Marzipan Matzo Minis
Unheard of, right?, that such an unbelievably delicious dessert is so-o-easy to make. That’s one of my goals in sharing recipes with friends, colleagues, clients around the world. Easy, yummy and mostly healthy. These marzipan matzo minis don’t even have to be baked. ©Joyce Hays, Target Health Inc.
Chocolate Matzo-Marzipan Heaven! ©Joyce Hays, Target Health Inc.
Sharing a fresh batch with Jules, a few days ago. We always taste test everything, several times, before sharing it in our newsletter. ©Joyce Hays, Target Health Inc.
One of the most delectable desserts I have ever made! ©Joyce Hays, Target Health Inc.
Easily Obtainable Ingredients. ©Joyce Hays, Target Health Inc.
One of the ingredients for the Marzipan Matzo Minis is leftover Jerusalem Cake (or any simple pound cake). Here is the leftover Jerusalem cake we made a few days earlier. ©Joyce Hays, Target Health Inc.
1 cup of left-over Jerusalem cake crumbs or PLAIN pound cake or biscotti, or left over coffee cake
1 cup of matzo crumbled up by hand
3.5 Tablespoons of soft non-dairy margarine
2 heaping Tablespoons of cacao powder (highest percent pure cacao)
5 Tablespoons rum or your favorite liqueur, like amaretto
2 cans Marzipan (11 ounces), (make it yourself, or buy it from Whole Foods or from Nuts.com)
Blue food coloring
White (you get white when you add zero food coloring)
1 whole bar of semi-sweet chocolate
In a medium mixing bowl, start by mixing margarine, cake crumbs, matzo crumbs and rum together.
Mix the cacao powder into the bowl.
Next, mix all the ingredients in the bowl, until they’re combined well.
The filling will look like this. The matzo crumbs stand out, at first as the biggest, but by the time you eat this delicious dessert, everything will be well mixed together. ©Joyce Hays, Target Health Inc.
Roll the filling out, with a rolling pin, on a sheet of wax paper, (and put a 2nd piece of paper or saran wrap over the filling, before you roll it out) like one big chocolate pancake. Make this a thin pancake. Put another sheet of wax paper on top of the filling dough and put into the freezer for 1 hour.
While the filling dough is in the freezer, prepare the marzipan.
Divide the marzipan (2 cans, 11 oz. each), into 2 separate bowls. Into one bowl add 3 drops of the blue food coloring. Leave the second bowl, plain, as is, so you get a white color.
Use your hands, and work the blue coloring into the marzipan dough, so it becomes a beautiful soft color. Wash your hands after you finish squeezing the blue food coloring into ? of the marzipan.
Work the food coloring into the marzipan, as if you were playing with a stress ball. The white marzipan is the way it comes out of the can. If you wanted all the marzipan matzo to be blue, then add 3 or more drops of blue food coloring to the second portion, which I left to be white. ©Joyce Hays, Target Health Inc.
After the filling has been in the fridge for at least 1 hour, or more, take it out.
Prepare the white and blue marzipan.
Roll out the blue marzipan, so it’s thin, but not so-o thin that it breaks apart and cannot hold the filling. Roll the marzipan between two pieces of saran wrap or waxed paper, so you don’t get annoying little pieces, sticking to the rolling pin.
The blue marzipan is being rolled out between two sheets of waxed paper or saran wrap. ©Joyce Hays, Target Health Inc.
White marzipan, between two pieces of saran wrap, is being rolled out. ©Joyce Hays, Target Health Inc.
When you take the chocolate/rum filling out of the fridge, divide it into two parts. After you roll out the two different parts of the marzipan, remove the top layer of saran wrap from the marzipan.
Put one half of the filling on the rolled out blue marzipan and the other half of filling on the rolled out white marzipan and slowly, roll the marzipan around the chocolate filling, until you have a completed tube of marzipan rolled around the chocolate.
Starting to roll the marzipan around the filling. ©Joyce Hays, Target Health Inc.
Marzipan tube is done; now ready to trim the ends off. Of course, you will eat the trimmed ends or arrange them attractively on a plate for others to pick at. ©Joyce Hays, Target Health Inc.
If you get a little break in the marzipan (see above) as you roll it around the filling, just pinch it together or take a tiny piece of marzipan from the end, and patch it over the break, pinching and molding it together, like clay or playdough. This is a very forgiving recipe; there’s nothing here that can’t be fixed, as you go along. You could also, try first, not to roll the marzipan out, too thin. ©Joyce Hays, Target Health Inc.
After you trim unruly ends off of the marzipan tube, you will divide the tube into 4 to 6 separate mini cakes. ©Joyce Hays, Target Health Inc.
After you make a tube of blue marzipan and a tube of white, cut each tube into mini cakes about an inch and 1/2 long.
Put these minis in the freezer again, for 1 hour.
While the rolls are in the freezer, in a small double boiler, or tiny pan, melt the chocolate carefully. Melt the chocolate over a very low flame. If you have a simmer setting on your stove, put the chocolate on simmer.
Melting the semi-sweet baking chocolate. Mmmmm, smells so-o good. ©Joyce Hays, Target Health Inc.
After an hour, take out the rolls, from the freezer, and dip each of the ends of the 1.5 inch rolls, into the melted chocolate. Put on foil or paper towel to cool down and harden.
Into the melted chocolate, dip one end of the mini cake, then the other end. Do this step very slowly, or else you could get chocolate dripping all over the place. Even after experimenting with this recipe at least 10 times this year, there’s a chocolate finger print (above) that couldn’t be helped. It won’t show up as much on the blue minis, but just be aware of this. ©Joyce Hays, Target Health Inc.
Dipping the other end into the melted chocolate. ©Joyce Hays, Target Health Inc.
Dipping a blue marzipan-matzo in the melted chocolate. ©Joyce Hays, Target Health Inc.
Dipping the other side of the blue marzipan-matzo. ©Joyce Hays, Target Health Inc.
Cooling down and hardening, on a piece of foil. ©Joyce Hays, Target Health Inc.
Note: Make the Jerusalem cake way before the marzipan-matzos. On its own, it’s a delicious dessert (serve it soaked in rum, with apricot jam on top, then add cool whip) and warmed up in the morning, it’s wonderful with a nice hot cup of freshly ground coffee. Later, use it crumbled, as one of the ingredients in the filling of the marzipan-matzos. ©Joyce Hays, Target Health Inc.
Let the marzipan matzos cool on a counter, so the chocolate hardens.
When the chocolate has hardened, put on a plate, dessert serving platter or small tray.
Serve and enjoy!
One of our favorite whites is Stag’s Leap Wine Cellars, (Napa Valley) Sauvignon Blanc, Aveta, served chilled. ©Joyce Hays, Target Health Inc.
Spring in Manhattan is beauty stretched out in ribbons of color. It’s been nice and cool here, so all the blossoms are lasting for weeks and weeks. Hope your weekend was relaxing and re-energizing, so the week ahead goes smoothly.
