Expert opinion is mixed on whether a new class of painkillers will solve the problems plaguing pain management efforts.
Pharmaceutical companies are developing new classes of painkillers that purportedly would be non-addictive, lessening the use of addictive opioids that are causing workers compensation claims to skyrocket.
Indeed, the use of opioids — a $57 billion global market — represents on average nearly 40 percent of workers' comp medication costs, averaging 15 percent in the first year of the claim to 35 percent in the fifth year, according to Integrated Prescription Solutions in Costa Mesa, Calif.
The main reason is the highly addictive nature of opioids, experts say. In the 2014 report, "A Nation in Pain," St. Louis-based Express Scripts found that nearly half of those who took opioid medications for more than a month in their first year of treatment then refilled their prescriptions for three years or longer.
Addictions can also lead to death: the number of overdose deaths from prescription painkillers in 2013 roughly quadrupled from 1999, to 16,000, according to the U.S. Centers for Disease Control and Prevention.
But new classes of non-addictive medications could lessen those punches. A Wall Street Journal article last month reported on the development of experimental non-addictive painkillers by such firms as Pfizer Inc. in San Diego, Biogen Idec Inc. in Cambridge, Mass., Nektar Therapeutics in San Francisco, and Cara Therapeutics Inc. in Shelton, Conn. The new painkillers purportedly work differently than traditional opioid medications by alleviating pain without the commensurate euphoria, and hence, theoretically reducing the chance that a person would become addicted to the drugs.
Robin Hendrickson, senior vice president, workers' compensation claims at ABD Insurance & Financial Services in San Mateo, Calif., said she supports the development of such painkillers "100 percent," as increased use of opioid medications in the treatment of work-related injuries such as back strains or for post-surgical pain have resulted in longer recoveries, more time off work and increased claim costs. In California, the medical portion of a workers' compensation claim can be as high as 60 to 70 percent. If narcotics are being prescribed long-term, these costs can be further escalated.
Some experts are skeptical about the new classes of painkillers.
"It may not be possible to separate the euphoric effects from the analgesic effects, but even if we could produce an opioid that lacked the risk of addiction or abuse, it wouldn't change the efficacy side of the equation," said Andrew Kolodny, chief medical officer at New York City-based Phoenix House substance abuse treatment centers.
While opioids are "essential" for short-term severe pain, such as after surgery, or end-of-life care, "they are lousy drugs when used long-term for most patients with chronic pain," Kolodny said.
Medical practitioners should stop searching for a "magic bullet," and instead employ alternative medications and non-pharmalogical treatments to lessen long-term chronic pain, he said. Current effective non-addictive medications for pain include nonsteroidal anti-inflammatory drugs such as aspirins; ibuprofens such as Motrin and Advil and naproxens such as Aleve; as well as acetaminophens such as Tylenol.
"Hopefully there will be more education on the problem of opioids so the medical community can return to the days of using safer pain medications that are more effective for long-term chronic pain," Kolodny said.
Use of opioids in workers' comp claims may not only exacerbate disability, but actually initiate disability, said Gary M. Franklin, research professor in the Department of Environmental and Occupational Health Sciences at the University of Washington in Seattle, who published a research study on the topic last year in the American Journal of Industrial Medicine.
In addition to using alternative medications such as acetaminophens and nonsteroidal anti-inflammatory drugs, injured workers can also lessen their pain through graded exercise and cognitive behavioral therapy, which can include "reactivation" programs to gradually build up both physical and mental stamina, and activity coaching, he said.


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Israeli archaeologists find treasures in ancient shipwreck
Darell King December 23, 2021
The Israel Antiquities Authority said in a statement that the ring The gold octagon bears on its green gem the 'Good Shepherd' motif of a young shepherd in a long shirt and carrying a ram or sheep on his shoulders.
The ring was found among a group of Roman coins dating back to the third century, in addition to a bronze statue of an eagle, bells to drive away evil spirits, pottery and a statue of a Roman actor with a comic mask, according to the source.
salad said Archaeology In the relatively shallow waters, a red gemstone engraved with a lyre was also found, as well as the remains of the wooden hull of the ship.
Caesarea was the local capital of the Roman Empire in the third century and its port was a major center of Rome's activity, according to Helena Sokolow, coordinator of the coinage department of the Israel Antiquities Authority, who has researched the subject of the "Good Shepherd" seal.
periods Sokolov: "The presence of such a symbol on a seal belonging to a Roman active in or around Caesarea probably makes sense, given the ethnically and religiously heterogeneous nature of the port in the third century, when it was one of the first centers of Christianity."
"We are talking about a period when Christianity was in its infancy, but it certainly grows and develops, especially in mixed cities such as Caesarea," she told AFP, noting that the ring itself is small, which means that it may have belonged to a woman.
Besides the Roman-era finds, Divers from the Antiquities Authority also unearthed in a second wreck at a nearby site a treasure containing some 560 Mamluk coins dating back to the 14th century.
See also China has reported its first human case of H10N3 bird flu. It is not clear how Aeroslas was transported
It is estimated that the two ships sank 1700 and 600 years ago.
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Christine Hine is a sociologist of science and technology who has a particular focus on the role played by new technologies in the knowledge construction process. She has a major interest in the development of ethnography in technical settings and in "virtual methods" (the use of the Internet in social research). In particular, she has developed mobile and connective approaches to ethnography that combine online and offline social contexts. In common with many scholars in Science and Technology Studies, Christine has a scientific and technical background herself. She studied Botany (BA, Oxon) and Biological Computation (MSc, York) and completed her DPhil in the Biology Department at York before making a transition to Sociology of Science and Technology.


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Vol 2 (April 2019) /
Gut flora "the second brain" connects Eastern and Western medicine: intestinal hyper-permeability or Qi...
Gut flora "the second brain" connects Eastern and Western medicine: intestinal hyper-permeability or Qi deficiency can affect brain, mind, and whole body
Naoki Umeda
Department of Wellness and Preventive Medicine, Center for Integrative and Lifestyle Medicine, Cleveland Clinic, Cleveland, OH, USA
Correspondence to: Naoki Umeda, MD. Clinical Assistant Professor of Medicine, Cleveland Clinic Lerner College of Medicine; Department of Wellness and Preventive Medicine, Center for Integrative and Lifestyle Medicine, Cleveland Clinic, 1950 Richmond Road, Lyndhurst, Ohio, USA. Email: umedan@ccf.org.
Abstract: There are two famous "the Father of Modern Medicine"—Hippocrates (a Greek physician) said "all disease begins in the gut" and Sir William Osler (a Canadian physician) said "a man is as old as his arteries." It is known that gut microbiota imbalance (dysbiosis) and intestinal hyper-permeability are related to high level of advanced glycation end-products (AGEs) which damage blood vessel's endothelial function and potentially cause multi-organ dysfunction. On the other hand, Traditional Chinese Medicine (TCM) doctors already knew the importance of digestive system thousands of years ago since the production of "Qi" which is vital energy for whole body largely rely on abdominal condition, and Qi deficiency triggers multiple mental and physical symptoms. It may sound two leading Integrative Medicine (IM) systems, Western IM and TCM use "different languages," but it is not well known that their essence is very similar (illness is a result of "dis-ease" or "dysfunction of Qi."). Genome analysis technology, such as DNA sequencing and microbiota researches have enabled us to understand how intestinal dysbiosis is related to obesity, metabolic syndrome, brain disorders, autoimmune diseases, or mood disorders (Brain-Mind-Gut axis). In addition, making the most of artificial intelligence's (AI) "deep learning" technology might be a potential "prescription" to heal worldwide medical-economical crisis, spend more time with patients (for medical providers), and prevent providers' burnout. AI-assisted TCM-style history taking computer and portable wrist pulse diagnostic device are about to be used in China. In the new era of preventive medicine, gut microbiota research, precision medicine with genome analysis, AI technology and TCM ancient wisdom can be combined together. Blending the new and the old will make it possible to detect and treat "pre-clinical disease" before real diseases happen since Western IM and TCM are actually using a "same language."
Keywords: Intestinal hyper-permeability; systemic disease; gut microbiota; Qi deficiency; stagnating flow; Chinese herbal medicine; pre-clinical disease; preventive medicine; artificial intelligence (AI)
Received: 01 April 2019; Accepted: 15 April 2019; Published: 19 April 2019.
doi: 10.21037/lcm.2019.04.01
2,000 years ago, Hippocrates (the "Father of modern medicine") and Traditional Chinese Medicine doctors were probably thinking the same thing. Gut microbiota imbalance (dysbiosis) can be a root cause of brain/mind/physical disorders which are related to "Qi energy" deficiency
"All disease begins in the gut." (Hippocrates, a Greek physician who lived around 400 BCE) (Figure 1) "You are what you eat." (Anthelme Brillat-Savarin, a French lawyer and politician wrote in his book in 1826) "You have a second brain in your gut." (modern scientists' quote) "I have a gut feeling." (people would feel like this when they are nervous.)
Figure 1 History of Traditional Chinese Medicine and Modern Medicine.
