Evaigeren

RF FOR RENAL CANCER

Elderly patients with renal cancer and patients with comorbidities who are poor candidates for surgery do well after treatment with percutaneous radiofrequency ablation and have few complications and recurrences, according to a new study.

"Nearly half of all renal cancers are now diagnosed incidentally because of the increasing use of imaging. For these patients, a conservative surgery has been developed to preserve renal function," lead investigator Pierre Balageas, MD, from Saint-André Hospital in Bordeaux, France, told Medscape Medical News.

However, Dr. Balageas, who presented the results here at the European Congress of Radiology (ECR) 2013, pointed out that "there still are patients with small renal cancers who are poor candidates for surgery because of advanced age or comorbidities. For these patients, percutaneous radiofrequency ablation works well."

To evaluate the effectiveness of the approach, Dr. Balageas and his team retrospectively reviewed all T1a renal cancers treated with percutaneous radiofrequency ablation at a single centre from 2002 to 2009. A total of 93 patients (median age, 73.5 years) underwent the procedure.

The technique used depended on tumor size, morphology, and location. "Most patients were treated with computerized-tomography-guided ablation," but 2 were treated with ultrasound guidance, Dr. Balageas noted.

The survival analysis involved 62 patients (mean age, 69.5 years) with 71 tumors (mean size, 23.9 mm). Mean follow-up was 38.8 months.

After initial treatment of the tumors, the technical success rate was more than 95%. After the retreatment of recurrences, the secondary success rate was more than 98%.

There was no change in real function 2 and 6 months after the procedure. Rates of both tumor progression (~3%) and metastatic evolution (~10%) were relatively low, and median survival was 68 months, Dr. Balageas reported.

One year after radiofrequency ablation, more than 98% of patients were alive and free of disease; 3 years after, 92% were; and 5 years after, approximately 61% were.

"In our study, tumor site was the only independent factor predicting risk for residual tumor or in situ recurrence," Dr. Balageas said, "and all tumors less than 40 mm were completed ablated after 1 procedure."

Major complications occurred at a rate of 5.9% per session. Central location of the tumor was the only factor associated with an increased risk for complications.

"Our experience using radiofrequency for renal tumors is increasingly being helped, not only by our good results, but also by the treatment strategy established with members of our surgical team, who have become convinced of the benefits of this technique," Dr. Balageas observed.

Session chair Jurgen Fütterer, MD, from the Radboud University Nijmegen Medical Centre in the Netherlands, who was asked by Medscape Medical News to comment on this study, noted that both radiofrequency ablation and cryoablation can be used to treat small renal tumors with curative intent.

"Not every patient with renal cancer is a candidate for radiofrequency ablation, but patients with localized disease who have a high mortality risk with general anesthesia are," he said.

Dr. Fütterer noted that the literature suggests that radiofrequency ablation has a success rate of ~80%, so the success rate achieved by Dr. Balageas and colleagues is very good.

Factors Affecting Success

In another study presented during the same session, Vanessa Acosta-Ruiz, a medical student at Uppsala University in Sweden, reported that her team also found very high success rates in 44 patients treated with percutaneous radiofrequency ablation over a period of 4.5 years.

"After the first ablation, 75% of the tumors were completed ablated, 8 tumors were incompletely ablated, and 7 were retreated, so we ended up with a total success rate of 85%," Acosta-Ruiz said.

Correct positioning of the electrode over the tumor favorably affected results, as might be expected, she added.

However, a tumor smaller than 30 mm and a distance from the tumor to the collecting system of at least 10 cm were more likely to be associated with complete ablation, she added.

Food Reward Friday

This week's "lucky" winner... milkshakes!

Neuronal Control of Appetite, Metabolism and Weight

Last week, I attended a Keystone conference, "Neuronal Control of Appetite, Metabolism and Weight", in Banff. Keystone conferences are small, focused meetings that tend to attract high quality science. This particular conference centered around my own professional research interests, and it was incredibly informative. This post is a summary of some of the most salient points.

Rapid Pace of Scientific Progress

Read more »

Flood safety awareness: What to do to get ready

Photo by Liz Roll/FEMA

True or false? Floods only happen during hurricanes and in places close to sea level.

Answer: False. The truth is that floods can occur in unexpected places. According to the National Weather Service, flooding can occur in any state at any time of the year. That means you should be prepared for a flood emergency even if you don’t live close to the water.

Floods are serious business: They cause an average of $5 billion in damage annually and about 100 deaths. The majority of those deaths occur while driving, particularly during flash floods. Flash floods can be the most dangerous because they happen with little warning.

This is National Flood Safety Awareness Week, sponsored by the National Weather Service. The week is a great opportunity to make sure you and your family are ready for a flood emergency.

