image002.gifThis map of the spread of the Black Death in Asia in the fourteenth century was created Melissa Snell and is copyright © 2003 . Geographical data was derived from the National Geographic Atlas of the World, sixth edition; Historical data was derived from The Black Death by Philip Ziegler and from the Encyclopedia Britannica.

By Peter Popham
The Independent, UK

On average the Venetians who lived during the glory days of the Republic were rather small, just five feet five inches in height; they were well nourished, and if they lacked sugar and fat the result was excellent teeth with no cavities.

These are among the first findings of a group of archaeologists exploring a treasure trove of Venetian history that has been locked away and forgotten for centuries: the graves of Lazzaretto, an island in the Venetian lagoon whichbecame the world’s first isolation hospital.

Following an outbreak of the plague in 1348, the Doge and his advisers put their minds to thinking up a way to prevent a recurrence. The upshot, at the beginning of the 15th century, was the world’s first isolation hospital occupying the entire small island.

In 1630 the hospital was dissolved and the island taken over by a military garrison; later it was used to hold stray dogs. In the 1960s it was abandoned altogether.

Now it has become the subject of intensive study. Backed by Consorzio Venezia Nuova, the quango directing the building of the underwater gates designed to protect Venice from flooding, the archaeologists have uncovered more than 1,500 skeletons of Lazzaretto patients. Luigi Fozzatti, who is in charge of excavations, said: “It wasn’t difficult to imagine that some people would have been buried on the island but we had no idea we would find so many.”

The first grave was found when the excavators began clearing away rubble for the rebuilding of one of the sheds. Since then more than 240 have come to light, some crowded with skeletons, some housing only a few. To date 1,560 individual skeletons have been found, dating from four, five and six centuries ago, most of them in perfect condition.

“With the research they will undergo in the laboratory, they will yield a mountain of information without precedent,” the anthropologist Luisa Gambaro of the University of Padua told La Repubblica newspaper.

Already a picture of the harsh lives of some of those confined here is beginning to emerge. A number of the patients were afflicted with a disease called Schmorl’s Node, a type of hernia caused by heavy stress on the back – probably the occupational hazard of the porters who lugged Venice’s merchandise around on their backs.

Yet although these skeletons by definition belonged to people who were extremely sick, they were remarkably fit.

Some had arthritis, some tuberculosis, some had fractures that had healed badly, but in general they seem to have enjoyed a nutritious diet and a healthy lifestyle.

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Target Health is pleased to announce the publication of an article in Applied Clinical Trials (March 2007) entitled The Critical Path Initiative Meets Medical Devices. The article is co-authored by Vanessa Hays, Mary Shatzoff and Glen Park. This is our 5th article in Applied Clinical Trials. The article reviews CDRH’s implementation of FDA’s Critical Path Initiative.

Science Daily — The incidence of cancer in northern Sweden increased following the accident at the nuclear power plant in Chernobyl in 1986. This was the finding of a much-debated study from Linköping University in Sweden from 2004.

Was the increase in cancer caused by the radioactive fallout from Chernobyl or could it be explained by other circumstances? New research from Linköping University provides scientific support for the Chernobyl connection.

“This issue is important because the indicated increased risk may come to influence the prevailing exposure limits for the population. Enhanced knowledge of the risks entailed by radioactive radiation is key to work for radiation safety and makes it possible to prevent diseases,” says Martin Tondel, a physician and researcher in environmental medicine who will soon be defending his doctoral dissertation Malignancies in Sweden after the Chernobyl Accident in 1986.

In two studies using different methods, Martin Tondel has shown a small but statistically significant increase in the incidence of cancer in northern Sweden, where the fallout of radioactive cesium 137 was at its most intense.

The cancer risk increased with rising fallout intensity: up to a 20-percent increase in the highest of six categories. This means that 3.8 percent of the cancer cases up to 1999 can be ascribed to the fallout. This increased risk, in turn, is 26 times higher than the latest risk estimate for the survivors of the atom bombs in Hiroshima and Nagasaki, whose exposure was many times higher.

The increase in Tondel’s studies came a remarkably short time after the disaster, since it is usually assumed that it takes decades for cancer to develop. The dissertation discusses the interpretation of the research findings from the perspective of the theory of science.

The conclusion is that there is scientific support for a connection between the radioactive fallout and the increase in the number of cancer cases.

