Medical Book Description:
This practical and evidence-based resource for emergency medicine and acute care providers will guide physicians in the selection of an effective therapy, define appropriate dosages to use and, equally important, when a treatment doesnt work, explain why, and what to do next. It opens with chapters on the assessment of pain, the safe and effective provision of analgesia in special populations, and featuring a reference table of drug names and interactions.
Click Here To Get This Book.

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Ladies and gentlemen, this is a time for courage.
We are gathered here today in common purpose. We are here to remind our government that the United States of America is our country, We the People are still in charge, and our government is still our servant and not our master.
Our Nation’s founding document is The Declaration of Independence. It tells us that our rights come from God and not from our government and certainly not from our President.
Our Declaration of Independence was signed 233 years ago. Today is our Nation’s birthday. Eleven score and 13 years ago our Founding Fathers signed the Declaration of Independence.
Our Founding Fathers pledged their lives, their fortunes, and their sacred honor in support of our Declaration of Independence. In these trying times, when our freedoms are again challenged, we must do no less in support of our own quest for Liberty.
We are gathered here today in peaceful resistance. We are rebelling against the unwarranted spending and taxation that has descended like a tidal wave sweeping across our great nation.
Our Founding Fathers established the United States of America and its Constitution on a solid foundation of Christian religious principles with very limited Federal powers.
Our Founding Fathers realized that a reliance on God was the necessary foundation on which our government and our society rest. Without this solid foundation, our government would become one of evil men and women doing evil deeds to gain power.
We believe that the United States of America is an exceptional nation that has done much to provide and protect freedom throughout the World. The people of the United States have given generously from the great bounty that has resulted from their hard work and sacrifice.
We are angered that our President apologizes for the exceptionalism and heroism of the United States of America. We are deeply troubled he told others the United States is not a Christian nation. Obama’s Marxist views discredit our Nation’s great history, our military, and the blood, sweat, and tears of all those whose sacrifices have made our nation that bright and shining city on the hill.
Our Constitution starts with the words “We the People.” Our Constitution was written for ordinary Americans like you and me. Our Constitution protects us from our government and from the politicians.
Our Constitution protects us from our President. It protects us from the tax cheats, hate mongers, and racists who serve our President and who wish to destroy our Nation with class and racial civil war, taxes, debt, and inflation.
President Obama has complained that our Constitution gives too much protection to ordinary people like you and me. Obama wants a lot more of that power for himself.
Obama has ridiculed us for the high value we place on our Bibles, our guns, our personal property, and our Liberty. He tells us we do not deserve to keep the money we have earned.
President Obama promises that he will one day take away our guns. If he cannot take our guns, he has promised to take our ammunition.
President Obama and his fellow Progressives tell us that freedom has not worked. Personal responsibility, free enterprise, and Liberty have not been effective.
We are told that defending our nation against Radical Islamic Terrorists is wrong. We are told that defending our families and ourselves is wrong.
President Obama does not appear to understand that any negotiating with an enemy must be backed up with the very serious treat of imminent military consequences and not just the empty threat of “sanctions.” Iran laughs at our threats of sanctions and proceeds to develop nuclear weapons, which Iran assures us it will use on Israel and on us. North Korea fires missiles at us and is building more nuclear bombs.
There are two distinct views of peace. One follows military action and the defeat of the forces of Evil. The other follows surrender and disarmament.
The first results in freedom, the second in slavery and serfdom. We must continue to choose victory. Defeat for the United States of America must never be an option.
The fact that the United States is so feared and hated by evil people can mean only one thing our Nation is truly a beacon of freedom to the rest of the World.
From our own Revolutionary beginnings, to the Polish Resistance of World War II, the fall of the Berlin Wall, and the elections in Afghanistan and Iraq, We the People and our United States of America continue to enable and inspire the oppressed to risk all for freedom.
Freedom is worth the sacrifice of war and even death. As President Reagan said on June 6, 1984, the 40th anniversary of D-Day, “Ones country is worth dying for, and democracy is worth dying for, because its the most deeply honorable form of government ever devised by man.”
President Obama has given Miranda rights to terrorists. Obama will soon try to give terrorists, illegal aliens, and felons the right to vote if our Congress and our Supreme Court do not stop him.
We are told that our government will now make more of our decisions for us. Politicians and bureaucrats will decide what medical care we can have and when they think it is time that we should die.
Obama wants to take control of all our health care. It only took a few months for Obama to destroy General Motors, at one time the largest corporation and biggest employer in the World. How long do you think it would take for Obama to set our health care back 100 years?
Obama is shutting down car dealerships by the hundreds. It appears he and his thugs are targeting those who did not financially support his political campaign.
What will happen when they start to close down hospitals by the hundreds? Might we expect they will preferentially close down hospitals in Texas and other Red States?
President Obama said last week that we will need to tolerate our pains and discomforts and take a lot more pain medication. He said pain medicines are cheaper than surgery. Obama said he would cut medical costs by rationing and significantly limiting our medical care.
Obama said we should receive no expensive medical care during the last 6 months of our lives. Ladies and gentlemen, only God knows when we are in the last 6 months of our lives. I have been a surgeon for more than 30 years. I cannot predict when someone is entering the last 6 months of their lives and neither can any other human.
God tells us in the Holy Bible that only He knows when we will die. So how can Obama claim to know when to stop our medical care? Does Obama think he is God?
President Obama wants to spend as much as $2.5 trillion to give health insurance to 16 million people. Obama’s health insurance will cost as much as $150,000 for each person. That is a lot of money with which Obama plans to line the pockets of 10s of thousands of health care bureaucrats and thousands of trial lawyers. These people will vote for Obama.
President Obama said last week that his family would not be receiving the same government health care he plans to force on you and me. Obama said he wants only the best medical care for his family. There will be no waiting in line and there will be no rationing of medical care for the Obama family.
I do not enjoy going to the Department of Public Safety to renew my driver’s license. I do not enjoy going through airport security screening with the Transportation Security Administration. Government employees are often unpleasant and arrogant.
Why would anyone want to voluntarily go to government bureaucrats for their health care?
Our nation champions free enterprise and personal freedoms. We have fought wars to end Socialist tyranny. We have stood firm against North Korea, Cuba, and other Communist dictatorships. How is it that we are now on a path to socialized medicine when Canada, Britain, and even Russia and China are seeking free market economic solutions to their socialized health care problems?
The solutions for health care financing are quite simple. Our elected officials must find the courage to return health care, retirement, and other personal decisions to the people.
We the People can make the best decisions for our own families and for ourselves. Washington bureaucrats have not idea what our individual need might be, and they could care less. If it comes down to helping us or taking a coffee break, most will take the coffee break.
We have had enough of the meddling government nannies telling us what to eat, how to flush our toilets, what kind of car to drive, what kind of light bulbs we can purchase, and how much toilet paper we can use.
Our government tells us it is okay to put oil on our salads. They tell us that salads with oil and vinegar are healthy foods.
Our government also tells us that putting that same oil on potatoes and making French fries results in bad food and we will surely die.
Ladies and gentlemen, it is time to get the government out of our lives. It is time to vote most of those in Washington out of office. It is time to return Washington to adult supervision.
President Obama wants many more taxes. He wants to place a multi-trillion dollar Cap and Trade tax on our energy. He claims that taxing us into poverty will help to cool the Earth. What Obama did not tell us is that an Environmental Protection Agency report said the Earth is already getting colder. Obama also did not tell us the White House ordered this report to be hidden from the public so his massive tax could be passed.
Other than our military, I cannot think of one Federal government agency I have ever found to be helpful.
And speaking of our military, how about those Navy Seals who blew the heads off those three terrorist pirates?
Don’t you just wish our entire government would function with such efficiency, professionalism, and courage?
Don’t you wish President Obama would have the courage to direct our military to kill more terrorists and pirates every day?
We wish President Obama would side with the Iranian people in their pursuit of freedom.
Don’t you just wish we could be confident that President Obama is really on our side?
President Obama recently allowed PETA to attack him for killing a fly. If Obama can no longer kill flies, is Obama going to order the killing of any bad guys?
President Obama wants to sit and talk peace with the North Korean and the Iranian leadership. Negotiating with evil people does not result in good outcomes.