From Our Table to Yours !
FDA Approves New Drug For Chronic Lymphocytic Leukemia In Patients With A Specific Chromosomal Abnormality
Congratulations to our colleagues at Abbott Molecular Diagnostics and AbbVie on this approval.
According to the National Cancer Institute, chronic lymphocytic leukemia (CLL) is one of the most common types of leukemia in adults, with approximately 15,000 new cases diagnosed each year. CLL is characterized by the progressive accumulation of abnormal lymphocytes. Patients with CLL who have a 17p deletion lack a portion of the chromosome that acts to suppress cancer growth. This chromosomal abnormality occurs in approximately 10% of patients with untreated CLL and in approximately 20% of patients with relapsed CLL.
The FDA approved Venclexta (venetoclax) for the treatment of patients with CLL who have the chromosomal abnormality 17p deletion and who have been treated with at least one prior therapy. Venclexta is the first FDA-approved treatment that targets the B-cell lymphoma 2 (BCL-2) protein
The efficacy of Venclexta was tested in a single-arm clinical trial of 106 patients with CLL who have a 17p deletion and who had received at least one prior therapy. Trial participants took Venclexta orally every day, beginning with 20 mg and increasing over a five-week period to 400 mg. Results showed that 80% of trial participants experienced a complete or partial remission of their cancer.
Venclexta is indicated for daily use after detection of 17p deletion is confirmed through the use of the FDA-approved companion diagnostic Vysis CLL FISH probe kit.
The most common side effects of Venclexta include low white blood cell count (neutropenia), diarrhea, nausea, anemia, upper respiratory tract infection, low platelet count (thrombocytopenia) and fatigue. Serious complications can include pneumonia, neutropenia with fever, fever, autoimmune hemolytic anemia, anemia and metabolic abnormalities known as tumor lysis syndrome. Live attenuated vaccines should not be given to patients taking Venclexta.
The FDA granted the Venclexta application breakthrough therapy designation, priority review status, and accelerated approval for this indication. These are distinct programs intended to facilitate and expedite the development and review of certain new drugs in light of their potential to benefit patients with serious or life-threatening conditions. Venclexta also received orphan drug designation, which provides incentives such as tax credits, user fee waivers and eligibility for exclusivity to assist and encourage the development of drugs for rare diseases.
Venclexta is manufactured by AbbVie Inc. of North Chicago, Illinois, and marketed by AbbVie and Genentech USA Inc. of South San Francisco, California. The Vysis CLL FISH probe kit is manufactured by Abbott Molecular of Des Plaines, Illinois.
Clothes that receive and transmit digital information are closer to reality
April 13, 2016
Ohio State University
Researchers who are working to develop wearable electronics have reached a milestone: They are able to embroider circuits into fabric with 0.1 mm precision — the perfect size to integrate electronic components such as sensors and computer memory devices into clothing.
Researchers who are working to develop wearable electronics have reached a milestone: They are able to embroider circuits into fabric with 0.1 mm precision — the perfect size to integrate electronic components such as sensors and computer memory devices into clothing.
With this advance, the Ohio State University researchers have taken the next step toward the design of functional textiles — clothes that gather, store, or transmit digital information. With further development, the technology could lead to shirts that act as antennas for your smart phone or tablet, workout clothes that monitor your fitness level, sports equipment that monitors athletes’ performance, a bandage that tells your doctor how well the tissue beneath it is healing — or even a flexible fabric cap that senses activity in the brain.
That last item is one that John Volakis, director of the ElectroScience Laboratory at Ohio State, and research scientist Asimina Kiourti are investigating. The idea is to make brain implants, which are under development to treat conditions from epilepsy to addiction, more comfortable by eliminating the need for external wiring on the patient’s body.
“A revolution is happening in the textile industry,” said Volakis, who is also the Roy & Lois Chope Chair Professor of Electrical Engineering at Ohio State. “We believe that functional textiles are an enabling technology for communications and sensing — and one day even medical applications like imaging and health monitoring.”
Recently, he and Kiourti refined their patented fabrication method to create prototype wearables at a fraction of the cost and in half the time as they could only two years ago. With new patents pending, they published the new results in the journal IEEE Antennas and Wireless Propagation Letters.
In Volakis’ lab, the functional textiles, also called “e-textiles,” are created in part on a typical tabletop sewing machine–the kind that fabric artisans and hobbyists might have at home. Like other modern sewing machines, it embroiders thread into fabric automatically based on a pattern loaded via a computer file. The researchers substitute the thread with fine silver metal wires that, once embroidered, feel the same as traditional thread to the touch.
“We started with a technology that is very well known–machine embroidery–and we asked, how can we functionalize embroidered shapes? How do we make them transmit signals at useful frequencies, like for cell phones or health sensors?” Volakis said. “Now, for the first time, we’ve achieved the accuracy of printed metal circuit boards, so our new goal is to take advantage of the precision to incorporate receivers and other electronic components.”
The shape of the embroidery determines the frequency of operation of the antenna or circuit, explained Kiourti.
The shape of one broadband antenna, for instance, consists of more than half a dozen interlocking geometric shapes, each a little bigger than a fingernail, that form an intricate circle a few inches across. Each piece of the circle transmits energy at a different frequency, so that they cover a broad spectrum of energies when working together–hence the “broadband” capability of the antenna for cell phone and internet access.
“Shape determines function,” she said. “And you never really know what shape you will need from one application to the next. So we wanted to have a technology that could embroider any shape for any application.”
The researchers’ initial goal, Kiourti added, was just to increase the precision of the embroidery as much as possible, which necessitated working with fine silver wire. But that created a problem, in that fine wires couldn’t provide as much surface conductivity as thick wires. So they had to find a way to work the fine thread into embroidery densities and shapes that would boost the surface conductivity and, thus, the antenna/sensor performance.
Previously, the researchers had used silver-coated polymer thread with a 0.5-mm diameter, each thread made up of 600 even finer filaments twisted together. The new threads have a 0.1-mm diameter, made with only seven filaments. Each filament is copper at the center, enameled with pure silver.
They purchase the wire by the spool at a cost of 3 cents per foot; Kiourti estimated that embroidering a single broadband antenna like the one mentioned above consumes about 10 feet of thread, for a material cost of around 30 cents per antenna. That’s 24 times less expensive than when Volakis and Kiourti created similar antennas in 2014.
In part, the cost savings comes from using less thread per embroidery. The researchers previously had to stack the thicker thread in two layers, one on top of the other, to make the antenna carry a strong enough electrical signal. But by refining the technique that she and Volakis developed, Kiourti was able to create the new, high-precision antennas in only one embroidered layer of the finer thread. So now the process takes half the time: only about 15 minutes for the broadband antenna mentioned above.
She’s also incorporated some techniques common to microelectronics manufacturing to add parts to embroidered antennas and circuits.
