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Beijing Academy of Artificial Intelligence 592

2014-42/1179/en_head.json.gz/7265

Desperate older women going abroad for IVF 'putting health at risk' for mother and baby Desperate older women denied the chance of motherhood in the UK are flocking abroad for IVF treatment they cannot get at home.Hundreds of British women may be travelling to clinics in countries such as Spain and the Czech Republic each month, a study suggests.Most are over 40, and likely to have been refused In-Vitro Fertilisation on the NHS because of their age.Faced with having to pay private fees costing up to £6,000, they are looking outside the UK for easier access and cheaper treatment. Risky move: The hundreds of British women, many over 40, who are going abroad for IVF treatment are more likely to suffer serious complications Another reason for British women going abroad for IVF is said to be the lack of egg donors in the UK.But women could be risking their own health and that of their babies by placing themselves in the hands of non-UK clinics, the study warned.The biggest hazard is multiple pregnancies, which can lead to a host of problems for both mother and child.In the UK, clinics are encouraged to implant only one embryo into a woman's womb during a treatment cycle, but some foreign centres routinely transfer two or three.Women who go abroad and suffer complications from having twins or triplets may end up being treated back home, with the NHS picking up the bill.According to figures from last year, the proportion of IVF treatments producing triplet pregnancies is only 0.5 per cent in the UK, but 1 per cent in Spain, 2.4 per cent in Hungary and 5.1 per cent in Serbia.Fertility experts analysed data on cross-border patients from clinics in six countries, Belgium, the Czech Republic, Denmark, Slovenia, Spain and Switzerland.A total of 1,230 patients were seen in the clinics over a one month period.Of these, the largest proportion (31.8 per cent) were from Italy, followed by Germany (14.4 per cent), the Netherlands (12.1per cent) and France (8.7 per cent).The UK was sixth on the list, providing 4.3 per cent of travelling IVF patients.Altogether, people from 49 countries crossed borders for fertility treatment.In reality significantly higher numbers of patients were believed to be travelling abroad, since many clinics chose not to take part in the survey. The 71 centres that returned data represented only about half of the total number contacted.Dr Francoise Shenfield, from University College Hospital in London, co-ordinator of the Eshre Task Force study, said it was possible hundreds of British women were visiting foreign clinics each month.More than 60 per cent of travelling UK patients were over the age of 40, according to the figures.'Access is a big reason for women from the UK,' said Dr Shenfield.'It's very difficult for us to get funding for patients over the age of 39.'When they're 39 or 40 they're stuck. Britain is bad at access. We know that 75 per cent of IVF cycles in the UK are still carried out in the private sector.'The shortage of donated eggs in the UK was also important, she said.Numbers of both sperm and egg donors had decreased in recent years, partly because of changes to anonymity rules. Since 2005, British donors have had to give up their right to anonymity, making it possible for them to be identified as the biological mother or father of an IVF child. This has deterred many people from helping childless couples by donating gametes, said Dr Shenfield.She added that women classified as obese - having a Body Mass Index of over 30 - were also refused IVF treatment on the NHS.'It's a complex ethical issue,' said Dr Shenfield, who presented the findings today at Eshre's annual meeting in Amsterdam. 'Having a child is not a right, but from the point of view of health and quality of life, it's an essential part of a life project and it's not something that goes away.' Patients from different countries had different reasons for getting IVF treatment abroad, the study showed.Legal restrictions were the biggest factor, particularly affecting countries such as Catholic Italy and Germany - where it is illegal to donate eggs, but not sperm. In the Netherlands, which has extensive IVF waiting lists, women faced long delays before being referred for treatment. Share or comment on this article Fraudster pretended to be in a coma for TWO YEARS to avoid court over £40,000 scam but was caught walking around Tesco after police traced him using loyalty card Pictured: Recent Muslim convert Michael Zehaf-Bibeau who shot dead a solider and opened fire on Canadian Parliament Teacher whose skull was shattered after teens dropped 5lb rock on her car from an overpass shows her incredible recovery as she leaves hospital after three months New lead in hunt for Flight MH370 as experts say 'contrails' could be key to finding plane amid claims it is NOT in ocean at all Damned if she botoxes, damned if she doesn’t: Don’t torment Renee, blame the misogynist tyranny that forces even a natural beauty to turn herself into another fake-featured blonde Comfort eating? Chinese woman, 26, spends an entire WEEK in KFC after being dumped by boyfriend Hilarious moment professional boxer is KNOCKED OUT after just 16 seconds sparring with old man in woolly jumper

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San Jacinto News Times - Local News Copyright 2012 - Polk County Publishing Company West Nile cases increasing COLDSPRING – Montgomery County has reported two additional cases of the human West Nile virus, bringing the total number of cases to four as of Friday. Reports from the Texas Department of State Health Services indicate there are 552 state-confirmed cases of West Nile illness in Texas so far this year, including 21 related deaths. Currently there are no reported cases in San Jacinto County, but there have been six cases of human (WNND) in Angelina County and one case of West Nile Fever. Trinity County has one reported case of West Nile Fever, as does Liberty County. In addition to aerial spraying efforts in Dallas and Harris County state health officials are urging people to protect themselves by using insect repellent and draining standing water, which can be a breeding ground for mosquitoes. During a recent meeting of the Deep East Texas Council of Governments (DETCOG), it was announced that funding may be available for aerial spraying of mosquitoes, which transmit the virus from birds to humans. “County Emergency officials in the DETCOG region should file a request for assistance under the same provisions that they normally follow,” DETCOG Executive Director Walter Diggles said. San Jacinto County Emergency Management Coordinator Judy Eaton urges anyone participating in outdoor activities to always use mosquito repellent containing DEET and follow label directions regarding the proper use. According to the Texas Department of State Health Services, West Nile virus is a virus commonly found in Africa, West Asia, and the Middle East. It is not known how long it has been in the United States, but the Centers for Disease Control and Prevention (CDC) believe the virus probably has been in the eastern United States since early summer 1999. It is closely related to St. Louis encephalitis virus found in the United States. The virus can infect humans, birds, mosquitoes, horses, and some other animals. Most people infected with West Nile virus will not have any signs of illness. Twenty percent of people who become infected will have mild symptoms such as fever, headache, body aches, and occasionally a skin rash on the trunk of the body and swollen lymph glands. The symptoms of severe infection (West Nile neuroinvasive disease) include headache, high fever, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness, and paralysis. Only about one out of 150 people infected with West Nile virus will develop this more severe form of the disease. The incubation period of West Nile virus in humans is Homethree to 14 days. Symptoms of mild disease may last a few days. Symptoms of severe disease may last several weeks, although neurological effects may be permanent. Rarely, death can occur. People older than 50 have the highest risk of severe disease, and people with weakened immune systems are at an increased risk for West Nile virus. The best way to protect your family from West Nile Virus is by removing standing water or other potential mosquito breeding areas from around your home. If you find a dead bird, do not handle it with your bare hands. Contact local emergency management or health department officials for instructions on reporting and proper disposal of the body

医学

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Contact: Beth Bukata [email protected] American Society for Radiation Oncology ASTRO publishes supplement on protecting cancer patients by reducing radiation doses, side effects The Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC) review has been published in the International Journal of Radiation Oncology*Biology*Physics, the official journal of the American Society for Radiation Oncology (ASTRO) to update recommendations for the safe irradiation of 16 organs. For each organ, the relationship between dose/volume and clinical outcome is reviewed. These reviews replace initial recommendations published in 1991. When physicians began using radiation therapy to treat cancer, there was limited technology available to image a tumor and then target radiation specifically to it while limiting the dose to nearby healthy tissues. In the 1980s and 1990s, the field of imaging was revolutionized through the use of computed tomography-based diagnosis and radiation therapy treatment planning, allowing for treatments to be targeted more directly to the tumor and minimizing exposure to surrounding tissues. No radiation treatment can be given while avoiding all nearby healthy tissue, but unlike cancer cells, normal tissue cells can repair themselves after receiving radiation. The QUANTEC review was published to help the radiation oncology treatment team decide which areas of healthy tissue surrounding a tumor can most safely receive radiation and to provide guidance for selecting doses/volumes to be treated. The review also highlights areas in which there are gaps in knowledge and outlines future research in these areas. "The information provided in the QUANTEC review is critical to providing cancer patients with the most effective radiation treatments to cure their cancer while minimizing side effects to normal tissue," Randall K. Ten Haken, Ph.D., one of the guest editors of the QUANTEC review and a professor at the University of Michigan Department of Radiation Oncology in Ann Arbor, Mich., said. "The field of radiation oncology is growing rapidly, and it's very important to know the limitations of the human body in receiving radiation; the QUANTEC review helps provide this information." These reviews were produced through an extensive two-year project led by a QUANTEC steering committee comprising Dr. Ten Haken and fellow guest editor Lawrence B. Marks, M.D., a radiation oncologist at the University of North Carolina, Chapel Hill, as well as S�ren M. Bentzen, Ph.D., D.Sc., University of Wisconsin in Madison, Wis., Louis S. Constine, M.D., University of Rochester in Rochester, N.Y., Joseph O. Deasy, Ph.D., Washington University in St. Louis, Avraham Eisbruch, M.D., University of Michigan in Ann Arbor, Mich., and Andrew Jackson, Ph.D., and Ellen D. Yorke, Ph.D., both from Memorial Sloan-Kettering Cancer Center in New York. Mary K. Martel, Ph.D., from M.D. Anderson Cancer Center in Houston served as an associate guest editor. More than two dozen of the world's leading radiation oncologists, medical physicists and radiobiologists worked together on this extraordinary publication. The supplement can be found online at https://www.redjournal.org/issues. ### ASTRO is the largest radiation oncology society in the world, with more than 10,000 members who specialize in treating patients with radiation therapies. As the leading organization in radiation oncology, biology and physics, the Society is dedicated to improving patient care through education, clinical practice, advancement of science and advocacy. For more information on radiation therapy, visit www.rtanswers.org. To learn more about ASTRO, visit www.astro.org.

医学

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Contact: Julia Capaldi [email protected] Lawson Health Research Institute Lawson recieves Grand Challenges Explorations grant for groundbreaking research Lawson's Dr. Gregor Reid studying potential benefits of enriched yogurt in Africa LONDON, ON � Lawson Health Research Institute announced today that it is a Grand Challenges Explorations winner, an initiative funded by the Bill & Melinda Gates Foundation. Dr. Gregor Reid and his team are the first London, Ontario-based researchers to receive funding from the Gates Foundation. The research project will study the impact of probiotic yogurt mixed with the nutrient rich plant called Moringa on the health outcomes of pregnant women and their children. Dr. Reid's work focuses on the benefits of bacteria in promoting nutrition and disease prevention. This study will investigate if those benefits can pass from mothers to their children. It will be based out of a newly-opened yogurt kitchen in Mwanza, Tanzania and will be part of the Western Heads East program. "A lot of what happens later in life is impacted by the first thousand days � the nine months of pregnancy and the first two years after birth," says Dr. Reid. "Much of the work of Gates Foundation is focused on that period of life, so it was a natural fit. We're thrilled to be working with them." Dr. Reid is Assistant Director at Lawson Health Research Institute, Director of the Canadian Research & Development Centre for Probiotics at Lawson, and a professor of Microbiology & Immunology and Surgery at the Schulich School of Medicine & Dentistry at Western University. Grand Challenges Explorations funds individuals worldwide to explore ideas that can break the mold in how we solve persistent global health and development challenges. Dr. Reid's project is one of over 100 Grand Challenges Explorations Round 8 grants announced by the Bill & Melinda Gates Foundation. "Grand Challenges Explorations encourages individuals worldwide to expand the pipeline of ideas where creative, unorthodox thinking is most urgently needed," said Chris Wilson, director of Global Health Discovery and Translational Sciences at the Bill & Melinda Gates Foundation. "We're excited to provide additional funding for select grantees so that they can continue to advance their idea towards global impact." To receive funding, Dr. Reid and other Grand Challenges Explorations Round 8 winners demonstrated in a two-page online application a bold idea in one of five critical global heath and development topic areas that included agriculture development, immunization and nutrition. Grand Challenges Explorations is a US$100 million initiative funded by the Bill & Melinda Gates Foundation. Launched in 2008, over 600 people in 45 countries have received Grand Challenges Explorations grants. The grant program is open to anyone from any discipline and from any organization. The initiative uses an agile, accelerated grant-making process with short two-page online applications and no preliminary data required. Initial grants of US$100,000 are awarded two times a year. Successful projects have the opportunity to receive a follow-on grant of up to US$1 million. Applications for the current open round, Grand Challenges Explorations Round 9, will be accepted through May 15, 2012. Lawson Health Research Institute. As the research institute of London Health Sciences Centre and St. Joseph's Health Care, London, and working in partnership with The University of Western Ontario, Lawson Health Research Institute is committed to furthering scientific knowledge to advance health care around the world. www.lawsonresearch.com Julia Capaldi 519-685-8500 ext. 75616 www.lawsonresearch.com

医学

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Contact: Laurel White [email protected] Study explores medical exemptions from school vaccination requirements across states Findings suggest need to ensure medical exemptions are granted only to children who truly need them In states where medical exemptions from vaccination requirements for kindergarten students are easier to get, exemption rates are higher, potentially compromising herd immunity and posing a threat to children and others who truly should not be immunized because of underlying conditions, according to a study published in The Journal of Infectious Diseases and now available online. Nationwide in scope, the study found inconsistency among states in standards allowing medical exemptions from school immunization requirements. The investigators concluded that medical exemptions should be monitored and continuously evaluated to ensure they are used appropriately. In their study, Stephanie Stadlin, MPH, Robert A. Bednarczyk, PhD, and Saad B. Omer, MBBS, MPH, PhD, from the Hubert Department of Global Health at Emory University Rollins School of Public Health in Atlanta, evaluated state medical exemptions from kindergarten entry requirements over seven school years (from 2004-'05 to 2010-'11), which totaled 87,631 medical exemptions nationwide over the period studied. The researchers found that, compared to states with more stringent criteria for getting medical exemptions, states with easier requirements saw a significant increase in these exemptions. Their findings suggest that requiring more accountability of both parents and physicians for granting medical exemptions can be helpful in ensuring that these exemptions are valid and not used as an alternative to non-medical exemptions because they are easier to obtain. "The appropriate use of medical exemptions is important to maintaining sufficient herd immunity to protect those who should not be vaccinated due to medical contra-indications," said Dr. Omer, the senior investigator of the study. "Medical providers, parents, school officials, and state health officials are responsible for ensuring that medical exemptions are actually medically indicated." In an accompanying editorial, Daniel A Salmon, PhD, MPH, and Neal Halsey, MD, of the Johns Hopkins Bloomberg School of Public Health in Baltimore, noted that "children with valid medical exemptions need to be protected from exposure to vaccine preventable diseases by insuring high coverage rates among the rest of the population. Granting medical exemptions for invalid medical contraindications may promote unfounded vaccine safety concerns." The researchers' findings, they added, should be useful to those responsible for implementing and enforcing school immunization requirements at the state and local levels. Fast Facts: Rates of medical exemptions from kindergarten immunization requirements were higher in states where these exemptions are easier to obtain and in states that allow permanent compared to temporary exemptions. The appropriate use of medical exemptions from immunization requirements is important in maintaining community or herd immunity and protecting public health. Improper medical exemptions from school vaccination requirements can result in serious and life-threatening infections in children and others who truly cannot be vaccinated due to underlying conditions. Founded in 1904, The Journal of Infectious Diseases is the premier publication in the Western Hemisphere for original research on the pathogenesis, diagnosis, and treatment of infectious diseases; on the microbes that cause them; and on disorders of host immune mechanisms. Articles in JID include research results from microbiology, immunology, epidemiology, and related disciplines. JID is published under the auspices of the Infectious Diseases Society of America (IDSA). Based in Arlington, Va., IDSA is a professional society representing more than 9,000 physicians and scientists who specialize in infectious diseases. For more information, visit www.idsociety.org

医学

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Contact: Andy McGlashen [email protected] Peer support shows promise in epilepsy fight Peer support groups show promise for combating the debilitating stigma that surrounds epilepsy in much of the developing world, according to a new study led by a Michigan State University medical student. The researchers report in the journal Epilepsy and Behavior that young people with the disease felt significantly less stigmatized after meeting regularly to discuss their illness. While drugs are widely available to reduce epileptic seizures, the stigma and discrimination that arise from those seizures is a thornier problem, said Melissa Elafros, who is pursuing medical and doctoral degrees in MSU's Department of Epidemiology and Biostatistics. "In Africa a lot of people think epilepsy is contagious or associated with witchcraft," she said. "If you're told something often enough, you start to believe it's true. So people with epilepsy start to internalize that stigma." That feeling of shame leads some people to stop seeking treatment, Elafros said. Children with epilepsy often drop out of school, and some adults stop looking for work. Peer support groups have been shown to help with other kinds of stigma, so Elafros and colleagues decided to test the groups as an intervention for epilepsy patients. They trained local partners to facilitate monthly meetings of support groups made up of men, women and youths from 12 to 18 years old. The meetings involved guided discussion among the participants of epilepsy-related challenges they'd faced and solutions they'd found. After a year of meetings, an evaluation of the youths showed that they felt significantly less stigmatized. There was a trend toward improvement in felt stigma among the adults, though it was not statistically significant. "It could be that adults have just learned to cope with things as they are," Elafros said. "Or adults may need some larger intervention than that." Still, the findings offer a much-needed glimmer of hope after decades in which several studies described the problem of epilepsy-related stigma but few systematic interventions were aimed at fixing it. "This shows we can finally do something for people with epilepsy," she said. "The idea that you could intervene in a teenager's life and help them better cope with a condition they may have for the rest of their life, I think that's really quite significant." Elafros was funded by the National Institutes of Health and mentored by MSU's Gretchen Birbeck, a professor of neurology and ophthalmology who's been working on epilepsy in Africa for two decades. For more on their work to help people with epilepsy in Africa, visit Spartans Will. 360. Michigan State University has been working to advance the common good in uncommon ways for more than 150 years. One of the top research universities in the world, MSU focuses its vast resources on creating solutions to some of the world's most pressing challenges, while providing life-changing opportunities to a diverse and inclusive academic community through more than 200 programs of study in 17 degree-granting colleges.

医学

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States Use Big Data to Target Hospital Super-Users Analytics and data sharing help spot areas with high rates of emergency room use and hospital re-admissions. by David Raths / April 3, 2014 Michael Powell, chief innovation officer, Maryland David Kidd In some cities, 1 percent of the population accounts for as much as 30 percent of hospital costs. Dr. Jeffrey Brenner, a physician working in one of the poorest cities in the country, Camden, N.J., has attracted a lot of attention for developing programs to provide this small percentage of hospital service “super users” with better, more coordinated care to keep them out of the emergency room and decrease the overall cost to the system. Now, other locations are starting to emulate the work of the Camden Coalition of Healthcare Providers in focusing on the needs of hospital super-users. Speaking at the State Healthcare IT Connect Summit in Baltimore on April 2, Mike Powell, chief innovation officer of Maryland, said the state spends a lot of money on people who are hospitalized for conditions that could have been prevented. To curb those costs, Powell said Maryland uses data gathered by the state health information exchange and GIS tools from ESRI to help health system, Medicaid and public health officials identify trends and better target their limited resources. One effort involves the creation of five Health Enterprise Zones funded with $4 million in state general funds. As part of the plan, the Anne Arundel Health System established a patient-centered medical home -- staffed by a physician and medical assistants -- in an underserved area of downtown Annapolis with high rates of emergency room utilization, hospital admissions and re-admissions, and a large volume of medical 911 calls. Under a Medicare waiver, the state of Maryland also is using a new model to reimburse providers based on the health of populations rather than the amount of services they provide. That has led to a hunger for data about patient populations and hospital re-admissions. “A few years ago we set a goal of lowering readmissions by 15 percent by 2015,” Powell said, “and we are already around 11 or 12 percent of that.” He added that the target would likely be reset looking ahead to 2020. Noting that Maryland just added 235,000 people to its Medicaid rolls, Powell said the state has to do a better job of keeping people healthy. “The more information you have about patients, the better able you are to measure results,” Powell said. The statewide health information exchange, the Chesapeake Regional Information System for our Patients (CRISP), is central to that data gathering and sharing. The consortium of hospitals made Maryland the first state to have all acute-care hospitals sharing data on admissions and readmissions with one another. “We have a better picture of health than when everyone was in a silo,” Powell said. “This information collected by hospitals is one of the fundamental things we need to achieve our goals.” Scott Afzal, CRISP's director of statewide health information exchange, said getting hospitals accurate information about readmissions anywhere in the state is a major step. Hospitals are being penalized for readmissions no matter where they occur, and previously there was no way to know if your patients were being admitted elsewhere, he explained. Beyond inter-hospital readmission reports, CRISP is moving on to “hot spotting” super-users by specific location -- an effort that's growing out of Brenner’s work in New Jersey. The state data shows that 5 percent of patients represent 70 percent of readmissions. Now Maryland is working with 24 local health departments to identify innovative approaches to treating these super-users. But Afzal admitted there are privacy and security concerns around mapping health data and who gets access to the maps. If a patient lives in what is defined as a hospital’s primary service area but gets all his care across the state, is the local hospital allowed to see that data? Can data provide valuable geographic information to public health providers while protecting the privacy of individual patients? These are questions that policymakers will have to address, Afzal said. Kentucky also is targeting super-users. Speaking at the same Baltimore summit meeting, Dr. John Langefeld, chief medical officer for the Kentucky Department of Medicaid, noted that Medicaid is historically the largest payer in the state, with approximately 25 percent of the state's population eligible for the program. He said Gov. Steve Beshear asked Langefeld's organization to focus on super-utilization of emergency rooms. Research indicated that among patients who visited the emergency room 10 or more times in a 12-month period, 79 percent had behavioral health issues, and 45 percent had a substance abuse diagnosis. So obviously behavioral health providers have to be part of the solution. Langefeld said the Cabinet for Health and Family Services is using the state HIE to deliver alerts to hospitals and newly forming care coordination teams. The state also is working to improve data sharing among its many program areas. In both Maryland and Kentucky, state health information exchanges are playing a critical role in getting data to providers who are seeking more effective ways to care for patients with chronic conditions. L.A. County Energy Efficiency Project Receives EPA Recognition Smart Hospital Provides Safe Training for Students Experts Weigh Big Data's Benefits, Pitfalls in Health-Care Delivery UPMC: As Many as 27,000 Employees Affected in Data Breach How to Jump-Start Analytics in Your City Using Data and Analytics to Make Pittsburgh Neighborhoods Great David Raths 5 Trends Driving the Future of Human Services Local Governments Help Lead the Way to HHS Convergence (Industry Perspective) Massachusetts Signs $50 Million MMIS Contract Q&A: What are States Doing to Prepare for an Ebola Outbreak? Data Analytics and the Soup that Made You Sick Dangerous Heart Rates in Children Treated Remotely with Smartphone Device

医学

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Scott Gettings, MD Chief Medical Officer Dr. Gettings currently serves as the chief medical officer of Health First. In this role, he serves as the liaison for all physicians in the system, as well as providing oversight for clinical quality processes and outcomes throughout the system. Dr. Gettings first came to Health First Holmes Regional Medical Center in 1981, where he developed and managed the emergency medicine program at Holmes and Palm Bay hospitals. Over 20 years of medical practice included multiple leadership and quality improvement positions and responsibilities. Beginning in 2008, Dr. Gettings served as vice president of medical affairs for Health First Holmes Regional Medical Center. In this role he served as physician liaison for the medical staff, and managed its trauma program, hospitalist services, and medical directors. Dr. Gettings also served as a Health First physician advisor for over five years. After initial training in engineering, chemistry and microbiology, Dr. Gettings served at NASA prior to attending medical school. He was the founder and president of Brevard Emergency Services, the founder and president of Physicians Computer Systems, a senior partner of Eagle Mountain Properties, and the medical director for DSHI Systems. Dr. Gettings earned his medical degree at the University of South Florida and residency at the University of South Florida Affiliated Hospitals. He also serves as an assistant professor of medicine at University of Central Florida College of Medicine.

医学

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Community Hospitalse-Newsletter Community Hospitals > CNR - Spotlight Obama’s Re-election Entrenches PPACA John Commins, for HealthLeaders Media, November 7, 2012 And yet, the PPACA remains standing, even as many of its political foes have fallen by the wayside. Regardless of whether or not you support it, "Obamacare" is the law of the land and it isn't going away. Most people who work in healthcare have already accepted that reality. Still, there remain nettlesome issues that will likely soon become political flashpoints that, depending upon a state's "Red" or "Blue" status, could leave healthcare providers in a lurch. One big concern centers on states' efforts and their enthusiasm toward constructing health insurance exchanges that will allow consumers and small businesses to buy health insurance on the open market. The degree to which states are ready to implement these exchanges, which go into effect in 2014, varies wildly. In May the Kaiser Family Foundation reported that 15 states would develop their own exchanges. Another Seven states said they had no plans to create exchanges, which means that the Department of Health and Human Services will step in to run the exchanges. Because a federal fallback plan is in place, the political intransigence of individual states should not be an insurmountable obstacle for the exchanges to operate. The more pressing problem is with Medicaid. 1

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Juan Carlos Galofré University of Navarra, Spain Juan Carlos Galofré is a consultant endocrinologist and Assistant Professor of Medicine at the University of Navarra (UN) in Pamplona (Spain). Dr. Galofré graduated from the Autonoma University of Barcelona (Spain). After a period of research at the University of Santiago de Compostela (Spain), where he acquired his PhD, he continued his career following a postdoctoral research program in the laboratory of cancer gene therapy in the UN. Afterwards he completed a postgraduate internship, residency, and clinical fellowship training in endocrinology at the UN. He worked as Clinical Research Fellow in the Section of Endocrinology in the Department of Medicine at the University of Wales College of Medicine, Cardiff (UK). He has been Visiting Professor at the Division of Endocrinology, Department of Medicine at the Mount Sinai School of Medicine, University of New York. NY (USA), and Observer in the Department of Endocrine Neoplasia and Hormonal Disorders, Division of Internal Medicine, at the University of Texas MD Anderson Cancer Center, Houston, TX (USA). He is an active member of the Committee for the study of Thyroid Cancer of the Spanish Society Endocrine and Nutrition (SEEN). Dr Galofré’s research production has been focused mainly in both basic and clinical thyroid disorders. Biography Updated on 27 February 2011

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Scientists Make Strides Toward Drug Therapy for Inherited Kidney Disease Gail Gallessich [email protected] George Foulsham [email protected] Santa Barbara, Calif. –– Scientists at UC Santa Barbara have discovered that patients with an inherited kidney disease may be helped by a drug that is currently available for other uses. The findings are published in this week's issue of the Proceedings of the National Academy of Sciences.Over 600,000 people in the U.S., and 12 million worldwide, are affected by the inherited kidney disease known as autosomal-dominant polycystic kidney disease (ADPKD). The disease is characterized by the proliferation of thousands of cysts that eventually debilitate the kidneys, causing kidney failure in half of all patients by the time they reach age 50. ADPKD is one of the leading causes of renal failure in the U.S."Currently, no treatment exists to prevent or slow cyst formation, and most ADPKD patients require kidney transplants or lifelong dialysis for survival," said Thomas Weimbs, director of the laboratory at UCSB where the discovery was made. Weimbs is an associate professor in the Department of Molecular, Cellular and Developmental Biology, and in the Neuroscience Research Institute at UCSB.Recent work in the Weimbs laboratory has revealed a key difference between kidney cysts and normal kidney tissue. They found that the STAT6 signaling pathway –– previously thought to be mainly important in immune cells –– is activated in kidney cysts, while it is dormant in normal kidneys. Cystic kidney cells are locked in a state of continuous activation of this pathway, which leads to the excessive proliferation and cyst growth in ADPKD. The drug Leflunomide, which is clinically approved for use in rheumatoid arthritis, has previously been shown to inhibit the STAT6 pathway in cells. Weimbs and his team found that Leflunomide is also highly effective in reducing kidney cyst growth in a mouse model of ADPKD. "These results suggest that the STAT6 pathway is a promising drug target for possible future therapy of ADPKD," said Weimbs. "This possibility is particularly exciting because drugs that inhibit the STAT6 pathway already exist, or are in active development."[RETURN TO TOP] † Top image: A polycystic mouse kidney (left) is several times larger than a normal mouse kidney (right). The tissue architecture of the diseased kidney is destroyed by the growth of numerous cysts.Credit: Thomas Weimbs and Erin Olsan†† Bottom image: Thomas Weimbs with images of mouse polycystic kidney sections.Credit: George Foulsham, Office of Public Affairs, UCSB (69) Office of Public Affairs • 805-893-2191 Copyright © The Regents of the University of California, All Rights Reserved.

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ACA & Catheter Infections Environmental Hygiene HAI Prevention Imperatives Infection Prevention OR/SPD The Science Behind the Technology Toolbox Infection Control Today Infection Control Today Magazine Clostridium Difficile Clostridium difficile (C. diff) is a spore-forming, Gram-positive anaerobic bacillus that produces two exotoxins: toxin A and toxin B. Clostridium difficile is shed in feces. Any surface, device, or material that becomes contaminated with feces may serve as a reservoir for the Clostridium difficile spores. Clostridium difficile spores are transferred to patients mainly via the hands of healthcare personnel who have touched a contaminated surface or item. Clostridium difficile infection be prevented in hospitals by the prudent use of antibiotics; the use of contact precautions for patients with known or suspected Clostridium difficile infection; preventing contamination of the hands via glove use and handwashing; and implement an environmental cleaning and disinfection strategy. The impact of antibiotic misuse has far-reaching consequences in healthcare, including reduced efficacy of the drugs, increased prevalence of drug-resistant organisms, and increased risk of deadly infections. A new study featured in the February issue of Infection Control ...More Dog Trained to Sniff Out Clostridium difficile A new study published in BMJ conducted by investigators at two large hospitals in The Netherlands shows that a trained dog was able to detect Clostridium difficile with high estimated sensitivity and specificity, both in stool samples and in hospital patients infected with ...More Bugs Without Borders: Researchers Track Emergence Global Spread of Clostridium difficile Researchers show that the global epidemic of Clostridium difficile 027/NAP1/BI in the early to mid-2000s was caused by the spread of two different but highly related strains of the bacterium rather than one as was previously thought. The spread and persistence of both ...More Study of Clostridium difficile Infection Attempts to Reveal True Incidence of Disease The EUropean, multi-center, prospective bi-annual point prevalence study of CLostridium difficile Infection in hospitalized patients with Diarrhea (EUCLID), the largest study of the prevalence of CDI ever conducted in Europe, has been launched. For the first time experts ...More Researchers Discover How Clostridium difficile Sends Immune Response Into Overdrive Researchers in the Nutritional Immunology and Molecular Medicine Laboratory at Virginia Bioinformatics Institute have discovered how a common diarrhea-causing bacterium sends the body's natural defenses into overdrive, actually intensifying illness while fighting infection. ...More When Antibiotics Lead to Deadly Diarrhea It’s day five of Get Smart About Antibiotics Week. In today’s CDC Safe Healthcare Blog, Matthew Wayne MD, CMD, of the American Medical Directors Association (AMDA) takes a close look at Clostridium difficile, a major cause of acute, antibiotic-associated diarrhea in the ...More MRSA and C. difficile Identified From a Variety of Surfaces in the General Hospital Environment The hospital environment has been suggested as playing an important role in the transmission of hospital-associated (HA) pathogens. However, studies investigating the contamination of the hospital environment with methicillin-resistant Staphylococcus aureus (MRSA) or ...More C. difficile Infections Becoming More Common, Severe in Children and Elderly Clostridium difficile infections are becoming more common and more severe in hospitalized children and the elderly, in large part due to greater use of antibiotics, Mayo Clinic researchers report in studies being presented at the American College of Gastroenterology annual ...More Using Human Stool to Treat C. difficile is Safe, Effective A novel therapy that uses donated human stool to treat the deadly and contagious Clostridium difficile infection is safe and highly effective, according to a Henry Ford Hospital study. Researchers found that 43 of 49 patients recovered swiftly after treatment and had no ...More Progress Reported in Tackling Initial, Recurrent HAIs Surgeons are making progress toward preventing initial and recurrent episodes of Clostridium difficile colitis, a vicious bacterial infection that is estimated to affect about 336,000 people each year, typically patients on antibiotics. Using mouse models, researchers at ...More

医学

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Saying no to drugs with Mad PrideFor some mentally ill people, being different is better than being doped upJill Carlson on Friday 07/17/2009, (1) Comment Depressed? There's a pill for that. Anxious? There's a pill for that too. Manic? Schizophrenic? Bipolar? There are pills for all of these conditions. But psychiatric meds can produce serious and debilitating side effects - like weight gain or loss, a dulling of the senses, lowered libido, manic episodes and suicidal thoughts. This downside has spurred a grassroots movement among people with mental illness to try getting by without a little help from their pharmaceutical friends. It's called Mad Pride, and although there are local adherents, the Mad does not stand for Madison. Rather, the movement is a revolt against the numbing of peculiar personalities with powerful chemicals. Those who take this path - sometimes with the help of medical professionals, sometimes in defiance of them - say they would rather embrace their madness then try to stifle it. Among them is a Madison couple, Christin and her husband "Thom." Christin is her real first name; Thom is a pseudonym. Both are in their late 20s. Christin works at a local nonprofit; Thom is a personal-care assistant for people with dementia and Alzheimer's. Christin was diagnosed with major depressive disorder at age 16 and with bipolar disorder eight years ago. She figures she's been prescribed almost 40 meds, including the antidepressants Paxil, Xanax and Effexor and mood stabilizer Lamictal. "Being told you are going to be on an antidepressant for the rest of your life is quite a blow," says Christin. "Receiving treatment by a psychiatrist who doesn't know you as a person and wants to rewire your neurochemistry with meds was not what I wanted. I didn't feel a connection with my therapists. I felt isolated and alienated. I could relate better to my peer group who were going through the same thing that I was." Thom, meanwhile, was diagnosed four years ago with bipolar disorder. He used alcohol and street drugs to help him cope. Then his doctor prescribed Effexor. The drug is meant to treat depression and anxiety, but Thom says it made him extremely manic, staying up for days without sleep. And when the mania ended, he became suicidal. He ended up going to the emergency room and was hospitalized for two days. "At first I felt a lot of relief that he was getting help by professionals and that he would feel better soon," Christin explains. "I was so stressed out, feeling really helpless and confused. I was still in the mindset that getting professional help was the wisest and perhaps only way to deal with crisis situations." Now she and Thom doubt it. They have come to see medication as part of the problem, not the solution, and are working to free themselves from it. For Christin, it's the end of a long journey, to hell and back. "Eventually I couldn't tell if what I was feeling was because of the meds or because of what was going on in my life." Christin has a term - "dumbed down" - for what Thom was like after he came home from the hospital with an array of prescribed medications. "I don't know which is worse," she says, "to be manic and dysphoric or to be subdued and soulless on a chemical cocktail." During a four-year period, Thom was prescribed 20 different medications and experienced negative side effects with each. He gained 80 pounds while taking one med. While on lithium, he developed a benign thyroid tumor. Currently he's on Depakote to stabilize his moods, Klonopin for anxiety and Geodon, an anti-psychotic. "My goal is to get off the meds, but if I go off the Depakote too quickly I could have a grand mal seizure," Thom says. He ended up in a detox clinic in Waukesha for two weeks after his dosage of Klonopin got too high. "It was a quality facility, but I was in there with heroin addicts and didn't feel that I belonged there." In an interview, Thom seems preternaturally subdued, laidback and unenthusiastic. He says it feels as though his personality is slipping away. "I've become progressively dull. My creative drive to write music has declined substantially. My friends wonder what's happened." Christin, for her part, is in the last stages of tapering off use of Effexor XR. But it isn't easy. This is her fourth attempt to get off Effexor because of withdrawal effects that include "brain zaps," periods of serotonin imbalance she says are unpleasant to the point of being painful: "It feels like some of the atoms in my body are stuck in time and kind of hiccup back and forth." It was while surfing the web in search of answers that Christin learned about the Icarus Project, which began in Manhattan in 2004. The group, which now has more than 8,000 people on its web forum (www.theicarusproject.net), argues that those with mental illness ought to be able to treat their symptoms with such alternative methods as yoga and changes in diet and sleep patterns. The Icarus Project is named after the boy in Greek mythology who flew too close to the sun with wings made of wax and feathers. Its co-coordinator is Will Hall, 43, who also co-founded the Freedom Center (www.freedom-center.org) in 2001. Based in Northampton, Mass., the Freedom Center is a support and activist organization that opposes the routine use of drugs as the medical standard for the mentally ill. Both the Freedom Center and the Icarus Project are officially pro-choice with regard to medical treatment. They advocate a partnership between patients and therapists, as well as support systems among people with similar conditions. Explains Hall, "Having a community of people with whom you can share your experiences in the mental health system is beneficial." For most of his life, Hall has experienced what he calls altered states of consciousness. He hears voices and has extreme emotions and out-of-body experiences. Afraid to share what was going on in his head, he isolated himself from others. "My first experience with psychiatry was when I was 24," Hall relates in a phone interview. "The doctor prescribed Prozac, which at first made me feel better and productive. Then I started having manic episodes that included arguing with my co-workers, wearing weird clothes and acting strangely at work. Neither my doctor nor therapist warned me of the side effects or took me off the Prozac." Hall's manic episodes cost him his career. He ended up wandering the streets of San Francisco hearing voices that urged him to kill himself. He was picked up and taken to a locked unit in a public psychiatric facility. "I wasn't asked if I wanted to go," he says. "I was just taken." He was labeled schizophrenic and was in the public health system for a year, including two months in lock-up. Hall says that despite all the medications, his mental health problems went from bad to worse. "I wasn't exercising, ate more junk food and was traumatized by the things I saw and heard in the facility." And so Hall began considering his options rather than accepting what authorities told him. He's now been free of psychiatric meds for 14 years. "Mad Pride is the last frontier of civil rights," Hall says. "It's the least-valued set of civil rights." In 2006, Christin and Thom were living in Minneapolis, where she started an Icarus Project group after one of her friends committed suicide. Eventually the group had about 70 people on its email list, and attendance at the weekly meetings ranged between five and 10. The couple moved to Madison last August in order to live in a smaller, less hectic environment. But they missed the connection with others that the Icarus Project group provided. And so, last December, Christin started the Mad Rads (short for Madison Radical Mental Health Collective). She says the first meeting attracted a dozen people; now attendance at meetings ranges from 10 to 20 people, with about 70 on the group's email list. "It's still in the baby-steps stage," says Christin. "We have people who are trying to wean off meds, some who want to share their experiences with therapists and others who have found a med that works for them without hideous side effects but want the support of a peer group." The group includes people diagnosed with bipolar disorder, schizophrenia, major depression, borderline personality disorder and other mental health problems. The group's website (www.theicarusproject.net/madrads) proclaims it a collective of "self-identified crazies, dreamers, manic depressives, compulsive (everythingers), dancers, thinkers, erratics and people with sensitive hearts and nervous systems." Members meet weekly at the InfoShop on Williamson Street for two hours to share personal stories and offer support. They also talk about therapists who are supportive of their approach and those who aren't. "People ask how radical we are," notes Christin. "I reply that it's pretty radical to talk to a group of strangers about personal things in your life." But the mainstream medical establishment looks at the Mad Pride movement with skepticism, even alarm. As they see it, patients with mental illness who stop taking their medication risk going into crisis and becoming ever more deluded. Dr. Ronald Diamond, medical director of the Mental Health Center of Dane County and a tenured professor of psychiatry at the UW-Madison, has been in practice for 37 years, 23 of them at the Mental Health Center. He teaches psychopharmacology to social workers, counselors, nurses, clients and families of individuals with mental illness. In his view, medications are used successfully to treat a wide range of illnesses. Sure there are side effects, but Diamond argues that they are seldom worse than the conditions they treat. "There are no meds without side effects," he says. "Even aspirin has side effects." While he wants to respect his patients' wishes, Diamond usually sees value in pharmaceuticals. "When patients come to my office and ask to get off their meds, I ask them how their life would get better without the meds," he says. "I try to steer away from moral judgment and not discourage them, but I have to ask them if they are better off living with the side effects." One client, Diamond says, complained of weight gain from a medication that in other respects worked well. He says he responded: "You can either be a happy fat lady or an unhappy skinny lady, the choice is yours." Diamond, who hadn't heard of the Icarus Project (the subject of a recent article in Newsweek), thinks abandoning medication is not a useful strategy. "People need to be educated about their diagnosis and the meds that will help them lead a more productive life." Yes, therapy and support groups are helpful, but he thinks these should augment medication and not replace it. Other practitioners are more receptive to those who want to try different approaches. "Everyone is different in how they tolerate antidepressants and other meds," says Susan A. Brown, Ph.D. Brown, an advanced practice nurse prescriber, has been in private practice for 30 years in Madison, and has helped wean patients from meds. "If someone wants to get off their meds, it should be done under the counsel of the practitioner who prescribed the meds," she says. When she prescribes meds to patients, she has them sign a form so they know what they are taking along with the benefits and the risks. People who abruptly stop taking antidepressants commonly experience symptoms including lethargy, insomnia, anxiety, dizziness, nausea and gastrointestinal problems. In his book Comfortably Numb: How Psychiatry Is Medicating a Nation, Charles Barber talks about the overmedication of Americans. Barber, a lecturer in psychiatry at the Yale University School of Medicine, says in a phone interview with Isthmus that the vast majority of prescriptions for antidepressants are written by doctors who have no training in psychiatry and no clue as to how the drugs work. "When a patient complains of the side effects, they are largely ignored," says Barber, who urges people to assert their right not to take things that make them feel bad. "People need to take charge of their health instead of being a passive recipient. Often they settle for taking a pill rather than taking control of their treatment." Barber says that patients and therapists need to work as a team to determine the best course of action, and that therapists need to closely monitor patients taking antidepressants. According to Barber's book, the use of antidepressants has skyrocketed over the past two decades. Thirty-three million Americans were prescribed at least one psychiatric drug in 2004, up from 21 million in 1997. Between 1995 and 2002, the use of antidepressants and other psychotropics increased 48%. By 2002, 11% of American woman and 5% of American men (which equates to about 25 million people) were taking antidepressants. Zoloft's American sales of $3.1 billion in 2005 exceeded those of Tide detergent for the same year. A study by the Centers for Disease Control looked at the 2.4 billion drugs prescribed in visits to doctors and hospitals in 2005. Of these, 118 million were for antidepressants. A year later, the number of antidepressant prescriptions rose to 227 million. Barber explains that Big Pharma or the medico-pharmaceutical complex composed of companies that create psychotropic drugs have seen their profits soar. The combined profits of the top 10 drug companies in 2002 were greater than the profits of all the other 490 Fortune 500 companies put together. Christin and Thom have discovered that they need to listen to their bodies and respond appropriately. "When I start to sleep less and eat less, I need to address it immediately so things don't spiral out of control," says Christin. "It's not as easy as it sounds, and it's not foolproof, but I am aware enough now that I know how to stabilize myself from stress and mood swings." Taking vitamins, eating whole foods (including a pound of vegetables per day), following a vegan diet, maintaining a consistent sleep schedule and getting enough omega-3 fatty acids and B vitamins in her diet are ways that Christin copes as she tries to taper her meds. Thom plans to enter nursing school to specialize in caring for those with second-stage dementia and Alzheimer's disease. He's turned to spirituality and hopes to soon be writing music again. Getting off psychiatric drugs - some advice Even those who advocate discontinuing the use of psychiatric drugs acknowledge the risks. They recommend some guidelines: Prepare yourself by learning all you can about withdrawing from your psychiatric drug. Timing is important. Wait until you have what you need - housing, stability, a regular schedule - in place. Get help if you can. Working with a doctor or health-care practitioner who is on your side can make a huge difference. Involve supportive friends and family. Create a "Mad Map" or "advance directive," a crisis plan telling people what to do if you go into serious crisis and have trouble communicating or taking care of yourself. Strengthen your immune system with plenty of rest, fresh water, healthy food, exercise, outdoor air, sunlight, visits to nature and connections with your community. Go slow and taper off gradually. Withdrawing from psychiatric drugs abruptly can trigger dangerous effects, including seizures and psychosis. As a general principle, the longer you are on a drug, the longer you should take going off it. Start with one drug. Choose the one that is giving you the worst negative effects, the drug you feel is the least necessary, or the one that's easiest to stop. If withdrawal is unbearable, too difficult or continues for too long, increase the dose again. Extrapolated from the Harm Reduction Guide to Coming off Psychiatric Drugs, www.theicarusproject.net. From Robert Jordan on 07/17/09 at 4:23 pm I like the idea of trying to get off of the meds, when the disease is depression. I am very concerned about the attempt to get off the meds when the disease is schizophrenia. Voices telling you to kill yourself are too close to voices telling you to kill another. I have a close family member that has schizophrenia. He has auditory and visual hallucinations, as well as paranoia. His voices have told him to kill himself, and usually these voices are demons, and/or jesus talking to him. He also says that he can't tell people about the really bad stuff he hears because "they would lock me away." He continues to try to go off his meds, and becomes increasingly dillusional. The only thing that has worked is the meds. He has used alcohol for years to deal with it, but the meds work the best. This is unfrotunately a very tough situation that REQUIRES medication. Yes, this society is overmedicated when it comes to anti-depressants, but do not lump all medicines in with prozac and zoloft. Schizophrenia is a debilitating disease that needs the medication that is available. Unfortunatley, the current medication is not great. Time will tell if the scientific community can develop better medications that reduce the symptoms AND side effects. And for everyone complaing about the cost of meds... the thousands of schizophrenia drugs being developed in pre-clinical work will not be to the market for close to a decade. Each step from pre-clinical (millions of dollars) all the way up to phase IV (tens of millions of dollars) most of the potential drugs will fail. Meaning that of the thousands of potential drugs currently out there, maybe a couple will make it. maybe. Close CommentsLog in or register to comment >>Back To Top Select a Movie

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Physician NetworkBecome a PatientFind a Network DoctorServices We ProvidePracticesImmediate CarePatient FormsPatient ResourcesFinancial Policy Home » Physician Network » Practices » Dynamite Creek Medical Center » Our Physicians C. Daniel Murphy, MD Justin W. Wight, MD Jerome E. Rubbelke, MD Therese "Terry" G. Argyros, FNP C. Daniel Murphy, MD Dr. Murphy is a family physician who places an emphasis on preventive medicine. He specializes in treating patients over age two whose conditions range from mild trauma to serious illness or injury. He is on staff at both John C. Lincoln Deer Valley Hospital and John C. Lincoln North Mountain Hospital. A native of Canada, Dr. Murphy earned his medical degree from the University of Ottawa Medical School in 1968. He relocated to Arizona in 1981 where he established his family practice while serving as the team physician for professional football and hockey teams. Dr. Murphy is a member of the American Medical Association, the Arizona Academy of Family Physicians, and the Maricopa County Medical Society. He is also a charter member of the American Society of Sports Medicine. Return to top Jerome E. Rubbelke, MD Dr. Rubbelke has been practicing family medicine in Phoenix since 1993 and is board certified by the American Board of Family Practice. He is on staff at both John C. Lincoln Deer Valley Hospital and John C. Lincoln North Mountain Hospital. He received his medical degree from Wayne State University in Detroit, Michigan in 1984. His medical experience also includes serving in the U.S. Air Force from 1987 to 1993, during which time he was Chief of the Family Practice Department for the 58th Medical Group at Luke Air Force Base in Arizona. Dr. Rubbelke is a member of the American Academy of Family Physicians. Return to top Justin W. Wight, MD Dr. Wight received his medical degree from Ross University School of Medicine in North Brunswick, New Jersey, and completed a family practice internship and residency at St. Joseph's Hospital & Medical Center in Phoenix, Arizona. He is on staff at both John C. Lincoln Deer Valley Hospital and John C. Lincoln North Mountain Hospital. In addition to his training in family medicine, Dr. Wight also has experience in urgent care, wellness and weight management. Dr. Wight is a member of American Association of Family Practitioners and American Society of Bariatric Physicians. His special interests in medicine include health, wellness and weight loss education. Dr. Wight joined Dynamite Creek Medical Center in January 2010 and welcomes new patients. Return to top Therese "Terry" G. Argyros, FNP Terry Argyros has been a family nurse practitioner since 2001 and is involved in the assessment, diagnosis and treatment of patients of all ages. Ms. Argyros holds a master's degree in nursing from University of Phoenix. She has worked in women's and infants' services and in neonatal intensive care at several Valley hospitals, providing care to newborns in high-risk and emergency situations, as well as educating patients and staff. She is a member of the Arizona Nurses Association, the American Academy of Nurse Practitioners, the National Association of Neonatal Nurses, Neonatal Nurse Practitioners of Arizona and the Arizona Perinatal Trust. Return to top Dynamite Creek Appointments, Insurance, Prescriptions and Referrals Physician Network Resources John C. Lincoln Wellness at John C. Lincoln HealthBeat Newsletter Upcoming Health Events John C. Lincoln Breast Health and Research Center Contributes to Groundbreaking 3D Mammography Study Maggi Griffin Appointed CEO of John C. Lincoln North Mountain Hospital MGMA Presents Award for Healthcare Quality to John C. Lincoln

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Show/hide main menu Home | Institute of Psychiatry, Psychology & Neuroscience | News, Events & Engagement | News Stories | Child mental health issues need to be addressed Child mental health issues need to be addressed Professor Robert Goodman in the Department of Child and Adolescent Psychiatry at the Institute of Psychiatry at King's was interviewed in the Guardian this month on the topic of common child and adolescent mental health problems which commonly affect around 10 per cent of all children and adolescents. So much so that they cause substantial distress with problems markedly interfering with children’s lives. He comments: "The problems are not usually outgrown in the short term – even three years on, most of the affected individuals are still experiencing a lot of symptoms. Although there are good evidence-based treatments, it is only a minority (and probably a small minority) who receive these. No social group is immune from these difficulties, but disabled, deprived and excluded groups suffer disproportionately. For example, around half of all children and adolescents who are “looked after” by local authorities have definite mental health problems, and many of the rest have borderline problems. Professor Goodman masterminded recent Department of Health (DoH) surveys that produced these dramatic figures - indicating that a 10th of British children at any one time suffer emotional, behavioural or concentration difficulties and says understandably that we should be appalled by them. "If it had been diabetes, it would have been a national scandal.” He said. He continues: "Our Anglo-Saxon way of life - laissez-faire, everyone for themselves - is economically successful but not child-friendly." He is backed up by last year's Unicef research showing that children from Britain and the US are the least happy in the developed world. One source of reference is the website Youth In Mind to which Goodman has contributed advice, www.youthinmind.co.uk which has been set up as a source for more parents teachers and youths to get appropriate advice and help and feel less alone. Youth In Mind offers the first national directory of mental health services available to the general public. It's a reviewed resource bank of hundreds of books and websites. But its biggest innovation is the chance to take online the questionnaire that was a basic tool of the DoH surveys. The questionnaire asks 25 to 33 questions that can be completed in under 10 minutes by worried parents or teachers, or by 11- to 17-year-olds themselves. Questions like: Does your child think things out before acting? Does he/she steal from home, school or elsewhere? Is he/she kind and helpful? are instantly analysed in a brief report indicating possible causes for concern. Demand for such a service is soaring. Of the disturbed 10%, half have behavioural problems, 40% anxiety or depression, 15% attention-deficit hyperactivity disorder (ADHD), and 8% autistic spectrum disorders (some children have multiple problems). Goodman says that behaviour is significantly worse than 25 years ago, with "a steep social gradient in emotional problems. Nowadays more deprived children have more emotional difficulties." Everyone has their pet explanation - lack of fish oil, TV-watching, illegal drugs, lack of exercise. Likely candidates in Goodman's eyes are widening inequality, family breakdown, school pressures and a materialist, consumerist society. "Not having the right trainers has become a much worse stress." "Both behaviour and ADHD are much worse in Britain. Norwegians live in a much more equal society, with shorter working days, more time spent with families, particularly on outdoor sports at weekends, public values publicly shared. They eat lots of oily fish, too! Italy has a much more intact family structure: people typically live surrounded by family and lifelong friends. They enforce social rules differently. Minor peccadilloes like running children are tolerated. By contrast, infringements of personal space and property are immediately sanctioned, and not only by parents. Italians are physically and emotionally warm, too. That pattern is pretty much exactly what parenting programmes like ours are about." Over the past 20 years, the Institute of Psychiatry and the Maudsley have pioneered the scientific understanding of parenting, led by Professor Stephen Scott; obsessive compulsive disorder (OCD), led by Dr Isobel Heyman; and hemiplegia (a kind of cerebral palsy affecting one in 1,000), led by Goodman himself. Yet developing a reliable statistical tool to analyse the needs of whole populations may turn out the most important of all, globally. The questionnaire, in over 70 languages, is available free from www.sdqinfo.com for any non-profit, non-charging organisation. "Doing these surveys made me realise how much unnecessary suffering was caused by common mental-health problems," says Goodman. "These problems were not being treated. Yet I knew that for many of them, there were effective treatments." He gives as examples parent management training for behavioural disorders and cognitive behavioural therapy for OCD, anxiety and depression. The DoH surveys showed that only around a quarter of those in need got specialist help; and this was not necessarily the right kind. Comedian Jo Brand elected Honorary Fellow at King'sIoP hosts major summit to challenge stigma and discrimination in mental health

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All Boston bombing patients likely to live By MARILYNN MARCHIONE AP Chief Medical Writer In this Monday, April 15, 2013 file photo, medical workers aid an injured woman at the finish line of the 2013 Boston Marathon. (AP Photo/Charles Krupa) BOSTON (AP) - In a rebuttal to the terrorists and a tribute to stellar medical care, all of the more than 180 people injured in the Boston Marathon blasts one week ago who made it to a hospital alive now seem likely to survive.That includes several people who arrived with legs attached by just a little skin, a 3-year-old boy with a head wound and bleeding on the brain, and a little girl riddled with nails. Even a transit system police officer whose heart had stopped and was close to bleeding to death after a shootout with the suspects now appears headed for recovery."All I feel is joy," said Dr. George Velmahos, chief of trauma surgery at Massachusetts General Hospital, referring to his hospital's 31 blast patients. "Whoever came in alive, stayed alive."Three people did die in the blasts, but at the scene, before hospitals even had a chance to try to save them. A Massachusetts Institute of Technology police officer who police say was fatally shot Thursday by the suspects was pronounced dead when he arrived at Massachusetts General.The only person to reach a hospital alive and then die was one of the suspected bombers - 26-year-old Tamerlan Tsarnaev.But the remarkable, universal survival one week later of all others injured in the blasts is a testimonial to fast care at the scene, on the way to hospitals, then in emergency and operating rooms. Everyone played a part, from doctors, nurses and paramedics to strangers who took off belts to use as tourniquets and staunched bleeding with their bare hands.As of Monday, 51 people remained hospitalized, three of them in critical condition and five listed as serious. At least 14 people lost all or part of a limb; three of them lost more than one.Two children with leg injuries remain hospitalized at Boston Children's Hospital. A 7-year-old girl is in critical condition and 11-year-old Aaron Hern is in fair condition.The surviving bombing suspect, 19-year-old Dzhokhar Tsarnaev, is in serious condition at Beth Israel Deaconess Medical Center with a neck wound.