AP) — More than 800 of them have lost an arm, a leg, fingers or toes. More than 100 are blind. Dozens need tubes and machines to keep them alive. Hundreds are disfigured by burns, and thousands have brain injuries and mangled minds.

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Marine Cpl. Joshua Pitcher, 22, is recovering
from a brain injury and shrapnel wounds from
a grenade blast in February.

These are America’s war wounded, a toll that has received less attention than the 3,500 troops killed in Iraq. Depending on how you count them, they number between 35,000 and 53,000.

More of them are coming home, with injuries of a scope and magnitude the government did not predict and is now struggling to treat.

“If we left Iraq tomorrow, we would have the legacy of all these people for many years to come,” said Dr. Jeffrey Drazen, editor-in-chief of the New England Journal of Medicine and an adviser to the U.S. Department of Veterans Affairs. “The military simply wasn’t prepared for its own success” at keeping severely wounded soldiers alive, he said.

Survival rates today are even higher than the record levels set early in the war, thanks to body armor and better care. For every American soldier or Marine killed in Iraq, 15 others have survived illness or injury there.

Unlike previous wars, few of them have been shot. The signature weapon of this war — the improvised explosive device, or IED — has left a signature wound: traumatic brain injury.

Soldiers hit in the head or knocked out by blasts — “getting your bell rung” is the military euphemism — sometimes have no visible wounds but a fog of war in their minds. They can be addled, irritable, depressed and unaware they are impaired.
Invisible injury

An estimated 2,000 cases of brain injury have been treated, but doctors think many less obvious cases have gone undetected. One small study found that more than half of one group of wounded troops arriving at Walter Reed Army Medical Center had brain injuries. Around the nation, a new effort is under way to check every returning man and woman for this possibility.

Some of those on active duty may have subtle brain damage that was missed when they were treated for more visible wounds. Half of those wounded in action returned to duty within 72 hours — before some brain injuries may have been apparent. The military just adopted new procedures to spot these cases, too.

Back home, concerns grow about care. The Walter Reed hospital scandal and problems with some VA nursing homes have led Republicans and Democrats to call for better care for this new crop of veterans.

Mental health problems loom large. More than a third of troops received psychological counseling shortly after returning from Iraq, and in a third of those a problem was diagnosed, a recent Pentagon study found. The government plans to add 200 psychologists and social workers to help treat post-traumatic stress disorder and other issues.

No one knows what the ultimate cost will be. Harvard University economist Linda Bilmes estimates the lifetime health-care tab for these troops will be $250 billion to $650 billion — a wide range but a huge sum no matter how you slice it.
Numbers at issue

Counting the wounded can be contentious. Earlier this year, the Department of Defense changed how it tallies war-related injuries and illness, dropping those not needing air transport to a military hospital from the bottom-line total.

Bilmes, the economist, thinks this is disingenuous.

“An accident that happens while they’re there is a cost of war, particularly when you factor in the length of deployment” and injury-inducing conditions like very hot weather, carrying heavy packs, and more vehicle accidents because it is not safe to walk anywhere, she said.

As of June 2, 25,830 troops had been wounded in action. Of these, 7,675 needed airlifts to military hospitals and the rest were treated and remained in Iraq.

Of the half-million troops who have left active duty and are eligible for VA health care, about one-third have sought it. The most complicated cases end up at one of the four polytrauma centers, in Tampa, Florida.; Richmond, Virginia.; Palo Alto, California; and Minneapolis, Minnesota.

These were formed after doctors realized they were missing problems — amputees who were confused and unable to put on their prosthetics because of undiagnosed brain injuries, and guys who could remember their therapy dog’s name but not their doctor’s, or who could carry on a conversation but not recall what they had for breakfast. Most of these injuries are caused by IED blasts, which send a pressurized air wave through delicate tissues like the brain, sometimes send it smacking against the inside of the skull and shearing fragile nerve connections that control speech, vision, reasoning, memory and other functions. Lungs, eardrums, spinal cords — virtually anything — can be damaged by the pressure wave. Injuries also come from collapsing buildings, flying debris, heat, burns or inhaled gases and vapors.

Much needs to be learned about how to treat these injuries, Kilpatrick said, but credited the military medical staff for having the chance.

“It’s just amazing to me every day when I look at these numbers,” he said. “The good news is that the majority of these people who become ill or injured … are going to survive and are going to be able to return either to the military or to civilian life and be productive.”

