DiversityNursing Blog

By Ronnie Cohen

Millions of people could be trying to measure their blood pressure with untested, inaccurate and potentially dangerous smartphone applications, or apps, a new study finds.

Researchers analyzed the top 107 apps for "hypertension" and "high blood pressure" that are available for download on the Google Play store and Apple iTunes and found that nearly three-quarters offered useful tools for tracking medical data.

But they also found seven Android apps that claimed users needed only to press their fingers onto phone screens or cameras to get blood-pressure readings - claims that scientists say are bogus.

"This technology is really in its nascent stages, and it's not quite ready for prime time," lead author Dr. Nilay Kumar told Reuters Health.

Kumar, an attending physician at the Cambridge Health Alliance in Cambridge, Massachusetts and a Harvard Medical School instructor, was surprised to learn that apps marketed as turning smartphones into blood pressure measuring devices had been downloaded at least 900,000 times and as many as 2.4 million times.

"That's concerning that such a small number of apps have been downloaded so many times," he said. "We were surprised by the popularity."

He wasn't sure how the technology supposedly works but said the phone camera appears to read a finger pulse.

"It's really in a research-and-development stage. It's not ready for clinical use. For now, we need to be careful that we are not using things that are inaccurate and could be potentially dangerous," he said.

Apps that inaccurately measure blood pressure could lead to false alarms and possibly fatal false assurances, Kumar said.

About one in three American adults has high blood pressure, according to the U.S. Centers for Disease Control and Prevention. Also known as hypertension, the condition has been called the silent killer because it often shows no warning symptoms but increases the risk of heart disease and stroke, two leading causes of death.

A growing number of hypertension patients use mobile-health technologies to track and manage their conditions, the authors write in the Journal of the American Society of Hypertension.

The study, conducted earlier this year, in general found good news about blood pressure apps. The majority, or 72 percent, of the most popular apps allowed consumers to keep track of their medical data. About a quarter could directly export recorded information to physicians' offices. And nearly a quarter included tools to enhance medication adherence.

But healthcare agencies, such as universities, helped develop only a tiny fraction of the apps, 2.8 percent, the study found.

The U.S. Food and Drug Administration (FDA), which regulates medical devices, has not approved any of the blood pressure apps, the authors write.

The study's findings raise "serious concerns about patient safety" and reveal an "urgent need for greater regulation and oversight in medical app development," the authors say.

Dr. Karen Margolis, an internist and director of clinical research at HealthPartners Institute for Education and Research in Minneapolis, would also like to see more oversight.

"The idea that you're going to be able to stick your finger on the camera of your smartphone and get an accurate blood pressure reading is pretty farfetched right now," she told Reuters Health.

Margolis has studied devices to measure blood pressure but was not involved in the current study.

"There is virtually no information at all about how accurate these apps are," she said. "It doesn't sound to me like it's ready for routine use in any way that medical decisions could be based on."

Regulatory authority over smartphone apps that can be turned into medical devices remains unclear, Kumar said.

Writing earlier this year in The New England Journal of Medicine, a group of three lawyers, led by Nathan G. Cortez of the Southern Methodist University Dedman School of Law in Dallas, Texas, warned that mobile health, or mHealth, poses a challenge for the FDA.

"Many members of Congress and industry believe that regulation will stifle mHealth innovation," the lawyers wrote. "The true challenge, however, is creating a regulatory framework that encourages high-value innovation while also preventing the market from being overcome with products that are ineffective or unsafe."

Source: www.huffingtonpost.com

By LIZ NEPORENT

Adopting a stray dog while in the midst of battling a disease that was deemed incurable hardly seems like the best timing, yet that’s exactly what Bill Hogencamp and his wife Kathy decided to do.

They believe that decision helped save his life.

Hogencamp, an 84-year-old semi-retired architect from Phenix, Alabama, was diagnosed with incurable cancer of the gall bladder, liver, colon and the lining of his abdomen back in May. Doctors told him he wouldn’t live to see Christmas.

“I have seven children and I’ve traveled all around the world,” Hogencamp said. “I thought if this is it, then this is it.”

Hogencamp chose to undergo treatment even though his doctor told him there was no hope, he recalled. In October, he had an operation to remove three large tumors.

Eleven days after his surgery, his wife was on her way to pick him up from a rehabilitation facility when she spotted a small white dog wandering down the middle of the road, in danger of being hit by a car. Although she was in a rush, she said something compelled her to stop and rescue the pup.

“He walked past six other cars right up to the side of my car and put his paws up on the door,” she recalled.

While his wife was hooked on the cute little dog right away, Hogencamp needed some convincing.

“I hadn’t had a dog in twenty years and I had no desire to have a dog,” he said. “I kept saying we need to find his owner.”

Despite an extensive search and nearly a dozen false leads, the Hogencamps were never able to track down the dog’s owner. They learned from a vet they visited during their search that he was a Maltese, probably around 6 years old, fixed but not chipped.

Besides, the dog very quickly won Hogencamp over. They soon became inseparable.

Whenever Hogencamp sat down, the dog -- who they named Mahjong after Kathy’s favorite card game -- would jump in his lap. Whenever Hogencamp napped, Mahjong would curl up next to him. When Hogencamp returned home after being out, Mahjong would hop onto his hind legs and dance with joy.

As he and his wife settled into life with a dog, Hogencamp underwent chemotherapy. Just before the holiday he received some miraculous news: Tests showed that he was now cancer free.

The doctors are at a loss to explain this amazing turn of events, Hogencamp’s wife said. But she said the family believes that Mahjong has played a huge part in her husband’s recovery.

“The dog seemed to know right away that Bill was sick and it was his job to take care of him -- and Bill knew it was his job to take care of the dog,” she said.

Hogencamp agreed. He said their relationship gave both him and the dog a sense of purpose. Although he knows he owes much of his cure to great medical care and a lot of luck, he said that he is convinced the little white dog was sent to him to help him get better.

As they celebrate Christmas, Hogencamp said he has two final chemotherapy treatments. He said he’s spending the day with friends, family and of course, Mahjong.

“My life has been a miracle,” Hogencamp said. “And now Mahjong is part of that miracle.”

Source: http://abcnews.go.com

By Eun Kyung Kim

Even before she had a groom in mind, Katie Breland Hughes knew she wanted to walk down the aisle at her wedding on her own two feet.

It became one of her initial goals after a horrific car accident left her paralyzed from the waist down. But first, she needed to survive her injuries.

“Honestly, I had so many skin graft surgeries and so many burns, my first goal was just to sit up in the bed," said Hughes, now 27. "I was literally at rock bottom."

In October 2011, the Louisiana personal trainer and physical therapy assistant missed a stop sign while driving home from an appointment with a client. A truck hit her vehicle broadside, and Hughes went flying through her windshield. She landed in a ditch and, seconds later, her burning car landed on top of her, searing her back.

Conscious throughout the ordeal, Hughes knew she was either paralyzed or that her legs were amputated because she couldn’t feel either one.

“Immediately, I started asking myself all the physical therapy questions. Is my spinal cord severed? What kind of injury is this? How far up? How low down?” she recalled for TODAY.com. 

At the hospital, doctors told Hughes that she would never walk again. But during a nine-hour surgery to insert rods and plates along her spine to stabilize it, they learned that Hughes' spinal cord wasn’t severed as they originally thought. 

“That was all I needed to hear to keep pushing forward,” she said. “That was kind of my prayer.”

After her 100-day hospital stay, Hughes went home and immediately started training. An athlete all her life —she was supposed to run a marathon the week after her crash — exercise had always given Hughes an emotional outlet. After the accident, her love of exercise proved critical to her recovery, and to attaining the new goal she had created for herself.

“I told my sister from the beginning, I will not get married — whoever it be to, or whenever it happens — I will not do it until I can walk down the aisle. I just won’t be in a wheelchair,” she said. “So that was always a goal. I didn’t know the next year it would actually happen.”