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Study ties fertility treatment, birth defect risk By MARILYNN MARCHIONE, AP Chief Medical Writer The study was coordinated at the University of Adelaide in Australia. Test-tube babies have higher rates of birth defects, and doctors have long wondered: Is it because of certain fertility treatments or infertility itself? A large new study from Australia suggests both may play a role.Compared to those conceived naturally, babies that resulted from simple IVF, or in vitro fertilization — mixing eggs and sperm in a lab dish — had no greater risk of birth defects once factors such as the mom's age and smoking were taken into account.However, birth defects were more common if treatment included injecting a single sperm into an egg, which is done in many cases these days, especially if male infertility is involved. About 10 percent of babies born this way had birth defects versus 6 percent of those conceived naturally, the study found.It could be that the extra jostling of egg and sperm does damage. Or that other problems lurk in the genes of sperm so defective they must be forced to fertilize an egg."I don't want to scare people," because the vast majority of babies are born healthy, said the study's leader, Michael Davies of the University of Adelaide in Australia.Couples could use simple IVF without sperm injection, freeze the embryos and implant only one or two at a time, he said. All of those can cut the chance of a birth defect.The study was published online Saturday by the New England Journal of Medicine and presented at a fertility conference in Barcelona, Spain. Health agencies in Australia paid for the research.More than 3.7 million babies are born each year through assisted reproduction. Methods include everything from drugs to coax the ovaries to make eggs to artificial insemination and IVF. Fertility treatments account for about 4 percent of births in Australia and as many as 8 percent of them in Denmark, where costs are widely covered, Davies said.In the United States, more than 60,000 babies were born in 2009 from 146,000 IVF attempts. About three-quarters of them used ICSI, or intracytoplasmic sperm injection.ICSI was developed because of male infertility. But half the time, it was not done for that reason but to improve the odds that at least some embryos will be created from an IVF attempt. Many clinics do it in all cases.IVF costs around $10,000 to $12,000 per attempt and another $2,000 for sperm injection.The study used records on nearly 303,000 babies conceived naturally and 6,163 conceived with help in Australia from 1986 through 2002, plus records on birth defects detected by age 5. Researchers counted heart, spinal or urinary tract defects, limb abnormalities and problems such as cleft palate or lip, but not minor defects unless they needed treatment or were disfiguring.They looked at birth defect rates according to type of fertility treatment. They also had three comparison groups of women who conceived naturally, including some with some history of infertility or who previously needed help to get pregnant.Among fertility treatments, only ICSI, the sperm injection, resulted in higher rates of birth defects once other factors that affect these odds were taken into account."They take a sperm that is probably not normal and force it to conceive," said Dr. Darine El-Chaar, an OB-GYN at Canada's University of Ottawa. She led a smaller previous study of this and called the new work impressive and "the study that needed to be done" to sort out the source of these risks.In the study, frozen embryos were less likely to result in birth defects than fresh ones used soon after they were created. Defective ones may be less likely to survive freezing and thawing, so the fittest embryos result in pregnancies, Davies said.Babies born to women with a history of infertility who ended up conceiving on their own, or who had natural pregnancies after assisted ones, also had higher rates of birth defects. That suggests that infertility itself is playing a role.Dr. Glenn Schattman, president of the Society for Assisted Reproductive Technologies and a Cornell University fertility specialist, said it was reassuring that ordinary IVF is safe. If ICSI is chosen because male infertility is involved, "parents have to be aware that by having a child with their own genetic material, they might be increasing their risk" of a birth defect, he said.Dr. Joe Leigh Simpson, a geneticist and research chief at the March of Dimes, said doctors should take this work seriously and discuss it with patients. He said techniques have improved over the last decade and ICSI may be safer now than when this study began.Even with genetic testing for various diseases, "we always tell our patients that this doesn't guarantee a perfect baby," he said.

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An Open Letter to President-Elect Obama about Homecare, Jobs, and a Reason to Live By Nancy Becker Kennedy by Nancy Becker Kennedy – Anyone who knows me knows how I wept with tears of joy when I heard you give the keynote speak at the Democratic convention. I said “This man is the balm for our wounds.” And I appreciate how you always mention people at disabilities in all your speeches. I’ve been waiting to hear that for a long time. I’ve had an Obama 2008 sticker plastered to the back of my wheelchair for almost two years now. I’ve met the nicest people that way, but this is not the reason I’m writing to you. I need to tell you about how we could save billions in healthcare dollars while creating millions of jobs for workers who might otherwise be dependent on Public Assistance. I helped to found and have served for 11 years as a member, and most recently as the vice chair, of the Los Angeles County’s Personal Assistance Services Council (PASC), the largest public authority in the United States. Our PASC oversees the In-Home Supportive Services program in Los Angeles County serving 168,000 seniors and persons with disabilities partnered with the SIEU’s home care workers Union to give seniors and people with disabilities dignity and empowerment in their own homes at less than a third of the cost of warehousing us in nursing homes. Our public authority employs 139,000 home care workers. In our program, here in California, which could serve as a model for the nation, we save very substantial sums. The cost of the average person receiving assistance on the IHSS program in California is approximately $12,400 while the annual cost of maintaining such a person is a skilled nursing facility is over $57,000. Nationally, this program could employ millions of workers. You’ve spoken many times of the need for jobs, as well as the need for service. I can think of little that could be this effective to promote both these causes. And while promoting service and empowerment, we could at the same time eliminate a great evil. By that I’m referring to the waste of human talent and cutting short the lives of millions of people inappropriately placed in nursing homes. Nursing home abuse and neglect ranges from unconscionable to horrific. Older people are left to get bedsores and lie in their own excrement, while nursing homes cut costs, and the patient ratios are terrible. When I visited with four women in a nursing home for a year, I’ll never forget waiting with one woman crying, who was holding her bladder for close to two hours until one of the nurses aides, who was responsible for eight other patients came in to put her on the toilet. Young people in nursing homes are robbed of the vital life they could have and are not even made aware of their options. Instead, some states are now offering them assisted suicide. The prejudice against and marginalization of people with disabilities is so pervasive that we are viewed as people whose lives are not worth living. For young people and seniors who don’t require skilled nursing, being warehoused in an institution is to live a life akin to a political prisoner — with no real civil rights or rights to even move about the community. I broke my neck at age 20, and had I been sent to a nursing home, I swear to G-d that I would have been dead decades ago, from cross-contamination because of my indwelling catheter, but more importantly, I would have withered away from a life without hope or purpose. My mother and I had a suicide pact. Tomorrow I will be 57 years old, and having had a life of purpose, energy, adventure, service, marriage and even visiting England and France, I shudder to think that I could have made that decision. I didn’t make that decision because the Rehabilitation Institute of Chicago expected too much of me, the University of Illinois gave me a wheelchair accessible campus to return to, and most importantly in-home care gave me the passport I needed to return home to an independent life in the community. Had I not had these gifts, I might have asked for that lethal injection. The wrong public policy kills — not only physically, but it kills people’s spirits, and the cherry on top is that it cost taxpayers over three times the money to do it. With homecare I was able to return to college to earn a master’s degree, become a news and public affairs producer for public television and later become a comedian and always an activist for people with disabilities. And now, thanks in large part to Senator Kennedy, Jim Jeffords, and my very dear friend, John Podesta, who is heading up your transition team, I work as a therapist at the Hollywood Sunset Free Clinic because of the Work Incentives Improvement Act. But I had the best of everything. My fate was so much different than the young people who have my same injury today. Now HMOs send newly injured young people to nursing homes — nursing homes that hire a physical therapist to come in once a month and then euphemistically refer to themselves as “rehabilitation centers.” As someone who received her rehabilitation from the Rehabilitation Institute of Chicago and later worked with newly injured people at the Rancho Los Amigos National Rehabilitation Center, I know what real rehabilitation is. When my mother suffered from a fall last year, and she could not return to her assisted living for several days, the acute care hospital told me they were transferring her to a “rehabilitation center.” They promised me that in the three days my mother would stay there, they would give her physical therapy twice a day, and I wanted that because she was falling and we didn’t know why. When I arrived the next day to this “rehabilitation center” with no telephone for me to reach my mother, there was no physical therapist there. Instead, my mother had been lying in bed for 10 hours, been drugged, put in diapers, and looked like she was not even alive –while a large slice of French bread pizza was the only item on her dinner plate. My mother takes insulin for diabetes. When I protested that a diabetic should not be given only a large piece of French bread pizza filled with starch, they said “Our diabetic care is calorie controlled,” another euphemism for not giving a damn about what they feed people with medical conditions as long as it’s cheap. When I asked why she hadn’t been gotten out of bed for 10 hours, they said “She didn’t want to,” another euphemism for not feeling energetic because you are being dosed with Vicodin four times a day at 85-years old. My mother was lucky. She had me to advocate for her and to take her back to the decency of her assisted living, but other people are not so fortunate. People are dying from these euphemisms. Whenever I visit my doctor, I try to always go up to the rehab floor to visit with the newly injured patients. In the last two years, you could shoot cannon through these real rehabilitation centers. Where I used to visit 40 patients, there are now two, as HMOs send young people to nursing homes. It is a quiet genocide that robs them of their spirit and their futures. It kills their body through cross-contamination and neglect, but worst of all, the eclipse of hope sends them to an early death. I have always been in the right place at the right time, but it shouldn’t be a crapshoot, whether you live or die in hope or despair. It isn’t fair that paraplegics living in one state should die an early death in a nursing home because they don’t have homecare or because when they were able-bodied, they didn’t have the medical sophistication to know what their HMO would do and how to keep themselves out of nursing homes when trauma strikes. People don’t know what they can have. They die of despair, without adequate services, and the time is long overdue to rectify this evil. Making in-home supportive services a national choice would not only give the gift of dignity and efficacy of millions of seniors and people with disabilities, but it would employ millions of home care workers as well. When I visited those women in the nursing home, there was one worker for eight women. Three home care workers are employed taking care of me. That means that people who might otherwise be on public assistance could have jobs, and we have the opportunity to go out into the world and make a difference. President Obama, you talk about the need to look for wasteful programs and replace them with good ones. For people inappropriately placed in nursing homes, this is one the finest changes you could possibly make. One of the greatest days of my life when I sat by my friend John Podesta’s side on a freezing day in Washington, in front of the Franklin Roosevelt monument (the real one where he was sitting down In a wheelchair) after Senator Kennedy’s and Jim Jeffords’ bipartisan bill, the “Work Incentives Improvement Act” was signed as the last piece of legislation the 20th century. That “Ticket to Work” was a start to remove the barriers that forced millions of people with disabilities into idleness with the threat of losing their health care and in-home supportive services if they tried to work. We need to go further, because many of us are still on a very short leash and cannot escape poverty by only being permitted to earn $900 a month, or save because we cannot have more than $2,000 in our bank accounts. But it was a grand beginning. There are still many rivers to cross for people with disabilities, but I firmly believe that the time is now to release seniors and people with disabilities who don’t belong in skilled nursing facilities, from imprisonment and despair, and back to their rightful place in the American life with its promise of liberty and pursuit of happiness. Perhaps what we crave even more is the opportunity to contribute our gifts to this world and put meaning in to our lives. We need to make it possible for every young person in every state to have the gift of in-home supportive services. It saves money, it saves lives, it creates jobs, and it unleashes vast stores of human enterprise among seniors and people with disabilities who still have work to do and people to love. Some may say this is too ambitious, but I believe that you, President-elect Obama will understand best of all, that this is a bold request born out of the “audacity of hope.” This is respectfully submitted on behalf of all of us who have been “wheeling on air” for the last two days! Most Sincerely! Nancy Becker Kennedy PS Robert Kuttner, journalist, economist, and author of the book “Obama’s Challenge: a Transformative Opportunity.” was on NPR’s “Fresh Air” tonight. Kuttner has previously been a columnist for Business Week as well as the Chief Investigator of the US Senate Banking Committee. In the interview he talks about the expansion of jobs to fix the infrastructure and emphasizes expansion of service job like those of caregivers as a strategy to create jobs as FDR did to infuse the economy to end the Great Depression. I am including the link here. Click here: NPR Media Player Nancy Becker Kennedy is a nationally recognized expert, who has been featured in and contributed to Ms. Magazine, The New York Times, The Washington Post, and The New Republic. She is also a contributing editor of the award winning national magazine, Spinal Network’s New Mobility. She has been seen on Sixty Minutes, Nightwatch with Charlie Rose, and A Closer Look with Faith Daniels. She is the first person to address the American Congress of Rehabilitation Medicine and edited the first consumer section of the Western Journal of Medicine. More here. Photo shows a moment from I Had to Break My Neck to Get Here starring Nancy Becker Kennedy, an actress, activist and comic. Adapted for the stage from Nancy’s diaries, the one-woman show is told with humor, but deals with everything from self-image issues to quadriplegia and battling breast cancer. Posted on November 8, 2008 Comments Toni Cepican says November 9, 2008 at 2:42 pm Nancy…You Are Exquisite!!! As a 15 year old (I lied about my age to get a job) I worked in one of those nursing homes…..I was a paid babysitter instructed to not let anyone escape, and other than that, no training what so ever! I always felt that my punishment in life as an “old lady” would be to be placed in a nursing home and have someone like me be in charge of me!! To this day, (I am 59) I remember my patients names, I pray for their forgiveness to me. I collect angel statues and have named them after my patients…so that I will never forget, and I forgave that young 15 year old girl as well. You can add my name to your letter to our dear President-elect and Thank You! Thank You! Thank You! for ALL you have done and will continue to do. I was honored to have your letter come into my life today. Namaste Linda Banks says November 9, 2008 at 8:32 am I applaud you, thanks for bringing this issue to the front; this service is needed. When I was earning a BSW; and attending La Sierra University in Riverside California, I did my 9 months internship at San Bernardino County facility. I had the opportunity to make assessment for people with disabilities and Senior who wanted to remain in their homes.

医学

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Colon Cancer Basics Colon Cancer Treatments Colon Cancer Articles Living with Colon Cancer Red meat tied to worse colon cancer outcomes: study NEW YORK (Reuters Health) - People who report eating the most red and processed meat before being diagnosed with colon cancer are more likely to die during the next eight years, according to a new study."It's another important reason to follow the guidelines to limit the intake of red and processed meat," said Marjorie McCullough, the study's lead author from the American Cancer Society in Atlanta.While the new study can't prove eating red or processed meats - such as beef, hot dogs and sausages - causes colon cancer deaths, previous studies have found that eating the meats is tied to an increased risk of developing the cancer.There's less evidence, however, on how people's diets after colon cancer diagnoses affect their chances of survival.The U.S. National Institutes of Health estimates that about 143,000 Americans will be diagnosed with colon and rectal cancers in 2013, and about 51,000 people will die from them.For the new research, McCullough and her colleagues used data from a different study on 184,000 Americans who didn't have cancer between 1992 and 1993, and who were periodically asked about what they ate. After excluding people, who had - among other things - multiple types of cancer, unverified diagnoses and missing information, the researchers had data on 2,315 men and women who were diagnosed with colon or rectal cancer between the start of the study and June 30, 2009.Overall, 966 of them died between the start of the study and December 31, 2010.The researchers found no link between how much red or processed meat a person ate after their diagnosis and their risk of death, but the amount of meat a person ate before their diagnosis was tied with their risk of dying during the study.About 43 percent of the 580 people who ate about 10 servings of red or processed meat per week at the start of the study died during the follow up period. That compared to about 37 percent of the 576 people who ate about two servings per week.The researchers also found that people who consistently ate more red or processed meat before and after their colon cancer diagnosis were more likely to die from that cancer during the study, compared to those who at the least before and after diagnosis.'THREE OR FOUR TIMES PER WEEK'Dr. Jeffrey Meyerhardt, who wrote an editorial accompanying the new study in the Journal of Clinical Oncology, said it's possible that the link between red and processed meats and colon cancer comes from cancer-causing compounds found in cooked meat or preservatives."The primary message is a confirmation that increased intake of red or processed meat can have detrimental effects on the development of colon cancer, the type of cancer and other health effects of patients in the long term," Meyerhardt, a gastrointestinal oncologist at the Dana-Farber Cancer Institute in Boston, said.McCullough said about three or four servings of red or processed meats per week is a good target for people."We're not saying people need to be vegetarians. It's really just limiting intake and making it more the exception than the rule," she said.Dr. Elisa Bandera, associate professor of epidemiology at Rutgers Cancer Institute of New Jersey in New Brunswick, said in an email to Reuters Health that maintaining a healthy weight, healthy diet and regular exercise likely has benefits for cancer prevention and survival.But she cautioned that these are only findings from one study."We need more studies evaluating the impact of meat and other dietary factors on cancer survival before any recommendations can be made to cancer survivors," wrote Dr. Elisa Bandera, who was not involved with the new study.SOURCE: http://bit.ly/w1orcd Journal of Clinical Oncology, online July 1, 2013.

医学

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LIJ Medical Center Receives $3.85M Federal Contract to Partner with Queens World Trade Center Clinical Center at Queens College NEW HYDE PARK, NY – LIJ Medical Center today announced the award of a five-year, $3.85 million federal contract to partner with the Queens World Trade Center (WTC) Clinical Center of Excellence at Queens College to increase access to medical and mental health services for WTC responders in the borough of Queens. The funding is part of the recently enacted James Zadroga 9/11 Health and Compensation Act , which provides $4.3 billion in federal funding to address the health crisis surrounding the WTC tragedy. The program is administered by the National Institute for Occupational Safety and Health and the US Centers for Disease Control and Prevention . Jacqueline Moline, MD , the center’s new director, and vice president and chair of Population Health at the North Shore-LIJ Health System, will lead the newly-merged WTC Queens Center of Excellence (QCCE). Steven B. Markowitz, MD, who directs the Center for the Biology of Natural Systems at Queens College , which has sponsored the Queens-based World Trade Center Health Program since 2003, will co-direct the program. Previously, Dr. Moline served as the principal investigator and director of the largest WTC Medical Monitoring and Treatment Program, located at the Mount Sinai School of Medicine. In late September 2001, she and her colleagues began treating first responders and other patients with immediate health consequences after the terrorist attacks in New York City on September 11. First responders and others who served at the WTC site have developed health problems including lung disease, asthma and gastroesophageal disease. Responders also experienced mental health problems such as post-traumatic stress disorder, anxiety and depression. “The recent federal funding that the Queens Clinical Center of Excellence received guarantees that we will be able to continue to provide high-quality medical care and mental health services to WTC responders for the next five years, without interruption, as well as increased access to critical healthcare services,” said Dr. Moline, who is board certified in internal medicine and occupational medicine. “To further improve access to care, we plan to relocate the center from its present location in Flushing to a larger facility in Rego Park in the next few months.” The QCCE is one of five clinical centers of excellence in the New York/New Jersey area that provide medical monitoring examinations, diagnosis and treatment services for WTC-related health conditions. Currently, there are 5,563 responders enrolled in the WTC Medical and Monitoring Treatment Programs from the borough of Queens. Dr. Markowitz noted that “the new partnership between Queens College and LIJ Medical Center to re-configure the Queens World Trade Center Clinical Center of Excellence will be a tremendous benefit to WTC responders in the borough of Queens because it opens up a very large network of physician specialists, clinicians and mental health providers in Queens. Dr. Moline and her occupational medicine colleagues will also be an invaluable asset.” “I am delighted that the outstanding and multiple resources of the LIJ Medical Center will now be a full partner with the Queens World Trade Center Clinical Center at Queens College to expand health care services and programs for first responders who were affected by the terrorist attack on America. Increased access to quality medical care and services for first responders in Queens, which already has more than 5,500 responders in WTC-related programs, will provide more space, personnel, specialists and an entire network of care to cover a multitude of medical conditions of individuals and their families,” said Queens Borough President Helen Marshall . “The high quality care provided by LIJ Medical Center and the North Shore-LIJ Health System makes them an ideal candidate for this Clinical Center of Excellence.” LIJ Medical Center is part of the 15-hospital North Shore-LIJ Health System. In addition to inpatient care at LIJ and other health system hospitals, responders will have access to the outpatient network of physician groups with offices in Queens and other areas. They include: the North Shore-LIJ Medical Group, a multispecialty group practice with over 2,000 faculty physicians, the health system’s provider network of 7,000 affiliated physicians and healthcare professionals. More than 1,000 of these providers are located in Queens. Access to mental health services will be strengthened through the expert services available at the Zucker Hillside Hospital in Glen Oaks, Queens, one of the specialty hospitals within the North Shore-LIJ Health System and part of LIJ Medical Center. The hospital, known for its pioneering work in the diagnosis, treatment and research of mental illness, provides a comprehensive continuum of behavioral health services to all ages with programs provided in inpatient and outpatient settings. Patients served by the QCCE will also have access to North Shore-LIJ’s Rosen Family Wellness Center, which provides no-cost, confidential behavioral health services to law enforcement and military personnel and their families. Through a Journey for 9/11 grant, the center will provide behavioral health services to World Trade Center first responders. The Rosen Center offers mental health and psychiatric evaluations and specializes in evidence-based cognitive behavioral therapies (CBT), including trauma-focused CBT, prolonged exposure therapy and CBT conjoint therapy for post-traumatic stress disorder. To ensure continuity of care, QCCE will work to continue relationships with the current established network of external healthcare providers. Members will be informed about the expanded options of healthcare providers within the North Shore-LIJ Health System network. As part of the contract and to improve quality of care, the QCCE will adopt the North Shore-LIJ’s electronic health record system. For more information, contact QCCE at 718-670-4174; WTC Health Program at 1-888-WTC-HP4U (1-888-982-4748); or http://www.cdc.gov/niosh/topics/wtc/. Betty Olt, Director, Special Projects [email protected]

医学

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�Coming out� on Mental Health Sunday By Joanne Kelly, Former NAMI Colorado president; Cofounder, Interfaith Network on Mental Illness Every fourth bulletin was marked with a colored dot to represent the one in four living with mental illness. From the North Carolina High County skirting the Great Smoky Mountains, to cities nestled in the shadow of the Rockies and many places in between and beyond, people in United Church of Christ (UCC) communities across the country “came out” to their congregations on Oct. 20. They were telling their stories�some for the first time publicly�about living with a mental illness. At the Community UCC in Champaign, Ill., the pastor talked about her experience with acute postpartum depression. Allie, the church’s religious education coordinator who is normally shy and soft-spoken, confidently reviewed her years-long struggle with anorexia and her subsequent involuntary admission to a locked psych unit where no pens, drawstrings or diet coke were allowed. “If you ever want to hit the dirt-floor bottom of your soul, try ending up somewhere where it’s considered risky to have a ballpoint pen,” she said. “The room was absolutely at attention for the whole three minutes she spoke,” said Ken Gilbert, a psychiatrist, member of the UCC Mental Health Network and member of Community UCC. “There was a deep sense in the room that this is sacred time.” Ken believes one reason Allie’s testimony was so powerful is that Allie is clearly a daughter of the church, raised in a stable Protestant home. “She could easily be one of our kids,” he said. The Rev. Dr. Don Matthews, currently a professor of religious studies at Naropa University. At High County UCC in Vilas, N.C., a congregant named “Cath” told of her journey living with depression, PTSD and anxiety and her struggle with the stigma that surrounded those disorders. She told of creating a life for herself in a 400-square-foot cabin in the woods without running water. She realized her lifestyle defied societal definitions of success, but it worked to keep her grounded and mentally healthy. “This is the first time our church used a regular worship service for this purpose and the response from our congregation has been overwhelmingly positive,” said Cath. “People were very moved. “As one of those who shared a personal story during the service, it was somehow both extremely uncomfortable and extremely liberating. Some confided in us afterward about more closeted struggles of their own or of a family member and almost all expressed thanks for our honesty.” The services at Community UCC, High Country UCC and elsewhere were arranged in response to an invitation issued by the UCC Mental Health Network for churches to hold “Mental Health Sunday” celebrations. The organization prepared a variety of resources�including sermon starters, prayers, litanies, hymn suggestions and bulletin inserts�to make it easy for churches to participate. “We see Mental Health Sunday as a way for congregations to begin to chip away at the stigma that surrounds mental illness,” said Rev. Alan Johnson, chair of the UCC Mental Health Network. “When we widen our welcome and support to members with mental health challenges, we follow the example of Jesus who showed us how to embrace those who are marginalized by society. And by including these members in the life and work of our churches, we are all enriched.” The UCC Mental Health Network hopes to make Mental Health Sunday an annual event at its communities across the country on the first Sunday of May, which is Mental Health Awareness Month.

医学

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Maryland Newsline Select services and providers for CT scans in your area from MedlinePlus What is CT scanning of the body? RadiologyInfo answers this question and more. Use of CT Scans for Early Detection on Rise By Sharahn D. Boykin Capital News Service ANNAPOLIS - Lorraine Burdette was not worried when the radiologist called her to his office to discuss results of her full body computed tomography scan, also known as CT scan. She thought she would be told everything was fine - just as her husband had been after his scan a few days before. "I am a person that would get my once a year pap smear, and I would get my mammogram ... I did all the general things that all of us do," said Burdette, who stayed in shape by taking yoga classes and walking for 25 to 45 minutes five times a week. But instead of the clean bill of health she was expecting, the radiologist told her he saw something "sort of dark" in her kidney. Early the next day, Burdette received a call from the CT screening center, YourScan, telling her she needed to have additional tests right away. Within days, Burdette got the news: She had cancer. Doctors told her three-fourths of her right kidney was cancerous, and that it would have to be removed. It was a slow-growing cancer, they said, and it would have probably been a year before she would have begun to experience symptoms. Burdette was one of a growing number of people who opted to pay out of their own pocket for various kinds of CT scans in hopes of detecting diseases they have no reason to believe they have. Health insurance companies usually don't pay for the screenings. But despite their growing popularity, use of the scans on apparently healthy people is still controversial. The American College of Radiology warns against having them performed unnecessarily. "If there is no medical reason for having a test done that involves radiation, we are not in favor of it," said Shawn Farley, a spokesman for the American College of Radiology. The CT screenings at YourScan, in the Weems Creek Medical Center in Annapolis, range from $195 for a heart scan to $950 for a full body scan and virtual colonoscopy. Individuals may be eligible for a reduced rate by participating in their Healthy Lung Scan clinical trial. "I've seen too many patients walk in off the street feeling fine and found they had a significant disease," said Dr. James Reinig, a YourScan radiologist who himself had a heart scan and a virtual colonoscopy when he turned 50. The CT screenings are perhaps finding their greatest acceptance among medical professionals as a way of detecting lung cancer earlier than a normal chest X-ray would. St. Agnes Hospital in Baltimore offers lungs scans for as little as $75 as part of the International Early Lung Cancer Action Program clinical trial. But, participants must be 50 or older and must be a smoker or have been exposed to second-hand smoke. "I believe this is the biggest breakthrough in lung cancer in the past 15 years," said John Welby, a St. Agnes spokesman. "This is a giant leap forward for lung cancer." A study in the New England Journal of Medicine found that screening was effective in detecting lung cancer in the early stages when it is treatable. But some researchers question whether the screening is effective on large populations and worry about the impacts the results may have on patients. "CT is very good at detecting pathology in the lung," said Dr. Elliot Fishman, a professor and radiologist at Johns Hopkins University, "but simply detecting is not enough." Johns Hopkins is one of several test sites for the National Lung Screening Trial which is comparing the risk and benefits of spiral CTs and chest X-rays in detecting lung cancer. One of the problems some experts and health care organizations see with the scans is that they can lead to an increase in health care costs and patient anxiety when apparent irregularities are found and more tests are ordered. "There is no doubt that CT is sensitive enough for picking up lung cancer," Fishman said. "But the question is, is it the right thing to do?" With lung screenings, if a nodule is found, sometimes patients will have to wait several months for a follow-up visit to see if the nodule grows. This waiting period can be an agonizing source of anxiety, Fishman said. The National Cancer Institute reports that studies show that in CT scans of smokers and former smokers, 25 percent to 60 percent will show abnormalities. The institute reports that these abnormalities can range from smoking scars to inflamed areas and sometimes look like lung cancer on a scan. Johns Hopkins will only perform the scans if the patient has a referral from a doctor. "We want to make sure if we see something you're managed correctly," Fishman said. Whether for the lungs or the full body, proponents say the screenings are not geared toward young healthy individuals with no family history of disease. "Somebody that is younger is probably not going to have a whole lot of findings," said Julie Miller, a spokeswoman for YourScan. "We didn't want to have unnecessary exposure to radiation." Individuals must be at least 30 for heart and lungs scans and 40 or older for full body scan and virtual colonoscopy at YourScan. For patients like Burdette, though, the value of having a scan is not debatable. Since having her kidney removed three years ago, she has been cancer free and has a checkup each year. "Having the scan saved my life," Burdette said. "I thank God every day I had the scan." Copyright � 2007 University of Maryland Philip Merrill College of Top of Page | Home Page

医学

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Tags: cholesterol Cholesterol Drugs Cut Prostate Cancer Deaths Monday, 06 May 2013 11:12 AM By Nick Tate Print | A A Cholesterol-lowering statin drugs have been found to offer a potential secondary benefit to men with prostate cancer: They appear to significantly reduce the risk of death, compared to men who don’t take such medication, according to study by researchers at Fred Hutchinson Cancer Research Center. The research, published online in the journal The Prostate, tracked about 1,000 Seattle-area cancer patients for 8 years and found that just 1 percent of statin users died, compared to 5 percent of nonusers. "If the results of our study are validated in other patient cohorts with extended follow-up for cause-specific death, an intervention trial of statin drugs in prostate cancer patients may be justified," said lead researcher Janet L. Stanford, co-director of the Prostate Cancer Research Program and a member of the Hutchinson Center's Public Health Sciences Division. About 30 percent of the study participants reported using statin drugs to control their cholesterol, the researchers said. "While statin drugs are relatively well tolerated with a low frequency of serious side effects, they cannot be recommended for the prevention of prostate cancer-related death until a preventive effect on mortality from prostate cancer has been demonstrated in a large, randomized, placebo-controlled clinical trial," said co-researcher Milan S. Geybels, formerly a researcher in Stanford's group who is now based at Maastricht University in The Netherlands. The researchers suggested cholesterol in tumor cells may play a key role the survival of prostate cancer cells. Statin drugs block an essential precursor to cholesterol production called mevalonate and that may reduce the risk of fatal prostate cancer. The study was funded, in part, by the National Cancer Institute. © 2014 NewsmaxHealth. All rights reserved. Print Get More Relevant Updates. Close To get more focused news, please provide us with more information. Bosnia-Herzegovinia Congo (Dem. Republic) Island of Man Korea (Democratic Republic of) Papua-New Guinea Re union Republic of Dominica

医学

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PO 360 October 21, 2001 George T. DiFerdinando, Jr., MD, MPH Acting Commissioner For Further Information Contact: Laura Otterbourg or Dennis McGowan Testing and Clean-Up Plan for Anthrax Exposure at Route 130 Mail Processing Center in Hamilton Township and West Trenton Post Office is Announced Trenton - The Department of Health and Senior Services last evening presented to the American Postal Workers Union a response plan to ensure the health and safety of postal employees at the Route 130 Mail Processing Center in Hamilton Township and the West Trenton Post Office in Ewing Township - by addressing further environmental testing and decontamination approaches. State Epidemiologist and Senior Assistant Commissioner Eddy Bresnitz, MD and Senior Assistant Commissioner for Public Health Protection and Prevention James Blumenstock represented the Department of Health and Senior Services (DHSS). The response plan was drafted at a meeting held earlier yesterday at the Hamilton Township facility and included representatives from the DHSS, the Federal Bureau of Investigation (FBI), the Centers for Disease Control and Prevention (CDC), the United States Postal Service, and the United States Postal Inspection Service. "Keeping the clinical samples in mind at this time and based on the environmental sampling results we've received today - in which 13 of the FBI crime scene samples came back preliminary positive for anthrax, we have designed collaboratively a response plan that ensures the health and safety of all the workers," said Dr. Bresnitz. "Our number one goal is to protect the safety of all workers and then to get the facilities fully up and running - but only when all environmental tests are negative after the clean-up work is done." Dr. Bresnitz summarized for the workers the environmental sampling to date at both facilities. At the Hamilton Township facility, 13 out of the 23 samples collected by the FBI tested preliminary positive for anthrax - with final results expected in the near future. All 22 environmental samples taken mostly from public access areas by the DHSS show no growth thus far for anthrax. Preliminary results for the West Trenton facility of the crime scene sampling conducted by the FBI are not yet known. The DHSS and the FBI collected environmental samples on October 18 from the Hamilton Township facility, and on October 19 from the West Trenton facility; the FBI samples are crime scene samples. In his step-by-step presentation, Dr. Bresnitz began by saying there is still epidemiological information to gather; the DHSS, New Jersey Department of Environmental Protection (DEP) and CDC will do additional representative environmental sampling today at the Hamilton Township facility - with preliminary test results within 24 to 36 hours. When the sampling is done, the Postal Service's contractor will begin the clean-up process starting with the crime scene area already sampled by the FBI and working outward. Results of additional environmental samples will guide further clean-up plans. Dr. Bresnitz said the DHSS and CDC team is preparing to make telephone calls on Sunday (Oct. 21) to a sampling of workers who had been selected for nasal swabbing. The DHSS and CDC team will also ask workers to complete questionnaires. Results of the nasal swabbing will be provided to the workers by the end of the week. Dr. Bresnitz explained that this group of workers was selected based on where they work at the facility, with the goal of identifying a representative sampling of workers from all areas of the facility. The sampling is done for disease investigation (to see where exposures might have occurred) and not as a diagnostic test for disease. Many workers have already received anthrax exposure testing at Robert Wood Johnson University Hospital at Hamilton; some will be asked to come in and take another test if contacted by the DHSS and CDC team. This past Friday (October 19), the DHSS recommended that all postal workers at the Hamilton Township facility and the West Trenton facility see a physician and begin a seven-day course of antibiotics as a precaution while the criminal and health investigation of potential anthrax exposure and disease at the two facilities progresses. One postal worker from the West Trenton post office has been confirmed as a definite case of cutaneous anthrax in testing conducted by the CDC. A second postal worker stationed at the Hamilton Township facility is considered by the CDC to be a suspect case at this time. A third postal worker, also from the mail processing center in Hamilton Township but a resident of Bucks County, Pennsylvania, has been confirmed as a definite case of cutaneous anthrax in testing conducted by the Pennsylvania Department of Health. According to Acting Health and Senior Services Commissioner George T. DiFerdinando, MD, preliminary skin culture tests were negative as the two New Jerseyans had been on antibiotics before testing. Blood samples for both workers and a skin biopsy from one worker were sent to the CDC for further testing. The skin biopsy was positive for anthrax. Serum specimens were positive for anthrax in both workers. On October 13, both New Jersey patients' physicians notified the Department of Health and Senior Services (DHSS) after hearing about the cancelled letter from Trenton that was sent to New York City. They reported that their patients may have been in contact with the letter received by Tom Brokaw at NBC-TV. Both patients had been treated with antibiotics in late September to early October. The DHSS received specimens from both patients on October 14 and skin cultures were performed that same day. Blood for antibodies was sent to the CDC also on October 14. The skin biopsy was delivered to the State laboratory and examined by the State Medical Examiner on October 16, which was then sent to the CDC by the FBI later that day. The CDC received the biopsy specimen on October 17 and reported results to DHSS on the morning of October 18. According to Secretary of Health Robert S. Zimmerman, the Pennsylvania's resident anthrax sample was forwarded October 17 from Frankford Hospital (Bucks County Campus) to the Pennsylvania Department of Health's Bureau of Laboratories for testing on October 18 where laboratory tests of the sample detected anthrax bacteria. The patient is also being treated with antibiotics and is improving. The state laboratory has received over 547 environmental samples, such as envelopes and packages, collected by law enforcement agencies from across the state. Testing on 98 of those specimens has been completed and all are negative for anthrax. In addition, 161 samples have tested negative in preliminary tests. The lab conducts preliminary (gram/spore stain) tests and culture tests on environmental samples and on clinical samples that meet established testing protocols. The Department has established a bioterrorism phone line at the Emergency Operations Center at 609-538-6030 that is open between 8 am and 11 pm until further notice. Since the phone line opened on October 12, 2001, about 1,500 calls have been received. From 11 p.m. to 8 a.m., the number is 609-392-2020. Information is also available on the website at www.state.nj.us/health. # # # department: njdhss home | index by topic | programs/services statewide: njhome | my new jersey | people | business | government | departments | search

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Project Aims to "Bridge the Gap" From Remission to Cure in Multiple MyelomaAuthor: Brian G.M. Durie, MD Chairman, International Myeloma Foundation, North Hollywood, CA When patients respond well to treatment for multiple myeloma, doctors can’t tell them whether they’ve been cured. That news comes 10 years later, after the patients have been monitored carefully for recurrence. “During that time, you’re constantly watching and waiting for the second shoe to drop,” according to Brian G.M. Durie, MD, chairman and co-founder of the International Myeloma Foundation (IMF). Through an IMF project, Durie and his colleagues are seeking to remove that long period of uncertainty for such patients. Under the Black Swan Research Initiative, the team plans to develop the first definitive criteria for a myeloma cure, and to set forth treatment plans to achieve those criteria. The project will involve developing tests sensitive enough to determine whether patients have any myeloma cells left in their bodies following treatment. Those who don’t have such cells would be considered cured, and would know that in the short term. Those who do would be offered different treatments until tests show that their residual cancer cells have been eliminated. Durie expects the work to be completed within three years. “We’re ready to bridge the gap from long-term remission to cure, by identifying the best treatments at the best time to achieve the best objective, our objective being a new definition of cure based on a complete eradication of any residual myeloma,” Durie said. In an interview with OncologyLive, Durie provided details about the Black Swan initiative and how he expects the project to develop. Why is this project called Black Swan? Here in the Northern Hemisphere, everybody knew swans were white until 1697, when Willem de Vlamingh sailed up Swan River in Western Australia and found black swans. Based on that, we realized swans could be any color. The idea is that we need to be open to new ideas, to look at things you may have been looking at already, but in a new light. At the same time, we can learn something from the 2010 edition of The Black Swan: The Impact of the Highly

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PD 101 "What's Hot in PD?" Blog You are here: Patients > January 2012 Are Blood Tests for Parkinson’s Disease on the Horizon? You can find out more about NPF's National Medical Director, Dr. Michael S. Okun, by also visiting the NPF Center of Excellence, University of Florida Center for Movement Disorders & Neurorestoration. Patients and family members have been waiting for news about the possibility of a blood test to detect Parkinson’s disease. In November, a small article was published in the FASEB journal where Foulds and colleagues reported the results of a pilot study that examined phosphorylated alpha-synuclein as a potential candidate for use as a blood test in detection of Parkinson’s disease. In this month’s What’s Hot column we will examine this recent paper, discuss the current state of the field, and discuss how the development of a blood test could affect those at risk, and those suffering from Parkinson’s disease. The investigation focused on a protein called alpha-synuclein which is thought to be important to the cause of Parkinson’s disease, and is a critical component in the deposits that accumulate in the Parkinson brain. The authors measured alpha-synulcein in both Parkinson’s disease and in control patients. They reported that Parkinson’s disease patients had an abnormal phosphorylated form of alpha-synuclein. The changes in the blood were sampled over a three-month period, and were found to be stable in 30 patients; and they were in general, not present in control subjects. There were, however, several issues with this study. First, the sample size was too small to conclude that this test will prove viable in a much larger population of Parkinson’s disease patients. Second, the authors provided little information on the actual patients they studied. Parkinson’s disease is not one disease, and as groups develop blood tests, they will need to carefully characterize and report the clinical symptoms of the patients studied. Additionally, groups will need to be cautious in understanding which types of patients will reveal blood changes, and more importantly, which groups will not. Finally, changes in phosphorylated alpha-synuclein could possibly occur in other Parkinsonian syndromes, other neurological diseases, and other systemic diseases. These other diseases must be carefully investigated. Though there were important methodological issues with this study, it is still likely we will see Parkinson’s disease blood tests and biomarkers in the near future. If successfully developed how would a blood test for Parkinson’s disease be used? There are several potential options for this emerging technology. First, if a disease modifying therapy can be developed, then identifying at risk patients for early intervention could be critical. A blood test could potentially identify those at risk, and help to facilitate early intervention. Another important use for a blood test could be in monitoring the symptomatic treatment of current Parkinson’s disease sufferers, especially in those enrolled in drug trials. The test would however, need to reflect changes in biological activity over time, and would also need to closely correlate to changes in disease state (e.g. progression of symptoms). A blood test for Parkinson’s disease would also introduce important ethical considerations, especially for asymptomatic individuals. Though the test may not reflect genetic status, it may unmask a Parkinson’s disease diagnosis. Revealing a potential risk to develop Parkinson’s disease could profoundly change a person’s life. Studies of genetic counseling have revealed that once patients understand the implications of a blood/genetic test, they will often decline it. Additionally, for currently symptomatic individuals, close monitoring of disease status could result in stress, anxiety, and worry that may translate into a worsened overall quality of life. It is important to understand that many groups around the world are attempting to develop blood tests and biomarkers for Parkinson’s disease. It is likely that many of the methodological limitations limiting blood tests will soon wane, and that successful approaches will emerge. As we move forward it will be important for the field to clearly define the potential uses of a blood test, and especially to protect patients and also to protect families. It is also important that patients understand that there will likely be more than one blood test in the future, and that close communication with their doctors will be critical in deciding which test, or which battery of tests would be appropriate to check. In summary, the development of blood tests and biomarkers has the potential to improve the lives of many Parkinson’s disease patients, and also to push the research horizon in a positive direction. These tests must be pursued cautiously and with an open mind as to how they will affect both the population at risk, and the people currently living with Parkinson’s disease. Selected Reference Foulds, P. G., Mitchell, J. D., Parker, A., Turner, R., Green, G., Diggle, P., Hasegawa, M., Taylor, M., Mann, D., Allsop, D. Phosphorylated alpha-synuclein can be detected in blood plasma and is potentially a useful biomarker for Parkinson’s disease. FASEB J. 25, 4127–4137 (2011). www.fasebj.org Posted: 1/3/2012 8:14:06 AM by Cathy Whitlock Browse current and archived What's Hot in PD? articles, the National Parkinson Foundation's monthly blog for people with Parkinson's written by our National Medical Director, Dr. Michael S. Okun. September 2014 Deep Brain Stimulation for Parkinson’s Disease: NPF Congratulates Mahlon DeLong and Alim-Louis Benabid and Looks to a Bright Future in Human Neural-Network Modulation Everything You Need to Know About Medical Marijuana and Parkinson’s Disease The End for Levodopa Phobia: New Study Shows Sinemet is a Safe Initial Therapy for Treatment of Parkinson's Disease Is light therapy a potential treatment modality in Parkinson’s disease? How does the most common genetic cause of Parkinson’s Disease (LRRK2) cause Parkinson’s disease and could it be used to help develop a better therapy? An Update on DAT Scanning for Parkinson’s Disease Diagnosis Could Northera (Droxidopa) Be an Alternative Treatment for Low Blood Pressure and Passing Out Symptoms? The Dream of a Pill Free Existence and the Continuous Dopaminergic Pump for the Treatment of Parkinson's Disease Should I take Inosine to Raise my Uric Acid Levels and Treat my Parkinson’s Disease? Could Fungus and Mold be an Important Contributor to Parkinson’s Disease? Pimavanserin and the Hope for a Better Drug for Hallucinations and Psychosis in Parkinson’s Disease Halting of the Creatine Study The Importance of Identifying and Treating Caregiver Strain Putting Parkinson’s Disease Information into the Palm of Your Hand: Parkinson’s Enters the Smartphon What Parkinson’s Disease Patients Need to Know about H. Pylori Gastrointestinal Infections A2A Receptor Antagonists and Parkinson’s Disease Treatment Another Setback for Trophic Factor Treatment in Parkinson's Disease IPX066 and What Patients Really Want in New Carbidopa/Levodopa (Sinemet) Formulations March 2013 The Weather Forecast for Parkinson’s Disease Calls for Worldwide Economic Storm Defeating the Barriers to Implementing Exercise Regimens in Parkinson’s Disease Patients When should you start medication therapy for Parkinson’s disease? Neurologist Care Reduces Hospitalizations in Parkinson's Disease A Victory in Court for Parkinson's Disease Patients who Require Ongoing Rehabilitative Therapies Given the recent FDA announcement about Mirapex (pramipexole), should I be worried about dopamine agonists? September 2012 What about the new Parkinson’s Disease Vaccine? What should I know? Caffeine as a Potential Treatment for Parkinson’s Disease Time to Consider GPi DBS for Parkinson’s Disease: A Shift in the Practice of Patient Selection for DBS A New Treatment for Parkinson’s Disease-Related Constipation Too Many Pills: Improving Delivery Systems for Parkinson’s Disease Drugs Measuring Quality and Assessing Depression in Parkinson's Disease Watch out for Unexpected Obstacles if You Use a Cueing Strategy to Break Freezing of Gait in Parkinson’s Disease Pill Color, Generic Medications and Insurance Issues: Important Medication-Related Tips for the Parkinson’s Disease Patient Placing Stem Cells in Animal Models of Parkinson’s Disease: Another Important Step Important News for the Parkinson’s Disease Community: More Evidence that Sinemet and Madopar are Not Toxic and do Not Accelerate Disease Progression The Case for All Parkinson’s Disease Patients to be Co-managed by a Primary Care-Neurologist Team Scientists say Research on Brain Proteins Involved in Parkinson’s Disease is “Shaping” Up Who Actually Takes Care of Most of the Parkinson’s Patients Worldwide: The Need for Education and the Parkinson’s Toolkit If you are Dizzy or Passing Out, it could be Your Parkinson’s Disease or Parkinson’s Disease Medications How Will Group Visits for Parkinson’s Disease Fit into the Future of Parkinson’s Disease Care? Why Patients Should be Wary of Chelation Therapy for Parkinson’s Disease Opening the Door to Gene Therapy in Parkinson’s Disease: The Need for Refinement of the Technology and Approach Does it Matter if I Can’t Get Brand Sinemet? Should I get a DaTscan or PET scan to confirm my diagnosis of Parkinson’s disease? A Critical Reappraisal of the Worst Drugs in Parkinson’s Disease Environmental Risks for PD: Manganese, Welding, Mining, and Parkinsonism Calling for the FDA to Revise the Eight Sinemet a Day Rule Dry Cleaning Solvents and Potential Environmental Risks for Developing Parkinson’s Disease Maintaining the Balance: Why Parkinson’s Disease Patients Need to Understand Drug Recalls, Withdrawals, and Safety Alerts Shining a Light on Parkinson’s Disease: Optogenetics Has a Bright Future in Research Poor Medication Management of Parkinson's Disease During Hospital Admissions: Patients and Families Can Improve Their Hospital-Based Management Why Are Patches and Continuous Release Technology a Big Deal to Parkinson's? Is the PD SURG Trial Another Surge Forward for DBS Therapy? Cycling in PD in Those Who Can’t Walk: Is it Possible? March 2010 New iPS Stem Cells for PD: What Does it Mean? Time for Comprehensive Care Networks for PD Is Parkinson's Disease a Prion Disease? Parkinson's Disease Linked to Gaucher's Disease Brain Cells Keep Time Stamps: Implications for Parkinson's Disease Therapies Is it Safe to Have an MRI with a DBS in Place? Take Care of Your Bones as They Are Affected in Parkinson's Disease (Even in Men) Is it Time to Start Paying Attention to Pain Symptoms in Parkinson's Disease Patients? Glutathione Fails to Demonstrate Significant Improvement in PD Symptoms Keeping an Eye on Trials Important to the Parkinson's Disease Patient Increased Risk of Melanoma in Parkinson's Disease Finally a DBS Expert Consensus Statement Aimed at Their True Customers: The Patients Pesticides and Environmental Exposure in Parkinson's disease: Should We Stay Away From the Stink Truck? Is Exercise Effective Treatment and Protection Against PD? Why are Transplant Trials Struggling to Succeed in the Treatment of PD? Are Monoamine Oxidase Inhibitors Disease Modifying or Neuroprotective in PD? Update on Gene Therapy for Parkinson's Disease Currently: 0 (0 ratings) Each month, we will feature a new column by NPF's National Medical Director, Dr. Michael Okun, on the latest developments in Parkinson's disease research. Read the latest "What's Hot in PD?" below.