Here are some things you should keep in mind:

Do not try to cross flooded areas — the water may be deeper and moving more swiftly than it appears. If your car gets stuck in a flood, do not open the car door. Try to climb out through car windows, if possible.
Keep up to date on tetanus shots in case you are hurt during a flood. Adults need a tetanus booster shot every 10 years.
Store nonperishable food in waterproof containers in a high place. Stock one gallon of bottled water per day per person in your household, and plan on at least three days of supplies.
During post-flood cleanup, wear gloves and regularly wash hands in clean water — boiled, if from the tap — and soap.

Check out our Get Ready flood fact sheet so you’ll know what to do before, during and after a flood happens. Come high water, you’ll be ready!

Food Reward Friday

This week's luck winner(s)... pastries!!

DIGOXIN USE IN AF INCREASE MORTALITY

SAN FRANCISCO, California — Patients with atrial fibrillation (AF) starting digoxin for the first time showed an independently significant jump in mortality over an average of one year compared with nondigoxin users in an observational study reported here today at the American College of Cardiology 2013 Scientific Sessions. Stratified analysis showed the effect to be consistent in men and women and by age.

Digoxin was given for rate control; patients with heart failure had been excluded from the study.

Although mortality doubled with digoxin use, hospitalizations appeared unaffected, suggesting that the people died at home, according to lead author Dr James V Freeman (Stanford University School of Medicine, CA). And though there were no data on cause of death, he toldheartwire that ventricular arrhythmias are a hazard from digoxin toxicity, "so our hypothesis is that maybe [digoxin users] had an increase in arrhythmic death and sudden cardiac death. But there's no way to know that for certain."

Digoxin in one form or another is one of the oldest still-used drugs in medicine and was never tested in substantial clinical trials for efficacy or safety in AF. Still, Freeman observed, the drug "is much more commonly used than people think, and it's not just that people who were using it 20 years ago are still using it."

The current findings support a recent propensity-adjusted secondary analysis of the AFFIRM trial,which found a 41% jump in all-cause mortality in AF patients taking vs not taking digoxin. As previously reported by heartwire , the increased hazard was seen in both men and women and in patients with and without underlying heart failure.

The group looked at 23 272 digoxin-naive patients newly diagnosed with AF from 2006 to 2009 within Kaiser Permanente Northern and Southern California. Of that group, 12.9% were started on digoxin for rate control.

The adjusted hazard ratio (HR) for all-cause mortality over a median of 0.8 years was 2.06 (95% CI 1.73–2.45) and for hospitalization was 1.05 (95% CI 0.98–1.13). The mortality finding remained significant in subgroup analysis by sex and three age groups.

Adjusted HR (95% CI), digoxin vs no digoxin use, for death from any cause in adults with incident AF (2006–2009)

Subgroup	HR (95% CI)*
Sex
Male	2.03 (1.58–2.60)
Female	2.13 (1.67–2.71)
Age (y)
21–74	2.31 (1.68–3.17)
75–84	1.66 (1.23–2.23)
>85	2.50 (1.85–3.38)

*Adjusted for age, race, income, laboratory parameters, prior CV disease and procedures, hypertension, dyslipidemia, cancer, lung disease, and cardiovascular medications

"This is about as strong an observational cohort study as you can get. I say that for a number of reasons," Freeman noted. It's large and from a "closed" healthcare system that is responsible for all patients' medications and lab results, and it would be known whether a patient might be noncompliant with meds, for example.

And there is potential from residual confounding due to differences in comorbidities and medications, which could--though they were adjusted for--suggest the study's results are conservative rather than overstated, he observed. Interestingly, nondigoxin users were sicker and showed a significantly greater baseline history of MI, stroke, and coronary revascularization, as well as more dyslipidemia and hypertension. Understandably, they were also on more CV medications.

The strong observational data for a hazard and thin evidence base supporting it, according to Freeman, is enough to recommend a reassessment of digoxin for AF rate control and maybe to give more consideration to certain patients--such as those who are highly symptomatic--for catheter ablation.

ODSP Does NOT Accommodate the Disabled

This is the total income I received from ODSP and Federal Tax credits in 2012. Total expenses are shown below. These amounts can all be proven with receipts.

The thing is, I'm lucky. I live in subsidized housing and I get some financial support from my family. What do people do who aren't so lucky? After all, no new affordable housing has been built for years. Also, not everyone is lucky enough to have a family member or friend who is ABLE to give them the legal amount of $500 extra dollars per month.

It is because I receive this amount from family that I'm still able to survive.

It is out of care and compassion for others who aren't so lucky, that I am writing this Blog.