Many people tried to negotiate with and to appease Adolph Hitler. All those wasted efforts simply gave Hitler more time to prepare for war.
We must remember that Christ did not negotiate with Satan or try to appease Satan. Christ stood up to Satan, confronted Satan, and defeated Satan. We, Ladies and Gentlemen, must also confront Evil and defeat it.
We watch in disbelief as our beloved United States is weakened economically, militarily, and morally by a Radical President and his eager accomplices.
Obama is now systematically destroying what has taken generations to build. He is destroying jobs, our economy, our military, our national security, and the future of this country. He is destroying the future of your children, the future of your grandchildren, and the future of generations yet to come.
He is replacing our businesses and jobs with the same government controlled Socialist Evil that brought poverty, destruction, despair, and death to untold hundreds of millions in Russia, China, and many other Socialist countries.
President Obama wants to rule over poor miserable subjects and not rich prosperous citizens. This increased separation from his subjects will give Obama a greater sense of omnipotence.
President Obama cannot handle leading a prosperous nation of free and brave citizens. Obama must rule a broken and dependent nation. He envisions his future subjects as unarmed, submissive, and weak.
With a broken nation and weak subjects, Obama plans to rebuild the United States as he wishes from the bottom up.
Such is what one experiences under the rule of Socialists and Communists who can achieve and maintain their power only by force.
Obama takes our hard earned money and gives it to his political supporters. That is what he did with the “stimulus” money he demanded. Obama warned us if his “stimulus” bill were not quickly passed, unemployment would reach 8.8%. Ladies and gentlemen, unemployment has passed 9.4% and will reach 10% before the end of this summer – maybe even before the end of this month.
President Obama has borrowed and printed trillions of dollars. Obama said it was to “stimulate” our economy. Obama gave the money to his political supporters on Wall Street and to the unions.
Joe Biden told us last month that Obama and he “guessed wrong” about fixing our economy.
Ladies and gentlemen, guessing is not an acceptable leadership tool for a President of the United States any more than is voting “Present.” We the People do not want guesswork from our President. The job of the President of the United States is to protect us and to keep us safe so we can live long, work hard, and prosper.
Much of what Barack Obama is doing to the United States of America is not in his job description. He is ignoring our Constitution and his sworn duty to “preserve, protect and defend the Constitution of the United States.”
President Obama has denied the existence of the “War on Terror.” He tells our enemies in Iran and North Korea that he will talk with them and give them things to make them happy. He has promised that he will not use military force against them. He appeases Russia and China.
President Obama has repeatedly insulted Britain, our closest Ally. The Prime Minister of Britain and the Queen paid appropriate recognitions and honors to President Obama. Obama gave each of them cheap worthless trinkets as gifts.
The President of the European Union warned President Obama that his Socialist economic plans are taking the World down the “road to Hell.” Even Pravda, Russia’s legendary Communist newspaper, has warned us that Barack Obama is a Marxist who is destroying our nation.
The path to power for Socialists and Marxists includes taking God and guns from the citizens. Without spiritual and physical protection, people cannot defend themselves and their Liberty. The people soon cease being citizens and become subjects and slaves.
You and I are angered that we have been called cowards and racists because we oppose Socialism. Socialism is not racial. Socialism is an equal opportunity destroyer.
We are angered that a Department of Homeland Security report, issued less than three months after Obama took office, singled out our military men and women who are returning home as being radical threats.
The report also characterized you and me as right-wing extremists and radicals because we favor smaller government and lower taxes.
We were told that we are potential security threats because we want to make our own health care decisions, choose our own cars and trucks, and remain in charge of our own lives and those of our children.
You and I are ordinary citizens who believe just like most of our fellow Americans. We want our government to leave us alone and to keep its hands off our money, our religion, our guns, our private property, and our lives.
We demand that our government stop spending money it does not have.
Stop confiscating our money and private property.
Stop printing money.
Stop subsidizing Fannie Mae, Freddie Mac, and the other failed financial institutions and companies.
Mr. President, stop appointing tax cheats and racists to positions of power and influence.
Mr. President, secure our borders. You may welcome the terrorists and criminals. We do not.
Mr. President, do not give voting rights to millions of illegal aliens and felons. You have no more right to create new voters for your benefit than you do to use our money to buy the 2010 and 2012 Elections.
Mr. President, do not divert money from our missile defense, F-22 Raptors, and other vital military equipment. This gives encouragement, aid, and comfort to our enemies. Protecting us is your number one job.
We fear you, President Obama. You are arrogant and you look down your nose at common people like us. We do not trust you. We do not think you care about anything except the power you are grabbing for yourself and your Progressive supporters. We do not confuse your arrogance with leadership.
We gather peacefully here today because there is a growing concern for what our government is doing to us and to our future. We fear for the very survival of our Republic.
Thomas Jefferson said, “When the people fear their government, there is tyranny; when the government fears the people, there is liberty.” We the People choose liberty.
In spite of all the destruction that has already taken place, there is much to make us hopeful and to fill our hearts with optimism and courage. This is still our country!
President Ronald Reagan said, “Evil is powerless if the good are unafraid.” Ladies and gentlemen, this is indeed a time for great courage.
The Constitution of the United States belongs to We the People.
Our Constitution still protects us from our government. It is time to take back our government and put it in the hands of responsible people who love the United States of America as much as we do.
We have no time to lose. Our first step is to get the attention of our elected officials in Washington.
Call every possible elected official, including our President, Vice President, and the Speaker of the House. Call Democrats and call Republicans.
Demand that our Congress and President Obama stop stealing our money and stop giving our money to ACORN and their other political supporters in order to buy votes.
Call Senators Cornyn and Hutchison, and your Representatives in Washington. Thank them for what they do that is right. Urge them to do much more.
Remind them now is a time for action and not for political campaigning for election. Remind them that if they do not protect our Constitution and us, we will vote them out of office.
Volunteer to work on our 2010 Census. Keep ACORN honest. Keep our Census honest.
We must not allow President Obama to take control of our Census for his political advantage. Once he has control of our Census, the White House can cook the books and rig the elections Chicago style.
We must replace as much of our Far Left Congress as possible in 2010, and this includes several Republicans. Get involved. Do not let ACORN control our 2010 Election. Vote for the most Conservative candidates and those who most strongly oppose Obama.
The problems we face today have occurred because we have not defended our Nation against Socialism. For too long we have allowed the wrong people to make the worst possible decisions.
We have allowed students to be indoctrinated with Liberal propaganda, twisting their minds and confusing their logic. Our young relatives, friends, and neighbors helped to elect Obama.
Many of them are now starting to wake up because the debt Obama is creating will be on their shoulders for their entire lives.
Talk with someone every day who does not understand our Nation’s history and our great heritage. Tell them why the United States is a good and prosperous nation. It still remains that brightly lit city on the hill. It still is the best hope for all mankind.
Talk with all of the young people you can find. They are our future. Many do not understand what they have and that their future is being quickly destroyed.
Encourage your elected State officials to pass legislation that will protect us from our Federal government. Governor Rick Perry and others have done that for Texas. They have promised me that they will do more. Thank them and pray for them.
Romans 8:28 assures us, “We know that all things work together for the good of those who love God those whom he has called according to his plan.”
Ladies and gentlemen, I believe that Texas and the United States of America are a major part of God’s plan. The task now falls upon We the People to restore the United States to its foundations and to cleanse our government of the Socialist Evil that has been brought upon us over the past many years.
This is a time for courage. This is a time for strong peaceful action. Let us pray that We the People can quickly return our government to its Constitutional foundations and responsibilities.
Our President and our Congress were elected to be our servants and not our masters. Barack Obama was elected to be our President. He was not elected to be our Dictator. His job is clearly defined in Article II of our Constitution. President Obama is not doing his job.
May God help our President and Congress to quickly realize the error of their ways and stop their reckless and unwarranted spending, cut our taxes, and reduce the size of our Federal bureaucracy.
May our Congress have the wisdom and courage to quickly stop Obama’s Marxist destruction of the United States.
If Congress will not protect the United States and its Constitution, may God grant us the courage and determination to vote them out of power next year.
May God’s blessings and His peace be upon Texas and upon the entire United States of America! May God grant us the wisdom and courage for the challenges and work that lie before us!
May God richly bless and protect each of you, and our Constitution, as together we pursue Liberty!
Thank you.