Hughes heard about a Michigan trainer who had worked with other paraplegics. She reached out to him and flew to Michigan to begin training.

“The first time I talked to her on the telephone, she was like, ‘Look, I don’t want to be in this chair forever. I understand what happened to me, but I want to work hard and see where I can get,’” said Mike Barwis, a strength and conditioning coach who frequently works with Olympic and professional athletes. 

It was during a session with Barwis that Hughes moved her legs for the first time since the accident. 

Meanwhile, Hughes had reconnected with a former acquaintance, Odie Hughes. She initially worried about meeting him again now that she was in a wheelchair.

“I didn’t know how he would accept that, or how he would feel about that,” she recalled. “But it was like he never even saw the chair, he just saw me. He believed everything with me. If I told him, ‘I think I can do this. I want to try this,’ then he would be my biggest cheerleader.”

Within three months, they were engaged. Hughes started the clock: She had nine months to get on her feet. Barwis said he had no doubts they could make it happen.

“Katie is a vibrant person. She has an amazing personality and she’s very driven,” he said. “Her mentality has been one of absolute determination.”

But while working to build up the strength in her legs, Hughes also had to plan a wedding. She also opened a gym she started in her community of Bogalusa, about 70 miles north of New Orleans. 

There was also the issue of finding a wedding gown. 

“I actually bought three dresses. I didn’t like any of them,” she said. After getting ready to settle on one of them, she received a call from the cable network TLC, asking if she wanted to be featured on the show, “Say Yes to the Dress.” Hughes flew to the Atlanta bridal store featured on show (the episode airs Jan. 2) and finally found a gown she was happy with.

“Everything about it was perfect,” she said.

Except she never practiced walking in it until the day of her wedding. "I didn’t want anybody to see the real one," she explained. So instead, she practiced using one of the other gowns. She started in a full-body brace, then with a walker before moving on to two canes. Finally, she used two leg braces that went up from her feet to just above the knees, all while holding on to a person on each side of her.

On her wedding day, Sept. 20, Hughes walked down the aisle, on her own two feet, holding the hands of the two men giving her away: Her dad, who stood to her right, and Barwis, on her left. 

As excited as she was, Hughes said she never anticipated the nerves she experienced as she stared down the aisle at her guests.

“I felt like this was everybody’s fairytale ending. This was the story they had been following for so long and this was the ending they were waiting to see,” she said. “So I felt like there was a lot of pressure but there was no greater reward than getting to the end of that aisle, for sure.”

Waiting for her there with a huge smile was her fiance.

"When her foot caught that slip my heart stopped. But she just held it together like a champ," said Odie Hughes. "I had complete faith in her."

He said he never for a second doubted the woman he considers "the most stubborn person I know" 

"When she said she was gonna do it, it was a done deal," he said. "Never one doubt in my mind she'd not only make it down the aisle but she'd do it in dramatic fashion. That's my Katie." 

Months later, Katie is back at work, keeping busy with her physical therapy patients and running her gym, Katie's Shed, where she teaches various cardio and full-body workout classes.

She enjoys newlywed life and said it helps to have a partner who is familiar with life-altering injuries: Her husband once broke his neck during a car accident that left him with metal rods in his legs.

“Me and him both just really understand how quick this life is and how short it can be made,” she said. “We really value each other and the time we have together and with our family. We know first hand how quickly it can be taken from you, so we try to make the best of that.”

Hughes still uses her braces, alternating between them and her wheelchair, depending on the circumstances.

She speaks at local and regional events about her accident and hopes her story will inspire others to reach beyond traditional expectations.

“A lot of people would say, ‘Okay, I did it and now I’m going to be content with my progress right now.’ But I think contentment is our worst enemy a lot of times, just being content with where you are,” she said. “You should always try to excel forward and move forward and continue to reach goals and set new ones.”

Source: www.today.com

Gay men who've abstained from sex for one year would be able to donate blood in 2015, ending a lifetime ban for the gay community, under a proposed FDA policy change unveiled Tuesday.

The current lifetime ban by U.S. Food and Drug Administration states dates back to 1983 and forbids men who have had sex with men from becoming blood donors because the group is "at increased risk for HIV, hepatitis B and certain other infections that can be transmitted by transfusion," the FDA has ruled.

But the FDA is now seeking a change in that policy and would allow such blood donations based on an independent expert advisory panel's recommendation, the agency said.

The proposed change would align the one-year deferral period "with that of other men and women at increased risk for HIV infection," the FDA said.

The agency will be gathering public comments on the proposed change.

"We encourage all stakeholders to take this opportunity to provide any information the agency should consider, and look forward to receiving and reviewing these comments," FDA Commissioner Margaret A. Hamburg said in a statement.

The National Heart Lung and Blood Institute and the FDA would monitor a national blood surveillance system to see any effects of the proposed policy change and to ensure the continued safety of the blood supply, Hamburg said.

"A history of male-to-male sex is associated with an increased risk for exposure to and transmission of certain infectious diseases, including HIV, the virus that causes AIDS," the FDA said. Men who have had sex with other men represent approximately 2% of the U.S. population, yet are the population most severely affected by HIV, according to the FDA.

In 2010, male-to-male sex accounted for at least 61% of all new HIV infections in the United States, and "an estimated 77% of diagnosed HIV infections among males were attributed to male-to-male sexual contact," the FDA said.

Source: www.cnn.com

By Rebecca Riffkin

In 2014, Americans say nurses have the highest honesty and ethical standards. Members of Congress and car salespeople were given the worst ratings among the 11 professions included in this year's poll. Eighty percent of Americans say nurses have "very high" or "high" standards of honesty and ethics, compared with a 7% rating for members of Congress and 8% for car salespeople.

Americans have been asked to rate the honesty and ethics of various professions annually since 1990, and periodically since 1976. Nurses have topped the list each year since they were first included in 1999, with the exception of 2001 when firefighters were included in response to their work during and after the 9/11 attacks. Since 2005, at least 80% of Americans have said nurses have high ethics and honesty. Two other medical professions -- medical doctors and pharmacists -- tie this year for second place at 65%, with police officers and clergy approaching 50%.

Historically, honesty and ethics ratings for members of Congress have generally not been positive, with the highest rating reaching 25% in 2001. Since 2009, Congress has ranked at or near the bottom of the list, usually tied with other poorly viewed professions like car salespeople and -- when they have been included -- lobbyists, telemarketers, HMO managers, stockbrokers and advertising practitioners.

Although members of Congress and car salespeople have similar percentages rating their honesty and ethics as "very high" or "high," members of Congress are much more likely to receive "low" or "very low" ratings (61%), compared with 45% for car salespeople. Last year, 66% of Americans rated Congress' honesty and ethics "low" or "very low," the worst Gallup has measured for any profession historically.

Other relatively poorly rated professions, including advertising practitioners, lawyers, business executives and bankers are more likely to receive "average" than "low" honesty and ethical ratings. So while several of these professions rank about as low as members of Congress in terms of having high ethics, they are less likely than members of Congress to be viewed as having low ethics.

No Professions Improved in Ratings of High Honesty, Ethics Since 2013

Since 2013, all professions either dropped or stayed the same in the percentage of Americans who said they have high honesty and ethics. The only profession to show a small increase was lawyers, and this rise was small (one percentage point) and within the margin of error. The largest drops were among police officers, pharmacists and business executives. But medical doctors, bankers and advertising practitioners also saw drops.

Honesty and ethics ratings of police dropped six percentage points since last year, driven down by many fewer nonwhite Americans saying the police have high honesty and ethical standards. The clergy's 47% rating last year marked the first year that less than 50% of Americans said the clergy had high ethical and honesty standards -- and the current 46% rating is, by one percentage point, the lowest Gallup has measured for that profession to date.