One prototype antenna looks like a spiral and can be embroidered into clothing to improve cell phone signal reception. Another prototype, a stretchable antenna with an integrated RFID (radio-frequency identification) chip embedded in rubber, takes the applications for the technology beyond clothing. (The latter object was part of a study done for a tire manufacturer.)
Yet another circuit resembles the Ohio State Block “O” logo, with non-conductive scarlet and gray thread embroidered among the silver wires “to demonstrate that e-textiles can be both decorative and functional,” Kiourti said.
They may be decorative, but the embroidered antennas and circuits actually work. Tests showed that an embroidered spiral antenna measuring approximately six inches across transmitted signals at frequencies of 1 to 5 GHz with near-perfect efficiency. The performance suggests that the spiral would be well-suited to broadband internet and cellular communication.
In other words, the shirt on your back could help boost the reception of the smart phone or tablet that you’re holding — or send signals to your devices with health or athletic performance data.
The work fits well with Ohio State’s role as a founding partner of the Advanced Functional Fabrics of America Institute, a national manufacturing resource center for industry and government. The new institute, which joins some 50 universities and industrial partners, was announced earlier this month by U.S. Secretary of Defense Ashton Carter.
Syscom Advanced Materials in Columbus provided the threads used in Volakis and Kiourti’s initial work. The finer threads used in this study were purchased from Swiss manufacturer Elektrisola. The research is funded by the National Science Foundation, and Ohio State will license the technology for further development.
Until then, Volakis is making out a shopping list for the next phase of the project.
“We want a bigger sewing machine,” he said.
- Asimina Kiourti, Cedric Lee, John L. Volakis. Fabrication of Textile Antennas and Circuits With 0.1 mm Precision. IEEE Antennas and Wireless Propagation Letters, 2016; 15: 151 DOI:10.1109/LAWP.2015.2435257
Source: Ohio State University. “Computers in your clothes? A milestone for wearable electronics: Clothes that receive and transmit digital information are closer to reality.” ScienceDaily. ScienceDaily, 13 April 2016. <www.sciencedaily.com/releases/2016/04/160413135913.htm>.
April 13, 2016
DOE/Brookhaven National Laboratory
Scientists have produced the first direct evidence of a state of electronic matter first predicted by theorists in 1964 — a ‘Cooper pair density wave.’ The discovery may provide key insights into the workings of high-temperature superconductors.
Scientists at the U.S. Department of Energy’s Brookhaven National Laboratory, Cornell University, and collaborators have produced the first direct evidence of a state of electronic matter first predicted by theorists in 1964. The discovery, described in a paper published online April 13, 2016, inNature, may provide key insights into the workings of high-temperature superconductors.
The prediction was that “Cooper pairs” of electrons in a superconductor could exist in two possible states. They could form a “superfluid” where all the particles are in the same quantum state and all move as a single entity, carrying current with zero resistance — what we usually call a superconductor. Or the Cooper pairs could periodically vary in density across space, a so-called “Cooper pair density wave.” For decades, this novel state has been elusive, possibly because no instrument capable of observing it existed.
Now a research team led by J.C. Séamus Davis, a physicist at Brookhaven Lab and the James Gilbert White Distinguished Professor in the Physical Sciences at Cornell, and Andrew P. Mackenzie, Director of the Max-Planck Institute CPMS in Dresden, Germany, has developed a new way to use a scanning tunneling microscope (STM) to image Cooper pairs directly.
The studies were carried out by research associate Mohammed Hamidian (now at Harvard) and graduate student Stephen Edkins (St. Andrews University in Scotland), working as members of Davis’ research group at Cornell and with Kazuhiro Fujita, a physicist in Brookhaven Lab’s Condensed Matter Physics and Materials Science Department.
Superconductivity was first discovered in metals cooled almost to absolute zero (-273.15 degrees Celsius or -459.67 Fahrenheit). Recently developed materials called cuprates — copper oxides laced with other atoms — superconduct at temperatures as “high” as 148 degrees above absolute zero (-125 Celsius). In superconductors, electrons join in pairs that are magnetically neutral so they do not interact with atoms and can move without resistance.
Hamidian and Edkins studied a cuprate incorporating bismuth, strontium, and calcium (Bi2Sr2CaCu2O8) using an incredibly sensitive STM that scans a surface with sub-nanometer resolution, on a sample that is refrigerated to within a few thousandths of a degree above absolute zero.
At these temperatures, Cooper pairs can hop across short distances from one superconductor to another, a phenomenon known as Josephson tunneling. To observe Cooper pairs, the researchers briefly lowered the tip of the probe to touch the surface and pick up a flake of the cuprate material. Cooper pairs could then tunnel between the superconductor surface and the superconducting tip. The instrument became, Davis said, “the world’s first scanning Josephson tunneling microscope.”
Flow of current made of Cooper pairs between the sample and the tip reveals the density of Cooper pairs at any point, and it showed periodic variations across the sample, with a wavelength of four crystal unit cells. The team had found a Cooper pair density wave state in a high-temperature superconductor, confirming the 50-year-old prediction.
A collateral finding was that Cooper pairs were not seen in the vicinity of a few zinc atoms that had been introduced as impurities, making the overall map of Cooper pairs into “Swiss cheese.”
The researchers noted that their technique could be used to search for Cooper-pair density waves in other cuprates as well as more recently discovered iron-based superconductors.
Source: DOE/Brookhaven National Laboratory. “Elusive state of superconducting matter discovered after 50 years.” ScienceDaily. ScienceDaily, 13 April 2016. <www.sciencedaily.com/releases/2016/04/160413135713.htm>.
April 12, 2016
Carnegie Mellon University
The human brain was initially used for basic survival tasks, such as staying safe and hunting and gathering. Yet, 200,000 years later, the same human brain is able to learn abstract concepts, like momentum, energy and gravity, which have only been formally defined in the last few centuries. New research has now uncovered how the brain is able to acquire brand new types of ideas.
The human brain was initially used for basic survival tasks, such as staying safe and hunting and gathering. Yet, 200,000 years later, the same human brain is able to learn abstract concepts, like momentum, energy and gravity, which have only been formally defined in the last few centuries.
New research from Carnegie Mellon University has now uncovered how the brain is able to acquire brand new types of ideas. Published in Psychological Science, scientists Robert Mason and Marcel Just used neural-decoding techniques developed at CMU to identify specific physics concepts that advanced students recalled when prompted. The brain activation patterns while thinking about the physics concepts indicated that all of the students’ brains used the ancient brain systems the same way, and the patterns revealed how the new knowledge was formed — by repurposing existing neural systems.
The findings could be used to improve science instruction.
“If science teachers know how the brain is going to encode a new science concept, then they can define and elaborate that concept in ways that match the encoding. They can teach to the brain by using the brain’s language,” said Mason, a senior research associate in the Dietrich College of Humanities and Social Sciences’ Department of Psychology.
Mason and Just, the D. O. Hebb University Professor of Psychology, recruited nine advanced physics and engineering students to participate in the study. Each student’s brain was scanned at CMU’s Scientific Imaging and Brain Research (SIBR) Center while they were shown a set of 30 familiar concepts, such as gravity, entropy, inertia, refraction and velocity.