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Home September 2012 Monthly Message Investment in Neuroscience is Deficit-Reduction Plan To Consider, says Former Congressman Patrick KennedyFormer Congressman Patrick J. Kennedy is co-founder of One Mind for Research, a newly formed national coalition seeking new treatments and cures for neurologic and psychiatric diseases of the brain that afflict one in every three Americans. In this interview, Kennedy discusses his vision for the future of neuroscience investment, and how the race to “inner space” can galvanize the nation and reduce the deficit. Click here to read more. The 112th Congress: Where are we?Congress came back to Washington after August recess and voted on a Continuing Resolution to keep the government funded through March 2013. What does this mean for the Parkinson’s community? And, will sequestration harm current Parkinson’s research? Click here to read the full article. Join PAN on October 3 for the 2012 Morris K. Udall Awards DinnerCelebrate the Parkinson’s community at the Parkinson’s Action Network’s Morris K. Udall Awards Dinner on October 3! Colonel Karl Friedl, Ph.D. is the recipient of the Morris K Udall Award for Public Service. Michael Church and Gretchen Garie-Church are the recipients of the Milly Kondracke Award for Outstanding Advocacy. The Honorable Patrick J. Kennedy is our special program guest. It’s an exciting night in Washington, and proceeds from the dinner directly support the work of the Parkinson’s Action Network. Click here to learn more, become a sponsor, or buy tickets to the dinner! Meet Sarah King, PAN’s State Director – Southern California“Start by participating in whatever way is most comfortable to you and employs your skills. Maybe you’re intimidated by the idea of working with the media or meeting with your representatives, but you love to plan events. Start out doing something you know you’ll enjoy, and work toward developing those other skills. Reach out to other advocates for advice — it’s all about pooling knowledge and helping each other.” Great advice from PAN California State Director Sarah King about becoming an advocate! Read more of our interview with Sarah about her advocacy work here. NCATS Names New Director and Appoints Todd Sherer to Advisory CouncilThe National Center for Advancing Translational Sciences at the National Institutes of Health (NIH) appointed Christopher P. Austin, M.D. as its Director. PAN CEO Amy Comstock Rick served on the search committee to fill this position. The NIH also named Todd Sherer, Ph.D., CEO of The Michael J. Fox Foundation for Parkinson’s Research, to the NCATS Advisory Council. PAN CEO Appointed to NINDS Advisory CouncilPAN CEO Amy Comstock Rick was welcomed to the National Neurological Disorders and Stroke Advisory Council, the principal advisory body to the National Institute of Neurological Disorders and Stroke (NINDS) at the National Institutes of Health (NIH). Read NIH’s press release here. Save the Date: 2013 PAN ForumThe Parkinson’s Action Network will hold its open-to-the-public 2013 PAN Forum in Washington, D.C., February 25 – 27, 2013. Click here for more details! Parkinson’s in the MediaA round-up of some recent news articles of interest to the Parkinson’s community. Click here. Site by Fuse IQ

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Home/Beautypedia Product Reviews/Expert Reviews/All Brand Reviews/Avon Avon At-A-GlanceStrengths: Broad-spectrum sun protection from most of the SPF products; a selection of good cleansers, moisturizers, and serums; a phenomenal concealer and a handful of other excellent makeup products at bargain prices; the company provides complete ingredient lists on its Web site and offers some of the most helpful Customer Service associates in the industry.Weaknesses: The Clearskin products are mostly irritating and poor choices for anyone battling blemishes; the Anew Clinical lineup isn’t as impressive as its made out to be; an overreliance on jar packaging diminishes the antioxidants found in many Avon moisturizers; endless, unnecessarily repetitive moisturizers with exaggerated, outlandish claims; some of the foundations look unnatural. The last few years have been an interesting time for the world's largest direct seller. Avon is sold in 120 countries and has an enormous range of products that goes beyond skin care and makeup, all sold by five million Avon representatives racking up annual sales of over $8 billion (Source: www.avoncompany.com). Yet due to several quarters of lackluster or poor financial performance, the company announced a multiyear restructuring plan in 2006. The anticipated cost of these changes is upwards of $500 million, which includes downsizing underperforming areas and focusing on remarketing their star products. In recent years, those key products have had "cosmeceutical" appeal, with claims that have gone beyond reality (but overexaggerated claims sell big in the cosmetics industry).The Anew Clinical line ushered in several products claiming to work like (or, in some instances, better than) cosmetic corrective procedures. Whether you are considering laser treatments, Botox, Thermage, collagen injections, or even liposuction, the ads for Anew Clinical were designed to make you rethink that decision.It is definitely impressive that Avon invested $100 million on a state-of-the-art research and product development facility in New York, but despite some innovative products that compete with the best of the best (typically for much less money), no cosmetics company has (or will) produce skin-care products that rival or beat the results obtainable from medical procedures. It's admittedly easier to slather on a cream or stroke a pad over your face than to make an office call and shoulder the expense for a cosmetic corrective procedure, but in this case convenience and savings don't equal—or even come close to—comparable results. And lest we forget, despite the onslaught of so-called cosmeceutical products claiming to mimic the results such procedures provide, the number of these procedures being performed increases each year. If any of these works-like-(insert cosmetic corrective procedure here) products did work, the number of procedures would be declining, not rising.The National Advertising Division (NAD) took issue with several claims Avon made in ads for their Anew Clinical products (Source: www.nadreview.org/default.asp?SessionID=1149178&DocType=1&CaseType=1). In some cases, Avon reworded their claims in ad reprints, while in others they "respectfully disagreed" with the NAD conclusions but agreed to take their comments into consideration for future ads. We'll see how this turns out, but, based on their current ads, the message remains that Anew Clinical products are at the forefront of making cosmetic corrective procedure results as easy as calling your Avon representative and reciting your credit card number.As a major international cosmetics company, Avon has several initiatives in place that prove its commitment to women and the environment. Whether donating to women's health concerns (most notably breast cancer), surpassing environmental regulations, or financially supporting alternative methods to animal testing, Avon's principles are responsible and admirable. If you pay attention to the best of what they have to offer, you will not only be supporting Avon's mission to improve the lives of women but also gaining some wonderful products, making it a win-win situation.The bad news is that unless you know what you want and order from Avon's Web site, dealing with an Avon representative tends to be a frustrating experience. Try as they might, most of them are mere order-takers. They cannot keep up with the product assortment, sales, and changes that occur between Avon's "campaigns." One of the representatives we dealt with was quite frank about how much she didn't know, and mentioned that they are not kept as up-to-date as they should be, not to mention the haphazard assortment of testers or samples available. On the flipside, Avon is a wonderful mail-order company should you need to return or exchange products. Unlike companies with a similar business model (Arbonne comes to mind), Avon makes the process smooth and hassle-free, with a "if you're not happy, we're not" motto that epitomizes outstanding customer service.For more information about Avon, call (800) 500-AVON or visit www.avon.com.Avon MakeupIf you've been noticing more magazine and television ads for Avon recently, it's no accident. According to an article in the November 21, 2005, issue of The Rose Sheet, Avon's ad spending through 2008 will reach "historical heights" due in part to the brand's flat performance the past couple of years. Avon's CEO Andrea Jung admitted that the company's makeup business has struggled due to increased competition, a point we wholeheartedly agree with. Avon may be viewed as a skin-care innovator, but when it comes to makeup they're more follow-the-leaders than trail blazers. Admittedly, their foundations, powders, blush, and lipsticks have smoother, more state-of-the-art textures than ever, but with few exceptions none of them are setting a precedent that other, more innovative companies are likely to follow.You will find some outstanding Avon makeup products to consider, but perhaps due to the sheer size of the collection there are far too many mediocre products, especially among the eyeshadows, pencils, and mascaras. Given that Avon isn't as easy to obtain as comparable products at your local drug or department store, many of the makeup items end up being a tough sell. After all, who wants to go out of their way for average products? Turning to what Avon does really well, you'll find their loose and pressed powders have amazingly silky textures and natural finishes. Their blushes are wonderful, and a few of the lipsticks and foundations are definitely worth talking about with enthusiasm. Another positive point is that Avon regularly discounts their makeup, often upwards of 50% during any given campaign (Avon's campaigns run for two weeks and the specials change each time). If you shop at the right time, the best of Avon color can be yours for less than you'd pay for most low-cost drugstore makeup. Banishing Cream Skin Discoloration Improver - Avon Solutions Lighteners Without Hydroquinone $8.50

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Invitation from the Network Chair “Joining PH Professional Network is the first step you can take toward staying well-informed”- Melisa Wilson, ARNP, ACNP-BC, Chair of PH Professional Network For more than two decades, the Pulmonary Hypertension Association (PHA) has worked with patients, families, caregivers and medical professionals to raise awareness, to provide resources, education and support, and to fund research that will ultimately lead to a cure for pulmonary hypertension (PH). The PH Professional Network (PHPN) is a diverse group made up of the many individuals involved in PH practice, including nurses, pharmacists, physician assistants, nurse practitioners, respiratory therapists, physical therapists, social workers, dietitians and more. We recognize the importance of collaboration across many disciplines and work to provide support and targeted resources for all of those involved in PH patient care. PHPN was established in 1999 to provide educational opportunities and facilitate networking among allied health professionals involved in the care of PH patients. Since its founding, PHPN has helped build links among allied health professionals around the U.S. and abroad. The colleague-to-colleague connection that PHPN provides has significantly contributed to improved care and outcomes for PH patients and families. Joining PHPN is the first step you can take toward staying well-informed about the clinical research arena, the treatments that are available for PH patients and the provision of optimal patient care. By providing a network of support and resources, PHPN makes sharing knowledge easier so that allied health professionals do not have to “reinvent the wheel.” PHPN’s success comes from the dedication of its members who understand the importance of working together toward a common goal. There are so many ways to be an active member in PHPN, such as attending a conference or symposium, writing articles for our newsletter, or serving as a mentor. We encourage you to learn more about our committees and member benefits and we hope you will join us as a new member of PHPN. Melisa Wilson, ARNP-ACNP-BCChair, PH Professional Network Not a PHPN Member? Join today! Membership in PH Professional Network is available to all PH-treating allied health professionals for an annual fee of $35, with multiple year memberships available. Join PHPN today

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Folic acid supplementation for rheumatoid arthritis patients on methotrexate: the good gets better By: Jasvinder Singh On: July 22, 2013, 16:00 A recently updated Cochrane Review by Beverley Shea and colleagues looks at the evidence for low-dose folic acid or folinic acid supplementation for reducing side effects of methotrexate (MTX) in patients with rheumatoid arthritis.[1] The review highlights some key aspects of the use of folic acid that merit further discussion. MTX is an effective and commonly used disease-modifying anti-rheumatic drug (DMARD) for treating rheumatoid arthritis.[2-4] It is used alone and in combination with other DMARDs or newer biologic therapies targeting various inflammatory cytokines and cells.[4] Treatment guidelines from the American College of Rheumatology (2012) and the European League Against Rheumatism (2010) highlight MTX as the first line of treatment alone or in combination therapy.[5,6] Although its exact mechanism of action in rheumatoid arthritis is unclear, we know that polyglutamate metabolites of MTX interfere with folate-dependent enzymes such as dihydrofolate reductase and 5-aminoimidazole-4-carboxamide ribonucleotide (AICAR) transformylase. The resulting accumulation of AICAR leads to the extracellular release of adenosine, which interacts with receptors on neutrophils and mononuclear cells, and this is likely to contribute to MTX's anti-inflammatory effects. Several aspects of MTX treatment are particularly attractive to patients, rheumatologists, and other healthcare providers: once-weekly oral administration; efficacy in treating signs and symptoms of rheumatoid arthritis; and relatively few serious side effects. The main challenges to the continued use of MTX are its few side effects and its lack of efficacy in some patients.[7,8] A common reason for discontinuation is gastrointestinal side effects (nausea, vomiting, abdominal pain) followed by stomatitis (oral ulcers), liver function abnormalities, bone marrow suppression, alopecia, and other side effects.[7] Patients and physicians alike are looking for ways to continue MTX for longer without side effects. One well-known solution is folic acid or folinic acid supplementation. (Folinic acid is a derivative of tetrahydrofolic acid that has vitamin activity equivalent to that of folic acid, but its function is unaffected by drugs such as MTX.) The use of folic or folinic acid has been variable, ranging from regular use in everyone who starts MTX to use only in those with side effects, or no use at all (because of an unfounded fear of reduction in MTX efficacy). The updated Cochrane Review provides important data on this topic. The review includes six randomised controlled trials involving 624 rheumatoid arthritis patients taking MTX, of whom 385 also took low-dose folic acid (≤ 7 mg/week). The concomitant use of folic acid significantly reduced: (1) gastrointestinal toxicity by 26% relative and 9% absolute risk reduction (relative risk [RR], 0.74); (2) abnormal serum transaminase elevation by 77% relative and 16% absolute risk reduction (RR, 0.23); and (3) patient withdrawal from MTX for any reason by 61% relative and 15% absolute risk reduction (RR 0.39). There was no significant reduction in MTX efficacy, as measured by disease activity measures such as tender and swollen joint counts or physician's global assessment scores. What are the implications of these findings for patients and rheumatologists? I believe that this Cochrane Review provides conclusive evidence for the efficacy of low-dose folic or folinic acid supplementation in patients taking MTX to treat rheumatoid arthritis. The reductions in two major MTX side effects (gastrointestinal toxicity and liver enzyme elevations) are impressive. The review provides estimates for these reductions based on recent trial data that we can now share with patients. A key consideration is that the risk of bias was assessed to be low (or unclear) for key domains and there was no significant heterogeneity between trials when folic acid and folinic acid were pooled. The review's findings also have major implications for rheumatology practices. In my practice (and I suspect similarly in several of my colleague rheumatologists' practices) the three most common reasons for patients stopping MTX are inefficacy, gastrointestinal toxicity, and liver enzyme elevations. That a single daily folic acid pill (or equivalent) can significantly and dramatically overcome two of those three reasons is spectacular and confirms the classic teaching of the benefits of folic acid supplementation. Another important message from the review is that patient withdrawal from MTX for any reason was lower in those receiving folic acid than in those who did not. Strategies that improve the persistence of MTX in rheumatoid arthritis patients are increasingly important and are likely to help patients, as most DMARD and DMARD-biologic combination regimens include MTX. These findings are relevant given the recent emerging evidence that MTX-based conventional DMARD regimens may be as effective as MTX-biologic combinations.[9-11] As MTX monotherapy and combination regimens are mainstays of treatment, folic acid supplementation is an important therapeutic intervention. Considering the low cost of folic acid supplementation and its overwhelming benefits without any evidence of reduction of MTX efficacy, its use should be considered in all rheumatoid arthritis patients taking or starting MTX. Due to cost differences between folic acid and folinic acid, and the availability of folic acid in multivitamin preparations that are available easily over the counter in many countries, folic acid may be more affordable for patients than folinic acid. Low-dose folic acid (equivalent to ≤ 7 mg/week), commonly as a 1 mg daily pill, should be prescribed to rheumatoid arthritis patients taking MTX. A higher persistence to MTX and less switching may also reduce healthcare utilisation and excess medication costs from use of more expensive biologics and other DMARDs. Policy makers and guideline developers should consider including folic acid supplementation for MTX users in their recommendations as a cost-effective and perhaps cost-saving treatment strategy for every rheumatoid a

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L+M workers did not know details of deal till they voted By Judy Benson New London - As Lawrence + Memorial Hospital and the union representing about 800 nurses and technicians vow to put aside their past adversarial relationship and more details of the contract approved last week are emerging, questions still linger among the rank-and-file."Nobody knew what was in the contract until you got there to vote," said one technician, who asked not to be named. "A lot of people are still upset about that."One registered nurse, who also declined to give her name out of fear of retaliation, said the suddenness of the announcement that an agreement had been reached, coupled with limited communication about the details of the contract before the Feb. 3 vote, have left her and other nurses feeling "powerless.""Neither side told us anything," she said. "We all feel like we can't trust anybody."A snowstorm on the day of the vote prevented her and many others from being able to get to New London to cast their ballots, she said. Requests to postpone the vote were denied, she said. She and others said they still don't know the entire content of the contract, which will be in effect for the next 2½ years.Hospital spokesman Mike O'Farrell said a copy will be posted on L+M's internal website for employees.AFT Connecticut, the union for the two bargaining units for the registered nurses, licensed practical nurses and technicians, said a majority of the 800 workers did cast ballots, though it did not release numbers. Fewer than 20 of the votes cast were against approving the contract, the union said. The tentative agreement was announced in the afternoon on Jan. 31, a Friday, and the vote scheduled for the following Monday."It's not unusual for an agreement to be taken to the membership right after it's reached," said Matt O'Connor, union spokesman. "There was a strong hope that the agreement could be voted on quickly."He said the union did "outreach efforts" about the contract to members the weekend before the vote, and also held informational sessions on the day of the vote."And we answered questions one on one," he said.The vote followed what was perhaps the most grueling contract negotiation in the 101-year-old nonprofit hospital's history, intensifying during a four-day strike and three-week lockout by the hospital of the nurses and technicians in late November and December. Workers returned Dec. 19 under terms of the expired contract, and the situation remained in limbo until issues relevant to the contract began being aired during a federal labor law hearing that began in mid-January. The newly approved contract settles the issues raised in the National Labor Relations Board case, which centered on seven union jobs lost when the hospital transferred outpatient services from the main hospital to affiliated nonunion physician practices in the community.Under the new contract, the hospital will limit the number of union positions it will transfer to affiliates in the future. Both sides agreed not to disclose the specific departments or numbers of employees affected."We wanted to avoid the winners-versus-losers discussion that would follow," O'Connor said of the reason for not releasing contract details to the public. "It was premised on a new relationship between the hospital management and labor."O'Farrell, the hospital spokesman, said both sides pledged to engage in "a new way of doing business" that will be more cooperative.While neither side would reveal details of the contract, sources knowledgeable about it disclosed that in addition to limited job protection guarantees, it also preserves pensions for current employees. New employees would not be included in the pension, however. It also changes the way seniority is counted for employees for "bumping rights" - when laid-off employees are allowed to move into the jobs of less senior employees - and other benefits, sources said. Instead of counting seniority by years of total service at the hospital, including any years union workers spent in nonunion management positions, only years in unionized positions will count under the new system, the sources said.The contract also establishes rules for union-organizing efforts at the affiliated physician practices in Lawrence + Memorial Medical Group, which employ about 150 workers at about 70 primary care and speciality care doctors' offices in southeastern Connecticut and Westerly. The union had launched an organizing effort there last year and in April announced that a majority of the workers had signed cards stating that they wanted to form a union.One source close to the negotiations said that acknowledging the union-organizing effort in the contract helps establish a nonadversarial tone as the two sides move forward."When there's been conflict and uncertainty, it's important to clarify the process," the source said. "It's a confidence-building measure."[email protected] Source says contract limits number of jobs L+M can move Nurses, technicians ratify contract with L+M

医学

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INTEGRA Administrative Group, Inc. Selects ACS to Drive Savings on Ancillary Healthcare Spending DALLAS --(Business Wire)-- American CareSource Holdings, Inc. (NASDAQ: ANCI) has added a prominent new client: INTEGRA Administrative Group, Inc., a national third-party administrator (TPA) based in Seaford, Delaware. American CareSource (ACS (News - Alert)) offers a single-source cost-containment service focused on ancillary categories such as dialysis, laboratory, diagnostic imaging, infusion, durable medical equipment and home health. Through the relationship with ACS, INTEGRA clients are expected to save an additional 7-9 percent on their ancillary healthcare spend, as well as gain access to ACS' analytics functionality. ACS' comprehensive network includes 4,900 ancillary service providers at more than 34,000 sites across the United States. As a result of the relationship between ACS and INTEGRA, ACS strengthens its position in the Mid-Atlantic region, where thousands of additional member lives will now have access to its network of ancillary service providers. "We selected ACS because of its unique focus on ancillary categories and its proven savings results. Working with ACS moves us forward in our mission to control medical spend without increasing costs to our employer groups," said D. Scott Smith, chief marketing officer for INTEGRA. William J. Simpson, Jr., president and chief operating officer of ACS, added, "Our agreement with INTEGRA is a significant win for ACS. The company looks forward to bringing the value of our suite of ancilary provider solutions to INTEGRA's clients." About INTEGRA Administrative Group, Inc. INTEGRA Administrative Group has worked in the group health industry for over 30 years, managing the administrative needs of employers - both regionally as well as nationally. INTEGRA works with brokers and employers to create customized health benefits plans to meet their specific needs. INTEGRA then manages that benefit plan in the most effective and efficient manner. INTEGRA aggressively manages medical spend and is committed to providing world class service. For more information, visit www.integratpa.com. About American CareSource Holdings, Inc. American CareSource Holdings is the first national, publicly traded ancillary care network services company. The company offers a comprehensive national network of more than 4,900 ancillary service providers at more than 34,000 sites through its subsidiary, Ancillary Care Services. ACS provides ancillary healthcare services through its network that offers cost-effective alternatives to physician and hospital-based services. These providers offer services in 30 categories including laboratories, dialysis centers, free-standing diagnostic imaging centers, infusion centers, long-term acute care centers, home-health services and non-hospital surgery centers, as well as durable medical equipment. The company's ancillary network and management provide a complete outsourced solution for a wide variety of healthcare payors and plan sponsors including self-insured employers, indemnity insurers, PPOs, HMOs, third-party administrators and both federal and local governments. For additional information, please visit www.anci-care.com. ANCI-G Safe Harbor Statement Under the Private Securities Litigation Reform Act of 1995: Except for the historical information contained herein, the matters discussed above are forward-looking statements made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995, as amended. These forward-looking statements involve risks and uncertainties as set forth in the Company's filings with the Securities and Exchange Commission. These risks and uncertainties could cause actual results to differ materially from any forward-looking statements made herein.

医学

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Health System > Medical Center > Children’s Hospital > Breastfeeding fraught with early challenges for most first-time ... Tricia Tomiyoshi-MarsomUC Davis Health System Pat Bailey UC Davis News Service NEWS | September 23, 2013 Breastfeeding fraught with early challenges for most first-time mothers (SACRAMENTO, Calif.) — Breastfeeding problems are extremely common among first-time moms, often causing them to introduce formula or completely abandon breastfeeding within two months, report researchers at the University of California, Davis, and the Cincinnati Children’s Hospital Medical Center. Mother and newborn infant © iStockphoto Strategies should be developed for evaluating infant breastfeeding and alleviating the concerns of the new, breastfeeding mothers soon after birth, recommend the researchers, who report their findings online this week in the journal Pediatrics.“Findings from our study indicate that certain breastfeeding problems or concerns are experienced almost universally by first-time mothers, and some of those problems greatly increase the chances they will stop breastfeeding earlier than they planned,” said study co-author Caroline Chantry, a pediatrician at the UC Davis Medical Center, where the research with the first-time mothers was based.“If we can enable mothers to achieve their breastfeeding goals, we will have a healthier nation,” Chantry said. She noted that although 75 percent of mothers in the United States initiate breastfeeding, only 13 percent of those women ultimately breastfeed exclusively for the recommended first six months of the child’s life.The new study, based on a sample of 532 first-time mothers, included interviews while the women were pregnant and at six other times between birth and 60 days after the babies were born.Ninety-two percent of the new moms reported at least one breastfeeding concern three days after birth. The most predominant concern was that the infants were not feeding well at the breast (52 percent), followed by breastfeeding pain (44 percent) and perceived lack of sufficient milk (40 percent).The researchers collected reports of thousands of breastfeeding problems and concerns from the mothers. The concerns that were reported at interviews conducted at days three and seven after the baby’s birth were strongly associated with the moms’ subsequent decisions to supplement with formula or stop breastfeeding altogether.“These interviews at three and seven days were conducted at a time when there may be a gap between hospital- and community-based lactation support resources,” said co-author Kathryn Dewey, a UC Davis nutrition professor and authority on maternal and infant nutrition.“Based on these findings, we would recommend that first-time moms, in particular, need more support to alleviate breastfeeding concerns that may arise during the first two weeks after their babies are born,” Dewey said. “Such support could help allay any unwarranted concerns and provide new moms with the reassurance and assistance they need to meet their breastfeeding goals.”Researchers on the study from the Perinatal Institute at Cincinnati Children’s Hospital Medical Center were lead author Laurie Nommsen-Rivers, an assistant professor and UC Davis alumna, and nutritionist Erin Wagner.Breastfeeding exclusively — rather than using infant formula — is recommended for the first six months after birth by the American Academy of Pediatrics because of the risks of using formula to the health of both infants and moms. For more information, visit the academy’s breastfeeding policy website.The website for the U.S. Centers for Disease Control and Prevention also offers evidence-based examples of how healthcare providers and communities can support breastfeeding.This study was supported by grants from the National Institutes of Health (NIH HD063275-01A1) and (MC 04294) and the Maternal and Child Health Research Branch, DHHS (C 04294). UC Davis Health System is improving lives and transforming health care by providing excellent patient care, conducting groundbreaking research, fostering innovative, interprofessional education, and creating dynamic, productive partnerships with the community. The academic health system includes one of the country's best medical schools, a 619-bed acute-care teaching hospital, a 1000-member physician's practice group and the new Betty Irene Moore School of Nursing. It is home to a National Cancer Institute-designated comprehensive cancer center, an international neurodevelopmental institute, a stem cell institute and a comprehensive children's hospital. Other nationally prominent centers focus on advancing telemedicine, improving vascular care, eliminating health disparities and translating research findings into new treatments for patients. Together, they make UC Davis a hub of innovation that is transforming health for all. For more information, visit healthsystem.ucdavis.edu.

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Research at UC Davis Health System Health System > Research > UC Davis scientist receives funding from Shriners Hospitals ... Clinical Trials at UC Davis IRB - Human Subjects Research Research Training and Career Development Building Interdisciplinary Research Careers in Women's Health Integrating Medicine into Basic Science Mentored Clinical Research Training Program Stem Cell Training Program Karen Finney, UC Davis Health System Catherine Curran, Shriners Hospitals for Children NEWS | January 18, 2013 UC Davis scientist receives funding from Shriners Hospitals for Children for juvenile arthritis research Editor's note:View or download a high-resolution photograph of Iannis Adamopoulos. Iannis Adamopoulos, a researcher dedicated to studying diseases of the immune and skeletal systems, has received $1 million in grants from Shriners Hospitals for Children to find new treatment targets for juvenile arthritis — the most common cause of orthopaedic disability among children.Adamopoulos is an assistant professor of rheumatology, allergy and clinical immunology at UC Davis and principal investigator for the Institute for Pediatric Regenerative Medicine, a research collaboration of the UC Davis School of Medicine and Shriners Hospitals for Children – Northern California. He will use the funding to define the role of leukotriene B4 (LTB4) in juvenile arthritis.Iannis Adamopoulos“We have preliminary evidence that LTB4 is found in inflamed joint tissue and stimulates bone destruction through the activation of specialized bone-destroying cells,” said Adamopoulos, who has been investigating inflammatory arthritis for several years. “We think that LTB4 could potentially be a critical factor in juvenile arthritis.”The funding will also support the research of Hong Qiu, an expert in leukotriene biochemistry and researcher in the Adamopoulos lab, who will test the potential of leukotriene inhibitors in treating juvenile arthritis.“Collectively, our studies will provide a detailed understanding of the pathogenetic mechanisms of LTB4 and will foster new therapeutic strategies for juvenile arthritis with improved outcomes,” Adamopoulos said.Juvenile arthritis and related disorders are estimated to affect nearly 300,000 children in the U.S. It causes episodes of joint stiffness and pain that can be accompanied by rashes and fevers at the onset. If experienced long term, the disease can permanently affect a child’s mobility, internal organs and eyesight. Current treatments are only partially effective, highlighting the critical need for new therapies that specifically address arthritis in children.“We are very proud to include Dr. Adamopoulos among our investigators,” said David Pleasure, director of research at Shriners Hospitals for Children – Northern California and a UC Davis professor of neurology and pediatrics. “He is a leader in the rapidly evolving field of osteoimmunology, which focuses on the interactions of bone formation, bone destruction and the immune system. His work illuminates the role of immune attack in juvenile arthritis and points the way toward novel therapies for this disorder.”Adamopoulos is known for discovering that the abnormal expression of an immune system cytokine known as interleukin 23 (IL-23) causes severe bone loss in mice. He has since confirmed that finding in human cells and is currently testing the potential of IL-23 inhibitors as a treatment for adult arthritis. His groundbreaking work led to his recognition in 2011 as an Arthritis National Research Foundation Scholar and Sontag Foundation Fellow.The UC Davis School of Medicine is among the nation's leading medical schools, recognized for its research and primary-care programs. The school offers fully accredited master's degree programs in public health and in informatics, and its combined M.D.-Ph.D. program is training the next generation of physician-scientists to conduct high-impact research and translate discoveries into better clinical care. Along with being a recognized leader in medical research, the school is committed to serving underserved communities and advancing rural health. For more information, visit medschool.ucdavis.edu.Shriners Hospitals for Children – Northern California is a regional pediatric medical center devoted to transforming the lives of children through treatment, teaching and research. The hospital provides comprehensive and compassionate care to children with orthopaedic conditions, spinal cord injuries, burns, cleft lip and scars from any cause. Admission to the program is based on age and diagnosis. For more information, visit shrinershospitalsforchildren.org.The Institute for Pediatric Regenerative Medicine, a joint initiative of Shriners and UC Davis, conducts basic and translational stem cell research to help children with spinal cord dysfunction, orthopaedic disorders and burns. All News Releases UC Davis Health System | 2315 Stockton Blvd. | Sacramento, CA 95817 | 24-hour Sacramento campus operator: (916) 734-2011

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Oscar Pistorius sentenced to five years in prison ... Federal funds headed to Finger Lakes for home heating ... Staples investigating possible data breach ... Oscar Pistorius sentenced to five years in prison ... Federal funds headed to Finger Lakes for home heating ... Staples investigating possible data breach ... Life after the lump: What it takes to get through breast cancer treatment Click inside to read about how women have coped with having breast cancer. Also be sure to check out our special Breast Cancer Awareness Month site - Pink - by clicking the banner at the top of this site. We have articles with advice on how to deal with a diagnosis, what you should be aware of before buying pink merchandise a... By More Content Now News It’s something almost every woman fears — a lump in the breast that turns out to be cancer. A devastating diagnosis to be sure, but breast cancer isn’t what it was even 20 years ago. With greater awareness, early detection and advances in treatment, survival rates are on the rise. Survivors will tell you, there is life after the lump. Sharing lessons learnedMarried with a grown daughter, Deborah J. Cornwall was 55, healthy and fit, a primary partner in a small consulting firm with no family history of breast cancer. She was an active volunteer for the American Cancer Society and the Cancer Action Network in the Boston area where she lives.As the world shook with the events of Sept. 11, Cornwall’s personal world crumbled when the calcification — “a little white spot” — her doctor was tracking turned out to be breast cancer. After a regular mammogram showed something the doctors wanted a closer look at, she was called back for reshoots and later an ultrasound. “At first I was aggravated because I would get home from work and get the message to call radiology. But at that time of night, I couldn’t speak to anyone,” Cornwall said. Follow-ups sometimes took as long as three weeks, making Cornwall more and more anxious. When the call finally came, Cornwall was “furious” when her primary care physician phoned to say, “I’m just calling to say you have cancer.” The doctor “was cheery, so casual, but I learned later there is no good way to tell someone they have cancer.”Cornwall said she “is one of the lucky ones” and that hers was only a “brush with cancer.” In the end “all the cancer came out in the biopsy,” but she did undergo 35 days of radiation and took Tamoxifen for five years.The process from diagnosis to treatment and eventually to becoming cancer-free redefined what really matters in life, Cornwall said. She continues to volunteer with various cancer causes including the AstraZeneca Hope Lodge in Boston, a facility that offers lodging for those receiving care at Boston medical centers. The stories she heard through her volunteer work resulted in a book published a year ago, “Things I Wish I’d Known.” The book blends caregivers’ stories, factual information and practical guidance.Page 2 of 3 - Some lessons learned:- “First, take a deep breath. Look around and make sure you find the support you need,” Cornwall said. Which leads directly to her second lesson: Surround yourself with a great medical team. “Every hospital is claiming to be a world-class cancer center, but they are not all equally competent. You want to choose a hospital that specializes in the type of cancer that you have,” Cornwall said. - To find the best medical team, look at the hospital or cancer center’s certification. If possible, Cornwall urged, seek a hospital with certification from the National Cancer Institute or the American Society of Clinical Oncology, which is called the Quality Oncology Practice Initiative. - It’s also critical that your oncologist is trained in palliative care “to treat your quality of life, pain control, nausea control and anxiety relief,” Cornwall said. “Not every oncologist is trained in palliative care; be sure to check.”And when you schedule those first appointments, don’t go alone. “When you hear the C word, something happens to your mind. If possible, bring along a caregiver to hold your hand and take notes,” Cornwall said.- To take care of your personal well-being, “engage in a support group,” Cornwall said. The word “cancer” is almost taboo, she said. “When you start down this road, most people don’t realize how isolating it is. ... You don’t realize how alone you will feel,” Cornwall said. ‘It wasn’t a matter of ‘if’’Cynthia Bolanowski’s mother hated doctors, and so her diagnosis of breast cancer came too late. Her mother passed away in spring 1952 at age 36. “I was 4 1/2. Somehow I felt that this would become my fate as well; it wasn’t a matter of ‘if,’ it was a matter of ‘when,’ ” said Bolanowski, who lives in the Chicago suburbs. “Through the years I diligently scheduled exams and annual mammograms and did self-exams, with the only result being a benign cyst now and then.” Fate came knocking in spring 2007. “I felt a lump in my right breast unlike the previous cysts I had experienced. My scheduled appointment was within a few weeks, so I just waited. My doctor felt it, too, but assured me that the majority of these lumps were nothing to worry about,” Bolanowski said. In hindsight, Bolanowski looks back on the medical experience with a different perspective. Page 3 of 3 - “This is the same man who had put me on hormone replacement therapy medication even though I questioned its safety due to my family history,” she said. Going through a divorce and menopause simultaneously, Bolanowski went along with his advice but now feels it wasn’t the best choice for her. On her 60th birthday, a letter arrived along with many greeting cards. There was a suspicious lump that needed further inspection. The next few weeks were a blur. Approaching the ordeal with a positive attitude, a sense of humor and a will to fight helped her get through the tough times. “Attitude helps a great deal. You need to be surrounded by positive people,” she said. Especially helpful is talking with others who are going through the same treatment so you can identify with each other’s journeys, Bolanowski said.“Funny thing … I never cried. I always knew I would be just fine.” Six years have gone by since the diagnosis. Five years of follow-up medication ended in March. In June, Bolanowski complied with her daughters’ request to have genetic tests for the BRCA1 and BRCA2 genes. “They wanted to know rather than live their lives as I did, thinking that it would just be a matter of time.” By More Content Now News

医学

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Watch List of Drugs Expands in Fungal Meningitis Outbreak By: Andy Alcock, Associated Press Email Updated: Wed 3:23 PM, Jan 09, 2013 By: Andy Alcock, Associated Press Email Home / Article This photo provided Oct. 9, 2012, by the Minnesota Department of Health shows shows vials of the injectable steroid product made by New England Compounding Center implicated in a fungal meningitis outbreak that were being shipped to the CDC from Minneapolis. (AP Photo/Minnesota Department of Health) There's a new expanding list of drugs on a watch list after a national fungal meningitis outbreak. A representative for the Georgia Department of Health says the Food and Drug Administration expanded its list as a precaution. However, she points there has been no confirmed connections of fungal meningitis from drugs on the expanded list. To date, there have been 257 confirmed cases from tainted steroids across the country. There have been 20 deaths. There have been 13 cases in Florida and three deaths. However, none of them have been in our area. State leaders say 8 medical facilities in Florida have received contaminated drugs from the New England Compounding Center in Massachusetts. But none of them are in our area. Additionally there have no confirmed reports of any cases or deaths related to the outbreak in Georgia. It's important to note the fungal meningitis cases are NOT contagious.However, the Centers for Disease Control estimates about 14-thousand patients may have received injections from the three confirmed contaminated steroid shipments. Agency leaders say 97 percent of those people have been contacted for further follow up. The death toll has reached 15 in a nationwide meningitis outbreak. As of today, there are 214 reported cases in 15 states, the latest state to report a case of the disease was Illinois. Health officials have broadened their warning to doctors about other medicines made by the specialty pharmacy linked to the outbreak. The food and drug administration took the step today because of reports of new illnesses that may be tied to other products. Atlanta, GA - October 14, 2012 - At the main campus of the Centers for Disease Control and Prevention, dozens of people are working day and night to bring a meningitis outbreak under control. Dr. John Jernigan is a medical epidemiologist at the CDC leading the clinical investigation team for the outbreak response. He says this infection, which is caused by a fungus, is very unusual. Meningitis is typically caused by a virus or bacteria. The fungus linked to this outbreak is common in dirt and grasses, but it is making people sick because it found its way into a steroid injected into people with back pain. That steroid was distributed by a Massachusetts pharmacy that is currently under investigation. Nearly 200 people in more than a dozen states have been sickened, including 15 who have died. Atlanta, GA (AP) -- Health officials say they have now confirmed more than 90 cases of a rare fungal meningitis that has been linked to a steroid commonly used to ease back pain. The Centers for Disease Control and Prevention posted updated figures to its website Sunday. The death toll stood at 7, the same number as a day earlier. The outbreak is spread across nine states, the same states reported Saturday: Florida, Indiana, Maryland, Michigan, Minnesota, North Carolina, Ohio, Tennessee and Virginia. The CDC figures show there are 91 cases in the U.S. altogether. The steroid linked to the outbreak has been recalled, and health officials have been scrambling to notify anyone who may have received an injection of it. The Massachusetts pharmacy that made it has said it is cooperating with investigators.

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iTunes Trade, foreign policy, diplomacy and health Menu Trade, foreign policy, diplomacy and health Foreign policy and global health Global health diplomacy Human Immunodeficiency Virus (HIV) is the retrovirus that weakens the immune system, particularly by causing the death of many CD4+T cells, which coordinate the human immune system's response to intruders. This weakening of the immune system leaves the body open to attack from opportunistic infections, eventually leading to the development of Acquired Immune Deficiency Syndrome (AIDS). HIV/AIDS affects every country in the world and in many infection rates are increasing rapidly. Today, an estimated 42 million people live with HIV/AIDS. Sub-Saharan Africa is the region of the world worst affected. Nearly three-quarters of persons living with HIV/AIDS (PLWHA) are in sub-Saharan Africa. Of the 3.1 million people who died of HIV/AIDS in 2002, 2.4 million were in sub-Saharan Africa. The disease has already orphaned 12 million children in Africa and that number could grow to a staggering 40 million by 2010. It is argued that the rapid spread of HIV/AIDS is linked with globalization, which makes it easier for people to travel and may promote some risk behaviours. HIV/AIDS is also undermining the benefits of globalization for many countries. Between 1960 and 1990, life expectancy in Africa increased by a very substantial nine years. The impact was to add between 1.7% and 2.7% a year to the growth rate of per capita gross domestic product (GDP). The HIV/AIDS epidemic, however, is reversing these gains. According to a World Bank report, HIV/AIDS may subtract an additional 1% a year from GDP economic growth in some sub-Saharan African countries, owing to the continuing loss of skilled and unskilled workers in the prime of life. In South Africa HIV/AIDS may depress GDP by as much as 17% over the next decade. HIV/AIDS also creates much higher costs of health care for governments and may undermine health insurance schemes, as premiums become unaffordably high in countries with high prevalence rates. See also: Data for Policy Decisions Global Burden of Disease Health Financing Cross-Border Health Risks Trade, foreign policy, diplomacy and health Glossary of globalization, trade and health terms

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New Batch of Alzheimer's Genes DiscoveredNew Batch of Alzheimer's Genes Discovered 2013-Oct-28 :: -- Robert PreidtHealthDay News Home | News Archive | News CategoriesMONDAY, Oct. 28 (HealthDay News) -- Researchers report they have pinpointed 11 new genes linked to late-onset Alzheimer's disease, doubling the number of potential targets for drug development.The international team of scientists analyzed genetic data from more than 25,500 Alzheimer's patients and more than 49,000 people without the memory-robbing disease in 15 countries.Along with adding 11 new genes to those already known to be associated with Alzheimer's, the researchers identified 13 other genes that require further investigation, according to the study published Oct. 27 in the journal Nature Genetics.The findings provide a wider view of the genetic factors that contribute to Alzheimer's and increases the understanding of the disease to new areas. This includes the immune system, where a genetic overlap with other neurodegenerative diseases, including multiple sclerosis and Parkinson's, was identified."The discovery of [new] pathways is very encouraging, considering the limited success of Alzheimer's disease drugs tested so far," Margaret Pericak-Vance, director of the Institute for Human Genomics at the University of Miami Miller School of Medicine, said in a school news release. "Our findings bring us closer toward identifying new drug targets for Alzheimer's and other neurodegenerative diseases. We'll continue to expand and analyze our data set with this incredible group so that we can better understand the genetic influences on this devastating disease, and find new medical and therapeutic interventions," said Pericak-Vance, co-leader of the analysis teams for the American Alzheimer's Disease Genetics Consortium that worked on the study. Several of the 11 genes identified in the study confirm known biological pathways of Alzheimer's disease. One of the more significant new genes was found in a part of the genome that plays a role in the immune system and inflammatory response. This suggests that diseases where abnormal proteins accumulate in the brain -- Alzheimer's, Parkinson's and multiple sclerosis -- may have a common mechanism and possibly a common drug target.More informationThe U.S. National Institute of Neurological Disorders and Stroke has more about Alzheimer's disease. 2013Copyright © 2013 HealthDay. All rights reserved. Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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Why Today's Healthy You Has Trouble Planning for Tomorrow's Sick You by David Berreby An aging man, a physician, learns he has Alzheimers. Determined to avoid the worst of it, he assembles a lethal collection of pills. As the next few years pass, the bottle in his nightstand comforts him with the thought that he'll have them when the right moment comes. But what comes instead is the moment when he can't remember what the pills are for. This is a true story. I heard it by the man's son, because we'd been talking about living wills, advanced medical directives and other instruments Americans are encouraged to wield at the end of life. I'd asked him about a nagging doubt I had: It concerns the gap between I, David, aged 54 and in good health, creating my instructions for end-of-life care, and I, David, aged 84 and terminal, who has to live under those instructions. Those two aren't the same guy. I think of this as the Krapp's Last Tape problem (after the Beckett play in which 69-year-old Krapp torments himself by listening to the taped ramblings of men he scorns and despises: Himself, at age 39 and age 20.) We are expected to make these immensely consequential decisions about how we wish to be treated when when we are sick, feeble, demented—but those choices are to be made when we're none of those things. Should we be confident we know today what we'll want tomorrow? Research suggests we should not be. For instance, in this paper (pdf) on the legal implications of people's "incorrect, intuitive theories about the impact of disability on happiness," Peter A. Ubel and George Loewenstein note that paraplegics and blind people aren't markedly less happy than typical people; nor do colostomy patients and dialysis recipients report sadder lives than ordinary people. Yet those ordinary people estimate that being paralyzed, blinded, having kidney failure or getting a colostomy must be life-ruining catastrophes. The research on colostomy patients, detailed in this study, was especially revealing: The researchers found the expected gap—people with colostomies adapted and felt OK, non-patients asked about colostomy said they expected it would be a terrible thing. Here, though, is a wrinkle: Colostomies, in some cases, are reversible. So the authors could compare people who had permanent conditions with those who had been through the experience and returned to a more typical life. It turns out the former colostomy patients also thought the procedure was terrible. They recalled their lives with colostomy bags in a very negative light, while people who must live with such a bag for the rest of their lives felt pretty much fine. (Ubel, a physician and social scientist now at Duke's Fuqua School of Business, calls this effect "the dark side of hope.") In academia, "Rational Economic Man" is a model of the mind and a theory of human behavior, and it's under assault. However, in the institutions that organize our lives, Rational Economic Man is an unspoken assumption—an article of faith that can't be challenged because it's not even stated explicitly. So it is with end-of-life planning. Creating a medical directive involves estimating what will be acceptable and what will be unbearable to us in some future state, and the evidence is that we're terrible at making such estimates. Why the mismatch? Because our legal structures for this stage of life are based on "rational economic man" assumptions: first, that people see supposedly objective facts in the same way, no matter their own situation; and, second, that people are coherent and consistent over time, so we can assume that their preferences expressed at age 39 are still valid at age 69; and, third, that because of the first two, you can be sure you know today what you will want in that final hospital bed 25 years from now. A pretty unfortunate situation, all in all. What to do? That's not a rhetorical question. I'd very much like to hear from you, readers, on two points. First, have any of you had an experience, yourself or with a loved one, in which this problem came up? Second, are any of you aware of any practical approaches to end-of-life planning that take the Krapp's Last Tape problem into account? Please leave your thoughts and stories in the comments section, or if you prefer, email me at the address in my bio. Illustration: The Seven Ages of Man, 1820. Follow me on Twitter: @davidberreby Ubel, P., & Loewenstein, G. (2008). Pain and Suffering Awards: They Shouldn’t Be (Just) about Pain and Suffering The Journal of Legal Studies, 37 (S2) DOI: 10.1086/529072 Smith, D., Sherriff, R., Damschroder, L., Loewenstein, G., & Ubel, P. (2006). Misremembering colostomies? Former patients give lower utility ratings than do current patients. Health Psychology, 25 (6), 688-695 DOI: 10.1037/0278-6133.25.6.688 The NRA, Which Blames Shooting Games for Gun Violence, Has Just Released a Shooting Game Once Again, A Compelling Explanation for Falling Crime Rates Proves Untrue About Mind Matters In markets, medicine, justice, politics, psychology, and economics, "Rational Man" is dead. As the science of human behavior enters the post-rational era, we no longer think of ourselves as cool calculators in pursuit of our objective self-interest. Mind Matters is about this change and its effects on how we live. It's about the reasons people perceive, feel, think, and act as they do, and the gaps between what we think we're doing and what research says we're doing. Most importantly, it's about how this sea change affects the institutions we live by: courts, hospitals, governments, stock markets and other entities that still run on the presumption that people act rationally. How Much Violence Is Being Committed In Your Name? What We Mean When We Say 'I Did Something I Didn't Want to Do' Study: You'll Be Happier Throwing Out That Bucket List Than Chasing It Should You Be Able to Sue the Government That Nudged You? Study: Cities Speak A Different Language Than Their Small-Town Neighbors Government-By-Nudge Is a Global Phenomenon Why Your Devices Shouldn't Do the Work of Being You Why You Don't Have to Be Rational to Run Your Own Life How Social Networks Help Foster Genocide What's Behind Humanity's Strange Tolerance for the Deaths of Innocent People? Why Today's Healthy You Has...

医学

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Balancing Full Freedom With Full Coverage Question: What is your ideal model of healthcare? Newt Gingrich: I think everybody, certainly we at the Center for Health Transformation would like to see 305 million Americans with health insurance, or with some form of financial coverage. We would accept the libertarian argument that if you don’t want to buy health insurance, you could be allowed to post a bond or in some other way to be financial responsible, but we do think everybody should be in a position to have healthcare without having to rely on the state, or rely on charity. Having said that, we don’t want a singer payer system, we don’t want a government dominated system, we don’t want a bureaucratically imposed system. We want a system where the individual and their doctor have a relationship that’s direct and where the individual has substantial choices and substantial opportunity to make responsible decisions. Question: What is your organization working toward in this area? Newt Gingrich: Well, we helped found the Center for Health Transformation to develop a new 21st century model of health and healthcare designed to save lives and save money. We believe you can save, for example, between $70 and $120 billion a year from fraud, from people who are crooks stealing money in Medicare and Medicaid. We believe you can get a dramatically better system by focusing first on the individual, getting them to be responsible for their health, getting them to be aware of their health, getting them to monitor and manage their health. And we think that you need fundamental payment reform to align incentives with what we say our values are in terms of keeping people healthy. We believe you need litigation reform, which has led to unnecessary expense because of defensive medicine. So, we believe you could have a bi-partisan, transparent, openly achieved health reform bill. We’d be glad at the Center for Health Transformation to work on such a bill with the Obama Administration, but they’d have to give up their commitment to left-wing authoritarian, big government models and be willing to actually talk openly about reform rather than the kind of this direction they’ve been going in. Question: How would you advise Obama in forming a more bi-partisan plan? Newt Gingrich: There was a recent book that came out called The Pact, which talked about how Clinton and I had worked together and planned a whole series of major reforms. President Clinton came recently to Senator Trent Lott’s hanging of his portrait as the former Senate Majority Leader, and the three of us were together and President Clinton said, as part of his remarks, “The people will forget how much we got done together by being practical. And we could fight half the day and we could cooperate have the day. And we understood which half was which.” My first advice to the President would be, slow down, open up, invite the American People to participate. It was an enormous mistake to allow Pelosi and Reed to write the stimulus package and to pass it without anybody who was elected having read it. It was an enormous mistake to ram through a left-wing, high tax, energy bill in the House. It’s a huge mistake to try to ram through health reform for one-sixth of the economy on a partisan basis with secret negotiations in the White House. This country would love to have a bi-partisan, or tri-partisan, Democrat, Republican, and Independent effort out in the open to work together to solve our problems. No one will be totally comfortable. But it would be dramatically healthier for the country. It is possible. It’s not possible as long as there is a Reed/Pelosi machine in charge of the Congress and it’s not possible as long as the President talks one way in public and acts another in private. And that’s why, the eight times he’s on videotape promising that C-Span would cover the negotiations and the fact that he has turned down C-Span’s offer to cover the negotiations is so devastating. If you say something once that might be an idea, if you say it eight times, that’s a promise. And I think the President’s got to decide, does he really want to spend the next three years governing in secret in a partisan way? Or does he want to fundamentally change and learn the lessons of the first year of his administration? More ideas from Newt Gingrich Why Scott Brown Will Torment Washington Democrats Camus, Orwell, and the Next American Bubble Newt Gingrich: How Republicans Can Win Big in 2012 by Newt Gingrich Newt Gingrich explains his ideal model of healthcare, where an increased accessibility to insurance doesn’t come at the hands of a “bureaucratically imposed system.” Balancing Full Freedom With...

