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This is a good way to use left-over turkey and so easy and delicious.


This is a good large portion for one person, so depending on how many you want to serve, simply double or triple (etc) this recipe.



1 cup of chopped turkey (left-overs can be white or dark meat)

½ cup of chopped salt-free walnuts

¼ to ½ cup chopped dried cranberries (or count out 15 and chop them)

1 onion, chopped fine

½ cup chopped celery

Juice of 1 clove garlic (or 2 if you love garlic), squeezed, and discard the pulp.

2 Tablespoons Kraft Mayo (there’s enough salt in the mayo, so don’t add more)….or Kraft Mayo light.

¼ cup chopped parsley

Pinch fine black pepper(or grind it)



Mix and serve on lettuce leaf or on top of broccoli sauteed in oil and garlic

Mix and serve in a hollowed out tomato.  And don’t waste the scooped-out tomato, put it into some Tabouleh or marinara sauce, etc.


By Todd Neale, Staff Writer, MedPage Today
Published: February 10, 2011
Reviewed by Michael Thomas Mullen Jr, MD; Clinical Instructor of Vascular Neurology,

  • In this double-blinded study 5,599 patients with atrial fibrillation and at least one other risk factor for stroke were randomly assigned to aspirin or apixaban, a novel factor Xa inhibitor.
  • All patients in this study were considered unsuitable for treatment with warfarin.
  • Treatment with apixaban was associated with a significant reduction in stroke and systemic embolism without an increased risk of hemorrhagic complications.


LOS ANGELES — In patients with atrial fibrillation who can’t take vitamin K antagonist therapy, the experimental anticoagulant apixaban is superior to aspirin for preventing stroke or systemic embolism, final results of the AVERROES trial confirmed.

Through about one year of follow-up, the rate of stroke or systemic embolism was 1.6% per year in the apixaban group and 3.7% per year in the aspirin group (HR 0.45, 95% CI 0.32 to 0.62), according to Hans-Christoph Diener, MD, PhD, of University Duisburg-Essen in Germany.

The rate of death was lower among patients taking apixaban (3.5% versus 4.4% per year) but this did not reach statistical significance (P=0.07). There was a significant reduction in the risk of a first hospitalization for cardiovascular causes (12.6% versus 15.9% per year, P<0.001).

The rate of major bleeding — the primary safety endpoint — was not raised in the apixaban group (1.4% versus 1.2% per year; HR 1.13, 95% CI 0.74 to 1.75), Diener reported here at the American Stroke Association’s International Stroke Conference.

The findings, which confirm the initial results presented last year at the European Society of Cardiology meeting, were reported simultaneously online in the New England Journal of Medicine.

Diener and his colleagues noted in their paper that treating 1,000 patients for one year with apixaban rather than aspirin would prevent 21 strokes or systemic emboli, nine deaths, and 33 hospitalizations for cardiovascular causes, at the cost of two major bleeds.

“The net clinical benefit of apixaban in these patients was therefore substantial,” they wrote.

Some patients are not good candidates for vitamin K antagonist therapy for numerous reasons, including an unwillingness to comply with regular testing, a proven inability to maintain an INR within the therapeutic range, a moderate risk of stroke, or a refusal to receive the therapy.

Aspirin reduces the risk of stroke for patients with atrial fibrillation, and adding clopidogrel (Plavix) reduces the risk even further, but the combination increases the risk of major hemorrhage.

Diener and his colleagues evaluated apixaban — a novel factor Xa inhibitor — as a treatment option for patients with atrial fibrillation who cannot take vitamin K antagonist therapy.

The AVERROES trial randomized 5,599 patients to apixaban (5 mg twice a day) or aspirin (81 to 324 mg daily) at 522 centers in 36 countries; 37% of the patients were from North America or western Europe.

In addition to unsuitability for vitamin K antagonist therapy, all patients had at least one risk factor for stroke.

The trial was stopped prematurely by its data and safety monitoring board after a mean follow-up of 1.1 years because prespecified interim analyses identified a clear benefit for apixaban in reducing stroke or systemic emboli.

The treatment effects were consistent in various subgroups, including high-risk patients who had already had a stroke or a transient ischemic attack.

Although major bleeding was not significantly increased in the apixaban group, an on-treatment analysis that included only those events occurring within two days of permanent study drug discontinuation approached significance (1.4% versus 0.9% per year; HR 1.54, 95% CI 0.96 to 2.45).