Using a machine learning program, Mason and Just were able to identify which of the 30 concepts a student was thinking about because the thought of each concept created its own brain activation pattern. They also could break down the patterns into the different neural pieces used to build the full concepts.
The research showed for the first time how learning physics concepts is accomplished by repurposing neural structures that were originally used for general everyday purposes. More specifically, the brain is able to learn physics concepts because of its ability to understand the four fundamental concepts of causal motion, periodicity, energy flow and algebraic (sentence-like) representations.
Brain systems that process rhythmic periodicity when hearing a horse gallop also support the understanding of wave concepts in physics. Similarly, understanding gravity involves visualizing causal motion, like an apple falling from a tree; energy flow uses the same system as sensing warmth from a fire or the sun; and understanding how one concept relates to others in an equation uses the same brain systems that are used to comprehend sentences describing quantities.
“This is why humans have been able to move ahead and innovate — because we can use our brain for new purposes,” Just said. “Human brains haven’t changed much over a few thousand years, but new fields like aeronautics, genetics, medicine and computer science have been developed and continuously change. Our findings explain how the brain is able to learn and discover new types of concepts.”
These findings are examples of the many brain research breakthroughs at Carnegie Mellon. CMU has created some of the first cognitive tutors, helped to develop the Jeopardy-winning Watson, founded a groundbreaking doctoral program in neural computation, and is the birthplace of artificial intelligence and cognitive psychology. Building on its strengths in biology, computer science, psychology, statistics and engineering, CMU launched BrainHub, an initiative that focuses on how the structure and activity of the brain give rise to complex behaviors.
Read the full study: http://www.ccbi.cmu.edu/reprints/Mason_Psychological-Science-2016_CCBI-preprint.pdf
Source: Carnegie Mellon University. “Scientists discover how the brain repurposes itself to learn scientific concepts.” ScienceDaily. ScienceDaily, 12 April 2016. <www.sciencedaily.com/releases/2016/04/160412132608.htm>.
New study has significant implications for how we address rapid climate change
April 11, 2016
University of Warwick
New simulations of plant evolution over the last 3000 years have revealed an unexpected limit to how far useful crops can be pushed to adapt before they suffer population collapse. The result has significant implications for how growers, breeders and scientists help agriculture and horticulture respond to quickening climate change.
New simulations by researchers at the University of Warwick and UCL’s Institute of Archaeology of plant evolution over the last 3000 years have revealed an unexpected limit to how far useful crops can be pushed to adapt before they suffer population collapse. The result has significant implications for how growers, breeders and scientists help agriculture and horticulture respond to quickening climate change.
The new study has just been published in the journal Evolutionary Genomicsand is entitled “Evolutionary Genomics Surprisingly Low Limits of Selection in Plant Domestication” It runs counter to the most common current thinking that plants are able to cope with evolutionary pressures that strain thousands of points of change in a plant and its genetic make-up at a time. While there is a cost to the plant population in undergoing such a selection pressure that cost was seen as affordable.
The new research led by Professor Robin Allaby from the University of Warwick’s School of Life Sciences, simulated 3000 generations of crop plants with an annual cycle. The researchers found that in fact if pushed to change too much too soon these plants came up against a genetic cliff face. The plants moved from a high likelihood of survival as a species if faced with anything up to 50-100 change pressures at a time, to almost certain irreversible population collapse and extinction if pushed even slightly beyond 50-100 such changes.
This new study turns the spotlight back to the original thoughts of acclaimed evolutionary biologist JBS Haldane. He was the one of the first scientists to suggest that there may be a relatively low limit to the number of traits (or loci in plants governed by such mechanisms as genetic changes) that can be under selection pressures to change before that overall plant population suffers a population collapse sufficiently severe as to threaten the plant’s extinction.
Professor Robin Allaby believes these findings give crucial insights into both the past and the future of agriculture
“In terms of our past this is a challenge to the idea of a rapid transition model of agricultural origin in which domesticated forms of crops appeared over a very short time period in a “Neolithic Revolution. This was already beginning to be challenged by new discoveries the archaeological record leaning more to the protracted appearance of domesticated crops and gaps in the record that suggest period when agriculture collapsed. Under protraction, traits may have been selected more slowly in the face of gene flow between cultivated and wild populations, resulting in the appearance of relatively weak selection coeffcients.”
“These simulations show how and why the spread of agriculture was likely tempered by the ability of crops to adapt to new environments, leading to economic collapse when the pace was too fast. Now we face a similar situation as modern environments change with the climate.”
“In terms of our future the limits to sudden evolutionary change may restrict our ability to breed traits into crops to keep pace with rapid climate change. Faced with such challenges we may have to be more open to changing the range of things we choose to grow if our climate changes rather than pushing what we currently grow beyond its limits.”
- Robin G. Allaby , James l. Kitchen, and Dorian Q. fuller. Evolutionary Genomics Surprisingly Low Limits of Selection in Plant Domestication. Evolutionary Genomics, April 2016
World Trade Week NYC Small Business Global Award to Target Health Inc.
Target Health is very pleased to announce that it has been selected to receive the Small Business Global Award at the Annual International World Trade Week NYC Awards Breakfast being held on the 16th of May 2016. This is an award from the great city of NY so this recognition is quite an honor. The award will be listed after the breakfast. It should be noted that without all of the heroic efforts of the great and loyal staff at Target Health, this could never have happened.
World Trade Week NYC is an active network of more than 40 organizations in the New York metro region working together to underscore the importance of international trade, logistics and port operations on the region’s economy and to use their collective expertise to help the region’s businesses grow through international trade. Every year, the President of the United States declares the third full week of May as World Trade Week. Trade organizations, businesses and other stakeholders come together both nationally and locally to promote and facilitate international trade in the U.S. economy. The New York tri-state region’s trade and transportation community celebrates World Trade Week throughout the month of May, offering a full agenda of educational seminars, global business networking events and the International Trade Awards Breakfast that recognizes the exemplary achievements by practitioners in the field.
From our good friend and colleague James Farley, photographer extraordinaire from the great state of North Carolina.
This moth landed on a tree at our home, Friday evening. I have not seen a Luna Moth in twenty years and this was my first opportunity to photograph one, so this was quite a treat! These photos have zero crop, with the exception of changing dimensions from 8×12 to 5×7. The colors are real. Shot on my Canon 5D Mark III with 100mm Macro f2.8 lens at f6.3.
Luna Moth ©JFarley Photography 2016
ON TARGET is the newsletter of Target Health Inc., a NYC – based, full – service, contract research organization (eCRO), providing strategic planning, regulatory affairs, clinical research, data management, biostatistics, medical writing and software services to the pharmaceutical and device industries, including the paperless clinical trial.
For more information about Target Health contact Warren Pearlson (212-681-2100 ext. 165). 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.
