Health

"is the packed spun volume of whole that is made up of s and is expressed as a percentage of total . It can be measured or calculated as Hct = (RBC × )/10. Abnormal calculated hematocrit values may occur as a result of interferences that may cause erroneous RBC and MCV measurements which include very high count, high concentration of s, or … An increased hematocrit may be due to or . Decreased values may be due to , , , or . Pregnancy may also cause slightly decreased hematocrit due to an increase in blood volume."

"The ' measures the volume of s compared to the total (red blood cells and ). The normal hematocrit for men is 40 to 54%; for women it is 36 to 48%. This value can be determined directly by microhematocrit centrifugation or calculated indirectly. s calculate the hematocrit by multiplying the the red cell number (in millions/mm3) by (MCV, in s). When so assayed, it is subject to the vagaries inherent in obtaining an accurate measurement of the MCV (see Chapter 152)."

"When most physicians are asked about the realm of biosecurity, they often are able to discuss the subject in broad strokes that include concepts such as bioterrorism, , and s. However, the restriction of knowledge of biosecurity solely to these components does not make the concept adequately concrete; consequently, biosecurity remains a floating abstraction with no firm tie to reality, constraining the ability of physicians to fully converse with government policy makers and the public on this vital national security matter. Biosecurity in the Global Age: Biological Weapons, Public Health, and the Rule of Law, by internationally renowned law professors and David Fidler, provides an opportunity to develop a robust understanding of biosecurity and its role in national and international policy."

"The secure and continuous production of and are key to U.S. national security. The introduction of foreign-origin or emerging animal, plant, and human diseases by intentional acts of , terrorism, , or criminal activity can lead to severe consequences for domestic and international s, the economic security of the agricultural community, and food security, and the credibility of responsible state and federal agencies. Early public, animal, plant health, law enforcement, and intelligence assessments and investigations of suspected or confirmed intentional threats are critical additions to existing interagency prevention, response, and management protocols. Forensic microbiology, a multidisciplinary science, is essential to the nation's readiness for responding to a potentially criminal, intentional, or otherwise nefarious incident in the agricultural sector (plant or animal), and of eventual supporting attribution and the prosecution of the perpetrators."

"In a strict sense, biosecurity involves issues dealing directly with s and s, such as prevention of emergence, loss, accidents, theft, or use, and remediation after pathogenic damage. It addresses procedures and practices to help ensure that s and relevant sensitive information remain secure and out of the hands of terrorists. But we have to be practical. We inevitably pay a price for security."

"A leaflet drops through your letter box advising on ways to avoid contracting and spreading . Your bag is searched as you enter a country on the start of your holiday — and there's a fine of $200 for an undeclared apple. You drive across a disinfectant mat on a visit to a local farm. You call the council for advice on the spreading from your neighbour's garden. You switch to eating after reading about the role of industrial farming in the production of risk. You shudder as you remember the smell of . In many different ways you may have encountered events, practices, procedures, narratives and knowledges contained within the complex issue of ‘biosecurity’."

"Unfortunately, all organs, with the exception of corneas, have this unfortunate characteristic: in order to be transplanted, they must be removed from the “donor's” body while their heart is still beating, their blood is still circulating, their skin is still rosy and warm, their kidneys are still secreting urine, and any pregnancy is still continuing, to the extent that it is necessary to administer curare drugs to prevent unpleasant reactions when the surgeon makes the incision. Do these seem like corpses to you? Yes, transplant surgeons assure us. No, according to a law of the state: in fact, “corpse means: ‘The human body deprived of cardiorespiratory and cerebral functions’” (Ministry of Health circular no. 24 of 24 June 1993)."

"When you transplant a heart from a baboon into a baby as we did, and you say the body of that baby is sacred, does that profane heart from the baboon become sacred when you place it in the body? Or when you take out a gallbladder and throw it in the garbage, is that a sacred gallbladder in the garbage? Or as soon as it's out of the body it loses its sanctity? You see the silliness of our mythology? Children ask the questions I'm just asking now. Trouble is, children get slapped for asking questions like that because they have no defense. But you can't slap me. I can ask the question. It's a logical question."