Target Health Inc. – High Tech Booth
2007 DIA Annual Meeting
Atlanta, GA
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Nassim Nicholas Taleb is not afraid to say “I don’t know.” In fact, he’s proud of his ignorance. A mathematician, philosopher and hedge-fund manager all in one iconoclastic package, Taleb demonstrates the wisdom in admitting the limitations of our knowledge.

If statistics also interest you, take a look at this.

To reduce the spread of infections, a new automated hand-sanitizing system uses RFID to monitor how well health-care workers wash their hands.

By Beth Bacheldor
RFID Journal Inc.
Copyright RFID Journal LLC 2008, Used With Permission

June 20, 2007—RFID continues to make its way into a number of health-care applications. Now the technology is being employed in an automated, touchless hand-washing system, to help reduce the spread of infections at health-care institutions.

Next week, Resurgent Health and Medical is introducing its CleanTech IC line of automated hand-washing systems, which utilizes RFID tags and interrogators to identify each person using the hand-washing system—and records how long. The system will be unveiled at the Association for Professionals in Infection Control and Epidemiology’s (APIC) 2007 Annual Conference in San Jose, Calif.

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Health-care-associated infections affect nearly 2 million individuals annually in the United States, and are responsible for approximately 80,000 deaths each year, according to a guide published by the Centers for Disease Control and Prevention (CDC), in collaboration with APIC, the Infectious Disease Society of America (IDSA) and the Society of Healthcare Epidemiology of America (SHEA). The transmission of health-care-related pathogens most often occurs via the contaminated hands of health-care workers, according to the guide, titled the “Guideline for Hand Hygiene in Healthcare Settings”.

This, says Resurgent Health and Medical, makes it important to promote and track the hand hygiene of health-care workers. Located in Golden, Colo., the manufacturer makes hand-washing and sanitizing systems for health-care, agriculture, food-processing and clean-room manufacturing companies.

The CleanTech IC will be available in three different versions: the IC In-Counter, designed to be built into existing workplace countertops or other small areas; the portable, freestanding IC Table Mount; and the IC Wall Mount, intended to keep workplace floors clear and accessible.

When washing hands, a caregiver wearing an RFID badge is identified by the CleanTech machine’s RFID interrogator. The reader identifies the employee by scanning that person’s unique tag ID number, associated with the caregiver’s name in a back-end database. The device records the date and time, as well as the beginning and end of the wash cycle, then communicates that information to the database, which uses the interrogator’s Ethernet card MAC address to identify each CleanTech and the department in which it is located.

The wash cycle automatically starts when the caregiver’s hands are inserted into the machine’s cylindrical openings. Water and sanitizing solution is applied for 10 seconds through 20 high-pressure nozzles, located in each opening and designed to clean the hands from fingertips to wrists.

If a caregiver removes the hands before the 10-second cycle finishes, the interrogator transmits this information to the back-end database. Hospital administrators can then run departmental statistics and other compliance reports to determine which caregivers have completed the washing cycles.

“There are two ways to live life.
One is as though nothing is a miracle.
The other is as though everything is a miracle”

Albert Einstein

By RONI CARYN RABIN
Published: June 19, 2007
The New York Times
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Advances in radiology have radically transformed medical practice, with CT scans and nuclear medicine exams providing physicians with the ability to quickly pinpoint internal bleeding, diagnose kidney stones or confirm appendicitis, assess thyroid function and identify and open blockages in the blood vessels to the heart.

The downside is that Americans are being exposed to record amounts of ionizing radiation, the most energetic and potentially hazardous form of radiation.

According to a new study, the per-capita dose of ionizing radiation from clinical imaging exams in the United States increased almost 600 percent from 1980 to 2006. In the past, natural background radiation was the leading source of human exposure; that has been displaced by diagnostic imaging procedures, the authors said.

“This is an absolutely sentinel event, a wake-up call,” said Dr. Fred A. Mettler Jr., principal investigator for the study, by the National Council on Radiation Protection. “Medical exposure now dwarfs that of all other sources.”

The study, financed by the federal government, is to be published by early next year. It found a particularly sharp rise in the number of CT scans — to 62 million in 2006, from 3 million in 1980. Though CTs make up only 12 percent of all medical radiation procedures, they deliver almost half of the estimated collective dose of radiation exposure in the United States. A CT scan exposes patients to far more radiation than a standard X-ray, and multislice CT scanners deliver higher doses of radiation than single-slice scanners.