	Annual	Monthly
Revenue
ODSP	$9,950.15	$829.18
Federal	837.36	69.78
Total	$10,787.51	$898.96

Expenses
Shelter
Rent	$1,044.00	87.00
Hydro	905.63	75.47
Phone – basic rate (mandatory for bldg security)	406.08	33.84
Insurance (mandatory)	306.06	25.51
Food* (inc toiletries, personal, & household cleaning supplies)	2,400.00	200.00
Laundry (2 loads per week, $2/machine)	384.00	32.00
Medical Supplies	1,020.00	85.00
Phone (less basic rate), Internet,	607.22	50.60
Cell Phone (mandatory for safety and accessibility)	812.92	67.74
Transit	$2,212.50	184.38
Total Expenses	$10,098.41	$841.54
Monthly/Annual Balance after mandatory expenses	$689.10	$57.42

* lower than published “real-cost” amounts (see: “Cost of Eating Healthy (in Kingston) 2012”

This begs the questions:

What does a person do who does NOT live in subsidized housing? How do they afford to survive?
What does a person do who does not receive outside financial help from family or friends?
What does a person with a disability do who literally cannot work in a community filled with barriers?

Does this make sense?

Remember, for a person to get ODSP they must be declared medically disabled. Here is the definition given in the ODSP Act:

Person with a disability

4. (1) A person is a person with a disability for the purposes of this Part if,

(a) the person has a substantial physical or mental impairment that is continuous or recurrent and expected to last one year or more;

(b) the direct and cumulative effect of the impairment on the person’s ability to attend to his or her personal care, function in the community and function in a workplace, results in a substantial restriction in one or more of these activities of daily living; and

(c) the impairment and its likely duration and the restriction in the person’s activities of daily living have been verified by a person with the prescribed qualifications. 1997, c. 25, Sched. B, s. 4 (1).

Under the AODA (Accessibility for Ontarian's With Disabilities Act), the definition is:

“disability” means,

(a) any degree of physical disability, infirmity, malformation or disfigurement that is caused by bodily injury, birth defect or illness and, without limiting the generality of the foregoing, includes diabetes mellitus, epilepsy, a brain injury, any degree of paralysis, amputation, lack of physical co-ordination, blindness or visual impediment, deafness or hearing impediment, muteness or speech impediment, or physical reliance on a guide dog or other animal or on a wheelchair or other remedial appliance or device,

(b) a condition of mental impairment or a developmental disability,

(c) a learning disability, or a dysfunction in one or more of the processes involved in understanding or using symbols or spoken language,

(d) a mental disorder, or

(e) an injury or disability for which benefits were claimed or received under the insurance plan established under the Workplace Safety and Insurance Act, 1997; (“handicap”)

If one is disabled and feels like they're ready and able to work, they can apply for jobs. They can even get support from ODSP Employment Supports. But what does one do when there are too many physical or attitudinal barriers in their community that prevent them from being able to work?

Employers look for candidates who have work skills, the ability to be flexible (i.e. get to work when scheduled, not when public transit can get them there), and who won't cost extra money to accommodate if they are hired. It is illegal to discriminate, but it's not always easy to enforce the Human Rights Code. If one were to rely on the new Integrated Accessibility Standard Regulation created under the AODA (Accessibility for Ontarian's With Disabilities Act)m they may be waiting awhile. The timeline for the

Employment Standards to become enforceable is January 2013 (for provincial government jobs) to January 2017 for all jobs (public and private).

How does the new plans to merge ODSP with OW and download the responsibility for delivering these two programs onto the municipalities, help those who have a disability, and by circumstance, not by choice, can't work?

Our new Premier, Ms. Kathleen Wynne has promised to immediately implement the recommendations set out in the Don Drummond Report and the Social Assistance Review: Brighter Prospects by downloading the responsibility for delivering ODSP to the municipalities.

In these reports it is also recommended that the rates for people on OW be immediately increased by $100. This raise is not recommended for people who are disabled and currently receive ODSP.

I'm trying to figure out how this makes sense.

To read more factual information on what the impact of all this will have on people with disabilities, please visit: http://sareview.ca/

It’s hard to fathom that, in a country as rich as Canada, we still must face these barriers and, worse, endure the indignities of being forced to live in extreme poverty on an ODSP income just because we're disabled.

If you agree this is a problem, please contact your MPP and voice your concerns. Thank you.

Please read my other Blogs:

Transportation: wheelchairdemon-transit.blogspot.com

Health Care: wheelchairdemon-health.blogspot.com

New breath of life for health body

The new health advisory body established to provide independent advice on the health needs of asylum seekers has officially begun operations.

The Immigration Health Advisory Group (IHAG) members, led by former Defence Force medical officer Dr Paul Alexander, include medical professionals, psychiatrists, psychologists and GPs, as well as advocates and officials.