"Specific to spinal cord injured patients, immuno-suppressive drugs are not an option in a stem cell transplant procedure because of the increased risk of side effects. Spinal cord injuries cause many individuals to be more susceptible to respiratory infection due to an inability to clear secretions, limited chest movement, and a need for ventilation assistance. In addition, there is a greater risk of bladder infection and sepsis due to chronic catheterization. Some spinal cord patients who incur an infection are further compromised by the infection seeding around the heart. Urinary tract infections and skin breakdowns due to immobility are common causes of dsyreflexia, an event which often triggers heart attacks and strokes. I have been told by Dr. John McDonald of Washington University in St. Louis, that because this immune system of a spinal cord patient is already so compromised, it would be irresponsible to transplant stem cells into an individual that did not match his or her own DNA. Although there is still a risk of rejection, no reputable doctor would prescribe Cyclosporin, the leading immuno-suppressive drug therapy, to a spinal cord injured patient because the risk of death is too great. Somatic cell nuclear transfer could dramatically improve the treatment efficacy of any stem cell transplant because it uses one's own genetic makeup. In addition, there is the potential of eliminating the risks and side effects associated with highly toxic immuno-suppressive agents."

"The real problem is that the price to pay for saving these lives is the tragic one of suppressing others. The utilitarian principle that one can do evil to achieve good is being replaced by the Western and Christian maxim that it is not permissible to do evil, even to achieve a greater good. Whereas in the past the traditional “signs” of death were used to ascertain that a living person was not considered dead, today the new Harvard criterion treats the living as corpses in order to be able to transplant them."

"The truth is that the definition of brain death was proposed by Harvard Medical School in the summer of 1968, a few months after the first heart transplant performed by Christian Barnard (December 1967), to ethically justify heart transplants, which required that the heart of the donor still be beating, meaning that, according to traditional medical standards, he was still alive. In this case, the removal of the heart was equivalent to murder, albeit carried out “for a good cause”. Science posed a dramatic moral question: is it permissible to kill a sick person, even if they are terminally ill or irreversibly injured, in order to save another human life of superior “quality”?"

"... 's part in the has drawn fire as a quixotic quest after the mirage of collective security through the , an allegedly utopian, or "Wilsonian," endeavor that traded vague dreams for harsh realities and derailed a more realistic settlement, which might have lasted. Worst of all, arguments about the political fight at home over the treaty and membership in the League have cast him as a stubborn, self-righteous spoiler who blocked reasonable compromise. That view of him has often overlooked or minimized one glaring fact: in the middle of this fight, he suffered a stroke that left him an invalid for his last year and a half in office. Wilson's stroke caused the worst crisis of presidential disability in American history, and it had a effect on him. Out of a dynamic, resourceful leader emerged an emotionally unstable, delusional creature."

"(AF) is associated with an increase in mortality and morbidity, with a substantial increase in stroke and systemic . Strokes related to AF are associated with higher mortality, greater disability, longer hospital stays, and lower chance of being discharged home than strokes unrelated to AF."

"What is a stroke? ... how common is it? It is the leading cause of serious disability of adults in the United States. It is the fifth leading cause of deaths in the United States. Moreover, it is the second leading cause of deaths worldwide ... it is characterized by injury to the brain from or rupture of a . There are two broad types of stroke. The first is blockage of a blood vessel — that accounts for eighty percent of strokes ... And there's , which accounts for twenty percent ... due to rupture of a blood vessel."

"Our stroke expert, Sarah Song, MD, MPH, assistant professor of neurology at in Chicago, offers this valuable advice. Act FAST. Being able to recognize the signs of stroke will help you respond faster and get help sooner and may result in less disability, says Dr. Song. "Remember the acronym FAST: Face, Arm, Speech, Time," she says. "The face can droop on one side. The arm can be weak or numb. Speech can be garbled, slurred, or nonsensical. Time is of the essence." If you notice any of these symptoms in yourself or anyone else, call 911 and get to the hospital as quickly as possible. "Treatment for stroke is most effective for patients who arrive at the hospital within four and a half hours of the start of symptoms," says Dr. Song. Always call 911. "Some people think they should drive to the emergency department," says Dr. Song. But stroke units in hospitals across the country now work closely with first responders, she says. EMTs are trained to spot the signs of stroke and can connect patients with stroke doctors quickly to prevent long waits in waiting rooms and emergency triage. "Calling 911 is the single best way to get yourself or someone you love evaluated and treated for stroke," she says."