Similar posts: evidence based medicine

The RCPE organises an extensive programme of educational events including Evening Medical Updates, Update Symposia in Specialty areas, in General and Acute Medicine and on emerging Hot Topics in medicine, and international consensus conferences. These events are likely to be of interest to hospital doctors at all stages of their careers, GPs, nurses and other health professionals. Details of all forthcoming RCPE educational events can be accessed below.

Similar posts: evidence based medicine

Last October, after one of the presidential election debates that had addressed healthcare and reform, I asked you whether you thought healthcare in America should be a right or a responsibility. Overwhelmingly -- almost 2 to 1 -- you felt healthcare should be a right that all Americans should enjoy. Along comes an interesting article by Tom Head, the About.com Guide to Civil Liberties, who asks the question, Is Universal Health Care a Human Right? Beyond just whether it should be a right for Americans, he's looking at human rights and government declarations. According to his article, healthcare IS a right, based on "widely accepted international human rights treaties" which have been both drafted and signed by American representatives. That's right. Evidently we've made it known throughout the world that we think healthcare is a right. But in the United States, healthcare clearly is not a right. If it were, we would not have 47 million Americans who can't get the medical attention they need. So I have to ask -- is this a question of "do as we say but not as we do?" Or do we believe healthcare should be a right for the rest of the world, but not for us? Tom's article points out a major disconnect -- lip service vs reality. We can only hope that our congressional representatives take a look at what we're telling the rest of the world so they can make it jive with the reality of American healthcare, too. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Learn more or join the conversation.

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Thirteen years after NINDS, and right on the heels of ECASS-3, just as doctors are becoming more comfortable with TPA these authors decide to publish a reanalysis of the NINDS findings from 13 years ago. Evidently Hoffman and his co-author David L. Schriger MD, MPH feel that after 13 years we still dont have the research we need to determine whether some patients with ischemic stroke will benefit from TPA. What has their novel reanalysis of the NINDS data revealed that the rest of us dont know? Ill reserve judgment about the paper until I have access to the full text.

Meanwhile as emergency medicines key opinion leaders continue to discourage widespread adoption of published guidelines for thrombolysis in ischemic stroke doctors in the trenches of emergency medicine are faced with questions. How should they interpret 13 years of perseveration against the guidelines by their leaders? Is it healthy skepticism or extreme cynicism driven by contempt for the pharmaceutical industry? What do you think?

Pending my review of the full text of Hoffmans paper heres my take on TPA for ischemic stroke:

Some proponents, I concede, have been excessive in their zeal to promote the treatment (see this ridiculously inaccurate New York Times piece).

Properly patients stand a better chance of having a good stroke outcome when treated.

Some patients will die as a direct result of treatment with TPA while others who would have died from their ischemic stroke will survive as a result of improvement after TPA, making the mortality effect neutral in the aggregate.

Bad outcomes directly attributable to TPA are dramatic and pose special difficulties for families and treating physicians.

The treating physician needs to be armed with some numbers to get informed consent based on sufficiently detailed information. Some guidance can be found here.

I do not believe it should be considered standard of care but, then again, I dont like that term for any treatment. Its too dogmatic and only gives fuel to the trial lawyers.

Similar posts: evidence based medicine

clinical trial comparing standardized acupuncture, individualized acupuncture, placebo-acupuncture, and usual care. In that discussion I emphasized the comparison between the three acupuncture groups, which did not show any difference in outcome. These results are consistent with the overall acupuncture literature, which shows in the better controlled trials that it does not matter where you stick the needles or even if you stick them through the skin. Therefore the scientific evidence fails to reject the null hypothesis (that acupuncture does not work). This did not stop the press from declaring, almost uniformly, that acupuncture works for back pain, contributing to the public misunderstanding of clinical science.
This week I am going to focus on the other aspect of the trial - the one the researchers and the press chose to focus on - the comparison of the two real and one placebo acupuncture arms to usual care. This too was misrepresented by the press, encouraged by the overinterpretation of the evidence by the researchers.
In the comments to Part I of this discussion David Gorski correctly pointed out that the study in fact did not even constitute a comparison of acupuncture to standard medical treatment. He is absolutely correct, and the many reasons for this are worth explaining in detail. Understanding the technology of clinical trials is central to science-based medicine, including all of their pitfalls and limitations. For practical and logistical reasons there is almost never a perfect clinical trial, but mischief only ensues when limitations are not understood, leading to a misinterpretation (and almost always an overinterpretation in the direction of the researchers bias) of the evidence.