A spokesman for the Department of Immigration and Citizenship (DIAC) said IHAG would have a broader scope than the former Detention Health Advisory Group (DeHAG) which had been “instrumental in facilitating improvements in health care for people in detention"

“Since DeHAG’s establishment, there have been significant changes in the size, nature and complexity of the immigration detention and status resolution environment, including expanded use of community detention and the use of bridging visas for clients who formerly would have been in immigration detention,” the spokesman said.

“This has meant that the type of health services provided, and the way in which services are used by clients, have also significantly changed.”

He said the new group would not only advise on the needs of people in detention but also on the health of asylum seekers in the community, as well as recent humanitarian visa holders.

“The expanded capacity of the group includes the design, development, implementation and evaluation of health and mental health policies and services for asylum seekers, refugees or recently granted permanent visa holders receiving support through the department’s assistance programs,” he said.

Source http://www.psnews.com.au/Page_psn3537.html

Chris Hedges Looks at Nick Turse's Book "Kill Anything That Moves" American War Crimes in Vietnam

It was after watching a Democracy Now piece, back in January of this year, "Kill Anything That Moves": New Book Exposes Hidden Crimes of the War Kerry, Hagel Fought in Vietnam that I tried to write a follow up article. But for reasons I mention here,* it never got off the ground. However, not all is lost, for Chris Hedges, Pulitzer Prize-winning reporter, has taken up the challenge and produced a much better and far more comprehensive report than I could ever hope to achieve.

Firstly, and before moving on to horrors and inhumanity that are describe in the article, let me offer up in Hedges' quite polite words, his observations of the American psyche. I say polite, because in normal circumstances, if it is I that writes about such things, I can't get much further than employing such words as Cant and Hypocrisy, not to mention the total indifference Americans have to the suffering of others. And not least, wrapping the whole thing in sugar-coated religious piety that I, and many Europeans alike, find truly nauseating; it is after all, the American way.

Turse’s book (Kill Anything That Moves) obliterates the image we have of ourselves as a good and virtuous nation. It mocks the popular belief that we have a right to impose our “virtues” on others by force. It exposes the soul of our military, which has achieved, through relentless propaganda and effective censorship, a level of public adulation that is terrifying. Turse reminds us who we are. And in an age of expanding wars in the Middle East, routine torture, murderous air and drone strikes and targeted assassinations, his book is not so much about the past as about the present. We have worked, consciously and unconsciously, to erase the terrible truth about Vietnam and ultimately about ourselves. This is a tragedy. For if we were able to remember who we were, if we knew what we were capable of doing to others, then we might be less prone to replicating the industrial slaughter of Vietnam in Iraq, Afghanistan, Pakistan, Somalia and Yemen.

Should you wish, you can meet the author Nick Turse, "Kill Anything That Moves" in this Democracy Now clip, about fifteen minutes.

Don't Look Away: We Must Confront the Horrific Industrial Violence the American Military Is Capable of

Nick Turse's Vietnam War book, 'Kill Anything That Moves,' shows how the trauma that plagues most veterans is tied to the horrors they inflicted.
by Chris Hedges
March 14, 2013

Nick Turse’s “ Kill Anything That Moves: The Real American War in Vietnam” is not only one of the most important books ever written about the Vietnam conflict but provides readers with an unflinching account of the nature of modern industrial warfare. It captures, as few books on war do, the utter depravity of industrial violence—what the sociologist James William Gibson calls “technowar.” It exposes the sickness of the hyper-masculine military culture, the intoxicating rush and addiction of violence, and the massive government spin machine that lies daily to a gullible public and uses tactics of intimidation, threats and smear campaigns to silence dissenters. Turse, finally, grasps that the trauma that plagues most combat veterans is a result not only of what they witnessed or endured, but what they did. This trauma, shame, guilt and self-revulsion push many combat veterans—whether from Vietnam, Iraq or Afghanistan—to escape into narcotic and alcoholic fogs or commit suicide. By the end of Turse’s book, you understand why.

This is not the book Turse set out to write. He was, when his research began in June 2001, a graduate student looking at post-traumatic stress disorder among Vietnam veterans. An archivist at the U.S. National Archives asked Turse whether he thought witnessing war crimes could cause PTSD. He steered Turse to yellowing reports amassed by the Vietnam War Crimes Working Group. The group, set up in the wake of the My Lai massacre, was designed to investigate the hundreds of reports of torture, rape, kidnapping, forced displacement, beatings, arson, mutilation, executions and massacres carried out by U.S. troops. But the object of the group was not to discipline or to halt the abuses. It was, as Turse writes, “to ensure that the army would never again be caught off-guard by a major war crimes scandal.” War crimes, for army investigators, were “an image management” problem. Those charged with war crimes were rarely punished. The numerous reports of atrocities collected by the Vietnam War Crimes Working Group were kept secret, and the eyewitnesses who reported war crimes were usually ignored, discredited or cowed into silence.