Bottom Line

Americans continue to rate those in medical professions as having higher honesty and ethical standards than those in most other professions. Nurses have consistently been the top-rated profession -- although doctors and pharmacists also receive high ratings, despite the drops since 2013 in the percentage of Americans who say they have high ethics. The high ratings of medical professions this year is significant after the Ebola outbreak which infected a number of medical professionals both in the U.S. and in West Africa.

At the other end of the spectrum, in recent years, members of Congress have sunk to the same depths as car salespeople and advertising practitioners. However, in one respect, Congress is even worse, given the historically high percentages rating its members' honesty and ethics as being "low" or "very low." And although November's midterm elections did produce a significant change in membership for the new Congress that begins in January, there were also major shakeups in the 2006 and 2010 midterm elections with little improvement in the way Americans viewed the members who serve in that institution.

Previously in 2014, Gallup found that Americans continue to have low confidence in banks, and while Americans continue to have confidence in small businesses, big businesses do not earn a lot of confidence. This may be the result of Americans' views that bankers and business executives do not have high honesty and ethical standards, and the fact that their ratings dropped since last year.

Survey Methods

Results for this Gallup poll are based on telephone interviews conducted Dec. 8-11, 2014, with a random sample of 805 adults, aged 18 and older, living in all 50 U.S. states and the District of Columbia. For results based on the total sample of national adults, the margin of sampling error is ±4 percentage points at the 95% confidence level.

Each sample of national adults includes a minimum quota of 50% cellphone respondents and 50% landline respondents, with additional minimum quotas by time zone within region. Landline and cellular telephone numbers are selected using random-digit-dial methods.

Source: www.gallup.com

By KELLI DUNHAM

I'm a proud nurse from a proud family of nurses, yet I would never claim that a layperson would enjoy watching mainstream medical dramas with us. We end up yelling at the screen: "There is nothing about that sexy get-up that remotely resembles a nursing uniform," and "Doctors don't fire nurses, nurse managers fire nurses," and "No emergency room nurse would ever have to be told by a doctor to start CPR!"

So when the Baymax, the nurse/robot in the hit Disney movie Big Hero Six turned out to be reasonable, competent and not dressed in fishnet stockings, I was thrilled.

You know your profession has an image problem when you point to a balloonish animated robot doll and say, "Yes, that's good. That accurately reflects what I do on a daily basis. More representations like that, please."

Baymax might not look like any nurses you know, but unlike most nurse characters in the media he actually provides nursing care. He assesses the health condition of his charge, the boy-genius Hiro, makes recommendations related to his health and teaches him about his neurochemical processes.

Once Hiro reprograms Baymax with fighting capabilities, Baymax becomes Hiro's terrifying defender. If you've ever heard a nurse on the phone with an insurance company insisting that a patient get needed care paid for, you know this is not a misplaced metaphor.

Contrast this with the Nurse Dawn character in the HBO comedy Getting On. She has sex with a new nurse manager within hours of meeting him; doesn't seem to notice when a patient dies; cowers submissively in front of even the most incompetent doctors and never seems to provide any actual nursing care because she is too busy with self-created drama and paperwork.

Or the Nurse Beverly character in Fox's comedy The Mindy Project. She is fired from an office medical practice for incompetence, breaks a doctor's nose in angry response, and when she is rehired in a clerical position expresses relief that she finally has a job where she doesn't have to wash her hands.

Or the nurses in the Fox medical drama House. Rather than being sexually inappropriate or incompetent, these nurses all seem to be on a series-long coffee break. It is the doctors who are shown providing nursing care: starting IVs, doing patient teaching, negotiating complicated family dynamics at the bedside.

Even when nurses are shown to be competent, compassionate patient-focused experts like Jackie Peyton, the main character in Showtime's Nurse Jackie, the creators aren't satisfied with the life-and-death drama of a high-level trauma center in a huge city. The nurse character has to be an unethical, lying, stealing, not quite-in-recovery drug addict as well.

The argument could be made that it's the job of Hollywood to create fiction of all the professions, and that popular culture gets everything about health care wrong.

Certainly examples of this exist: the new Fox teen drama Red Band Society is populated by exceedingly healthy looking, extremely attractive gravely ill teenagers who live for months in hospital rooms the size of two-bedroom apartments for no other apparent reason than to make it more convenient for them to kiss each other.

Any scenes in which the dying but randy teens are portrayed interacting with medical care (one patient is shown receiving dialysis for liver failure) are so ludicrous that it makes you wonder if the procedure for the show's writers is to ask their medical adviser how something might accurately be conveyed and then write the exact opposite.

But even though this is just entertainment, the stakes for the future of nursing are high. Research has repeatedly demonstrated that Americans believe what TV shows say about medical care and health policy.

For 13 years the non-profit advocacy organization Truth About Nursing has been researching and documenting nurse representations in popular culture and has come to the conclusion that "the vast gap between what skilled nurses really do and what the public thinks they do is a fundamental factor underlying most of the more immediate apparent causes of the [nursing] shortage [including], understaffing, poor work conditions, [and] inadequate resources for nursing research and education."

This is bad news for nurses, but worse news for patients. Nurses make the difference in good health care; increased RN staffing decreases the overall patient death rate as well as the rate of hospital acquired pneumonia, falls, pressure ulcers and blood clots after surgery. When nurses show more signs of burnout related to understaffing, postsurgical infections increase.

And there's the hard-to-quantify but essential benefit of being cared for. When I was in the hospital this past January after a life-threatening complication of knee-replacement surgery, I woke up one night in pain and unable to figure out how to move within the many drains, tubes and wires attached to, or inserted in, my body. I muttered an expletive and from around the corner a nurse appeared.

"I'm right here," she said. Even before she started to untangle my IV and troubleshoot better pain management, my panic was instantly calmed.

Baymax's programming won't allow him to disengage until the patient has answered, "Are you satisfied with your care?" in the affirmative. This is inconvenient for the characters in an action adventure movie, but it's a good question to ask in a hospital. If you're satisfied with your care, you may well have a nurse to thank.

Source: www.npr.org

What do all nurses want for this holiday season? We asked the nursing community on Facebook and reddit and we discovered that yes, it’s not necessarily a pair of scrubs. Here are their answers:

1. Better staffing and better nursing jobs

   Top of the list are these answers that we think go hand-in-hand:

   “A job. Going 2 months strong being unemployed (currently living the dream of being a stay at home wife). When I was working: Adequate staffing.” – mogris, from reddit

   “I second the ‘adequate staffing’. I'm a little worried that my Christmas night will be crushingly busy.” – CrossP, from reddit

   “I'm in the same unemployment boat as you. It is not a fun ride. I just want to be someone's nurse again.” – OkieDokieArtichokee, from reddit

   “Better nurse to patient ratio!” – Lisa B., from Facebook

   “Low census and adequate staffing” – nocturnalnurse, from reddit

   When hospitals and other healthcare facilities don’t want to hire more nurses, then obviously there are fewer nursing jobs created. Meanwhile, the existing staff will have to bear a heavier workload.

2. The right to die with dignity

   “Legalized euthanasia.” – Vilalintine, from reddit

   After all, death shouldn’t be something to be afraid of. Controversial as this may sound, sometimes it is the better option for the patient.

3. The company of family and friends, at home or even at work

   All nurses want for Christmas is “to spend it with their families.” – Leslie C., from Facebook

   “To not be pulled to another unit. I'm already away from my home family, don't take me away from my work family too!” – FunkeeBananas, from reddit

   “Word. Worst Christmas ever involved me and another nurse getting pulled to another unit, that nurse crying, my pod mate being a total bitch, and my two being patients sad, sad trainwrecks. Ugh.” – abermanlebt, from reddit

   Who doesn’t want to feel at home this Christmas, even at work?