Similar posts: evidence based medicine

Dr. Louis Aronne, founder and director of the Comprehensive Weight Control Program at New York/Presbyterian Hospital/Weill Cornell Medical Center has a new weight loss guide.
In his new book, The Skinny, Aronne shares his secrets to losing weight without being hungry and tackles the challenge of how to keep the weight off. Free of fads, The Skinny offers healthy methods for controlling cravings and eating smart without counting calories.
The Skinny gives extensive advice on how to achieve healthy, long-term weight loss and includes recipes and tips for eating out, along with an easy-to-stick-to exercise guide.
The Solution for Lasting Weight Loss
Some surveys indicate that roughly 80 percent of people who lose weight regain most or all of it within a year. I want you to fall into the other category, the category of people we rarely hear about. I want you to be a part of the 20 percent who keep it off. To stay successful, use this plan for maintaining your weight loss.
Your first step in achieving lasting weight loss lies in determining when to stop losing and start maintaining. Many dieters pick an arbitrary finish line.They want to get down to a specific clothing size or see a specific number on the scale, but you just cant bully your body into losing the perfect amount of weight. Will you shed enough fat to fit into a size four, six, or eight, or into the jeans you wore in high school? I cant make that promise. At some point, as you lose weight, your body will fight back. It will defend your weight, and if you try to battle your body at this point, youll end up feeling extremely hungry despite choosing the most filling foods and plateau anyway because your metabolism will slow.Trying to fight against this biology is like trying to push a car uphill. You may manage to go a few steps, but, eventually, biology wins, and your weight-like that car-goes in the other direction. I know this isnt what you want to hear, and I wish I could tell you the magical secret that would allow you to get your body to that pre-determined perfect place, but I just cant. Id much rather be honest, and Id much rather give you the tools to help you get to a healthy weight and then stay there. If you have a lot of weight to lose and cant consider some of the options such as medication and surgery discussed in chapter 10, Id rather you lost a little weight and kept it off than lost a lot of weight and then gained a lot of it right back.
Forget about that coveted number or clothing size. Instead, focus on your behavior on successfully following this books nutrition and lifestyle principles and let your maintenance weight find you.To do so, follow the Phase 1 menus and exercise as directed in Part 2 for as long as you can. Once you feel deprived or bored with the Phase 1 choices, slowly transition to Phase 2 eating as described in chapter 3. Increase exercise as directed in chap-ter 9. Eventually, no matter how closely you monitor your eating or how diligently you exercise, youll stop losing weight. This is your mainte-nance weight. Expect to Gain a Little Back Ive got some more news that you probably wont like. Most people gain back about 10 percent of their total weight loss. In other words, if you lost 20 pounds, you can expect to regain 2 to 3 pounds. If you lost 100, you may regain 10. Although few if any diet authors will admit it, everyone who loses weight regains a little. Its normal and it happens to almost everyone no matter how closely they follow their dietary and fitness regimens.
Why does it happen? Youve transformed your body from one with chronically high levels of the fullness hormone leptin and low levels of the hunger hormone ghrelin to the opposite. Now leptin is low and ghrelin is high. These low leptin levels are, in part, what caused your plateau. As leptin levels drop, so does thyroid hormone, reducing metabolism so you burn fewer calories. Low leptin levels also allow hunger hormones to enter the brain unchecked.
We dont yet know all of the physical reasons why this happens, but regaining just a few pounds seems to increase leptin levels above some threshold level we havent been able to identify, and brain chemicals stop sending out so many eat more and burn less signals.Your appetite and your metabolism reach a and your weight plateaus. Your body reaches an equilibrium that it can maintain. Skinny Secrets for Staying Skinny To maintain your weight loss after you gain that initial 10 percent, do the following.
Keep moving. Continually look for ways to add more lifestyle walking to your daily repertoire. Its the best way I know of for overcoming plateaus and for maintaining weight loss. Its one of the few strategies that seem to help prevent low leptin levels from making your muscles more efficient. As a result, your metabolism can no longer act as such a brake on your weight loss. Some of my patients have plateaued, started a regular exercise program, and then experienced a new onset of weight loss to a lower plateau.
Exercise also helps overcome occasional overeating. Whenever you overdo it, your body has to decide what to do with the extra calories. If your muscles are metabolically active from exercising, calories will be sent to your muscles to be burned rather than to your fat cells to be stored. When researchers from Brown University and the University of Colorado studied longtime weight maintainers, they discovered that people who tended to regain weight got lax on their exercise hab-its.Those who kept the weight off tended to increase exercise as they maintained, with the average maintainer moving for sixty minutes a day, mostly through walking and light- intensity activities such as housework and gardening.
Weigh yourself regularly. Researchers from Cornell University asked a group of freshmen women to weigh themselves daily. They asked another group of women to weigh themselves just twice at the beginning of the semester and at the end. At the end of the semester, the women who weighed daily gained no weight, whereas the women who didnt weigh gained between 4 and 8 pounds.
Why did daily weighing help? Even though the researchers provided the students with no information about dietary and exercise habits, the women who stepped on the scale each day naturally found ways to control their weight. If they saw an increase, they either ate less or moved more.They skipped snacks, skipped dessert, shrank portions, or stepped up their exercise efforts. They didnt count calories, but the feedback of the scale gave them constant nudges in the right direction.
Youll need to strike a careful balance between denial (its just water weight, I dont need to do anything differently) and negativity (I gained weight, I may as well eat whatever I want). Many factors affect your weight beyond the size of your fat cells. You can expect your weight to fluctuate by about 5 pounds based on the amount of fluid your body is retaining, the regularity or irregularity of your bowel habits, and the amount of carbohydrate stored in your liver and muscles. In the study I just mentioned, the college freshmen plotted their weight on a graph such as the one on page 158. A slight up- and- down line was nothing to worry about. A steady upward line, however, meant they needed to take corrective action.
What types of corrective actions should you take? Your first action should be to see if youve strayed from your Phase 2 menus or cut back on exercise. If so, reestablish those habits. If youre gaining despite carefully following the Skinny menus and tips described in the rest of this chapter, then see your doctor.You may have a health problem thats affecting your weight. Read chapter 10 to see if a sleep problem, a weight-gaining medication, or something else is affecting your weight. And try to make small dietary or lifestyle changes. Can you add five or ten additional minutes of movement a day? Can you fill up on fewer calories by eating even leaner, sneaking more veggies into a meat dish, or shrinking your starch portions?
Fight hunger with lean protein plus vegetables. As you maintain, you may ?nd that at times, you feel hungrier than usual. During these times, increase your lean protein and your vegetable portions. By eating more of the right foods, youll be able to more easily eat less of the wrong foods, and youll more easily maintain your weight, too. But remember, just cutting back on calories is often not productive and can lead to overwhelming hunger because the counterbalancing systems get activated.To maintain your weight, its always better to add than to subtract. Eat more filling foods, so they naturally displace the fattening ones.
Turn off the tube. People who regain weight tend to watch more TV than people who dont. The average American watches four hours a day, and more than 60 percent of average Americans are overweight or obese. Research completed at Brown University and a number of other institutions, however, shows that successful weight maintainers watch far less. More than a third of people who have maintained a 30- pound weight loss for a year or longer watch fewer than five hours a week and another third fewer than ten hours.The more TV study participants watched, the less they exercised and the more weight they regained.
Be vigilant when life gets more stressful. When patients come to see me after regaining weight, I always ask,What changed? Inevitably, something has. They take on more responsibility at work, move, have a baby, have a sick family member, or twist an ankle and cant walk as much.Whenever something changes in your life, its time to be more vigilant.Thats when youre most likely to backslide. Be consistent. Use The Skinny to guide your eating during the week, on the weekends, and during vacations and holidays. Dont use it on some days and not on others. For example, many dieters like to have cheat days and cheat meals. They follow an eating approach flawlessly during the week and then go hog wild on weekends.That may be okay for some people, but this type of eating could damage your fuel gauge, causing you to start each week feeling excessively hungry from your weekend dessert-and- starch binge. Research shows that the most successful maintainers eat consistently every day, no matter the occasion.
In particular, always: Eat protein for breakfast. Although some people can get away with cereals, oatmeal, toast, juice, or another starchy breakfast once or twice a week, most maintainers cant eat these foods every day without noticing an increase in hunger. Most maintainers find that they must consume protein foods (from their Phase 1 breakfast options) most days of the week. The protein controls hunger and cravings for the rest of the day, so they naturally eat less for lunch and dinner. If you feel you have to have a starch for breakfast, have it with protein. For example, have a whole- grain English muffin with peanut butter, an egg, or turkey sausage.
Eat starch and dessert last. Always consume starch or dessert at the end of the meal, after youve consumed your vegetables, salad, soup, and lean protein.This is when youll have most control, so one reasonable serving of pasta does not turn into one gargantuan serving. For the same reason, never consume alcohol as an appetizer or just before your meal.Always have it with the main course or after dinner.
Use the three- bites rule. Im a weight- loss doctor. Does that mean I never eat cake or cookies? No way. As long as most of what you eat is rich in lean protein, fiber, and nutrients, you can occasionally eat sweets in moderation. The two important keys here are occasionally and in moderation. A few bites of dessert once or twice a week is probably okay for most people. A large serving every day probably isnt. Once you fix your fullness resistance, you can eat the small serving.
Lose What You Gain This is another one of those dirty little secrets about dieting that no one will tell you. Nearly everyone who loses weight gains and reloses many times. They dont lose 60 pounds and keep that 60 pounds off for life. Rather, their weight maintenance resembles the up- and- down rhythm of an EKG readout. They gain 3 pounds, take steps to address it, and then lose 3 pounds. They gain 2 pounds, make another change, and then lose it.They gain 5, and then they lose 5.
They do this over and over again. If you gain, do the following to turn the numbers around. Keep a food log. One big mistake every day can easily cause weight regain and stoke up your appetite. Many of my patients, during maintenance, ate nearly perfectly all day, but they gained because of one really bad food choice. They reverted to eating bread before dinner instead of after, for example, or they reverted to drinking juice with breakfast. They didnt even realize they had made the change, but they did realize they were hungrier, and didnt know why. They were not eating massive quantities of any one food, but they were eating one fattening food every single day and increasing their overall appetite as a result.
The following foods can be because they increase your appetite, making it harder to maintain your weight loss. If you find yourself gaining, write down everything you eat, and look over your records daily and weekly. Look for patterns. What fattening foods have returned to your daily repertoire? Heres a list of common offenders: Bread Sweets Soft drinks Juice Large servings of pasta Large servings of any type of starch, even a whole- grain starch Wine or beer before dinner Starch before dinner Artificial sweeteners Fatty foods
Add more exercise. Find more ways to sneak in more activity. Can you take a short walk before or after meals? Consider straightening up the house in the evenings instead of reading or watching TV. Ride a bike short distances instead of taking your car.
Add more vegetables. Vegetables are the most filling foods on the planet and the best way to reduce your overall calorie intake without feeling as if you are eating less. Look for ways to sneak vegetables into your favorite recipes. Can you add more chopped veggies to your omelet, mushrooms to that burger, or shredded carrots to your meat loaf ?
Get a checkup.You may be developing diabetes or another health condition, which makes controlling your weight more difficult.You also may have started taking a medicine that is increasing your appetite or slowing your metabolism.
You may slip up, regain, and then recommit and lose many times before your weight stays within an even fluctuation. Rather than seeing each small gain as a personal failure, think of small gains as success builders. The more often you get yourself back on track, the stronger you will become.The longer you maintain, the better you will become at maintaining your weight. Research shows that the longer people keep off lost weight, the easier it is for them to maintain. All of their new eating and exercise habits become part of their lives. These habits become so automatic that they rarely think about their food choices.