Turse used the secret Pentagon reports and documents to track down more than 100 veterans—including those who had reported witnessing atrocities to their superiors and others charged with carrying out atrocities—and traveled to Vietnam to interview survivors. A decade later he produced a masterpiece. Case after case in his book makes it painfully clear that soldiers and Marines deliberately maimed, abused, beat, tortured, raped, wounded or killed hundreds of thousands of unarmed civilians, including children, with impunity. Troops engaged in routine acts of sadistic violence usually associated with demented Nazi concentration camp guards. And what Turse describes is a woefully incomplete portrait, since he found that “an astonishing number of marine court-martial records of the era have apparently been destroyed or gone missing,” and “most air force and navy criminal investigation files that may have existed seem to have met the same fate.”

The few incidents of wanton killing in Vietnam—and this is also true for the wars in Iraq and Afghanistan—that did become public, such as My Lai, were dismissed as an aberration, the result of a few soldiers or Marines gone bad. But, as Turse makes clear, such massacres were and are, in our current imperial adventures, commonplace. The slaughters “were the inevitable outcome of deliberate policies, dictated at the highest levels of the military,” he writes. They were carried out because the dominant tactic of the war, as conceived by our politicians and generals, was centered on the concept of “overkill.” And when troops on the ground could not kill fast enough, the gunships, helicopters, fighter jets and bombers came to their assistance. The U.S. Air Force contributed to the demented quest for “overkill”—eradicating so many of the enemy that recuperation was theoretically impossible—by dropping the equivalent of 640 Hiroshima-sized atomic bombs on Vietnam, most actually falling on the south where our purported Vietnamese allies resided. And planes didn’t just drop bombs. They unloaded more than 70 million tons of herbicidal agents, 3 million white phosphorus rockets—white phosphorous will burn its way entirely through a body—and an estimated 400,000 tons of jellied incendiary napalm. “Thirty-five percent of the victims,” Turse writes, “died within fifteen to twenty minutes.” Death from the skies, like death on the ground, was often unleashed capriciously. “It was not out of the ordinary for U.S. troops in Vietnam to blast a whole village or bombard a wide area in an effort to kill a single sniper,” Turse writes.

Page 2

Murder is an integral part of war. And the most disturbing form of murder, because it is so intimate, is carried out by infantry troops. The god-like power that comes with the ability to destroy anything, including other human beings, along with the intoxicating firepower of industrial weapons, rapidly turns those who wield these weapons into beasts. Human beings are reduced to objects, toys to satiate a perverse desire to dominate, humiliate, control and kill. Corpses are trophies. Many of the Vietnamese who were murdered, Turse relates, were first subjected to degrading forms of public abuse, gang rape, torture and savage beatings. They were, Turse writes, when first detained “confined to tiny barbed wire ‘cow cages’ and sometimes jabbed with sharpened bamboo sticks while inside them.” Other detainees “were placed in large drums filled with water; the containers were then struck with great force, which caused internal injuries but left no scars.” Some were “suspended by ropes for hours on end or hung upside down and beaten, a practice called ‘the plane ride.’ ” Or they “were chained with their hands over their heads, arms fully extended, so their feet could barely touch the ground—a version of an age-old torture called the strappado. Untold numbers were subjected to electric shocks from crank-operated field telephones, battery-powered devices, or even cattle prods.” Soles of feet were beaten. Fingernails were ripped out. Fingers were dismembered. Detainees were slashed with knives, “suffocated, burned by cigarettes, or beaten with truncheons, clubs, sticks, bamboo flails, baseball bats, and other objects. Many were threatened with death or even subjected to mock executions.” Turse found that “detained civilians and captured guerrillas were often used as human mine detectors and regularly died in the process.” And while soldiers and Marines were engaged in daily acts of brutality and murder, the Central Intelligence Agency “organized, coordinated, and paid for” a clandestine program of targeted assassinations “of specific individuals without any attempt to capture them alive or any thought of a legal trial.”

“All that suffering,” Turse, writes, “was more or less ignored as it happened, and then written out of history even more thoroughly in the decades since.”

Turse, in one of many accounts, describes a string of atrocities committed in the Duc Pho/Mo Duc border region in spring 1967 by Charlie Company, 2nd Battalion, 35th Infantry under the command of Capt. James Lanning. A wounded detainee, Turse writes, was dumped into a boat and pushed into a rice paddy where he was riddled with bullets and finished off with a grenade. A wounded woman was covered with a straw mat and set on fire. Paul Halverson, a soldier and military combat correspondent who accompanied the unit, when asked about the total number of civilians killed by Lanning’s force, stated in the book: “The entire time I was over there—just by Charlie Company—I’d say it would be in the hundreds.”