Joyce Hays, Founder and Editor in Chief of On Target
Jules Mitchel, Editor
A positive wrist sign in a patient with Marfan syndrome. In case of a positive wrist sign the thumb and little finger overlap, when grasping the wrist of the opposite hand. Photo credit: Staufenbiel I, Hauschild C, Kahl-Nieke B, Vahle-Hinz E, von Kodolitsch Y, Berner M, Bauss O, Geurtsen W, Rahman A – http://www.ncbi.nlm.nih.gov/pubmed/24165013, CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=42107027
Marfan syndrome (also called Marfan’s syndrome) is a genetic disorder of connective tissue. It has a variable clinical presentation, ranging from mild to severe systemic disease. The most serious manifestations involve defects of the 1) ___ valves and aorta, which may lead to early death if not properly managed. The syndrome also may affect the lungs, eyes, dural sac surrounding the spinal cord, the skeleton, and the hard palate. People with Marfan syndrome tend to be unusually tall, due to the disorder causing people with the condition to have long limbs and long, thin fingers and toes. Marfan syndrome is caused by the misfolding of fibrillin-1, a glycoprotein which forms elastic fibers in connective tissue and contributes to cell signaling activity by binding to and sequestering transforming growth factor beta (TGF-Beta). This results in an accumulation of excess TGF-Beta in the lungs, heart valves, and aorta. This in turn causes abnormal structure and function of vascular smooth muscle and reduced integrity of the extracellular matrix, which weakens the tissues and cause the features of Marfan 2) ___s.
Named after Antoine Marfan, the French pediatrician who first described the condition in 1896, the disease is an autosomal dominant disorder. Management often includes the use of angiotensin II receptor antagonists (ARBs) and beta blockers. Connective tissue provides strength and flexibility to structures such as bones, ligaments, muscles, blood vessels, and heart valves. The signs and symptoms of Marfan syndrome vary widely in severity, timing of onset, and rate of progression. The two primary features of Marfan syndrome are vision problems caused by a dislocated lens (ectopia lentis) in one or both 3) ___ and defects in the aorta that distributes blood from the heart to the rest of the body. The aorta can weaken and stretch, which may lead to a bulge in the blood vessel wall (an aneurysm). Stretching of the aorta may cause the aortic valve to leak, which can lead to a sudden tearing of the layers in the aorta wall (aortic dissection). Aortic aneurysm and dissection can be life threatening. Many people with Marfan syndrome have additional heart problems including a leak in the valve that connects two of the four chambers of the heart (mitral 4) ___ prolapse) or the valve that regulates blood flow from the heart into the aorta (aortic valve regurgitation). Leaks in these valves can cause shortness of breath, fatigue, and an irregular heartbeat felt as skipped or extra beats (palpitations).
Individuals with Marfan syndrome are usually tall and slender, have elongated fingers and toes (arachnodactyly), and have an arm span that exceeds their body height. Other common features include a long and narrow face, crowded teeth, an abnormal curvature of the spine (scoliosis or kyphosis), and either a sunken chest (pectus excavatum) or a protruding chest (pectus carinatum). Some individuals develop an abnormal accumulation of air in the chest cavity that can result in the collapse of a lung (spontaneous pneumothorax). A membrane called the dura, which surrounds the brain and spinal cord, can be abnormally enlarged (dural ectasia) in people with Marfan syndrome, causing pain in the back, abdomen, legs, or head. Most individuals with Marfan syndrome have some degree of nearsightedness (myopia). Clouding of the lens (cataract) may occur in mid-adulthood, and increased pressure within the eye (glaucoma) occurs more frequently in people with Marfan syndrome than in those without the condition. The features of Marfan syndrome can become apparent anytime between infancy and adulthood. Depending on the onset and severity of signs and symptoms, Marfan can be fatal early in life; however, the majority of affected individuals survive into mid- to late adulthood. Marfan sundrome is inherited in an autosomal dominant pattern, which means one copy of the altered 5) ___ in each cell is sufficient to cause the disorder. At least 25% of Marfan syndrome cases result from a new mutation in the FBN1 gene. These cases occur in people with no history of the disorder in their family.
Marfan Syndrome Foundation
About 1 in 5,000 people have Marfan syndrome, including men and women of all races and ethnic groups. About 3 out of 4 people with Marfan syndrome inherit it, meaning they get the genetic mutation from a parent who has it. But some people with Marfan syndrome are the first in their family to have it; when this happens it is called a spontaneous mutation. There is a 50% chance that a person with Marfan syndrome will pass along the genetic mutation each time they have a child. Knowing the signs of Marfan syndrome can save lives. People with Marfan syndrome are born with it, but features of the disorder are not always present right away. Some people have a lot of Marfan features at birth or as young children – including serious conditions like aortic enlargement. Others have fewer features when they are young and don’t develop aortic enlargement or other signs of Marfan syndrome until they are adults. Some features of Marfan syndrome, like those affecting the heart and blood vessels, bones or joints, can get worse over time. It’s very important for people with Marfan syndrome and related disorders to have ongoing monitoring, especially for life-threatening aspects of the condition like aortic enlargement. An accurate and early diagnosis helps to ensure proper treatment.
Marfan Syndrome Foundation
Every person’s experience with Marfan syndrome is slightly different. No one has every feature and people have different combinations of features. Marfan syndrome can affect many parts of the body, and each person is affected differently. This is called variable expression. Features can even vary among people in the same 6) ___ who have the condition. More than 30 different signs and symptoms are variably associated with Marfan syndrome. The most prominent of these affect the skeletal system and are found in numerous other diseases (see Differential diagnosis, below). Therefore, distinguishing Marfan syndrome from other marfanoid syndromes requires the assessment of non-skeletal clinical and laboratory findings?especially of the eyes, aorta, and heart. Complicating the physical assessment of such persons, considerable clinical variability occurs within families carrying an identical DNA variant. Most of the readily visible signs are associated with the 7) ___ system. Many individuals with Marfan syndrome grow to above-average height. Some have disproportionately long, slender limbs with thin, weak wrists and long fingers and toes. Besides affecting height and limb proportions, people with Marfan syndrome may have abnormal curvature of the spine, abnormal indentation or protrusion of the sternum, abnormal joint flexibility, a high-arched palate, malocclusions, flat feet, hammer toes, stooped shoulders, and unexplained stretch marks on the skin. It can also cause pain in the joints, bones and muscles. Some people with Marfan have speech disorders resulting from symptomatic high palates and small jaws. Early osteoarthritis may occur. The health of the eye can be affected in many ways but the principal change is partial lens dislocation (the lens is shifted out of its normal position). This occurs because of weakness in the connective tissue strands which suspend the lens within the eye. Nearsightedness and blurred vision are common, but farsightedness can also result. Other problems are a greater risk of retinal detachment, an earlier onset of cataract formation and a higher risk of chronic open angle glaucoma. The most serious signs and symptoms associated with Marfan syndrome involve the cardiovascular system: undue fatigue, shortness of breath, heart palpitations, racing heartbeats, or chest pain radiating to the back, shoulder, or arm. Cold arms, hands and feet can also be linked to Marfan syndrome because of inadequate 8) ___. Commonly associated with Marfan syndrome is mitral valve prolapse, aortic regurgitation). However, the major sign that would lead a doctor to consider an underlying condition, is a dilated aorta or an aortic aneurysm. Sometimes, no heart problems are apparent until the weakening of the connective tissue causes an aortic aneurysm or aortic dissection, a surgical emergency. An aortic dissection is most often fatal and presents with pain radiating down the back, giving a tearing sensation.