“The on-treatment analysis may provide a more specific measure of the effect of therapy but does so at the risk of introducing potential bias,” the authors wrote.

There was no suggestion of an increase in intracranial bleeding — a feared complication of antithrombotic therapy, according to the researchers — in the apixaban group, with 11 cases in that group and 13 in the aspirin group.

“This finding, together with the report of a much lower risk of hemorrhagic stroke with dabigatran (Pradaxa) as compared with warfarin, indicates that reduction of intracranial bleeding will be one of the most important benefits of the newer oral antithrombotic drugs over vitamin K antagonist therapy,” Diener and his colleagues wrote.

Serious adverse events occurred less frequently in the apixaban group (22% versus 27%), a difference mostly driven by fewer events related to vascular disorders of the central nervous system.


The authors acknowledged that early termination of the trial could have inflated the measured benefit.


AVERROES was funded by Bristol-Myers Squibb and Pfizer.

Connolly reported receiving payment for serving on the boards of Boehringer Ingelheim, sanofi-aventis, Portola, and Merck, consulting fees from Boehringer Ingelheim, sanofi-aventis, Portola, and Merck, grant support on behalf of his institution from Boehringer Ingelheim, sanofi-aventis, Portola, and Bristol-Myers Squibb, and lecture fees from Boehringer Ingelheim, sanofi-aventis, and Portola.

Diener reported receiving payment for serving on the boards of Abbott, AstraZeneca, Boehringer Ingelheim, CoAxia, D-Pharm, GlaxoSmithKline, Janssen-Cilag, Medtronic, MindFrame, Neurobiological Technologies, Novartis, sanofi-aventis, Servier, and Solvay, consulting fees from Abbott, AstraZeneca, Bayer Vital, Bristol-Myers Squibb, Boehringer Ingelheim, CoAxia, D-Pharm, Fresenius, GlaxoSmithKline, Janssen-Cilag, Knoll, Merck Sharpe and Dohme, Medtronic, MindFrame, Neurobiological Technologies, Novartis, Novo-Nordisk, Paion, Parke-Davis, Pfizer, sanofi-aventis, Sankyo, Schering-Plough, Servier, Solvay, Thrombogenics, Wyeth, and Yamaguchi, grant support on behalf of his institution from AstraZeneca, GlaxoSmithKline, Boehringer Ingelheim, Novartis, Janssen-Cilag, and sanofi-aventis, lecture fees from Abbott, AstraZeneca, Bristol-Myers Squibb, Bayer Vital, Boehringer Ingelheim, CoAxia, D-Pharm, GlaxoSmithKline, Merck Sharpe and Dohme, MindFrame, Neurobiological Technologies, Novartis, sanofi-aventis, Servier, Solvay, and Thrombogenics, payment from Boehringer Ingelheim and sanofi-aventis for manuscript preparation, and payment from Boehringer Ingelheim for developing educational presentations.

Their co-authors reported extensive relationships with industry. One of the authors is employed by Bristol-Myers Squibb.


Primary source: New England Journal of Medicine
Source reference:
Connolly S, et al “Apixaban in patients with atrial fibrillation” N Engl J Med 2011; DOI: 10.1056/NEJMoa1007432.

Related Article(s):

nsylvania and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner




AHA: Drug-Coated Balloons Expand PCI Options

Drug-eluting Balloons

On Drug-eluting Balloons



By Chris Kaiser, Cardiology Editor, MedPage Today
Published: November 18, 2011



ORLANDO — Drug-eluting balloons can be used in place of stenting in patients at high risk of bleeding, Mariusz Zadura, MD, explains in this exclusive InFocus report.

They are particularly useful for patients on warfarin, Zadura, of the Heart and Diabetes Center in Karlsburg, Germany, told cardiology editor Chris Kaiser.

When drug-eluting stents are implanted, dual antiplatelet therapy is contraindicated for 12 months; when balloons are deployed, antiplatelet therapy can begin a month later.

The balloons also offer a solution for bare-metal instent restenosis, Zadura said.

The authors reported they have no conflicts of interest.


Primary source: American Heart Association
Source reference:
Zadura, M, et al “Drug eluting balloon-PCI is an alternative to drug-eluting stents in patients with a high risk of bleeding complications” AHA 2011; Abstract 10265.