There are number of interesting phrases and quotes regarding the "Brain-Mind-Gut axis" even 2,000 years ago in the modern medicine world. As a matter of fact, this had been already addressed by Traditional Chinese Medicine (TCM) doctors since 3000 BCE (about 5,000 years ago). For example, "The Yellow Emperor's Classic of Internal Medicine (Huangdi Neijing)" is the first textbook which was compiled and edited around 200 BC (Figure 1), and the Yin-Yang theory and Qi energy have been the core essence of TCM. Especially, the abdomen (for instance CV4 acupuncture point "Guanyuan" located 2 inches below the umbilicus) has been considered as one of the most important parts to generate Qi which is "vital energy" to nourish whole body (internal organs, brain, heart, skin, muscle, and mind). This is why diet and herbal therapy are vital to human lives according in the TCM world. Interestingly, "fecal transplantation" was first documented in a TCM textbook around CE 350—a Chinese physician, Ge Hong treated acute food poisoning patients by a therapy called "yellow soup" which was made from a healthy person's stool (Figure 1).
On the other hand, about 2,000 years after Hippocrates passed away, science based modern medicine has advanced very rapidly. In 1674, Antonie van Leeuwenhoek, a Dutch scientist first found bacteria in the stool. In 1928, Sir Alexander Fleming, a Scottish physician found penicillin, and the progress of modern medicine has been accelerated rapidly. Although antibiotics saved millions of people's lives from infectious diseases, the overuse triggered different issues such as antibiotics-resistant bacteria and pseudomembranous enterocolitis (PE). In 1958, Dr. Ben Eiseman, an American surgeon treated PE patients by fecal transplantation (Figure 1) (1). This was about 1,600 years later than Ge Hong did the fecal transplantation in China, and he probably thought that this should improve the patients' Qi production. This is one of the most beautiful examples to understand what were in common between TCM and modern science.
As genome sequencing technique advanced dramatically in the 21st century, scientists have found that the number of total microbiota ("gut flora") per person could be 100 trillion (2) while the number of normal cells of one human body is about 60 trillion. In addition, total microbial genes are over 3.3 million which outnumbers human genes by 150:1 which gives us the sense of "second brain in the gut" and "Brain-Mind-Gut axis." For instance, short-chain fatty acid (SCFA) which is produced inside the colon when the bacteria ferments fibers is considered to be beneficial to prevent diseases in multiple organs such as colon cancer (3), liver cancer (4), obesity, and diabetes (5). SCFA can also send signals to the brain in order to suppress appetite and modulate systemic immune system (6). With further scientific advancement, in 2013, a randomized clinical trial of fecal microbiota transplantation (FMT) revealed significant effectiveness for refractory Clostridium difficile infection (7). Now there is no doubt that gut microbiota imbalance which is called "dysbiosis" is strongly related to "Qi deficiency."
Dysbiosis triggers "Intestinal hyper-permeability" (modern science) which is almost same as "Qi deficiency" (TCM). "Bad things" in the gut could be spread systemically to affect whole body, brain, and mind—systemic inflammation, immune imbalance, and multi-organ dysfunction
In recent years, a non-technical term "Leaky gut" has been used frequently by healthcare bloggers. Professionally, this is referred as "intestinal hyper-permeability" (Figure 2). When dysbiosis happens inside the intestinal lumen, "bad things" (such as pathogenic bacteria and toxin) start passing through the intestinal wall and go into the bloodstream ("leaking" from the intestinal lumen to outside of the intestine), and consequently be spread to the whole body to affect multiple organs.
Figure 2 Intestinal hyper-permeability and Qi deficiency can affect multiple organs.
There is an "intestinal mucosal barrier" [this term was first adopted by Cummings (8) in 2004] where bidirectional interaction ("cross talk") happen all the time between "non-self antigens" (such as microorganisms, toxins, and foods) and normal cells (such as enterocytes and immune cells including dendritic cells) (9). Normally, this "cross talk" regulates molecular trafficking (via interleukin-22, Immunoglobulin A, and so forth) and the intestine acquire tolerance or immunity to "outsiders." However, when this barrier is damaged (loss of tight junction between mucosal enterocytes) due to some reasons (Figure 2 and Table 1), "bad things" start passing through the barrier which is the state of "intestinal hyper-permeability." This could consequently cause chain reactions involving multiple organs leading to systemic inflammation, immune imbalance, and oxidative stress (10). According to TCM theory, "Qi deficiency" triggers multi-organ dysfunction and there are a lot in common with "intestinal hyper-permeability." Therefore, it would be very reasonable to say that "intestinal hyper-permeability" and "Qi deficiency" are very similar or almost same pathopysiology.
Table 1 Factors that potentially predispose toward the development of intestinal hyperpermeability
A prescription to heal a country? How can we stop the healthcare crisis which is associated with exponential rise in the cost? Let's borrow ancient wisdom from TCM preventive medicine, and treat "pre-clinical disease" by taking care of the gut (regarding intestinal permeability and Qi energy)
What is "pre-clinical disease" in TCM? In "Huangdi Neijing (The Yellow Emperor's Classic of Internal Medicine)," there is a sentence "Great physicians do not treat disease, but they treat pre-clinical disease." (Figure 1) In another classical TCM textbook "Qian Jin Fang", it is described that "Top level physicians heal the whole country, middle level physicians treat people, while lower level physicians treat diseases only." This means that the top level physicians can save the country by treating "pre-clinical disease."
"Pre-clinical disease" is the state with some symptoms but (almost) no abnormalities in the tests [for instance, irritable bowel syndrome (IBS), chronic fatigue, migraine, or cold sensitivity], or the state with no symptoms but some test abnormalities (for instance, metabolic syndrome and obesity). Scientifically, microbiota dysbiosis is related to advanced glycation end-products (AGEs) which are glycated proteins/lipids as a result of exposure to sugars. AGEs damage blood vessels' endothelial function by suppressing nitric oxide and producing inflammatory cytokines (11), and consequently trigger arteriosclerosis ("arterial aging") (12), and metabolic syndrome. Sir William Osler [1849–1919], a Canadian physician who is also described as the "Father of Modern Medicine" (so is Hippocrates) said "A man is as old as his arteries." Qi deficiency, dysbiosis, intestinal hyper-permeability, and pre-clinical diseases—these are all related to each other (13,14), and there is no doubt that some natural interventions based on TCM should be applied as the first step of preventive medicine. Borrowing ancient wisdom might save many countries from their healthcare cost crisis.
If patients have chronic symptoms involving three or more different organs, intestinal hyper-permeability and Qi deficiency should be strongly suspected
Factors that potentially predispose toward the development of intestinal hyper-permeability (Figure 2) include being born by Caesarean section, not being fed by breast milk, frequent antibiotics use, stress, non-steroidal anti-inflammatory drugs (NSAIDs) use, high-fat and/or high-calorie diet, genetically modified foods, chemical or processed foods, preservative use, trauma, infections (virus, bacteria, mold, or parasites), and heavy metal toxicity (Table 1). If a patient presents with chronic symptoms involving three or more organs, for instance, fatigue, bloating, and frequent colds, Qi deficiency should be strongly suspected (Figure 3). Once serious conditions [such as cancers, liver/kidney failure, hypothyroidism, inflammatory bowel diseases (IBDs), or brain diseases] are ruled out by tests (blood test, X-ray, CT/MRI, or endoscopy as needed), the TCM-based diagnosis of Qi deficiency can be made. Other common symptoms of Qi deficiency include insomnia, constipation/diarrhea, abdominal pain, cold hands/feet, migraine/tension headache, sinus congestion, dry skin, hair loss, chemical sensitivity, smell sensitivity, and so forth. Especially, cold hands/feet is a very important finding in the TCM diagnostic system, and the severe one is considered as Raynaud's syndrome (fingers and toes turn white/blue and feel cold and numb). From modern medicine standpoint, the cause of Raynaud's attack is still unknown, but this is one of the typical signs of Qi deficiency in TCM.
Figure 3 Symptoms and treatments for Intestinal hyper-permeability, Spleen Qi deficiency, Kidney Qi deficiency, and stagnating Qi flow.
Two different "Qi" are important from the standpoint of intestinal permeability. Spleen Qi is related to food, and Kidney Qi is related to telomere. Kidney Qi deficiency would cause stronger symptoms than Spleen Qi deficiency
As each person has different DNA, each person has different microbiota ("microbial fingerprints") (15), which means the TCM diagnosis and treatment would be different from person to person. In TCM, there are five different Qi energies (five element theory) with different treatments, but two of them, Spleen and Kidney Qi are especially related to intestinal function. (Please note: "Spleen" or "Kidney" in TCM are different from the real organs of spleen and kidney.) (Figure 3).
Roughly speaking, "Spleen Qi" is made from food-related nutrients absorbed by the digestive system. Therefore, harmful foods triggers microbial dysbiosis, and this leads to impaired production of Spleen Qi. While Spleen Qi is also called "acquired Qi" which people can creat by themselves after they are born, "Kidney Qi" is also called "inherited Qi" which people inherit from their parents, and its amount is highest at birth but decreases by aging. Kidney Qi seems to be directly related to genetic makeup, especially "telomere" which is a region of repetitive DNA sequences at the end of a chromosome, and protects the end of the chromosome from deterioration. Its length is longest at birth, but it becomes shorter by aging (15,000 at birth, but will decrease to 8,000 around age 35). Its importance has been deeply researched by Dr. Elizabeth Blackburn who was awarded for Nobel prize in 2009 (Figure 1). If telomere becomes shorter, the chromosome becomes unstable. This state disturbs the cell to divide, and consequently increases overall health risks, impairs multiple organs, and leads to premature mortality (16-20). In addition, psychological stress can also shorten telomere (21-23). This is why telomere and Kidney Qi seem to be strongly and directly related.