4. The ability to not get tired

   “Feet that don't hurt after 12hrs.” –Hottiemcgee, from reddit

5. A break during their shift or sometimes a break from nursing itself.

   “A break…” – Nancy G., from Facebook

   “Nonnursey gifts. ;) seriously, get me a new game or help with the gaming PC I'm building and I will love you forever. Or blankets. My husband keeps this apartment freezing! Same there's only do many layers and blankets I can cover up in before it impedes my gaming.” – thackworth, from reddit

   “Steam gift cards and a matched pair of GeForce GTX 980s. ...or is that just me?” – auraseer, from reddit

   Everyone does need a break from nursing once in a while—and that break takes different forms. For some of our nurses, it’s a day of playing their favorite video games. So before you go shopping to get some gifts for nurses, you may want to consider this fact. (Hint: if your nurse friends aren’t gamers, a day of pampering is always nice.)

6. And of course, all nurses want the best for their patient.

   “For the NICU babies to go home with their family.” – kitty-cat-meow, from reddit

   “An empty waiting room.” – A_guy_in_scrubs, from reddit

   No patients means no one’s sick, and hence, no problem!

We’ll end this post with a Christmas carol from rninnj, posted on reddit:

12 filled meds from pharmacy

11 family members leaving

10 toes on a diabetic

9 days off

8 beds ready, no new admissions

7 cups of coffee

6 smiling patients

5 sleeping patients

4 extra staff members

3 patent lines

2 uninterrupted breaks

1 partridge in a pear tree

Wishing all nurses a happy holiday season!

Source: www.nursetogether.com

By David McNamee

Between 1990 and 2013, global life expectancy increased by nearly 5.8 years in men and 6.6 years in women, according to a new analysis of the Global Burden of Disease Study 2013 published in The Lancet.

"The progress we are seeing against a variety of illnesses and injuries is good, even remarkable, but we can and must do even better," says lead author Dr. Christopher Murray, professor of Global Health at the University of Washington. 

"The huge increase in collective action and funding given to the major infectious diseases such as diarrhea, measles, tuberculosis, HIV/AIDS and malaria has had a real impact," he says. 

"However, this study shows that some major chronic diseases have been largely neglected but are rising in importance, particularly drug disorders, liver cirrhosis, diabetes and chronic kidney disease."

The analysis suggests that life expectancies in high-income regions have been increased due to falling death rates from most cancers - which are down by 15% - and cardiovascular diseases - which are down by 22%.

In low-income countries, rapidly declining death rates for diarrhea, lower respiratory tract infections and neonatal disorders have boosted life expectancy.

Despite the increases in global life expectancy by nearly 5.8 years in men and 6.6 years in women, some causes of death have seen increased rates of death since 1990.

These increased causes of death include:

• Liver cancer caused by hepatitis C (up by 125%)
• Atrial fibrillation and flutter (serious disorders of heart rhythm; up by 100%)
• Drug use disorders (up by 63%)
• Chronic kidney disease (up by 37%)
• Sickle cell disorders (up by 29%)
• Diabetes (up by 9%)
• Pancreatic cancer (up by 7%).

HIV/AIDS has 'erased years of life expectancy' in sub-Saharan Africa

The report also points to one notable global region where life expectancy is not increasing. Deaths from HIV/AIDS have erased more than 5 years of life expectancy in sub-Saharan Africa, say the authors. HIV/AIDS remains the greatest cause of premature death in 20 of the 48 sub-Saharan countries.

Since 1990, years of life worldwide lost due to HIV/AIDS is reported as having increased by 334%.

In Syria, war is the leading cause of premature death - the conflict caused an estimated 29,947 deaths in 2013, and up to 54,903 and 21,422 deaths in each of the preceding 2 years.

Countries that the authors consider to have made "exceptional gains in life expectancy" over the past 23 years include Nepal, Rwanda, Ethiopia, Niger, Maldives, Timor-Leste and Iran - where, for both sexes, life expectancy has increased by more than 12 years.

Life expectancy at birth in India increased from 57.3 years for men and 58.2 years for women in 1990 to 64.2 years and 68.5 years, respectively, in 2013. The authors say that India has made "remarkable progress" in reducing deaths, with the death rates for children dropping 1.3% per year for adults and 3.7% per year for children.

The report also welcomes dramatic drops in child deaths worldwide over the study period. In 1990, 7.6 million children aged 1-59 months died, but this death rate was down to 3.7 million by 2013.

Igor Rudan and Kit Yee Chan, from the Centre for Population Health Sciences and Global Health Academy at the University of Edinburgh Medical School in the UK, write in a linked comment:

"Estimates of the causes of the global burden of disease, disability, and death are important because they guide investment decisions that, in turn, save lives across the world.

Although WHO's team of experts have been doing fine technical work for many years, its monopoly in this field had removed incentives to invest more time and resources in continuous improvement [...] the competition between WHO and the GBD [Global Burden of Disease Study] has benefited the entire global health community, leading to converging estimates of the global causes of death that everyone can trust."

 

Source: www.medicalnewstoday.com

NAHN is pleased to present the NAHN National Certification for Bilingual Healthcare Providers Medical Spanish Course & Exam in partnership with Canopy Apps, a health tech company that is improving access to information across language barriers to improve healthcare.

In line with NAHN’s dedication to the professionalism and advancement of Hispanic nurses, the NAHN Medical Spanish Certification offers access to improved provider competencies in Hispanic culture and language. Healthcare providers- both on the individual and organizational level - benefit from increased proficiency in medical Spanish, resulting in the ability to reach individuals who are unable or afraid to get assistance because of linguistic barriers. The acceptance of this credentialing in the provider community on a wide-spread basis has broad-reaching potential, including reduced risk of medication and treatment non-adherence in a growing Hispanic American population with increasing medical needs. 

The NAHN Medical Spanish Course is a comprehensive, self-paced online course covering the essentials of patient-provider communication in Spanish. The medical Spanish knowledge provided in the three-level program results in a provider who can communicate with and provide appropriate care to Hispanic patients. Following the program, the NAHN Medical Spanish Certification exam assesses the ability for an individual to communicate directly with Hispanic patients in a clinical setting without the use of an interpreter. The program offers 18 Continuing Nurse Education (CNE) hours for completion of the course. 

NAHN members receive a discount on both the course and the exam. When registering for the course and/or the exam, please login using the email address from which you received this email to receive your discount. 

Source: http://www.nahnnet.org

By DENNIS THOMPSON

Chickenpox befell Angelina Jolie this week, preventing the actress-turned-director from attending the premiere of her new film.

Meanwhile, an outbreak of mumps has hit the National Hockey League, sidelining more than a dozen players and two referees.

These are considered kids' diseases. Most adults have vivid, fretful childhood memories of standing in line to get vaccinations that they expected to provide lifetime protection.

Why, then, are these prominent adults -- and scores of others -- coming down with these infections?

Mainly, it comes down to two factors, experts say.

Vaccination rates have declined among children in some parts of the United States, increasing everyone's risk of exposure to virulent diseases like chickenpox, measles, mumps and whooping cough, said Dr. Aaron Glatt, a spokesman for the Infectious Diseases Society of America.

"These vaccines are not perfect," said Glatt, who's also executive vice president of Mercy Medical Center in Rockville Centre, N.Y. "If you don't have a perfect vaccine and you couple that with a less-than-ideal number of people getting it, then if one person gets it then it's more likely to spread to others."

On top of that, even adults who got their shots as kids are at risk of contracting these diseases once exposed to them, because the protection provided by childhood vaccinations can fade over time.

"You can be vaccinated for something and have antibodies that wane over time or disappear entirely," said Dr. Len Horovitz, an internist and lung specialist at Lenox Hill Hospital in New York City. "You can have intermittent immunity, or no immunity."

America's public health defense against infectious diseases is built on a concept called "herd immunity," Glatt explained. If enough people are vaccinated against diseases like chickenpox, influenza, mumps and whooping cough, then even those who aren't vaccinated benefit because those who are immune can't spread the disease.

Skepticism over the effectiveness and safety of vaccines has caused vaccine rates to decline in some parts of the country, Horovitz and Glatt said. In those locations, adults with waning or imperfect immunity could fall prey to childhood infectious diseases, particularly if there's an outbreak.