Additional source: American Heart Association
Source reference:
Zadura M, et al “Durg-Eluting Balloon-PCI is a New Terapeutic Option for Patients with In-Stent Restenosis in Bare Metal Stents” AHA 2011; Abstract 10244.


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Re-engineering New York: More Than a Sci-Fi Dream?



At an urban-planning conference last week, Mary Ann Tighe, a prominent commercial real estate broker and glamorous presence in any room full of people who think about sewage flow, aligned herself against a certain strain of traditionalism. The most powerful woman in New York, according to a recent ranking by the business publisher Crain’s New York, Ms. Tighe lamented returning home from China to a skyline she now views only in the quaintest terms.


James Estrin/The New York Times

Cheni Yerushalmi, left, a founder of the Sunshine Bronx Business Incubator, chatting with his colleague Don’Angelo Bivens at the start-up center.



“I always think to myself, what a romantic 20th-century city,” Ms. Tighe told the audience. Implicit in her comment is the notion that to compete with Guangzhou we must look like Guangzhou. I suspect that this is a woman who doesn’t watch “Annie Hall” and get wistful.

Positioning New York for 21st-century global supremacy has been a preoccupation of the Bloomberg administration, and one central to the mayor’s vision of greatly expanding the technology sector by ratcheting up elite science education. The city is reviewing seven proposals from 17 universities and research institutions (Stanford and Cornell are among those that have forged alliances) bidding to create an applied sciences and engineering campus here — one that could spring up on Roosevelt Island or at the Brooklyn Navy Yard, among other potential locations. The city is offering land and up to $100 million in capital to achieve all this.

It is also providing us with an invitation to imagine what New York would look and feel like as a kind of mid-Atlantic Silicon Valley. Is it even possible to mastermind such a world?

The city already has tech enclaves around Union Square and most notably now in Dumbo, Brooklyn. But of course there are reasons to remain skeptical of any future evolution. “Regions around the world have tried for decades to replicate the Silicon Valley experience, without success,” AnnaLee Saxenian, a professor of urban planning and dean of the School of Information at the University of California, Berkeley, told me. “There are also world-class technical universities all over that don’t generate ongoing commercial innovation and economic growth.” (And research generally, in the aggregate, loses money, as some economists will tell you.)

At the same time, Northern California’s Silicon Valley, Boston’s Route 128 and Austin, Tex., have all emerged as technology centers through some combination of major universities, Cold War government research money and proximity to venture capital. New York doesn’t have much in the way of military-financed research and development, but as a major medical center it has hundreds of millions of dollars flowing to it from the National Institutes of Health. James Parrott is an economist who now focuses on issues affecting New York State, but he wrote his dissertation on the emergence of Route 128’s tech corridor and he is optimistic about the city’s plan. “It is a model anyone would follow,” he said.

The mythology, and partial truth, of Silicon Valley is that genius was birthed in so many attached garages. In New York we don’t have garages, we have underground labyrinths that take $400 a month from us to park a car 10 blocks away from our apartments. But we do have places for businesses to grow, once we think about New York as a city that extends beyond Upper and Lower Manhattan.

The South Bronx, for instance. The soon-to-open Sunshine Bronx Business Incubator seems like an apt model for what could come. It occupies part of a floor in the 420,000-square-foot BankNote Building, a former currency-printing plant in Hunt’s Point, which was erected in 1909 and is virtually impossible to describe without sounding like a Corcoran brochure. It has clean lines, high ceilings, enormous windows, sweeping views of the Robert F. Kennedy Bridge and the city beyond, and it is fairly easy to get to, transportation being key to the blossoming of any tech hub.

After an application process and for $195 a month, technology entrepreneurs and other self-employed workers can join Sunshine and avail themselves of a mod, meticulous office space with video-conferencing facilities, open desks, private cubicles, conversation areas, healthy vending-machine snacks, continuing education, camaraderie. The model is a co-operative, and the point is to help people foster allegiances both within their fields and outside them, so that the guy working on a software start-up has ready access to the intellectual property lawyer, who, in turn, can easily find someone to develop her Web site. Those considered to be lacking the correct spirit of fraternity face being expelled.

The Bronx site was opened in part with a modest investment from the city’s Economic Development Corporation. The rest came from Sunshine, whose founders, Cheni Yerushalmi, an Israeli immigrant, and his Iraqi best friend, Joseph Raby, have been running similar sites in NoHo and TriBeCa. The company has helped give rise to Zipmark, a mobile and online payment company; the Vitamin Creek, an online supplier of nutritional supplements, and Atlassian, a $600 million software company; it also owns a retreat for its members (called “shiners”) in Vermont. Given the warehouse stock, the city sees the southern part of the Bronx as a place where tech businesses (and coworking particularly) could really flourish.