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Book description
Guice (pronounced “Juice”) is the Jolt Award winning, 100% Java icing on the cake of Java dependency injection. Unlike other popular DI frameworks such as Spring, Guice fully embraces modern Java language features and combines simplicity with stunning performance and developer–friendliness.
Google Guice: Agile Lightweight Dependency Injection Framework will not only tell you “how,” it will also tell you “why” and “why not,” so that all the knowledge you gain will be as widely applicable as possible. Filled with examples and background information, this book is an invaluable addition to your knowledge of modern agile Java.
Learn simple annotation–driven dependency injection, scoping and AOP, and why it all works the way it works.
Be the first to familiarize yourself with concepts that are likely to be included in a future Java EE or SE release (through JSR 299).
Get things done without having to write any XML.
What you’ll learn
Find out why dependency injection frameworks solve your problems, and how Guice fills that gap.
What Guice can do, can’t do and how to apply that knowledge.
How Guice compares to popular alternatives like the Spring Framework.
What the future has in store, including Guice IDE, the next Guice version and the standardization of Guice’s concepts through JSR 299.
How you can build real–world, Guice–powered web applications using popular frameworks like Wicket or Struts 2.
How to develop a full stack Guice/Struts 2/Hibernate application.
What you can really do with modern Java.
Who is this book for?
This book is for professional Java developers who are interested in dependency injection and modern Java coding practices, and who want to tackle complexity with a simple, powerful, and high–quality solution that powers one of Google’s highest profile applications: AdWords. This may be an alternative to Spring for many.
About the Author
Robbie Vanbrabant is an experienced Java developer based in Belgium. In his professional life, he advises companies how to design and implement their Java based solutions. Robbie has a broad interest in software that goes from platforms like Java and .NET to programming languages,
API design, agile processes, and developer productivity. Following that interest, he recently discovered Google’s Guice, a lightweight, elegant, and purely Java–based dependency injection framework. Since then, he’s been one of the most active members in the Guice community and can often be found on the mailing list answering questions.

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• The paragraphs about HIV looks like someone stuck it in there, as it bears little resemblance to the rest of the story.
• It says "Health authorities are particularly worried that the capability to mutate already exhibited by the virus could eventually let it combine with the human immunodeficiency virus, which causes AIDS." Then it gives a sentence comparing that to the Spanish flu, and that's the end of the possible "mixing" with HIV. No sources on this at all, only the very ambiguous "health authorities."
• It throws out completely unsubstantiated data with no source. There is also no background info on that--even in the absence of resources, it gives no background on why anyone would think that it could combine with HIV, or how that could even happen. Or what makes this flu strain so special that it would have a special affinity for HIV.
• Reuters uses some pretty loose language too. I think they're both overinterpreting the WHO statement, which discusses the comorbidity of the two infections, not some apocalyptic biological combination.
• There is no scientific basis for such speculation, or evidence that it has occurred in the decades that both viruses have been around.
• The speculation makes about as much sense as saying that because dogs and cats are both pets, some day they might combine to produce a dat or cog.

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These stories illustrate problems in the hospitalist movement which Ive written about many times before. Here are the main points:

The original appeal of hospital medicine was that it was an opportunity for a clinician to focus on and ascend the unique clinical learning curve of hospital based internal medicine.

But because the role has not been carefully defined it is morphing into that of a jack-of-all-trades house doctor, a career few of us signed up for.

Uncritical enthusiasm for some nebulous notion of has blurred the boundaries of responsibility among hospitalists and other specialists and forced hospitalists into clinical encounters way beyond the scope of their training, pushing them out of their comfort zones and creating liability concerns.

Under the rubric of comanagement some hospitalist programs are being made to function as HP and discharge planning services in which they perform the clerical scut work on surgical and subspecialty patients who have no need of their clinical expertise.