"There is less vaccination going on than there was previously," Glatt said. "These childhood diseases have not gone away, and there is a strong anti-vaccine lobby that plays a role in people's decision to have their children vaccinated."

Since the early 1980s, there has been an overall increasing trend of whooping cough in the United States, said Angela Jiles, a spokeswoman for the federal Centers for Disease Control and Prevention.

Between Jan. 1 and Aug. 16 of this year, the CDC received reports of 17,325 cases of whooping cough, a 30 percent increase from the same time period in 2013 and the most cases seen in six decades, Jiles said.

California is experiencing its worst outbreak of whooping cough in seven decades.

There also have been more reported mumps cases in the United States this year, due to some larger outbreaks, according to the CDC. A reported 1,078 people have contracted mumps in 2014, compared with 438 the year before. In 2006 -- the worst year in recent history -- there were 6,584 cases of mumps, largely due to outbreaks on college campuses, according to the CDC.

No one has said how Jolie might have contracted chickenpox, but many of the NHL players appear to have gotten mumps from each other, despite efforts by the hockey league to get players vaccinated.

A single dose of mumps vaccine is about 80 percent effective, and two doses is about 90 percent effective, Amy Parker Fiebelkorn, an epidemiologist with the CDC's measles, mumps, rubella and polio team, told The New York Times.

"There is no vaccine that's 100 percent effective," Fiebelkorn said. "There is some margin for fully vaccinated individuals to still be infected with mumps if they're exposed to the virus."

Unfortunately, adults who contract these diseases are in for a rougher ride than children. They are more likely to develop serious complications, and are at higher risk of death, Glatt and Horovitz said.

These viruses also can increase a person's risk of future illness. For example, chickenpox patients like Jolie have a lifetime risk of shingles, a disease that can cause terrible rashes and intense nerve pain. The chickenpox virus hides in deep reservoirs inside the human body, and then emerges later in life to cause shingles.

Concerned adults can ask their doctor for a blood test that will check their antibodies and see if they remain immune to these infectious diseases, Horovitz said.

"It's something that could be done in the course of your annual exam. It takes no more than an extra tube or two of blood," the same as regular checks for blood sugar and cholesterol, he said. "It would be particularly important for people with chronic medical conditions or who do a lot of foreign travel where these diseases are running rampant."

People also can talk with their doctor about vaccinations that are recommended for adults. For example, the CDC recommends that adults get a booster shot every 10 years for tetanus, diphtheria and whooping cough, as well as an annual flu shot.

Source: www.cbsnews.com

A paralysed woman who controlled a robotic arm using just her thoughts has taken another step towards restoring her natural movements by controlling the arm with a range of complex hand movements.

Thanks to researchers at the University of Pittsburgh, Jan Scheuermann, who has longstanding quadriplegia and has been taking part in the study for over two years, has gone from giving "high fives" to the "thumbs-up" after increasing the manoeuvrability of the robotic arm from seven dimensions (7D) to 10 dimensions (10D).

The extra dimensions come from four hand movements--finger abduction, a scoop, thumb extension and a pinch--and have enabled Jan to pick up, grasp and move a range of objects much more precisely than with the previous 7D control.

It is hoped that these latest results, which have been published today, 17 December, in IOP Publishing's Journal of Neural Engineering, can build on previous demonstrations and eventually allow robotic arms to restore natural arm and hand movements in people with upper limb paralysis.

Jan Scheuermann, 55, from Pittsburgh, PA had been paralysed from the neck down since 2003 due to a neurodegenerative condition. After her eligibility for a research study was confirmed in 2012, Jan underwent surgery to be fitted with two quarter-inch electrode grids, each fitted with 96 tiny contact points, in the regions of Jan's brain that were responsible for right arm and hand movements.

After the electrode grids in Jan's brain were connected to a computer, creating a brain-machine interface (BMI), the 96 individual contact points picked up pulses of electricity that were fired between the neurons in Jan's brain.

Computer algorithms were used to decode these firing signals and identify the patterns associated with a particular arm movement, such as raising the arm or turning the wrist.

By simply thinking of controlling her arm movements, Jan was then able to make the robotic arm reach out to objects, as well as move it in a number of directions and flex and rotate the wrist. It also enabled Jan to "high five" the researchers and feed herself dark chocolate.

Two years on from the initial results, the researchers at the University of Pittsburgh have now shown that Jan can successfully manoeuvre the robotic arm in a further four dimensions through a number of hand movements, allowing for more detailed interaction with objects.

The researchers used a virtual reality computer program to calibrate Jan's control over the robotic arm, and discovered that it is crucial to include virtual objects in this training period in order to allow reliable, real-time interaction with objects.

Co-author of the study Dr Jennifer Collinger said: "10D control allowed Jan to interact with objects in different ways, just as people use their hands to pick up objects depending on their shapes and what they intend to do with them. We hope to repeat this level of control with additional participants and to make the system more robust, so that people who might benefit from it will one day be able to use brain-machine interfaces in daily life.

"We also plan to study whether the incorporation of sensory feedback, such as the touch and feel of an object, can improve neuroprosthetic control."

Commenting on the latest results, Jan Scheuermann said: ""This has been a fantastic, thrilling, wild ride, and I am so glad I've done this."

"This study has enriched my life, given me new friends and co-workers, helped me contribute to research and taken my breath away. For the rest of my life, I will thank God every day for getting to be part of this team."

Source: www.sciencedaily.com

At birth, a newborn baby is still attached to its mother through the umbilical cord, which is either cut very early - within the first 60 seconds - or later, with some women opting to wait until after the cord has stopped pulsating. Though the right timing for cutting the cord - also referred to as clamping - is widely debated, a new study suggests delaying cord clamping by 2 minutes results in better development for the newborn during the first days of life.

What do you think about it? Do you think the 2 minutes makes a difference? Perhaps you can share a personal and/or professional experience about this.

The research, carried out by scientists from the University of Granada and the San Cecilio Clinical Hospital in Spain, is published in the journal Pediatrics, the official journal of the American Academy of Pediatrics (AAP).

According to the American Congress of Obstetricians and Gynecologists (ACOG), the reason that cord clamping timing is so controversial is that a previous series of studies into blood volume changes after birth concluded that in healthy term infants, more than 90% of blood volume was attained within the first few breaths he or she took after birth.

As a result of these findings, as well as a lack of other recommendations regarding optimal timing, the amount of time between birth and umbilical cord clamping was widely shortened; in most cases, cord clamping occurs within 15-20 seconds after birth.

However, before these studies, in the mid-1950s, cord clamping within 1 minute of birth was defined as "early clamping," and "late clamping" was defined as more than 5 minutes after birth. And the ACOG have stated that "the ideal timing for umbilical cord clamping has yet to be established."

Meanwhile, the World Health Organization (WHO) advocate for late cord clamping (between 1-3 minutes after birth), as it "allows blood flow between the placenta and neonate to continue, which may improve iron status in the infant for up to 6 months after birth."

Waiting 2 minutes increased antioxidant capacity

To provide further evidence in the debate of early versus late cord clamping, the researchers from this latest study, led by Prof. Julio José Ochoa Herrera of the University of Granada, assessed newborn outcomes for infants born to 64 healthy pregnant women to determine the impact of clamping timing on oxidative stress and the inflammatory signal produced during delivery.

All of these women had a normal pregnancy and spontaneous vaginal delivery. However, half of the women's newborns had their umbilical cord cut 10 seconds after delivery and half had it cut after 2 minutes.

Results revealed beneficial effects of late cord clamping; there was an increase in antioxidant capacity and moderation of inflammatory effects in the newborns.

Commenting further, Prof. Ochoa says:


"Our study demonstrates that late clamping of the umbilical cord has a beneficial effect upon the antioxidant capacity and reduces the inflammatory signal induced during labor, which could improve the development of the newborn during his or her first days of life."