Beyond that, though, it is the city’s goal to create a whole population of engineers, men and women whose skills could serve all manner of industries. After the financial crisis, Seth Pinsky, president of the Economic Development Corporation, told me: “We went out to hundreds of people through the city and we asked one simple question. We said, ‘Put resources to the side; what would have the most dramatic impact on our economic competiveness?’ ” Over and over again, the answer was engineering talent. Mr. Pinsky, for his part, would like to see New York become a center for rapid prototyping, which involves the development of sophisticated machinery that serves, essentially, as a three-dimensional printer for product models.

And what if it did? What if legions of engineers lived among us? What would they wear? Where would they eat? What kind of space would they take up in our imagination? Would we ever get to a point, say, where the Engineer Living in Fieldston was as much of a cliché as the Writer Living in Brooklyn, the Editor Eating at Michael’s, the Fund Manager in the Fifth Avenue Apartment?

“New York just doesn’t feel like an engineering town,” a friend, a native and astute observer of the city’s culture, remarked to me recently. I wanted to disagree, but in truth, I couldn’t.


This article has been revised to reflect the following correction:

Correction: November 19, 2011

An earlier version of this article mistated the fee that technology entrepreneurs and other self-employed workers pay to use the facilities at Sunshine Bronx Business Incubator. It is $195.

FDA Meeting on Direct Data Entry and Risk-Based Monitoring



As part of Target Health’s commitment to transparency on its programs using risk-based monitoring and direct data entry integrated with Target e*CTR® (eClinical trial record), we would like to share the results of a recent end-of phase 2 meeting where the topic of risk-based monitoring plan, coordinated with direct data entry, was discussed. As part of our Briefing Document, it was requested that the FDA review division invite a representative from the Office of Scientific Investigations (OSI), which they did.


Under the Regulatory section of the Briefing Document, we wrote: “As was done in the Phase 2 study, the pivotal trial will utilize Target e*CTR (eClinical Trial Record) for direct data entry and the generation of the original data at the time of the patient visit. Target e*CTR allows for the clinical sites to enter clinical trial data at the time of the patient encounter, which are then transmitted directly into a secure trusted 3rd party environment prior to the data reaching the EDC database. In this way, original data entered at the time of the patient visit can be maintained in electronic format in lieu of paper records. The system is validated, 21 CFR Part 11 compliant, and fully integrated with Target e*CRF (EDC). The clinical development program will also utilize Target Document for the eTMF (trial master file) for document management and control for both the sponsor and the clinical sites. The system allows for electronic signatures and document control. Target Document is being used in the phase 2 study in lieu of paper records. The system is validated and 21 CFR Part 11 compliant. FDA can be given access to these software products and the EDC application at any point during the study as well as during onsite and offsite inspections. Does FDA agree that these systems are acceptable for data capture in the pivotal trial?”


At the meeting, we stated verbally that: “Our goal is to conduct the study, in part, by being compliant with the 2010 Draft eSource and 2011 Draft Risk-Base Monitoring Guidances. Similar to what we did in the initial Phase 2 study, we plan to use validated software products that allow for 1) direct data entry of clinical trial data into our EDC system, with the creation of an original record prior to the data being entered into the EDC database; 2) the use of an online eTMF; 3) the use of online monitoring reports; and 4) the performance of risk-based monitoring. We have included our overall plans in the Quality Section of the protocol as recommended by the guidances and look forward to feedback from the Agency.”


The FDA review division agreed that any and all questions related to the Quality Section of the protocol should be sent to the review division under the IND and they would forward the request to the OSI for their feedback. We were told to make it very clear in our IND submission what specific questions and specific documents were to be forward to OSI.