Nuclear medicine exams increased to 18.1 million in 2006, from 6.4 million in 1980. They represent almost a quarter of the estimated collective radiation dose, with cardiac studies making up most of the dose.

X-rays have been classified as carcinogens by the World Health Organization, the Centers for Disease Control and Prevention and the National Institute of Environmental Health Sciences, because studies have shown that exposure causes leukemia and cancers of the thyroid, breast and lung.

Yet with the exception of mammography, scans remain largely unregulated. (The Food and Drug Administration regulates manufacturers of equipment but does not inspect facilities, which are licensed by states. Radiation doses for mammography are limited by federal law.) Radiation doses for the same procedure can vary drastically, as different machines in the hands of different practitioners deliver doses that vary by as much as a factor of 10, experts say.

Radiologists say they do not want to scare people away from having scans and exams when necessary, but they want patients — as well as physicians — to carefully evaluate the benefits and risks of each scan or exam, make sure the procedure is appropriate and keep track of cumulative exposure levels. Full-body CT scans should be avoided unless there is a good medical reason.

“We’re not saying you shouldn’t have X-rays or CT scans — they’re wonderful, they’ve totally revolutionized the practice of medicine,” said Dr. E. Stephen Amis Jr., a former president of the American College of Radiology who is chairman of radiology at Albert Einstein College of Medicine and Montefiore Medical Center in New York. “But if you go into the emergency room with recurrent pain and get a CT scan every time you show up, that’s not good. Use a little common sense.”

Studies of atomic bomb survivors in Japan found a statistically significant increase in cancer at high levels of exposure — 50 millisieverts, or mSv, about 16 times the current annual average for Americans from medical exams. But that figure is controversial; it is not clear that lower levels of radiation exposure are safe. Nor would it be unusual for a patient to exceed this level, according to a recent paper from the American College of Radiology.

“It is worth noting that many CT scans and nuclear medicine studies have effective dose estimates in the range of 10 to 25 mSv for a single study, and some patients have multiple studies; thus it would not be uncommon for a patient’s estimated exposure to exceed 50 mSv,” the paper said, adding that “the International Commission on Radiological Protections has reported that CT doses can indeed approach or exceed levels that have been shown to result in an increase in cancer.”

A single CT scan of the abdomen, body or spine can expose a patient to 10 mSv, according to the American College of Radiology patient information Web site (www.radiologyinfo.org, see Safety). Mammography, on the other hand, delivers only 0.7 mSv, and a bone-density scan is only 0.01 mSv.

There are several steps patients can take to protect themselves, and they should not be shy about asking questions, doctors and other experts say.

“They can always inquire of the referring physician, ‘Is this test necessary?’ ” said Richard Morin, chairman of the radiology college’s quality and safety committee, adding that “exams are often done for reasons that are not quite appropriate.”

Doctors should be familiar with the radiology college index of appropriateness criteria, which rates the imaging procedures for some 200 medical conditions. Dr. Morin suggests asking the doctor ordering the test about its rating for a given condition.

Scores range from 1 to 9, he said, and “if the number turns out to be 1 or 2, you should look for some other exam.”

When undergoing a scan or exam, patients should try to use a facility accredited by the American College of Radiology. The accreditation, which is voluntary, means the machines are surveyed and calibrated to use the correct level of radiation and the technologists are certified. It also means the images are likely to be of higher quality, reducing the likelihood of having to repeat a procedure and suffer additional exposure.

Research studies closely regulate and monitor radiation doses, so participating in a research study may provide some protection, Dr. Morin said. Hospitalized patients are also often scanned routinely once a day when they are very ill, he said, and “it’s not unreasonable for someone to ask, ‘Do I really need this exam every day?’ ” Patients may also want to ask the radiologists or technicians whether the machines are routinely inspected by a medical physicist.

Women should tell the doctor or technician if they might be pregnant; generally, women, children and young people should try to avoid scans.

If patients are given a CD of their scan, along with the interpretation, they should hold onto it, to avoid having to repeat a procedure. People who are undergoing multiple studies may want to keep a record tracking all the radiological procedures they have had, and inform their physicians of their history, said Dr. Amis, of Albert Einstein.

“Patients should have a questioning demeanor when going in for any kind of health care,” he said. “Unfortunately, the majority do not.”

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