In order to understand TCM concept easier, please imagine a motor vehicle equipped with "hybrid energy" which are gasoline and (un-rechargeable) battery. They correspond to Spleen and Kidney Qi respectively (Figure 3). Gasoline can be fueled repetitively (Spleen Qi can be increased again by eating beneficial foods), but the battery (Kidney Qi) is difficult to be recharged. However, if microbial dysbiosis happens, Spleen Qi level decreases ("out of gas") and people presents multiple symptoms at the same time including tiredness, insomnia, bloating, loose stool/constipation, cold hands/feet, headache, dizziness, or dry skin. If this remains unhealed, Kidney Qi ("electric power") starts to be consumed and intestinal permeability becomes very high. People's symptoms become intense, long-lasting, and complicated, such as chronic fatigue syndrome, migraine, depression, hair loss, frequent infections, intolerance to multiple foods, small intestinal bacterial overgrowth (SIBO), fibromyalgia, chemical sensitivity, or postural orthodontic tachycardia syndrome (POTS).
"Stagnating flow" can happen with Qi deficiency. This state might be related to autoimmune disorders or "Rheuma"-tic diseases (Note: In Greek, "Rheuma" means "flow.")
"Stagnating flow" is a unique diagnosis in TCM system (Figure 3). Qi is supposed to flow smoothly throughout the body all the time, but when the amount of Qi decreases (Qi deficiency), the flow becomes less smooth. Some symptoms and conditions such as menstrual disorder, hemorrhoids, joint pain, some autoimmune disorders including Hashimoto's thyroiditis are partially related to Stagnating flow. General rheumatic (autoimmune) disorders are also related to this state. In Chinese, rheumatic disorders are written as "Wind and Humid." In TCM, "wind" would irritate the skin which is a "barrier/defense mechanism" from outsiders, and scientifically this "wind issue" means immune system imbalance since there are many immune cells such as Langerhans cells in human's skin. "Humid issue" refers to whole body congestion due to "stagnating Qi flow" which leads to multiple joint inflammation.
On the other hand, interestingly, about 500 years after Hippocrates passed away, ancient Greek doctors (Hippocrates' followers) analyzed joint disorders by using words "Rrheo" or "Rheuma" whose meaning was "flow." They had an idea that "something good" were flowing from brain to whole body inside healthy human's bodies all the time, but joint inflammation/swelling could happen due to "flow disturbance." Science and TCM had already had something in common even 1500 years ago.
Treatment for Spleen Qi deficiency. Ginseng, Astragalus, Dong Quai, Licorice, Ginger, Jujube, and Cinnamon are beneficial. Probiotics and L-glutamine are useful to repair and rebuild the gut. TCM + modern science = Synergetic effect
Most of TCM remedies are blend of multiple herbs and natural things, and there are three frequently-used herbal remedies to increase (Spleen) Qi based on 5,000-year experience—Buzhong Yiqi Tang, Shiquan Dabu Tang, and Renshen Yangrong Tang (Figure 4). Especially, Ginseng, Astragalus, Dong Quai (Angelica sinensis), and Licorice are used in all three remedies, and they are considered as "herbal Qi energy booster" or adaptogen. Most of these herbs have been already studied scientifically. For instance, Ginseng is also called "Panax" in Greek which means "all-healing" since scientists thought Ginseng was beneficial for variety of diseases. Astragalus has anti-fatigue effect (24,25). Licorice has some data regarding the benefit or repairing gastric damage and to relieve stress (26,27) which exactly means restorative effect for Spleen Qi in the TCM theory. Dong Quai is often described in Western IM as a good estrogenic herb for menopausal women, but its essence is that Dong Quai is effective to increase Qi for both women and men for all ages. In addition, some of those remedies contain ginger, jujube (dates), and cinnamon (Figure 4) which are also consumed as healthy snacks or cooking spice. They are also considered to be "Qi-increasing foods."
Figure 4 Examples of Qi-increasing herbs.
From modern medicine side, probiotics and L-glutamine are used in Western IM since they are specifically good to "rebuild or strengthen" the gut system (Figure 3). Today variety of over-the-counter supplement type probiotics ("good bacteria") are available worldwide, and this should be beneficial to increase Spleen Qi. L-glutamine is an amino acid which is helpful to repair damages in the intestinal lining (28). This is rich in bone broth, grass-fed beef, asparagus, turkey, and so forth.
Treatment for Kidney Qi deficiency. Rehmannia is a good TCM herb. Resveratrol might be a good Western IM treatment
In TCM world, Liuwei Dihuang Wan which is a blend of six ("Liu" means six) different herbs, is one of effective remedies to increase Kidney Qi. Among the six herbs, the most important one is Rehmannia ("Dihuang" in Chinese) (Figure 3) which is beneficial for immune system (29), gut microbiota, and obesity (30).
From modern science side, resveratrol (Figure 3) might be good to restore telomere (31) which should be beneficial to increase Kidney Qi. This is rich in red wine, skin of grapes/blueberries/raspberries/peanuts, and also available as over-the-counter supplements in many countries. Studies (21-23,32) also showed that meditation and positive psychological change was associated with higher levels of telomerase activity. This explains the connection among Kidney Qi, telomere, and mind-body medicine.
Other Qi-enhancing (for both Spleen and Kidney Qi) TCM therapy
Cordyceps ("Dongchong Xiacao" in Chinese) which is a fungus that lives on certain caterpillars is also very effective to enhance energy, immune system, male sexual function and so forth by increasing both Spleen and Kidney Qi (especially Kidney) (Figure 3). It also has scientific data showing the benefit for microbiota and intestinal immunity (33,34). Goji berry ("Gouqi" in Chinese) has multiple beneficial effects including immune and energy enhancement, anti-oxidant, anti-inflammation, and improving hypertension/hyperlipidemia/diabetes.
Treatment for "Stagnating flow."
There are three major blended remedies to make the energy flow smoother. Donquai Shaoyao San, Guizhi Fuling Wan, Taohe Chengqi Tang (Figure 5). Peony ("Shaoyao" in Chinese), Prunus persica ("Taoren"), and Poria ("Fuling") are used in those remedies, and these are considered to be anti-inflammatory herbs, roughly speaking. From modern science side, Omega 3-rich oils (made from fish or flaxseed) or Curcumin are frequently used as natural anti-inflammatory medications (Figure 3) (35,36).
Figure 5 Examples of herbs to improve Qi flow.
Fungal (yeast) dysbiosis—yeast syndrome?
Fungal (yeast) dysbiosis is a controversial topic, and there is little evidence to support that "gut yeast syndrome" could cause fatigue, headache, bloating, and poor memory. It is considered normal to find yeast in the gut, but an overgrowth of yeast may exacerbate existing inflammatory bowel disease (IBD) such as ulcerative colitis or Crohn's disease (37,38). Some doctors believe anti-fungal pharmaceutical medications are beneficial for this "yeast syndrome," but there are no clinical trials that document the efficacy, and these medications should not be used due to strong concern of creating drug-resistant yeast.
However, if some patients who have developed acute candida (fungal) vaginitis with medical history of chronic fatigue and IBS take an anti-fungal medication which has been officially prescribed to treat vaginitis (not for intestinal dysbiosis), their abdominal symptoms and fatigue may also improve unexpectedly. This could be just a coincidence or a placebo effect, but there is a hypothesis that reducing candida has resulted in good bacteria increase in the gut. If this phenomenon is analyzed by TCM's "Yin and Yang" theory, that would mean just "removing a burden" can promote human's own "self-healing ability" without fueling any energy.
For this purpose, berberine which is one of benzylisoquinoline alkaloids found in plants is useful as a "natural antibiotic" to reduce yeast in the gut. Berberine has been used in TCM as Phellodendron amurense (PA, "Huangbo") or Coptic chinensis (CC, "Huanglian"), and is widely available as over-the-counter supplements such as Oregon grape in the U.S. and Europe (Figure 3). In Western Integrative Medicine (IM) area, oregano oil is a different botanical products which can be used for the same purpose (39,40), and this is also available as an over-the-counter supplement.
Small intestinal bacterial overgrowth (SIBO) is another factor of microbiota dysbiosis. There are specific diagnostic tests and useful antibiotics. Qi-enhancing herbs might be of value to reduce SIBO recurrence
Unlike fungal dysbiosis, SIBO which is a state that "bad bacteria" have grown abnormally has a definitive diagnostic criterion using breath tests (Glucose/Fructose/Lactulose). The mainstay of therapy is oral antibiotics such as rifaximin, metronidazole, and neomycin to reduce bacteria, and approximately 60 percent of patients respond to the treatment while rest of them have persistent symptoms or frequent recurrence (41). Some patients have underlying issues (diabetes-related abnormal intestinal motility, alcoholism, cirrhosis, or excessive proton pump inhibitor use) while some do not. Since probiotics are not adequate to prevent SIBO recurrence (42) in many cases, adding TCM herbs might be useful. The "berberine containing herbs" (PA and CC) and oregano oil can reduce bad bacteria, and "Qi-increasing herbs" (Ginseng, Astragalus, Dong Quai, Licorice, Rehmannia, Cordyceps, and Goji berry) can grow good bacteria faster (Figure 3). Combining pharmaceutical medications for (sub)acute problems and TCM for prevention or chronic maintenance seems to be a very reasonable way, but further research is warranted.