For more information about Target Health contact Warren Pearlson (212-681-2100 ext. 104). For additional information about software tools for paperless clinical trials, please also feel free to contact Dr. Jules T. Mitchel or Ms. Joyce Hays. The Target Health software tools are designed to partner with both CROs and Sponsors. Please visit the Target Health Website

BioEngineering: Cat Brain Provides a Step Toward the Electronic Equivalent


A cat can recognize a face faster and more efficiently than a supercomputer. That’s one reason a feline brain is the model for a biologically-inspired computer project involving the University of Michigan. (Credit: iStockphoto/Jonny Kristoffersson)



A cat can recognize a face faster and more efficiently than a supercomputer. That’s one reason a 1) ___ brain is the model for a biologically-inspired computer project involving the University of Michigan (U-M). U-M computer engineer Wei Lu has taken a step toward developing this revolutionary type of machine that could be capable of learning and recognizing, as well as making more complex decisions and performing more tasks simultaneously than conventional 2) ___ can. Lu previously built a “memristor,” a device that replaces a traditional transistor and acts like a biological synapse, remembering past voltages it was subjected to. Now, he has demonstrated that this memristor can connect conventional circuits and support a process that is the basis for memory and learning in 3) ___ systems. A paper on the research is published online in Nano Letters.


“We are building a computer in the same way that nature builds a brain,” said Lu, an assistant professor in the U-M Department of Electrical Engineering and Computer Science. “The idea is to use a completely different paradigm compared to conventional computers. The cat brain sets a realistic goal because it is much simpler than a 4) ___ brain but still extremely difficult to replicate in complexity and efficiency.”


Today’s most sophisticated supercomputers can accomplish certain tasks with the brain functionality of a cat, but it’s a massive machine with more than 140,000 central processing units and a dedicated power supply. And it still performs 83 times slower than a 5) ___ brain, Lu wrote in his paper. In a mammal’s brain, neurons are connected to each other by synapses, which act as reconfigurable switches that can form pathways linking thousands of neurons. Most importantly, 6) ___ remember these pathways based on the strength and timing of electrical signals generated by the neurons. In a conventional computer, logic and memory functions are located at different parts of the circuit and each computing unit is only connected to a handful of neighbors in the circuit. As a result, conventional computers execute code in a 7) ___ fashion, line by line, Lu said. They are excellent at performing relatively simple tasks with limited variables.


But a brain can perform many operations simultaneously, or in parallel. That’s how we can recognize a face in an instant, but even a supercomputer would take much, much 8) ___ and consume much more energy in doing so. So far, Lu has connected two electronic 9) ___ with one memristor. He has demonstrated that this system is capable of a memory and learning process called “spike timing dependent plasticity.” This type of plasticity refers to the ability of connections between neurons to become stronger based on when they are stimulated in relation to each other. Spike timing dependent plasticity is thought to be the basis for memory and learning in mammalian brains. “We show that we can use voltage timing to gradually increase or decrease the electrical conductance in this memristor-based system. In our brains, similar changes in synapse 10) ___ essentially give rise to long term memory,“ Lu said. The next step is to build a larger system, Lu said. His goal is to achieve the sophistication of a 11) ___ in a machine the size of a two-liter beverage container. That could be several years away.


Lu said an electronic analog of a cat brain would be able to think intelligently at the cat level. For example, if the task were to find the shortest route from the front door to the sofa in a house full of furniture, and the computer knows only the shape of the sofa, a conventional machine could accomplish this. But if you moved the sofa, it wouldn’t realize the adjustment and find a new path. That’s what engineers hope the cat brain computer would be capable of. The project’s major funder, DARPA or, 12) ___ ___ ___ ___ ___, and the National Science Foundation, isn’t interested in sofas. But this illustrates the type of learning the machine is being designed for.


ANSWERS: 1) feline; 2) computers; 3) biological; 4) human; 5) cat’s; 6) synapses; 7) linear; 8) longer; 9) circuits; 10) conductance; 11) supercomputer; 12) Defense Advanced Research Projects Agency

Hospital Tests Reveal the Secrets of an Egyptian Mummy


Images from the recent CT scans of the mummy show that the child still had some of its baby teeth, with adult teeth coming in. (Credit: Photo by David Hunt, Smithsonian Institution)



Images from the recent CT scans of the mummy show that the child still had some of its baby teeth, with adult teeth coming in. (Credit: Photo by David Hunt, Smithsonian Institution)


An ancient Egyptian mummy has had quite an afterlife, traveling more than 6,000 miles, spending six decades in private hands, and finally, in 1989, finding a home at the World Heritage Museum (now the Spurlock Museum) at the University of Illinois. The mummy’s travels did not end there, however. It has made two trips to a local hospital – once in 1990 and again this year, 2011 – for some not-so-routine medical exams.