医学

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Our Blog Team Alz.Org Is Alzheimer’s Really Linked to Poor Dental Health? Current Studies, Risk Factors/ Prevention 33883 Responses »http%3A%2F%2Fblog.alz.org%2Fis-alzheimers-really-linked-to-poor-dental-health%2FIs+Alzheimer%27s+Really+Linked+to+Poor+Dental+Health%3F2013-09-25+15%3A42%3A35Michael+Rafii+M.D.+Ph.Dhttp%3A%2F%2Fblog.alz.org%2F%3Fp%3D3388 British scientists recently reported finding signs of the gum-disease bacterium (P. gingivalis) in the brains of Alzheimer’s patients. The new study is being widely reported as adding to a growing body of evidence linking periodontal (gum) disease to an increased risk for Alzheimer’s disease. However, such data needs to be considered very carefully. In fact, what the study found was that substances on the surface of the bacterium (lipopolysaccharides) were present in the brain tissue of four out of 10 recently deceased people who had Alzheimer’s. It was found in zero out of 10 age-matched patients who did not have Alzheimer’s. The bacteria itself was not found in the brain tissue of any people. The theory behind linking gum disease with Alzheimer’s is that the presence of gum bacteria lipopolysaccharides in the brain may cause inflammation. This in turn could trigger a biological cascade that may be linked to the brain changes associated with Alzheimer’s disease. We already know that P. gingivalis is commonly found in chronic periodontal (gum) disease, and, if there is significant dental disease, it can enter the bloodstream through such everyday activities as eating, brushing teeth and invasive dental treatments. While in the bloodstream, the bacteria can settle on heart valves and damage them. Hence, patients with mitral valve prolapse and other heart anomalies often take an antibiotic before dental procedures to prevent the bacteria from depositing within the heart. However, no bacteria have been reported in the brains of patients with gum disease, as the brain is an immunologically, well-protected organ, more so than any other. It is important for readers to know that these types of studies show an association between gum disease and Alzheimer’s disease, but do not prove causation. For example: The number of subjects is extremely small to make a definitive conclusion, and the finding could have occurred simply by statistical chance. Only four out of 10 subjects with Alzheimer’s had such changes, not 10 out of 10. If the gum disease was causative, one would expect more than just a minority of patients exhibiting the lipopolysaccharides. Finally, what if very early stage dementia caused people to actually brush their teeth less often, or altered their dietary intake? They would be at risk of developing gum disease. But the gum disease would have resulted from the early dementia, not vice versa. It is also important to note that previous studies have shown links between gum disease and other illnesses, including heart disease and certain forms of cancer; these findings are not specific to Alzheimer’s. The study is important and should be followed up with larger sample sizes, but given the above limitations, the study does not show that “brushing teeth reduces the risk of dementia” or that “gum disease can lead to dementia.” Michael S. Rafii, M.D., Ph.D. Director, Memory Disorders Clinic Associate Medical Core Director, Alzheimer’s Disease Cooperative Study This post originally appeared in Alzheimer’s Insights, an ADCS Blog. Prevention and Risk of Alzheimer’s Disease Healthy Volunteers Needed for Alzheimer’s Research What Is Alzheimer’s Disease Posted by Michael Rafii M.D. Ph.D at 10:42 am Tagged with: Alzheimer's prevention, alzheimer's research, Alzheimer's study, teeth brushing and disease Stress and Alzheimer’s Disease: A Hormonal Connection 27811 Response »http%3A%2F%2Fblog.alz.org%2Fstress-and-alzheimers-disease-a-hormonal-connection%2FStress+and+Alzheimer%E2%80%99s+Disease%3A+A+Hormonal+Connection2013-04-05+15%3A24%3A44Michael+Rafii+M.D.+Ph.Dhttp%3A%2F%2Fblog.alz.org%2F%3Fp%3D2781 Recently, findings were published in the Journal of Alzheimer’s Disease that may help explain why people who are susceptible to stress are at more risk of developing Alzheimer’s and why — increasingly — we are finding evidence that physical activity, which reduces stress levels, may reduce the chances of developing Alzheimer’s. It is widely believed that the stress hormone corticotrophin-releasing factor (CRF) may have a protective effect on the brain, including the memory changes brought on by Alzheimer’s. CRF is associated with the production of stress and is found in high levels in people experiencing various forms of anxiety. Normal levels of CRF are beneficial to the brain, keeping cognitive abilities sharp and aiding the survival of nerve cells. Interestingly, previous studies have shown that people with Alzheimer’s disease have a reduced level of CRF. In this paper, researchers used an experimental drug to prevent CRF from binding to the brain receptor called CRFR1 in mice with Alzheimer’s that were free from memory impairments, therefore blocking its effects. They discovered that the mice had an abnormal stress response with reduced anxiety and impaired learning. Moreover, they found that interrupting the hormone from binding to the CRFR1 receptor blocked the improvement of memory normally promoted by exercise. However, in mice with Alzheimer’s disease, moderate exercise restored the normal function of the CRF system allowing its memory enhancing effects. The effects of stress on the brain have been studied for decades—ever since the initial work by Canadian endocrinologist Hans Selye, who coined the term”stress.” Selye himself went on to publish 33 books and more than 1,600 scientific articles, almost all of them on the subject of stress. This study of biological stress and its effects is a science that continues to make advances today by connecting stress to illness, including Alzheimer’s disease. Certainly, more research is needed to map out the functions of CRF and CRFR1 in normal aging as well as in Alzheimer’s, and the findings published here are compelling for such work. Pardon et al. Corticotropin-Releasing Factor Receptor 1 Activation During Exposure to Novelty Stress Protects Against Alzheimer’s Disease-Like Cognitive Decline in AßPP/PS1 Mice, Journal of Alzheimer’s Disease. This gallery contains 1 photos Posted by Michael Rafii M.D. Ph.D at 10:24 am Tagged with: Alzheimer's prevention, Alzheimer's risk, caregiver stress, stress, stress and Alzheimer's, stress and illness Brain Atrophy and B Vitamins Alzheimer's & the Brain, Current Studies 5844 Responses »http%3A%2F%2Fblog.alz.org%2Fbrain-atrophy-and-b-vitamins%2FBrain+Atrophy+and+B+Vitamins2010-09-22+18%3A56%3A54Michael+Rafii+M.D.+Ph.Dhttp%3A%2F%2Fblog.alz.org%2F%3Fp%3D584 Brain atrophy involves the loss of neurons. Some degree of atrophy and subsequent brain shrinkage is common with old age, even in people who are cognitively healthy. However, this atrophy is accelerated in people with mild cognitive impairment and even faster in those who ultimately progress from mild cognitive impairment to Alzheimer’s disease. Many factors have been implicated in affecting the rate of brain atrophy, one of which is high levels of an amino acid in the blood called homocysteine. Studies have shown that raised levels of homocysteine increase the risk of Alzheimer’s disease. In a recent randomised controlled trial, researchers investigated the role of vitamin B in regulating levels of homocysteine. They specifically wanted to test whether lowering homocysteine through giving high doses of vitamin B for two years could reduce the rate of brain atrophy in people with pre-existing mild cognitive impairment. Volunteers aged 70 and older with concerns about their memory were recruited for this study. It was specified that volunteers should have a diagnosis of mild cognitive impairment (MCI), defined using specific criteria. These included a concern about memory that did not interfere with activities of daily living and pre-specified scores on some cognitive scales assessing word recall and fluency. The study excluded people with a diagnosis of dementia, who were taking anti-dementia drugs or who had active cancer. People taking folic acid and vitamin B6 or B12 above certain doses were also excluded. Every six months, the volunteers were randomly assigned to receive either high-dose oral vitamin B tablets (0.8 mg folic acid, 0.5 mg vitamin B12 and 20 mg vitamin B6) or placebo pills during the two-year period. The participants, their partners and all staff directly involved in the study were unaware which pills participants were taking. The double blind nature of the study was important as it eliminated potential biases associated with the patients’ or researchers’ knowledge of which treatment was being received. MRI scans were performed at the start of the study and again after two years. The researchers used these scans to calculate the rate of brain atrophy each year. A total of 271 people were randomly assigned a treatment, although five did not start the study. A similar proportion from each treatment group dropped out along the course of the study. The researchers measured adherence to the study treatments by counting returned tablets. For the main analysis of brain shrinkage, the researchers used data on 168 people (85 receiving active treatment and 83 receiving placebo) who had completed an MRI at both the start and at follow-up. The analyses took into account a variety of factors that may be linked to brain atrophy or use of vitamin B, which the researchers had tested and found to be important. These factors were age, blood pressure, initial brain volume and concentration of homocysteine at the start of the study. Treatment with vitamin B tablets had notable effects on the levels of homocysteine in the blood, reducing it by 22.5 percent. Levels of homocysteine increased by 7.7 percent in the placebo group. Overall, treatment with B vitamins for a period of 24 months led to a reduction in the rate of brain atrophy. After the age of the participants was taken into account, the rate of shrinkage in people receiving the vitamins was 30 percent less than in the placebo group (0.76 percent shrinkage and 1.08 percent shrinkage respectively). The effect was greater in people who were more compliant with taking their medication and in those who started with the highest levels of homocysteine. The researchers also found that, overall, the safety of vitamins was good with no adverse events. The researchers concluded that they have shown that a “simple and safe treatment” can slow down the accelerated rate of brain atrophy in people with mild cognitive impairment. This is an important but early study in establishing the effects of vitamin B on the stages of brain atrophy that precede Alzheimer’s disease. It assessed the effects of the vitamin on the rate of brain shrinkage, a process that has been linked to old age, mild cognitive impairment and Alzheimer’s disease in other studies. Although other studies have found that the rate of brain atrophy is linked to cognitive decline, this particular study did not assess whether the participants’ brain changes translated into changes of cognitive ability or memory. This was a well-conducted, albeit small, study. It was a randomized controlled trial, which is the most appropriate way to assess the effects of a new treatment. No study is perfect, though, and the researchers highlighted some shortcomings: The treatment was a combination of three B vitamins, so the researchers could not determine whether these have different effects individually. The study was not set up to assess the effects of treatment on cognition, but only on the rate of change in brain measurements. This study will pave the way for future research into the use of vitamin B to prevent Alzheimer’s disease. Based on the evidence gathered so far, it is too early to claim that vitamin B can prevent clinical disease, but these results are promising. It is also interesting to note that this is a major study that exemplifies the use of potential biomarkers such as imaging, in therapeutic trials for MCI and AD. A, Smith SM, de Jager CA et al. Homocysteine-Lowering by B Vitamins Slows the Rate of Accelerated Brain Atrophy in Mild Cognitive Impairment: A Randomized Controlled Trial. PLoS One 5(9): e12244 Associate Medical Director, ADCS Medical Core Understanding Prevention Research Physical Exercise and Diet Posted by Michael Rafii M.D. Ph.D at 6:56 pm Tagged with: Alzheimer and vitamin B, alzheimer and vitamins, Alzheimer's and homocysteine. Alzheimer's and vitamins, Alzheimer's and vitamin B, Alzheimer's prevention Subscribe to BLOG.ALZ.ORG via Email BLOG CATEGORIES #ENDALZ Alzheimer's & the Brain Breakthrough Ride Diagnosing Alzheimer's Risk Factors/ Prevention The Longest Day 2012 Voices of Alzheimer's Women & Minorities LEARN MORE ON ALZ.ORG Causes Treatment Horizon BLOG ROLL Alzheimer's Disease Cooperative Study Harry Johns/ Huffington Post Maria Shriver/Huffington Post Mayo Clinic Alzheimer Blog StoryCorps: A Grandfather Reflects Alzheimer's Association of Northern California & Northern Nevada Support the Alzheimer's Association. Alz.org main site | Research | Advocacy | Care and support | Message boards | Disclaimer | Donate | Contact us | Sign up for e-news © 2011 Alzheimer's Association | Blog

医学

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Education and Training Sheikh Zayed Institute for Pediatric Surgical Innovation Senior Staff and Faculty Joseph E. Robert, Jr., Fellows Mahdi Azizian (2011-2012) Mahdi Azizian, PhD, has a special interest in robotics, and came to the Sheikh Zayed Institute from the University of Western Ontario, where he completed his doctorate in electrical and computer engineering in the Canadian Surgical Technologies and Advanced Robotics (CSTAR) engineering and robotics laboratories. His bachelor’s degree is also in electrical engineering, from Amirkabir University of Technology (Tehran Polytechnic), Iran. As a Robert Fellow he developed provisional patent applications related to PICC line insertion and stereo vision tracking and control for automated anastomosis. He also prepared several publications. Currently, Mahdi is a systems analyst at Intuitive Surgical. Alana Beres (2011-2012) Alana Beres, MD, CM, completed a pediatric trauma fellowship at the Hospital for Sick Children in Toronto before joining the Sheikh Zayed Institute. Prior to that, she did her general surgery residency at the University of Saskatchewan, Baystate Medical Center at Tufts University in Massachusetts, and McGill University in Montreal. Her medical degree comes from McGill University and her undergraduate degree in chemistry and biochemistry from the University of Western Ontario. While a Robert Fellow, she contributed to early stages of High Intensity Focused Ultrasound (HIFU) projects, planning animal and clinical studies; and of a necrotizing Enterocolitis (NEC) clinical study. Alana is currently senior pediatric surgery fellow at Montreal Children's Hospital. “The fellowship taught me that bringing together a multi-disciplinary team really allows for ‘out-of-the-box thinking’ and leads to innovative approaches to problem solving.” Amy Burns (2011-2012) Amy Burns, MD, came to the Sheikh Zayed Institute from the University of Virginia, where she completed her medical degree and residency in general surgery and urology. She also has a bachelor’s degree in history from the University of Virginia, in history. While a Robert Fellow, her interests spanned pediatric care, from how to reinforce the importance of hand-washing in the hospital, to the use of mobile devices to help with neurogenic bladder control and the use of Dexmedetomidine for pain management during urologic surgery. She produced several publications while a Robert Fellow and filed a provisional patent. In 2013, she completed her clinical year as a pediatric urology fellow at Children’s National. She is a pediatric urologist on the faculty at the Children’s Hospital of Pennsylvania State University, Hershey, where she is involved in the Pediatric Innovation Program. Gabriela Andrade Calhoun (2013-2014) Gabriela Calhoun, MD, graduated from medical school at the Federal University of Bahia, Brazil. She completed her anesthesiology residency training at Irmandade Santa Casa de Misericordia in Sao Paulo and practiced for two years in Salvador. Prior to coming to the Sheikh Zayed Institute, she acquired significant research experience in the fields of sickle cell anemia and microcirculation as a research fellow at the Medical College of Virginia/Virginia Commonwealth University in Richmond. During this time she developed transgenic sickle cell models in mice for the purposes of studying microcirculatory parameters as well as effects of new treatments and interventions. She is very interested in pain management and novel treatment methods, and as a Robert Fellow she is working with the Pain Medicine Division to develop objective ways to diagnose, measure and treat pain. John Costello (2013-2014) Johnny Costello, MD, received his bachelor’s in medical microbiology/immunology from the University of Wisconsin-Madison and his medical degree from Johns Hopkins University School of Medicine. He completed two years of clinical general surgery residency at Georgetown University Hospital before joining the Cardiac Surgery Research Laboratory at Children’s National in July 2012 to pursue two dedicated years of research in pediatric cardiac surgery. His second year is being spent as a Robert Fellow. His work includes novel clinical and educational applications within the fields of pediatric cardiac surgery and pediatric cardiology. Katharine Davenport (2011-2012) Kate Davenport, MD, received her medical degree from the University of Texas at Houston following a degree in biomedical engineering at Texas A&M. She completed her general surgery residency at Eastern Virginia Medical School. Kate contributed actively to several ongoing bioengineering projects on laparoscopic surgery, image fusion and 3D scope, as well as on an appendix microbiome project. She was co-lead writing a business plan for a new approach to PICC line insertion. In her role as Institute fellow in 2010-2011 before the inauguration of the Robert Fellows program, she contributed invaluably to the planning of the new curriculum. Her feedback also guided the group towards important revisions for 2012-2013. An active publisher, her work as a Robert Fellow includes papers, posters and abstracts. Kate is in her second year of a pediatric surgery fellowship at the University of California, San Diego. Mariana Mafra Junqueira (2012-Dec 2013) Mariana Junqueira, MD, completed all of her studies in Rio de Janeiro, Brazil. Her medical degree comes from Fluminense Federal University. After completing a pediatrics residency at Fernandes Figueira Institute, she decided to be an anesthesiologist and completed her residency at Bonsucesso General Hospital. Mariana has always been interested in ways of transforming the outpatient and hospital stay experience for children and their families, especially when it comes to pain management and painful procedures. For this reason, after working for two years as a pediatric and neonatal anesthesiologist in Brazil and after reading about Dr. Julia Finkel’s work and publications in the area of pain medicine, Mariana decided to leave her country to work with the team in Sheikh Zayed Institute. She is working on the development of the algometer, a new device for pain measurement, and a needle-free local anesthesia placement device. Aaron Martin (2012-2013) Aaron Martin, MD, MPH, completed his urology residency at the Mayo Clinic in Phoenix. His MD and MPH come from Louisiana State University (LSU) Health Sciences Center in New Orleans. His bachelor’s in microbiology also comes from LSU, in Baton Rouge. The majority of his research endeavors have focused on robotic and minimally invasive procedures for urologic diseases. Prior to residency, he gained experience in a wide variety of research techniques while working at the Tulane National Primate Research Center and LSU Department of Microbiology including drug therapy targeting, gene sequencing, tissue culture, and environmental benthic fauna sampling on the bayou. As a Robert Fellow, Aaron was involved in product innovation to simplify common pediatric urology procedures and investigation of new imaging analysis for diagnosis and evaluation of hydronephrosis. He filed a provisional patent based on his work and founded ReConduit Technologies. Having completed his clinical year as a pediatric urology fellow prior to becoming a Robert Fellow, he is a practicing pediatric urologist and assistant professor of urology at LSU Healthcare Network. Reza Seifabadi (2013-2014) Reza Seifabadi received his PhD in mechanical engineering from Queen’s University, Kingston, Canada and conducted his PhD thesis research as a visiting scholar at the Johns Hopkins University. During his doctoral studies, he developed enabling technologies for tele-operated prostate needle interventions (including biopsy and brachytherapy) under real-time MRI guidance. During this period, he had the opportunity to collaborate closely with the Brigham and Women’s Hospital at Harvard Medical School and Worcester Polytechnic Institute. He obtained a bachelor’s of science degree in manufacturing and production engineering and a bachelor’s degree and a master’s. degree in mechanical engineering from Amirkabir University of Technology (Tehran Polytechnic), Iran. At the Sheikh Zayed Institute, he is getting lean-startup training for the first time with like-minded entrepreneurs, and continues his research on medical robotics and devices in pediatrics. Kelly Swords (2012-2014) Kelly Swords, MD, MPH, completed both her surgical internship and her urology residency at the University of South Florida. Her medical degree and masters of public health come from the University of Carolina Chapel Hill, where she also obtained her bachelor’s in communications. Her current research includes application development for improved physician communication, patient and family education, prevention of medical error and reduction of pain post-surgery. She filed a provisional patent based on her work and founded ChronoKair™. She has won many awards, and traveled to Vietnam and Ethiopia for humanitarian work with IVU med and Healing the Children. Ramesh Thoranaghatte (2012-2013) Ramesh Thoranaghatte, MD, PhD, brought unique expertise to the Sheikh Zayed Institute, with a background in both medicine and engineering. His medical degree comes from JJM Medical College at Kuvempu University, India, where he also completed one year of residency in general surgery. His PhD in bioengineering comes from the ARTORG Center at the University of Bern, Switzerland. His strong software design and development expertise helped him to design and develop an “Augmented Reality based Endoscopic-Surgery Navigation System” which won the Venturekick award from the Swiss innovation agency. His research interests are surgical navigation, minimally invasive surgery, robotic surgery, computer vision for medical applications. Ramesh lives in Bern, Switzerland, where his company is exploring applications of a new endoscope-based navigation system. Kyle Wu (2012-2014) Kyle Wu, MD, MBA, joined the Sheikh Zayed Institute from Georgetown University Medical Center, where he completed two years of residency in general surgery. His medical and business degrees are from Columbia University, and his bachelor’s in bioengineering is from Johns Hopkins University. His primary interests are solid organ transplantation and medical device development. He is currently looking into novel device design and image analysis algorithms for wound assessment. His past projects include the design of a cervical bio-impedance sensor to better predict the onset of labor in order to provide timely intervention. Kyle successfully launched a non-profit organization linking education and philanthropy; the organization raised more than $30,000 for various charitable foundations. In the past he consulted for a hospital chain in India as well as for health policy development for the Mayor’s Office in New York City.

医学

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Lapatinib plus Herceptin May Target Estrogen-Negative, Her2-Positive Breast Cancer News from the Baylor College of Medicine:HOUSTON -- (May 18, 2011) -- A subset of breast cancer patients who have tumors overexpressing a protein called the human epidermal growth factor receptor 2 (HER-2 positive) may benefit from a combination of targeted treatments and may not need chemotherapy, said researchers from the Lester and Sue Smith Breast Center at Baylor College of Medicine on behalf of the Translational Breast Cancer Research Consortium in an abstract released today by the American Society of Clinical Oncology. Dr. Jenny Chang, previously with the Smith Breast Center and now director of the Methodist Cancer Center in Houston, will present the results of this clinical study (TBCRC 006) in an oral presentation at the annual ASCO meeting in Chicago in June. The clinical trial involved 64 women with large tumors that tested positive for HER-2 and some that were also estrogen-receptor positive. Using two drugs – lapatinib and trastuzumab – that target HER-2 in different ways, physicians were able to eradicate tumors in 38 percent of estrogen-receptor negative patients and 21 percent of estrogen receptor-positive patients, said Dr. C. Kent Osborne, director of the Smith Breast Center and a senior author of the report. Estrogen-receptor positive patients were also given an aromatase inhibitor to stop production of estrogen. Preclinical models developed at BCM "We have shown in preclinical models that complete blockage of the HER-2 family including HER-1, 2 and 3 with the drugs lapatinib and trastuzumab leads to eradication of HER-2 positive tumors in mice," said Dr. Mothaffar Rimawi, medical director of the Smith Breast Center and current principal investigator on the study. "These drugs alone only partially inhibit the pathway, quickly resulting in resistance to treatment." Rimawi developed this model in 2004 as a fellow in the laboratory of Osborne and Dr. Rachel Schiff, associate professor in the Smith Breast Center and a co-author on the paper. "We conducted two prior clinical studies over the last ten years that show that lapatinib and trastuzumab are effective as single agents but our preclinical data suggested they would likely work better when used together," said Chang. The research team at Baylor College of Medicine sought to translate these findings to patients, so they initiated a multicenter clinical trial through the TBCRC. The same response (eradication of tumors) that Rimawi and his team observed in preclinical models in the laboratory was also seen in many patients in this clinical trial, Osborne said. Study design The TBCRC 006 trial recruited a total of 64 patients through the Smith Breast Center (at the Baylor Clinic and Ben Taub General Hospital sites), the Vanderbilt University School of Medicine, the University of Alabama at Birmingham, the University of Chicago, and the Mayo Clinic College of Medicine. The patients had large (average of 6 cm) HER-2 positive tumors in the breast when they were initially diagnosed. They were given a combination of lapatinib (Tykerb®) daily and trastuzumab (Herceptin®) once weekly for 12 weeks before surgery without standard chemotherapy. Lapatinib is a pill that blocks the enzyme activity of HER-2 and its close family member HER-1. Trastuzumab is an antibody administered intravenously that blocks HER-2 in a different way. Some patients’ tumors were also estrogen-receptor positive (grow in the presence of the hormone estrogen). These patients were given an aromatase inhibitor to stop production of estrogen. "With this combination, we are able to block all of the cancer-promoting signals from the HER family, which we know is crucial for growth of this kind of breast cancer," said Osborne, also director of the NCI-designated Dan L. Duncan Cancer Center at BCM. "Each of these drugs hits a different receptor, thereby shutting down the pathway responsible for the breast cancer’s growth." No patients were given chemotherapy during that 12-week period. Tumor biopsies were gathered at study entry, 2, 8 and 12 weeks (the time of surgery) to study how the drugs were working. Study results After 12 weeks, 38 percent of the estrogen-receptor negative, HER-2 positive patients had eradication of invasive breast cancer from the breast – "the type of breast cancer that can spread beyond your breast and invade healthy, surrounding tissue, and other organs," said Rimawi. A significant benefit was also observed in the estrogen-receptor positive group, Rimawi said. "Twenty-one percent of these patients had complete disappearance of their tumors and another 34 percent had near eradication with only small amounts of tumor left after treatment." "We have seen similar results in other recently reported studies using the lapatinib/trastuzumab combination, but this is the first study not to use chemotherapy," said Osborne. "The side effects of chemotherapy can be significant and eliminating the need for chemotherapy in certain patients would represent a groundbreaking approach to treatment." Another strong point of this trial was the representation of minority women in the study group. Of the group, 33 percent were Hispanic and 21 percent were African-American, Rimawi said. Next steps in research "Our next step with this research will be to determine the optimal duration of treatment," said Rimawi. "In an upcoming multicenter TBCRC clinical trial led by us at Baylor College of Medicine, we will compare 12 weeks with 24 weeks of treatment." Studies are underway now to identify which patients can be safely treated without chemotherapy for this subtype of breast cancer which used to be considered difficult to treat. For more information on enrolling in that trial, please contact Anne Pavlick at 713-798-7814 or [email protected]. This study was supported by GlaxoSmithKline and the Translational Breast Cancer Research Consortium. Coffee may reduce ER- risk, study says, but.... Research from Sweden’s Karolinska Institute shows a connection between significant caffeine intake—more than five cups a day—and a reduction in the risk of hormone-negative breast cancer. The study, published in Breast Cancer Research, was on 6,000 post-menopausal women, who saw a 57 percent reduced estrogen-negative breast cancer risk, no matter whether on not they used hormone-replacement therapy or alcohol, and independent of their educational status. Researchers suggest that compounds in coffee, such as trigonolline, may provide some level of protection. Hormone-receptor status was available for only 65 percent of those studied, however. And they did not specify types of coffee, so women could have been drinking decaf or different blends that are available outside of Sweden.Some things to remember: This research was on postmenopausal women, and TNBC is more likely to affect premenopausal women, so the effects on that population are not clear. Likewise, other dietary effects may come into play here—it could be that these women had a healthier overall diet, or a healthier lifestyle otherwise, so the effects of caffeine were mediated by other factors. Whatever the case, too much caffeine in general is not good for you. In fact, reducing caffeine can improve your overall health. Who needs the extra nervousness that coffee brings, when you are already stressed? Switching to decaf coffee can help, but while decaf has less caffeine, it is not caffeine-free. Researchers at the University of Florida compared caffeine in decaf coffee and found that different brands had from 8.6 mg to 13.9 mg, compared to an average of 85 mg for caffeinated coffee. Source: Li, Jingmei, Seibold, Petra, Claude, Jenny C., Janys, Dieter F., Liu, Jianjun, Czene, Kamila, Humphreys, Keith Hall, Per, 'Coffee consumption modifies risk of estrogen-receptor negative breast cancer', Breast Cancer Research , vol. 13, no. 3, R49+ (2011). Find the full article at http://breast-cancer-research.com/content/pdf/bcr2879.pdf Posted by Five Years Cancer-Free I made it to five years--and to Machu Picchu! At present I am too tired from the trip to say more, so I will let these two wonderful facts stand on their own. Off to celebrate five years--almost On May 16, I will be five years past diagnosis. Yes! So, as a pre-celebration, we are going to Machu Picchu. I'll be off this site for at least a couple of weeks. See you after I soak up the Inca's sacred sites. Lapatinib plus Herceptin May Target Estrogen-Negat...

医学

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Preventing or Treating Infectious Illnesses With Natural Medicine The body must contend with constant attacks by microscopic organisms. In order to defend against this onslaught, it deploys a wide range of defenses that together are called the immune system. People with diseases that cause immune deficiency, such as , fall victim to infectious microorganisms that a healthy person could ward off easily. However, even healthy people get sick from time to time, victims of infections that manage to sneak by the defenses. And some apparently healthy people nonetheless get sick quite often. If you fall into this latter category, you may wish to find treatments that can strengthen your immune system. Unfortunately, this is easier said than done. To explain why it is so difficult to improve resistance to illness, we need to delve a bit deeper into the nature of immunity. The Immune System The immune system consists primarily of various types of white blood cells and the chemicals that they manufacture (such as antibodies). In certain conditions, such as AIDS, many of these white blood cells are damaged or dead. In such cases, the term immune deficiency is clearly appropriate. The circumstance is analogous to an army that lacks, say, guns. However, careful examination of most people who get frequent (or attacks, for example) fails to turn up any visible deficits in the immune system. They have all the immune cells and antibodies they need in roughly the right amounts, and all the various parts appear to work just fine. So why do such people get sick so often? The short answer is, we do not know. One can hypothesize that in some people the immune system fails to function properly for a relatively subtle, invisible reason, much as a well-equipped army might lose its fighting form due to apathy or disunity. However, keep in mind that even people who develop frequent colds manage to fight off thousands of other infections every day. (If they did not, they would be dead.) For this reason, an alternate hypothesis comes to mind: that over-susceptibility to a particular type of infection may be caused by something more specific than general immune weakness. As an example, chronically inflamed mucous membranes might lead to frequent colds, since an inflamed mucous membrane may be more porous to cold viruses. Similarly, a woman’s bladder wall might allow particularly easy attachment of bacteria, leading to frequent bladder infections. In reality, though, these are all speculations. We truly do not know why some people frequently develop minor infections. For this reason, it is very difficult to find a way to fix the problem. Immunomodulation Many natural products are said to boost general immunity. However, while we can scientifically study the effect of a single treatment on a single illness, at the present state of knowledge there is no way we can even that a treatment strengthens the immune system in general. Scientists can measure the effects of an herb on individual white blood cell types and note changes in activity, but they do not know how to interpret the results of those measurements as a whole. After all, the immune system is a , and systems are notoriously complicated to analyze. Current knowledge does not allow us to predict the ultimate effect of fine changes in the parts. To acknowledge this limitation, scientists tend to use the term immunomodulatory rather than immune-stimulating when they refer to a substance that causes measurable alterations in immune function. This terminology notes a change (modulation), but does not jump to conclusions regarding whether that change is good, bad, or indifferent. Hundreds or thousands of herbs have immunomodulatory effects, so many that we will make no attempt to list them here. In many cases, these may represent nothing more than the body’s reaction to the herb as a foreign presence—an immune reaction to the herb itself, in other words, with no special benefits. In some cases, observed immunomodulatory effects indicate an alteration in immune function with potential benefits under certain conditions, but it is as yet impossible to know. Theoretically, it is possible that some natural substance could boost all aspects of immunity. However, if it did, it would be a highly dangerous substance! The immune system is balanced on a knife edge. An immune system that is too relaxed fails to defend us from infections; an immune system that is too active attacks healthy tissues, causing autoimmune diseases. A universal immune booster might cause Hashimoto’s thyroiditis , among other problems. Rather than an immune booster, one might rather prefer a treatment that somehow fine-tunes the immune system. Does such a treatment exist? No one really knows, although claims abound. There is no doubt that good general nutrition is necessary for strong immunity. However, excessive intake of some nutrients ( , for example) may weaken immunity. For information on which nutrients might be worth taking to improve your nutrition, see the article on general nutritional support . In that section, we also discuss some specific scientific evidence indicating that multivitamin/multimineral supplements may help certain people stay well. A number of herbs and supplements have shown promise for preventing or treating certain specific infections. For more information, see the articles on herpes infection Immunizations are a widely used method for strengthening the immune response to specific illnesses, such as . However, some people (especially seniors) may not respond adequately to immunizations. Certain natural products, such as may enhance the response. is widely hyped as an immune strengthening herb, but current evidence suggests that regular use of echinacea does help prevent colds or other infections. (Echinacea may, however, help colds that have already begun.) The fungi products are widely believed in Japan to help support the immune system during cancer treatment. However, there is no reliable evidence to indicate that they are in fact effective. Substances that enhance the growth of “friendly” bacteria in the large intestine have been studied for their favorable effects on the immune system with mixed results. Probiotics (eg, acidophilus) consist of various bacterial species capable of rebalancing the healthy population of bacteria in the gut. Certain types of starches, called prebiotics, are not fully digested, and therefore, remain in the intestine and “feed” healthy bacteria. There is some evidence that probiotics and, to a lesser extent, prebiotics may lead to a reduction in allergic symptoms and possibly minor infections, especially in children. See the articles on Acidophilus (Probiotics) Fructo-oligosaccharides (Prebiotics) There is little doubt that if you live a healthy lifestyle with good nutrition and plenty of exercise, you will approach more closely a state of optimum health. Keep in mind, however, that the key is moderation. Too much exercise (as in marathon running) can weaken the immune system, leading to infections. (If you wish to engage in heavy endurance exercise, have shown some promise for preventing the “post-marathon sniffle.”) Although it is commonly said that high levels of sugar intake weaken immunity, there is no meaningful evidence to support this view. Similarly, while severe clearly damages immune function, there is no evidence that moderate alcohol consumption increases risk of infections. Does getting cold cause colds? Possibly, but it has not been proven. There is also no reliable evidence that reducing intake of dairy products will prevent respiratory infections. Finally, contrary to popular belief, early antibiotic treatment of children with does not seem to damage the child’s immunity and thereby cause a greater rate of ear infections. Various alternative therapies are said to be able to enhance overall health and thereby prevent illness in general. These include methods such as chiropractic spinal manipulation . However, there is as yet little to no meaningful scientific evidence to indicate that these methods have any specific positive effect on immunity. Kaleida PH, Casselbrant ML, Rockette HE, et al. Amoxicillin or myringotomy or both for acute otitis media: results of a randomized clinical trial. Grimm W, Muller H. A randomized controlled trial of the effect of fluid extract of on the incidence and severity of colds and respiratory infections. Vonau B, Chard S, Mandalia S, et al. Does the extract of the plant influence the clinical course of recurrent genital herpes? Int J STD AIDS Turner RB, Riker DK, Gangemi JD. Ineffectiveness of echinacea for prevention of experimental rhinovirus colds. Antimicrob Agents Chemother

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Home News Local Mental health services for young people a "grave situation" Mental health services for young people a "grave situation" , Posted: Tue, May 20 2014 at 5:17 PM, Updated: Thu, May 22 2014 at 12:47 AM Grants Pass, Ore. -- When it comes to mental health care for kids and young adults in Southern Oregon, the situation is grave. That's according to a Rogue Regional Medical Center psychiatrist. On Monday, NBC 5 spoke with RRMC and Medford Police officials about the lack of mental health help in Jackson County and the state of Oregon. However, the reality is it's our young people in particular who some say are suffering the most. Surviving with mental illness A tattoo on 21-year-old Lauren Conn's arm is a constant reminder that it wasn't too long ago that she was in a dark place. "It says you never need to apologize about how you chose to survive," read Conn. The quote is from a poem and now covers scars from cutting herself. "I got it over the scars on my arm to remind myself that it's not something I need to apologize for or be ashamed of," Conn said. For Conn, surviving her teen years and the transition between middle school and high school was difficult. "I was 14 when the depression got bad and it was within that same year when the self harm started and I think I was 15 when the eating disorder really came into play," explained Conn. However at 18, Conn said she hit her lowest point when she was raped. It was then that she realized she needed help. She got it at Kairos, a Grants Pass organization that helps teens and young adults living with mental illness. Not enough help for young people But not everyone is so fortunate to get mental health help specifically tailored for youth. "It's really a grave situation right now with children and adolescents." Rogue Regional Medical Center psychiatrist Dr. Anne O'Connell said the psych unit at RRMC that's typically used for people in a mental health crises, is not an ideal place to treat young people as it can be traumatic. "Police are coming in with violent agitated patients ... The only acute psychiatric in-patient facilities for adolescents and children are both up in Portland," said O'Connell. Least served population: young adults While she said there's a lack of services for children, others say young adults specifically are suffering as well. "The population that has probably been the least served, locally statewide and nationally is young adults," said Bob Lieberman, the CEO of Kairos. "The adult system isn't attuned to the developmental needs of people who are in many ways still in late adolescence," he continued. According to Lieberman, statewide there are less than 100 high end psychiatric beds for kids under 18. It's worse when it comes to intensive beds in secure facilities for severely troubled young adults, ages 17-24 "For young adults at this level of care, there's 12," said Lieberman. He said there's only a dozen beds for the entire state of Oregon, and he says all of those beds are at Three Bridges in Grants Pass, a one of a kind program in the country, run by Kairos. It's the same program where Conn found the help she needed. "They use a more strengths based and trauma informed approach," began Conn. "A lot of programs, it's like they're just pointing out everything that's wrong with you," she said. Coping with mental illness While she said she is proud of how far she's come, she still has moments where she struggles. "I'm not going to lie and say everyday is easy or I'm happy all the time because that's just not how it is. I definitely still struggle with anxiety, mild depression but I've learned how to manage that," said Conn. Now she just wants to help others and show them that if she can make it they can too. "I just think it's important with all the bad times in my life to turn that into something good," Conn explained. She's trying to inspire young people living with mental illness to get help, that while difficult to find, is still out there. Conn, Lieberman and O'Connell agree there needs to be more prevention efforts in schools and the community. More resources surfacing soon However, Lieberman said there are some big plans in the works with new programs for teens and young adults on the horizon. We'll have more about what's being done to help people struggling with mental illness in part three of my series, coming up on Wednesday. Copyright KOBI-TV. All rights reserved unless otherwise stated. This material may not be published, broadcast, rewritten, or redistributed without written permission. Tags: Grants Pass, Josephine County, Medford Police, mental health, mental illness, Oregon Medford Police see skyrocketing mental health callsMore mental health help on the horizon About the Author Christine Pitawanich Christine Pitawanich was born and raised in the Pacific Northwest. In 2010, she received a master's degree in Broadcast Journalism from the S.I. Newhouse School of Public Communications at Syracuse University in New York. Christine also has a Bachelor of Arts degree in Communications from the University of Washington. Before joining the NBC5 News team, she had the opportunity to file reports from Washington D.C. for WFFT FOX Ft. Wayne News in Indiana. Christine has also interned at KOMO-TV in Seattle. Christine loves to ski, try new food and have fun in the outdoors. Catch Christine anchoring weekdays on NBC 5 News at 5pm. Connect with Christine

医学

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Devastating disease provides insight into development and death of motor neurons Researchers at UCLA have been searching for the cause of a rare disease that virtually no one has ever heard: PCH1, or pontocerebellar hypoplasia type 1, which attacks the brain and the spine. It's a particularly cruel disorder, occurring mostly in infants, who begin manifesting symptoms at or soon after birth, with poor muscle tone, difficulty feeding, growth retardation and global developmental delay. Now, thanks to the cooperation of a California family stricken by the disorder and a state-of-the-art genomic sequencing lab at UCLA, Dr. Joanna Jen, a UCLA professor of neurology, and colleagues discovered a specific mutation of a gene that is responsible for PCH1 in this family, then confirmed mutations in the same gene in several other PCH1 families around the world. The study appears in the April 29 in the online edition of the journal Nature Genetics. The diagnosis of PCH1 is often delayed or never made because the combination of cerebellar and spinal motor-neuron degeneration is very rare and not commonly recognized. The discovery of the gene, EXOSC3 (exosome component 3), showed that it is critically important in the normal development and survival of neurons, especially in the cerebellum, and for motor neurons in the spine, which innervate or stimulate muscles. Five years ago, Jen began working with a family living in Southern California with four boys who were neurologically afflicted. They were floppy at birth, suffered from progressive muscle wasting and were never able to stand, walk or speak. Today, they range in age from 9 to the teens, and none weighs more than 50 pounds. The family was referred to Jen because of her special interest in rare neurological disorders. As Jen reviewed the medical history and examined the children to reach a clinical diagnosis, she began searching for the causative gene in collaboration with Dr. Stanley Nelson, a professor and vice chair of the UCLA Department of Human Genetics. Nelson, who also directs the UCLA Clinical Genomics Center, and his graduate student Michael Yourshaw, used a new technique called exome sequencing. The exome is the part of the genome that directs those proteins that are actually expressed — that is, it provides the genetic blueprint for functional genes. Exome sequencing searches just the protein-coding regions in the genome to pinpoint disease-causing mutations. In this way, they were able to quickly survey some 22,000 protein-encoding genes to identify a defect in the EXOSC3 gene in this single California family. To confirm their finding, Jen reached out to other neurologists around the world, eventually verifying the presence of the same defective gene in eight other families stricken with PCH1. And by using a model of the disease in zebrafish, Jijun Wan, a UCLA research scientist in neurology, found that preventing the EXOSC3 gene from expressing in zebrafish caused embryonic maldevelopment and poor movement reminiscent of human clinical features. These symptoms were largely reversed when the researchers injected normal EXOSC3, suggesting that it was indeed the mutations that disrupted normal function. The EXOSC3 gene encodes a core component of the RNA exosome complex, which is essential for all organisms and which is emerging as the major cellular machinery in the processing of RNA to regulate gene expression, Jen said. There is increasing appreciation for the diversity of RNAs, she noted, as it is becoming clear that the majority of genomic information is transcribed into RNA. "When we began this study, mutations in the RNA exosome had not been associated with any human disease," Jen said. "Relatively little is known about the human RNA exosome. It is surprising that a gene that is expressed in every cell should have such a selective detrimental impact on the cerebellar and spinal motor neurons. There is increasing focus on RNA metabolism in motor neuron diseases such as amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease, and spinal muscular atrophy (SMA), the leading genetic cause of infant mortality, Jen said. The discovery of defects in the RNA exosome causing combined SMA and PCH further emphasizes the importance of the regulation of RNA metabolism. "The discovery may lead to potential targets for treatment and in addition enhances our understanding of the biological function of the RNA exosome," said Jen. She is working with other neurologists to better define the clinical spectrum of EXOSC3-associated PCH1. "It is remarkable that all of the affected children in this family have survived beyond infancy. We are grateful for the generosity of the family in sharing their experience and participating in research to improve the lives of other children who are similarly affected," said Jen. Researchers find synthetic RNA lessens severity of fatal disease A team of University of Missouri researchers have found that targeting a synthetic molecule to a specific gene could help the severity of the disease Spinal Muscular Atrophy (SMA) – the leading genetic cause of infantile ... Scientists identify mutation in SIGMAR1 gene linked to juvenile ALS Researchers from the Kingdom of Saudi Arabia have identified a mutation on the SIGMAR1 gene associated with the development of juvenile amyotrophic lateral sclerosis (ALS). Study findings published today in Annals of Neurology, a jour ... New discovery may block ALS disease process New Orleans, LA –In the first animal model of Amyotrophic Lateral Sclerosis (ALS), developed by Dr. Udai Pandey, Assistant Professor of Genetics at LSU Health Sciences Center New Orleans, Dr. Pandey's lab has found in ... New form of intellectual disability discovered Researchers at the Centre for Addiction and Mental Health (CAMH) led a study discovering a gene for a new form of intellectual disability, as well as how it likely affects cognitive development by disrupting neuron functioning. Researchers identify a gene responsible for Lou Gehrig's disease A team of Canadian and French researchers has identified a novel gene responsible for a significant fraction of ALS (sporadic amyotrophic lateral sclerosis) cases. ALS is commonly referred to as Lou Gehrig’s disease, an ...

医学

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Print Large Text Choices in Breast Cancer Treatment Alysa Cummings, OncoLink's Poet-in-Residence The Abramson Cancer Center of the University of Pennsylvania Authors: Kenneth D. Miller, MD, editor The Johns Hopkins University Press, 2008 | $18.95 US paperback OncoLink Rating: Call me “Coach.” Breast Cancer Coach, to be exact. It’s a volunteer role I play on a regular basis. The phone might ring on a quiet Sunday evening after dinner. Or an unexpected email will pop up on my computer screen. The woman reaching out to me might be a-friend-of-a-friend-of-a-friend. Or the niece of a co-worker. (When it comes to Breast CancerLand, the female underground is a true thing of beauty, isn’t it?) Typically the women I connect with are newly diagnosed and eager to hear part of my personal story - how did I make my treatment decisions way back when? Ultimately the ladies bring the discussion around to the same burning question every time: what should I do? they ask me. I listen and feel their intense frustration. “I’ve gotten four opinions,” said one woman to me recently. “Mastectomy or lumpectomy with radiation. One doctor said I absolutely needed eight rounds of chemotherapy. Another one said I didn’t need radiation at all. What am I supposed to do? Go to medical school so that I can figure it all out?” There’s a far less painful option, ladies: please read Dr. Miller’s book. According to Dr. Miller, a practicing medical oncologist, “…unlike many other medical conditions that have a single best plan of action presented by the doctor, breast cancer is a disease that requires each patient to make many decisions about her treatment plan. Initially, most women feel totally unequipped to face this challenge. Most are very scared, and the complexities of the treatment choices can seem overwhelming at first.” Choices in Breast Cancer Treatment is actually two books in one: a Breast Cancer 101 Course textbook (that teaches patients all they need to know about the disease, surgery, chemotherapy, radiation and breast reconstruction), as well as a collection of breast cancer survivor memoirs (survivors representing stages 0-4 share their CancerLand journeys in their own words). An added bonus is a section of survivor accounts written by three women who are also health care professionals. In my opinion, a breast cancer book like this one that neatly balances clinical information with patient anecdotes fills a real gap in the literature. Clearly, this is a reference volume that invites the reader to browse based on need. Dr. Miller organizes the book with the factual elements in the first half. He makes these chapters more accessible to the layperson by featuring a photograph of each chapter author and by including illustrations to depict difficult concepts. Many such concepts are repeated from chapter to chapter to effectively clarify them for the reader. In the latter part of the book, the memoir section groups survivor stories by stage so that a woman diagnosed with stage 2 breast cancer, for example, can find her own situation reflected on the page. One survivor shares these words of wisdom: “The first life lesson that this has taught me was that you have to take charge of your own body. You can go to as many people as you want for opinions, but the ultimate decision has to be your own. To make a decision like this you have to feel confident that you have exhausted all intellectual avenues to discover what your options are.” In an era where the hope is that breast cancer patients work as partners with their medical team, Dr. Miller’s Choices in Breast Cancer Treatment is a wonderful tool to meet that goal.

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The Economic Risks of Climate Change in the United States Explore the Report Al Sommer Dean Emeritus, Bloomberg School of Public Health, Johns Hopkins University Dr. Sommer is a Gilman Scholar and University Distinguished Service Professor at Johns Hopkins University; Johns Hopkins Professor of Epidemiology, Ophthalmology, and International Health; and Dean Emeritus of the Johns Hopkins Bloomberg School of Public Health. He received his MD from Harvard Medical School (1967) and his Master of Health Science in Epidemiology from the Johns Hopkins School of Public Health (1973). He has published 6 books and over 300 scientific articles; has received numerous awards including the Albert Lasker Award for Clinical Research, the Warren Alpert Foundation Prize, and the Duke Elder International Gold Medal for Contributions to Ophthalmology; has delivered over 40 named lectureships, including the Jackson Memorial Lecture (American Academy of Ophthalmology), Duke Elder Oration (Royal College of Ophthalmologists), De Schweinitz Lecture (College of Physicians, Philadelphia), Doyne Lecture (Oxford Ophthalmo

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With Orders of 4 Boxes or More Join Our Tribe Connect on Facebook Connect on Twitter Connect on Instagram Connect on Google+ Login | Cart hide (x) Visit the shop hide (x) Buy Our Bars 2 Degrees Food Fund Find our bars near you! Childhood hunger is a global problem. Hungry children have too few nutrients — either from lack of access to food or from too much of the wrong foods. Their bodies slow down, learning is inhibited, and the likelihood of living in poverty as an adult is increased. At 2 Degrees, we believe it is possible to help these children. Malnutrition is the number one killer of children under five in the developing world. Community-based Therapeutic Care (CTC) and Ready-to-Use Foods (RUF) have revolutionized how malnutrition is diagnosed and treated. By supporting these effective methods, 2 Degrees is helping children receive the care they need to live and thrive. Diagnosis with Mid-Upper Arm Circumference (MUAC) Band Chronic Hunger or Undernourishment Constant hunger weakens the immune system, forces the body to function with insufficient energy to support an active life, increases vulnerability to disease and infection. Over 200 million children suffer from chronic hunger. The vast majority of these children live in developing nations in Africa, South America and South East Asia. However, there are hungry children even here in the U.S. who struggle to find adequate nutrition on a daily basis. Ready-to-Use Foods (RUF) or nutrient-rich foods are used for the treatment of chronic hunger and prevention of malnutrition. These meals can be peanut-based or have other base ingredients, like lentils or chickpeas or other seeds and nuts. The goal is to provide food to children who do not have adequate or secure access to food. Moderate or Chronic Malnutrition Moderate malnutrition is defined by a weight-to-height ratio and may include moderate "wasting" or "stunting", or a combination of both. If uncared for, moderate malnutrition can often progress toward severe malnutrition. Prevalence Moderate malnutrition affects approximately 40 million children, nearly twice as many children as severe acute malnutrition. Ready-to-Use Supplementary Foods (RUSF) or other nutrient enriched foods are used for the treatment of moderate or chronic malnutrition. These foods are often soya-based but some have other seed, nut or grain bases as well. These foods are used to provide malnourished children with nutrient-dense, easy to digest foods. Severe Acute Malnutrition Severe Acute Malnutrition is defined by visible, severe "wasting", extremely low weight-to-height ratio and the presence of nutritional oedema. Severe acute malnutrition compromises the immune system and all-too-frequently results in health complications and mortality. Roughly 20 million children suffer from severe acute malnutrition globally; each year, over 1 million children die as a direct result of severe acute malnutrition. Even more die from related complications. Ready-to-Use Therapeutic Foods (RUTF) are a revolutionary treatment for children suffering from Severe Acute Malnutrition (SAM). RUTF allow for community-based management of large numbers of children who suffer from SAM. RUTF are enhanced with a medically formulated vitamin and mineral supplement and are formulated to give children calorie and nutrient-dense, therapeutic, easy-to-digest food and are certified by the World Food Program for this purpose. For every 2 Degrees bar you buy, we feed a hungry child. Buy a Bar, Feed a Hungry Child About Blogger Inquiry Our mission is to bridge the gap between you and hungry children all over the world. Buy a Bar Join Our Tribe Connect on Instagram Connect on YouTube Sign up for 2 degrees news & promotions © 2 Degrees, Inc. 2014 Privacy Policy Terms of Use Union Street Media

医学

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Alzheimer's Awareness Helpful for Tri-City Residents By: Erin Myers Email Updated: Fri 11:40 PM, Nov 16, 2012 By: Erin Myers Email Home / Article November is Alzheimer's awareness month and Alexandra Dillon with the Alzheimer's Association says now is the time to start addressing a disease that has been surrounded by stigma. "People don't want other people to know that they're losing some of their cognitive abilities and skills. So there's a lot of denial, a lot of covering up and it's very difficult to process," said Dillon. Dillon says many people feel like they're the only one experiencing the disease, but according to data, that is far from the truth. "When we start to look at numbers... Alzheimer's is the sixth leading cause of death for people of all ages in the United States. Age is the greatest risk factor and we have a baby boomer population that is aging. By the age of 85, 1 in 2 people have Alzheimer's Disease. So people aren't alone. They're just not communicating," said Dillon. That communication is something Carolyn Rasmussen was looking for. She cares for an aging parent and was looking for answers at a recent meeting offered at YWCA in Grand Island. "For me, it was the difficulty of knowing that perhaps we are heading down that road," said Rasmussen. She says the resources offered by Dillon were helpful in differentiating between normal aging and possible warning signs. The Alzheimer's Association has a list of ten warning signs that could be indicators of the disease. Alexandra Dillon says it's important to remember that your memory naturally goes through changes as we get older, but memory loss that affects daily functioning is not a typical part of aging. Rasmussen says the best thing to do as a caregiver is get educated and know that resources are available. "I think we all need to be aware of it because as the world grows and the population grows, there's going to be more and more people diagnosed with Alzheimer's and we need to know the resources and where to go," said Rasmussen.