Hospitalists are increasingly coming to be viewed as administrative and business solutions more than clinicians. Not exactly what a candidate looks for in a career.

These factors may increase the risk of burnout, increase turnover in hospitalist programs and exacerbate the shortage in the work force.

Given this climate candidates who seek hospitalist jobs are increasingly likely to be short timers docs who are moonlighting, are between jobs or are waiting to grab a fellowship.

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Posted 1 p.m. Fri., May 8: While speculation continues to swirl around former state Treasurer Sarah Steelman's political plans, her husband -- prominent lawyer David Steelman -- is continuing to provide some partisan sparks. Missouri's GOP world is abuzz about his commentary piece this week in the new Missouri Record, an online political site that just went up this week. It's created by Patrick Tuohey, a conservative Kansas City-based pollster and communications consultant who says he hopes to offer a variety of political writings.

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Clockwise:
HVLA manipulation
Prince Charles
Prof. Edzard Ernst
Artichoke
Dandelion






When I saw the BBC headline (see below) I asked myself what the best way would be to denounce an unjust attack on Prince Charles, by Professor Edzard Ernst, of Peninsula Medical School, Exeter University (the UK's first professor of complementary medicine).

Under a headline 'Prince Charles detox 'quackery' the BBC reported Ernst as saying that a detoxification product (dandelion/artichoke extracts), produced by Duchy Originals, the Prince's marketing company "was based on "outright quackery."

Ernst continues: "Where are the studies that demonstrate efficacy? They do not exist, and the reason is simple: these products have no real detoxification effects."

BUT THEY DO! ... please see the end of this blog posting for references

I reflected for a moment on a discussion that took place this last weekend, while I was teaching in Exmouth, just down the road from where Professor Ernst wields his flailing sword of truth and justice.
A number of course participants had discussed their perception of what they judged to be Ernst's inaccurate distortion (writing with his colleague Canter) when reporting on the value of osteopathic and chiropractic treatment.
This reminded me of the editorial I had written following a similar unjustified attack (see below - Chaitow 2006). I am quoting extensively from this to offer a sense of just why Ernst's claim of objectivity is seen to be suspect (to put it mildly!).

"Ernst and Canter (2006) have placed osteopathic and chiropractic manipulation methods under a spotlight, when following a systematic literature review they found them wanting in regard to treatment of neck and back pain.
Writing in the Journal of the Royal Society of Medicine they claim that the data gave little evidence of effectiveness despite many individual studies that do show benefit. (Assendelft et al., 2003).
The Ernst and Canter article is very similar to one that appeared in 2005 in the Wiener Klinische Wochenschrift (in this instance, Canter and Ernst, 2005) and to some extent it is also a rehash of information that appeared in a paper by Ernst (2004).

At that time, in a comprehensive review evaluating the evidence base for use of a variety of therapeutic approaches to musculoskeletal conditions, Ernst highlighted the usefulness of massage (which not many may know he practised as a medical student many years ago), but questioned spinal manipulations value in treatment of back pain: For acute back pain, spinal manipulation (high velocity low amplitude manipulationHVLA) was superior to sham therapy and to treatments known to have detrimental effects on back pain. Spinal manipulation generated no advantage over general practitioner care, analgesics, physical therapy, exercise or back school. For chronic back pain, the results proved to be similar.

Unpicking this quoted statement brings sharply into focus the danger of relying on such evidence:
Acute back pain may have a wide variety of causes, ranging from biomechanical to pathological, psychological and functional, possibly involving intervertebral disc problems, facet joint dysfunction, hypermobility, muscular and/or ligamentous imbalances, sacro-iliac restrictions, trigger points and disturbed emotion/ somatisation (among others), making it a virtual certainty that acute back pain will not respond to a single intervention, whether HVLA manipulation or anything else.

Professor Ernst and his co-author may or may not be aware that categorisation of problems such as back pain can predict, with some accuracy, which forms of back pain will, and which will not, respond to manipulation (DeLitto et al., 1995; Fritz et al., 2003). There is no indication as to which, if any, of the studies in their systematic review used categorisation in selection of patients to receive manipulation.
The term spinal manipulation may mean HVLA, or it might refer to employment of mobilising articulation, or soft tissue methods such as muscle energy technique, or combinations of these, or use of chiropractic adjustments.
And even where HVLA is the specified intervention, there are a wide range of possibilities as to how, and where this was applied, making evaluation of for acute back pain a virtually meaningless exercise, or at best a questionable oneunless each patient (irrespective of etiology) received precisely the same manipulative attention, at precisely the same spinal region.

Similar variables exist in other words/terms used in Ernsts quoted text. What for example can it be assumed that general practitioner care, physical therapy and actually mean, emerging as they do from a systematic review of numerous research papers in which untold variations of each of these areas of care might have been included?

Leaving aside the difficulty of applying systematic review to so many variables it may be useful to reflect on examples of the denseness of the fog surrounding much research. Consider that many research studies emerging from osteopathic medicine describe manual intervention as osteopathic manipulative treatment (OMT).
When the content of is broken down, it is sometimes stated to include HVLA, myofascial release, ligamentous balancing, muscle energy and strain-counterstrain techniques (amongst others) (Yates et al., 2002).

To those unfamiliar with these methods it is necessary to say that there can hardly be more diverse methods of
modifying tissue status, or mobilising joints, than those listed. There is frequently therefore no uniformity in application of OMT, apart from the fact that one or other, or a combination of these methods were employed.
This is not a criticism of the use of OMT in this way, since a selection of diverse methods is essential if
patients are to receive individualised attention. However, it is a criticism of reviewers who attempt to homogenise outcomes where actual treatmentuniformly listed as OMTmight have involved all or any of the methods mentioned.

To be sure, in some studies, precise descriptions are offered as to which elements of OMT have been utilised. For example, in a study of the use of OMT in treatment of chronic asthma (Bockenhauer et al., 2002), it is clearly stated that four methods (balancing ligamentous tension in the upper cervical and upper thoracic junctions; normalisation of elevated first rib; mobilisation of lower rib exhalation restrictions; diaphragmatic release) were employed, sequentially, in each patient (by the same practitioner). When the positive outcomes (increased upper thoracic and lower thoracic forced respiratory excursion) that emerged from this OMT intervention are compared with sham treatment, credible, useful and potentially reproducible information is the result.

The generalised content of the term is no more confusing than use of terms such as physical therapy (a.k.a. physiotherapy).
A recent study (Mehling et al., 2005) compared gold standard physical therapy with breathing rehabilitation (also not clearly defined), in treatment of chronic low back pain. Both approaches produced good to excellent resultshowever, since the reader is left with the mystery as to what gold standard physical therapy is, and just how breathing rehabilitation is achieved, the chances of reproducing the results remains questionable.
JBMTs position is that for these (and other) reasons Ernst and Canters controversial finding that osteopathic and chiropractic manipulation have little value in treatment of back and neck pain, is itself of little value, flying as it does in the face of the clinical experience of the chiropractic and osteopathic professions, where manipulation, when appropriately applied, to match the specific needs of the individual, appears to offer clear benefit in a range of back and other problems.
This highlights the need in published studies to carefully describe both generic and specific use of modalities, methods and techniquesnot least massage and manipulation (HVLA). And it raises the question as to the credibility of systematic reviews applied in this way.