Low dose naltrexone (LDN) therapy has anti-inflammatory effect (scientific standpoint) or Qi flow-improving effect (TCM standpoint)
This new therapy is to use naltrexone, a medication for opioid or alcohol dependence, at very low dosage (only about 5% of usual dosage). Clinical reports of LDN have demonstrated possible benefits in multiple sclerosis, fibromyalgia, cancers (lung and kidney) (43,44), Crohn's disease, or psoriasis by reducing systemic inflammation. Our clinical impression is that LDN's effect is similar to Donquai Shaoyao San (DSS) which is one of commonly used herbal remedies to correct "Stagnating Qi flow" although these two are completely different treatments. Especially, "Yin type" people who have "sensitive stomach" and the whole body being "slightly thin" tend to experience more benefit from LDN or DSS.
For instance, for those who have just ran full marathon (42.195 km or 26.2 miles) and are completely exhausted, they cannot run any more even if they were given some "energy drink." Instead, if they receive "gentle leg massage" therapy, they might able to run another mile. In some cases, improving Qi flow "smoother" is more effective rather than giving Qi energy. This seems to be how LDN and DSS works in a similar way, but scientific research (e.g., if DSS reduces LDN-related inflammation markers) is definitely warranted.
Diet is as critical as herbal therapy, and it consists of two parts, which are removing "bad foods" and increasing "good foods." For Qi deficiency, reducing refined sugar, dairy products, and gluten is reasonable to try since those foods have higher likelihood of triggering dysbiosis-related intestinal and systemic inflammation. In the U.S., number of patients would experience remarkable improvement by reducing gluten for digestive issues, fatigue, pain, or mood even if they were proved not to have Celiac disease. It is strongly suspected that microbial dysbiosis and gluten sensitivity are partially related to each other.
"Good foods" include probiotic-rich fermented foods, such as Douchi (fermented soy beans) and Furu (fermented Tofu), and "Qi-increasing foods" such as ginger, bone broth, cinnamon, black pepper, dates (jujube), tangerine's skin.
Benefit of vitamin D
Vitamin D is important for gut health and Qi since it can influence the composition of gut microbiota (45) and decrease inflammation in the gut (46,47). If serum level is low, supplementing Vitamin D seems to be effective to improve Spleen/Kidney Qi deficiency and stagnating flow from TCM standpoint (Figure 3).
Mind-body therapy is beneficial to increase Spleen/Kidney Qi
As described above, some researches suggest that psychological stress can also shorten telomere (21-23), and this might be related to reduction in Kidney Qi. As shown in Table 1, stress can increase the intestinal permeability, and this will probably lead to Spleen Qi reduction. Considering this Brain-Mind-Gut connection, mind-body therapy should be useful for both Spleen and Kidney Qi deficiency (Figure 3).
Cancer treatment and Qi deficiency
Since the cell division speed of the digestive tract cells is generally faster than other organs cells, those who undergo chemotherapy and/or radiation therapy for abdominal/pelvic area tend to experience treatment-related digestive adverse effects (Table 1) more frequently. Needless to say, main stream of cancer treatment must be conventional therapies (surgery, medications, and radiation), but from standpoint of the gut, their adverse effects are considered as "accidentally created" intestinal hyper-permeability or Qi deficiency. Even after these treatments are completed, many cancer survivors would have chronic aftereffects such as fatigue, IBS, immunosuppression (frequent infection), or neuropathy. Treatments to improve intestinal permeability and Qi energy should be beneficial for these chronic symptoms. Particularly, Ginseng has been already well studied in some randomized double-blinded clinical trials, and it is considered to be useful for chronic fatigue for cancer survivors (48,49).
Basically, TCM herbal remedies should not be administered for those who under active chemotherapy or molecularly targeted therapy due to the concern for unfavorable drug-to-herb interactions. Those who are under active treatment or has a treatment history with immune check point inhibitors such as anti-PD1/PDL1/CTLA4 antibodies should avoid TCM herbs, probably indefinitely. These drugs are remarkably effective for certain cancers (such as melanoma, non-small cell lung cancer, and renal cell carcinoma), but it is reported that anti-cancer immune effect may last for decades (or maybe forever) in some patients even if they have already completed the immune check point inhibitors therapy. Since Qi-enhancing herbs could boost up patients' immune system, "too much immune enhancement" may occur even 5 or 10 years after the immune check point inhibitors therapy is finished.
A suggestion for the new era of IM: computer technology can combine modern science, Western IM, and TCM into one?
Artificial intelligence (AI) has "deep learning" technology which has been inspired by information processing in human brains, and it has been revolving rapidly since 2010. AI is already used in some medical fields such as genetic diagnosis to medical charts' voice recognition, and it can also interpret radiology scans 150 times faster than humans. It would be safe to say "today AI has come of age." Since the gut microbiota "second brain" is an extremely complicated system (much smarter than the "real brain"), AI which is by far more functional than human brain will be used more frequently in the future for the microbiota researches, stool tests, and gut flora treatments. On the other hand, in China, AI-assisted, TCM-style history taking computer and portable wrist pulse diagnostic device are about to be utilized at number of "minute clinics" in 2019. According to some TCM experts, they are able to "predict" and obtain "80% impression" of diagnosis only by history taking. Rest of it (20%) can be obtained by adding physical exams such as pulse diagnosis, tongue exam, and face expression reading. As a matter of fact, these exams sometimes could be more useful than history taking when making a diagnosis and determining the treatment plan. However, these experts strongly believe that the time for physical exams is critical to "establish rapport" with patients since touching (human to human) is the most beautiful and valuable communication tool in the medical field.
"Prediction" and "humanity" are the masterpieces of ancient traditional medicine, and they are exactly what are needed in the clinical settings today. In the future, AI should be used more both in TCM (diagnosis and treatment) and stool microbiota test, and this will make it easier for doctors to find "pre-clinical diseases" before they become "real diseases." In addition, AI can do "daunting tasks" on behalf of human doctors, and this will help healthcare providers to spend more time with patients, and to prevent providers' burnout and depression. The overarching goal is to bring back the humanity since the medical provider-patient relationship is a founding principle of health care. These masterpieces of TCM can be integrated into modern medicine by making the most of computer technology.
Another masterpiece is the fact that 5 to 10 different herbs/natural things are blended to create one remedy in TCM. The blending is expected to create "synergetic effect" (e.g., 1+1+1 becomes 10 or 20) but its mechanism has been very difficult to understand by Western IM practitioners. There has been a very big wall between TCM and Western IM for many years, and unfortunately, it still exists at this present time. However, there is a possibility that AI might be able to remove the wall by making the TCM's "theory of synergetic blending of multiple herbs" understandable to Western IM doctors. Even if it remains non-understandable, AI can assist TCM beginners to create the best personalized natural remedies.
On the other hand, one of the biggest advantages of science is the visualization of the diagnostic process and the treatment effectiveness. As human nature, since we are surrounded by computer technology all the time today, we tend to prefer seeing the evidence of diagnosis and treatment visually, especially in numbers. For instance, even if the Clostridium difficile infection is cured by the fecal transplantation therapy and the patients are feeling much better for their digestive system, they may also want to know how the number of "key bacteria" such as bacteroidetes or firmicutes have changed before/after the transplantation. Even if TCM herbal therapy could significantly improve the symptoms of autonomic dysfunction for instance, patients may say "please test my pulse pattern with the machine so that I can see the treatment effectiveness in number." In the past, patients were totally satisfied when TCM treatments just improved their symptoms. But today, patients may not feel in the same way, or they want something more. This difference between science and TCM seems to have been giving Western IM doctors the feeling of "they are two different languages." For this purpose, AI may be able to change TCM diagnosis and treatment process to numeric information which is understandable to everyone.
"You can obtain novel insight by studying old wisdom." This is one of sentences in The Analects ("Lunyu" in Chinese) which is a collection of Chinese sayings, traditionally believed to have been compiled around 300 BCE. Even 2,500 years ago, philosophers respected the ancient wisdom. For many years, it has been relatively challenging to understand TCM from scientific point of view, but genome analysis technology (such as DNA sequencing) and microbiota researches have enabled us to understand the strong relationship between TCM and modern medicine.
As mentioned above, about 2,000 years ago, Chinese physicians said "top level physicians can save the country by treating pre-clinical diseases" which should be started from treatments to improve gut microbiota balance and heal intestinal hyper-permeability or Qi deficiency. Constant demand for wellbeing, unmet needs for whole person care, mind-body connection, patient-centeredness, a new paradigm in primary and preventive health care, cost-conscience treatment, and personalized plan—all of these must be practiced by healthcare providers right now since many countries are facing healthcare financial crisis which unfortunately, is expected to continue getting worse. Integration of ancient wisdom, modern science, and AI seems to be one of the best solution for this issue. It is strongly anticipated that AI's deep learning technology would greatly accelerate the process of "connecting dots" in the fields of TCM and modern science to "make lines or shapes."