医学

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Biography of John Daniel Bewley, M. D. This page is part of a larger collection.Access the full collection at Muskogee And Northeastern Oklahoma. Coming to Miami in 1916, Dr. John Daniel Bewley has thoroughly demonstrated his ability as a physician and surgeon and his professional labors have been attended with a gratifying measure of success. He was born in Dover, Pope County, Arkansas, March 25, 1874, of the marriage of Benjamin V. and Triphenia (West) Bewley, the former a native of Tennessee and the latter of Arkansas. Her father was a major in the Mexican war and was stationed at old Fort Gibson, Indian Territory. Prior to the Civil war he retired from the United States army and made his home in Arkansas until his death. Benjamin V. Bewley became a resident of Arkansas, where he enlisted for service in the Civil war, and was commissioned a Colonel. He was one of the most successful farmers and prominent men of Pope County, where his demise occurred in 1907. He was an active and helpful member of the Methodist Church and fraternally he was identified with the Masonic order. The mother is still living. Their family numbered nine children. John Daniel Bewley, the sixth in order of birth, attended the public schools and a select school at Russellville, Arkansas, after which he devoted three years to educational work. He then entered the Memphis Hospital Medical School, which he attended for a time and later went to Witts Springs, Arkansas, where he practiced for two years, subsequently opening an office at Webbers Falls, Muskogee County, Indian Territory. From there he went to Tahlequah, in the Cherokee Nation, where for a time he engaged in practice, and then returned to Memphis fo

医学

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Bacterial & Viral Infections > A bout of chickenpox used to be a rite of passage during childhood. Since the vaccine to protect against varicella zoster virus (VZV) became available, most kids can now avoid this itchy infection. But anyone who has had chickenpox may later develop shingles — even children. The good news is that shingles is pretty rare in kids and teens with healthy immune systems. Shingles Basics Shingles, also called zoster or herpes zoster, is a skin rash caused by a viral infection of the nerves just below the skin. Shingles usually appears as a stripe of irritated skin and blisters on one side of the chest or back, but it can occur anywhere on the body, including on the face and near the eyes. Many cases of shingles have mild symptoms, but more severe cases can be very painful. Luckily, kids and teens almost always have mild cases; the severe cases usually only happen in older people. Shingles is caused by the same virus that causes chickenpox, so it's highly contagious, meaning it can be easy for a child to pass the virus to others who aren't immune to chickenpox. This includes anyone who hasn't already had chickenpox or gotten the chickenpox vaccine. However, if someone else gets infected, they won't get shingles. They'll get chickenpox instead. An episode of shingles will generally run its course and disappear in less than a month. Although a shingles flare-up usually resolves on its own, treatments can reduce a child's risk of complications and help him or her heal more quickly. Shingles and chickenpox are both caused by the varicella zoster virus. This virus is related to (but not the same as) the herpes viruses that cause cold sores and genital herpes, which is why shingles is sometimes called herpes zoster. After someone has had chickenpox, the virus stays in that person's nervous system for the rest of his or her life, even though the chickenpox goes away. The virus can stay there dormant, or sleeping, for years. In many people, it will never be heard from again. But in about 1 million Americans a year, it flares up and causes shingles. It is possible to get shingles more than once, although this is fairly uncommon. Doctors aren't sure why the virus suddenly flares up again after months or years of inactivity. It could be because our immune systems become more vulnerable to infections as we age, which might explain why shingles is more common in older adults. Children who've had chickenpox face a greater risk of developing shingles if their immune systems have been weakened by diseases such as AIDS or cancer, or by certain medications. In many cases, the first symptom of shingles will be tingling, itching, and sometimes pain in the area where the rash is going to appear. This can be frustrating: Your child may feel itchy, but you'll have no idea what's causing it. When the rash finally appears, it starts as groups of pimples on one side of the body or face. The pimples change to pus-filled blisters that break open and scab over in about 7 to 10 days. Once the blisters are scabbed over, they begin to heal. The scabs typically heal and fall off about 2 to 4 weeks after the rash appears. Some kids with shingles also may experience a fever, headache, fatigue, or general achiness. In rare cases, a child can experience the pain of shingles without having a rash. Some people will have more severe symptoms, but these usually happen in people over age 50. Most cases of shingles will heal on their own, with or without treatment, and won't lead to any other problems. In rare cases, shingles can lead to complications, including: Ongoing pain (post-herpetic neuralgia): Damaged nerve fibers in the skin send confused messages to the brain, leading to pain that can go on for a long time after a shingles rash has disappeared. Vision problems: If shingles occurs near or in a child's eye, it can lead to vision loss. Skin infections: A shingles rash can become infected with bacteria, leading to impetigo or cellulitis. Nervous system problems: Shingles on the face can involve different nerves that connect to the brain. This in turn can lead to nerve-related problems such as facial paralysis, hearing problems, and problems with balance. In very rare cases, shingles can lead to encephalitis (inflammation of the brain). If you think your child might have shingles, call a doctor. If there's a chance your child might have shingles on the face, it's really important to get a doctor's help immediately to keep the infection from spreading to the eyes. If your child has a weakened immune system, call a doctor right away to avoid complications. Usually, a doctor can diagnose shingles just by examining a child's rash and blisters. In rare cases, the doctor may remove a small sample of the infected tissue to be examined in a laboratory. Not all kids who get shingles need treatment. But if the doctor decides a treatment may help, it should be started as soon as possible. Antiviral drugs can't eliminate the virus from the body, but they can reduce the chances of complications and help speed the healing process. The earlier a treatment program is started, the more effective it will be, and the less risk there will be of complications. Talk with a doctor about whether medications might be helpful for your child. To treat the pain associated with shingles, doctors may prescribe a cream, spray, or skin patch to numb the skin and make it hurt less. Some prescription and over-the-counter medications also can help treat the pain. Don't give your child or teen aspirin, though, as it can lead to a rare but serious illness called Reye syndrome. If a case of shingles is accompanied by itching, the doctor may recommend medicated lotions or medications called antihistamines. To help ease the symptoms at home, keep the affected area clean. Wash it with water and a mild soap, and apply cool, wet compresses to the blisters several times a day to lessen pain and itching. Oatmeal baths also can bring relief. To prevent the virus from spreading to other people, keep your child's rash covered at all times. It's not possible to prevent shingles entirely. The chickenpox vaccine can make a case of shingles less serious. So if your child hasn't had chickenpox, it's not too late to ask your doctor about getting the chickenpox vaccine. There is a vaccine against shingles, but doctors usually only give it to older adults. That's partly because the older someone is, the more severe shingles can be. Kids are unlikely to be seriously affected by shingles. Children who get a shingles rash that can't be completely covered should be kept out of school and childcare until the blisters are scabbed over and dry. Newborn babies, pregnant women, people with weakened immune systems, and anyone who is not immune to chickenpox should avoid close contact with anyone who has shingles until the rash is completely healed. Reviewed by: Elana Pearl Ben Joseph, MD Cold Sores (HSV-1) Coping With Cold Sores First Aid: Chickenpox What Makes Chickenpox Itch? Your Child's Immunizations

医学

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ProUroCare Medical (GICI) to Showcase Investigational Portable Platform for Its Prostate Imaging Device at American Urological Association 2010 5/28/2010 10:41:58 AM MINNEAPOLIS, May 27 /PRNewswire-FirstCall/ -- ProUroCare Medical, Inc. (OTC Bulletin Board: PUMD, PUMDU and PUMDW), a provider of proprietary imaging products, today announced that it will be attending the American Urological Association (AUA) 2010 Annual Scientific Meeting in San Francisco, May 29 June 1. At the conference, the company's investigational prostate imaging system, the ProUroScan, will be presented to educate urologists about the concept and potential of elasticity (or mechanical) imaging of the prostate gland. The company will also be displaying a portable version of the system that is being developed to offer health care providers additional flexibility and adaptability in utilizing the patented technology, once approved by the FDA.The ProUroScan system is under review for market clearance by the FDA but is not currently marketed or sold in the United States. The product is intended to be used to produce an elasticity image of the prostate as an aid in documenting abnormalities of the prostate that are initially identified by digital rectal examination. The system utilizes a trans-rectal probe with pressure sensor arrays and a motion tracking system and provides real-time elasticity images of the prostate. This system is a documentation tool.According to Rick Carlson, CEO of ProUroCare, "The AUA Annual Meeting is a perfect venue for physicians to try the ProUroScan system on simulated prostate models."The AUA, founded in 1902, is the foremost professional association for the advancement of urologic patient care, and works to ensure that its more than 16,000 members are current on the latest research and practices in urology.About ProUroCare Medical, Inc.ProUroCare Medical, Inc. is a publicly traded company engaged in the business of creating innovative medical imaging products. The company's current focus is the ProUroScan prostate imaging system, which is used to map abnormalities of the prostate detected by DRE. Based in Minneapolis, Minn., ProUroCare is traded on the OTCBB.This news release contains certain "forward-looking" statements within the meaning of the Private Securities Litigation Reform Act of 1995. These statements are typically preceded by words such as "believes," "expects," "anticipates," "intends," "will," "may," "should," or similar expressions. These forward-looking statements are not guarantees of ProUroCare's future performance and involve a number of risks and uncertainties that may cause actual results to differ materially from the results discussed in these statements. Factors that might cause ProUroCare's results to differ materially from those expressed or implied by such forward-looking statements include, but are not limited to, the ability of ProUroCare to find adequate financing to complete the development of its products; the high level of secured and unsecured debt incurred by ProUroCare; the dependence by ProUroCare on third parties for the development and manufacture of its products; and other risks and uncertainties detailed from time to time in ProUroCare's filings with the Securities and Exchange Commission including its most recently filed Form 10-K and Form 10-Q. ProUroCare undertakes no duty to update any of these forward-looking statements.SOURCE ProUroCare Medical, Inc. ProUroCare Medical (GICI) Says FDA Cannot Complete 510(K) Review Devicor Medical Products to Buy Segment of Ethicon Endo-Surgery, Inc.; Spin-off to Choose Cincinnati Location for HQ ProUroCare Medical (GICI) Announces Filing of Request to Classify the Prostate Mechanical Imager ("PMI") as a Class II Device Kinetic Concepts, Inc. (KCI)'s Ulcer Device V.A.C.(R) Therapy System Gets FDA Approval ProUroCare Medical (GICI) to Attend 25th Anniversary EAU Congress in Barcelona April 16-20, 2010 Laser Used to Blast Away Cells Causing Irregular Heartbeat, Mount Sinai Medical Center Study Phase 3 Data on VIVUS, Inc. (VVUS)'s Avanafil for Erectile Dysfunction to be Featured at the American Urological Association 2010 Annual Meeting SonoSite Inc. (SONO) to Buy Toronto-Based VisualSonics; Deal Valued at $71 Million Including Debt Symposium on Nymox Pharmaceutical (NYMX)'s NX-1207 BPH Drug to be Held at Annual Meeting of American Urological Association in San Francisco Misonix Incorporated (MSON) Announces Sale of Focus Surgery Related HIFU Business and Other HIFU Assets to USHIFU, LLC For Up To $5.8 Million Please enable JavaScript to view the comments powered by Disqus. ProUroCare Medical

医学

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What's with the medtech registration scenario in Taiwan? Updated on 19 April 2013 Although Taiwan is working hard to make its regulatory processes a big hit with the rest of the world (by bringing in major reforms), it is yet to solve some of the problems associated with the system, like the issue of 'Country of Origin'. Lets have a look at the current medtech registration scenario in Taiwan What's the confusion about in Taiwan? Taiwan: Fosters global partnerships Taiwan gets on IT-bioscience growth curve ITRI biomed lab working with China on guidelines Taiwan grants trademark protection to MediPurpose Taiwan is a major economic player in the domain of electronics, information and communication technology, and is also considered a producer of intermediary and final products. Although its size and economy is not as robust as its neighbor, China, the island nation of 23 million inhabitants has a per capita gross domestic product (GDP) of $20,000 and spends around seven percent of its GDP on healthcare, which is higher than what is spent by most of its neighbors in Asia Pacific. Moreover, nearly 99 percent of its population is covered by the National Health Insurance Scheme. The medical device market in Taiwan is valued at about $1.8 billion and is the fifth-largest medical device market in Asia. However, surprisingly Taiwan imports 75 percent of its medical devices from overseas. This shows that a considerable number of medical devices are used in Taiwan and this demand for medtech devices is only going to increase as the nation's 20 percent population become over 65 of age by 2025. In Taiwan, all medical devices require registration with the Taiwan FDA (TFDA), regardless of the fact of whether they belong to Class I (pose the lowest risk) or Class III (pose the highest risk). For combination devices, classification depends on the product's primary function. There are two applications required for Class II and Class III medical device registration in Taiwan, the Quality System Documentation (QSD) and Product Registration. Regulatory changes made in 2012-13During late-2012, the Taiwan FDA announced that it would start using the Summary Technical Documentation (STED) format for medical device technical document submissions, joining regions such as Japan, Australia, Canada, the US, and the European Union. This change occurred to align the country with the Global Harmonization Task Force standards and to aid the goal of achieving uniformity between various countries' regulatory bodies. STED is expected to fully be implemented for all Class II and III medical devices by July 2013. For product registration, foreign medical device companies have henceforth been advised to include device description and product specification (including variants, components and accessories), as well as an essential principles checklist (including risk analysis and control summary, design and manufacturing process). Natco gets time till Aug 25 to reply to Bayer plea

医学

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Home » News » US Catholic Medical Association sees growth in troubled times CMA members at the 2013 March for Life in Washington D.C. Credit: Catholic Medical Association. Washington D.C., Jun 19, 2013 / 04:00 am (CNA/EWTN News).- The Catholic Medical Association has seen “steady growth” in membership, providing fellowship for Catholic medical professionals as conscience rights and religious freedom are increasingly threatened. “We’ve become more effective at witnessing in the world,” said John Brehany, the group's executive director. “It’s a great organization, full of great people, who are trying to live their faith.” “One of the purposes of the CMA is to assist the Church in communicating medical ethics and the Church’s teaching on life and love within the medical profession and within society at large,” Brehany told CNA June 18. “We strive to be of assistance to the Church whenever we can.” The association’s local chapters are present in 31 states and over 70 dioceses. Membership at the national level has almost doubled in the past seven years, while the number of chapters has increased from eight to 75 in the same time period. “Our goal is to get one chapter, at least, in every diocese of the U.S.,” Brehany said. “We provide opportunities for our members to connect on a local level.” Guilds host talks and organize service opportunities and socials. They provide mutual support and help their members know “that there are other good people out there in the field who are trying to live the Catholic faith.” The Catholic Medical Association was founded in the 1930s and reached a high point in the 1960s. Since then, declines in Mass attendance and Catholic school enrollment have had a negative impact on membership. The association has about 2,000 national members, and many chapters have local members who attend an annual White Mass for health care professionals or other events. “Anybody who wants to help integrate Catholic principles into healthcare can join at some level,” Brehany said. Active and retired physicians are the primary members. However, associate membership is open to dentists, podiatrists, physician assistants, nurse practitioners, and others with doctoral degrees. Affiliate membership is open to nurses, students, seminarians, clergy and religious, and other friends and supporters of the association and its mission. The association’s national conference provides members “a unique experience of faith and fellowship and education,” Brehany said. The conference provides spiritual sustenance such as daily Mass, confession, Eucharistic adoration and scheduled rosaries. Conference talks often focus on ethical issues in medicine, and fulfill continuing education requirements necessary for attendees to renew their medical licenses. The Catholic Medical Association publishes the ethics journal Linacre Quarterly, which according to Brehany is the oldest U.S. journal dedicated to ethics in medicine. This June, the association has a four-day “boot camp” in Philadelphia for medical students. The gathering provides opportunities for prayer, study and fellowship, and helps prepare students to defend their faith and to “grow to be solid Catholic caregivers.” Brehany said the Catholic Medical Association is particularly important in light of present trends. “Probably one of the biggest battles of our day, going on as we speak, is an attack on religious freedom and also conscience rights,” he said. He said conscience rights in health care “just never have been adequately protected.” Especially since the Supreme Court legalized abortion nationwide in 1973, those with “an ideology hostile to life” have tried to force doctors to perform abortions and sterilizations and to force students to be trained in these procedures, Brehany said. “They haven’t gone away. They’ve gotten even more powerful – even more determined – to enforce these things,” he said. “People get this pressure. Sometimes it is concerted and planned.” Other times, this pressure comes from a cultural atmosphere that holds that the role of the doctor is “to give the patient what she wants.” “That’s not ever what doctors thought, especially when it comes to doing abortion, and yet we see those attacks coming more and more.” He said there is no official litmus test on these issues to get into medical school or to advance in a career, “but there are these subtle pressures all the time to go along with our relativist culture, and that is a challenge.” The Catholic Medical Association is also engaged in the broader fight to defend religious freedom. Several dozen association members have spoken at religious freedom rallies sponsored by the Stand Up for Religious Freedom Coalition. The association is encouraging its members to participate in the upcoming Fortnight for Freedom, observed June 21-July 4, to support the U.S. bishops’ opposition to the federal contraception mandate. The mandate would require employers, including many Catholic organizations, to provide access to insurance coverage for sterilization and contraception, including abortifacient drugs. “We’re trying to get our doctors involved in local events and in local rallies, so they can help to explain to people why conscience rights and religious freedom are so important in medicine,” Brehany said. “They are important for the doctors and health care professionals who offer care, but they are important as well for patients who receive that care.” He said the relationship between a physician and a patient is “at the heart of medicine” and often involves trying to meet a patient’s emotional and spiritual challenges as well. He said the association has “great concern” about the extent to which the government is “taking more and more dictatorial control over medicine,” especially in its control over what services are provided or not. “We are afraid that they will be either ordering people to do things that violate their conscience, or to withhold treatments that are really of benefit to the patient.” Brehany encouraged Catholic medical professionals to “band together for mutual support,” to know their rights, and to use the resources of the Catholic Medical Association. “Catholics really have to stick together and give a unified, compelling, really nationwide interest.” Tags: Catholic Medical Association, Medical Ethics, Conscience Protection Most Popular Bipartisan warning issued over religious freedom threats in health care Global religious freedom law is ineffective, panel says US dioceses prepare for second Fortnight for Freedom Religious liberty is 'endangered,' warns Hispanic Christian leader

医学

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SHINE signs agreement with first customer, medical division of General Electric Jim Leute SHINE founder and CEO Greg Piefer shows off a full-sized version of his company's particle accelerator, which will be used in Janesville to manufacture medical isotopes. The company announced Thursday that it has signed its first big customer. Greg Piefer John Beckord JANESVILLE—The company that plans to build a medical isotope production plant in Janesville said Thursday it has signed a long-term deal with its first customer, a significant milestone in bringing the Janesville operation to fruition. SHINE Medical Technologies signed the agreement with GE Healthcare, a division of the General Electric. It is the first announcement of a major supply agreement with a U.S.-based producer of molybdenum-99, a medical isotope used in more than 30 kinds of diagnostic imaging procedures and more than 40 million medical imaging tests each year. “This is very significant, and we feel very good about it,” said Greg Piefer, SHINE's founder and chief executive officer. “GE is a major provider, and they do their homework before making decisions. “We feel really good that they're our first customer. It's a significant industry validation, and that's a really big deal.” SHINE is working toward regulatory approval for an $85 million plant that will use low-enriched uranium in a series of eight accelerators to produce moly-99. The company wants to fill a void expected when two other nuclear reactors that use highly enriched uranium to produce isotopes are taken out of service in 2016 and 2020. The plants in Canada and the Netherlands are the world's leading isotope suppliers. Within its first year of production, SHINE estimates it will generate annual revenues of $200 million. Piefer has said the Janesville plant would employ 150 people when it opens, most in high-paying technical jobs that he believes can be filled with local talent. “This is a very encouraging development, a commitment from a company whose name is recognized by everyone,” said John Beckord, president of Forward Janesville. “SHINE is really meeting their guidelines, and this news is one more indication that this project is one step closer to reality.” Under the terms of the agreement, SHINE will provide moly-99 to GE Healthcare on a regular basis once its facility becomes operational, most likely in 2017, Piefer said. In 2010, SHINE was selected as one of four commercial entities that the federal government partnered with to accelerate the establishment of a reliable U.S. domestic supply of moly-99 made without the use of highly enriched uranium. “GE Healthcare is very pleased to have entered into a long-term supply agreement with SHINE,” said Jan Makela, general manager of GE Healthcare Life Sciences Core Imaging. “The technology represents a significant, safe and viable option for the production of molybdenum‐99 in the future. “We believe SHINE will help secure the supply for global medical communities and their patients.” SHINE originally planned to start production in late 2016, but delays at the federal level likely will push that into 2017. It plans to start hiring nuclear, chemical and mechanical engineers later this year and round out its staff in 2016. Piefer said Canada's decision to discontinue moly-99 production in 2016 would create a void in the western hemisphere for medical isotopes. “Because medical isotopes decay so quickly, it's essential that the United States establish its own domestic production to meet the needs of our 20 million patients each year,” he said. “In addition, SHINE will contribute to the strength of the global supply chain." Piefer said SHINE would be able to produce isotopes much more efficiently because of new technology. He said GE, which is expected to be one of a handful of SHINE customers, has a proven track record in medical imaging. “By entering into this supply agreement with SHINE, GE Healthcare is effectively affirming that SHINE presents the best new option for western production and a strong option for supply around the globe,” he said. The federal government has committed $25 million to the project, and the city of Janesville has offered a $9 million development agreement—including private loan guarantees—that is contingent on the company meeting several benchmarks, including federal licensing and the creation of at least 125 high-paying jobs. Late last year, the city agreed to buy two additional parcels, which total about eight acres, to satisfy a federal buffering requirement for the plant on Highway 51 across from the Southern Wisconsin Regional Airport. The city's acquisition costs were about $150,000, which SHINE will repay when it takes occupancy of the plant. By the time the plant opens, SHINE officials have estimated that construction, equipment and regulatory costs will hit $180 million. Six arrested after drug-dog search in Parker High School parking lot Death Notices for Oct. 22, 2014 Central Fire Station costs falling in line Janesville police get trained in recognizing their biases Greg Peck: What stores does Janesville need most? Dr. Scary's mixes creepiness with cool technology for a memorable fright Most read

医学

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Health CenterimgNew Patient Forms EmergenciesMandatory Proof of Immunization Policy MissionLocation, Office Hours and Contact InformationServicesInsuranceReferral ServicesImmunization Updates & RecommendationsMeningococcal VaccineFlu VaccineSharps Container Exchange MRSA UpdateOnline ResourcesHealth Ride Mandatory Proof of Immunization Policy Measles can be a serious and life threatening illness. As a public health measure and in accordance with the Centers for Disease Control guidelines, the University requires verification of measles (Rubeola) immunity for all students born after December 31, 1956. You may not be permitted to register for courses without proof of measles (Rubeola) immunity at the Gonzaga University Health Center. Proof of immunity means: Two doses of measles (Rubeola) vaccine received after one year of age, at least one month apart, or A blood test showing measles (Rubeola) immunity, or Diagnosed measles (Rubeola) disease (health care provider's signature required). Acceptable documentation is (copies only, please keep your originals): School Certificate of Immunization, or Official immunization records from your health care provider or public health department, or Copy of your immunization card, or Copy of your military immunization record, or The Mandatory Proof of Immunization Form completed and Signed by your health care provider. Mandatory Immunization Form If you have any questions about this mandatory policy please contact the Health Center at (509)313-4066 Center for Disease Control (CDC) information about the measles (rubeola) What is Measles? Measles is an infectious viral disease that occurs most often in the late winter and spring. It begins with a fever that lasts for a couple of days, followed by a cough, runny nose, and conjunctivitis (pink eye). A rash starts on the face and upper neck, spreads down the back and trunk, then extends to the arms and hands, as well as the legs and feet. After about 5 days, the rash fades the same order in which it appeared. How can I catch measles? Measles is highly contagious. Infected people are usually contagious from about 4 days before their rash starts to 4 days afterwards. The measles virus resides in the mucus in the nose and throat of infected people. When they sneeze or cough, droplets spray into the air and the droplets remain active and contagious on infected surfaces for up to 2 hours. The symptoms of measles generally begin about 7-14 days after a person is infected, and include: Blotchy rash Red, watery eyes (conjunctivitis) Feeling run down, achy (malaise) Tiny white spots with bluish-white centers found inside the mouth (Koplik's spots) A typical case of measles begins with mild to moderate fever, cough, runny nose, red eyes, and sore throat. Two or three days after symptoms begin, tiny white spots (Koplik's spots) may appear inside the mouth. Three to five days after the start of symptoms, a red or reddish-brown rash appears. The rash usually begins on a person's face at the hairline and spreads downward to the neck, trunk, arms, legs, and feet. When the rash appears, a person's fever may spike to more than 104 degrees Fahrenheit. After a few days, the fever subsides and the rash fades. How serious is the disease? Measles itself is unpleasant, but the complications are dangerous. Six to 20 percent of the people who get the disease will get an ear infection, diarrhea, or even pneumonia. One out of 1000 people with measles will develop inflammation of the brain, and about one out of 1000 will die. Why is vaccination necessary? In the decade before the measles vaccination program began, an estimated 3-4 million persons in the United States were infected each year, of whom 400-500 died, 48,000 were hospitalized, and another 1,000 developed chronic disability from measles encephalitis. Widespread use of measles vaccine has led to a greater than 99% reduction in measles cases in the United States compared with the pre-vaccine era. However, measles is still common in other countries. The virus is highly contagious and can spread rapidly in areas where vaccination is not widespread. It is estimated that in 2006 there were 242,000 measles deaths worldwide-that equals about 663 deaths every day or 27 deaths every hour. If vaccinations were stopped, measles cases would return to pre-vaccine levels and hundreds of people would die from measles-related illnesses. Is measles still a problem in the United States? We still see measles among visitors to the United States and among U.S. travelers returning from other countries. The measles viruses these travelers bring into our country sometimes cause outbreaks; however, because most people in the United States have been vaccinated, these outbreaks are usually small. In the last decade, measles vaccination in the United States has decreased the number of cases to the lowest point ever reported. Widespread use of the measles vaccine has led to a greater than 99% reduction in measles compared with the decade before the measles vaccination program began, when an estimated 3-4 million persons in the United States were infected each year, 400-500 died, 48,000 were hospitalized, and another 1,000 developed chronic disability from measles encephalitis. If the chance of the diseases is so low, why do I need the vaccine? It is true that vaccination has enabled us to reduce measles and most other vaccine-preventable diseases to very low levels in the United States. However, measles is still very common-even epidemic-in other parts of the world. Visitors to our country and unvaccinated U.S. travelers returning from other countries can unknowingly bring (import) measles into the United States. Since the virus is highly contagious, such imported cases can quickly spread, causing outbreaks or epidemics among unvaccinated people and under-vaccinated communities. To protect your children, yourself, and others in the community, it is important to be vaccinated against measles. You may think your chance of getting measles is small, but the disease still exists and can still infect anyone who is not protected. What kind of vaccine is given to prevent measles? The MMR vaccine prevents measles and 2 other viral diseases-mumps and rubella. These 3 vaccines are safe given together. MMR is an attenuated (weakened) live virus vaccine. This means that after injection, the viruses grows and causes a harmless infection in the vaccinated person with very few, if any, symptoms. The person's immune system fights the infection caused by these weakened viruses and immunity develops which lasts throughout that person's life. How effective is MMR vaccine? More than 95% of the people who receive a single dose of MMR will develop immunity to all 3 viruses. A second vaccine dose gives immunity to almost all of those who did not respond to the first dose. GU Home \ Student Development \ Health Center

医学

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Home > Too Many Unnecessary Thyroid Biopsies Performed, Experts Say Simplified guidelines could reduce number of uncomfortable, worrying procedures -A A +AMore Sharing + MONDAY, Aug. 26 (HealthDay News) -- Many Americans are undergoing needless thyroid biopsies, researchers say, and simplifying clinical guidelines would go a long way toward curbing the problem. The investigators from University of California, San Francisco analyzed the medical records of about 8,800 patients who underwent thyroid ultrasound scans. Reporting in the Aug. 26 online issue of JAMA Internal Medicine, they said that more than 98 percent of the thyroid nodules found in patients were not cancerous. "Right now, we're doing far too many thyroid biopsies in patients who are really at very low risk of having thyroid cancer," study lead author Dr. Rebecca Smith-Bindman, a professor in the department of radiology and biomedical imaging, said in a UCSF news release. Based on the finding, her team is recommending that biopsies should be performed only when medical imaging reveals a thyroid nodule with tiny flecks of calcium, known as microcalcifications, or a nodule that is more than 2 centimeters in diameter and completely solid. Patients with any other findings have too low a cancer risk to require biopsy or continued surveillance, the researchers said . "Compared with other existing guidelines, many of which are complicated to apply, following these simple, evidence-based guidelines would substantially decrease the number of unnecessary thyroid biopsies in the United States," Smith-Bindman said. She noted that the procedures are discomforting, cause worry for patients, and require time off from work and other activities. "Plus, they are often inconclusive. And that can lead us down the path of open surgical biopsy, which is hardly trivial, and quite risky in itself, even in patients without cancer," Smith-Bindman said. Other experts agreed with the need to rein in thyroid biopsies. "Due to the high prevalence of thyroid nodules in the United States population, the increase of incidental detection of these nodules, the demand for higher cost-efficiency, and the avoidance of unnecessary invasive procedures, it is crucial that we begin to limit the number of fine-needle biopsies of these lesions," said Dr. David Hiltzik, director of otolaryngology and head & neck surgery at Staten Island University Hospital in New York City. Hiltzik believes the new study will help doctors "risk stratify each patient and to help decide which patients should and should not be biopsied." "Any cancer diagnosis has a psychological impact," Hiltzik added. "However, in light of the fact that the majority of thyroid cancer has a high survival rate, we must become more judicious in our diagnosis of this disease." Another expert in thyroid care concurred, and added that there may be better, noninvasive means of determining whether a thyroid growth poses a health risk. "The majority of thyroid nodules, particularly in women, are benign," explained Dr. Eric Genden, chair of otolaryngology at Mount Sinai Medical Center in New York City. "Although current techniques to assess a nodule for malignancy rely on cystology (viewing a sample of cells under a microscope), new techniques using molecular testing have the potential to decrease the risk of unnecessary surgery." About 15,000 men and 45,000 women in the United States will be diagnosed with thyroid cancer this year and 1,850 people will die of it, according to the U.S. National Cancer Institute. The American Cancer Society has more about thyroid cancer. Published Monday, August 26, 2013 Source URL: http://www.healthmonitor.com/too-many-unnecessary-thyroid-biopsies-performed-experts-say

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NEW YORK—April 1, 2008 In an effort to help orthopedic surgeons working in underserved areas in Greece continue to expand their medical knowledge and improve patient care, New York�s Hospital for Special Surgery (HSS) is hosting a group of 22 Greek surgeons in a two-day interactive symposium focused on hip disorders and hip replacement surgery. According to research recently presented at the American Academy of Orthopaedic Surgeons' (AAOS) annual meeting, hip replacement procedures are expected to increase by 101 percent, to 572,000 procedures, by 2030. This trend is also playing out internationally, the result of increased arthritis in the general population, an increased aging population, younger patients, and better diagnosis and treatment options. �As demand around the world for hip replacements continues to grow, this educational program provides an opportunity for HSS orthopedic surgeons to share their specialized knowledge with fellow physicians from Greece,� said Douglas E. Padgett, M.D., associate attending orthopedic surgeon and chief of the Hip Service at HSS. Funded by the Stavros S. Niarchos Foundation, the Hip Replacement Continuing Medical Education program will cover the full spectrum of hip replacement surgery with the patient in mind. Topics to be covered include innovative surgical techniques, pre- and postoperative care, treatment of infection, and rehabilitation. While the symposium is open to all Greek orthopedic surgeons, the goal of the program is to encourage surgeons who are early in their practicing career to take advantage of the type of educational program that isn�t always available to them in their native country. The two-day symposium, taking place on Friday, April 4 and Saturday, April 5, will be co-chaired by Dr. Padgett and Thomas P. Sculco, M.D., surgeon-in-chief at HSS, and will include a live minimally invasive hip replacement surgery. HSS surgeons perform approximately 2,800 hip replacements each year, more than anywhere else in the United States. They are consistently improving upon surgical techniques and implant technology to offer patients the greatest opportunity to return to normal function. Special Surgery has continuously opened its doors to international physicians. In the past, the hospital has hosted Japanese and Italian orthopedic surgeons in similar efforts to share knowledge. About Hospital for Special Surgery Founded in 1863, Hospital for Special Surgery (HSS) is a world leader in orthopedics, rheumatology and rehabilitation. HSS is nationally ranked No. 1 in orthopedics, No. 3 in rheumatology by U.S. News & World Report (2007), and has received Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center. In the 2006 edition of HealthGrades' Hospital Quality in America Study, HSS received five-star ratings for clinical excellence in its specialties. A member of the NewYork-Presbyterian Healthcare System and an affiliate of Weill Medical College of Cornell University, HSS provides orthopedic and rheumatologic patient care at NewYork-Presbyterian Hospital at New York Weill Cornell Medical Center. All Hospital for Special Surgery medical staff are on the faculty of Weill Medical College of Cornell University. The hospital's research division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases. Hospital for Special Surgery is located in New York City and online at www.hss.edu.

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Never-Ending Saga of “Flogged Off” - Transferred Hospitals 10.07.2008Will the Government Hold its Ground to “Medical Revolution”? Part I Nona Suvariani Eka Kevanishvili The implementation of general plan on hospital network development was followed by much heated controversy. Many publications were dedicated to this issue and many discussions have been held. However, the results of “large scaled” flogging off of medical facilities for the whole of Georgia hasn’t been yet realized. The purpose of our writing is to attempt to show the positions of all the range of stakeholders, as well as to predict and influence the overall situation that might follow the “big deals” made in the field of medical and the health implications. Doctors are predicting that there will be a “Medical Revolution”. This is understandable, especially since many of them will become jobless as a direct result of this massive privatization. Health Reform - Official Version – Everything is “Just Perfect” The construction of 100 new hospitals was planned within the frameworks of hospital sector development plan and a policy of health reform, which envisaged increasing the number of hospital beds from 5,000 to 7,800. In 2007, there were a total of 244 state hospitals in Georgia. The necessity of reforming hospital network had been acknowledged by everyone prior to the “Rose Revolution”. However, tangible steps were taken only after the “Rose Revolution”. The first part of our research is based on the information that we received at the time from Nikoloz Pruidze, Deputy Mister of Labor, Health and Social Affairs of Georgia, which was back in February of 2008. He talked about the government’s position explaining why all state hospitals of Georgia were transferred to investors and what the governmental was actually expecting from the much needed reforms in the health reform. The necessity of the medical sector reform had been unanimously acknowledged by all high-ranking officials. On January 15th, 2006 Zurab Nogaideli, Prime-Minister stated on the session of Governmental Commission for Institutional Reform Coordination in the Sector of Healthcare and Social Security that the situation in Healthcare system was rather difficult. The session was held in the State Chancellery. “We have terrible medical infrastructure, ineffective method of funding and the regulation of system that practically does not function. The society, the government, doctors and patients are all discontent with the situation. Everyone agrees that the reform of health sector was required.” He promised that “in three years following the implementation of the reform approximately 350 million GEL would be invested in hospital system development and that approximately 170 Million GEL would be spent on the development of ambulatory centers and on the non-hospital sector. The investments will bring renovated infrastructure, high quality service would be realized in Georgia and the most important benefit would be the improved heath condition of the population.” Kakha Bendukidze, former State Minister on Reforms Coordination was considered to be the most interested party in the implementation of medical sector reform. He used to say at that period that the old hospitals, even in the case of their reconstruction would be useless in 20 years. With this in mind, he came up with the best solution to the problem, and it was proclaimed as one that would have both immediate and long-term results; new hospitals would be constructed in place of old one and this turnaround would be accomplished in rapid fashion. Nikoloz Pruidze told us at the very beginning of the interview that the construction of new hospitals was a non profitable plan and that no money would be benefited to the state budget from such a project. “We offer a plot to the investor. The only condition is that the investor must construct a new hospital on some other territory. The investor will then be both the owner and manager of the new hospital. In other words I give you a plot with old hospital on it as a gift. The term of our agreement is that you must construct a new hospital somewhere else in payback. Both the old and new hospitals are yours to keep. You must first destroy the old hospital on the territory we gave you as a gift and you can build anything you wish on the plot, anything with the exception of a hospital.” 100 new hospitals must have been built in Georgia by 2010. All businesspersons that were interested could participate in the project. We already have a plan as in which districts these new hospitals would be constructed. We also know how many beds will be in the new hospitals. We also know that there would be 5 hospital clusters in Tbilisi. Pruidze admitted that manly constructing companies expressed a keen interest in buying the hospitals and that this “was not just rumor but hard fact, and investors are to construct hospitals on the territory that we have identified. Every city including Tbilisi has its own structure and Tbilisi ones are to have two entrances. Hospitals will be constructed where they logically should be located. One hospital will be built in Avlabari, one in Ortachala, one in Dighomi and one in Sanzona and so forth and so on. The Central Hospital will serve the central districts of the city. We have strategic approach to the situation and take into account the convenience of hospital location for the needs of the population. When they say that we give the investors prestigious places they are right as we want them to have great interest in investing money and building new premises as they know there would be a return on their investment; they will build new hospitals where they are most needed.” Nikoloz Pruidze states that those constructing companies that are interesting in buying hospitals consult with the medical sphere managers. He aslo says that not only constructing firms want to buy hospitals. “There are pharmaceutical companies which have some interests in medical sphere and also there are medical companies that are interested to get involved purely in the medical business.” He does not agree that the pharmaceutical companies are unreliable investors as they might have their private interests in mind over community health. “It is difficult to control the whereabouts of the companies in those countries where pharmaceutical firms are restricted from buying hospitals. In those countries a pharmaceutical company can establish a new company. This new company will then have all legal rights to purchase hospital. However, the company’s money will actually be pharmaceutical company’s money. In order to avoid this kind of machination, it was our intention to allow everyone to openly participate in the process. However, there is one condition: all newly constructed hospitals will be strictly controlled. The high degree of control will help to avoid any doubts that pharmaceutical firms will only want to use them in order to sell their drugs…” The problem of leaving hospital staffs jobless remains a serious problem and needs to be considered. According to the official plan, the personnel of the hospitals would stay on their positions until the investor constructed the new hospitals. Nikoloz Pruidze assured us at the time that the medical system reform would not increase the rate of unemployment of health care workers, including physicians. “The number of hospital beds will increase in 3 thousand. Today a hospital might have 500 beds but only 50 are actually occupied. We have 8-storied hospital in Gurjaani, 11-storied in Dusheti and 4-storied in Ambrolauri. However, there are a few patients there; the sheer facts speak for themselves. However, we lack doctors in the regions of Georgia. We have no specialists in the regions while many doctors remain without jobs in Tbilisi. When new hospitals are constructed and money is invested in hospitals the number of specialists will be immediately increased. For example, 60 % of doctors and nurses in Gori hospital come from Tbilisi. They are content with their jobs and a new hospital was established in Sachkhere. Almost 70 % of the doctors arrived from Tbilisi there. It is unacceptable to have 20,000 doctors in Tbilisi and almost none in the regions.” According to the general plan of hospital network development if the government controls the specialization and work of the newly constructed hospitals during 7 years and the investors fulfill all demands of the government, the investors will become the full owners of their hospitals after a period of 7 years. The investor will be able to act according then according to his discretion. He can even destroy or change specialization of the hospital. This part of the deal raised much protest throughout society. No one can guarantee that the hospitals will remain hospitals after 7 years. Even Nikoloz Pruidze can not guarantee that this will be the case as he considers that no guarantees are needed in this respect. He thinks if the government sees that there are some problems in the medical system that it will take appropriate action and take over control of the situation. However, Pruidze is convinced that no businessperson will refuse the opportunities from such a profitable business. Some people consider that if the hospitals are governed by private investors and if these investors will become greedy monopolists, prices on drugs and medical service will increase beyond the means of most people. However, Nikoloz Pruidze does not agree with this point of view. However, there is another opinion apart from the governmental perspective. According to this opinion, the medical system reform was conducted with problems and violations from the very beginning. Consequently questions as to how successful was the reform will then emerge. You will read how the tenders were held and who profited from taking over large property in the second part and things now done with a high degree of transparency. ///////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// << back

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Health Leaders Brainstorm Ways To Lower Ohio’s Infant Mortality Rate Wednesday, August 21, 2013 at 6:54 PM Members of the Ohio Senate Committee on Medicaid, Health and Human Services and other health professionals from around the state will be in Cincinnati Thursday to discuss how to improve Ohio’s infant mortality rate. From public radio member station WYSO in Yellow Springs, Jerry Kenney reports. Ohio now ranks 48th among states in infant mortality, averaging 7.7 deaths per 1,000 births from 2006 though 2010. According to the National Center for Health Statistics, that rate has remained fairly steady since 1997, but State Senator Shannon Jones, who chairs the Medicaid, Health, and Human Services committee says what’s happening in Ohio in no way resembles the progress that’s being made nationally. “During that same period of time, the infant mortality rates across the nation has dropped by 11%,” Jones says. “So the disparity between Ohio’s infant mortality rate and the rest of the nation continues to grow.” And, the Ohio Department of Health says Infant mortality rates go up dramatically for black populations in Ohio, to 15.5 deaths per 1,000 births – that’s more than double the rate for white infants. Jones says some of that disparity lies with access to medical care, “but also the kind of care that individuals are receiving. So, we need to understand that. I think our focus has to be here in the state on looking at evidenced-based practices that’s going to allow us to tackle this challenge.” That challenge will be the focus of a series of discussions, including Thursday’s meeting in Cincinnati. In July the Ohio Department of Health announced that they will work with Dayton and eight other Ohio communities to reduce infant deaths. Government/Politics, Health, Children's Health, Parenting/Child Care Leave a Comment

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Gum Disease More Common in People With RA 08/08/2012 08:08 PM Gum Disease More Common in People With RA By Associated Press Gum Disease More Common in People With RA Gum Disease in Rheumatoid Arthritis More Likely to Be Severe WebMD Health News By Denise Mann Reviewed by Louise Chang, MD More... Gum Disease More Common in People With RAGum Disease in Rheumatoid Arthritis More Likely to Be SevereWebMD Health News Rheumatoid Arthritis Drugs May Have Small Skin Cancer RiskChild, Teen Cancers Linked to TNF BlockersFDA OKs Cimzia for Rheumatoid ArthritisFDA Checking for Cancer-TNF Drug LinkAug. 8, 2012 -- People with rheumatoid arthritis (RA) may be up to four times more likely to have gum disease than people without this autoimmune disease. What's more, gum disease is often more severe in people with RA, a new study suggests.The findings, which appear in the Annals of Rheumatic Disease, add to a growing body of evidence linking oral health to systemic diseases including RA.During RA, the body's immune system misfires against its own joints and tissues, causing inflammation, joint damage, and pain.The new study compared the teeth and gums of 91 people with RA and 93 age-matched individuals without RA. None of the participants were smokers, and none of the people with RA were taking RA drugs known as disease-modifying anti-rheumatic drugs. Most participants were women and the average age was in the early 40s.Close to 65% of people with RA had gum disease, compared with 28% of their RA-free counterparts. Gum disease was more severe in people with RA. People with RA also had deeper pockets between their gums and teeth (a sign of gum disease severity) than those without RA. People with RA and gum disease were also more likely to test positive for the presence of anti-citrullinated peptide antibodies (ACPA). Researchers suggest that these antibodies may generate and maintain inflammation in the mouth and elsewhere in the body. Levels of ACPA tended to be higher in people with RA and gum disease than in those with RA and no gum disease.Oral Health and RA Are Linked"The connection is there and it's becoming better established," says David Pisetsky, MD, PhD. He is the chief of rheumatology at Duke University Medical Center in Durham, N.C."If you have RA, go to the dentist regularly and don't smoke," he says. Smoking is known to worsen both RA and gum disease.Gum disease is worse in people with RA, but we don't yet know what comes first, the gum disease or the RA, says Eric Matteson, MD, MPH. He is the head of rheumatology at Mayo Clinic in Rochester, Minn. "If you have RA and bad teeth, paying attention to your oral hygiene could be very important," he says. "Chronic inflammation in your mouth can be an aggravating factor for chronic inflammation elsewhere, and this is not widely appreciated by patients or doctors."In this sense, "the new study should serve as a springboard to heightened awareness of this problem."Saul Pressner, DMD, says he would like to see people with RA come in up to four times a year for cleaning. He is a dentist in private practice in New York City. SOURCES:David Pisetsky, MD, PhD, chief of rheumatology, Duke University Medical Center, Durham, N.C.Eric Matteson, MD, MPH, head of rheumatology, Mayo Clinic, Rochester, Minn. Saul Pressner, dentist, New York City.Potikuri, D. Annals of Rheumatic Diseases, published online Aug. 8, 2012.© 2012 WebMD, LLC. All rights reserved.

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Islander honored for philanthropy Joseph DiStefano, right, here with Rev. Thomas Tobin, Bishop of the Diocese of Providence, recently accepted an award from St. Joseph Health Services of Rhode Island. Jamestown resident Joseph R. DiStefano was recently honored by St. Joseph Health Services of Rhode Island (SJHSRI) as its 2008 Partner in Philanthropy. A partner with the law firm Adler, Pollock & Sheehan, DiStefano has been a member of the St. Joseph Health Services board of trustees since 1985. During that time, he has been actively involved in helping to guide the Catholic health system into a comprehensive community hospital provider. According to SJHSRI, DiStefano has chaired multiple board committees and has served on numerous ad hoc and special task forces, including a board helping to establish the hospital's development function and its annual fundraising gala, the Bishop's Ball. In addition, he has co-chaired capital campaigns, spearheaded special fundraising events and directed annual drives. Most recently, he was involved in the recent conversion of the fundraising program at the hospital to formal foundation status. The award recognizes the significant personal and professional contributions he has made to the hospital during his more than 30 years of association with the organization. The award was presented as part of a statewide ceremony marking national philanthropy day. "Joe has been the consummate trustee," said Bishop Thomas Tobin, chairman of the hospital's board. "He has served with honor and distinction and has volunteered immeasurable hours of his time, talent, expertise and resources to the St. Joseph organization for which it will be forever grateful." Return to top

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6th Human Case of West Nile in Montgomery County Posted: Tue 9:58 AM, Sep 18, 2012 / Article Montgomery County now has a sixth human case of West Nile virus, an official confirmed Monday. A 44-year-old resident of South Montgomery County was confirmed Friday as being diagnosed with West Nile virus, said Dr. Syed Ibrahim, chief epidemiologist for the Montgomery County Hospital District Public Health Department. There have been no confirmations of any deaths from West Nile virus in Montgomery County, Ibrahim said. All six of the county’s human cases have been in South Montgomery County.The Texas Department of State Health Services has confirmed 1,276 human cases of West Nile illness in Texas this year, including 58 deaths. Fifteen of those deaths were in Dallas County, while Harris County has had three. West Nile is a mosquito-borne virus. There are two forms of the illness; West Nile neuroinvasive disease and West Nile fever. The symptoms of severe infection from West Nile neuroinvasive disease include headache, high fever, neck stiffness, stupor, disorientation, coma, tremors, convulsions, muscle weakness and paralysis. West Nile fever is the milder form of the illness. Symptoms include fever, headache, body aches, and occasionally a skin rash on the trunk of the body and swollen lymph glands. Most people infected with the virus don’t know they have it, Ibrahim previously said, and less than 1 percent develop West Nile neuroinvasive disease, which includes inflammation of the brain, spinal cord or tissue surrounding the brain. People older than 50 and those with compromised immune systems are more likely to develop this form. To protect themselves, residents need to wear protective clothing (long sleeves and long pants) when outdoors, avoid going outside at dawn and dusk, and make their home unattractive to mosquitoes by emptying containers that may collect rainwater and sprinkler water. Adults should use insect repellant that contains more than 10 percent DEET; children should use insect repellents that contain less than 10 percent DEET, and DEET should not be used at all on babies. Perry Tours A&M Vaccine Facility That Could Mass Produce Ebola Treatment KBTX-TV Channel 3

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HomeNews Print this page Email to a friend Jewish Hospital Jewish Hospital Rudd Heart and Lung Center Goes Blue and Green to Raise Awareness for Organ Donation Louisville, Ky. (April 1, 2014)—To raise awareness of the importance of organ donation, Jewish Hospital Rudd Heart and Lung Building, part of KentuckyOne Health, will be lit blue and green each night during April, the colors of the Donate Life logo. April is National Donate Life Month, a month dedicated to honoring organ donors and their families for the lifesaving gift of organ donation, and to raising awareness of the importance of signing up to become an organ donor. There are currently more than 120,000 people waiting on the organ transplant list for a donor match and roughly 150 people are added to the list each day. Sadly, an average of 18 patients die every day waiting for a transplant because the organ they needed was not donated in time. A single donor can save or heal the lives of up to 50 people. If you are a Kentucky resident, register to be an organ donor at www.donatelifeky.org. If you are a resident of another state, visit www.donatelife.net to register. KentuckyOne Health will also host events later in April at University of Louisville Hospital and Jewish Hospital to honor organ donors who have given the gift of life. KentuckyOne Health Transplant Care at Jewish Hospital, a joint program with the University of Louisville School of Medicine, is nationally recognized for performing Kentucky’s first adult heart, pancreas, heart-lung and liver transplant. In addition, our transplant team was also responsible for the first minimally invasive kidney donation in Kentucky. About KentuckyOne HealthKentuckyOne Health was formed when two major Kentucky health care organizations came together in early 2012. KentuckyOne Health combines the Jewish and Catholic heritages of the two former systems – Jewish Hospital & St. Mary’s HealthCare and Saint Joseph Health System. In late 2012, the organization formed a partnership with the University of Louisville Hospital | James Graham Brown Cancer Center. The nonprofit system is committed to improving the health of Kentuckians by integrating medical research, education, technology and health care services wherever patients receive care. KentuckyOne Health has more than 200 locations including hospitals, physician groups, clinics, primary care centers, specialty institutes and home health agencies across the state of Kentucky and southern Indiana. KentuckyOne Health is the largest health system in Kentucky.

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HomeJournals LinksLinks DatabaseBlogNews News Professional Medical NewsProfessional Medical NewsHealth eLineHealth eLine Professor calls Prince Charles, others "snake-oil salesmen" Last Updated: 2011-07-25 14:57:27 -0400 (Reuters Health)By Kate KellandLONDON (Reuters) - A leading professor of complementary medicine accused Britain's heir-to-the-throne Prince Charles and other backers of alternative therapies on Monday of being "snake-oil salesmen" who promote products with no scientific basis.Edzard Ernst, who is stepping down from his post as Britain's only professor of complementary medicine at Exeter University, also said a long-running dispute with the Prince about the merits of alternative therapies had cost him his job - a claim Prince Charles's office denied."Almost directly, Prince Charles has managed to interfere in my professional life and almost managed to close my unit," Ernst told reporters at a briefing.A spokeswoman for Prince Charles told Reuters the royal heir was not involved in the dispute with Ernst and that she would not respond to professor's comments about snake-oil salesmen.Ernst's complementary medicine research unit at Exeter's Peninsula School of Medicine had been threatened with outright closure, but the university has now offered it a reprieve and says it is seeking a successor to Ernst to lead it."It looked as though I had to go, and that was the price for the unit to continue," Ernst said. "I pay the price gladly as it is a small price to pay for the unit to continue."Ernst said that during his 18 years of researching the efficacy of hundreds of different types of alternative medicine - from acupuncture, to herbal remedies, to homeopathy and chiropractic therapy - he has found that "snake-oil salesmen and pseudo-science are ubiquitous and dangerous".Asked whether he included Prince Charles in that category, he said, "yes."He said Prince Charles, a long-time advocate of alternative and integrated medicine and sustainable agriculture, was one of the main obstacles to allowing proper scientific analysis of the efficacy of complementary therapies.Referring to the prince's Duchy Originals food company as "dodgy originals" he said the firm's promotion of a "detox" tincture made from artichoke and dandelion was an example of how the prince peddled scientifically unproven therapies.In 2009 Ernst accused Prince Charles of "outright quackery" for promoting the detox tincture and other such products "under the banner of holistic and integrative healthcare".The 62-year-old prince founded Duchy Originals in 1990 to promote organic food and farming, with profits going to charity.Duchy Originals describes the product as "a food supplement to help eliminate toxins and aid digestion" and a spokeswoman for the firm said it had no comment about Ernst's remarks.Ernst's dispute with Prince Charles dates back to 2005, when the professor was asked to look at a report by an economist, Christopher Smallwood, who was investigating whether alternative remedies were cost-effective and should be offered more widely on Britain's taxpayer-funded National Health Service (NHS).Ernst objected to the report and decided to voice his concerns before it was published. In one section, the report said the NHS could save billions of pounds if some doctors could switch from prescribing conventional medicines to offering alternative therapies. "That was so unspeakable to me that I had to speak out," Ernst said.Ernst was accused in a letter from an adviser to Prince Charles, Michael Peat, of having breached a confidentiality agreement on the report and an investigation was launched. Ernst was cleared of wrongdoing, but he says he had by that time lost the support of his institution and its commitment to raise more funding for his work.A spokeswoman for Prince Charles said he "had no knowledge that a letter was being sent to the University of Exeter by Sir Michael Peat about Edzard Ernst's breaching of confidence of the Smallwood report in 2005" and was not involved in the dispute.Ernst and his team have run many clinical trials and published more than 150 so-called meta-analyses of other studies into complementary and alternative medicines.He says he has identified around 20 such therapies which "demonstrably demonstrate more good than harm" including the herbal remedy St John's Wort for the treatment of mild depression, hypnosis for the relief of labor pain and hawthorn for the treatment of congestive heart failure. © 2010 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world. © 2010-2013 Healthnostics, Inc.