He adds that umbilical cord clamping is one of the most frequent surgical interventions practiced in humans, with proof of the practice dating back centuries. 

Early clamping 'not advised unless newborn needs resuscitation'

With evidence of benefits for delayed cord clamping, however, why are most newborns separated from the placenta within 15-20 seconds after birth? According to the ACOG, there are concerns over universally adopting delayed clamping because it could "jeopardize timely resuscitation efforts, if needed, especially in preterm infants."

"However," the organization states, "because the placenta continues to perform gas exchange after delivery, sick and preterm infants are likely to benefit most from additional blood volume derived from a delay in umbilical cord clamping."

There are also other concerns regarding delayed cord clamping, including an increased potential for "excessive placental transfusion, which can lead to neonatal polycythemia" - an abnormally high level of red blood cells. This is especially of concern in the presence of risk factors including maternal diabetes, intrauterine grown restriction and high altitude.

Another concern stated by the ACOG is that delayed umbilical cord clamping "may be technically difficult in some circumstances."

Still, the WHO say late cord clamping is recommended for all births, and the improved iron status associated with it "may be particularly relevant for infants living in low-resource settings with reduced access to iron-rich foods."

The organization clearly states that early cord clamping - less than 1 minute after birth - is not advised unless the newborn is asphyxiated and needs to be moved for resuscitation.

Source: www.medicalnewstoday.com

By SYDNEY LUPKIN

What does a 9-year-old want after being struck by lightning and forced to spend three months in the hospital? He wants to cuddle his dog and set up his family's Christmas tree.

"He made me do it the first day I was home on Friday," the boy's father, Roger Hermann, told ABC News. "He can't move his legs, but he was directing some of the ornament placement."

Alex Hermann was on a soccer field in Austin, Texas, on Aug. 26, when a bolt of lightning struck him and stopped his heart. He suffered burn wounds and hypoxia, which is when the brain can't get enough oxygen.

Over the next three months, Alex underwent skin-grafting and wound-closure surgeries, as well as cardiac ablation, which corrects heart arrhythmias, at Dell Children's Medical Center of Central Texas. He still has a "number of issues" to address over time, but he's improving.

Although the hospital staff was great, Hermann said, Alex became homesick. Hermann added that he and Alex's mother promised that if he worked hard in therapy, they would try to get him home for Christmas.

Alex was also reunited with his beloved dog, a Catahoula Australian shepherd named Spice, who seemed pleased to have her buddy back.

"She sleeps on the bed with him," Hermann said. "She’s been guarding him."

Source: http://abcnews.go.com

By Meera Senthilingam

Its name means "bending over in pain." It has no treatment or vaccine. Its symptoms resemble Dengue fever. And it has infected more than 1 million people -- 155 of them fatally -- since spreading to the Americas one year ago.

The mosquito-borne Chikungunya virus has long been diagnosed in travelers returning from countries in Asia and Africa, where the disease is widespread. But in December 2013, the first people infected by mosquitoes local to the region were reported on the Caribbean island of Saint Martin.

This was the first outbreak of the debilitating disease in the Western hemisphere, health officials said.

All countries in Central America have now reported local transmission of Chikungunya [pronounced chik-un-GOON-ya], and the United States had 11 confirmed cases of local infection this year as of December 12, all in the state of Florida. There also have been 1,900 imported cases across the U.S. in returning travelers.

"It wasn't until 2013 that unfortunately a traveler resulted in local transmission of Chikungunya," said Erin Staples of the U.S. Centers for Disease Control (CDC), referring to the people infected in Saint Martin.

Those infected carry the virus in their bloodstream; it can then be picked up by mosquitoes as they bite, making them carriers. The virus has since spread rapidly and shows no signs of leaving, as ecological conditions are perfect for the disease to flourish.

"We knew it would spread," said Staples, a medical epidemiologist.

The big question perplexing officials: Why now?

Two mosquito species primed to the temperatures of Central and South America carry Chikungunya. The species -- Aedes aegypti and Aedes albopictus -- also carry the virus behind Dengue fever.

"Given the level of Dengue in the region, we knew there could be the same levels of Chikungunya," Staples said. Both diseases can cause joint pain and inflammation, headaches, rashes and fever, and can lead to death in rare cases.

But this tropical disease with an exotic name (which originates from the African Makonde dialect) causes more intense joint pain and inflammation. For some people the pain can last for months or years, resulting in additional psychological strain.

The lack of immunity among people living in the Americas provided a blank canvas for Chikungunya to spread throughout the population this year. As of December 12, more than 1.03 million people have been infected, in addition to the 155 who died, according to the Pan-American Health Organisation (PAHO). Almost all of the fatalities occurred in the Caribbean island countries of Guadaloupe and Martinique.

"Where we saw the biggest jump was after it reached the Spanish-speaking countries in the region," said Staples, referring to the weakened infrastructures and health systems of countries such as the Dominican Republic, which has reported more than 520,000 cases -- more than half of the overall outbreak and 5% of the island country's population.

As South American countries approach their summer, numbers are expected to rise there as the mosquitoes flourish in the heat.

"Brazil, Peru, Paraguay are coming into their summer months and reporting their first local transmission," Staples said. Already, more than 2,000 people have been infected in Brazil.

Is there cause for concern?

Because infection with Chikungunya is rarely fatal, the issue of most concern to officials is the burden on health services and the impact of the debilitating symptoms on the economy.

"The high number of cases can overload health services," says Dr. Pilar Ramon-Pardo, regional adviser for PAHO, the regional office of the World Health Organization. Until recently, monitoring for Chikungunya was not part of routine surveillance in the region.

"Clinicians have to be ready to diagnose," she said

About 20% to 30% of cases are expected to become chronic, with symptoms such as arthritis and other rheumatic manifestations leading to physical disabilities, Ramon-Pardo said. Further long-term effects are psychological as people become more depressed and tired.

All of this can result in missed work and lower school attendance, she said, hurting local economies.

Is it here to stay?

The warm climate of the region offers potential for Chikungunya levels to be maintained for years to come, just like Dengue fever. But areas of most concern are the tropics.

"The areas which have year-round favorable climate for the mosquito are at the greatest risk," says Dr. Laith Yakob of the London School of Hygiene and Tropical Medicine, which is monitoring the spread of the outbreak.

While the climate and mosquitos have long been present, Ramon-Pardo said, "we don't know why this is happening now." She said globalization is likely to blame, with increased population movement from one country to another. This offers more opportunities for local mosquitos to bite infected humans.

The CDC's Staples said she is temporarily at ease regarding numbers in the U.S. "We're moving into fall and winter periods, which should see activity decrease," she said. Cold temperatures reduce mosquito survival rates.

The rapid spread of Chikungunya this year also could help minimize future infections. "Chikungunya will go through a region quite rapidly and create a level of population immunity which helps mitigate large outbreaks of the disease," Staples said. Unlike Dengue, infection with Chikungunya results in lifelong immunity.

Like many other infections, Chikungunya could, however, remain in the background through animals capable of carrying the virus in their bloodstream and acting as so-called reservoirs of the disease.

"In Asia and Africa there is a transmission cycle in small mammals and monkeys," Ramon-Pardo said, meaning these animals keep the virus present within the population. "In the Americas ... we don't know yet."

Those words -- "we don't know" -- resonate throughout the community of scientists and government officials trying to control the outbreak.

The future risk of spread, levels of future immunity, risk from animal reservoirs, why this is only happening now, and the total economic impact are all unknown.

"Mathematical models are under construction by numerous research groups around the world to improve confidence over projections of future spread," said Yakob, whose team is modeling the disease. As they work, control efforts continue.

Getting it under control

When it comes to controlling Chikungunya, there are two main strategies -- reduce the likelihood of bites and remove the ever-biting mosquito. Prevention is the priority.