If a patient has a diagnosed disease, for instance Rheumatoid arthritis, modern medicine's guideline-based therapy such as methotrexate should be considered first. If a patient's medical issue is migraine only, serotonin 5-hydroxytryptamine (5-HT) receptor agonists ("Triptans") or some TCM herbal remedies which contain Evodia ("Wu zhu yu" in Chinese) might be most effective. However, in today's modern society, increasing number of people present to clinics with "pre-clinical disease" which is associated with multiple symptoms, but without a definitive diagnosis. For instance, some patients have been struggling with chronic headache, fatigue, depressive mood, and eczema at the same time, but unfortunately they would feel "lost" since they do not know which specialist to see (or they have to see all of the specialists?).
We should first consider some interventions to heal the "root causes" which are often related to the gut microbiota imbalance and Qi deficiency since "you are what you eat." The treatment should be "tailor-made" since everyone has different level of stress, different symptoms, different DNA, and different microbiota (so-called "microbial fingerprints"). Even for fecal transplantation which is a "cutting-edge" treatment, it is known that the treatment effectiveness would vary due to the difference in DNA of each patient's normal cells.
What I described in this article is just a rough sketch for Brain-Mind-Gut connection, or it could be only hypothesis-raising. Therefore, more scientific research is warranted for TCM to be utilized and well accepted in the new era of IM. Number of TCM herbs have been already researched scientifically (for instance, Ginseng for energy, Astragalus for immune system, and Licorice for digestion) with promising results. However, rather than assessing each herb separately, we should move to the next phase which is to elucidate the real essence of synergetic effects of multi-herbal TCM remedies with possible help from AI. AI-assisted TCM research combined with genome-analysis precision medicine will become the best pathway for the future of preventive medicine.
Conflicts of Interest: The author has no conflicts of interest to declare.
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Cite this article as: Umeda N. Gut flora "the second brain" connects Eastern and Western medicine: intestinal hyper-permeability or Qi deficiency can affect brain, mind, and whole body. Longhua Chin Med 2019;2:6.
Longhua Chinese Medicine (ISSN 2616-2806; LCM; Longhua Chin Med; lcm.amegroups.com) is an international, open access journal that focuses on international cutting-edge information on basic,...
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According to an IFT report, 36% of Mexican broadband users subscribe to an over-the-top (OTT) video service. The report stated that video is an important driver of online activity and watching videos appears to be the most recurrent activity among Mexicans.
Some 85% of online users watch free short videos over the Internet, with paid and subscription services being less popular. Out of the 36% registered OTT service subscribers, 70% are signed up to Netflix, stated the report.


text:
Ariya Forum UK Ariya Forum UK Nissan Ariya Forum Area Main Nissan Ariya chat
Nissan Ariya introduces the power of touch
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Post by Rob » Wed Aug 11, 2021 9:13 am
You're on a drive to a friend's house. It's a hot and sunny day, and you need to cool the cabin of your car. Doing this normally requires only muscle memory to reach out to the dash and turn a knob or tap a button. But for engineers this simple action demands extreme attention to detail and redefining ways to keep the sweat off your brow.
When developing the all-new Nissan Ariya electric crossover, its designers and engineers didn't just consider the ergonomics involved in reaching toward the dashboard. They were determined to create a new look and feel for controls that drivers generally take for granted. This required a rethink of cabin space, touch and positioning.
The Ariya's interior was crafted to be an open, spacious cabin offering a sense of calm and serenity. Part of that design is a dashboard free of traditional buttons. The stylish wood-grained trim bisecting the dashboard comes to life upon starting the Ariya, illuminating a set of environmental controls that reside just beneath the dashboard's surface. Utilizing a new generation of haptic feedback controls, these subtly integrated buttons open a world of possibilities in the relationship between function and design.
In the same way that we interact with a smartphone display to navigate and engage with apps, haptic feedback buttons in the Ariya react to touch, communicating through fingertip vibrations. When adjusting the Ariya's climate controls and drive modes, drivers will interact with a familiar set of icons. Yet, because the points of interaction are felt and heard, they can remain focused on the road. The design team's decision to integrate haptic feedback into the Ariya speaks to the vehicle's underlying design concept of Timeless Japanese Futurism, which takes a distinctive Japanese approach to design, conveying a simple yet powerfully modern impression.
Senior Designer Hideki Tago explains: "We created a clean space by blending the haptic controls with the grain of the interior's wood grain finish. We did this in a way that didn't affect the performance of the controls, allowing us to achieve both functionality and an attractive appearance."
"By applying a wood grain pattern to the plastic panels with a hydro-printing process, we gave them a very realistic wood-like feeling. At the same time, this allowed transparent icons to come to life when illuminated."
With the Ariya design team's final goal laid out, it was the engineering team's responsibility to make this sci-fi concept a reality. The process began with an exhaustive breakdown of the technology itself.
Haptic feedback buttons are grouped into two specific areas in the Ariya — on the main dashboard and on the adjustable center armrest. The goal was to not only integrate the technology into the cabin design as a means of wowing passengers, but also to give the technology a natural and responsive feel for a wide variety of drivers.
Following extensive testing, the team settled on electrostatic buttons that are not only bigger than traditional haptic controls, but also more broadly spaced. This allows for a realistic and intuitive feeling for users, and also generates a kind of air pressure "kick". This amplifies the tactile feedback with the click sensation of a traditional mechanical button, despite no traditional physical button being involved.
Then came the fine-tuning of the vibrations and sounds. That's right — sounds. "Vibration and sound are inseparable," explains Tomotaka Igarashi, the engineer in charge of the Ariya's interior HMI development. "It may seem obvious, but this challenged our team to develop a unique sound that would match the expectations of the driver while also designing it to be as pleasant as possible."
Such attention to detail in an all-electric crossover is, of course, a necessity, as the minimal sound emitted by the electric powertrain means that the sounds developed by the team will be clearly heard while driving. The development of the haptic controls required that every possible scenario be tested repeatedly to ensure easy use for a wide range of drivers. That meant extensive testing by people with different size fingers and fingernail lengths, and with different button-pressure strengths and engagement angles. Gloved hands were also tested to ensure button activation.
This is just one example of how design and function have been woven into the Ariya's development from the outset to deliver a wholly unique driving experience and level of interaction.
gonefishin
Post by gonefishin » Sat Aug 14, 2021 11:42 pm
Wow, I had no idea this was a feature! This seems super useful and actually really nice looking to view. I am surprised. Is this something a lot of electric cars focus on?
As I mentioned in another thread, I am brand new to electric cars. I know nothing! lol
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Factors associated with the lack of antiretroviral therapy initiation among eligible HIV-positive pregnant women in Swaziland
C. Chouraya*, G. Louwagie, B. Nhlabatsi, M. A. Mahdi, B. V. Girdler-Brown
Background. Antiretroviral therapy (ART) initiation is critical for the prevention of mother-to-child transmission (PMTCT) of HIV. Objectives. To quantify factors that were barriers or facilitators to the initiation of ART in pregnant HIV-infected women in Swaziland. Methods. We conducted a cross-sectional survey in HIV-infected women with at least one antenatal care (ANC) visit, who had delivered in maternity wards between April and August 2013 in Swaziland. Variables collected included intrapersonal, interpersonal and organisational factors. Logistic regression models were used to calculate univariate and adjusted multivariate measures of association between ART initiation and the independent variables. Results. Among the 163 pregnant women who were eligible for ART, 110 (67.5%) were initiated on ART by the time of delivery. The most commonly cited reason for not initiating ART (n=53) was women not being ready to initiate life-long treatment (24.5%). On multivariate logistic regression, favourable perceptions of the benefits of ART (adjusted odds ratio (AOR) 3.04; 95% CI 1.55 - 5.96) and presence of partner support (AOR 4.75; 95% CI 2.11 - 10.67) remained significantly and independently associated with ART initiation. Conclusion. ART initiation among ART-eligible pregnant women in Swaziland was independently associated with the presence of partner support and favourable perceptions of the benefits of ART. Stronger counselling and education for pregnant women and male involvement strategies need to be implemented as universal life-long ART for all HIV-infected pregnant women is implemented.
South African Journal of Obstetrics and Gynaecology
https://doi.org/10.7196/SAJOG.2017.v23i2.1184
Antiretroviral therapy (ART)
Prevention of mother to child transmission (PMTCT)
10.7196/SAJOG.2017.v23i2.1184
Dive into the research topics of 'Factors associated with the lack of antiretroviral therapy initiation among eligible HIV-positive pregnant women in Swaziland'. Together they form a unique fingerprint.
Eswatini Medicine & Life Sciences 100%
Pregnant Women Medicine & Life Sciences 49%
HIV Medicine & Life Sciences 42%
Logistic Models Medicine & Life Sciences 9%
Odds Ratio Medicine & Life Sciences 6%
Vertical Infectious Disease Transmission Medicine & Life Sciences 5%
Prenatal Care Medicine & Life Sciences 5%
Chouraya, C., Louwagie, G., Nhlabatsi, B., Mahdi, M. A., & Girdler-Brown, B. V. (2017). Factors associated with the lack of antiretroviral therapy initiation among eligible HIV-positive pregnant women in Swaziland. South African Journal of Obstetrics and Gynaecology, 23(2), 63-68. https://doi.org/10.7196/SAJOG.2017.v23i2.1184
Chouraya, C. ; Louwagie, G. ; Nhlabatsi, B. et al. / Factors associated with the lack of antiretroviral therapy initiation among eligible HIV-positive pregnant women in Swaziland. In: South African Journal of Obstetrics and Gynaecology. 2017 ; Vol. 23, No. 2. pp. 63-68.