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Home > Communities and Marketplace > Community Support > Southeastern > South Carolina > Behavioral Health Welcome! I’m Your local Community Support Coordinator. Here you will find helpful resources in your area. Helping Military Families: "A Handbook for Family & Friends of Service Members Before, During and After Deployment" More than 1.6 million men and women have served in Afghanistan and Iraq since 2001. Almost half of these heroes are married, and almost half have children - most of whom are five years and younger. Our service members make great sacrifices overseas, but so do the friends, families and loved ones they leave behind. A new one-of-a-kind resource handbook and video is being made available to servicemembers’ families and friends, courtesy of an independent film production company, Vulcan Productions, owned by philanthropist Paul G. Allen. The handbook and video aim to help families and friends prepare for the emotional challenges encountered before, during and after deployment Together in partnership with the representatives from the U.S. military, leading researchers and clinicians and veteran service organizations from around the country, Paul G. Allen's Vulcan Productions is honored to release a new multimedia resource to serve these military families: "A Handbook for Family & Friends of Service Members Before, During and After Deployment". The handbook is slated for release soon sign-up for notification of release at: http://thisemotionallife.mv.treehousei.com/Surveys/39/9F261268A509A18F/Thanks.aspx Disclaimer Disclaimer: Reference and mentioning herein to any specific business, private organization, manufacturer, appearance of external links on this site, or otherwise, does not constitute or imply its official endorsement, recommendation, or favoring by the United States Government, Department of Defense, United States Army or United States Army Family and MWR Command. The views and opinions of expressed herein do not necessarily state or reflect those of the United States Government, United States Army, Department of Defense or United States Army Family and MWR Command, and shall not be used for endorsement purposes. Upcoming Events Here you will find a frequently updated list of events and activities that are taking place in your local area. Check this area frequently to see if there's something of interest to you. Army OneSource Home Family Programs & Services Soldier & Family Housing Child, Youth & School Services Education, Careers & Libraries Recreation, Travel & BOSS Communities & Marketplace Volunter Management System Become a Partner! About Army OneSource Healthy Families make strong Soldiers. Strong Soldiers make a successful Army. And that’s what Army OneSource is all about. Army OneSource is enhancing unit readiness by addressing needs of Soldiers and their Family Members by providing them with the necessary information and resources needed, regardless of location. Army OneSource’s goal is to enable Soldiers and their Family Members to be strong, healthy and capable, by providing a full range of information and services made available to Soldiers and Family Members 24/7 – promoting resiliency and stability, during war and peace. Our Customers Army OneSource serves all Soldiers and Family Members of the Active Army, National Guard and Reserve, deployed Department of Defense civilian employees and their Family Members, as well as anyone else who supports the U.S. Army. Your browser does not support iframes.

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Love is in the Hair at Winnebago Salon Sabrina Santucci Love is in the Hair at Winnebago Salon By Associated Press Love is in the hair at one Winnebago beauty salon. Winnebago- More than two dozen people get their hair measured before donating to locks of love at Reflections Salon and Spa, 112 S. Benton Street. Then chop, chop. The hair is gone in an instant, but of course for a great cause. "I started to grow my hair for Locks of Love and then one of my best friend's husbands was diagnosed with cancer. And when I started thinking maybe I wouldn't make it that kind of gave me the gumption to keep going," explained Locks of Love Donator Marni Lawson. It's a good thing she didn't give up on growing her hair out. Reflections wanted to have enough donations to provide the organization with at least three hair pieces. According to stylists eight 10” inch pony tails are needed to make one hair piece.Those hair pieces are then donated to children living with medical hair loss."Hair is a big part of your personality and your style. And if you don't have it you don't feel as good about yourself, so for those people who don't have hair it is great to be able to give it to them," said Reflections Salon and Spa Owner Megan Blunt. Tery Havens set a record giving more than 100 inches of hair. He hadn't gotten a hair cut in six years. This is Havens fourth time donating. "Yes, I’ll grow it out again, so long as it goes for Locks of Love. That's the main thing, reason why I do it," said Havens. Meanwhile, Locks of Love Donator Katelin Downs has advice for anyone on the fence about donating their locks. "Don't be nervous just come on in and get your hair done," said Downs. For more information visit http://www.locksoflove.org

医学

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SPD Foundation Find a Pediatric Dermatologist SPD Members Click here to log in securely. SOCIETY FOR PEDIATRIC DERMATOLOGY AWARDS & GOALS COMMITTEE GRANT SUPPORT GUIDELINES 1. A completed application should consist of a single, collated PDF file that includes each of the following items in the order in which they are requested below. PDF files that exceed 5-7 MB in size may be sent to the SPD on a CD. Paper applications will not be accepted. Grant information sheet. Please download this file onto your computer before typing in and saving the requested information (the sheet is a fillable pdf). A narrative description of no more than five pages which clearly state the title, objective, rationale, methods and significance of the proposed project. The title of the grant and the principal investigators name, affiliation, address, and telephone and fax numbers should also appear on the first page of the application. Additional pages including a bibliography of the references cited in the narrative, curriculum vitae of the principal investigator, Figures, Letter of institutional approval from your grant administrator, and appropriate reprints if necessary to fully document the reason for the proposal. An estimated budget (which should be subdivided into categories such as salaries, supplies, etc.), and a statement of other pending or ongoing funding of research in the area of the grant. If other funding already exists for all or portions of this grant; explain how this award will augment the work. If other grant funds are pending, explain how this award will be used if funding of the other application is denied or discontinued. Chairman/Supervisor Letter. The department or division chairman must supply a letter of support detailing that the principal investigator will be responsible for conducting the research. 2. All work must begin within six months of the funding of the grant. Only under special circumstances and with the approval of the Awards and Goals Committee can the work be delayed beyond this time period. Applications should detail the anticipated amount of time needed to complete the proposed work. Grant research should be completed within eighteen months of initial funding. Additional time requirements should be detailed and submitted in writing to the Chairman of the Committee. 3. No more than one-half of the grant can be initially sent to an investigator. Once the research is underway and a written report (including details of all expenditures) is received by the Chairman of the Committee, further funding may be allowed if the previous use of funds is deemed acceptable by the Committee. More initial funding can be received earlier during the research, but this funding is at the discretion of the Awards and Goals Committee. 4. The budget for the research protocol must be approved by the Awards and Goals Committee. The Committee may accept the entire budget or portions of the budget. Funds issued by the SPD for specific investigations cannot be used for other purposes. In the event that the initial proposal cannot be undertaken, all funds must be returned promptly to the SPD VP Finance & Administration. Written updates detailing the progress of the research must be sent to the Chairman of the Awards and Goals Committee. Failure to provide a written update at the six-month interval may result in no further funding of the research. 5. Internal Review Board Approval. All research involving animals or human subjects must have institutional approval before being funded. A copy of the approval letter must be forwarded to 1) the Chairman of the Awards and Goals Committee, and 2) the SPD VP Finance & Administration. Proof of ongoing approval is necessary on a yearly basis. Because the approval process can take considerable time, to avoid delay in funding and initiation of work on the project, all applicants are strongly advised to begin the IRB approval process while awaiting the decision of the Awards Committee on their proposal. 6. Change of Address/Practice Type. If the funded investigator transfers locations or practice type (i.e., goes from a university to private practice, or the reverse), these changes must be sent in writing to: The Chairman of the Awards and Goals Committee, and The SPD VP Finance & Administration. The Awards and Goals Committee will determine if funding is to be ongoing after reviewing these changes. IRB approval must be maintained for the duration of the study if human subjects are involved. 7. Travel. Research funds may not be used for investigator travel expenses to attend meetings or to present their work. Justification must be provided that the proposed travel is essential to the success of the project. 8. Departmental Costs and Indirect Costs. Award funds are to be used only for the designated recipient and project for which the application was made, and cannot be used for indirect costs of the institution or departmental costs. Award funds may not be used for the salary of the principal investigator. 9. Society for Pediatric Dermatology Annual Meeting. The recipient of the William Weston Research Award may be invited to present the research results at the annual Society for Pediatric Dermatology meeting. If selected, the expenses for travel and housing for the meeting will be covered through the Society for Pediatric Dermatology. 10. Publications and Presentations. Publications and presentations related to the funded research should identify the support of the Society for Pediatric Dermatology. A copy of any such publication should be forwarded to the Awards and Goals Committee Chairman and to the SPD VP Finance & Administration of the Society for Pediatric Dermatology. 11. Multiple Submissions. A single proposal may be submitted for consideration in both grant categories (William Weston Research Award and Pilot Project Award). In addition, investigators may submit more than one proposal in a single category. 12. Resubmission of Grant Proposal. The SPD will accept and consider submissions from the previous year (i.e. a grant proposal submitted in 2014 and was not chosen for one of the grants can be "honed" and improved and resubmitted in 2015). Applications must arrive via email or on a CD (if the application exceeds 5-7 MB) by 5pm Eastern Time on May 1, 2015 to the following address: Kent Lindeman, CMP Society for Pediatric Dermatology 8365 Keystone Crossing, Suite 107 [email protected] Research List Copyright© 1998–2014 Society for Pediatric Dermatology Disclaimer

医学

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Most Recent Posts Week in Review: Collaborating to Improve Patient Health 06.06.14 | By Kaelan Hollon Ensuring patients have access to innovative new medicines require collaboration within the biopharmaceutical industry and across the health care ecosystem. With the rapid pace of research and development, pooling resources and brainpower helps identify and utilize the most pertinent information. As a result, cooperation is occurring not only within the private sector, but also with non-profit organizations, academia and the government to more quickly bring treatments to patients in need. Canada’s IP Policies Need New Look 06.06.14 | By Jay Taylor The current intellectual property (IP) environment in Canada has caused increased friction with its closest allies, particularly in the area of IP rights protections for biopharmaceutical products. By revoking 19 patents since 2005 through questionable decisions, Canadian courts have set a disturbing precedent that risks future investments in cutting-edge R&D projects in innovative industries, and the high-paying jobs that accompany them. Crossing the Finish Line in the Race to Cure Cancer 06.05.14 | By Robert Zirkelbach Our members are diligently working to bring new medicines to patients. To date, these treatments have helped make some of the most devastating diseases, including HIV, manageable conditions. To do the same for cancer, collaboration across the health care ecosystem is necessary. Research Unites People Living with Parkinson’s 06.05.14 | By Diane Stephenson, Ph.D. Parkinson’s disease (PD) affects up to 1.5 million Americans and without any change, that number is expected to more than double by 2040. Celebrating Survivors: A Pioneer in Leukemia Treatment and Hope For A Cure 06.04.14 | By Dr. Bill Chin On June 1, patients around the world participated in a very special celebration, National Cancer Survivors Day. This is a day everyone in remission hopes for, and one those currently in treatment are working so hard to achieve. In the United States alone, it is estimated there are 14 million people who have faced the challenges of a cancer diagnosis and are winning. Science of Medical Products Review and Evaluation Must Keep Pace with Rapid Advances in Research 06.04.14 | By Salvatore Alesci The process of translating biomedical discoveries into novel therapies continues to increase in complexity as science and technology rapidly evolve. To ensure timely patient access to safe and effective innovative medical products, it is critical that the science of drug review and evaluation keeps up with rapid advances in drug discovery and development, so that experts across the ecosystem are able to understand, adopt and apply new scientific tools, standards, and approaches in evidence-based decision making processes. Are Health Insurance Exchange Cost-Sharing Reductions Really Helping Low-Income Patients Access Medicines? 06.03.14 | By Allyson Funk Ensuring that patients have access to the medicines they need is at the heart of what biopharmaceutical research companies do every day. The Affordable Care Act put in place a new way for Americans to access health insurance coverage and even provides assistance in the form of tax credits and cost-sharing reductions for those who need it most. #ASCO14: Patients Should Be at the Center of the Value Proposition 05.31.14 Yesterday, ASCO held a panel entitled, “Can We Find Common Ground? Stakeholder Perspectives on Value in Cancer.” At the tail end, a woman stepped to the mike to make an observation to the panelists. Describing herself as a patient and an advocate, she declared that she heard little in the presentations about patient-reported outcomes, particularly in reference to ASCO's value initiative that is in the works. ICYMI: Castellani Op-Ed in The Hill: Health insurance model must evolve 05.31.14 | By Robert Zirkelbach In case you missed it, The Hill featured an op-ed by PhRMA President and CEO John J. Castellani, “Health insurance model must evolve,” to coincide with the start of the American Society of Clinical Oncology’ (ASCO) 50th anniversary conference. Week in Review: The Price of Innovation & Patient Well-Being 05.30.14 | By Kaelan Hollon The cost of innovative new medicines to treat devastating diseases such as cancer and Hepatitis C has been a hot discussion topic this week. A critical part of this discussion – the value of these treatments – however, has been overlooked. Collaboration among all stakeholders needed to improve drug development and optimize expanded access 05.30.14 | By Sascha Haverfield, Ph.D. Each patient facing a life-threatening disease lives with the hope that tomorrow will bring a new medicine to extend and improve his or her life. As a scientist, a new father, and as someone who lost a parent to stage IV lung cancer far too early in life, it is gut-wrenching to admit that modern drug development continues to be a highly challenging and far too often unsuccessful endeavor. Transforming Healthcare One Employee at a Time 05.30.14 | By Kenneth Thorpe, Ph.D. Businesses know the impact of poor health and see first hand how some communities are affected more than others. Truly improving health takes time, effort and investment from all of us. With one out of two Americans having at least one chronic condition, the costs of chronic disease are staggering and affect every community, every business, and every person. Focus on Prices is Penny Wise and Pound Foolish 05.29.14 | By John Castellani It is penny wise and pound foolish to focus solely on the price of a new medicine while completely ignoring the value it provides to patients and the health care system broadly. Curing Hepatitis C not only dramatically improves patients’ lives, but has the potential to save the U.S. The Reality of Prescription Medicine Costs in Three Charts 05.27.14 | By Robert Zirkelbach Recently, there has been a significant amount of conversation around the cost and value of innovative medicines, especially those intended for patients who suffer from chronic, debilitating diseases such as HIV, Hepatitis C and cancer. Providing benefit not only for patients, but the overall U.S. health care system, it’s important that we keep in mind short- and long-term human, economic and societal implications as we work together to address these costly illnesses head on. Week in Review: The Global Impact of Innovative Medicines 05.23.14 | By Kaelan Hollon Across our health care system, it’s critical that patients always remain at the center of our shared efforts to improve, extend and save lives. For PhRMA and the industry writ-large, this is a bedrock mindset and ongoing access to innovative medicines represents health care’s best shot at preventing and managing costly chronic diseases. This week, we focused on the importance of patient access – along with safety – both in the United States and around the globe. Pages« first‹ previous…5678910111213…next ›last » Share

医学

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The Host The Archive Press New Episodes Prevention: Avoiding Disability Tumblr More Destinations... GUEST: Wilson, John AIR DATE: 5/23/1987 Host: Richard D. HeffnerGuest: Sir John WilsonTitle: “Prevention: Avoiding Disability”VTR: 5/23/87 Heffner: I’m Richard Heffner, your host on THE OPEN MIND. You know there are on planet Earth, nearly half a billion disabled persons. A heartrending statistic. What’s worse is that so many of these persons need not have become disabled. Their disabilities, our disabilities are so largely preventable, whether they stem from disease of accidents. What’s good, of course, is that IMPACT, a UN affiliated, not-governmental international initiative against avoidable disability is now in being. Key to it, that extraordinarily insightful, though sightless Briton, Sir John Wilson, today’s guest on THE OPEN MIND. A visionary in every sense, Sir John was the principle speaker at the prestigious Albert Lasker Medical Research Awards luncheon in 1986 where I first heard and was literally mesmerized by his brilliance, his humanity, his profound wisdom and practicality. As Arthur Sackler’s (?) Medical Tribune later commented on the Lasker Award speaker, “Sir John brings to naught the scriptural injunction, Matthew 15:14, ‘If the blind lead the blind, both shall fall into the ditch’”. Indeed this amazing human being rises to grace, raises us, too, gives us hope as he documents the human imperative that we, all of us, work so much harder and so much more wisely to prevent the disabilities of all kinds that so needlessly plague mankind. In part it has been through the international IMPACT organization that Sir John has worked his miracles. Now there is a private, non-governmental, American IMPACT Foundation in Washington, DC, organized to take action against avoidable disability here at home and to add America’s resources to the global movement. It is not after all, God’s will that so many are disabled. Frequently, it is our own carelessness, sometimes the fact that we care less than our humanity dictates. So that today I want to begin THE OPEN MIND by asking Sir John about the degree to which, as he noted not so long ago, the world is suffering from compassion fatigue. Sir John: Well, Mr. Heffner, I think it’s a very fair question. After Band-aid and Sports-aid and the television documentaries about famine and pestilence and plague, it would be surprising if we weren’t suffering from compassion fatigue, because there is so much to do. But I really believe it is not happening. The charities which are concerned with famine are, in fact, doing as well this year as they were last year and I think it’s a great tribute to the expanding compassion of people, particularly in the developed countries, that this is happening. I mean I’m beginning to wonder whether this isn’t becoming part of a new epoch, if you like. Just as in science when our sight becomes too dull, we invent telescopes that will peer into the galaxies and microscopes that will look into the structure of an atom. And when our brains become too dull and too slow, we invent computers. So maybe when our world vision becomes too narrow, we begin to develop a new compassion, a feeling of oneness over this planet of ours, with all its problems. Of course, television, your medium has done more there than anybody…anything else… Heffner: By bringing to us the image of the suffering? Sir John: Yes, and identifying with it. I mean it’s not easy to identify with the plight of an Indian villager or an Arab refugee, just through reading about it or thinking about it. But when you put the thing on the screen just as I’ve seen so often in refugee camps and that sort of thing…I do try, I do try to talk about it and paint pictures, verbally. But it’s not as good as you or what you do. You can bring the thing right into the…the experience right into the drawing room. Heffner: But, Sir John, if you are correct that there may be a resurgence of compassion, perhaps a new kind of compassion today…How do we explain in terms of self-interest what has been, up to this point, the comparative failure on our part to be sufficiently aware of the need for prevention, for preventative measures? Just in terms of self-interest. Sir John: Don’t you think it is always a fact that prevention is pretty well the last thing you think about? Take motor accidents in this country. Fifty-two billion dollars a year are spent on repairing people after they’ve crashed in motor cars. And yet, in terms of self-interest you’d think that would be an unanswerable case. It’s even worst in some areas. The accident rate amongst motor cars in India is unbelievable and in Brazil. But still the emphasis is not on prevention. And I would have thought that…it’s just now beginning to happen…I would like to see the time when we don’t just have Ministries of Health, we have Ministries of Health and Prevention. Heffner: Is that what you’re aiming for with IMPACT internationally and here in the United States? Sir John: Don’t know about the United States, but certainly internationally. We’re trying to develop national programs for the prevention of disability. You see, the numbers that you said at the outset are phenomenal…and increasing. Not only could there well be five hundred million disabl

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Health System > Giving > June MIND Institute Distinguished Lecture to address adult ... All Leading Initiatives Comprehensive Cancer Center and Programs Children’s Hospital and Programs Informatics and Telehealth Stem Cell and Transplantation Student Scholarships and Support Emergency, Trauma and Surgical Services All Ways to Give Gifts of Stock, Real Estate, Other Why Support UC Davis? Your Giving Matters Health System Leadership Health System Strategic Plan Learn more about UC Davis Health System’s major awards and honors UC Davis Health System Annual Report (PDF) The campaign for UC Davis Major gifts Memorial and tribute gifts Gifts of stock, real estate, etc. Events Employee giving NEWS | May 28, 2014 June MIND Institute Distinguished Lecture to address adult treatments for neurodevelopmental disorders Alcino J. Silva, an internationally respected professor of Neurobiology, Psychiatry and Psychology, and director of the Integrative Center for Learning and Memory at UCLA, will discuss “Mechanisms and Adult Treatments for Neurodevelopmental Disorders” during the June UC Davis MIND Institute Distinguished Lecturer Series presentation. Alcino J. Silva The presentation will be offered on Wednesday, June 11 at 4:30 p.m. in the MIND Institute auditorium, 2825 50th St., Sacramento. It is free and open to the public and no reservations are required.Silva’s research has uncovered mechanisms and treatments for learning and memory disorders, including Neurofibromatosis type I, tuberous sclerosis, Noonan syndrome and schizophrenia. His findings illustrate how insights into the biology of molecular and cellular processes in the brain are changing our understanding of learning and memory disorders. Adult treatments could one day help the millions of people affected with neurodevelopmental and other learning and memory disorders.A pioneer in the field of molecular and cellular cognition, Silva founded and is the first president of the Molecular and Cellular Cognition Society, an international organization with more than 5,000 members with branches in North America, Asia and Europe. In 2006 and 2007 he served as scientific director of the Intramural Program of National Institutes of Mental HealthHis mouse model research has led to clinical trials for the first targeted treatments for learning disabilities. He has received numerous honors, including the Order of Prince Henry, MERIT award from the National Institute on Aging, Marco Canavezes Medal of Science and the Senior Roche Award for Translational Neuroscience. He is a fellow of the American Association for the Advancement of Science. The UC Davis MIND Institute in Sacramento, Calif., was founded in 1998 as a unique interdisciplinary research center where families, community leaders, researchers, clinicians and volunteers work together toward a common goal: researching causes, treatments and eventual preventions and cures for neurodevelopmental disorders. The institute has major research efforts in autism, fragile X syndrome, chromosome 22q11.2 deletion syndrome, attention-deficit/hyperactivity disorder (ADHD) and Down syndrome. More information about the institute and its Distinguished Lecturer Series, including previous presentations in this series, is available on the Web at mindinstitute.ucdavis.edu. Giving | UC Davis Health System | 4900 Broadway, Suite 1150 | Sacramento, CA 95820 | Phone: 916-734-9400 | FAX: 916-451-2637

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NASA Scientists Develop Osteoporosis Test That Detects Bone Loss Early By: CBS Posted By: Stephanie Schultz Posted: Wed 5:29 PM, May 30, 2012 By: CBS Posted By: Stephanie Schultz Home / Article (CBS News) NASA scientists are turning their attention from deep space to the millions of adults facing osteoporosis. They've teamed up with researchers from Arizona State University to develop a new technique that can detect bone loss earlier than currently used X-ray methods. The research could eventually change the way the disease is diagnosed, the scientists said. "NASA conducts these studies because astronauts in microgravity experience skeletal unloading and suffer bone loss," study co-author Scott M. Smith, a NASA nutritionist, said in a written statement. "It's one of the major problems in human spaceflight, and we need to find better ways to monitor and counteract it. But the methods used to detect the effects of skeletal unloading in astronauts are also relevant to general medicine." The test works by looking for traces of bone calcium in urine, called isotopes. Scientists tested the new method on 12 healthy subjects confined to bed rest for 30 days, because when a person lies down, less weight is placed on the legs and spine and bones start deteriorating. Extended periods of bed rest cause bone loss similar to that experienced by osteoporosis patients and astronauts, the scientists said. The new technique was able to measure net bone loss in as little as one week after bed rest, long before changes in bone density are detectable by the commonly used DEXA (dual-energy X-ray absorptiometry) test. The findings are published in the May 28 issue of Proceedings of the National Academy of Sciences. The isotopes can be found without any artificial dyes and without radiation exposure, so the researchers say it's safe. Next they want to test its accuracy in patients with bone-altering diseases. If successful, the test may pave the way for diagnosing not only osteoporosis but other diseases that result in isotope imbalances. Anna Barker, director of Transformative Healthcare at Arizona State University, who previously was deputy director of the National Cancer Institute, said, "There is an opportunity to create an entirely new generation of diagnostics for cancer and other diseases." Osteoporosis is a major public health threat for an estimated 44 million Americans, or 55 percent of those 50 years of age and older, according to the National Osteoporosis Foundation. In the U.S. today, 10 million individuals are estimated to already have the disease and almost 34 million more are estimated to have low bone density, placing them at increased risk for osteoporosis and broken bones.

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What is Mental Health Parity? The MHPA ensures that insurance companies offer the same treatment and prescription coverage for mental health conditions as physical ailments. Watch the Did-You-Know slideshow Mental health parity is a term that may be used in several different ways, but also represents a concept about how insurance companies should treat mental health benefits. Many US states have enacted parity laws, which vary tremendously, and countries with socialized medicine may also have some form of parity coverage. The basic concept of mental health parity is that most mental health conditions should not be treated by insurance companies (or government insurers) as uniquely different than any other health condition. In broadest terms this can mean that insurers, given a parity law, might have to provide mental health coverage that is equal to and not less than any coverage provided for other health conditions. In addition to states that have parity laws, the US government has had a parity law on the books, which many considered not true equality. The 1996 Mental Health Parity Act (MHPA) is a federal law that demands insurers not provide a lower amount of dollar coverage or maximum for mental health benefits. This law did not mean that insurers had to offer mental health coverage, or that they had to provide unlimited amounts of coverage to their clients. Employers who had less than 51 employees also did not have to abide by these laws. Ad The MHPA was considered inadequate by many in the mental health field, by a variety of physicians, and by many who suffer from mental health conditions, since insurers could still limit the number of therapy sessions they provided to those with health coverage. In response, a number of states enacted stronger parity laws, but numerous laws were only slightly stronger and had noted loopholes. From a bipartisan perspective, both Congressional houses viewed the MHPA as inadequate, and in October 2008, they passed a stronger bill, signed into law by President Bush. The new law, more clearly defines how mental health parity is to be understood. Under the new definition, any insurance company that offers mental health benefits must do so on an equal basis to “standard” benefits. This means insurers cannot treat most recognized disorders in the Diagnostic and Statistical Manual, as different than any other illness. Insurers may not limit the number of sessions, or offer unequal coverage for what are called “parity” conditions. Like the MHPA, employers with fewer than 51 employees do not have to offer parity coverage, and no insurer has to offer mental health coverage. Yet when they do, benefits for mental health must be treated exactly the same as benefits for physical health conditions, since mental health conditions are most often understood as having physical origin. The discussion of mental health parity takes slightly different turns when you are working with government run health care in systems provided by countries like Canada and the UK. In Canada, people can get free mental health coverage, but they must pay for a supplemental insurance that will cover prescription drugs. Some reports in Canada state that true mental health parity cannot exist when people do not have this supplemental insurance. People with lower incomes may not be able to afford prescribed medications for mental health conditions, which can render treatment ineffective. In the UK, people can also receive mental health treatment through government health care, and this treatment should be equal to care for physical problems, and should represent mental health parity. However, the UK has a variety of private therapists too, and many people cite the difficulty of receiving mental health treatment through the government, due to the high demand for this service. Many people opt to see a private therapist because there is less hassle involved, but those of lower socioeconomic status may not have this option. Those who rely on government provided assistance for mental health issues can wait a considerable amount of time before getting to see a public therapist, unless their condition needs immediate or emergency treatment. Ad What Is Socialized Health Care? How Do I Get Emergency Mental Health Care? What Are Mental Health Courts? What Is Mental Health Law? What Is Mental Hygiene? What Is Deinstitutionalization? What Is Mental Health Rehabilitation?

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Community Mental Health Closed for New YearSubmitted: 12/31/2012 Story By Ryan Abney MINOCQUA - Mental health care will be less accessible in the Northwoods starting tomorrow.Community Mental Health will close all four of its locations in 2013.The organization had offices in Crandon, Eagle River, and two in Rhinelander.Low-income patients could pay on a sliding scale. But former director Erv Teichmiller said that's no longer possible."The support for mental health has diminished over the past ten years. Those grants that have provided money have been more stringent in their qualifications." That's why the clinics have to close. Community Mental Health patients had to be reassigned to other for-profit centers.

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Cancer Docs Abuzz About New Leukemia Treatment By MIKAELA CONLEY Mikaela Conley More from Mikaela » Follow @mikaelaconley In preliminary research that's been dubbed "remarkable," "dramatic" and "sensational," doctors made the most common type of leukemia disappear in two patients, and reduced cancer cells by 70 percent in a third. Researchers at the University of Pennsylvania transformed patients' own white blood cells into "serial killers" capable of annihilating cancer cells within the body. The two patients who experienced full recovery are still in remission more than a year later. Right now, the only way to cure leukemia is through a bone marrow transplant, which carries several risks. "[The serial killers] can kill one tumor cell and then go and kill another, and we found in all three of our patients that the T-cells killed at least a thousand tumor cells, and that's the first time that has ever been shown anywhere near that kind of efficiency," said Dr. Carl June, the lead author of the study, in a video released with the research. "Previous attempts to engage the immune system in destroying cancer cells have often relied on 'vaccination' with tumor cells or tumor proteins," Dr. Douglas Faller, director of Boston University School of Medicine Cancer Center, wrote in an email to ABCNews.com. But in this case, researchers genetically altered and reprogrammed the killer cells of the immune system to recognize the leukemia tumor cells, Faller noted. And for the million dollar question: What does this mean for the future of cancer treatment? "This is an evolving area of treatment that is pretty sophisticated," said Dr. Steven Rosenberg, chief of the surgery branch at the National Cancer Institute. "Someone needs a fair amount of expertise in immunology and molecular biology, and there are very few groups that can do this around the world." In 2006, Rosenberg published the first study in which T-cell receptors were used for gene therapy, combined with chemotherapy, in 17 people who had advanced melanoma. Two patients from the trial remained disease-free several years after the study. Since then, a tumor-specific approach to treatment has been used in clinical trials of patients who had breast, prostate, sarcoma and colon cancer. "This study is probably the most clear-cut, well-studied and best-described of cases," said Dr. Renier J Brentjens, a medical oncologist at Memorial Sloan-Kettering Cancer Center, who specializes in treating acute and chronic leukemia through immunology. "It's very clear here that T-cells are responsible for this effect, and the effect is sustained." While the excitement among oncologists and the general public is apparent, experts cautioned that it was too early to tell whether this will become a mainstream cancer treatment. The final verdict is likely years away, experts said. "[This] probably indicates that this kind of treatment is possible but hugely resource-intensive, and the longer term toxicities and efficacy are not at all clear," said Dr. Bruce Chabner, clinical director at Massachusetts General Hospital Cancer Center. "It could be historic, but it will take several more years and many more cases before we know." "These are expensive trials, and it's hard to get funding," said Brentjens. "It might be a little easier now that these papers are published, but you still need a highly expert staff of well-trained specialists. It's a pretty large operation." Even with the proper monetary resources, only a handful of facilities across the country are capable of making these cells. Despite the financial and staffing hurdles, Brentjens remains optimistic. It gets me up every morning knowing that this is the future," said Brentjens. "This is very exciting, and I hope and pray that immunotherapy will one day replace the more toxic chemotherapy for treatment in cancer patients." NBA Great Kareem Abdul-Jabbar Has LeukemiaGirl Beats Deadly, Medicine-Resistant Fungus1st Official U.S. Virgin Mary Shrine: WisconsinDrug Gives Former Maverick Another Shot Gleevec for LeukemiaAlternative Approaches For Leukemia? Related Topics: Leukemia, Blood Disorders, Serial Killer, Clinical Trials, Colon Cancer, Gene Therapy, Skin Cancer, Prostate Health, Sarcoma

医学

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← Inspired by SHIP Conference Command Center Speeds Up Anti-Fraud Efforts → Supporting Every Provider in Delivering Better, More Coordinated, Patient-Centered Care By Dr. Rick Gilfillan, Director, Center for Medicare & Medicaid Innovation This month, 88 new Accountable Care Organizations (ACOs) joined the other Medicare Shared Savings Program ACOs that came on line earlier this year. Now, more than 150 organizations are partnering with Medicare in shared savings initiatives and offering more than 2 million patients better, more coordinated, patient-centered health care. At the Centers for Medicare & Medicaid Services (CMS), we see ACOs as part of the future of health care—part of a broader movement from the old fee-for-service system that simply paid more for more services regardless of the outcome, to one that rewards providers for high-quality, coordinated care. Providers also see ACOs as a path to better health care. During the rulemaking process for the Medicare Shared Savings Program, our agency heard from many small practices who wanted to become ACOs, but needed additional capital to meet the high bar for care coordination required of an ACO. We want to make sure that healthcare providers interested in forming ACOs have the opportunity to do so. That’s why we created the Advance Payment Model—to provide entities such as rural and physician-owned organizations that hope to become ACOs in the Medicare Shared Savings Program with the support they need to invest in staff and in health information technology. They will repay Medicare through savings they achieve. Last week, CMS was proud to announce the second group of fifteen Advance Payment ACOs. These organizations join five Advance Payment ACOs announced earlier this year. Like their Medicare Shared Savings Program colleagues, they represent communities across America, and are made up of a diverse group of healthcare providers, including independent practice associations that are owned and operated by physicians. The interest of these small, independent practices in the ACO model demonstrates that the desire to improve care and lower costs through improvement exists in small practices as well as large health systems. These providers are committed to improving the health and health care of their patients over the long haul. Recently, CMS announced that organizations accepted to the Medicare Shared Savings Program for January, 2013 would also have the opportunity to apply for Advance Payment Model. At CMS, we’re committed to an ACO program that supports a diverse set of ACOs, allowing groups ranging from health systems to physician-led organizations to partner with us. Like this:Like Loading... Filed under CMS Center for Medicare & Medicaid Innovation, CMS.gov

医学

2014-42/1179/en_head.json.gz/11903

« What People in 1859 Thought of the Great Solar Storm (Hint: They Were Very Confused) Flame Retardants Are Toxic & Haven't Been Shown to Save Lives. Why Are They Ubiquitous? » 16% of Cancers Are Caused by Viruses or Bacteria By Veronique Greenwood | May 9, 2012 3:03 pm Where viruses and bacteria cause cancer Strictly speaking, cancer is not contagious. But a fair number of cancers are clearly caused by viral or bacterial infections: lymphomas can be triggered by the Epstein-Barr virus, which also causes mononucleosis. Liver cancers can be caused by Hepatitis B and C. Cervical cancers can be caused by human papillomavirus, the major reason behind the development of a vaccine against it. For some of these cancers, nearly 100% of the cases have an infectious link—when researchers check to see if a virus or bacterium is working in the tumor or has left signs of its presence in a patient’s blood, the answer is nearly always yes. A new paper in The Lancet takes a look at the very best data on the prevalence of infection-caused cancers and comes up with some striking numbers. Overall, they estimate that 16% of cancer cases worldwide in 2008 had an infectious cause—2 million out of 12.7 million. Hepatitis B and C, HPV, and Helicobacter pylori, a bacterium that triggers stomach cancer, caused the lion’s share of those cases, about 1.9 million together. Eighty percent of all infection-caused cancers were in less developed regions, where vaccines and treatments for these infections may be harder to come by, and sometimes the numbers are shocking: in China, more than a quarter of cancer cases were infectious in origin. But still, a decent fraction were in the developed world, indicating that the problem hasn’t disappeared with current advances. And because this paper only looked infectious agents that are clearly carcinogenic, avoiding those there isn’t much data on, 2 million cases total is probably something of an underestimate. How many deaths from cancer are caused by these infections? The researchers didn’t have the data to answer that question rigorously, but they point out that most of the infection-caused cancers are pretty lethal. They make a rough extrapolation from their data and estimate that of the 7.5 million deaths from cancer in 2008, 1.5 million, or about one in five, were caused by an infection. That’s a lot of deaths from preventable causes. It argues for more work on getting existing vaccines to the populations that need them and continuing research and education on vaccines in places where they’re readily available. Image courtesy of de Martel et al, The Lancet CATEGORIZED UNDER: Health & Medicine MORE ABOUT: cancer, Epstein-Barr, HPV, infection, lymphomas, The Lancet, vaccines, viruses The term “preventable death” always amuses me greatly. To the best of my uneducated, back water knowledge, death is NOT preventable in living beings. That is what makes them living, otherwise they would be inanimate objects. I realize that it wasn’t directly stated this way but the inference is still there, just spend billions to prevent this death in order to die of something else. @Jo, sure, we all have to die, but the term “preventable cause of death” implies timing — life cut short before old age. Cancer would not be a huge problem if it only affected people at 95 years of age. The problem is that it can, for all intents and purposes, kill at any age. Cancer research is done not just to save lives, but to save “life-years” (aka life expectancy minus current age). Oh, and it’s also ridiculously horrible to die from most (if not all) forms of cancer, and that’s worth preventing no matter how old the patient. I have often wondered if aggression is not also the result of ones bacterial population. It takes practically nothing in the way of chemical emissions to ‘turn on’ genes to produce hormones etc.. http://www.facebook.com/IROQUOIS227 Ted Bohne this smells like an american black op. NSA or CIA. sick bastards!! http://www.facebook.com/profile.php?id=100000448885921 Allen South ah would you care to comment on the SE polyomavirus (sv-40) injected into millions of American kids ? hmmmm

医学

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Diagnostic Performance of Screening Tests for Cushing s Syndrome Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Information provided by: First Received Date ICMJE August 8, 2006 Start Date ICMJE September 2002 Brief Title ICMJE Diagnostic Performance of Screening Tests for Cushing s Syndrome Official Title ICMJE The Diagnostic Performance of Screening Tests for the Diagnosis of Cushing's Syndrome Brief Summary This study will test the accuracy of screening tests for Cushing s syndrome in overweight people with signs of the disorder. Cushing s syndrome is a rare disorder caused by excess production of the hormone cortisol. Patients may have various problems, such as weight gain, high blood pressure, diabetes, infections, mood problems, trouble concentrating, and increased blood clotting. These symptoms are seen in many other disorders as well, complicating the diagnosis. The reliability of tests currently used to diagnose Cushing s syndrome is not known. To test their accuracy, subjects in this study who test positive for Cushing s syndrome will be evaluated at NIH for 2 years to either confirm or refute the laboratory results. Patients between 18 and 75 years of age who are being treated at the George Washington University Weight Management Program (GWUWMP) may participate in this study. Candidates will be screened with a medical history, physical examination, measurement of body fat, blood tests, and oral glucose tolerance test. They will also complete a symptoms checklist and quality of life questionnaire. Participants will be tested for Cushing s syndrome with a saliva collection, 24-hour urine collection, and dexamethasone suppression test (DST). For the DST they will take 1 mg of dexamethasone at night and report to GWUWMP the next morning for a blood draw. All specimens blood, saliva, and urine will be tested for cortisol levels. People whose test results are abnormal will be seen at the NIH outpatient clinic for a medical history, physical examination, and blood tests; bedtime saliva collection; two 24-hour urine collections; and a 2-day 2-mg DST, followed by administration of corticotropin-releasing hormone (CRH). CRH is a naturally occurring hormone that causes cortisol levels to rise. Pre-treatment with dexamethasone prevents CRH from causing an increase in cortisol in healthy people, but not in patients with Cushing s syndrome. For the 2-day DST, the subject takes 0.5 mg dexamethasone every 6 hours for eight doses. Two hours after the last dose, CRH is injected through a catheter (thin plastic tube) inserted into an arm vein. Blood is drawn just before giving CRH to measure dexamethasone and cortisol levels and after giving CRH to measure cortisol levels. People whose test results are normal will not be seen further at NIH. Those with high cortisol levels will have repeat urine and saliva tests every 2 to 8 weeks for up to 24 months, and a 1-mg DST every 3 months during routine clinic visits at GWUWMP. People whose increased cortisol is found to be due to another condition besides Cushing s syndrome will be referred for evaluation and possible treatment. Those diagnosed with Cushing s syndrome will have standard tests to identify the tumor causing the disorder, followed by standard medical and surgical treatment. Detailed Description Cushing's syndrome is a rare disorder characterized by a variety of clinical signs and symptoms that reflect chronic exposure to hypercortisolism such as obesity, hypertension, glucose intolerance, infections, psychiatric disturbance, impaired cognition and hypercoagulability. Thus, it is important to screen for this treatable disorder so as to prevent its associated morbidity and mortality. Because many of the signs of Cushing's syndrome are common in the general population, information about the cost-effectiveness and diagnostic efficiency of various screening tests would be useful. This study will evaluate the diagnostic performance of various screening tests for Cushing's syndrome in overweight patients recruited from a weight loss center who have additional signs of the disorder. Patients with abnormal tests will be seen as outpatients at the NIH for further evaluation for up to two years to confirm or refute the possibility that they have Cushing's syndrome. Patients with the disorder will be treated. Study Design ICMJE Not Provided Condition ICMJE Cushing's Syndrome Publications * Castro M, Elias PC, Quidute AR, Halah FP, Moreira AC. Out-patient screening for Cushing's syndrome: the sensitivity of the combination of circadian rhythm and overnight dexamethasone suppression salivary cortisol tests. J Clin Endocrinol Metab. 1999 Mar;84(3):878-82. Crapo L. Cushing's syndrome: a review of diagnostic tests. Metabolism. 1979 Sep;28(9):955-77. Review. Gold PW, Loriaux DL, Roy A, Kling MA, Calabrese JR, Kellner CH, Nieman LK, Post RM, Pickar D, Gallucci W, et al. Responses to corticotropin-releasing hormone in the hypercortisolism of depression and Cushing's disease. Pathophysiologic and diagnostic implications. N Engl J Med. 1986 May 22;314(21):1329-35. Patients presenting for weight loss treatment at the GWUWMP Patients must have at least two of the signs and symptoms in Table 1 of the protocol, in addition to weight gain. If abdominal pain, backache and/or headache are present, only one of these symptoms can be used in any given patient, so that another feature must be present. Willing and able to be seen for up to 24 months Weight more than 350 pounds, the maximum weight for radiologist examination tables necessary for the evaluation of Cushing's Syndrome Renal failure, creatinine greater than 2.6, because of possible effects on dexamethasone metabolism Pregnancy, because it alters interpretation of adrenal function tests Current use of oral, inhaled or intranasal glucocorticoids or use within 30 days of study Other significant medical disorders that may complicate participation or interpretation of the results. For example, a patient with a collagen vascular disorder who has taken intermittent high dose glucocorticoids, and might need to do this again, might not be offered participation. Use of black licorice or chewing tobacco within two weeks of the study or anticipated use during the study Use of phenytoin, barbiturate, loperamide or opiates within two weeks of the study or anticipated chronic use during the study. Other Study ID Numbers ICMJE 020309, 02-CH-0309 Study Sponsor ICMJE Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Lynnette K Nieman, M.D. Information Provided By National Institutes of Health Clinical Center (CC)

医学

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EJGH Fact SheetLeadershipMission, Vision, ValuesOur HistoryAccreditationsAbout Jefferson ParishQuality & Patient SafetyPrivacy NoticeContact Us Home About Us Our History Our History In the late 1960s, community leaders saw the need for a healthcare facility to serve the burgeoning population of the East Bank of Jefferson Parish. The Jefferson Parish Council passed an ordinance creating a hospital service district on the East Bank and a bond issue was put before residents. Once the bond issue passed in November of 1965, officials planned and broke ground on 20 acres of undeveloped land that would become East Jefferson General Hospital. On February 14, 1971, the hospital opened its doors with 250 beds and 250 physicians. Today, East Jefferson General Hospital has 420 beds and over 650 physicians. With over 3,000 team members, the hospital is one of the largest employers in the parish. East Jefferson General Hospital, through the generosity of the EJGH Foundation and its supporters, has grown over the past three decades to become a medical landmark with the addition of medical office buildings, the Yenni Treatment Center for outpatient cancer treatment, and the Domino Pavilion, which houses Same Day Surgery, outpatient laboratory and outpatient radiology services. Most recently, the Wellness Center, a 38,000 square foot, state-of-the-art fitness facility and the East Jefferson Imaging Center, were added to the hospital's outreach. East Jefferson General Hospital has grown with the East Bank community, offering the clinical expertise and cutting edge technology our community expects and deserves. Today, the hospital remains publicly owned and not-for-profit. It is a service district hospital governed by a 10-member volunteer Board of Directors appointed by the Jefferson Parish Council and the Parish President. The hospital is accredited by the Joint Commission on Accreditation of Healthcare Organizations. In 2002, East Jefferson General became Louisiana's first Nurse Magnet Hospital and in 2006, the first in the state to earn reaccredidation. This honor is bestowed by the American Nurses Credentialing Center on select hospitals that demonstrate excellence in patient care and provide a superior environment for professional nurses.

医学

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Atretol Carbatrol Tegretol Tegretol XR Kava, Valerian, Passionflower, Hops Nicotinamide —Supplementation Possibly Helpful, But Take at a Different Time of Day —Supplementation Probably Helpful, But Take at a Different Time of Day —Supplementation Possibly Helpful for Pregnant Women Carbamazepine is an anticonvulsant agent used primarily to prevent seizures in conditions such as epilepsy. Other anticonvulsant agents include . In some cases, combination therapy with two or more anticonvulsant drugs may be used. This interaction involves potential contaminants in ginkgo, not ginkgo itself. A recent study found that a natural nerve toxin present in the seeds of made its way into standardized ginkgo extracts prepared from the leaves. This toxin has been associated with convulsions and death in laboratory animals. Fortunately, the detected amounts of this toxic substance are considered harmless. However, given the lack of satisfactory standardization of herbal formulations in the US, it is possible that some batches of product might contain higher contents of the toxin depending on the season of harvest. In light of these findings, taking a ginkgo product that happened to contain significant levels of the nerve toxin might theoretically prevent an anticonvulsant from working as well as expected. The amino acid glutamine is converted to glutamate in the body. Glutamate is thought to act as a neurotransmitter (chemical that enables nerve transmission). Because anticonvulsants work (at least in part) by blocking glutamate pathways in the brain, high dosages of the amino acid glutamine might theoretically diminish an anticonvulsant's effect and increase the risk of seizures. Grapefruit juice slows the body's normal breakdown of several drugs, including the anticonvulsant carbamazepine, allowing it to build up to potentially dangerous levels in the blood. A recent study indicates this effect can last for 3 days or more following the last glass of juice. Because of this risk, if you use carbamazepine, the safest approach is to avoid grapefruit juice altogether. Ipriflavone, a synthetic isoflavone that slows bone breakdown, is used to treat osteoporosis. Test tube studies indicate that ipriflavone might increase blood levels of the anticonvulsants carbamazepine and phenytoin when they are taken therapeutically. Ipriflavone was found to inhibit a liver enzyme involved in the body's normal breakdown of these drugs, thus allowing them to build up in the blood. Higher drug levels increase the risk of adverse effects. Because anticonvulsants are known to contribute to the development of osteoporosis, a concern is that the use of ipriflavone for this drug-induced osteoporosis could result in higher blood levels of the drugs with potentially serious consequences. Individuals taking either of these drugs should use ipriflavone only under medical supervision. HopsKavaPassionflowerValerian The herb kava (Piper methysticum) has a sedative effect and is used for anxiety and insomnia. Combining kava with anticonvulsants, which possess similar depressant effects, could result in "add-on" or excessive physical depression, sedation, and impairment. In one case report, a 54-year-old man was hospitalized for lethargy and disorientation, side effects attributed to his having taken the combination of kava and the anti-anxiety agent alprazolam (Xanax) for 3 days. Other herbs having a sedative effect that might cause problems when combined with anticonvulsants include ashwagandha(Withania somnifera) calendula(Calendula officinalis) catnip(Nepeta cataria) hops(Humulus lupulus) Cypripedium species), lemon balm(Melissa officinalis) passionflower(Passiflora incarnata) (Sassafras officinale) skullcap(Scutellaria lateriflora) valerian(Valeriana officinalis) and yerba mansa (Anemopsis californica). Because of the potentially serious consequences, you should avoid combining these herbs with anticonvulsants or other drugs that also have sedative or depressant effects unless advised by your physician. Nicotinamide (also called niacinamide) is a compound produced by the body's breakdown of niacin ( ). It is a supplemental form that does not possess the flushing side effect or the cholesterol-lowering ability of niacin. Nicotinamide appears to increase blood levels of carbamazepine and primidone, possibly requiring a reduction in drug dosage to prevent toxic effects. Carbamazepine blood levels increased in two children with epilepsy after they were given nicotinamide, but the fact that the children were on several anticonvulsant drugs clouds the issue somewhat. Similarly, nicotinamide given to three children on primidone therapy increased blood levels of primidone. It is thought that nicotinamide may interfere with the body's normal breakdown of these anticonvulsant agents, allowing them to build up in the blood. The anticonvulsant agents carbamazepine, phenobarbital, and valproic acid have been reported to cause increased sensitivity to the sun, amplifying the risk of sunburn or skin rash. Because St. John's wort and dong quai may also cause this problem, taking them during treatment with these drugs might add to this risk. It may be a good idea to wear a sunscreen or protective clothing during sun exposure if you take one of these herbs while using these anticonvulsants. Anticonvulsants may deplete biotin, an essential water-soluble B vitamin, possibly by competing with it for absorption in the intestine. It is not clear, however, whether this effect is great enough to be harmful. Blood levels of biotin were found to be substantially lower in 404 people with epilepsy on long-term treatment with anticonvulsants compared to 112 untreated people with epilepsy. The effect occurred with phenytoin, carbamazepine, phenobarbital, and primidone. Valproic acid appears to affect biotin to a lesser extent than other anticonvulsants. A test tube study suggested that anticonvulsants might lower biotin levels by interfering with the way biotin is transported in the intestine. Biotin supplementation may be beneficial if you are on long-term anticonvulsant therapy. To avoid a potential interaction, take the supplement 2 to 3 hours apart from the drug. It has been suggested that the action of anticonvulsant drugs may be at least partly related to their effect of reducing biotin levels. For this reason, it may be desirable to take enough biotin to prevent a deficiency, but not an excessive amount. Folate (also known as folic acid) is a B vitamin that plays an important role in many vital aspects of health. Carbamazepine appears to lower blood levels of folate by speeding up its normal breakdown by the body and also by decreasing its absorption. Other antiseizure drugs can also reduce levels of folate in the body. Low folate can lead to anemia and reduced white blood cell count, and folate supplements have been shown to help prevent these complications of carbamazepine treatment. Adequate folate intake is also necessary to prevent neural tube birth defects, such as spina bifida and anencephaly. Because anticonvulsant drugs deplete folate, babies born to women taking anticonvulsants are at increased risk for such birth defects. Anticonvulsants may also play a more direct role in the development of birth defects. The low serum folate caused by anticonvulsants can raise levels, a condition hypothesized to increase the risk of heart disease. However, the case for taking extra folate during anticonvulsant therapy is not as simple as it might seem. It is possible that folate supplementation itself might impair the effectiveness of anticonvulsant drugs, and physician supervision is necessary. Anticonvulsant drugs may impair calcium absorption and, in this way, increase the risk of osteoporosis and other bone disorders. Calcium absorption was compared in 12 people on anticonvulsant therapy (all taking phenytoin and some also taking carbamazepine, phenobarbital, and/or primidone) and 12 people who received no treatment. Calcium absorption was found to be 27% lower in the treated participants. An observational study found low calcium blood levels in 48% of 109 people taking anticonvulsants. Other findings in this study suggested that anticonvulsants might also reduce calcium levels by directly interfering with parathyroid hormone, a substance that helps keep calcium levels in proper balance. A low blood level of calcium can itself trigger seizures, and this might reduce the effectiveness of anticonvulsants. Calcium supplementation may be beneficial for people taking anticonvulsant drugs. However, some studies indicate that antacids containing calcium carbonate may interfere with the absorption of phenytoin and perhaps other anticonvulsants. For this reason, take calcium supplements and anticonvulsant drugs several hours apart if possible. Carnitine is an amino acid that has been used for heart conditions, Alzheimer's disease, and intermittent claudication. Intermittent claudication is a possible complication of atherosclerosis, in which impaired blood circulation causes severe pain in calf muscles during walking or exercising. Long-term therapy with anticonvulsant agents, particularly valproic acid, is associated with low levels of carnitine. However, it isn't clear whether the anticonvulsants cause the carnitine deficiency or whether it occurs for other reasons. It has been hypothesized that low carnitine levels may contribute to valproic acid's damaging effects on the liver. The risk of this liver damage increases in children younger than 24 months, and carnitine supplementation may be protective. However, in one double-blind crossover study, carnitine supplementation produced no real improvement in "well-being" as assessed by parents of children receiving either valproic acid or carbamazepine. L-carnitine supplementation may be advisable in certain cases, such as in infants and young children (especially those younger than 2 years) who have neurologic disorders and are receiving valproic acid and multiple anticonvulsants. Anticonvulsant drugs may interfere with the activity of vitamin D. As proper handling of calcium by the body depends on vitamin D, this may be another way that these drugs increase the risk of osteoporosis and related bone disorders. (See the previous Calcium topic.) Anticonvulsants appear to speed up the body's normal breakdown of vitamin D, decreasing the amount of the vitamin in the blood. A survey of 48 people taking both phenytoin and phenobarbital found significantly lower levels of calcium and vitamin D in many of them as compared to 38 untreated individuals. Similar but lesser changes were seen in 13 people taking phenytoin or phenobarbital alone. This effect may be apparent only after several weeks of treatment. Another study found decreased blood levels of one form of vitamin D but normal levels of another. Because there are multiple forms of vitamin D circulating in the blood, the body might be able to adjust in some cases to keep vitamin D in balance, at least for a time, despite the influence of anticonvulsants. Adequate sunlight exposure may help overcome the effects of anticonvulsants on vitamin D by stimulating the skin to manufacture the vitamin. Of 450 people on anticonvulsants residing in a Florida facility, none were found to have low blood levels of vitamin D or evidence of bone disease. This suggests that environments providing regular sun exposure may be protective. Individuals regularly taking anticonvulsants, especially those taking combination therapy and those with limited exposure to sunlight, may benefit from vitamin D supplementation. Phenytoin, carbamazepine, phenobarbital, and primidone speed up the normal breakdown of vitamin K into inactive by-products, thus depriving the body of active vitamin K. This can lead to bone problems, such as osteoporosis. Also, use of these anticonvulsants can lead to a vitamin K deficiency in babies born to mothers taking the drugs, resulting in bleeding disorders or facial bone abnormalities in the newborns. Mothers who take these anticonvulsants may need vitamin K supplementation during pregnancy to prevent these conditions in their newborns. Arenz A, Klein M, Fiehe K. Occurrence of neurotoxic 4'-O-methylpyridoxine in leaves, ginkgo medications and Japanese ginkgo food. Mizuno N, Kawakami K, Morita E. Competitive inhibition between 4'-substituted pyridoxine analogues and pyridoxal for pyridoxal kinase from mouse brain. Wada K, Ishigaki S, Ueda K, et al. An antivitamin B6, 4'-methoxypyridoxine, from the seed of Chem Pharm Bull (Tokyo). Yagi M, Wada K, Sakata M, et al. Studies on the constituents of edible and medicinal plants. IV. Determination of 4-O-methylpyridoxine in serum of the patient with gin-nan food poisoning [in Japanese; English abstract]. Yakugaku Zasshi. Takanaga H, Ohnishi A, Murakami H, et al. Relationship between time after intake of grapefruit juice and the effect on pharmacokinetics and pharmacodynamics of nisoldipine in healthy subjects. Almeida JC, Grimsley EW. Coma from the health food store: interaction between kava and alprazolam. Bourgeois BF, Dodson WE, Ferrendelli JA. Interactions between primidone, carbamazepine, and nicotinamide. Krause KH, Bonjour JP, Berlit P, et al. Biotin status of epileptics. Said HM, Redha R, Nylander W. Biotin transport in the human intestine: inhibition by anticonvulsant drugs. Kishi T, Fujita N, Eguchi T, et al. Mechanism for reduction of serum folate by antiepileptic drugs during prolonged therapy. Reynolds EH. Mental effects of anticonvulsants, and folic acid metabolism. Berg MJ, Stumbo PJ, Chenard CA, et al. Folic acid improves phenytoin pharmacokinetics. Lewis DP, Van Dyke DC, Willhite LA, et al. Phenytoin-folic acid interaction. Lewis DP, Van Dyke DC, Stumbo PJ, et al. Drug and environmental factors associated with adverse pregnancy outcomes. Part I: Antiepileptic drugs, contraceptives, smoking, and folate. Ono H, Sakamoto A, Eguchi T, et al. Plasma total homocysteine concentrations in epileptic patients taking anticonvulsants. Wahl TO, Gobuty AH, Lukert BP. Long-term anticonvulsant therapy and intestinal calcium absorption. Weinstein RS, Bryce GF, Sappington LJ, et al. Decreased serum ionized calcium and normal vitamin D metabolite levels with anticonvulsant drug treatment. Carter BL, Garnett WR, Pellock JM, et al. Effect of antacids on phenytoin bioavailability. Ther Drug Monit. McElnay JC, Uprichard G, Collier PS. The effect of activated dimethicone and a proprietary antacid preparation containing this agent on the absorption of phenytoin. De Vivo DC, Bohan TP, Coulter DL, et al. L-carnitine supplementation in childhood epilepsy: current perspectives. Epilepsia. Coulter DL. Carnitine deficiency: a possible mechanism for valproate hepatotoxicity [letter]. Ater SB, et al. A developmental center population treated with VPA and L-carnitine. In: Update: inborn errors of metabolism in the patient with epilepsy. Sigma-Tau Pharmaceuticals; 1993. Dreifuss FE, Langer DH. Hepatic considerations in the use of antiepileptic drugs. Freeman JM, Vining EP, Cost S, et al. Does carnitine administration improve the symptoms attributed to anticonvulsant medications? A double-blinded, crossover study. Hahn TJ, Hendin BA, Scharp CR, et al. Effect of chronic anticonvulsant therapy on serum 25-hydroxycalciferol levels in adults. Jubiz W, Haussler MR, McCain TA, et al. Plasma 1,25-dihydroxyvitamin D levels in patients receiving anticonvulsant drugs. Brodie MJ, Boobis AR, Dollery CT, et al. Rifampicin and vitamin D metabolism. Williams C, Netzloff M, Folkerts L, et al. Vitamin D metabolism and anticonvulsant therapy: effect of sunshine on incidence of osteomalacia. 1984;77:834-836, 842. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Increased incidence of neonatal vitamin K deficiency resulting from maternal anticonvulsant therapy. Cornelissen M, Steegers-Theunissen R, Kollee L, et al. Supplementation of vitamin K in pregnant women receiving anticonvulsant therapy prevents neonatal vitamin K deficiency. Asadi-Pooya AA, Ghetmiri E. Folic acid supplementation reduces the development abnormalities in children receiving carbamazepine. Epilepsy Behav . 2005 Dec 24. [Epub ahead of print]

