and Their Life Afterwards The lobotomy is now considered the worst medical mistake to ever take place, but back in the 1920s to the 1950s it was “normal” to subject someone that was diagnosed with a mental illness to this procedure. With no alternative types of medicine to help mental patients, this was seen as the only means of curing the problem they may or may not have been having. Rosemary Kennedy At the age of 23, Rosemary Kennedy was given a lobotomy to control her “moodiness.” Rosemary had been known to have a violent behavioral pattern and Dr. Walter Freeman, the leading doctor to perform this procedure, had suggested to Joseph Kennedy, her father, that she undergo this procedure. So, in 1941, when only sixty-five lobotomies had been performed, Mr. Kennedy gave his permission. The surgery left her incontinent and her brain was reduced to an infantile mentality. She would stare at walls blankly for hours and her verbal skills went to unintelligible babble. Eight years after the lobotomy was performed, she was moved to a home for disabled people. She became detached from the family, due to her mental capacity, but received regular visits from her sister Eunice. There were occasions when she would visit her family and even her childhood home. The family hid what had happened to her for years saying that she was mentally handicapped. She passed away at the ripe old age of 86 of natural causes. Howard Dully At the age of 12, Howard Dully was subjected to this unnecessary procedure, thanks in part to his stepmother, who couldn’t handle a normal pre-teen boy. Dr. Walter Freeman claimed that Howard had childhood schizophrenia, when other doctors that have seen him never came to that diagnosis. IT has taken Howard decades to recover from the surgery. He lived his life in institutions, he was incarcerated, homeless and even an alcoholic. He finally sobered up and got a college degree. He has since researched what happened to him and has even written his memoirs, with the help of Charles Flemming. He is now a talk show host on National Public Radio, where he speaks to other lobotomy victims. Alys Robi was a Canadian born singer. She was nationally known, after the start of her career at the age of twelve. When she was 25, she was driving to Hollywood and was in an accident. She was injured and became depressed. She had been misdiagnosed numerous times and had a romance that failed. After that, she suffered a mental breakdown and was institutionalized. She had a lobotomy against her will. After the procedure was performed, she claimed that it was the key to her recovery and she was released from the institution. She returned to the stage, but because of her well known mental illness she was never became popular again. She continued to write music and had success again in the 1990s. She has written and published two autobiographies depicting her time before, after and during stay in the institution. Rose Williams is the beloved sister of well renowned playwright Tennessee Williams. She was two years older than him and was diagnosed as having schizophrenia. She had a lobotomy and was subjected to living in a mental institution for the rest of her life. She had been immortalized as characters in his plays, Suddenly, Last Summer, The Glass Menagerie, and A Street Car Named Desire. Tennessee was often heard saying that his sister was one of the sweetest, genuine people he has ever known. He left the bulk of his estate to her when he passed away. Written by Harmony Stalter – Copyrighted © www.weirdworm.com Advertisements Random Loading... Pop Culture 8 Kid’s Shows Which Are Mind-Numbing for Parents Pop Culture 7 TV and Movie Side Characters That Deserve Their Own Spinoffs Pop Culture 8 Incredible Facts About Game of Thrones

医学