Egyptologists, a radiologist, a pathologist, a physical anthropologist and a mummy expert are using the best diagnostic tools available to learn about the mummy without unwrapping its red linen shroud or cutting into it. The team will discuss its findings during a symposium Nov. 2 at the museum in Urbana, Ill. The first round of tests in 1990 included X-rays and CT scans, as well as an analysis of tiny fragments of cloth, insects and hardened resins collected from the fraying base of the mummy. Dr. Joseph Barkmeier, medical director of diagnostic services and regional outreach at Carle Foundation Hospital and Physician Group in Urbana, conducted the CT scans at the hospital. He repeated the scans this year at Carle with much-improved CT technology. “Medical diagnostic technology has experienced tremendous advancements in the past two decades,“ Barkmeier said. “Image resolution is nearly 10 times greater than it was when we first imaged the mummy in 1990, and we can reconstruct images faster and view them from multiple vantage points.“


The scans and an analysis of the materials used in embalming (including carbon-14 dating of a wooden plank that supports the body) found that the mummy was a child of a wealthy family from the Roman period of ancient Egypt. Examining a digitized mummy constructed from cross-sectional CT scans is similar to actually dissecting it – with some notable limitations, said Sarah Wisseman, project coordinator of the mummy studies and director of the Program on Ancient Technologies and Archaeological Materials (ATAM) at the Illinois State Archaeological Survey. Wisseman is the author of “The Virtual Mummy,“ a book about the research.


The scans reveal the bone structure and also show that the embalmers left the brain, the heart and lungs in the body, she said. The images also offer insight into the materials used to stabilize, wrap and “fill out“ the body. But they do not provide fine details of the soft tissues that remain, she said. David Hunt, of the Smithsonian Institution’s National Museum of Natural History, observed that the child still had some of its baby teeth, with adult teeth coming in. This and evidence that the long bones were still growing at the time of death indicate that the child was 7 to 9 years old, Wisseman said.


Several signs — including a cracked skull with no evidence of bleeding and the detection of carrion beetles in the body — suggest that the embalmers “did a crummy job or this body was lying around for a while before it was treated,“ Wisseman said. If the child died during an epidemic there could have been a lot of corpses to deal with, she said, causing delays or forcing the embalmers to rush. “All of the evidence, however, suggests that this is a child from a wealthy family,“ she said. “They’re using expensive red pigment from Spain. They’re using gold gilt decoration. This is a fairly high-class kid.“


Despite the high-tech probing, the mummy has maintained some of its secrets. Its hands are positioned in front of its collapsed pelvis, hiding any evidence of its sex. And DNA tests of a sample collected from the damaged region near its base have yielded no definitive results so far. There are some “tantalizing“ clues to the child’s gender in the face portrait attached to the mummy, Wisseman said, but such images can be misleading. “There’s a suggestion around the portrait of a tunic with a stripe on it. This alone would suggest that the child inside is a boy,” she said. “But there are other mummies that have one person depicted on the outside and then you discover it’s a different gender or even an animal instead of a human, so you can’t tell a book by its cover.“ The CT scans also revealed something that might be a lock of hair on one side of the child’s head, Wisseman said.


“In the Roman period in Egypt, around A.D. 100, we do have examples of Roman face portraits with a shaved head and then a lock of hair on one side,“ she said. Boys had the lock on one side, girls on the other. But the evidence is not conclusive. “We may not ever know whether the child was male or female,“ she said. “And we still don’t know the cause of death.“ The symposium, called “The Return of the Mummy: New Imaging Results on the Spurlock Museum’s Egyptian Mummy,” is at the Knight Auditorium, Spurlock Museum, 600 S. Gregory St., Urbana.


Story Source: The above story is reprinted from materials provided by University of Illinois at Urbana-Champaign.

Wood Stove Intervention Can Reduce Childhood Pneumonia



Pneumonia kills almost 1.6 million children each year. Though childhood deaths from pneumonia are relatively uncommon in the United States, it kills more children worldwide than any other disease. Open fires used for heating and cooking are thought to be a major cause of pneumonia.


According to a study published in The Lancet (2011;378: 1717-1726), cooking stoves with chimneys can lower exposure to indoor wood smoke and reduce the rate of severe pneumonia by 30% in children less than 18 months of age. The study showed that rates of severe childhood pneumonia were significantly reduced in households provided with a wood stove connected to a chimney, compared with homes where open, indoor wood cooking fires were used. The lead researchers at the University of California, Berkeley, report that carbon monoxide exposure levels were reduced 50% on average in the homes equipped with chimneys.