医学

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Mr. PURDY. Mr. McCamy, if you have any comments during the questions directed to Dr. Levine, please feel free to add them. Dr. Levine, what is your occupation? Dr. LEVINE. I am a dentist. Mr. PURDY. How does the process of dental identification work? Dr. LEVINE. The forensic odontologist or forensic dentist will examine a particular piece of dental evidence and attempt to find all the particular unique and individual characteristics in that piece of evidence. He will then attempt to secure a prior record which contains those same characteristics. Mr. PURDY. In the case of the X-rays of President Kennedy, what was your task? Dr. LEVINE. My task basically was to examine the films taken during the course of the autopsy of President Kennedy and to determine if in fact the person who was X-ray was the late President. Mr. PURDY. To what extent are X-rays considered adequate for identification purposes? Dr. LEVINE. X-rays are excellent dental evidence for identification purposes. They contain the positions of the teeth in relation to each other. They contain the shapes and sizes of the fillings and the lining or basing materials that the teeth contain. We can find anomalous or bizarre situations, pathology such as cysts, roots, and consequently there are a myriad of areas for comparison in X-ray film. Mr. PURDY. Do X-rays exist showing the teeth and jaws of President Kennedy taken prior to the autopsy X-ray? Dr. LEVINE. Yes sir, they do. Mr. PURDY. Where are they? Dr. LEVINE. There were 22 such films in the custody of the National Archives. Mr. PURDY. Generally, what do these films show? Dr. LEVINE. Thirteen of the films are dental X-ray type films. The other nine are marked JFK sinus. The X-ray films show teeth, jaws, dental restorations, bony patterns, and the like. The sinus films are both anterior, posterior, front to back, and lateral skull films taken side to side. Mr. PURDY. What is the basis for your opinion as to whether or not the autopsy X-rays were actually made on President Kennedy? Dr. LEVINE. Well, the first thing that I did was to compare each of the photographs in the National Archives with each other and I was very readily able to determine that all the films were taken on the same person, President Kennedy. There are four sources of the films, including a Captain Petter of the U.S. Navy Dental Corps, and a Dr. Robert Morris of New York City. The sinus films were taken by Dr. Stephen White of New York City, and by Drs. Groover, Christie, and Merit in Washington, D.C., through the years 1960 to 1962. These names appear either on the films themselves or on the film mounts, which is normal procedure. Mr. PURDY. Dr. Levine, will you please examine these items marked JFK exhibits F-295 and F-296 and tell us what they represent? Dr. LEVINE. May I walk over there, Mr. Counsel? Mr. PURDY. Yes. Dr. LEVINE. F-295 is a composite of certain of the films in the National Archives, and autopsy films 1 and 2. I have in fact examined autopsy films 1, 2, and 3 and was able to authenticate all of those, but at the time I had my permission to do the photography work it was my understanding that I was not to photograph injury pattern and in order to authenticate film No. 1 that would have showed injury pattern in that the frontal sinuses were used to authenticate autopsy film 1. Mr. PURDY. Dr. Levine, what do the autopsy Nos. 1, 2, and 3 represent, what views of the President? Dr. LEVINE. They are all skull films. Autopsy 1 is a front to back and back to front--an AP-type film. Nos. 2 and 3 represent lateral films taken from side to side, so to speak. Mr. PURDY. Mr. Chairman, I would like to have these exhibits, marked JFK F-295 and F-296, introduced into the record at this time. Chairman STOKES. Without objection, they may be entered into the record at this time.[The above-referred-to JFK exhibits F-295 and F-296 follow:] JFK EXHIBIT F-295 Mr. PURDY. Could you please demonstrate the areas of comparison in the exhibits? Dr. LEVINE. Yes, sir. The four films on top in F-295--and these in F-296--are actually duplicates of each other with certain of the areas of comparison color coded in red. The four films on top were taken by Dr. Robert Morris in New York City I believe on January 18, 1962, right side and left side. The film in the lower corner on both the exhibits on the "J" side is the Stephen White film taken on August 14 of 1960, and the film on the left side is the Drs. Groover, Christy, and Meritt film taken in Washington, D.C., and this is of a lateral skull film on August 17, 1960. This is the dentition and supporting structures on both autopsy 2 and autopsy 3. We can see some very distinctive areas that makes comparison not too difficult. But one thing we must understand, the dental films are taken by placing the piece of film in the mouth, and so you get the one tooth. The lateral skull films are taken by passing the X-rays, so to speak, through the skull to the film on the other side, so that we get a composite very often, or the teeth of both sides superimposed upon each other, which has happened in the four films here. We have elements then of both the right and left sides in autopsy 2 and autopsy 3. Autopsy 3 is very evident from the very distinctive shapes of the fillings. For example, in the upper second molar we see a "W" shape filling and we can follow them as we go forward. So that there is absolutely no difficulty in authenticating that. One of the elements that has stayed throughout is a kidney-shaped area of cement base in the lower left second molar, and this shows very readily in this area here, in the 60 film, in both autopsy films. There are others, too, just to point out--- Mr. PURDY. Dr. Levine, I appreciate your pointing out a couple of those areas. Based on the comparison X-rays that you have used, are you able to state a firm opinion as to whether or not the three skull X-rays you viewed from the autopsy materials are in fact X-rays taken of President Kennedy? Dr. LEVINE. Yes, sir, there is absolutely no question of that. Mr. PURDY. Mr. Levine, will you please examine this item marked "JFK exhibit F-323" and identify this report you have submitted to us. If the clerk will give the report. [Document handed to the witness by the clerk.] Mr. PURDY. Dr. Levine, is this the report you submitted to the staff of this committee? Dr. LEVINE. Yes, it is. Mr. PURDY. Mr. Chairman, I would like this report marked "JFK exhibit F-323" and have it entered into the record at this time. Chairman STOKES. Without objection, it may be entered into the record at this time. [The above-referred-to JFK exhibit F-323 follows:] Mr. PURDY. I have no further questions for Dr. Levine. I will move on to Mr. McCamy. What is your occupation? Mr. McCAMY. I am a scientist specializing in photography and the measurement of color. Mr. PURDY. Have you examined the photographs said to be taken of President Kennedy at the time of the autopsy? Mr. McCAMY. Yes, I have. Mr. PURDY. Did anyone else on the photographic panel examine these materials? Mr. McCAMY. Yes; they were examined in great detail by Frank Scott, by David Eisendrath, by Bennett Sherman, and by one of the professors from RIT. Mr. PURDY. Did you observe anything of interest in the photographs which is relevant to the issue of the authenticity of the autopsy photographs? Mr. McCAMY. Yes; there were numbers embossed on the edges of the color films. These numbers indicate the batch numbers of emulsions. Sometimes but not always, a manufacturer of the film can date the film knowing these numbers. David Eisendrath copied down two of these numbers from the color film and he prepared a letter to the manufacturer, Eastman Kodak, asking about the date of the films. As it happened, he had some old boxes of film on which the dates were known. He took the numbers of some of those films and submitted them at the same time just as a control procedure. Mr. PURDY. Did you notice anything else on the autopsy photographs relevant to the issue of authenticity? Mr. McCAMY. Might I remark that the Eastman Kodak Co. did respond. They were able to date David Eisendrath's films and they were able to date the films that were taken at the time of the autopsy and they said the films were manufactured in 1963, which is an appropriate finding. Mr. PURDY. Thank you. As I was saying, Mr. McCamy, is there anything else you observed on the autopsy photographs relevant to the issue of authenticity? Mr. McCAMY. Yes. Of course we examined the films in great detail to see whether or not there were any indications, any evidence whatsoever, of falsification of the photographs. We found no disturbing of the surface of the film. We found nothing taken away from the film or added to the film, no evidence of any cutting or pasting or construction of a montage, in short, found no evidence whatsoever of any such faking. Mr. PURDY. You mentioned earlier to members of the staff that you were able to view some of the photographs stereoscopically. Could you briefly state what it means to view photographs stereoscopically and why you believe this is evidence of authencity? Mr. McCAMY. Yes. We have an exhibit. The human eyes are located a short distance apart. Mr. PURDY. Mr. Chairman, could we examine this item and mark it as JFK exhibit F-294 and enter it into the record at this time. Chairman STOKES. Without objection, it may be entered into the record at this time.[The above referred to JFK exhibit F-294 was marked erroneously and should have been marked JFK exhibit F-203.] Mr. McCAMY. As you can see on the diagram, if a person looks at a small square peg in front of him, the right eye may see the front and part of the side of the peg. The left eye can see the front and part of the left side of the peg. This is a disparity, a difference in the two views that the two eyes see. Another fact is observed. For the right eye, the peg lines up with the left hand spot in that diagram in the background where, for the left eye, the peg lines up with the right hand spot, so we have what is called parallax, that is, a difference of a linement in the photograph. Mr. PURDY. Mr. McCamy, were there autopsy photographs in which you were able to observe parallax? Mr. McCAMY. Yes, sir. Mr. PURDY. Which autopsy photographs were those? Mr. McCAMY. They were photographs of the back of the head, of the top of the head, the front of the body showing the neck wound, the back showing the back wound. Mr. PURDY. Mr. McCamy, based on your viewing of these photographs and your determination that parallax was evident in them, to what extent are you able to say that these photographs were unaltered? Mr. McCAMY. I would say on the basis of the examination of these photographs, stereoscopically, it is highly unlikely that they were altered in any way. Mr. PURDY. Why do you have this opinion based on viewing them stereoscopically? Mr. McCAMY. Let me take four cases because-- Mr. PURDY. Mr. McCamy, if we could deal with the general principle of stereoscopic vision, could you tell us why your ability to view them steroscopically permits you to say they are authentic. Mr. McCAMY. Yes. Suppose, first, we take the possibility that someone substituted a body and that it was not the body of the President. Viewing these photographs stereoscopically provides the best kind of view because you can observe not only lateral dimensions but dimensions in depth, so it provides the best kind of view for identification. In this case, we must remember we are looking at professional photographs taken at short range, not distant photographs, so there is very little difficulty in identifying the person and the things seen. The fact that it is in stereo gives the observer full advantage of the information available to him. Mr. PURDY. Mr. McCamy, then it is your opinion that based on your examination of these stereo pairs that you are able to conclude that it is very unlikely these photographs are altered? Mr. McCAMY. Yes, extremely unlikely. We have considered the possibilities of various photographic techniques that could have been used in a train of events to produce these photographs. Some of them are virtually impossible because of the stereoviewing. Others would be exceedingly difficult, if not impossible. Mr. PURDY. Thank you, Mr. McCamy. Mr. Chairman, I have no further questions. Chairman STOKES. Thank you, Counsel. Dr. Levine, Mr. McCamy, thank you both for your testimony here this morning and you are now excused. [Witnesses excused.]

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Study: Mycophenolate is superior to azathioprine as treatment for lupus nephritis Mary Anne Dooley, M.D., MPH, is first author of the study, which is published in the New England Journal of Medicine. Credit: UNC Rheumatology/Thurston Arthritis Research Center A new large, international study finds that the immunosuppressant drug mycophenolate mofetil is superior to azathioprine, an older immunosuppressant, as a maintenance therapy for lupus nephritis. "This is a huge step forward for people who suffer from lupus nephritis," said Mary Anne Dooley, MD, MPH, associate professor in the University of North Carolina at Chapel Hill School of Medicine and first author of the study, which is published in the Nov. 17, 2011 issue of the New England Journal of Medicine. Lupus nephritis is an inflammation of the kidney caused by systemic lupus erythematosus (SLE), a disease of the immune system. Lupus nephritis may cause weight gain, high blood pressure, dark urine, or swelling around the eyes, legs, ankles, or fingers. In some patients the inflammation may be severe enough to cause kidney failure. However, some people with SLE have no symptoms of kidney disease. The new study adds one more badly needed drug to the arsenal that physicians can use to treat lupus, Dooley said. In addition, it should help persuade health insurance companies to pay for the drug when it is used as maintenance therapy for lupus nephritis. Some insurers have refused to cover it because the drug is not FDA-approved for that indication, she said. Both mycophenolate mofetil and azathioprine have been FDA-approved since the mid-1990s for use in kidney transplant patients, to help prevent organ rejection. Neither is FDA-approved as a maintenance therapy for lupus nephritis, but their immunosuppressant qualities make them useful for that purpose and physicians have been prescribing them off-label for that indication for many years. The study included 227 patients who had previously responded well to an earlier round of treatment, called induction therapy. The patients were enrolled at 71 centers in 19 countries in Asia, Australia, Europe, North America, Latin America and South Africa. Researchers followed the patients for three years (36 months), with 116 receiving mycophenolate mofetil twice a day while 111 received azathioprine twice a day. The results showed that mycophenolate mofetil was superior in virtually every aspect to azathioprine. There was a 16.4 percent treatment failure rate in the mycophenolate group, compared to 32.4 percent in the azathioprine group. Patients responded well to mycophenolate for a longer period of time than patients on azathioprine, and negative side effects were more common with azathioprine. This study also found that African-American patients in particular responded better to mycophenylate mofetil than to cyclophosphamide (Cytoxan) as an induction therapy and better than azathioprine as a maintenance treatment, Dooley said. Provided by University of North Carolina School of Medicine Alternative therapy for lupus nephritis Lupus is a rare but serious disease that mainly affects women of child-bearing age and occurs when the body's immune system goes awry, damaging a variety of organs. When kidneys are targeted, patients develop lupus nephritis, ... Alternative treatment for preventing relapse of certain type of vasculitis appears less effective In a comparison of treatments for maintaining remission of a certain type of vasculitis (inflammation of blood vessels), the immunosuppressant mycophenolate mofetil, regarded as an alternative to the drug often used to prevent ... 'Multi-target' immune therapy improves outcomes of severe lupus nephritis A new treatment using a combination of drugs targeting different parts of the immune system improves the recovery rate for patients with severe lupus involving the kidneys, according to a report in the October Journal of ... We've come a long way, researchers: How a decade of research is helping lupus patients Today, individuals with lupus nephritis benefit from better treatments than a decade ago, according to a review appearing in an upcoming issue of the Journal of the American Society Nephrology (JASN). The article suggests that ... Rituximab reduces kidney inflammation in patients with lupus Treatment with the targeted drug rituximab can significantly benefit some patients with severe lupus nephritis who do not respond to conventional therapy, according to a study appearing in an upcoming issue of the Clinical Jo ...

医学

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South not the fattest part of US after all, study says by Nicole Wyatt Enlarge U.S. Census Regions and Divisions. It goes against popular belief, but a recent study from the University of Alabama at Birmingham (UAB) shows that the southern region of the United States is not the fattest part of the country. "The obesity epidemic is overwhelming the U.S., and there's this strong perception that Mississippi and Alabama are number one and number two in obesity—fighting for last place," said George Howard, Dr.P.H., professor in the Department of Biostatistics in the UAB School of Public Health. Howard said that according to data from the long-running REGARDS (Reasons for Geographic and Racial Differences in Stroke) study, the West North Central part of the country, which includes North and South Dakota, Minnesota, Nebraska, Iowa, Kansas and Missouri, is the fattest area—with a 41 percent obese population. These findings were recently published online by the journal Obesity. "We were thinking since people living in the South are generally more hypertensive and have higher rates of diabetes and stroke, it would be the fattest region," Howard explained. "But when we looked at our data, people in the South were really not the fattest." The study grouped states into regions used by the U.S. Census Bureau in order to compare data to the National Health and Nutrition Examination Survey (NHANES) to confirm the findings from REGARDS. Mississippi and Alabama are part of the East South Central region of the U.S., which also includes Tennessee and Kentucky. REGARDS ranked the region fifth out of nine regions with 34 percent obese, and the NHANES showed that it was seventh out of eight regions with only 31 percent obese (NHANES ranks fewer regions than REGARDS because NHANES has fewer measurements collected for reporting the New England states of Maine, New Hampshire, Vermont, Massachusetts, Rhode Island and Connecticut). Also, both REGARDS and NHANES used data sets gathered from measured height and weight. Howard said the state-by-state obesity rankings typically cited are from data that used self-reported height and weight information. "Asking someone how much they weigh is probably the second worst question behind how much money they make," Howard explained. "From past research, we know that women tend to underreport their weight, and men tend to over-report their height." Howard said as far as equivalency between the self-reported and measured data sets, the East South Central region showed the least misreporting. "This suggests that people from the South come closer to telling the truth than people from other regions, perhaps because there's not the social stigma of being obese in the South as there is in other regions," Howard said. Howard said it is important that obesity rankings be correct, as a lot rides on these numbers. "A lot of decisions are based on geographic differences in obesity – such as how much federal funding goes to regions to fight obesity," Howard said. "Typically, the South has received the most because others have said it's the fattest, but it might not be. The South has had very bad obesity problems, but not worse than some other regions." More information: onlinelibrary.wiley.com/doi/10… 2/oby.20451/abstract Journal reference: Obesity Provided by University of Alabama at Birmingham Obesity rates still rising in many states In 1995, no state had an obesity rate above 20 percent. Now, all but one does. Group: 39 US states' obesity to pass 50 percent (AP)—A group campaigning against obesity predicts that more than half the people in 39 U.S. states will be obese—not merely overweight, but obese—by 2030. Diabetes rates rocket in Oklahoma, South The nation's diabetes problem is getting worse, and health officials say the biggest changes have been in Oklahoma and a number of Southern states. Obesity rates rising, Mississippi's still fattest (Update) (AP) -- Mississippi's still king of cellulite, but an ominous tide is rolling toward the Medicare doctors in neighboring Alabama: obese baby boomers. Mississippi tips scale as nation's fattest state (AP) -- Rural Mississippi is the country's fattest state for the seventh year in a row, according to an annual obesity report issued Thursday. Colorado, a playground for hikers and outdoor enthusiasts, is the nation's thi ...

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meeting the clown I was asked to share what our experience has been with medical clowns, and I wanted to share it here on our blog as well. If you're like I was, you likely have very little idea what one is and how amazingly helpful they can be, especially for children who have a lot of anxiety in medical situations. I wish all hospitals had them!---It was a dark and dreary day...Actually, I don't remember what the weather was like. But, if Emma's emotions could be compared to the weather, it would be a dark and dreary day.We were new in town, coming here from Texas to Cincinnati Children's in an effort to save Emma's life. We were sitting in a little conference room, with just a table and some chairs, finishing up a meeting with our bone marrow transplant coordinator and about to start meetings with a couple other ladies.Emma had already had a busy day of doctor appointments, and the last thing she wanted was to be sitting in there, staring at the wall, while I talked to others about her least favorite topic - her health. Seeing that Emma was bored, and we still had a long way to go, our transplant coordinator left the room, telling us she was going to go get a craft for Emma to do while we talked.A few minutes later, she came back with a clown. Emma and I looked at each other in surprise. I could see her eyes were bright, and she was tucking away a little smile as she watched him walked towards her.I had no idea of the impact that this very first meeting would have on Emma, or me as her mother, or the impact it would make in her hospital experience as a whole.After spending 45 minutes with Pauly the clown, and after learning how to hold a spinning plate on a stick, how to stand a feather on her hand, and how to toss rings back and forth, our shy little, 10 year old Emma - who never wants to be at the hospital - didn't want to leave. He invited her to a circus activity that they were having and gave me his card with their info on it.Emma was so excited. She wanted to go so badly. I felt like the worst mother in the world when I had to tell her no. She couldn't go because she was in isolation for a bone marrow transplant. She tried to act like she was okay about it, but soon she was in tears, sobbing her little heart out that she couldn't see Pauly the clown anymore. All I could do was hold her and feel like crying myself.Back when Emma was born, she had open heart surgery at four days old. Just days later, she was diagnosed with Fanconi Anemia (FA), which is a fatal genetic disorder that causes bone marrow failure and cancers. A bone marrow transplant can extend her life, but as of yet, there is no cure for the cancer portion of her disorder.Any chance of a normal life poofed away into non-existence at that diagnosis. She has had a life full of doctor visits, specialists, blood test after blood test after blood test, bone marrow biospies and aspirations, and various other medical interventions. While we've tried our best to give her control and avoid unnecessary appointments, it's a lot for a little girl, who just wants to be normal, to go through...constantly.She's learned that she has no control. Picking which arm to have them take her blood out of isn't exactly the choice she wants to be forced to make all the time. Being in a medical environment, when she hates it, is suffocating for her. Then dealing with seemingly harmless comments from them - things like, "This really doesn't hurt her" while she's screaming at everyone that it's hurting her - and it's obvious it really does - they have unintentionally created a world for Emma where even her feelings are being denied by them. Where she truly has almost no voice. No choice. No freedom. No way to escape.As her mother, I do my best to give her as much say and choice as I can. I do my best to protect her from them. Since being at Cincinnati Children's, I haven't had to do that nearly as much as before (the people at this hospital are incredible). But, in our previous hospitals, I have sometimes had to literally standing between them and her and not let them near her until I see that she is okay. I feel like a momma bear who has to protect her cub. I try to be her voice when she's too overwhelmed to speak - making them take their time, making them slow down, making them treat Emma AS EMMA and not just another patient to rush through. When she's screaming and needs someone to hear her, I hear her. But it's not enough.All combined, it's left Emma with extreme anxieties in medical environments.We've done play therapy. We've talked with child life. They've been very helpful, but her anxiety remains. At one point, in an effort to help her anxiety, we even went against the medical recommendations for her illness and avoided the hospital for a long period of time...once. If six months can be considered a long period of time. We've tried giving Emma as much of a break that we could. But, with kids like her, you can only do that so much before you're forced to go back. Where, if you want your child to simply remain alive, you have to go back. There truly isn't an option to give her freedom from that.So, holding Emma in my arms, as she sobbed over Paul, I knew something needed to happen. I knew there was something special about what he had done for her. At that point, I had never heard of medical clowns. I had no idea what they did. While I knew she couldn't be like other kids and go to group activities, I wondered if maybe he could see her privately again at the hospital.I took out the card he had given me, and I found his contact info, and I emailed him, asking him if he could see Emma. That started our life changing experience with the truly amazing medical clown, Pauly.Knowing Paul was at the hospital on certain days, Emma would ask to go to the hospital to see him. Yes, that's what I just said. EMMA WANTED TO GO TO THE HOSPITAL. Often they played after appointments, doing ring tosses, standing a feather on her hand, and trying to get that plate to spin on a stick. He was always so funny and made everyone around him laugh. She loved it and never wanted to leave.At one point, Emma had a surgery coming up. In the past, when she has had procedures that she is put to sleep for, we have always given her Versed. While this works great before surgery, at making her loopy and takes away her anxiety, when she wakes up, it's not so great. The medication makes her very upset and grouchy, and it can take a while to clear her system.Paul had sent me information on medical clowns, and I saw how it could help kids before surgeries. I knew that's what we wanted to try, and I asked him if he could come. Luckily it worked out. Paul was allowed to come and see her as we got everything ready for her surgery. We chose a medical clown instead of Versed.Before, with procedures like this, I'm used to seeing an Emma who is crying, scared, not wanting to be there. I'm used to it being a very emotionally exhausting experience as her mother, watching my baby girl be so upset and not being able to save her from it.But when Paul walked in, Emma went from being stressed and anxious to immediately smiling and happy. He went right to work and played with her. I saw her anxiety level drop tremendously. While I was explaining to nurse after nurse and doctor after doctor, all the details about Emma's little life that they needed to know, Emma was distracted and happy. She usually cannot stand hearing all the health issues explained and re-explained. She's a little girl who just wants to be normal. So to have to hear all those details SO OFTEN is upsetting to her. Plus, I never seem to get to share any of the other details about her - that she's a little girl that loves to jump on the trampoline, she loves to do front flips, she loves to color, sing, dance. She loves being a big sister and her family is so important to her. When she's better, she wants to go to Disney World. She wants to go down a water slide. She wants to see the Northern Lights.Instead, all that we focus on is all the "negatives" about Emma. Understandably, it's not fun for her.However, with Paul there, she didn't bat an eye about the things they were asking me or things we were talking about. She was too busy laughing and playing. There were times when different doctors and nurses needed to listen to her and check her out, and while she initially resisted, she allowed them when Paul encouraged her (with just a little eye roll, in protest, towards the doctors). Then when it was time to go, Emma walked hand in hand with Paul to the room where she was put to sleep. Instead of screaming and crying and clinging to us, I heard a soft little, "I'm scared," as she fell asleep. The difference in her, when Paul is around, is astounding.As a mother, I watch it all play out in front of me. I'm more on the sidelines when Paul is there. There is a huge burden lifted from me in protecting and caring for her because I see that she is okay. Whatever is happening with this medical clown is changing our whole medical experience...drastically.In June, when we first arrived in Cincinnati, Emma was very quiet in medical situations. She refused to speak to doctors and nurses, just as she had done for the years prior to coming here. It was the one thing she could control, and she used it often. I knew that was what she was doing, and I protected her right to do so. If she didn't want to talk, she didn't have to. Luckily the medical personnel at Cincinnati Children's are fantastic. Their goal wasn't to force her to talk, it was to gain her trust enough that she would feel safe talking to them. And, they were able to do that through Paul the medical clown.After having Paul visit her often, she has opened up so much more. Her anxiety has fallen off of her, and her little walls have fallen down. For the first time in ten years, I got to see Emma talk, almost non-stop, to the nurses and even the doctors. This little girl, who appeared so scared and shy before, was a chatterbox. Just with regular interactions with Paul, it affected how she reacted to her whole medical experience as a whole.However, when transplant started, so did more extreme restrictions for obvious and good reasons, except for one. Paul wasn't allowed to come.I suppose this seems like a small, trivial thing to some, but having seen the "magic" that was worked on Emma before her transplant, it was a huge change for us. Emma's walls started going back up. She started refusing to speak again. She would ask for Paul, only for me to say that he wasn't allowed to be there. Thankfully we were able to see him during some of our OT/PT appointments, but we definitely missed being able to call on Paul should Emma be having an extra stressful day and needed someone to help pull her out of it.We've never been to a hospital as incredible as Cincinnati Children's. The quality of care here is truly astounding...from the nurses to doctors to medical clowns. We are "clownies" now (That's a real term, right? Fans of medical clowns!), and we think it's a real show of compassion for Cincinnati Children's to come equipped with them. Our only hope is that the role of medical clowns will be investigated more, and they will become a regular option to families, should they want that service. I've seen him interact with other kids, and they almost all react the same. They are very intrigued and interested and end up laughing. Their worries and fears melt right off of them. I would love for us to have had the choice to have BMT medical clowns that could come see Emma and help reduce her anxiety with some laughter. I would love to ALWAYS have the choice of a medical clown in place of Versed.The work we've seen Paul do is beyond words. When we go back home to Texas, we are changing hospitals. We don't even bat an eye at the fact that we'll be leaving her hematologists, that we've had for seven years, in order to do so. We want a hospital and medical staff that is as much like Cincinnati Children's as we can get, including one that has medical clowns because they mean that much to her...and to us.---If you want to read more details about medical clowning and what they do, here's a good blog entry about it (the photos are of Emma back when she still hair her rainbow hair!). And, if you're local, you can go to an event Paul is having:Free Clowning WorkshopThursday, October 3 from 6 to 9 pmat Circus Mojo (322 Elm St in Ludlow, Kentucky, 41016)Here's the link:http://goodthingsgoingaround.com/children-2/circus-mojo-is-building-medical-clowning-training-site/ teresa belle AnonymousOctober 3, 2013 at 8:28 PMWOW, this is sooooooo impressive and THANK YOU for taking the time to share about this experience. You are a real role model yourself!ReplyDeleteAdd commentLoad more... First Name Last Name Blog Archive All Time Stats (View)

医学

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There are no cures for the common cold Feb 21, 2011 By Liz Szabo Americans catch an estimated 1 billion colds each year. And by this time of year, as weary cold sufferers line up at local pharmacies, it may not sound surprising that Americans spend at least $4.2 billion annually on over-the-counter cough and cold medications - and even more on alternative therapies. Yet here are the dirty little secrets about the common cold: Nothing cures it. And most popular remedies have little to no real effect on symptoms. "In a nutshell, there's nothing that works," says physician Aaron Glatt, a spokesman for the Infectious Disease Society of America. "There's a tremendous industry out there, and some people really swear by them. But there really aren't great studies to show any benefit." Some remedies have been more rigorously tested than others. In a petri dish, many appear promising. When tested in humans, however, cold remedies tend to fizzle out, Glatt says. And there's just not enough rigorously performed research to know whether folksy remedies - such as hot tea, garlic or chicken soup - have any effect, say pediatricians Rachel Vreeman and Aaron Carroll, authors of "Don't Swallow Your Gum! Myths, Half-Truths and Outright Lies About Your Body and Health." That's partly because big drug companies tend not to invest in studies of common foods or products that people can buy anywhere. "When it comes to over-the-counter therapies, they're pretty cheap, so people will buy them anyway," Carroll says. "But if they don't work, you shouldn't be surprised." Yet he adds, "if tea makes you feel better, go ahead. If a warm blanket and a pillow makes you feel better, do it." In some cases, however, even over-the counter drugs can have serious side effects. In children, cough and cold remedies are not only ineffective, but can also be harmful, Vreeman and Carroll say. That's why manufacturers no longer sell these drugs for kids under age 4. Because colds go away on their own in about a week, improving a little each day after symptoms peak, it's easy to believe that favorite medicines - rather than time - should get the credit, says James Taylor, a pediatrics professor at the University of Washington whose research has been funded by the National Center for Complementary and Alternative Medicine, or NCCAM, at the National Institutes of Health. Cold sufferers are so desperate for help that even placebos can make people feel better about a third of the time, says Glatt. There's no objective way to assess whether something makes someone feel less congested or sneezy, Taylor says. So researchers have to rely on imprecise measurements, such as asking people to rate their symptoms on a scale. And many studies are of such poor quality as to be unreliable, he says. Patients shouldn't put a lot of stock in a single study, because results may be a fluke. Doctors usually wait until findings have been replicated before endorsing new treatments. USA Today asked experts to summarize the evidence for some of the most commonly used over-the-counter and alternative remedies. In the lab, these over-the-counter drugs look like a winner. Decongestants shrink dilated blood vessels in the nose, which should provide relief for that stuffed-up feeling, says Elizabeth Funderbunk, a spokeswoman for the Consumer Healthcare Products Association. In the real world, however, their effects are modest at best. A single dose of a nasal decongestant reduces adults' symptoms by 6 percent, according to a 2007 Cochrane Systematic Review. Additional doses reduced symptoms by just 4 percent. While a 1998 study found that antihistamines slightly reduce sneezing or a runny nose, another review found they offer little to no relief for overall cold symptoms or coughs. To reduce the risk of side effects, it's best to take the lowest dose possible - such as found in nasal sprays, says Sidney Wolfe, director of Public Citizen's Health Research Group. He prefers antihistamine nasal sprays because they contain 25 to 50 times less medication than pills. Even then, people shouldn't use nasal sprays for more than a few days, because overuse can actually increase congestion. Wolfe also advises avoiding products that treat multiple symptoms, because they typically provide much more medication than people really need, increasing the risks without adding to their benefits. Nobel Prize winner Linus Pauling popularized the idea of taking high doses of vitamin C to prevent colds. A variety of recent studies have shown this is just wishful thinking, however, Vreeman and Carroll say. A review of studies with a total of 11,000 people found that taking 200 milligrams or more of vitamin C a day didn't reduce the chance of getting a cold, and it reduced the duration of a cold only by a matter of hours. The only people who got any protection against colds from vitamin C were those whose bodies were under extreme stress, such as soldiers in sub-arctic conditions, according to the NCCAM. Echinacea, an herb, has been used for years as a folk remedy, Taylor says. Scientists have been intrigued by echinacea because of laboratory studies suggesting that some constituents decrease inflammation, while others appear to boost the immune system. But improving immunity in a human being is far more complicated than in a petri dish, says Wendy Weber, a program officer at NCCAM. She notes that there are three species of echinacea that are used medicinally, and concentrations can vary from bottle to bottle. Three studies funded by NCCAM concluded that echinacea was no better than a placebo for treating or preventing a cold. While doctors continue to research echinacea, Weber says there isn't yet enough evidence to prescribe it. And although echinacea is the most commonly used herbal supplement in children, studies also show it can slightly increase kids' risk of rash. Although research has produced mixed results on zinc, a new analysis suggests that these supplements offer some help - if people can stand them. In a research review of 15 studies published last week in The Cochrane Library, taking zinc lozenges or syrup within 24 hours after the beginning of symptoms cut short people's colds by about one day. Although the review suggests that these zinc products might also make cold symptoms less severe, Vreeman notes that the quality of the studies wasn't very strong - suggesting that future research could come up with a different conclusion. "One of the big challenges with this research is that they have a hard time making a placebo that people actually believe in," Vreeman says. "The bad taste of zinc, and the fact that it often makes people feel nauseous, are common, and tend to make it clear who is getting the zinc and who is getting the placebo." Vreeman notes that many people may decide that the treatment is worse than putting up with a cold for one more day. Some forms of zinc also pose serious risks. The Food and Drug Administration in 2009 warned consumers not to use any intranasal zinc products because of concerns that it can make people lose their sense of smell. Generations have turned to hot tea with honey to soothe a sore throat. One study, in which children over age 2 were given up to 2 teaspoons of honey before bedtime, found that honey did help reduce coughing. But Weber notes that additional studies are needed. She says honey should never be given to children under age 1 because of the risk of botulism. And while many people like honey cough drops, Weber notes that they can be a choking hazard to babies and toddlers. In a recent study in Pediatrics, children with cough and cold symptoms improved the most when their parents rubbed their chests with Vicks VapoRub, rather than with a placebo ointment. But those benefits could be due to the placebo effect, says Daniel Frattarelli, a doctor and spokesman for the American Academy of Pediatrics. Because of VapoRub's strong fragrance, parents could tell if they were using the real thing or a placebo, even though researchers did their best to "blind" parents to which treatment they were using, according to the study, funded by manufacturer Procter & Gamble. Still, there were no serious side effects, suggesting that the ointment isn't dangerous, says Frattarelli. Even many doctors tell patients to treat congestion by using humidifiers, taking steamy showers or using small pitchers or plastic squeeze bottles to flush salty water through their nasal passages. While these treatments seem safe, there's also no data that they relieve symptoms, Glatt says. When using a humidifier, doctors suggest cool mist, rather than hot steam, which can scald small children. "I'm not aware of any studies showing a humidifier can help (children) to sleep" when congested, Glatt says. "But I'm never going to argue with a parent who tells me that it does." (c) 2011, USA Today. Zinc reduces the burden of the common cold Zinc supplements reduce the severity and duration of illness caused by the common cold, according to a systematic review published in The Cochrane Library. The findings could help reduce the amount of time lost from work a ... Got a cold? Study says echinacea won't help much Got the sniffles? The largest study of the popular herbal remedy echinacea finds it won't help you get better any sooner. Zinc lozenges an ineffective treatment for colds Despite 20 years of research, the benefits of zinc lozenges as a therapy for the common cold have not been proven. A new study, published in the Sept. 1 issue of Clinical Infectious Diseases, currently available online, review ... OTC cough medicine: Not worthwhile for children or adults? Alert parents know that small children should not take over-the-counter cough medications. Now researchers say the stuff might not help adults much, either. Hot drinks help fight cold and flu A hot drink may help reduce the symptoms of common colds and flu, according to new research by Cardiff University's Common Cold Centre. Vapor rub relieves cold symptoms for children, helps them sleep better Applying a vapor rub is effective for treating children with night-time cough and congestion and improves sleep for children with cold symptoms, according to Penn State College of Medicine researchers.

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Studies offer encouraging data on preventing Crohn's disease recurrence Aug 05, 2010 Biological agents may play an important role in maintaining remission in Crohn's disease, according to two new studies in Clinical Gastroenterology and Hepatology, the official journal of the American Gastroenterological Association (AGA) Institute. "Post-surgical recurrence of Crohn's disease occurs very frequently. Unfortunately, none of the traditional drugs used to treat the naturally occurring disease has really shown a clear-cut benefit in this situation," said Dario R. Sorrentino, MD, of the University of Udine School of Medicine, Italy, and lead author of one of the studies. "Our study results indicate great potential for infliximab, a monoclonal antibody, which has shown remarkable efficacy in preventing this type of recurrence." Infliximab is known by the brand name Remicade®. This video is not supported by your browser at this time. Doctors performed a prospective cohort study in 12 consecutive patients treated immediately after surgery with standard maintenance infliximab (5 mg/kg body weight every eight weeks) who did not have evidence of disease recurrence after 36 months. Treatment with infliximab was then discontinued. Patients with disease recurrence (i.e., with intestinal inflammation) were then given lower doses of infliximab in an attempt to re-establish the integrity of the intestinal mucosa, which helps ensure an adequate supply of nutrients. The study authors showed that infliximab administration immediately after surgery effectively prevents recurrence of the disease (no intestinal inflammation and no symptoms) at three years. However, upon suspension of the medication, intestinal inflammation appears after four months in the large majority of patients (83 percent), thus indicating the need for long-term uninterrupted maintenance therapy. Nevertheless, a 40 percent reduction from the standard dose of 5 mg/kg (i.e., a dose of 3 mg/kg) was sufficient to re-establish the integrity of the intestinal mucosa and avoid disease recurrence in all patients at one year. "Additional studies may be needed to confirm our findings. However, lowering the dose of infliximab may be potentially safer and is more cost effective than standard dose strategies for prevention of post-operative recurrence of Crohn's disease. This should be considered in the long-term management of patients undergoing surgery for this indication," added Dr. Sorrentino. In a second study published in Clinical Gastroenterology and Hepatology, doctors found that certolizumab pegol — another type of biologic therapy — effectively maintains remission of Crohn's disease for up to 18 months. In addition, continuous therapy is more effective than interrupted therapy. Certolizumab pegol is known by the brand name Cimzia®. Subcutaneous certolizumab pegol administered every four weeks is an effective and well-tolerated, long-term maintenance therapy for patients with moderate to severe Crohn's disease. Continuous maintenance therapy with certolizumab pegol is more likely to produce response and remission than interrupted therapy, without negatively impacting patient safety. Doctors assessed the long-term effectiveness, safety and immunogenicity (ability to create an immune response) of five continuous versus interrupted maintenance therapy with subcutaneous certolizumab pegol in patients with Crohn's disease. Patients who responded to induction therapy at week six of the PRECiSE 2 trial (one of two large, pivotal, randomized, placebo-controlled, phase III studies) were randomly assigned to groups given certolizumab pegol (continuous) or placebo (drug-interruption). Patients who completed PRECiSE 2 were eligible to enter PRECiSE 3, an ongoing, open-label extension trial in which patients have received certolizumab pegol every four weeks for a total of 80 weeks. PRECiSE 3 is the first prospective trial in which patients received continuous or interrupted therapy for greater than 12 months and were not offered the option to increase their dose. Responses at week 26 for the continuous and drug-interruption groups were 56.3 percent and 37.6 percent, respectively. Corresponding remission rates were 47.9 percent and 32.4 percent, respectively. Of patients responding at week 26, response rates at week 80 in the continuous and drug-interruption groups were 66.1 percent and 63.3 percent, respectively. Among patients in remission at week 26, week 80 remission rates were 62.1 percent and 63.2 percent, respectively. More patients in the drug-interruption group developed antibodies against certolizumab pegol and had lower plasma concentrations of certolizumab pegol than the continuously treated group. Explore further: Where Ebola battles are won Provided by American Gastroenterological Association Infliximab may help prevent post-operative Crohn's disease recurrence The administration of infliximab after intestinal resective surgery was found to be effective at preventing endoscopic and histological recurrence of Crohn's disease, according to a new study in Gastroenterology, the official ... 2-drug combo twice as effective for Crohn's disease remission A study led by Mayo Clinic suggests remission from Crohn's disease may be more likely if patients get biologic therapy combined with immune-suppressing drugs first instead of immune-suppressing drugs alone. The study, published ... Ulcerative colitis treatment reduces need for surgery by almost half A new study led by Mayo Clinic researchers has found that ulcerative colitis patients had a 41 percent reduction in colectomy after a year when treated with infliximab, according to a study published in the October 2009 issue ... Gene mutation improves leukemia drug's effect Gene mutations that make cells cancerous can sometimes also make them more sensitive to chemotherapy. A new study led by cancer researchers at Ohio State University shows that a mutation present in some cases of acute leukemia ... Anti-cancer Rituxan cuts lymphoma recurrence in half: study Long-term treatment with anti-cancer medication Rituxan, produced by Swiss laboratory Roche, can cut the recurrence of follicular lymphoma in some patients by half, a new study said. Colitis patients diagnosed later in life tend to have better disease outcomes Adults diagnosed with ulcerative colitis after age 50 are more likely to achieve remission from their symptoms than patients diagnosed at younger ages, even when those patients receive similar treatments, ...

医学

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Geneticists oppose singling out Jewish women in European breast cancer patent Jewish women in Europe may face genetic discrimination in access to breast cancer diagnosis if the patent on the BRCA2 gene, which is currently being disputed, is not withheld by the European Patent Office (EPO) on June 29. The European Society for Human Genetics (ESHG) is strongly opposed to the selection of a particular racial group as a diagnostic target in a gene patent claim and is calling on the EPO to take action to prevent this situation. On June 29 the EPO will hear the opposition of several European genetic societies and research institutes against the patent on the second breast cancer gene, BRCA2, to which the US-based Myriad Genetics holds the exclusive, worldwide license. In preparation of these hearings, the patent owners have now rewritten the original claims in the patent, to specifically protect the identification of one particular mutation � frequent in the Jewish population - "for diagnosing a predisposition to breast cancer in Ashkenazi-Jewish women". This is the first time that a racial or ethnic group has been specifically singled out as a diagnostic target in this way. "This is not the way to go for genetic testing", said Professor Gert-Jan van Ommen, from the Center of Human and Clinical Genetics, at the Leiden University Medical Center, The Netherlands. "What it means in practice is that genetic centres that do not have licences for this test � or where the healthcare systems cannot afford to pay for it � may be forced to deny it to Ashkenazi Jewish women." One of 100 Ashkenazi Jewish women carries the BRCA2 mutation which predisposes her to breast cancer, and gives a 65-70% chance of developing the disease. The ESHG is calling on the EPO to rescind this patent claim on ethical and practical grounds. At their recent meeting in Prague, the board and members agreed their strong opposition to this development. "Almost all European geneticists are very unhappy about the introduction of specific racial, ethnic or familial references in patent claims", said Professor Andres Metspalu, from the Estonian Biocentre at the University of Tartu, Estonia, and President of EHSG. "This is genetic discrimination, as the consequence of this practice would be that some individuals and patients could find themselves legally denied clinical diagnostic services, based on their belonging to a specific genetic heritage. While this particular mutation in the BRCA2 gene is frequent in the Ashkenazi population, we are equally opposed to similar claims on mutations in this and other genes that may be prevalent in other populations or specific to individual families.". The ESHG is calling on the European Patent Office (EPO) to thoroughly consider the legal, economical and social consequences in its decision in June and to revoke this patent on the basis of the following considerations: It is against 'ordre public' and morality to introduce genetically discriminating considerations in patent language, and thus in breach of Article 53 (a) of the European Patent Convention The definition of a racial, ethnic of otherwise hereditarily determined groups is fraught with technical uncertainties and lack of precision, which, once introduced in patent language, will lead to a burgeoning of poorly determined terms. While the latter would further inflate the cost of intellectual property protection, "both aspects may well unfavourably affect the perception of the work of the patent authorities by European citizens and the genetics community" said Professor Gert Matthijs, from the Department of Human Genetics, Catholic University of Leuven, Belgium, and chair of the ESHG Patenting and Licensing Committee. Between 2001 and 2003, the European Patent Office (EPO) has granted several patents to Myriad Genetics Laboratories in the US on familial breast cancer genes BRCA1 and BRCA2. The breast cancer gene patents relate to research done in the early nineties which led to the identification of these genes in 1994 and 1995 respectively. The basis for these breakthroughs in familial breast and ovary cancer research had largely been laid in the years before by academic research groups and by a world-wide international collaboration between those groups through the so-called Breast Cancer Linkage Consortium (BCLC). Consequently, soon after these genes were identified, many genetic laboratories and cancer institutes in Europe included BRCA mutation testing in their service, and many women with a family history of breast cancer have now been analysed. However, the legal situation of this service became uncertain when the patents were granted. Indeed, the patents have allowed Myriad Genetics Laboratories to gain and retain monopoly on BRCA1 and BRCA2 testing. This has met with strong opposition in the European genetics community as it was seen to interfere with national policies regarding DNA-based diagnostic services. Following opposition to the three BRCA1 patents by several European genetic societies and research institutes, led by the French Institut Curie, l'Assistance Publique-H�pitaux de Paris and the Institut Gustave-Roussy, and by the Belgian and Dutch societies for Human Genetics, one of the patents was revoked in May 2004, and in January 2005 the second and third patents were restricted in scope. Currently, scientists and health care providers do not consider the patents a threat to diagnostic practice in Europe, but the patent holders have appealed the decision, so the BRCA1 dispute is still ongoing. However, Myriad Genetics also holds exclusive worldwide license rights on the second gene, BRCA2, and the opposition hearings of this patent are to be held on June 29 at the EPO in Munich. With the recent changes described above, aiming this patent to a specific ethnic group, this patent, like the BRCA1 patents, is generating major concern amongst European geneticists, which has led to the current reaction of the ESHG. Source: Eurekalert & others A man can get discouraged many times, but he is not a failure until he begins to blame somebody else and stops trying.~ John Burroughs

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Equine magnetic therapy: the positives and negatives Jan 01, 2009 By Kenneth Marcella, DVM DVM360 MAGAZINE You want to believe. You really do. And there are many well-known horsemen, doctors, physicists and PhD's telling you that you should. Dr. Robert Holcomb MD, PhD, at the Vanderbilt University Medical Center, writes, "Magnetic fields produce the following results when in direct contact with the body: increased circulation; vasodilatation; muscle relaxation; reduction of edema; reduction of nerve-cell firing (which reduces pain); and reduction of free radicals (which improves the body's ability to fight inflammation and improves the immune system). Magnetic-therapy proponents rely on physics to validate their belief in the healing action of magnets and will take you through a discussion of Faraday's Law and the Hall effect. "The combination of the electromotive force, altered ionic pattern and the currents (caused by physical effects based on physics principles) causes blood-vessel dilation with a corresponding increase in blood flow," states Dr. M. Porter in a 1997 article in Equine Vet Data. Your clients see advertisements for magnetic-therapy devices in all the popular equine magazines, and owners and trainers routinely give testimonials as to the varied beneficial effects that these units produce. What could be better than to apply a magnetic joint wrap, footpad or body blanket and improve circulation, reduce inflammation and help your horse heal? You'd really, really like to believe, but ... Arguments pro and con The problem is that there are equally many well-known scientists, clinicians and researchers on the other side of this issue. David Ramey DVM, a California practitioner fast becoming the "Ralph Nader" of the profession, concludes, "There appear to be no published scientific studies available that demonstrate that any form of magnetic therapy is valuable in the treatment of disease conditions in the horse." Dr. Phillip Steyn and a group of researchers in the Department of Radiological Health Services at the College of Veterinary Medicine at Colorado State University looked at the effects of static magnets on blood flow in the metacarpas of the horse and concluded, "static magnetic fields associated with the application of commercially available magnetic wraps for 48 hours did not increase the blood flow pattern of the metacarpas under the wrap." Even though electromagnetic field therapy used for treatment of delayed and non-union fractures in humans is FDA-approved and supported by numerous studies, work by Dr. Bramlage, Dr. Collier and others failed to show similar usefulness in the horse. Other studies done in horses call the claims of "increased blood flow" and "pain reduction" following magnetic therapy into question. But no sooner than you decide to discount this modality, a new study is published that makes you rethink your position — again. Dr. Carlos Vallbona investigated the pain response in post-polio patients at the Baylor College of Medicine's Institute for Rehabilitative Research in Houston, Texas. In a double-blind study of 50 patients using magnets, a significant reduction in pain was reported by those patients using active magnets as opposed to patients using "sham" magnets. Twenty-nine of the patients with active magnets reported that, on average, they felt a reduction in pain from 9.6 to 4.4 (0 to 10 scale) while the 21 other patients using the sham magnets reported a reduction in pain of 9.5 to 8.4. This significant difference lends some "science" to the magnetic-therapy discussion. Dr. William Jarvis, president of the National Counsel Against Health Fraud, previously was a detractor of magnetic therapy, calling it "essentially quackery." But after Dr. Vallbona"s findings were published, Dr. Jarvis tentatively admits that it (magnetic therapy) may have value. Dr. Michael Weintraub and the magnetic-research group from the Department of Neurology at New York Medical College reported a randomized, double blind, placebo-controlled study looking at the reduction in diabetic-associated peripheral neuropathy achieved by wearing static magnetic shoe insoles. These investigators concluded, "Although many questions remain about a precise mechanism of action, the present study provides convincing data confirming that the constant wearing of static, permanent, magnetic insoles produces statistically significant reduction of neuropathic pain." This study and others have led some veterinarians and owners to try magnetic footpads or magnetic bell boots as treatment for hoof-related pain.