"... The results of the European Cooperative Acute Stroke Study III (ECASS III) ... (ClinicalTrials.gov number, NCT00153036), reported in this issue of the Journal, teach us many lessons, some medical and some political, and clearly provide powerful, persuasive evidence that is safe and effective for patients with acute stroke. … The rationale for ECASS III arose from a pooled analysis of several previous studies that had differing time windows for enrollment. ... Analyses from the resulting pooled sample suggested that thrombolytic therapy could be beneficial even when given more than 3 hours after the onset of symptoms, and ECASS III was designed to confirm this hypothesis. As the authors of this article point out, however, neither their results nor those of the previous pooled analysis suggest that the ideal window for acute thrombolytic therapy is 4.5 hours after the onset of a stroke, because we know that the potential for neurologic rescue declines monotonically with every passing minute. ... I like to pose this scenario to my trainees: a patient presents to you 30 minutes after the onset of a left hemispheric stroke; how long do you have to initiate thrombolytic therapy? The correct answer is 1 minute, not 2.5 hours, and ECASS III does not now justify an answer of 4 hours. From the moment the patient arrives at the door, every minute counts ..."

"Stroke versus TIA? s (TIA) occur in approximately 15% of patients before an eventual stroke, with the highest risk in the first days following an event ... While TIAs do not always come to medical attention, their presentation in the acute stroke setting ostensibly complicates the treatment decision in patients who may be exhibiting improvement. The majority of TIAs resolve in less than 60 minutes whereas the majority of true strokes reach peak deficit in the same time frame. A 2009 scientific statement from the / discourages the use of traditional time-based definitions of TIA in favor of a tissue-based definition (i.e. the presence or absence of lesions on diffusion-weighted ) ..."

"There is high‐certainty evidence that can aid long‐term smoking cessation. However, bupropion also increases the number of adverse events, including psychiatric , and there is high‐certainty evidence that people taking bupropion are more likely to discontinue treatment compared with placebo. However, there is no clear evidence to suggest whether people taking bupropion experience more or fewer than those taking placebo (moderate certainty). also appears to have a beneficial effect on smoking quit rates relative to placebo. Evidence suggests that bupropion may be as successful as and nortriptyline in helping people to quit smoking, but that it is less effective than varenicline. There is insufficient evidence to determine whether the other antidepressants tested, such as s, aid smoking cessation, and when looking at safety and tolerance outcomes, in most cases, paucity of data made it difficult to draw conclusions."

"Cigarette smoking is the primary cause of , and smoking cessation is the most effective means of stopping the progression of chronic obstructive pulmonary disease. Worldwide, approximately a billion people smoke cigarettes and 80% reside in low-income and middle-income countries. Though in the United States there has been a substantial decline in cigarette smoking since 1964, when the Surgeon General's report first reviewed smoking, smoking remains widespread in the United States today (about 23% of the population in 2001). Nicotine is addictive, but there are now effective drugs and behavioral interventions to assist people to overcome the addiction. Available evidence shows that smoking cessation can be helped with counseling, nicotine replacement, and bupropion. Less-studied interventions, including hypnosis, acupuncture, aversive therapy, exercise, , s, , s, and , have assisted some people in smoking cessation, but none of those interventions has strong research evidence of efficacy. To promote smoking cessation, physicians should discuss with their smoking patients “relevance, risk, rewards, roadblocks, and repetition,” and with patients who are willing to attempt to quit, physicians should use the 5-step system of “ask, advise, assess, assist, and arrange.”"

"’s (AC) method is a pharmacotherapy-free approach to quit smoking that is delivered through seminars, online courses, or in the form of a book. It has gained popularity, but its effectiveness remains controversial due to a lack of scientific evidence."