Maj. Gordon Livingston, a regimental surgeon with the 11th Armored Cavalry Regiment, in 1971 testified before Congress that he witnessed “a helicopter pilot who swooped down on two Vietnamese women riding bicycles and killed them with the helicopter skids.” The pilot, after being grounded briefly and investigated, was soon exonerated and allowed back in the air.

Soldiers and Marines, as is common in all wars, collected body parts of dead Vietnamese—heads, noses, scalps, breasts, teeth, ears, fingers, genitals—and displayed them or wore them in necklaces. “There was people in all the platoons with ears on cords,” Jimmie Busby, a member of the 75th Rangers during 1970-1971, told an Army criminal investigator. Corpses were dressed up and twisted into comic poses for photographs or gruesomely mutilated. Severed heads of Vietnamese were mounted on pikes or poles in Army camps. The dead were lashed onto Army vehicles—which at times ran over Vietnamese civilians for sport—and driven through villages.

Go to page 3

* Were you to follow the link, a series of John Pilger "Outsider" interviews will be revealed. Interviewees include: Jessica Mitford, Wilfred Burchett, Martha Gellhorn and Costa-Gavras. Recommended.

Food Reward Friday

This week's lucky "winner"... fried Coke!

Atherosclerosis in Ancient Mummies Revisited

Many of you are already aware of the recent study that examined atherosclerosis in 137 ancient mummies from four different cultures (1). Investigators used computed tomography (CT; a form of X-ray) to examine artery calcification in mummies from ancient Egypt, Peru, Puebloans, and arctic Unangan hunter-gatherers. Artery calcification is the accumulation of calcium in the vessel wall, and it is a marker of severe atherosclerosis. Where there is calcification, the artery wall is thickened and extensively damaged. Not surprisingly, this is a risk factor for heart attack. Pockets of calcification are typical as people age.

I'm not going to re-hash the paper in detail because that has been done elsewhere. However, I do want to make a few key points about the study and its interpretation. First, all groups had atherosclerosis to a similar degree, and it increased with advancing age. This suggests that atherosclerosis may be part of the human condition, and not a modern disease. Although it's interesting to have this confirmed in ancient mummies, we already knew this from cardiac autopsy data in a variety of non-industrial cultures (2, 3, 4, 5).

Today’s the day: Remember to check your stocks!

Did you remember to turn your clocks ahead for daylight saving time this weekend? We hope so!

There’s one more thing we want you to remember to do: Check your stocks. It’s easy to forget about your emergency supplies until a storm or power outage happens, but that’s no time to find you’re out of something important.

That’s why today is a perfect day to check your emergency stockpile. Make sure that you have flashlights, fresh batteries and a manual can opener. Check your canned food to make sure that nothing has expired. Have at least one gallon of water on hand for each person in your household for at least three days — and have extra for your pets!

If you don’t have an emergency stockpile, you can start today. We have great fact sheets with tips on stockpiling food and water, and advice on how to stockpile on a budget.

After you’ve taken care of your own stockpile, remind your loved ones to check their supplies, too. Send them an email, post it on Facebook, send out a tweet! A few minutes of preparedness today can make a big difference the next time an emergency happens!

Salmonella

Salmonella infections don’t just come from contaminated food—they can come from contact with animals, too. Many Salmonella infections occur in people who have contact with certain types of animals. In 2012, there were two records involving outbreaks of human Salmonella infections linked to live poultry:

Eight outbreaks were reported which was more than any year in history and these outbreaks resulted in more than 450 illnesses –and-
The largest outbreak of human Salmonella infections linked to backyard flocks in a single year occurred.

Chicks, ducklings, and other poultry can carry Salmonella. Live poultry may have Salmonella germs in their droppings and on their bodies (feathers, feet, and beaks) even when they appear healthy and clean.

While it usually doesn't make the birds sick, Salmonella can cause serious illness when it is passed to people. Salmonella germs can cause a diarrheal illness in people that can be mild, severe, or even life threatening. Infants, seniors, and those with weakened immune systems are more likely than others to develop severe illness. These simple steps will help protect yourself and others from getting sick:

Wash hands thoroughly with soap and water right after touching live poultry or anything in the area where they live and roam. Adults should supervise hand washing for young children.
Clean any equipment or materials associated with raising or caring for live poultry outside the house, such as cages or feed or water containers.
Never bring live poultry inside the house, in bathrooms, or especially in areas where food or drink is prepared, served, or stored, such as kitchens, or outdoor patios.

Learn more about the risk of human Salmonella Infections from live poultry here.