医学

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Posted 9:02 am, August 20, 2014, by Katrina Lamansky FacebookTwitterGooglePinterestLinkedInEmail × (CNN) — Another patient is being tested in the United States for possible Ebola exposure — this time, in California. The unidentified patient is being isolated in a “specially equipped negative pressure room” at the Kaiser Permanente South Sacramento Medical Center. Trained staff are using protective equipment, coordinated with infectious disease specialists, to provide care for the patient, said Dr. Stephen M. Parodi, director of hospital operations at Kaiser Permanente Northern California, in a statement. The patient is considered “low-risk” and tests are being conducted out of “an abundance of caution,” the California Department of Public Health said. There are currently no confirmed cases of Ebola in the state, the agency said. The Centers for Disease Control and Prevention will be testing the patient’s blood samples to determine whether the Ebola virus is present. All necessary precautions are being taken to safeguard other patients and staff, the hospital said. No further information about the patient has been released. Earlier this month, a patient with a high fever and gastrointestinal symptoms was admitted to Mount Sinai Hospital in New York City for Ebola testing, but tested negative. He recently traveled to a country in West Africa where Ebola has been reported, the hospital said in a statement. In July, two Americans, Nancy Writebol and Dr. Kent Brantly, became infected with the virus when working with Ebola patients in Liberia. Both are currently being treated at Emory University Hospital in Atlanta. Ebola doesn’t spread through airborne or waterborne methods. It spreads through contact with organs and bodily fluids such as blood, saliva, urine and other secretions of infected people. There is no FDA-approved treatment for Ebola, and Emory will use what isolation unit supervisor Dr. Bruce Ribner calls “supportive care.” That means carefully tracking a patient’s symptoms, vital signs and organ function and taking measures, such as blood transfusions and dialysis, to keep patients stable. The Ebola virus causes viral hemorrhagic fever, which refers to a group of viruses that affect multiple organ systems in the body and are often accompanied by bleeding. Early symptoms include sudden onset of fever, weakness, muscle pain, headaches and a sore throat. They later progress to vomiting, diarrhea, impaired kidney and liver function — and sometimes internal and external bleeding. Emory’s isolation unit aims to optimize care for those with highly infectious diseases and is one of four U.S. institutions capable of providing such treatment. CNN’s Faith Karimi and Dana Ford contributed to this report. Filed in: Health, News Topics: California Department of Public Health, Centers for Disease Control and Prevention, Ebola outbreak Nominate someone for the Jefferson Award Dallas Ebola patient is in critical condition, hospital says How local hospitals have prepared for infectious diseases including Ebola CDC confirms first case of Ebola in the U.S. Ebola screenings to begin at Chicago’s O’Hare International Airport CDC director: Ebola outbreak unlikely in U.S. Thomas Eric Duncan: 6 ways his case differs from other U.S. Ebola cases Ebola virus has killed more than 1,900, health officials say What is the risk of catching Ebola on a plane?

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Men's Health Network Releases Free Publication to Help Men and Their Families Maintain Healthy Lungs -- Breathe easy: your lungs and COPD. -- WASHINGTON, DC, February 28, 2013 /24-7PressRelease/ -- Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death in the U.S. In an effort to provide guidance to the 12 million Americans who have COPD and the 12 million more whose symptoms remain undiagnosed, Men's Health Network (MHN) partnered with the Association of Black Cardiologists, the Veterans Health Council, and Men's Health Alliance to develop a new guide, "Breathe Easy: Your Lungs and COPD. Chronic Obstructive Pulmonary Disease," which can be downloaded and distributed freely in communities across the country. "Studies show that every four minutes an individual dies of COPD," said Scott Williams, MHN Senior Vice President. "We could not ignore this fact and had to address such an important health issue. The Breathe Easy publication is designed to educate the public regarding possible COPD symptoms and explains what to do once these symptoms are discovered. We hope that those who read this publication will examine their own situation and take action if needed." Authored by experts in the field of men's health and supported by a grant from Forest Laboratories, "Breathe Easy: Your Lungs and COPD. Chronic Obstructive Pulmonary Disease" is filled with important information for men and their families and added to the extensive library of educational materials which MHN has maintained since 1992. The guide may be downloaded as a PDF file from http://www.menshealthlibrary.org . Printed copies may be ordered by phone from the MHN main office. "As an individual who was diagnosed with genetic (Alpha-1 Antitrypsin Deficiency) COPD in the 1980s, I know first-hand what it's like to have an exacerbation, and what it feels like to be unable to breathe," said John W. Walsh, president and co-founder of the COPD Foundation. "This booklet is helpful to not only the COPD patient, but also their caregivers, family and friends who want to learn more about the third leading cause of death in the U.S." Breathe Easy also describes how COPD affects families and provides advice for caregivers. This guide is an essential read for every man who is concerned about his health and the well-being of his loved ones. Women are also at heightened risk, and the same factors that contribute to COPD in an adult can impact the life of a child and increase their susceptibility to developing the disease. "The heart is physically very close to the lungs and is connected to them by blood vessels. COPD can lead to damage to the heart resulting in heart failure. This adds to the symptoms that patients experience and it can complicate treatment," said Richard Allen Williams, MD, FACC, Founder, Association of Black Cardiologists, Inc.Men's Health Network (MHN) is a national non-profit organization whose mission is to reach men, boys, and their families where they live, work, play, and pray with health prevention messages and tools, screening programs, educational materials, advocacy opportunities, and patient navigation.# # # Contact Information: Alice AlecuMen's Health NetworkWashington, DCUnited States of AmericaVoice: 202-543-2727 ext. 101Website: http://www.menshealthnetwork.org

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Q&A Tool BMI Calculator Drug Savings Tool See All Health Tools » »The Healing Powers of ... The Healing Powers of Dance Dancing is more than fun — it's therapeutic by: Christina Ianzito, from: AARP The Magazine, March 24, 2011 Dance can improve balance and flexibility. — Allen Birnbach/Masterfile Valerie Perdue, 55, was diagnosed at age 42 with Sjögren's syndrome, a chronic autoimmune disease that left her exhausted to the point of immobility and in debilitating pain. "The doctor told me, basically, I wasn't going to get well," says Perdue. Then a friend introduced her to a modern dance class. Although she only had the strength to watch, she "was so emotionally moved by its beauty," she kept going, and eventually was able to participate: First she'd just breathe deeply, and move her arms while seated, then could stand for longer periods during the class. After many years of dogged practice, Perdue says, "I became physically stronger, mentally clearer. It was so transformative and healing to me." See also: Sign up for AARP's Health Newsletter Perdue is a convert to the church of dance – which some people consider a cure for much of what ails us. It may not be the answer to every health crisis, but there's no doubt that it can benefit the body and mind in many ways. Some of the physical effects are obvious: dance can – among other things — boost cardiovascular health and bone strength (because it's weight-bearing exercise), as well as improve balance and flexibility. But there’s evidence it does much more. A study published in The New England Journal of Medicine investigated the effect leisure activities had on the risk of dementia in the elderly. Researchers found that frequent dancing was the only physical activity of the 9 studied that appeared to lower the participants’ risk of dementia considerably. The lead author of the study, Joe Verghese, a professor of Neurology at Albert Einstein College of Medicine, says he's not sure why dancing had such a unique effect, but surmises that, "unlike many other physical activities, dancing also involves significant mental effort and social interactions." Both intellectual and social stimulation have been shown to reduce the risk of getting dementia. Dance seems to help Parkinson's patients as well, says Citlali Lopez-Ortiz, a research scientist at the Rehabilitation Institute of Chicago. She volunteers as a dance teacher for a class of Parkinson's patients twice a week. "The focus is on helping them find new ways of moving and to improve the speed at which they move," she says. Lopez-Ortiz introduces slow, ballet-like movements, sometimes taking the class to see the Joffrey Ballet for inspiration. With time, her students often become more mobile, and more confident. (She was thrilled when a student sent her an email telling her that for the first time in two or three years he was able to run for the bus.) More on Dancing Learn how to dance like a star. Watch Dance to keep your mind sharp. Read Meet the dance pro Corky Ballas. Read

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Acetyl-L-Carnitine.org L-Carnitine vs Acetyl L-Carnitine « Acetyl-L-Carnitine Facts Diet Pills » Can Acetyl L-Carnitine and Alpha Lipoic Acid Increase Strength and Performance? Just recently, scientific interest in alpha lipoic acid (ALA) and acetyl L-carnitine (ALC), has exploded and a large number of studies are now under way with human trials. The initial results used on mice looked encouraging, but what are the implications for human use– and can these nutrients be harnessed to improve performance? The reason for the increase of interest is because of a study done in California that found a significant increase in strength, memory, and energy in older aged mice. In this study the mice were given Acetyl L-Carnitine and Alpha Lapoic Acid to see if it would help increase the amount of energy that is produced from mitochondria. Carnitine is an amino acid that carries fatty acids into the mitochondria, where they are ‘oxidised’ to help create energy. Acetyl L-carnitine is very similar to the amino acid carnitine. Levels of acetyl L-carnitine tend to decrease after the age of 40. The main role of acetyl L-carnitine (ALC) is to carry fatty acids from the cytosol a par of the cell into the mitochondria another part of the cell so that these fatty acids can be oxidised for energy. Although L-carnitine carries out this role too, acetyl L-carnitine (ALC) also provides acetyl groups, from which acetyl-coenzyme-A can be regenerated, thereby facilitating the transport of metabolic energy and boosting mitochondrial activity. Acetyl L-carnitine (ALC) has a greater solubility in water, which helps it diffuse easily across the inner wall of the mitochondria and into the cell cytosol. This simply means that acetyl L-carnitine can reach parts of the cell and body that L-carnitine cannot and also enhances the action of the mitchondria. Acetyl L-carnitine (ALC) is also involved in the production of the key brain neurotransmitter acetylcholine and is also able to donate its acetyl group in a number of other biochemical reactions. This function explains why some studies have shown an increase in brain function. Alpha lipoic acid (ALA) is an antioxidant, which occurs naturally, in foods such as spinach, broccoli, beef, yeast, and organs such as the kidney and heart. Alpha lipoic acid (ALA) water soluble and fat soluble, which allows it to exert an antioxidant effect in almost every part of the body, including the brain. In the mitochondria, alpha lipoic acid (ALA) can act both as an antioxidant, capable of recycling other antioxidant nutrients such as vitamin C and vitamin E, and as a coenzyme for key metabolic enzymes involved in energy production. In addition to its role as an antioxidant, alpha lipoic acid (ALA) also raises the levels within cells of a substance called glutathione, which is critical for neural function, and aids in glycolysis, the first stages of breaking down carbohydrates for energy. As I mentioned earlier an increase interest in Acetyl L-Carnitine and Alpha Lapic Acid started with a team of researcher in California performed a study on elderly rats. A study before hand found that Acetyl L-Carnitine could reverse age related decline in the mitichondrial of rats. The problem was that their was an increase in oxidative damage. To revese this problem the antioxidant Alpha Lipoic Acid was added. They were hoping that they would get both to work with each other to cause an increase in mitochondrial energy production and reduced mitochondrial damage. The mix of both of these supplements seemed to work and produced the best results that they had seen. After a month of supplementation the rats had more energy and performed better memory tests. The rats being fed the supplementation showed signs of being middle aged rats rather than elderly rats. Could it Work For Humans? In a few months that followed the initial study, a number of human studies were started, many of which are still going on today. The problem that these studies face, is that humans live a lot longer than rats and it takes much longer to get proven and sound evidence of the effect of acetyl L-Carnitine and Alpha Lipoic Acid on humans A double blind, placebo controlled study was done at San Francisco State University on the effects of acetyl L-carnitine and alpha lipoic acid on humans. The study used biomarkers to determine the oxidative stress placed on the human body. The study found that there was a significant decrease in the oxidative stress on the human body for people taking the supplements compared to the people taking the placebo. If acetyl L-Carnitine and alpha lipoic acid can really decrease oxidative stress on the human body then this could be a huge benefit for middle aged and elderly people. The results of the test may also be important for athletes who have an increase in exercise induced oxidative stress. More human studies are under way, but so far there are no published human studies available, although positive studies in animals continue to proliferate. Last year, American researchers demonstrated that alpha lipoic acid (ALA) supplementation in older racehorses reduced the oxidative stress burden even under light training loads, while a number of other animal studies have shown that acetyl L-carnitine (ALC)/ALA supplementation reduces oxidative stress and improves mitochondrial function in a number of tissues, including brain, muscle and heart. In another study, researchers examined the effects of acetyl L-carnitine (ALC)/alpha lipoic acid (ALA) therapy on ageing and hearing in rats, and found that it reduced the normal age-associated deterioration in auditory sensitivity and improved inner ear function. They concluded that these improvements were related to the acetyl L-carnitine (ALC)/ALA combination’s ability to protect and repair age-induced mitochondrial DNA damage, thereby boosting mitochondrial function and improving energy turnover. However, while the initial evidence from animal studies looks extremely promising, the jury is still out as far as humans are concerned. As studies continue to poor out it is important to remember to take these studies one at a time. It is important to get all the details from more conclusive studies before jumping to conclusions. Acetyl L-carnitine is a fairly expensive supplement and the cheaper L-Carnitine supplementation has not be used in studies. One important thing to note with this research is that if the supplementation of acetyl L-Carnitine and Alpha Lipoic acid help repair and strengthen the Mitochondria then there is a good chance that this supplementation can help increase the average age and energy of humans. Proceedings of the National Academy of Sciences, 99; 1876-1881, 2002 J Nutr, 132(6 Suppl 2): 1628S-31S, 2002 Am J Otol, 21(2): 161-7, 2000 Med Hypotheses, 56(5): 610-13, 2001 High Alt Med Biol, 2(1): 21-29, 2001 Exp Gerontol, 37(2-3): 401-410, 2002 Bipolar Disord, 4(1): 61-66, 2002 Int Clin Psychopharmacol, 18(2): 61-71, 2003 Alpha Lipoic Acid and Acetyl L-Carnitine Can they improve sports performance?, article. Acetyl L-Carnitine & Alpha Lipoic AcidAcetyl-L-Carnitine FactsDiet Pills Adapexin P Contact Us | Terms of Use | Trademarks | Privacy StatementCopyright © 2010-2012 Acetyl-L-Carnitine.org. All Rights Reserved.

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/ March 2009 Volume 5 Number 7Chair's Columnby Vickie Yates Brown, Frost Brown Todd LLC, Louisville, KYThe Health Law Section held its 10th anniversary Emerging Issues Conference (EMI) recently at the Disney Yacht Club Resort in Lake Buena Vista , Florida. EMI was an overwhelming success. It is important to recognize and thank the Health Law Section staff and planning committee for a job well done. Their hard work, dedication, and attention to detail made this event an enjoyable, productive experience for all.As is the tradition, the current chair of the Section delivers a State of the Section address at the conference. The address began by recognizing the attendees who have attended all 10 of the EMI conferences. In addition, present and past Council members were recognized as well as the Section’s very capable staff and the winner of the law student writing competition, Lauren Nuffort. My State of the Section comments are set out below.The Health Law Section is a fairly young Section in the ABA; it is about 12 years old. Time has passed quickly, but close friendships have been established among those active in the Section. We have seen the markers indicated by the passage of time – we’ve celebrated births, seen children growing into adulthood and have even experienced the unexpected death of a dear friend and former Chair of this Section.The Council hopes you take pride in your membership in the Section and its accomplishments. The Health Law Section is a special group. Remember – this is your Section!I would now like to bring you up to date on its accomplishments, challenges and direction for the future.INVOLVEMENT IN ESTABLISHING PUBLIC POLICY: I want to first address the issue of influencing Public Policy. This is one of the Section’s foremost evolving accomplishments – its credibility to affect health care policy. This did not just happen overnight. This is something that has been gradual, systematic and a reflection of the respect the Section has built over the past 12 years. This credibility is due to a number of factors, including the important work of the Interest Groups, such as preparing government submissions, planning and hosting informative, practical and timely teleconferences and writing and publishing on cutting edge issues.The Council has also established task forces to study and advise on certain discreet issues. These task forces are established for specific purposes and for finite periods of time. One of these is the Section’s Access Task Force charged to study the issue of health care reform. This task force will interface with government and will work to influence ABA policy on the issue. The task force is also preparing a report and recommendation on anticipated elements of health care reform for submission at the ABA annual meeting. This task force is working with and servings as a resource to the ABA’s Access task force.This Section has also established a sort of think tank group known as the section’s Health Care Policy Task Force to identify, study and advise the Council on certain cutting-edge issues. This task force is currently working on topics in telemedicine and is preparing proposed policy for the ABA on issues surrounding “Direct to Consumer Genetic Testing” and Physician/Pharma Issues. The Council anticipates that this task force will have reports and recommendations on these issues ready for debate at the annual ABA meeting in August.These task force leaders, along with others in the Section, recently met in Washington, D.C. for a government submissions meeting to coordinate our efforts and establish a plan. I think you will see the Section becoming even more active in responding to what government does. The Interest Groups will be an integral part of this effort. We anticipate that efforts on health care reform will intensify soon now that the Stimulus Bill has been signed. The Section will continue to monitor and become more involved at appropriate points during this debate.INTEREST GROUPS: The Council will continue to examine whether the Interest Groups should be reorganized, such as forming subcommittees within some of them, updating their names and purposes, and establishing new ones. The Interest Groups are so important to the success of the Section it is essential they remain relevant. Your involvement in the work of the Interest Groups is important and your thoughts and suggestions would be greatly appreciated.MEMBERSHIP: We track membership of all types of member classifications, including health care attorneys, associate members, and law students. Membership appears to be stabilizing and in fact membership of health care attorneys and law students is trending up.PROGRAMMING: The Section has held two live programs since August – Washington Healthcare Summit and EMI. Both programs have been successful. Washington Healthcare Summit has become a solid conference as an opportunity to visit contacts on the Hill who are working on issues important to Health Lawyers. The Washington Healthcare Summit has proven to be an effective venue for the section to establish credibility in the area of Health Care Policy – making the summit popular with government attorneys who attend and speak at the conference.The success of our live programs allows us to make the teleconferences available to you at affordable rates. The Teleconference Fundamentals Series has been extremely well received. The Council will be considering additional program options such as providing programming through videos, iPods or other special conferencing capabilities.PUBLICATIONS: Publications are going well. The Section just published its newest book on patient safety organizations. The Section is also considering increasing its publications by publishing white papers on particular issues. We are very proud of The Health Lawyer and it continues to be one of the best scholarly resources on timely issues for practicing health attorneys. We also appreciate the Interest Group monthly contributions to the eSource, the Section’s monthly electronic newsletter.PUBLIC SERVICE: Our Section continues to place importance on public service. The Section continues its efforts to train attorneys to represent breast cancer patients through its breast cancer initiative and it also continues to work with the Centers for Disease Control and Prevention on the Expedited Partners Initiative. This program is getting a lot of positive feedback and as a result many states are now inquiring about how to set up such programs. This initative was discussed in more detail during one of the presentations at EMI.FINANCES: We have challenges in these tough economic times, but Council is committed to maintaining member services in spite of the downturn in the economy. The Council finance committee will continue to monitor this closely.Remember: This is your Section. Attending EMI is a great opportunity to identify ways to get involved in the Section. EMI is essentially our Section membership’s annual meeting and educational program. Section leadership is here and accessible, including the Council and Interest Group leaders. I want to encourage each of you to get involved with your Section. There is a lot to do and the Council needs your help.I also want you to know that it has been a privilege for me to serve as your Section Chair. I began my remarks by noting the success of the Section and that one of the benefits of Section involvement has been the friendships which have established through the years. The Section offers this “Recipe for Success”:Recipe for Section’s Success2 C. knowledge2 C. willingness to share and become involved1 C. fun½ C. Courtesy¼ C. friendly wordsA pinch of praiseNo baking, steaming, or stewing needed. Season with the spice of life. Serve in generous portions topped with kindness and respect.I think that sums up our Section’s Recipe for Success and is the reason the State of the Section is positive, even during these difficult economic times.The ABA Health eSource is distributed automatically to members of the ABA Health Law Section . Please feel free to forward it! Non-members may also sign up to receive the ABA Health eSource.

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News, events and publications: News, events and publicationsHealth newsAll health news Sewage treatment contributes to antibiotic resistanceJul22 Wastewater treatment plants are unwittingly helping to spread antibiotic resistance, say scientists. Their research suggests that processing human, farm and industrial waste all together in one place might be making it easier for bacteria to become resistant to a wide range of even the most clinically-effective antibiotics.It seems that with so many different types of bacteria coming together in sewage plants we could be giving them a perfect opportunity to swap genes that confer resistance, helping them live. This means antibiotic-resistant bacteria may be evolving much faster than they would in isolation.The research, published in Journal of Antimicrobial Chemotherapy, shows that there are now reservoirs of highly resistant gut bacteria in the environment, threatening human and animal health.It suggests we urgently need to find new ways to process waste more effectively so we don't inadvertently contribute to the problem of drug-resistant bacteria. 'The way sewage plants mix up different types of waste means they're hotspots, helping bacteria share genes that mean they can deactivate or disarm antibiotics that would normally kill them,' says Professor Elizabeth Wellington of the University of Warwick, who led the study. Earlier studies have suggested that farming and waste processing methods contribute to reservoirs of resistant bacteria in the environment. But, until now, very few studies had looked at whether or not wastewater effluent contributes to the problem. 'A greater volume of antibiotics is used in farming than in anything else. Huge amounts are used globally, mainly for treating infections in food animals but also to promote growth,' Wellington says. She and colleagues from the universities of Warwick and Birmingham, and the Health Protection Agency, decided to see if they could find any of these bacteria near wastewater treatment plants. They analysed sediment samples from both upstream and downstream of a sewage works. They found many more bacteria resistant to a class of clinically-important antibiotics called third-generation cephalosporins (3GC). These drugs are broad-spectrum antibiotics used to treat a whole range of problems, including meningitis, septicaemia, and so-called hospital-acquired infections. Most worryingly, the scientists found that 3GC-resistant E. coli were seven times more common downstream of a UK sewage plant than upstream. 'Our findings suggest that resistance is spreading, because of a gene called blaCTX-M-15. This gene is carried on a mobile genetic element called a plasmid. Bacteria collect these genes to allow them to adapt to their environment,' says Wellington. 'This is a big deal, because this is the most common bacterial antibiotic resistance gene causing failures in treatment of infections, and it's the first time anyone has seen this gene in UK rivers. The problem is we're use river water to irrigate crops, people swim or canoe in rivers, and both wildlife and food animals come into contact with river water.' 'These bacteria also spread during flooding. And with more flooding and heavy rain, this could get worse.' 'Primarily what we've shown is that there are increased numbers of clinically-important antibiotic resistant bacteria in sediment downstream of a large waste water treatment plant, which is significant given the types of resistance genes we've identified. There is some evidence that selection may have taken place in the plant or in the river, based on genetic analyses of the resistance genes,' says Dr William Gaze of the University of Exeter, co-author of the study. A previous study found that a third of people swimming in areas of the River Thames come down with some kind of stomach bug, highlighting the threat to human health posed by rivers. 'You really run the risk of getting gastroenteritis,' added Wellington. 'An important outcome of the research was the discovery of environmental bacteria such as species of Pseudomonas bacteria with the same extended spectrum beta-lactamase genes as those found in the pathogenic strains of E. coli. It is therefore possible these bacteria acquired the genes in situ either in a treatment plant or more likely in the river,' says Wellington. As well as finding antibiotic-resistant bacteria downstream of the sewage plant, Wellington and her colleagues found E. coli which has become resistant to a less commonly used antibiotic called imipenem in the same region of the river – the first time such bacteria have been found in the wild. 'We've completely underestimated the role waste treatment processes play in antibiotic resistance,' says Wellington. 'Stricter regulations and higher levels of treatment are needed if we are to halt the rise in antibiotic resistance in the environment,' write the authors in their report. 'We're now looking at ways to get wastewater treatment plant effluent cleaner,' says Wellington. 'But we're keen not to point the finger at these plants. There's contribution from everywhere.' In 2013, Chief Medical Officer for England, Prof Dame Sally Davies, described the threat of antimicrobial resistance as a ticking time bomb, adding that it's as much of a threat as terrorism. 'We're on the brink of Armageddon and this is just contributing to it,' Wellington says. 'Antibiotics could just stop working and we could all be colonised by antibiotic-resistant bacteria.' This work was supported by the Natural Environment Research Council, co-author Dr Greg Amos was supported by a Biotechnology and Biological Sciences Research Council studentship, and co-author William Gaze has been supported by the European Regional Development Fund and European Social Fund since moving to the University of Exeter. This article first appeared in Planet Earth Online. ENDS Reference: G. C. A. Amos, P. M. Hawkey, W. H. Gaze and E. M. Wellington, Waste water effluent contributes to the dissemination of CTX-M-15 in the natural environment, Journal of Antimicrobial Chemotherapy 2014; 69: 1785 – 1791, published online 5 May 2014, doi:10.1093/jac/dku079. Tags: human health, industry, microbes, The University of Warwick Previous in Health21 July 2014 - Researchers develop new, powerful single-cell technique to study environmental effects on DNANext in Health24 July 2014 - Study shows how we metabolise folic acid risks overexposure

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A Bristol-Myers Squibb Company (BMY) Employee & Worries Over Its Diabetes Drug 3/6/2013 7:56:54 AM File this under ‘how to make a splash on the new job.’ In a curious footnote to a controversial study that was published last week about the risks of a pair of diabetes drugs, an accompanying editorial that also expressed concerns was co-authored by a researcher who was recently hired as a medical science manager by Bristol-Myers Squibb, which also sells one of the medicines featured in the study. As we reported, the study indicates that Byetta, which is sold by Bristol-Myers, and Januiva, the widely used Merck medication, can double the risk of developing pancreatitis, which is an inflammation of the pancreas that is linked to cancer and kidney failure (here is the abstract). This issue has plagued both drugs over the past few years, although the findings were quickly denounced by the drugmakers, Wall Street analysts and professional physician groups. Meanwhile, a two-page commentary also raised questions about the wisdom of using the drugs, which increase GLP-1, a hormone that stimulates insulin production from the pancreas. One of the two authors, however, was Belinda Gier, who was hired on February 1 as a medical science manager at Bristol (BMY). This detail, though, was not listed initially. Instead, her employment was updated yesterday, a change first noted by Retraction Watch. At first, her only affiliation was listed as the Larry Hillblom Islet Research Center at the University of California, Los Angeles, and David Geffen School of Medicine. But an ‘editor’s note’ says, “at the time this commentary was solicited, submitted, reviewed, and accepted for publication, the editors were unaware that Dr. Gier had any pending affiliation with Bristol-Myers Squibb.” Angry Parents Force Johnson & Johnson (JNJ) to do Damage Control Former AstraZeneca PLC (AZN) Employee Arrested for Bilking Drugmaker Manufacturing Jobs Outpace High-Tech Growth in Chicago Area Biopharma Employment Survey Upbeat About 2013 FDA Finds Problems Continue at IMPAX Laboratories, Inc. (IPXL) Factory in Hayward Drugmakers Weigh Carve-Outs as Abbott Laboratories (ABT), Pfizer Inc. (PFE) Set Pace Roche (RHHBY) Slapped for Vodka Shots & Dancing on Stage First Single Gene Mutation Shown to Result in Type 1 Diabetes, University Hospital in Basel Study Fresenius SE, B. Braun IV Fluids Tied to More Deaths, Study Finds Aurobindo Pharma Gets FDA Nod for Anti-Diabetes Drug Please enable JavaScript to view the comments powered by Disqus. Biotech/Pharma - Industry

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Five Star Cardiac Care NATIONAL RATINGS RECOGNIZE EISENHOWER’S QUALITY CARE Eisenhower Medical Center has received five star ratings for cardiac services for the Treatment of Heart Failure and the Treatment of Atrial Fibrillation in 2008 by HealthGrades®. Their Tenth Annual HealthGrades Hospital Quality in America Study, the largest study of its kind, analyzed patient outcomes at virtually all of the nation’s 5,000 hospitals over the years 2004, 2005 and 2006. The areas of cardiac care analyzed by HealthGrades include specific surgical procedures, such as coronary bypass surgery, as well as broader treatment areas like heart failure or atrial fibrillation, that encompass multiple treatment options for the condition. HealthGrades rates hospital programs in six different areas of cardiac care: coronary bypass surgery, a heart operation that uses blood vessels to “bypass” clogged coronary (heart) arteries so that blood can flow through the heart valve replacement surgery coronary interventional procedures, which are non-surgical procedures such as angioplasty or the placement of a stent to improve blood flow through clogged coronary arteries heart attack heart failure, in which the heart function declines due to a variety of conditions, and the heart is unable to pump blood effectively to other organs atrial fibrillation, an abnormal heart rhythm that puts patients at higher risk of stroke In each of these areas, analysts review Medicare data from virtually every hospital in the country, and analyze patient clinical outcomes for each program. HealthGrades ranks the outcomes with five stars for programs whose outcomes are better than expected, three stars for those that are as expected and one star for outcomes that are worse than expected. The Medicare population represents a majority of patients for most of the clinical areas reviewed by HealthGrades; for instance, Medicare patients account for 55 to 60 percent of all cardiac patients. QUALITY CAREEisenhower Smilow Heart Center, Eisenhower’s Cardiac Center of Excellence, offers comprehensive cardiac services, incorporating all of the medical and surgical disciplines involved in the care of patients. Eisenhower Medical Center is: Five Star Rated for Care of Heart Failure (2007 and 2008) Five Star Rated for Care of Atrial Fibrillation (2008) Rated Best in the Palm Springs Area for Overall Cardiac Care (2008) In addition to the cardiac care rankings, Eisenhower Medical Center received HealthGrades’ 2008 Distinguished Hospital Award for Clinical Excellence™ and the 2008 Distinguished Hospital for Patient Safety Award™. Eisenhower is one of only 80 hospitals in the nation to receive both awards, ranking it among the top five percent of hospitals in the nation in both categories. WHY ARE QUALITY RATINGS IMPORTANT? At a five star hospital like Eisenhower, patients can expect superior heart care and the best clinical outcomes. Five star ratings are awarded to only the top 10 to 15 percent of hospitals in each category. “Our nurses, physicians and staff work diligently to ensure our patients receive the best care possible,” says Louise White, Chief Nursing Officer and Vice President, Patient Care Services, Eisenhower Medical Center. “This acknowledgement from HealthGrades validates the work we have done and continue to do together, as we elevate patient care at Eisenhower Medical Center.” In its report, HealthGrades also noted that if all hospitals performed at the level of five star rated hospitals across 18 conditions reviewed in their overall study, 266,604 Medicare lives could have been saved. Of the potentially preventable deaths, 52 percent were associated with just four common hospital diagnoses, one of which is heart failure. Across all procedures and conditions studied, there was an approximate 71 percent lower chance of dying in a five star rated hospital compared to a one star rated hospital. Mortality rates were found to have improved 12.8 percent from 2004 to 2006 at the top-rated hospitals, as compared to 11.4 percent at the lowest rated hospitals. The outcome measures compare patient survival rates during a patient’s hospital stay, as well as one month after the patient’s release, and then again six months after release from the hospital. HealthGrades ratings are risk-adjusted, taking into account the differences in the degree of illness of each hospital’s patient population to make fair comparisons between hospitals. “Patients will find not only the most skilled physicians and latest technology, but also a safe, caring and healing environment.”For cardiac patients, the HealthGrades ratings provide an objective measure that can help them determine the best programs to treat the most serious cardiac conditions. Eisenhower Smilow Heart Center provides a full range of advanced cardiac care services. Patients will find not only the most skilled physicians and latest technology, but also a safe, caring and healing environment. EISENHOWER’S ATRIAL FIBRILLATIONPROGRAM RECEIVES FIVE STAR RATING Atrial fibrillation is one of the most common heart conditions, affecting three to five percent of the population over 65. A rapid, irregular heartbeat is caused by abnormal electrical impulses that cause the upper chambers of the heart to quiver. As a result, blood can pool in the atria and form clots that can travel to the brain and cause a stroke, significantly increasing the risk of stroke. Eisenhower is one of only a few centers in the country to offer a comprehensive approach to treat atrial fibrillation. Board Certified Electrophysiologists Leon Feldman, MD and Andrew Rubin, MD and Board Certified Cardiothoracic Surgeons S. N. Mitruka, MD and Joseph Wilson, MD lead Eisenhower’s Interventional Atrial Fibrillation Program, which customizes treatment for each patient and employs state-of-the-art technology. In 2004, 2005 and 2006, Eisenhower treated two and a half times more patients for atrial fibrillation than the national average among hospitals. Six months after treatment, Eisenhower’s atrial fibrillation patients have survival rates nearly five and a half percent better than the national average and nearly two percent better than other hospitals that received a five star rating for treatment of atrial fibrillation. [PHOTO dir="assets/news/story/tablePg36.JPG" align="center" caption="Treatment of Atrial Fibrillation" width="571"] EISENHOWER SMILOW HEART CENTER GET TO KNOW US, BEFORE YOU NEED US. Eisenhower Smilow Heart Center treats thousands of patients each year for all of the medical and surgical disciplines involved in the care of heart patients, from stress tests to angiography to open heart surgery. Eisenhower Medical Center was only the fourth center in California and the first in the Coachella Valley to receive accreditation by the Society of Chest Pain Centers. Studies show that Chest Pain Centers increase the chances of survival for patients with acute coronary syndromes by 63 percent. Eisenhower Medical Center was the first hospital in the Coachella Valley to receive designation as a STEMI (ST-Elevation Myocardial Infarction) Receiving Center for the treatment of patients having heart attacks. Primary intervention is to take patients to the Cardiac Catheterization Lab for emergency percutaneous coronary intervention (PCI)—a surgical procedure that opens narrowed or obstructed blood vessels. Eisenhower has two state-of-the-art Cardiac Catheterization Labs, where more than 2,000 cases were performed in the past year. Eisenhower Smilow Heart Center participates in clinical trials that offer patients promising new therapies that would otherwise be unavailable to them. Eisenhower’s Board Certified Cardiothoracic Surgeons perform more than 400 procedures annually. Eisenhower’s Interventional Atrial Fibrillation Program is one of fewer than ten in the nation to offer comprehensive services for the treatment of atrial fibrillation. Eisenhower Smilow Heart Center is among only a few cardiac surgery programs in the United States to perform the minimally invasive thoracoscopic maze procedure. The only fully-dedicated Electrophysiology Laboratory in the Coachella Valley, with nearly 800 cases each year. Eisenhower Renker Wellness Center—which includes the Glickman Heart Failure Clinic, Tamkin Cardiac and Pulmonary Rehabilitation program, state-of-the-art cardiac monitoring and exercise equipment—rated among the best (the top one percent) of the more than 3,000 cardiac rehabilitation centers in the United States by the American Association of Cardiovascular and Pulmonary Rehabilitation. A dedicated team of anesthesiologists, pulmonologists, perfusionists (heart-lung machine operators), surgical assistants and nurses specializing in the care of cardiac patients from admission to discharge. For more information about Eisenhower Smilow Heart Center and its programs, please call 760-837-8450. Healthy Living Magazine is a publication of Eisenhower Medical Center · © Copyright 2014 All Rights Reserved · Email the Webmaster

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/ Web-Only / Feature April 10, 2012, 12:01 AM How to Be Smarter An exclusive excerpt from Drop Dead Healthy, a new book in which Esquire's writer-at-large seeks to become the healthiest man in the world. Herein, his quest for the perfect brain. With hairnet. Michael Cogliantry via Simon & Schuster I'm back at the Brain Resource Center for my cerebral workout. I sit on Dr. Fallahpour's black leather chaise longue, my eyes trained on a computer screen, five electrodes dotting my scalp. The screen has three vertical bars — blue, red, and green — that bounce up and down in response to my brain's electrical activity. My job is to keep the bars inside their target zones. How? It's hard to explain. "Think of it this way," says Fallahpour. "It's like one of those freeway signs that shows your speed in real time. It says you're going seventy-five mph in a fifty-mph zone, and you slow down." If my brain nudges the bar above the line, I get a reward: relaxing tibetan chimes through my headphones. This regimen is neurofeedback, and Dr. Fallahpour is one of the country's experts on it. Neurofeedback, the idea that you can learn to control your brainwaves to improve your concentration and lower your stress, is a controversial procedure. It's far from proven science, and some dismiss it as flaky. But there's some evidence that it might be useful, including a study by the National Institutes of Mental health that found it could help combat attention deficit hyperactivity disorder in kids. A Stanford experiment has used neurofeedback involving brain imagery to alleviate some chronic pain. It's a strange feeling to try to manipulate your brain waves. "Okay, now focus on the sounds of the bells," I say to myself. That seems to work. The bells chime, the bar stays up. so I tell myself, "Let's make a note of that strategy. Concentrate on the bells." But as soon as I take myself out of the moment and make a note of the strategy, the bells go silent and my bar drops. It's like meditation turned into a video game. I did neurofeedback a half-dozen times, not as many as Fallahpour recommended. So many body parts, so little time. What I did, though, I liked. I always left feeling calm but energized, like I'd just had espresso but with no jitters. Overall, after my month of neurofeedback and neurobics and math and arguments, do I feel like my brain is less flabby? It's hard to quantify, but... yes, a little. I'm faster at math problems. I took an online intelligence test and scored 23 percent better at the end of the month. I can memorize poems more quickly. I played the card game hearts last weekend. Usually, I'm happy to play on hunches and vague approximations. But this time, my well-toned brain felt up to counting cards. I still lost the game, but I felt more precise doing it. It could all be the placebo effect. but as I've said before, the placebo effect is a godsend. Memories of My Grandfather I go to lunch at my grandfather's on a chilly Thursday. I open the door and spot him in his usual pose, sunk deep in his recliner, his slippers up, watching CNN. He smiles and gives me his signature raised-fist salute. With his daughter Jane's help, my grandfather heaves himself up and shuffles over to the lunch table. "We went out to dinner last night, didn't we, Poppy?" Jane says as we settle in. "Where'd you go?" I ask my grandfather. He pauses, searching his brain. "Well, I know I had something to eat, so that's a start," he says, then chuckles. My grandfather's memory is slipping away. But it's a selective vanishing — only for recent events. Any story that happened in the fifties and sixties — he knows it cold. This is officially called "Ribot's Law," named for the French psychologist who first studied it. The more times we recall a memory, the more encoded it becomes. Recent memories haven’t had time to gel into the brain's circuitry. And in my grandfather’s case, Ribot's Law means that visitors spend a lot of time reminiscing about the distant past. Which is okay by me, even though I've heard the same stories a dozen times. Today, we talk about the time my grandfather bought a pet alligator for my aunt Kate. They kept it in the bathtub until it nipped a guest and had to be given to the Bronx Zoo. A mention of Egypt leads to his favorite Africa story. I know it so well, I could recite it in stereo with him. In 1959, my grandfather helped organize what’s called the "Airlift to America." The goal was to get hundreds of Kenyan students to study in United States colleges and then have them return home to lead their country. My grandfather raised money in New York, then, on two days' notice, he flew to Kenya to conjure up some more. He didn't even have time to get his shots, so he took a syringe and a bottle of refrigerated medicine with him on the plane. He later forgot the medicine in the Nairobi hotel fridge. "I think it's still there today," he says, every time he tells the story. He bounced across unpaved roads in a Jeep to spread the word to Kenyan villages. He became the proud owner of a goat in a local auction — which he then donated to the cause. My grandfather wrote back home that the experience was "as inspiring as anything I have ever seen. Words cannot do justice to the reverence these people showed for education." My grandfather and his partners raised enough cash to charter planes that carried eight hundred students from Nairobi to New york. One of those students lived at my grandparents' house in Riverdale for a year while he studied economics at Columbia. More students longed to study in America than could fit on the planes. So the foundation provided scholarships to several other Kenyans. One of those students ended up at the University of Hawaii. His name was Barack Obama Sr. My grandfather — a lifelong Democrat — still gets misty-eyed when Barack Obama Jr. gives a speech on TV. What a feeling that must be, to be so enmeshed in history. In 2009, an author named Tom Shachtman wrote a book called Airlift to America. My grandfather keeps it on the living room coffee table. It might be pushing it, but I wonder if the Africa trip — and his other charity work — is one secret to my grandfather's longevity. Several studies argue that charity is good for your health. One MRI study showed that giving to charity lights up the pleasure centers of the brain. It's been called "helper's high." A 2004 Johns hopkins study concluded that volunteering slows mental and physical aging. You're more engaged, more challenged physically and cognitively. After my grandfather finishes the Obama story, I check my cellphone clock. I have to leave. "Can you give me a ride?" asks my grandfather. "Where are you going?" Jane asks him. He pauses. "Where I was before." "You've been here all day," she says. "This is your home." "Oh," my grandfather says. "Right." The mist seems to clear, at least momentarily, and he gives me another raised-fist salute. --From Drop Dead Healthy by A.J. Jacobs. Copyright © 2012 by A. J. Jacobs. Printed by permission of Simon & Schuster, Inc. CLICK HERE TO ORDER IT NOW >>

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Search Health Information Vitamin D Deficiency Often Seen in Traumatic Bone BreaksLow levels common in adult patients of all ages, study finds FRIDAY, Sept. 13 (HealthDay News) -- Low levels of vitamin D are commonly found in people who suffer traumatic bone fractures, according to a new study. Because vitamin D is an essential component in repairing bone damage, patients with low vitamin D levels are at higher risk for improper healing of broken bones. The University of Missouri researchers examined vitamin D levels in about 900 adults who suffered traumatic bone fractures as the result of incidents such as falls and car crashes. About 79 percent of men and 76 percent of women in the study had lower-than-recommended vitamin D levels, and about 40 percent of the women and 38 percent of the men had severely low vitamin D levels. "One interesting finding of the study is that low and deficient vitamin D is common for orthopedic trauma patients of all ages," Brett Crist, an associate professor of orthopedic surgery, said in a university news release. "We found that among young adults 18 to 25 years old, nearly 55 percent had low or severely low vitamin D, and 29 percent had deficient levels." The study was presented at the annual meeting of the American Academy of Orthopaedic Surgeons, as well as at other conferences. The data and conclusions should be viewed as preliminary until published in a peer-reviewed journal. Based on their findings, the researchers have started prescribing vitamin D medication for nearly all patients with broken bones as a protective measure to reduce the risk of healing problems. "More research is needed to demonstrate whether vitamin D medications can reduce the risk of bones not healing properly," Crist said. "But we know vitamin D is required for repairing damage to bones, and for most people there is very little risk in taking vitamin D medications. At this point, we believe it's a reasonable step for physicians to prescribe the medication as a protective measure." However, high levels of vitamin D can be dangerous for people with certain medical conditions, such as kidney disease or cancer. People should talk to their doctor before using vitamin D supplements, Crist said. The Harvard School of Public Health has more about vitamin D and health. SOURCE: University of Missouri, news release, Sept. 5, 2013 Copyright © 2013 HealthDay. All rights reserved. Finger Lakes Health 196 North Street, Geneva, NY 14456 315-787-4000

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As a pioneer in the development of treatments for rare disorders, Genzyme recognizes our responsibility to maintain transparency and an open dialogue around the factors affecting the cost of therapy. Products, Pricing, and Patients One of the realities of modern health care is that medical treatment can be expensive. This is especially so for rare diseases such as lysosomal storage disorders (LSDs). Yet for thousands of patients worldwide, these treatments have been transformative when no other treatment option was previously available. In the interest of promoting patient access to treatment globally, Genzyme takes a highly responsible approach in establishing the price of our products. We work closely with national health services and private insurers around the world to ensure that these products are accessible to covered patients. In developing countries, we help physicians and local authorities build sustainable health care systems that can pay for treatment – and where such systems do not yet exist, we provide our products free to patients to the best of our ability. Ensuring Patient Access Genzyme believes that developing transforming therapies carries with it the responsibility to increase access to these treatments for patients, regardless of their location, financial situation, or other circumstances. We have charitable access programs around the world to provide all of our enzyme replacement therapies for free to patients in need. Learn more about our Free Drug Programs Nevertheless, we recognize the concerns about the cost of these products, and we're committed to openly sharing our approach to pricing to help patients, physicians, insurers, governments, the press, and others understand the many complex issues. Factors Affecting the Cost of Treatment Genzyme produces four enzyme replacement therapies (ERTs) and one oral treatment for LSDs. While the products treat different diseases, they are all similarly affected by several factors that contribute to their cost – described below. Product Development Costs Developing any medication is an expensive endeavor – costing from hundreds of millions to well over a billion dollars. The expenses include early research and development as well as years of clinical trials. Moreover, regulatory agencies often require post-marketing studies, so development costs may continue for years even after product approval. The cost of therapies also makes it possible for Genzyme to continue research to develop new and improved treatments. Such efforts are currently underway to develop next-generation treatments for Pompe disease and Fabry disease, as well as therapies for rare diseases with no approved treatment options such as Niemann Pick disease type B. Health Benefits and Value to the Health Care System LSDs are complex, chronic diseases characterized by worsening progression if not treated. For many patients, our products can alter the course of their disease and alleviate symptoms. Our products deliver significant value to patients and the larger health care system by reducing the need for critical care services, costly procedures, and hospitalizations, and enabling patients to have greater independence and continue to work and care for a family. Our therapies are personalized medicines, each developed to treat only one genetically determined disorder. As a result, our products offer a high degree of efficacy to those patients with a confirmed diagnosis who are most likely to benefit from treatment. Disease Rarity and Small Patient Populations The most significant factor affecting the cost of our LSD therapies is the rarity of the diseases they treat. The U.S. Orphan Drug Act defines a rare disease as one affecting fewer than 200,000 people in the United States. The most common LSD, Gaucher disease, affects only about 10,000 people worldwide; the figures are smaller for the other LSDs. And the number of patients actually on our treatments worldwide is even lower. Thus Genzyme's development and product manufacturing costs are supported by a patient population that is a small fraction of those for most drugs. But we are committed to continuing to produce these treatments for even the relatively small groups of patients who need them. Ongoing Commitments The sustainability of Genzyme’s rare disease business model is dependent on generating sufficient revenue to support the following ongoing commitments: Developing new and better treatments to meet unmet medical needs Maintaining physician-led registries that capture information about the patient experience and provide data and insights that support ongoing research Continuing our patient advocacy initiatives which make sure patient needs are understood and addressed when we make important decisions related to our therapies Helping patients access medical benefits and reimbursement Investing in continuous improvement in our product manufacturing facilities and processes Providing educational materials for patients and physicians Sponsoring research conducted by academic labs and patient support programs led by advocacy groups We offer our perspective on several common questions raised about the cost of our products. How does Genzyme set prices for products? In setting the price of a drug, we consider all of the factors that can affect costs, including the value it delivers to patients and health care systems, development and manufacturing cost of the drug, the size of the patient population, and the essential need for Genzyme to be a viable business able to bring more drugs to patients who need them in the years ahead. What is the profit margin on these products? Like most companies, Genzyme doesn't report the profitability of individual products. Why can’t Genzyme lower the cost of these products? Genzyme has established prices for our therapies, based on the factors described above, which allow us to operate as a sustainable business. Our business was built on providing a treatment for Gaucher disease, which then allowed us to invest in developing similar treatments for Fabry disease, MPS I, and Pompe disease. These in turn supported the development of an oral therapy for Gaucher disease, providing an important new treatment option for patients. These self-sustaining business practices allow us to continue making and distributing our life-saving treatments to patients around the world. We're also committed to reinvesting in research on new treatments. We're currently conducting clinical studies of an oral drug for Fabry disease. We have also invested more than $200 million in gene therapy research, an approach that holds promise for LSD patients. Why aren't generics available for these products? Biologic products such as our ERTs are extremely sensitive to small changes in the manufacturing environment and process. Thus it's impossible to produce a true generic – and very difficult to create an acceptable biosimilar (also called a follow-on biologic). Regulatory bodies like the FDA have complex, rigorous requirements for approval of follow-on biologics. Genzyme supports the creation of a pathway for the regulation and approval of follow-on biologics, so long as they incorporate processes and requirements to ensure patient safety and treatment effectiveness. What is the price of Genzyme’s oral therapy for Gaucher disease compared to its ERT for the same disease? Genzyme’s goal is to price these treatments on par with one another to ensure that all patients are treated with the best medicine for their individual needs without considerations based on price. The price of our Gaucher therapies is based on development costs, the value these therapies bring, and the rarity of the disease. Both therapies have been shown to slow the progression of Gaucher disease, so they offer similar clinical benefits to patients and to the health care system. Back to top Last Updated: 8/19/2014 Manufacturing at Genzyme News Manufacturing Therapies Explore the complex process of manufacturing genetically engineered protein therapies from cell cultures to final product. Access to Treatment Find out how Genzyme provides free treatment to patients in need by working with local governments, humanitarian groups, and others. Read about our efforts R&D Pipeline Currently in Clinical Trials Learn about the latest product developments that are currently being studied by Genzyme, including clinical trials that are open for patient recruitment. See our pipeline

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