@article{a7c02032a11c4dc69aeab9e7c5256294,
title = "Factors associated with the lack of antiretroviral therapy initiation among eligible HIV-positive pregnant women in Swaziland",
abstract = "Background. Antiretroviral therapy (ART) initiation is critical for the prevention of mother-to-child transmission (PMTCT) of HIV. Objectives. To quantify factors that were barriers or facilitators to the initiation of ART in pregnant HIV-infected women in Swaziland. Methods. We conducted a cross-sectional survey in HIV-infected women with at least one antenatal care (ANC) visit, who had delivered in maternity wards between April and August 2013 in Swaziland. Variables collected included intrapersonal, interpersonal and organisational factors. Logistic regression models were used to calculate univariate and adjusted multivariate measures of association between ART initiation and the independent variables. Results. Among the 163 pregnant women who were eligible for ART, 110 (67.5%) were initiated on ART by the time of delivery. The most commonly cited reason for not initiating ART (n=53) was women not being ready to initiate life-long treatment (24.5%). On multivariate logistic regression, favourable perceptions of the benefits of ART (adjusted odds ratio (AOR) 3.04; 95% CI 1.55 - 5.96) and presence of partner support (AOR 4.75; 95% CI 2.11 - 10.67) remained significantly and independently associated with ART initiation. Conclusion. ART initiation among ART-eligible pregnant women in Swaziland was independently associated with the presence of partner support and favourable perceptions of the benefits of ART. Stronger counselling and education for pregnant women and male involvement strategies need to be implemented as universal life-long ART for all HIV-infected pregnant women is implemented.",
keywords = "Antiretroviral therapy (ART), Human immunodeficiency virus (HIV), Pregnant women, Prevention of mother to child transmission (PMTCT)",
author = "C. Chouraya and G. Louwagie and B. Nhlabatsi and Mahdi, {M. A.} and Girdler-Brown, {B. V.}",
note = "Publisher Copyright: {\textcopyright} 2017, South African Medical Association. All rights reserved.",
doi = "10.7196/SAJOG.2017.v23i2.1184",
journal = "South African Journal of Obstetrics and Gynaecology",
publisher = "South African Medical Association",
Chouraya, C, Louwagie, G, Nhlabatsi, B, Mahdi, MA & Girdler-Brown, BV 2017, 'Factors associated with the lack of antiretroviral therapy initiation among eligible HIV-positive pregnant women in Swaziland', South African Journal of Obstetrics and Gynaecology, vol. 23, no. 2, pp. 63-68. https://doi.org/10.7196/SAJOG.2017.v23i2.1184
Factors associated with the lack of antiretroviral therapy initiation among eligible HIV-positive pregnant women in Swaziland. / Chouraya, C.; Louwagie, G.; Nhlabatsi, B. et al.
In: South African Journal of Obstetrics and Gynaecology, Vol. 23, No. 2, 2017, p. 63-68.
T1 - Factors associated with the lack of antiretroviral therapy initiation among eligible HIV-positive pregnant women in Swaziland
AU - Chouraya, C.
AU - Louwagie, G.
AU - Nhlabatsi, B.
AU - Mahdi, M. A.
AU - Girdler-Brown, B. V.
N1 - Publisher Copyright: © 2017, South African Medical Association. All rights reserved.
N2 - Background. Antiretroviral therapy (ART) initiation is critical for the prevention of mother-to-child transmission (PMTCT) of HIV. Objectives. To quantify factors that were barriers or facilitators to the initiation of ART in pregnant HIV-infected women in Swaziland. Methods. We conducted a cross-sectional survey in HIV-infected women with at least one antenatal care (ANC) visit, who had delivered in maternity wards between April and August 2013 in Swaziland. Variables collected included intrapersonal, interpersonal and organisational factors. Logistic regression models were used to calculate univariate and adjusted multivariate measures of association between ART initiation and the independent variables. Results. Among the 163 pregnant women who were eligible for ART, 110 (67.5%) were initiated on ART by the time of delivery. The most commonly cited reason for not initiating ART (n=53) was women not being ready to initiate life-long treatment (24.5%). On multivariate logistic regression, favourable perceptions of the benefits of ART (adjusted odds ratio (AOR) 3.04; 95% CI 1.55 - 5.96) and presence of partner support (AOR 4.75; 95% CI 2.11 - 10.67) remained significantly and independently associated with ART initiation. Conclusion. ART initiation among ART-eligible pregnant women in Swaziland was independently associated with the presence of partner support and favourable perceptions of the benefits of ART. Stronger counselling and education for pregnant women and male involvement strategies need to be implemented as universal life-long ART for all HIV-infected pregnant women is implemented.
AB - Background. Antiretroviral therapy (ART) initiation is critical for the prevention of mother-to-child transmission (PMTCT) of HIV. Objectives. To quantify factors that were barriers or facilitators to the initiation of ART in pregnant HIV-infected women in Swaziland. Methods. We conducted a cross-sectional survey in HIV-infected women with at least one antenatal care (ANC) visit, who had delivered in maternity wards between April and August 2013 in Swaziland. Variables collected included intrapersonal, interpersonal and organisational factors. Logistic regression models were used to calculate univariate and adjusted multivariate measures of association between ART initiation and the independent variables. Results. Among the 163 pregnant women who were eligible for ART, 110 (67.5%) were initiated on ART by the time of delivery. The most commonly cited reason for not initiating ART (n=53) was women not being ready to initiate life-long treatment (24.5%). On multivariate logistic regression, favourable perceptions of the benefits of ART (adjusted odds ratio (AOR) 3.04; 95% CI 1.55 - 5.96) and presence of partner support (AOR 4.75; 95% CI 2.11 - 10.67) remained significantly and independently associated with ART initiation. Conclusion. ART initiation among ART-eligible pregnant women in Swaziland was independently associated with the presence of partner support and favourable perceptions of the benefits of ART. Stronger counselling and education for pregnant women and male involvement strategies need to be implemented as universal life-long ART for all HIV-infected pregnant women is implemented.
KW - Antiretroviral therapy (ART)
KW - Human immunodeficiency virus (HIV)
KW - Pregnant women
KW - Prevention of mother to child transmission (PMTCT)
U2 - 10.7196/SAJOG.2017.v23i2.1184
DO - 10.7196/SAJOG.2017.v23i2.1184
JO - South African Journal of Obstetrics and Gynaecology
JF - South African Journal of Obstetrics and Gynaecology
Chouraya C, Louwagie G, Nhlabatsi B, Mahdi MA, Girdler-Brown BV. Factors associated with the lack of antiretroviral therapy initiation among eligible HIV-positive pregnant women in Swaziland. South African Journal of Obstetrics and Gynaecology. 2017;23(2):63-68. doi: 10.7196/SAJOG.2017.v23i2.1184


Essie She's Pampered was included in my September 2014 Glossybox. I ALWAYS get excited about nail polish in subscription boxes, and was so excited because I didn't have this shade in my collection.
She's Pampered was part of the Winter 2012 collection and retails for $8.50.
GLOSSYBOX is one of the more expensive beauty subscription services ($21 versus both Birchbox and Ipsy's $10), but the quality is *so* much better- these are high end brands! I also LOVE the beautiful, high quality boxes they send each month. They are great for drawer organizing or keeping craft products in.
They also have a referral program and if you use my link to sign up, I'll receive 200 points, getting me closer to my free box! You can do the same with your friends after you sign up. During the month of October, if you sign up for a 3, 6, or 12-month subscription, you can use the promo code GBGLAM to receive a FREE deluxe sample-sized GlamGlow Youth Mud ($19 value) with any new subscription.


The League's sincere congratulations go to two youngsters who ruled the roost in the Shropshire Junior Merit.
Sinclair star Harry Church retained the main under-18 title by winning a thrilling final at Whixall on Saturday 21st July by beating Kieran Jones, who has been playing Premier League bowls for Meole Brace this season, 21-20.
And Shifnal's Joe Killen, who won the Mid Shropshire Under-18 crown earlier this season, made it a Mid Shropshire double by winning the consolation KO at Whixall for the Peter Ashton Trophy.
Very well done to both!


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Voyage features many of Scud's colleagues from previous films, such as the actors Byron Pang, Haze Leung, Adrian "Ron" Heung, and Linda So, as well as several technical staff, such as the Director of Photography, Charlie Lam, who worked on Scud's 2010 film Amphetamine. During filming, Scud said, "I am really enjoying shooting in Europe because people are so film-friendly.. I can see myself coming back to film again in Europe". The German episode includes appearances by the UK actress Debra Baker (Junkhearts) and the German actress Leni Speidel, who was also the Production Manager for filming in Europe.[1]
Italy was unquestionably the fountainhead of Renaissance civilization. As early as the 14th century, men of enlightenment, notably Petrarch and Boccaccio, were introducing Renaissance concepts and proclaiming a new allegiance to classical antiquity, and through the 15th century a feverish development toward new attitudes and styles marked the work of brilliant artists, scholars, philosophers, and men of letters. Through most of the 15th century, the achievements were predominantly Italian, but by the beginning of the 16th century the movement was spreading to other countries of western Europe; at the same time that Italy was losing her political independence through conquests by French, Spanish, and Austrian armies, she gradually yielded her preeminence in the arts and letters to France, Spain, and England.