Unlike the mosquitoes behind malaria, which bite at night, the species behind Chikungunya bite any time, day or night. Those living in affected areas are asked to use repellent, sleep under bed nets and wear long clothing to avoid getting bitten. The air conditioned and indoor environments of people living in the U.S. mean numbers are likely to stay low there.

But mosquito control is at the heart of it all. Mass spraying of insecticides and removal of any sources of shallow water in which mosquitoes can breed are taking place across the continents. According to the CDC's Staples, Florida has been highly aggressive with its approach to control. "We're only at 11 (cases) due to such proactive measures," Staples said. For now, prevention is all they have as officials wait and see how the outbreak pans out.

"There is no vaccine currently and no good antivirals, so we are trying to control the spread of the disease," Staples said. "There are a lot of questions and only time will tell what we'll see for Chikungunya in the future."

Source: www.cnn.com

By Terri Peters

When 2-year-old Ryan Aprea had cochlear implant surgery in November, his mom, Jennifer, says she wasn’t sure what to expect when the device was activated a month later.

Aprea shared the moment last week in a video that has now gone viral. In the clip, the Huntington Beach, California, mom says, “Hi, Buddy,” to her son, and is rewarded with a reaction she calls “amazing” — a fit of giggles from her little boy.

Born as a micro preemie at only 25 weeks gestation, Aprea says Ryan began his life with a seven-month stay in the neonatal intensive care unit, where she and her husband learned that he was deaf shortly before his discharge.

But a cochlear implant offered hope.

“We went into the appointment not knowing if he would respond at all. Throughout this process, they had informed us that while sound would enter his brain, every child has a different response. We weren’t sure if his brain would process the sound, but we wanted to give him a chance to hear us and communicate because he is also visually impaired,” said Aprea.

Aprea, who has posted frequently about the cochlear implant process on the Facebook page of her cloth diaper supply company, tells TODAY Parents that since the activation, Ryan has been doing great — exploring toys that make sounds for the first time and taking in his surroundings with his newfound ability to hear.

“He’s been interacting with us and giving us more intentional eye contact just in the few days since he’s had it turned on. My heart melts every single time he looks at me,” said Aprea.

As for future plans for Ryan’s treatment, Aprea says she and her family are taking things one day at a time. The mother of two says she’s looking forward to taking her son for a drive to look at holiday lights while listening to Christmas music — a tradition her family shares every year, but one that will have new meaning this season.

Aprea says she is shocked that her video has gone viral, adding that she looks forward to seeing more people learn about cochlear implants as videos and articles about stories like Ryan’s become more prevalent.

She’s heard a lot of strong opinions about cochlear implants from online commenters — including some negative ones — and offers some advice to parents dealing with big decisions about their child’s health care.

“You know your child better than anyone — I learned that one in the NICU. You need to do what’s best for him or her and give them every opportunity available to succeed in life. I would say, do a lot of research, talk to people who have been through it with their own kids, and then go with your heart,” she said.

Source: www.today.com

By Kimberly Yam

This little girl received a boost of confidence from a Disney princess that made her feel like she was in a fairy tale.

Isabella Harvey, 5, of Staten Island, New York, was first diagnosed with leukemia in January 2013, and while she went into remission for over a year, she relapsed this September and needed aggressive chemotherapy. The 5-year-old's hair began falling out, making her upset at her appearance.

"She was embarrassed," Isabella's mother, Pina told The Huffington Post in an email. "When her hair fell out the first time she was 3 so she really didn't understand. But now she is 5 and was having a hard time dealing with it."

In an effort to get Isabella to see herself in a more positive light, Pina reached out to Gianna Nicole’s Heart of Hope, an organization which helps families whose children are battling cancer. The charity teamed up with Bella Princess LLC, a princess party company to set up a photo shoot late last month for Isabella -- complete with special guest, Cinderella. The model who dressed as the Disney princess donned a bald cap, and showed the young cancer patient that she had nothing to be insecure about.

"After all she went through ... it was such an amazing feeling seeing her so happy," Pina told HuffPost.

Before finding out that Cinderella would be attending her special day, Isabella, who was accompanied by her siblings, was hesitant to participate in the photo shoot, uncomfortable with showing her head.

"At first she didn't want to go. Then, she said she would go with a hat on, and when we got there she still refused to take off her hat," Pina said about of her daughter's uneasiness.

It all changed, however, when Cinderella walked in, confident even without hair.

"She said, "she looks just like me!'" Alana Hubbard, the photographer behind Mother Hubbard Photography who shot the images, told HuffPost.

Pina added, "Her face lit up and seemed to relax a little. Isabella took off her hat. She was so happy and seemed more at ease taking pictures."

The photo shoot ended up having quite an effect on the 5-year-old, who recently saw the pictures for the first time.

"It re-enforces what I tell her every day -- that she is beautiful. That photo shoot just made her realize everyone feels the same way as [I do]," Pina told HuffPost.

Hubbard says she's ecstatic to hear about Isabella's newfound confidence, and hopes that the pictures will provide others going through the same thing with some comfort.

"We're really hoping that it shows other little girls who may be going through cancer too, that you can be a perfect princess with or without hair," Hubbard said.

Source: www.huffingtonpost.com

By Tony Marco and Catherine E. Shoichet

 It started with a sore throat on Thanksgiving and an antibiotic from a friend who wanted to help.

Now 19-year-old Yaasmeen Castanada is fighting for her life inside a California hospital's burn unit, suffering from an allergic reaction that's so severe she has large open wounds all over her body.

"It is heartbreaking, every day is a different look. Every day, she's like, shedding away. ... Overnight, it's a whole different person that you're looking at," Martha Hughes, Castanada's aunt, told CNN affiliate KABC.

Doctors diagnosed Castanada with Stevens-Johnson Syndrome, a rare disease that can be triggered by antibiotics or other medications.

"When she took the medication, she started having a hard time breathing, and she told her mom that her lips were burning, her throat, her eyes, they got so red that she couldn't talk. So she rushed her to the ER, and that's when they diagnosed her with the disease. And from there it has just spiraled to a nightmare," Hughes said.

Now Castanada, the mother of a 4-month-old, is in critical condition at the University of California, Irvine, burn center.

Her prognosis is good, even though the disease has a high mortality rate, according to Dr. Victor Joe, the center's director.

But the situation, Castanada's family says, has been devastating.

"Just unreal, just watching your daughter burn in front of you, literally, burn in front of you," her mother, Laura Corona, told KABC. "Every day, a new blister, a new burn, a new scar. And she's just, 'Mommy, I want to go home.' And I can't take her home. I can't put water on her lips."

Mom: 'Don't share medication'

On a website created to raise funds for Castanada's care, her mother said the harrowing ordeal began soon after her daughter took the medicine.

"A friend offered her an antibiotic pill that she had from a previous illness," Corona wrote. "She was thinking that it would help her. This would be the biggest mistake of her life."

Now, Corona says she's hoping to spread the word so others don't make the same mistake.

"Don't share medication. Don't give someone else your medication. Don't offer medication," she said.

She also advises parents to find out what their children are allergic to -- before it's too late.

Doctor: Reaction causing skin to separate

At first, doctors diagnosed Castanada with Stevens-Johnson Syndrome, which refers to a condition where between 10% and 30% of the skin on the body is affected, Joe said. Now she's experiencing Toxic Epidermal Necrolysis, the diagnosis when more than 30% of the body is affected. Joe estimates that 65% of Castaneda's skin and mucus membranes have been affected.

The allergic reaction is causing layers of Castaneda's skin to separate, Joe said, creating lesions that grow into large open wounds.

"Patients can experience problems with taste, swallowing, eyesight and sexual functions can be affected. In Yaasmeen's case, we are particularly concerned because her eyes have been affected. This can cause scarring of the corneas, which could lead to permanent blindness," he said. "We are trying to prevent that from happening."

Photos on the fundraising website show Castanada lying in a hospital bed, with openings for her eyes cut from the bandages that cover her.

As part of her treatment for the disease, doctors have wrapped her body in a special dressing, Joe said.