Other opinions are supportive of JBMTs stand:
1. The National Council for Osteopathic Research has accused Professor Ernst of working with out-of-date data.
2. The General Osteopathic Council, in a press release in response to the Ernst, Canter paper state:
"[There is] good evidence to support spinal manipulation for low back pain, particularly when combined with exercise guidancethis is typical osteopathic management. This suggests that Professor Ernst is out of date
with this review, a recognised problem when researching secondary data."

In summary, the research design/methodology is not a recognised systematic review, it is limited in
terms of scientific value, and the data presented does not support the conclusions made.
It behoves us all to be as precise as possible in our descriptions of methods, modalities and techniques, as well as in the way we search for evidence of efficacy of the use of these in general, and in specific, settings."

Now lets consider the attack on Prince Charles' health product.
Is there evidence of safe and effective use of the products incorporated into the 'detox' potion?
It took me around 5 minutes to identify the three studies listed below - that vindicate the usefulness of dandelion and artichoke extracts (in animals and humans) .... so I wonder how much time Ernst took to grab his headlines with this unjustified attack.

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It was only a matter of time before we would begin to see the swine flu facts clouded by the untruths. Remember that game called Telephone that we played as kids? That's what it reminds me of. Between the Internet and social media, the fiction is spreading faster than the flu itself! So I've addressed some of those swine flu myths. Do either Madonna or Salma Hayak have swine flu? What's this about Texas not getting any federal money because they are ready to secede from the Union? Can you really get swine flu by standing near someone who is Mexican? Seriously. These and more. You may have heard some I have not heard, too. Will you share them with us? Or -- if you are unsure about a rumor you have heard, will you share that with us, too? Here's a link to the myths. And a link to a place to share your myths or questions. Thanks for helping the rest of us hone in on the true facts - the ones that will keep us healthier. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Learn more or join the conversation.

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A sophisticated FBI-produced spyware program has played a crucial behind-the-scenes role in federal investigations into extortion plots, terrorist threats and hacker attacks in cases stretching back at least seven years, newly declassified documents show.
As first reported by Wired.com, the software, called a computer and internet protocol address verifier, or CIPAV, is designed to infiltrate a targets computer and gather a wide range of information, which it secretly sends to an FBI server in eastern Virginia. The FBIs use of the spyware surfaced in 2007 when the bureau used it to track e-mailed bomb threats against a Washington state high school to a 15-year-old student.
But the documents released Thursday under the Freedom of Information Act show the FBI has quietly obtained court authorization to deploy the CIPAV in a wide variety of cases, ranging from major hacker investigations, to someone posing as an FBI agent online. Shortly after its launch, the program became so popular with federal law enforcement that Justice Department lawyers in Washington warned that overuse of the novel technique could result in its electronic evidence being thrown out of court in some cases.
While the technique is of indisputable value in certain kinds of cases, we are seeing indications that it is being used needlessly by some agencies, unnecessarily raising difficult legal questions (and a risk of suppression) without any countervailing benefit, reads a formerly-classified March 7, 2002 memo from the Justice Departments Computer Crime and Intellectual Property Section.
The documents, which are heavily redacted, do not detail the CIPAVs capabilities, but an FBI affidavit in the 2007 case indicate it gathers and reports a computers IP address; MAC address; open ports; a list of running programs; the operating system type, version and serial number; preferred internet browser and version; the computers registered owner and registered company name; the current logged-in user name and the last-visited URL.
After sending the information to the FBI, the CIPAV settles into a silent pen register mode, in which it lurks on the target computer and monitors its internet use, logging the IP address of every server to which the machine connects.
The documents shed some light on how the FBI sneaks the CIPAV onto a targets machine, hinting that the bureau may be using one or more web browser vulnerabilities. In several of the cases outlined, the FBI hosted the CIPAV on a website, and tricked the target into clicking on a link. Thats what happened in the Washington case, according to a formerly-secret planning document for the 2007 operation. The CIPAV will be deployed via a Uniform Resource Locator (URL) address posted to the subjects private chat room on MySpace.com.

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The National Pregnancy Registry fof Atypical Antipsychotics
(Click here for more information)
If you are a pregnant woman between the ages of 18 and 45 and are currently treated with one or more of the following atypical antipsychotics:
• Abilify (aripiprazole)
• Clozaril (clozzpine)
• Geodon (ziprasidone)
• Invega (paliperidone)
• Risperdal (risperidone)
• Seroquel (quetiapine)
• Zyprexa (olanzapine)
Register now by calling 1-866-961-2388 and help make the future better for many other women just like you…
This study will involve 3 brief phone interviews over an 8-month period.
The National Pregnancy Registry for Atypical Antipsychotics is dedicated to evaluating the safety of atypical antipsychotic medications that may be taken by women during pregnancy to treat a wide range of mood, anxiety, or psychiatric disorders.

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Persistent delirium in older hospital patients: a systematic review of frequency and prognosis.
Age Ageing. 2009 Jan;38(1):19-26
Authors: Cole MG, Ciampi A, Belzile E, Zhong L
BACKGROUND: one explanation for the poor prognosis of delirium among older hospital patients may be that many of these patients do not recover from delirium. We sought to determine the frequency and prognosis of persistent delirium (PerD) in older hospital patients by systematically reviewing original research on this topic. METHODS: MEDLINE, EMBASE, PsycINFO and the Cochrane Database of Systematic Reviews were searched for potentially relevant articles. The bibliographies of relevant articles were searched for additional references. Eighteen reports (involving 1,322 patients with delirium) met the following seven inclusion criteria: original research published in English or French, prospective study design, study population of at least 20 hospital patients, patients aged 50 years or more, follow-up of at least 1 week, acceptable definition of delirium at enrollment and included at least one assessment for PerD at discharge or later. The methods of each study were assessed according to the six criteria for prognostic studies described by the Evidence-Based Medicine Working Group. Information about the sample origin and size, age, proportion with dementia, criteria for delirium, timing of follow-up assessments, criteria for PerD, proportion with PerD and prognosis of PerD was systematically abstracted from each report, tabulated and combined using standard meta-analysis techniques. RESULTS: the combined proportions with PerD at discharge, 1, 3 and 6 months were 44.7% (95% CI 26.8%, 63.7%), 32.8% (95% CI 18.4%, 47.2%), 25.6% (95% CI 7.9%, 43.4%) and 21% (95% CI 1.4%, 40.6%), respectively. The outcomes (mortality, nursing home placement, function, cognition) of patients with PerD were consistently worse than the outcomes of patients who had recovered from delirium. CONCLUSION: PerD in older hospital patients is frequent, appears to be associated with adverse outcomes and may account for the poor prognosis of delirium in this population. These findings have potentially important implications for clinical practice and research.

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GENERAL INFORMATION
This module provides health professionals from non-tropical countries an additional training in the diagnosis and management of tropical diseases, topics which are not or only minimally covered by university undergraduate curricula. Health professionals from the South may find this course a useful update on prior acquired knowledge.

The module stands on its own. Yet it is, together with the introduction in international health, making up the postgraduate course in tropical medicine and international health. We advise medical doctors, biomedical and pharmaceutical scientists with little or no professional experience in developing countries, to follow both modules.