During pregnancy, even in the absence of preconception cardiovascular abnormality, women with Marfan syndrome are at significant risk of aortic dissection, which is often fatal even when rapidly treated. Women with Marfan syndrome, then, should receive a thorough assessment prior to conception, and echocardiography should be performed every six to 10 weeks during pregnancy, to assess the aortic root diameter. A transgenic mouse has been created carrying a single copy of a mutant fibrillin-1, a mutation similar to that found in the human gene known to cause Marfan syndrome. This mouse strain recapitulates many of the features of the human disease and promises to provide insights into the pathogenesis of the disease. Reducing the level of normal fibrillin 1 causes a Marfan-related disease in mice.
Diagnostic criteria of Marfan syndrome were agreed upon internationally in 1996 but were recently revised in 2010. A diagnosis of Marfan syndrome is based on family history and a combination of major and minor indicators of the disorder, rare in the general population, that occur in one individual – for example: four skeletal signs with one or more signs in another body system such as ocular and cardiovascular in one individual.
Steinberg’s thumb sign (Marfan’s syndrome) – a flexed thumb grasped within a clenched palm protrudes beyond the ulnar border of that hand.Credit: Goopsmirk – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=32430111
The thumb sign (Steinberg’s sign) is elicited by asking the patient to flex the thumb as far as possible and then close the fingers over it. A positive thumb sign is where part of the thumb is visible beyond the ulnar border of the hand, caused by a combination of hypermobility of the thumb as well as a thumb which is longer than usual.
The wrist sign (Walker’s sign) is elicited by asking the patient to curl the thumb and fingers of one hand around the other wrist. A positive wrist sign is where the little finger and the thumb overlap, caused by a combination of thin wrists and long fingers. There is no 9) ___ for Marfan syndrome, but life expectancy has increased significantly over the last few decades and is now similar to that of the average person. Clinical trials are also under way for promising new treatments. At present, the syndrome is treated by simply addressing each issue as it arises and, in particular, preventative medication even for young children to slow progression of aortic dilation if such exists. Since angiotensin II receptor antagonists (ARBs) also reduce TGF-beta, these drugs have been tested in a small sample of young, severely affected people with Marfan syndrome. In some, the growth of the aorta was reduced. However, a recent study published in the NEJM demonstrated similar cardiac outcomes between the ARB, losartan, and the more established beta blocker therapy, atenolol.
Marfan syndrome is expressed dominantly. This means a child with one parent a bearer of the gene has a 50% probability of getting the syndrome. However, as the gene causing Marfan syndrome is known, arduous genetic techniques are able to circumvent this. In 1996, the first preimplantation genetic testing therapy for Marfan was conducted; in essence PGT means conducting a genetic testing on early stage IVF embryo cells and discarding those embryos affected by the Marfan mutation. Regular checkups by a cardiologist are needed to monitor the health of the heart valves and the aorta. The goal of treatment is to slow the progression of aortic dilation and damage to heart valves by eliminating arrythmias, minimizing the heart rate, and minimizing blood pressure. Beta blockers have been used to control arrythmias and slow the heart rate. Other medications might be needed to further minimize blood pressure without slowing the heart rate, such as ACE inhibitorsand ARBs. If the dilation of the aorta progresses to a significant diameter aneurysm, causes a dissection or a rupture, or leads to failure of the aortic or other valve, then surgery (possibly a composite aortic valve graft or valve-sparing aortic root replacement) becomes necessary. Although aortic graft surgery (or any vascular surgery) is a serious undertaking it is generally successful if undertaken on an elective basis. Surgery in the setting of acute aortic dissection or rupture is considerably more problematic. Elective aortic valve/graft surgery is usually considered when aortic root diameter reaches 50 millimeters (2.0 inches), but each case needs to be specifically evaluated by a qualified cardiologist. New valve-sparing surgical techniques are becoming more common As Marfan patients live longer, other vascular repairs are becoming more common, e.g., repairs of descending thoractic aortic aneurysms and aneurysms of vessels other than the aorta. The skeletal and ocular manifestations of Marfan syndrome can also be serious, although not life-threatening. These symptoms are usually treated in the typical manner for the appropriate condition, such as with various kinds of pain medication or muscle relaxants. It is also common for patients to receive treatment from a physiotherapist, using TENS therapy, ultrasound and skeletal adjustment. This can also affect height, arm length, and life span. A physiotherapist can also help improve function and prevent injuries in individuals with Marfan syndrome.
Prior to modern cardiovascular surgical techniques and drugs such as losartan and metoprolol, the prognosis of those with Marfan’s syndrome was not good: a range of untreatable cardiovascular issues was common. Lifespan was reduced by at least a third, and many died in their teens and twenties due to cardiovascular problems. Today, cardiovascular symptoms of Marfan syndrome are still the most significant issues in diagnosis and management of the disease, but adequate prophylactic monitoring and prophylactic therapy offers something approaching a normal lifespan, and more manifestations of the disease are being discovered as more patients live 10) ___.
ANSWERS: 1) heart; 2) syndrome; 3) eyes; 4) valve; 5) gene; 6) family; 7) skeletal; 8) circulation; 9) cure; 10) longer
Two Greats with Marfan Syndrome: Niccolo Paganini and Michael Phelps
Paganini became one of the world’s great virtuoso violinists. But what is especially fascinating is that part of Paganini’s great success came as a result of a rare physical ailment.
Niccolo (or Nicolo) Paganini (1782-1840), an Italian violinist, violist, guitarist, and composer, was the most celebrated violin virtuoso of his time who left his mark as one of the pillars of modern violin technique. His 24 Caprices for Solo Violin Op.1 are among the best known of his compositions, and have served as an inspiration for many prominent composers.
Paganini was born in Genoa, then capital of the Republic of Genoa, the third of the six children of Antonio and Teresa (nee Bocciardo) Paganini. Paganini’s father was an unsuccessful sea trader, but he managed to supplement his income through playing music on the mandolin. At the age of five, Paganini started learning the mandolin from his father, and moved to the violin by the age of seven. His musical talents were quickly recognized, earning him numerous scholarships for violin lessons. The young Paganini studied under various local violinists, including Giovanni Servetto and Giacomo Costa, but his progress quickly outpaced their abilities. Paganini and his father then traveled to Parma to seek further guidance from Alessandro Rolla. But upon listening to Paganini’s playing, Rolla immediately referred him to his own teacher, Ferdinando Paer and, later, Paer’s own teacher, Gasparo Ghiretti. Though Paganini did not stay long with Paer or Ghiretti, the two had considerable influence on his composition style. By the time Paganini was 18 he was well known around Genoa and Parma, and a decade or so later, the violinist had made a name for himself throughout Europe. When he died in 1840 in Nice, France, Paganini had established himself as one of the great masters of the violin. In his relatively short life, Paganini dramatically increased the technical possibilities of the violin. He could do what no one had ever done on the instrument. The virtuoso made left hand pizzicato and harmonics hallmarks of his style, and was even said to be able to play three octaves of notes across the four strings. Most violinists consider this impossible today.