There is a kind of state religion in Utopia which includes high priests and public worship. "They invoke God by no other name than Mythras, a name they all apply to the one divine nature, whatever it may be. No prayers are devised which everyone cannot say without offending his own denomination." (126) "When the priest [...] comes out of the sacristy, everyone immediately prostrates himself on the ground out of reverence; on all sides the silence is so profound that the spectacle itself inspires a certain fear, as if in the presence of some divinity." (128) Priests are held in such high esteem that "even if they commit a crime they are not subject to a public tribunal but are left to God and their own consciences. [...] For it is unlikely that someone who is the cream of the crop and is elevated to a position of such dignity only because of his virtue should degenerate into corruption and vice." (124)
Situated near the southern tip of the African continent, Namibia is a vast land brimming with adventure. The nation itself is quite large- about twice the size of California- but is home to only a little over two million inhabitants. With a low population to land ratio, the nation makes a name for itself with the numerous natural attractions that it has to offer, making it a true haven for lovers of the outdoors Namibia is covered in beautiful desert regions, including the Namib Desert, regarded at one of the oldest in the world, as well as lush countryside, plateau regions, and coastal plains of rolling sand dunes, with a subtropical and arid climate.
Reviewers of the game praised the visual and auditory art as well as the sense of companionship created by playing with a stranger, calling it a moving and emotional experience, and have since listed it as one of the greatest video games of all time. Journey won several "game of the year" awards and received several other awards and nominations, including a Best Score Soundtrack for Visual Media nomination for the 2013 Grammy Awards. A retail "Collector's Edition", including Journey, Thatgamecompany's two previous titles, and additional media, was released in August 2012.
Slavery is a feature of Utopian life and it is reported that every household has two slaves. The slaves are either from other countries or are the Utopian criminals. These criminals are weighed down with chains made out of gold. The gold is part of the community wealth of the country, and fettering criminals with it or using it for shameful things like chamber pots gives the citizens a healthy dislike of it. It also makes it difficult to steal as it is in plain view. The wealth, though, is of little importance and is only good for buying commodities from foreign nations or bribing these nations to fight each other. Slaves are periodically released for good behaviour. Jewels are worn by children, who finally give them up as they mature.
Gattaca is a science fiction film directed by Andrew Niccol, starring Ethan Hawke, Uma Thurman, and Jude Law. It depicts the life in the futuristic dystopian Earth society, in which quality genetic makeup controls the destiny of every person. The main protagonist Vincent was born in an old-fashioned way. He is seen as genetically inferior and is doomed to a life of servitude. He tries to change his destiny by buying identity of Jerome Eugene Morrow, a potential swimming star whose career ended in a car accident.
Whether hiking Table Mountain for one of the world's best views, riding horseback on safari, or engaging with local entrepreneurs in Cape Town, students always fall in love with South Africa. Full of adventure and captivating sights, Cape Town offers countless opportunities for cultural and natural exploration. Cape Town is also home to world-renowned social rights activist Archbishop Desmond Tutu, who students just may have the opportunity to meet as he is a member of the Institute for Shipboard Education Board of Trustees… and a big fan of Semester at Sea!
Utopia is a society under full and strict regimentation. Its culture is, in effect, nothing but what is a consequence of social regimentation. Nothing exists in the culture that is not a result of this pervasive social control. Utopians believe they do not live in a tyranny only because they accept and desire the collective regimentation under which they live. They are the perfect slaves.
Each city has not more than 6000 households, each family consisting of between 10 and 16 adults. Thirty households are grouped together and elect a Syphograntus (whom More says is now called a phylarchus). Every ten Syphogranti have an elected Traniborus (more recently called a protophylarchus) ruling over them. The 200 Syphogranti of a city elect a Prince in a secret ballot. The Prince stays for life unless he is deposed or removed for suspicion of tyranny.
Dr. Derek Alderman is a cultural and historical geographer interested in public memory, popular culture and heritage tourism in the U.S. South. Much of his work focuses on the rights of African Americans to claim the power to commemorate the past and shape cultural landscapes as part of a broader goal of social and spatial justice. His work spans many aspects of the southern landscape, including Civil Rights memorials, slavery and plantation heritage tourism sites, NASCAR, Graceland and Memphis, Mayberry and film tourism, and the cultural geography of kudzu.
H. G. Wells, A Modern Utopia. Wells was repeatedly drawn to utopias and dystopias, as is evident right from the beginning of his career and his first novel, The Time Machine (1895). The 1905 novel A Modern Utopia posits the existence of an alternate Earth, very much like our own world and populated with doubles of every human being on our own planet. The rule of law is maintained by the Samurai, a voluntary noble order.
Recognized historian of the Navajo Code Talkers of World War II, Zonnie Gorman is an expert in her field and a dedicated teacher. She has served as a consultant to numerous documentaries, museum exhibitions and authors. Gorman is currently the Project Coordinator for the Circle of Light Navajo Educational Project (CLNEP), a nonprofit organization founded in May 2001 and located in Gallup, New Mexico. CLNEP offers a variety of Navajo role models to youth and fosters cultural pride and self-worth, while educating them along with non-Navajos about the rich history, culture, language and contributions of the Navajo people.
One of the first signs of renewed enlightenment in England, after the rude and bloody 15th century, was the appearance of a group of "humanist" scholars that flourished at Oxford and in London in the early decades of the 16th century, notably John Colet, William Latimer, Thomas Linacre, Reginald Pole, and Thomas More — a group that Erasmus pronounced both congenial and distinguished.


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Lenox Health Greenwich Hospital
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Lenox Health Greenwich Village Northwell Health
Details: Lenox Health Greenwich Village, part of Northwell Health, represents a new model of community-based care that seamlessly integrates health and wellness services with access to 24-hour emergency care and a full range of medical specialists. The facility currently includes a full service emergency department, which is a division of Lenox Hill lenox health greenwich village ny
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LENOX HEALTH GREENWICH VILLAGE - 22 Photos & 96 …
Details: 96 reviews of Lenox Health Greenwich Village "Walked over this morning - 9:15 Monday - with no appointment to get an x-ray. Hoped not to have my fear confirmed that my elbow was broken. I'd waited for 9 days after a skateboard crashed into my bike and I slammed into the pavement. Finally had to accept the fact that while I was almost walking normally again, the pain and … northwell hospital in greenwich village
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Lenox Hill Hospital Northwell Health
Details: Lenox Hill is one of the best hospitals in the region, according to U.S. News & World Report.We offer world-class inpatient and surgical care at one of the largest and most sophisticated hospitals in New York City, as well as seamless, convenient access to care at Manhattan Eye, Ear & Throat Hospital (MEETH), Lenox Health Greenwich Village and nearby outpatient practices. northwell health greenwich hospital
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Lenox Hill Healthplex - Intricate Construction
Details: Lenox Health Greenwich Village is a state-of-the-art medical complex located in Greenwich Village. Lenox Hill Hospital's new HealthPlex, the first free-standing emergency room in Manhattan, was opened in 2014 providing the emergency care to … northwell health greenwich village
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Lenox Health Charged $1,000 to Look at a Bee Sting, Locals
Details: Northwell Health, the parent company of Lenox Hill and Lenox Health, has its own urgent care center in Gramercy, and plans to open one in Greenwich Village in May at 41 East 8th St., she said. northwell health greenwich
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Greenwich Hospital - Yale New Haven Health
Details: Greenwich Hospital. Comprehensive Cancer Services The Smilow Cancer Hospital Care Center on the Greenwich Hospital campus provides access to expert cancer care and treatment to patients from lower Fairfield County, Connecticut, and Westchester County, New York. northwell greenwich location
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LENOX HEALTH GREENWICH VILLAGE - 22 Photos & 94 Reviews
Details: 94 reviews of Lenox Health Greenwich Village "Walked over this morning - 9:15 Monday - with no appointment to get an x-ray. Hoped not to have my fear confirmed that my elbow was broken. I'd waited for 9 days after a skateboard crashed into my bike and I slammed into the pavement. Finally had to accept the fact that while I was almost walking normally again, the pain and … lenox hill healthplex
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Lenox Health Greenwich Village in New York, NY
Details: Lenox Health Greenwich Village is a group practice with 1 location. Currently, Lenox Health Greenwich Village specializes in Emergency Medicine with 1 physician. Lenox Health Greenwich Village Office Locations
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Emergency Department - Lenox Hill Hospital Northwell Health
Details: Lenox Health Greenwich Village, a division of Lenox Hill Hospital, has board-certified physicians and nursing staff who can handle any medical emergency. See wait times. Getting here. Our ED at Lenox Hill Hospital is located at 100 East 77th Street, New York, NY. What we offer. Our ED includes: 34 monitored beds;
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'It Felt Like Deception': An Elite N.Y.C. Hospital Charges
Details: In 2010, New York State awarded Lenox Hill the rights to take over the Greenwich Village building left empty by the closing of St. Vincent's Hospital. It …
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Lenox Hill HealthPlex Opens In Greenwich Village
Details: Recently, Lenox Hill Hospital has filled the void with a new freestanding emergency center for the residents of Greenwich Village: Lenox Hill HealthPlex, a project valued at $150 million. Lenox Hill HealthPlex will open its doors on July 15 and is located on 7 th avenue, between West 12 th and West 13 th .