INCREASED STROMAL CELLS WORSENS SURVIVAL IN COLORECTAL CANCER

Medscapers ahoy. I am David Kerr, Professor of Cancer Medicine at University of Oxford and past President of the European Society for Medical Oncology. Today I want to talk about another prognostic index for colon cancer. This is related to a recent publication^[1] in Annals of Oncology by Dr. Huijbers and colleagues from the University of Leiden, The Netherlands, and the excellent medical center there, and also with colleagues, including me, from the University of Oxford.

These investigators looked at the contribution of stromal cells to prognosis in colon cancer. It was a nicely conducted, large study of 710 patients who had participated in one of our adjuvant colon cancer trials, hence our involvement. We [at University of Oxford] supplied the biological materials to our colleagues in Leiden, who did all of the analysis. They looked at the percentage of stromal cells and, using simple morphologic criteria that were validated with a reading by 2 pathologists, showed that patients who have a high fraction of stromal cells [have a worse prognosis]: If more than 50% of the cells are stromal compared with [the percentage of] epithelial cancer cells, [the patient will have] a bad prognosis, with a hazard ratio of 2.0 and a P value of .0001. For patients who have high stromal components in their cancers, the 5-year survival rate is around 69% compared with an 83% survival rate for those with a low stromal involvement.

This was a validation study of 710 patients, which followed from initial observations in a couple hundred patients. Therefore, in terms of looking at American Society of Clinical Oncology criteria and how we should report biomarker evidence, the numbers are good, the biostatistics are strong, and multivariate analysis was done. Because this was a validation study, it is a retrospective-prospective trial of a novel prognostic biomarker that is morphologically simple to characterize, pathologically straightforward, and reveals very interesting data.

It does not surprise me, in a way. I must admit that I am becoming much more interested in the interaction between epithelial cancer cells and stromal cells. The stroma, of course, is composed of fibroblasts, infiltrating microphages, lymphocytes, and so on, and the interaction among these in terms of production of cytokines and growth factors clearly can have an enormous impact on the biology of the epithelial cancer cells.

Although I have spent almost a lifetime working with colleagues like Ian Tomlinson, wanting to understand the somatic tumor mutations and changes that drive the behavior of colon cancer, we must not forget environment, context, and the stroma. Next time you see a patient with colon cancer, perhaps ask the pathologist to check whether the patient has high or low levels of stroma within the tumor, and then consider how those with a high stromal component may have a significantly worse prognosis.

Food Reward Friday

This week's lucky "winner"... Yoplait Go-Gurt!

Groundwater: Out of sight, but not out of mind

National Groundwater Awareness Week, March 10-16, 2013, is a good time for the owners of household drinking water wells to test their water as managers of their own, personal drinking water system.

The Maine CDC recommends that private well owners test their water annually for bacteria, nitrate, and nitrite and every three to five years for arsenic, radon, uranium, lead, and fluoride.

Well owners should check their water more often than annually if:

There is a change in the taste, odor, or appearance of the water
A problem occurs such as a broken well cap or a new contamination source
Family members or houseguests have recurrent incidents of gastrointestinal illness
An infant is living in the home
There is a need to monitor the efficiency and performance of home water treatment equipment.

For a list of certified drinking water testing laboratories in Maine, see: Maine Certified Commercial Laboratories.

If your drinking water is supplied by a public water system, you can be assured that the water you receive is regularly monitored and tested to ensure that it meets federal and state drinking water standards and is safe to drink.

Whether you have your own private well or are supplied by a public water system, there are several things you can do to protect groundwater:

Properly maintain your septic system: make sure to have your septic tank pumped every 3 to 5 years and check for signs that your septic system is not working
Handle gasoline, motor oil, fertilizers, pesticides and other hazardous chemicals with care, making sure not to dump them on the ground or pour them down the sink. When you’re done with them, dispose of them properly at a recycling center
Inspect your heating oil tank and its piping to make sure it’s not leaking, starting to corrode or rust, or in danger of tipping over
Don’t throw away or flush unused or unwanted medications down the drain. There are several law enforcement agencies throughout the state that will accept unused prescription drugs for proper and safe disposal. For more information, visit: Maine State Map of Law Enforcement Agencies Accepting Unused, Unwanted Consumer Prescription Drugs for Disposal.

For more information about private wells, visit http://wellwater.maine.gov. For information about public water systems, visit www.medwp.com.

Spread the word: It’s almost time to set your clocks and check your stocks!

How often should you refresh your emergency supplies? At least every six months on any easy-to-remember date. That's the reasoning behind the Get Ready: Set Your Clocks, Check Your Stocks campaign: To remind people to refresh their emergency stockpile twice a year when they adjust their clocks for daylight saving time.