"If I mention , I am sure most people in this room understandably think of cocaine — but freebasing was invented by the . You add and to the tobacco leaf mixture — the smoke that's produced is more basic, more alkaline. And, as a consequence, nicotine is delivered across the {[w|Pulmonary alveolus|alveolar membrane}} even more rapidly than would otherwise be the case. And we know that the rapidity — with which a drug is delivered and sating a need for a drug — is an important determinant of its propensity to induce and maintain addiction, et cetera, et cetera, et cetera. And we could take the entire hour talking about the elements of cigarette design. … It is important that we understand that we have the most addictive substance in our community — whose use is facilitated by a perversely engineered drug delivery device."

"Smoking increases mortality from all causes and has a crucial role in . Active smoking and exposure determine more than 30% of mortality. The exact mechanisms of cardiovascular damages are not well known, but the detrimental effect of smoking on endothelial function has long been recognized. Smoking elicits oxidative processes, negatively affects platelet function, , inflammation and vasomotor function; all these proatherogenic effects double the 10-year risk of fatal events in smokers compared to non smokers. An intriguing issue about smoking is the vulnerability of female gender. The mortality from cardiovascular diseases (CVDs) is higher in female than male smokers and female smokers show a 25% higher risk of developing CHD than men with the same exposure to tobacco smoke. This female vulnerability seems to be related to genes involved in thrombin signaling. The effects of smoking cessation have also been extensively studied. Cessation at an early age (40 years) has an impressive 90% reduction in the excess risk of death."

"This variant plays essentially no role in whether an individual initiates smoking or not, which is strongly driven by environmental factors. However, if a person with the high-risk does begin smoking, they will smoke a higher number of s per day, have a higher intensity of smoking, and have a higher age of smoking cessation than those with the low-risk variant, increasing their risk for . The problem with smoking cessation pharmacotherapy using is that it works modestly, at best, and the vast majority of smoking cessation is done without any medication. However, data suggest that people with the high-risk variant rs16969968 have the greatest difficulty quitting and stand to benefit the most from medication, although the evidence is still controversial. This makes sense since this variant affects function. Improved implementation of pharmacotherapy, using patients’ genetics as a guide, could have a huge impact."

"Since becoming an in 1991, I have watched as barriers to abortion have been erected by legislatures around the country. Many laws have undermined the doctor–patient relationship — mandating that doctors say things to patients that are blatantly untrue, requiring that specific tests be performed whether the doctor thinks they are necessary or not, and requiring waiting periods regardless of whether the woman and her doctor think she is confident in her decision."

"The patient-physician relationship is under siege. I believe there are two sources that underlie the distress experienced by many patients and physicians in their interactions with each other. First, there is an intensification of the tension between the science and the art of medicine. Second, there are severe strains related to the rapid changes in the economics of medical practice. Concern about tensions between the science and the art of medicine is hardly new."

"The focus of recent commentary on the doctor-patient relationship has been on trying to systematize the phenomenon. In an early attempt at categorization, and (1956) describe three basic models: activity-passivity, guidance-cooperation, and mutual participation. In contemporary terminology, the first two are commonly considered "paternalistic," while the third is seen as a "partnership." Many other descriptors have been proposed: physician and patient as friends or neighbors; doctor as priest and patient as disciple; doctor as parent, teacher, or chief tutor; patient as consumer, client, or beneficiary; doctor as fighter, provider, or caregiver; patient as a broken machine and doctor as a body mechanic."

"With advances in scientific medicine and the application of ever more complicated techniques to the treatment of the sick and injured, the doctor-patient relationship as interaction between two human beings has tended to become slighted and neglected. It is this impersonalization and mechanization of treatment that are often so obnoxious to patients and which contribute not only to their dissatisfaction but also to therapeutic difficulties."