Scholars have pondered how Paganini was able to do these miraculous feats on the violin, for more than a century and a half, and many have come with the conclusion that the violinist had a little known medical condition called Marfan syndrome.
Drawing of Paganini’s Hands
Marfan syndrome is a genetic disorder that affects a person’s connective tissue, often making them unusually tall with lengthened limbs and long, thin fingers. Observers of Paganini frequently commented on his unique hands. In 1931, his personal physician wrote, Paganini’s hand is not larger than normal; but because all its parts are so stretchable, it can double its reach. For example, without changing the position of the hand, he is able to bend the first joints of the left fingers which touch the strings sideways, at a right angle to the natural motion of the joint, and he can do it with effortless ease, assurance, and speed. Essentially, Paganini’s art is based on physical endowment, increased and developed by ceaseless practicing.
An anecdote of Paganini’s unheard-of ability is especially telling. One night, a rich gentleman asked the virtuoso to serenade his lady friend. The air was quite damp, and the violin strings of the day did not respond well to this kind of humidity. First the E string broke. The violinist was not fazed. Then the A and D strings snapped. The older gentleman was instantly worried and feared that the serenade for his friend would be ruined. What did Paganini do, now that he only had one string to play on? He simply smiled and continued to play on one string just as if he was playing on all four. The serenade was a success after all, thanks to the virtuoso’s amazing ability.
Poster for a Paganini concert.
Having Marfan syndrome also created a certain mystique for Paganini. People called him Hexensohn (Witch’s Child) because of his seemingly superhuman ability. Some claimed that he had made a pact with the devil to play as well as he did. Reports of his demonic possession were enhanced by the medical condition which made him appear unusually thin and pale. Paganini loved all this notoriety and had fun with it. To accentuate the rumors, he would dress completely in black and sometimes arrive at a concert in a black carriage pulled by four black horses. And when he lost his teeth in 1828, his face looked even more ghostly. Of course, people flocked to his concerts. Some have even called him music’s first rock star. There were times when he dramatically entered the concert hall from the back of the audience, playing his violin as he sauntered up the aisle, enjoying the delight of his admirers, as he passed by the sold-out seats. Medical ailments are often viewed as things to overcome. With Paganini, Marfan syndrome actually enhanced an already considerable talent to help him become one of the world’s finest instrumentalists.
In 1801, the 18-year-old Paganini was appointed first violinist of the Republic of Lucca, but a substantial portion of his income came from freelancing. His fame as a violinist was matched only by his reputation as a gambler and womanizer. In 1805, Lucca was annexed by Napoleonic France, and the region was ceded to Napoleon’s sister, Elisa Baciocchi. Paganini became a violinist for the Baciocchi court, while giving private lessons to Elisa’s husband, Felice. In 1807, Baciocchi became the Grand Duchess of Tuscany and her court was transferred to Florence. Paganini was part of the entourage, but, towards the end of 1809 , he left Baciocchi to resume his freelance career.
1831 bulletin advertising a performance of Paganini
His international fame started with an 1813 concert at La Scala in Milan. The concert was a great success. As a result, Paganini began to attract the attention of other prominent, musicians across Europe. In 1827, Pope Leo XII honored Paganini with the Order of the Golden Spur. His fame spread across Europe with a concert tour that started in Vienna in August 1828, stopping in every major European city in Germany, Poland, and Bohemia until February 1831 in Strasbourg. This was followed by tours in Paris and Britain. His technical ability and his willingness to display it received much critical acclaim.
Throughout his life, Paganini was no stranger to chronic illnesses. Although no definite medical proof exists, he was reputed to have been affected by Marfan syndrome or Ehlers-Danlos syndrome. In addition, his frequent concert schedule, as well as his extravagant lifestyle, took their toll on his health. He was diagnosed with syphilis as early as 1822, and his remedy, which included mercury and opium, came with serious physical and psychological side effects. In 1834, while still in Paris, he was treated for tuberculosis. Though his recovery was reasonably quick, after the illness his career was marred by frequent cancellations due to various health problems, from the common cold to depression, which lasted from days to months. In September 1834, Paganini put an end to his concert career and returned to Genoa. Paganini devoted his time to the publication of his compositions and violin methods. He accepted students. In 1835, Paganini returned to Parma, this time under the employ of Archduchess Marie Louise of Austria.
Tomb of Paganini in Parma, Italy; Wikipedia commons
In 1836, Paganini returned to Paris to set up a casino. Its immediate failure left him in financial ruin, and he auctioned off his personal effects, including his musical instruments, to recoup his losses. At Christmas of 1838, he left Paris for Marseilles and, after a brief stay, travelled to Nice where his condition worsened. In May 1840, the Bishop of Nice sent Paganini a local parish priest to perform the last rites. Paganini assumed the sacrament was premature, and refused. A week later, on 27 May 1840, Paganini died from internal hemorrhaging before a priest could be summoned. Because of this, and his widely rumored association with the devil, the Church denied his body a Catholic burial in Genoa. It took four years and an appeal to the Pope before the Church let his body be transported to Genoa, but it was still not buried. His remains were finally laid to rest in 1876, in a cemetery in Parma. In 1893, the Czech violinist Frantisek Ondricek persuaded Paganini’s grandson, Attila, to allow a viewing of the violinist’s body. After this bizarre episode, Paganini’s body was finally reinterred in a new cemetery in Parma in 1896.
Though having no shortage of romantic conquests, Paganini was seriously involved with a singer named Antonia Bianchi from Como, whom he met in Milan in 1813. The two gave concerts together throughout Italy. They had a son, Achilles Cyrus Alexander, born on 23 July 1825 in Palermo and baptized at San Bartolomeo’s. They never legalized their union and it ended around April 1828 in Vienna. Paganini brought Achilles on his European tours, and Achilles later accompanied his father until the latter’s death. He was instrumental in dealing with his father’s burial, years after his death. After giving a recital when one string after another broke, first the E, then the A, and finally the D, leaving him only with the lowest, the G string, refusing to stop playing (or to re-string), he improvised on his one remaining string. Seeing the drama in such an event, at future concerts, he sometimes broke strings, just to awe his audience further, as he continued playing with only the one remaining string. And, in fact, Paganini did write his Moses Fantasy solely for the G string, offering tremendous difficulties that strike fear into the hearts of violinists and ensure that the music is rarely played. At any rate, restriction to the G string gives even the high notes a dark coloring that can lead unwary listeners to believe they’re hearing music for the viola.