We've created a range of free materials to remind people to check their emergency preparedness stockpile — from logos and e-cards to sample tweets and a video.

And for those who don't have an emergency stockpile, we also have fact sheets about stockpiling food and water, as well as tips for stockpiling on a budget. If you run a health center or agency, library, business or other organization, you can even add your own logo to our fact sheets!

Check out the Set Your Clocks, Check Your Stocks materials on our website.
Don’t forget to spread the word!

Does the Mediterranean Diet Reduce Cardiovascular Risk?

By now, most of you have probably heard about the recent study on the "Mediterranean diet" (1), a diet that was designed by diet-heart researchers and is based loosely on the traditional diet of Crete and certain other Mediterranean regions. The popular press has been enthusiastically reporting this trial as long-awaited proof that the Mediterranean diet reduces the risk of cardiovascular events-- by a full 30 percent over a 4.8-year period. I wish I could share their enthusiasm for the study.

Read more »

FLU VACCINE LINKED TO NARCOLEPSY

A study from England shows a significant 14-fold increased risk for narcolepsy in children vaccinated with AS03 adjuvanted pandemic A/H1N1 2009 influenza vaccine (Pandemrix, GlaxoSmithKline) during the pandemic.

The study points to a "causal association" consistent with findings from Finland and Sweden, Elizabeth Miller, consultant epidemiologist, Health Protection Agency, Colindale, London, United Kingdom, and colleagues reported online February 26 in the British Medical Journal.

The researchers emphasize that the risk might be overestimated by more rapid referral of vaccinated children, and they call for long-term follow-up of children who received the vaccine to get a better handle on the exact level of risk.

Interpret Cautiously

Pandemrix was introduced in Europe in October 2009 during the second wave of infection, initially for people with high-risk clinical conditions and then in healthy children. By March 2010, around 1 in 4 (24%) healthy children younger than age 5 years and just over a third (37%) aged 2 to 15 years in a risk group had been vaccinated. v

Altogether, more than 30 million doses of the vaccine were administered in European countries during the H1N1 flu pandemic. It was not used in the United States.

In August 2010, concerns were raised in Finland and Sweden about a possible association between narcolepsy and this vaccine.

A 2012 study from Finland reported a 13-fold increased risk for narcolepsy in children and young people aged 4 to 19 years who got the vaccine. Most of those who developed narcolepsy had onset within 3 months of vaccination, and all did so within 6 months of vaccination.

However, in October 2012, a review of the evidence by the European Medicines Agency (EMA)'s Committee on Human Medicinal Products (CHMP) concluded the evidence was not sufficient to confirm a link between the vaccine and narcolepsy cases.

"After careful consideration, the CHMP concluded that the data presented by the Finnish researchers are preliminary and that the evidence presented so far is insufficient to allow conclusions to be drawn, and does not lead to any new concerns regarding Pandemrixor other vaccines, including other influenza vaccines," an EMA statement noted. "On the basis of the current evidence, the role of the Pandemrix antigen and its adjuvant on the association between Pandemrix and narcolepsy remains unknown."

To evaluate the risk for narcolepsy afterPandemrixvaccination in England, Miller and colleagues reviewed the medical records of 245 children and adolescents aged 4 to 18 years seen at sleep and child neurology centers across England.

From this group, they identified 75 children with narcolepsy (56 with cataplexy) with onset after January 1, 2008. Eleven had received the vaccine before their symptoms started, and 7 had received it within 6 months of vaccination.

In children with a narcolepsy diagnosis by July 2011, the odds ratios were 14.4 (95% confidence interval [CI], 4.3 - 48.5) for vaccination at any time before onset and 16.2 (95% CI, 3.1 - 84.5) for vaccination within 6 months before onset, the researchers say.

In a self-controlled case series analysis, the relative incidence in those with a diagnosis by July 2011 with onset from October 2008 to December 2010 was 9.9 (95% CI, 2.1 - 47.9).

In absolute terms, the researchers calculated that 1 in 52,000 to 57,500 doses of Pandemrixare associated with narcolepsy.

This study shows that the increased risk for onset of narcolepsy in children and young people after Pandemrixvaccination is not confined to Scandinavian populations, the researchers say.

"The magnitude of the increased risk found in English children and young people is similar to that reported from Finland," they write.

Although further use of this vaccine for prevention of seasonal flu "seems unlikely," they say their findings "have implications for the future licensure and use of AS03 adjuvanted pandemic vaccines containing different subtypes such as H5 or H9."

"Further studies to assess the risk, if any, associated with the other A/H1N1 2009 vaccines used in the pandemic, including those with and without adjuvants, are also needed to inform the use of such vaccines in the event of a future pandemic," the researchers conclude.