The NIH Randomized Exposure Study of Pollution Indoors and Respiratory Effects (RESPIRE) trial included a total of 534 households in rural Guatemala with a pregnant woman or young infant. The study participants were randomly assigned to receive a locally developed cookstove with a chimney or to continue cooking using traditional open wood fires. In all, 265 children were from the chimney-stove homes and 253 children were in the control homes. Trained field workers visited the homes every week for two years to record the children’s health status. Sick children with cough and fast breathing were referred to physicians.


Although the study did not significantly reduce the total number of diagnosed childhood pneumonia cases, the reduction in severe pneumonia would likely result in reduced childhood mortality, according to the authors.

Intensive Therapy Halves Kidney Disease in Type 1 Diabetes



Nearly 26 million Americans have diabetes. In adults, type 1 diabetes accounts for 5 to 10% of all diagnosed cases of the disease. Formerly called juvenile-onset or insulin-dependent diabetes, type 1 diabetes develops when the body’s immune system destroys pancreatic beta cells, the only cells in the body that make the hormone insulin that regulates blood glucose. Type 1 diabetes usually arises in children and young adults but can occur at any age. Management involves keeping blood glucose levels as close to normal as possible with three or more insulin injections a day or treatment with an insulin pump, careful monitoring of glucose, and close attention to diet and exercise.


Type 2 diabetes, or adult-onset diabetes, accounts for about 90 to 95% of all diabetes diagnosed in adults. It usually begins as insulin resistance, a disorder in which the cells do not use insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce it. Type 2 diabetes is associated with older age, obesity, family history of diabetes, history of gestational diabetes, impaired glucose metabolism, physical inactivity, and race/ethnicity. African-Americans, Hispanic/Latino-Americans, American Indians, and some Asian-Americans and Native Hawaiians or other Pacific Islanders are at particularly high risk for type 2 diabetes and its complications.


Chronic kidney disease can lead to kidney failure, also called end-stage renal disease, requiring dialysis or a kidney transplant for survival. Chronic kidney disease affects more than 10% of Americans over age 20 and 35% of those over age 20 with diabetes. People with diabetes and chronic kidney disease account for 26.1%, or $18 billion, of Medicare costs for diabetes. Diabetes is the leading cause of kidney failure, accounting for nearly 38% (215,000) of Americans on dialysis or living with a kidney transplant. Each year 110,000 patients in the United States start treatment for kidney failure. These lifesaving treatments cost $42.5 billion annually.


According to an article published online in the New England Journal of Medicine (12 November 2011), controlling blood glucose early in the course of type 1 diabetes yields huge dividends, preserving kidney function for decades. Compared to conventional therapy, near-normal control of blood glucose beginning soon after diagnosis of type 1 diabetes and continuing an average six and a half years reduced by half the long-term risk of developing kidney disease, according to the Diabetes Control and Complications Trial (DCCT) and Epidemiology of Diabetes Interventions and Complications (EDIC) Research Group. The risk of kidney failure was also halved, but the difference was not statistically significant, perhaps due to the relatively small total number of patients who reached that stage of the disease.


The DCCT, conducted from 1983 to 1993 in 1,441 people with type 1 diabetes, found that intensive glucose control was superior to conventional control in delaying or preventing complications overall. EDIC continues to follow 1,375 DCCT participants to determine the long-term effects of the therapies beyond the initial treatment period.


The DCCT compared intensive to conventional control of blood glucose in people with type 1 diabetes. At the time, conventional treatment was one or two insulin injections a day with daily urine or blood glucose testing. Participants randomly assigned to intensive treatment were asked to keep glucose levels as near normal as possible. That meant trying to keep hemoglobin A1c (A1C) readings at 6% or less with at least three insulin injections a day or an insulin pump, guided by frequent self-monitoring of blood glucose. (A1C reflects average blood glucose over the previous two to three months.)


Participants entered the DCCT on average six years after onset of diabetes when complications of diabetes were absent or very mild. Half aimed for near-normal glucose control (intensive therapy) and the others received what was then standard glucose control. After an average 22-year follow-up, 24 in the intensive group developed significantly reduced kidney function and 8 progressed to kidney failure requiring dialysis or transplantation. On conventional therapy, 46 developed kidney disease, with kidney failure in 16.

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