The violinist, David Garrett, plays Niccolo Paganini in a wonderful recent film, The Devil’s Violinist, which gives authenticity to the colorful style of Paganini as he toured through Europe to great acclaim. This piece, by Paganini is called, Caprice 24
Paganini composed his own works to play exclusively in his concerts, all of which profoundly influenced the evolution of violin technique. His 24 Caprices were likely composed in the period between 1805 to 1809, while he was in the service of the Baciocchi court. Also during this period, he composed the majority of the solo pieces, duo-sonatas, trios and quartets for the guitar, either as a solo instrument or with strings. Paganini’s exceptionally long fingers enabled him to play three octaves across four strings in a hand span, an extraordinary feat even by today’s standards; no doubt a result of Marfan syndrome. The Paganini Competition (Premio Paganini) is an international violin competition created in 1954 in his home city of Genoa and named in his honour. A minor planet, 2859 Paganini, discovered in 1978 by Soviet astronomer Nikolai Chernykh is named after him.
Sources: NIH.gov; Medline.org; Wikipedia; http://inmozartsfootsteps.com/1032/paganini-violinist-helped-by-marfan-syndrome/
Michael Phelps, After Winning His 8th Gold Medal
Photo credit: Bryan Allison – CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=4679646
Michael Phelps, Athlete Extraordinaire
The most celebrated Olympian and Swimmer Michael Phelps has been regarded the most incredible swimmer in the world. He is known for his extremely tall and thin physique, great flexibility, speed in water faster than any other human and a grand wingspan.
Michael Fred Phelps II, born June 30, 1985), is an American competition swimmer and the most decorated Olympian of all time, with a total of 22 medals in three Olympiads. Phelps also holds the all-time records for Olympic gold medals (18, double the second highest record holders), Olympic gold medals in individual events (11), and Olympic medals in individual events for a male (13). In winning eight gold medals at the 2008 Beijing Games, Phelps took the record away from fellow swimmer Mark Spitz (7) for the most first-place finishes at any single Olympic Games. Five of those victories were in individual events, tying the single Games record. In the 2012 Summer Olympics in London, Phelps won four golds and two silver medals, making him the most successful athlete of the Games for the third Olympics in a row.
Apart from his achievements and efficiency he has been in news because of his curious physique associated with Marfan’s syndrome. The rumor became a truth when Phelps himself confirmed having Marfan’s syndrome although he tested negative for it but he still meets the criteria for the syndrome which a unique connective tissue disorder is affecting about 1 in every 20,000 people caused mostly due to a pathological condition of the protein fibrillin-1, a structural protein. The ones suffering from Marfan’s are extremely tall and have longer bones, limbs and fingers. Their detached retinas, larger aorta, and leaky heart valves make it a fatal disease and a rare genetic disorder. Michael Phelps, according to critics has been helped by this disorder helping him in his athletic pursuits because of the height and flexibility which is generally an advantage for the athletes. However this fatal disorder can be seen more in the context of posing threat to his life. In one of his training sessions his heart pace was alarmingly high that made him undergo tests for the fear of this syndrome. There is no doubt that he has the classic symptoms of Marfan’s syndrome with an elongated stature of about six feet and five inches and an arm span of six feet and seven inches (more than his height) an unusual clinical cut off. According to his mother, he grew unevenly with extremely long arms and unusual ears.
In one of his interviews after his autobiography was released he said If you reach out your arms and form a T and your wingspan is longer than your height, you can be at risk. In my case, those measurements have always been very close.
Phelps goes for an annual checkup and has maintained stronger tissues with a clear aortic rout and a heart in good condition. Marfan’s Syndrome has been known for causing abrupt death of athletes, especially after the event. Phelps however has the best doctors taking care of this condition and monitoring him time to time but that doesn’t really minimize the risks which can actually increase with his limits. Phelps has been more in the news because of his unusual conditions than his achievements as a fascinating subject of study among sports scientists, psychologists and physicians. Phelps also contains only two-thirds the lactic acid in the muscles as compared to the other swimmers and has an intake of food that is six times more than an average adult male.
Antiarrhythmic Drugs Beneficial When Used by EMS Treating Cardiac Arrest
Sudden cardiac arrest is a condition in which the heart suddenly or unexpectedly stops beating, cutting off blood flow to the brain and other vital organs. More than 300,000 people are treated for out-of-hospital cardiac arrest each year, with the vast majority occurring at home, according to the American Heart Association. Studies show that nationally only about 10% of people who suffer cardiac arrest outside the hospital survive. Effective treatments, such as CPR and defibrillation, can greatly increase a victim’s chance of survival.
EMS (emergency medical services) providers commonly use antiarrhythmic drugs for out-of-hospital cardiac arrest that is not responsive to defibrillation shocks to the heart for restoring its normal rhythm. However, doctors remain unclear whether these drugs have proven survival benefit or if any benefit might be undone by possible drug side effects. As a result, use of these treatments by paramedics varies.
As a result, a study published online in the New England Journal of Medicine (4 April 2016) has confirmed that certain heart rhythm medications, when given by paramedics to patients with out-of-hospital cardiac arrest who had failed electrical shock treatment, improved likelihood of patients surviving transport to the hospital. The study was and helps answer a longstanding scientific question about the effectiveness of two widely-used antiarrhythmic drugs, amiodarone and lidocaine, for treating sudden cardiac arrest. The study followed the patients from hospital admission to hospital discharge. Although neither drug significantly improved the overall rate of survival to hospital discharge, amiodarone showed a favorable trend in that direction. Survival to discharge is the point at which a patient is discharged from the hospital.
According to the authors, the trial shows that amiodarone and lidocaine offer hope for bringing patients back to life and into the hospital after cardiac arrest, and that while the overall increase in survival to hospital discharge of about 3% with amiodarone was not statistically significant, it came very close. Importantly, there was a significant improvement in survival to hospital discharge with either drug when the cardiac arrest was bystander-witnessed. A bystander-witnessed cardiac arrest is one that is witnessed by another person.
The three-year study began in 2012, and randomized 3,026 patients with out-of-hospital cardiac arrest caused by ventricular fibrillation andventricular tachycardia, life-threatening rhythms of the heart’s lower pumping chambers that are often resistant to electrical shock. Patients were assigned to treatment with amiodarone, lidocaine, or neither drug (a saline placebo) by rapid injection, along with all other standard resuscitation treatments. The study was conducted by the Resuscitation Outcomes Consortium, which includes clinical sites in the United States and Canada.
Results showed that survival among the approximately 1,900 patients in the study whose cardiac arrest was witnessed by a bystander was improved significantly, from about 23-28%, by either drug. With better than half of study participants fit this bystander-witnessed category. This suggests treating patients as soon as possible after their collapse might be a critical determinant of whether drugs like amiodarone or lidocaine will have a significant clinical effect.