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Lenox Health Greenwich Village · Lenox Hill Hospital · 30
Details: Lenox Health Greenwich Village (Facility# 9700) is a health facility registered with New York State Department of Health, Center for Health Care Facility Planning, Licensure, and Finance. The address is 30 Seventh Avenue, New York, New York 10011.
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Join a tour of the state-of-the-art Lenox Health Greenwich
Details: Lenox Health Greenwich Village, a division of Lenox Hill Hospital, is a state-of-the-art medical complex representing a new model of community-based care. Our facility currently includes a full service emergency department, a patient service center for blood collection and a state-of-the-art outpatient imaging center, allowing us to seamlessly
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Lenox Health Greenwich Village – Silman
Details: Lenox Health Greenwich Village. New York, NY. Photo credit: Franco Folini / CC BY-SA 2.0. Following the building's acquisition by Northwell Health, the design team undertook a comprehensive restoration and renovation to transform it into the city's first free-standing emergency department. Harlem Hospital Center. Harlem Hospital
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Northwell Hospital In Greenwich Village
Details: Lenox Health Greenwich Village to introduce specialized . Health (7 days ago) In 2020, Lenox Health Greenwich Village (LHGV) state granted approval to open cath labs at LHGV over other facilities because of its connection not only to Lenox Hill Hospital, but to the entire Northwell Health Cardiology program, which consistently ranks among the best in New York State."Our …
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Lenox Health Greenwich Village Parking - SpotAngels
Details: January 09, 2022 - Find free parking near Lenox Health Greenwich Village, compare rates of parking meters and parking garages, including for overnight parking. SpotAngels parking maps help you find cheap parking. Save money every time you park near Lenox Health Greenwich Village, NYC, NY.
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Lenox Hill's rich history: A legacy of innovation Crain
Details: That same year, Lenox Hill made a commitment to address the health care void created in Greenwich Village after the closure of St. Vincent's Hospital. Four years later, Lenox Health Greenwich
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Imaging Center At Lenox Health Greenwich Village in New
Details: Imaging Center At Lenox Health Greenwich Village. 200 W 13th St Fl 5. New York, NY 10011. (646) 665-6700. Monday. 7:30 AM - 7:00 PM. Tuesday.
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About us - Lenox Hill Hospital Northwell Health
Details: Lenox Hill is committed to providing the highest standard of care to a socioeconomically and ethnically diverse patient population, with multilingual translators available 24/7. 100 E 77th Street. New York, NY 10075. (212) 434-2000.
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Lenox Health Greenwich Village - Directory of HANYS
Details: Lenox Health Greenwich Village. Facility Type: Provider-Based Off-Campus E.D. Mark Schiffer, MD Executive Director. Dina Wong, Executive Director. 30 Seventh Avenue. New York, NY 10011. Phone: (646) 665-6000.
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Program Lenox Hill Hospital Psychiatric Outpatient Clinic:
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Division of Gastroenterology - Lenox Hill Hospital
Details: The Center for Advanced Therapeutic Endoscopy (CATE) at Lenox Hill Hospital focuses on the minimally invasive and multidisciplinary management of conditions considered to be too complex or too high risk to be handled elsewhere.
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Lenox Hill Hospital at Northwell Health in New York, NY
Details: Lenox Hill Hospital at Northwell Health in New York, NY is nationally ranked in 7 adult specialties specialties and rated high performing in 4 adult specialties and …
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Lenox Hill Orthopedics Northwell Health
Details: The knowledgeable team at Lenox Hill Orthopedics treats disorders of the spine, hip, knee, foot, ankle, shoulder, elbow, hand and more. The department has pioneered minimally invasive techniques in orthopedic surgery, as well as in the treatment of sports injuries and osteoarthritis.
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Lenox Hill Hospital - Wikipedia
Details: Lenox Hill Hospital (LHH) is a nationally ranked 450-bed non-profit, tertiary, research and academic medical center located at the Upper East Side of Manhattan, New York City, servicing the tri-state area.LHH is one of the region's many university-level academic medical centers. The hospital is owned by Northwell Health, the largest private employer in New York (state).
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Lenox Health Greenwich Village - Docomomo
Details: The Commercial Design Award of Excellence is awarded for the restoration of the Lenox Health Greenwich Village, formerly known as the Joseph Curran Building and the O'Toole Medical Services Building, in New York City. Designed by Albert C. Ledner in 1964, the building, which served as the National Maritime Union headquarters, was bold in its appropriate ship-like …
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Lenox Hill Hospital to open emergency medical center in
Details: Four years after St. Vincent's Hospital went broke and shut its doors leaving Greenwich Village residents in the medical lurch, Lenox Hill Hospital is opening a freestanding, 24/7 emergency center.
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The Forum on Lenox Health Greenwich Village Facility
Details: Lenox Health Greenwich Village (the correct label for this facility, after many different names changes) reps said they are progressing toward better and more complete services in Greenwich Village. Recently, new doctors' clinics opened in the 7th Avenue buildings; there is 24/7 psychiatric telehealth available at the facility.
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PROGRESS REPORT: LHGV: A growing healthcare hub at 5 years
Details: Lenox Health Greenwich Village is located on Seventh Ave. between W. 12th and W. 13th St., in a former St. Vincent's Hospital building. The structure was originally built — with a ship-like
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Meals Delivered — Feed the Frontlines NYC
Details: Greenwich Hospital. Hospital for Special Surgery. James J. Peters VA Hospital. Kings County Hospital. Lenox Health - Greenwich Village . Lenox Hill Hospital . Lincoln Medical Center. Long Island Jewish Medical Center. Manhattan VA Health Center. Memorial Sloan Kettering. Montefiore Medical Center, Moses Campus .
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CareConnect Facilities - Employee Benefits
Details: • Lenox Health Greenwich Village, 30 Seventh Avenue, New York, NY 10011, P: 646-665-6000 • Lenox Hill Hospital, 100 East 77th Street, New York, NY 10021, P: 212-434-2000 • Lincoln Medical & Mental Health Center, 234 East 149th Street, Bronx, NY 10451, P: 718-579-5000
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Greenwich Village Ambulatory Surgery Center - Northwell Health
Details: Northwell Health Greenwich Village Ambulatory Surgery Center (GVASC) is a multispecialty center specifically designed with patient comfort, safety and accessibility in mind. Located in the heart of Greenwich Village, this brand-new, state-of-the-art center offers surgical care in Orthopedics, Pain and Neurosurgery.
› Url: https://www.gvasc.net/ Go Now
CareConnect Facilities - New York Health Insurance Company
› Url: https://www.careconnect.com/media/1049/careconnect_facilities.pdf Go Now
Details: • Lenox Health Greenwich Village, 30 Seventh Avenue, New York, NY 10011, P: 646-665-6000 • Lenox Hill Hospital , 100 East 77th Street, New York, NY 10021, P: 212-434-2000 • Lincoln Medical & Mental Health Center , 234 East 149th Street, Bronx, NY 10451, P: 718-579-5000
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COVID-19 Boosters And Third Doses Available At Greenwich
Details: Health & Fitness COVID-19 Boosters And Third Doses Available At Greenwich Hospital First appointments are being offered for Saturday, Oct. 2 at Greenwich Hospital.
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Greenwich Hospital Photos and Premium High Res Pictures
Details: Browse 841 greenwich hospital stock photos and images available or start a new search to explore more stock photos and images. Person wears a face mask outside Lenox Health Greenwich Village hospital as the city continues Phase 4 of re-opening following restrictions imposed The Royal Naval College on the south bank of the Thames at Greenwich
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Dzwinka K. Carroll, MD Obstetrics and Gynecology - Westmed
Details: Northwell Health System - Lenox Hill Hospital. Board Certification. Greenwich Hospital. Office Locations (2) Greenwich 644 West Putnam Avenue Greenwich, CT 06830 Ph: 203-210-2880 Fax: 203-210-2881 Directions; Darien 106 Noroton Avenue Darien, CT 06820 Ph: 203-210-2890 Fax: 203-210-2891
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GREENWICH COVID-19 UPDATE: 31 Confirmed Cases; Hospital
Details: – Greenwich Hospital Chief Operating Officer Diane Kelly. Greenwich Health Dept is continuing operation of dedicated phone lines to receive residents' calls and answer concerns. The numbers are: 203-622 -7865, 203-622-7703, 203 …
› Url: https://greenwichfreepress.com/health/greenwich-covid-19-update-31-confirmed-cases-hospital-ups-icu-capacity-137219/ Go Now
Northwell Health opens $25M surgery center, $8M medical
Details: Northwell Health opened the Lenox Health Greenwich Village in New York City, which includes a surgery center, medical pavilion and orthopedic institute, according to Chelsea Now. Here are five insights: 1. The $25 million surgery center includes six operating rooms, two procedure rooms, eight prep areas and 23 recovery beds.
› Url: https://www.beckersspine.com/orthopedic-spine-practices-improving-profits/item/39001-northwell-health-opens-25m-surgery-center-8m-medical-pavilion-5-insights.html Go Now
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