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daily article, Joshua S. Trevinos main point is that the mainstream medias understanding of religion is deplorable, and about that hes certainly right. In the course of discussing Catholic doctrine and canon law in connection with the Recife case, however, Trevino says a few things I think go too far.
First, Trevino says that its a that the Catholic Church imposed excommunications on the young girls mother and physicians for aborting the girls unborn twins. His argument is that the excommunications were not the result of any juridical process in canon law (e.g., were not the result of any decision by any ecclesiastical official) but were rather excommunications latae sententiae, i.e., excommunications that happen automatically under canon law without any official action by anyone. In Trevinos account, The mother and physicians were not excommunicated by the Church; they excommunicated themselves.
This makes it sound as if the Church had nothing to do with the matter. The reality, however, is that Pope John Paul II, in revising the Code of Canon of Law in 1983, affirmatively chose to retain (it had existed in prior canon law too) the penalty of excommunication latae sententiae for the canonical crime of procuring an abortion. The pope, who makes canon law as he pleases, could have chosen to impose a lesser penalty on those who procure an abortion or no penalty at all. But, for various reasons, including the gravity of abortion in Catholic moral theology, John Paul chose to retain the penalty of excommunication latae sententiae. Right or wrong, this was a conscious decision by the Church made by an authority no less than the Roman Pontiff. The individuals excommunicated in the Recife case are excommunicated not only because they chose to procure an abortion but because the Church, in the person of the pope, chose to impose the penalty of excommunication latae sententiae on all Catholics who do such things. Hence, to say that the Church had nothing to do with excommunicating these people is simply untrue.
Second, Trevino says its a that the Church imposes a lesser sanction upon a pedophiliac rapist than upon a well-meaning abortionist. His argument is that rape, since its a mortal sin in Catholic moral theology, results in the loss of sanctifying grace in the soul of the perpetrator and thus in eternal damnation, unless the perpetrator repent in time. This, he thinks, is a more severe penalty than excommunication. But here Trevino is confusing several different things.
To start with, in Catholic theology procuring an abortion is just as much a mortal sin as rape is, and so it too results in the loss of sanctifying grace and eternal damnation, unless the perpetrator repent in time. Hence, as far as the loss of grace and eternal damnation go, the rapist and the abortionist are in the same boat.
Furthermore, the loss of grace and consequent eternal damnation are not punishments imposed by the Church. They are punishments imposed by God. The only sanctions the Church imposes are imposed pursuant to canon law. Under that law the most severe penalty is excommunication latae sententiae. It is the penalty reserved for the most serious canonical crimes, such as a priests directly violating the seal of the confessional (Cn. 1388), and, as Trevino recognizes, it is the penalty imposed on procuring an abortion. Rape, while probably punishable at canon law under Cn. 1397, is punished less severely. On any reasonable reading, therefore, the Code of Canon Law punishes procured abortion more severely than rape, even the forcible rape of a child. The sentence that Trevino says is a myth—that the Church imposes a lesser sanction upon a pedophiliac rapist than upon a well-meaning abortionist—is in fact the absolute truth.
What we actually have in the Recife case is the juxtaposition of an especially horrific rape with an especially sympathetic abortion. While everyone agrees that rape is always a terrible crime, everyone also agrees that some rapes are worse than others, and the repeated, forcible rape of a child is about as bad as it gets. Among people who think that abortion is wrong, everyone agrees that some abortions are less wrong than others, and an abortion performed for medical reasons on a very young girl who became pregnant as a result of a forcible rape is about as little wrong as abortion gets. Add to these facts canon laws blanket imposition of the penalty of excommunication latae sententiae on all who procure abortions, regardless of mitigating factors, and the result is that canon law—and thus the Church—can easily appear to be punishing the less guilty party more severely than the more guilty one.
Now, there may well be good reasons for this. With respect to law generally, we punish actions at law not simply because theyre immoral. Cruelly wounding the feelings of another, for example, is quite wrong, but it is almost never a crime under civil law. As to canon law in particular, it is not intended to be a general purpose penal code, setting forth just penalties for all crimes. It is intended, rather, to answer to the special theological purposes of the church, and thus it may make perfect sense for canon law to punish procured abortions—which are generally no longer crimes at civil law—but not rape, which is indeed a crime at civil law and which the state, at least most of the time, prosecutes diligently. If we want to make sense of the Recife situation, it is considerations such as these that we need to bring forward—considerations about why human societies in general and the Church as a supernatural society in particular makes any laws at all. The question is not merely about the moral gravity of the wrongdoing; it is about the nature and purposes of various kinds of legislation.

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Scientists at the University of Michigan have shown that gene therapy can be used to successfully stop the development of periodontal disease.
The U-M group is the first known to use the gene delivery approach to show potential in treating chronic conditions such as periodontal disease, said William Giannobile, professor at the U-M School of Dentistry.
Gene therapy has not been used in non-life threatening disease. (Periodontal disease) is more disabling than life threatening, said Giannobile, who also directs the Michigan Center for Oral Health Research and has an appointment in the U-M College of Engineering. This is so important because the next wave of improving medical therapeutics goes beyond saving life, and moves forward to improving the quality of life.
The preclinical study offers was a collaboration with the Seattle-based biotechnology company Targeted Genetics. In July, Targeted Genetics released human trial results that showed the same gene therapy approach used to stop periodontal disease had positive affects in human patients with rheumatoid arthritis, another chronic, non-life threatening, disabling condition. The company tested 127 human subjects and showed a 30 percent improvement in such things such as pain relief and gain of function.
People with rheumatoid arthritis are four times more likely to have periodontitis. Periodontal disease is also linked to systemic conditions such as heart disease, bacterial pneumonia and stroke, likely due to the spread of bacteria coming from the oral cavity that invade other parts of the body.
Using gene therapy, Giannobiles group found a way to help certain cells using an inactivated virus to produce more of a naturally-produced molecule soluble TNF receptor. This factor is under-produced in patients with periodontitis. The molecule delivered by gene therapy works like a sponge to sop up excessive levels of tumor necrosis factor, a molecule known to worsen inflammatory bone destruction in patients afflicted with rheumatoid arthritis, joint deterioration and periodontitis.
The gene also delivers  genetic bang for the buck. The periodontal tissues were spared from destruction by more than 60-80 percent with the use of gene therapy.
If you deliver the gene into the target cells once, it keeps producing in the cells for a very long period of time or potentially for the life of the patient; This therapy is basically a single administration, but it could have potentially life-long treatment effects in patients who are at risk for severe disease activity, says William Giannobile.
Adapted from materials provided by University of Michigan.

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In a complaint unsealed last week in US District Court in Boston, prosecutors allege that New York-based Forest Laboratories Inc. illegally marketed the drugs Celexa and Lexapro for use in children by paying kickbacks, including lavish meals and cash payments disguised as grants and consulting fees, to induce doctors to prescribe the drugs. They also say the company misled doctors and the public by failing to disclose the results of a negative study.
In the 34-page complaint, prosecutors said that from 1999 to 2006, Dr. Jeffrey Bostic, director of school psychiatry at the hospital, gave more than 350 Forest-sponsored talks and presentations in 28 states, many of which addressed pediatric use of Celexa and Lexapro. The government said that Bostic became s star spokesman in the promotion of Celexa and Lexapro for pediatric use and that the company paid him more than $750,000 between 2000 and 2006 for his presentations.
Bostic declined to be interviewed, but the hospital gave the Globe a statement describing him as a highly regarded practitioner and educator in the field of psychiatry.

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