"The hibakusha help us to describe the indescribable, to think the unthinkable, and to somehow grasp the incomprehensible pain and suffering caused by nuclear weapons"

"The rise of the was vigorously debated in the Journal in the late 19th century. ... ... With germ theory, the scientific foundation for the use of vaccines, new and old, was at last demonstrated. was a constant topic of debate in the Journal from its earliest years, as it remains in contemporary societies, conveying ongoing tensions between social mandates and individual liberties, the good of the many and the risks to the few. The Journal would report many “firsts” in subsequent years, including the first major quantitative study linking smoking to (1928), the introduction of the (1970), and early clinical descriptions of AIDS (1981). And breakthroughs reported elsewhere quickly found their way to the Journal. , for example, first described in the ' in 1922, received extensive review and discussion in the Journal later that year, and many articles analyzing its optimal use in diabetes followed. Myriad new diagnostic technologies accompanied changes in the theory and treatment of disease. The Journal offers a window onto the rise of new medical technologies, from stethoscopes to improved tourniquets, from 's x-rays to and beyond. Technologies that probe and visualize the body represented a critical aspect of the development of modern medical practice and the conceptualization of pathologies. The focus on disease specificity and causal mechanism that emerged with the germ theory would ultimately drive research at the molecular and genetic level that continues to be reflected in the Journal."

"The New England Journal of Medicine was made great by , who banged on every important door in Boston urging researchers to admit their best studies to the journal. The journal assumed the effortless but often genuine superiority of Bostonians so well described—but also ridiculed—by Henry James. ... To some this felt like arrogance, and the journal has always been hated as well as admired. Often the motivation for such hatred may have been jealousy or resentment at failure to make it into its hallowed pages. Ingelfinger was followed by , and the journal grew richer as well as grander. The Massachusetts Medical Society, the owner of the journal, made US$88m from publishing in 2005. My guess is that the journal accounts for at least US$75m of that and that its profits are probably at least US$15m. The society has grown fat on the profits and is keen not only to keep the profits coming but also to exploit the brand. This has led to tensions between the journal and the society, and those tensions were in many ways the undoing of and , the successors to Relman. Both Angel and Kassirer after leaving the journal published books bemoaning the excessive influence of the drug industry, ... while the society appointed a new editor, , who was depicted by some as a creature of the industry. ... He had had financial connections with 21 drug companies between 1994 and 2000."

"The New England Journal of Medicine is facing criticism for publishing a scathing review of a book which claimed that industrial and environmental pollutants may be responsible for outbreaks of cancer. The review was written by Dr Jerry Berke, the medical director of , a chemical company currently being blamed for polluting drinking water in a Boston suburb and for contaminating soils in Maryland with ."

"At a recent cardiology conference in New Delhi, the cardiologist Deepak Natarajan raised the concern that commercial were corrupting medical journals ... Natarajan cited “manipulated” publications in The New England Journal of Medicine (NEJM) as one example to support his view. His comments were met with silence and an air of indignation. Natarajan’s medical colleagues were stunned, disbelieving, and then, angry. Their response stemmed in part from the NEJM’s reputation as the premier medical journal in the world. The NEJM has the highest impact of any medical journal and physicians tend to see the NEJM – to use Natarajan’s words – as “the holy grail of publishing” ... Physicians wear their NEJM publications as a badge of prestige given the journal’s reputation and influence. But as Natarajan noted, so do research sponsors who compete to have their research studies published in the NEJM to influence prescribing habits of physicians and increase drug market share. Journals can profit handsomely from research sponsors buying reprints of their studies to distribute to physicians. And the NEJM does not make public what it earns from reprints."

"It is within the power of every living man to rid himself of every parasitic disease."

"Men ignore nature's laws in their personal lives. They crave a larger measure of goodness and happiness, and yet in their choice of dwelling places, in their building of houses to live in, in their selection of food and drink, in their clothing of their bodies, in their choice of occupations and amusements, in their methods and habits of work, they disregard natural laws and impose upon themselves conditions that make their ideals of goodness and happiness impossible of attainment."

"Not through chance, but through increase of scientific knowledge; not through compulsion, but through democratic idealism consciously working through common interests, will be brought about the creation of right conditions, the control of the environment."

"Right living conditions comprise pure food and a safe water supply, a clean and disease free atmosphere in which to live and work, proper shelter and adjustment of work, rest, and amusements."

"Probably not more than twenty-five percent in any community are capable of doing a full days work such as they would be capable of doing if they were in perfect health."

"Let the women live (in iddat) in the same style as ye live, according to your means: Annoy them not, so as to restrict them. And if they carry (life in their wombs), then spend (your substance) on them untilthey deliver their burden: and if they suckle your (offspring), give them their recompense: and take mutual counsel together, according to what isjust and reasonable. And if ye find yourselves in difficulties, let another woman suckle (the child) on the (father's) behalf."

"On the day when you shall see it, every woman giving suck shall quit in confusion what she suckled, and every pregnant woman shall lay down her burden, and you shall see men intoxicated, and they shall not be intoxicated but the chastisement of Allah will be severe."

"And We inspired the mother of Moses, saying: Suckle him and, when thou fearest for him, then cast him into the river and fear not nor grieve. Lo! We shall bring him back unto thee and shall make him (one) of Our messengers."

"Mothers shall suckle their children for two whole years; (that is) for those who wish to complete the suckling. The duty of feeding and clothing nursing mothers in a seemly manner is upon the father of the child. No-one should be charged beyond his capacity. A mother should not be made to suffer because of her child, nor should he to whom the child is born (be made to suffer) because of his child. And on the (father's) heir is incumbent the like of that (which was incumbent on the father). If they desire to wean the child by mutual consent and (after) consultation, it is no sin for them; and if ye wish to give your children out to nurse, it is no sin for you, provide that ye pay what is due from you in kindness. Observe your duty to Allah, and know that Allah is Seer of what ye do."

"And We had before forbidden foster-mothers for him, so she said: Shall I show you a household who will rear him for you and take care of him?"

"Fill high the bowl with Samian wine! Our virgins dance beneath the shade— I see their glorious black eyes shine; But gazing on each glowing maid, My own the burning tear-drop laves, To think such breasts must suckle slaves."

"Thy minnie scorns to suckle thee, thy minnie is an elf, Upon a bed of rose’s-leaves she lies and fans herself;"

"The other as goodly sight I saw, was women travayling the way, or toyling at home, carry their Infants about their neckes, and laying the dugges over their shoulders, would give sucke to the Babes behinde their backes, without taking them in their armes: Such kind of breasts, me thinketh were very fit, to be made money bags for East or West-Indian Merchants, being more then halfe a yard long, and as wel wrought, as any Tanner, in the like charge, could ever mollifie such Leather."

"A mother who suckles her children gives herself directly, gives her own body to nourish the children, who are unable to live without it. This is love. So, the workman, who for the welfare of others, wears out his body by toil, and thus brings himself to the verge of death, also gives himself, his body, to nourish others. And such love is possible only to the man for whom, between the possibility of the sacrifice of himself and those beings whom he loves, no obstacle to sacrifice exists. The mother who trusts her child to a foster-mother cannot love it; the man occupied in acquiring and keeping riches cannot love."

"Enough for Him whom Cherubim Worship night and day, A breastful of milk And a mangerful of hay;"

"Anyone offended by breastfeeding is staring too hard."

"Forbidden unto you are your mothers, and your daughters, and your sisters, and your father's sisters, and your mother's sisters, and your brother's daughters and your sister's daughters, and your foster-mothers, and your foster-sisters, and your mothers-in-law, and your step-daughters who are under your protection (born) of your women unto whom ye have gone in - but if ye have not gone in unto them, then it is no sin for you (to marry their daughters) - and the wives of your sons who (spring) from your own loins. And (it is forbidden unto you) that ye should have two sisters together, except what hath already happened (of that nature) in the past. Lo! Allah is ever Forgiving, Merciful."

"Mothers shall suckle their children for two whole years; (that is) for those who wish to complete the suckling. The duty of feeding and clothing nursing mothers in a seemly manner is upon the father of the child. No-one should be charged beyond his capacity. A mother should not be made to suffer because of her child, nor should he to whom the child is born (be made to suffer) because of his child. And on the (father's) heir is incumbent the like of that (which was incumbent on the father). If they desire to wean the child by mutual consent and (after) consultation, it is no sin for them; and if ye wish to give your children out to nurse, it is no sin for you, provide that ye pay what is due from you in kindness. Observe your duty to Allah, and know that Allah is Seer of what ye do."