"We have chosen to place a dressing that adheres to the open wound, which allows her skin to heal without having to remove the bandages to wash the wounds," he said.

Mortality for those suffering from Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis can be as high as 25% in adults, but tends to be lower with early treatment, according to the Merck Manual.

Though it's uncommon, Joe said his hospital has treated around six cases in the past year, because the burn center has experience treating open wounds.

"This is very sobering. The fact that you can get a life-threatening situation from taking a medication. It can happen, and most people don't think twice about taking pills for things," Joe said. "In fact, most of the time you do have some sort of side reaction to medication, just not this severe."

After recovering from Stevens-Johnson Syndrome, patients usually only have minor issues with their skin, such as dryness, Joe said.

"Hopefully new skin will come in," Corona told KABC. "I'm just there watching. All I can tell her is, "Hang on, hang on. It's almost over.'"

Source: www.cnn.com

By Jen Christensen and Elizabeth Cohen

A young Liberian woman who saved three of her relatives by nursing them back to health after they contracted the Ebola virus is coming to the United States to finish her nursing degree.

The news comes as Time magazine announced Wednesday that its "Person of the Year" honors go to the Ebola fighters, the "unprecedented numbers" of doctors and nurses who responded when Ebola overtook an already-weak public health infrastructure this year in West Africa.

Fatu Kekula is not named in the article, but she definitely holds a place among those being honored.

The 22-year-old, who was in her final year of nursing school earlier this year, single-handedly took care of her father, mother, sister and cousin when they became ill with Ebola beginning in July.

And she did so with remarkable success. Three out of her four patients survived. That's a 25% death rate -- considerably better than the estimated Ebola death rate of 70%.

Kekula stayed healthy, which is noteworthy considering that hundreds of health care workers have become infected with Ebola, and she didn't even have personal protection equipment -- those white space suits and goggles used in Ebola treatment units.

Instead, Kekula invented her own equipment. International aid workers heard about her "trash bag method" and taught it to other West Africans who can't get into hospitals and don't have protective gear of their own.

Every day, several times a day for about two weeks, Kekula put trash bags over her socks and tied them in a knot over her calves. Then she put on a pair of rubber boots and then another set of trash bags over the boots.

She wrapped her hair in a pair of stockings and over that a trash bag. Next she donned a raincoat and four pairs of gloves on each hand, followed by a mask.

It was an arduous and time-consuming process, but she was religious about it, never cutting corners.

UNICEF Spokeswoman Sarah Crowe said Kekula is amazing.

"Essentially this is a tale of how communities are doing things for themselves," Crowe said. "Our approach is to listen and work with communities and help them do the best they can with what they have."

She emphasized, of course, that it would be better for patients to be in real hospitals with doctors and nurses in protective gear -- it's just that those things aren't available to many West Africans.

No one knows that better than Kekula.

Her Ebola nightmare started July 27, when her father, Moses, had a spike in blood pressure. She took him to a hospital in their home city of Kakata.

A bed was free because a patient had just passed away. What no one realized at the time was that the patient had died of Ebola.

Moses, 52, developed a fever, vomiting and diarrhea. Then the hospital closed down because nurses started dying of Ebola.

Kekula took her father to Monrovia, the capital city, about a 90-minute drive via difficult roads. Three hospitals turned him away because they were full.

She took him back to another hospital in Kakata. They said he had typhoid fever and did little for him, so Kekula took him home, where he infected three other family members: Kekula's mother, Victoria, 57; Kekula's sister, Vivian, 28, and their 14-year-old cousin who was living with them, Alfred Winnie.

While operating her one-woman Ebola hospital for two weeks, Kekula consulted with their family doctor, who would talk to her on the phone, but wouldn't come to the house. She gave them medicines she obtained from the local clinic and fluids through intravenous lines that she started.

At times, her patients' blood pressure plummeted so low she feared they would die.

"I cried many times," she said. "I said 'God, you want to tell me I'm going to lose my entire family?' "

But her father, mother, and sister rallied and were well on their way to recovery when space became available at JFK Medical Center on August 17. Alfred never recovered, though, and passed away at the hospital the next day.

"I'm very, very proud," Kekula's father said. "She saved my life through the almighty God."

Her father immediately began working to find a scholarship for Kekula, so she could finish her final year of nursing school. But the Ebola epidemic shut down many of Liberia's schools, including hers.

After a story about Kekula ran on CNN in September, many people wanted to help her.

A non-profit group called iamprojects.org also got involved.

With some help, Kekula applied to Emory University in Atlanta, the campus with the hospital that has successfully cared for American Ebola patients. Emory accepted the young woman so that she could complete her nursing degree starting this winter semester.

In order to attend, iamprojects will have to raise $40,000 to pay for her reduced tuition rate, living expenses, books and her travel and visa so that she can travel between Africa and the United States.

Kekula's father has no doubt that his daughter will go on to save many more people during her lifetime.

"I'm sure she'll be a great giant of Liberia," he said.

Source: www.cnn.com

A nine-year-old horse has become a surprise hit at care homes across England.

Do you think this type of therapy will be used in America's future?

Rupert is a regular visitor to residential homes, where he entertains and interacts with aging residents.

Equine therapy has been shown to reduce stress and improve hand-eye coordination.

 Source: www.goodnewsnetwork.org

By John Gever

Not all children with severe brain injuries need to be monitored for subclinical seizures, researchers said here, which means that resources can be focused on those at the highest risk.

Victims of abuse, those younger than 2, and those with bleeding within the brain rather than only in the epidural compartment are the pediatric ICU patients most likely to show significant seizure activity that should be detected and treated, said Rajsekar Rajaraman, MD, of the University of California Los Angeles (UCLA).

A separate study by many of the same investigators also found that, in a broader range of pediatric brain injury cases, risk of seizures could be predicted with "fair-to-good" accuracy on the basis of clinical characteristics that would be recorded routinely at admission.

Both studies were reported at the American Epilepsy Society's annual meeting here.

A senior author on both studies, Nicholas Abend, MD, of Children's Hospital of Philadelphia, said at an AES press briefing that identifying and treating seizures is important in the pediatric ICU. When seizures are extremely frequent or long-lasting -- and these can easily go without detection in hospitalized children who are unconscious or lethargic -- they significantly increase the likelihood of poor short- and long-term outcomes.

Such seizures can only be detected via continuous EEG monitoring, Abend explained, which also requires interpretation from trained electroneurologists.

Another investigator in the studies, UCLA's Jason Lerner, MD, noted that children may appear to be napping peacefully while actually undergoing continuous seizures.

Although it would be desirable to perform intense monitoring on all pediatric cases involving head trauma, that is not feasible at most centers, Abend said. He said the field could benefit from risk-stratification models that would allow the care team to track only those patients at the highest risk for damaging subclinical seizures.

Such models, he added, could be tailored to meet the needs of individual centers on the basis of their patient mix, staffing, and other factors.

In a platform session at AES, Rajaraman described one approach to developing such a model. He and colleagues collected data on 135 consecutive pediatric patients (ranging in age from infant to late adolescent) with traumatic brain injury who were treated in ICUs at UCLA and at Children's Hospital of Colorado in Denver. These children had continuous EEG monitoring for detecting subclinical seizures.

They found that all such seizures occurred in children younger than 2 and in those with intradural bleeding, and that the vast majority also involved abusive head trauma. Rajaraman and colleagues then sought to validate these associations in a separate cohort of 44 pediatric ICU patients with head injuries treated at Children's Hospital of Philadelphia. The same patterns were seen.

Across both cohorts, 81% of those with subclinical seizures were determined to have been victims of abusive head trauma, whereas the prevalence of such trauma in all the patients was 25%. Abend said it was uncertain why abusive trauma should be such a strong predictor of these seizures, but speculated that "shaken baby syndrome" -- the most common form of abuse of infants and toddlers -- may produce fundamentally different injuries in the brain compared with falls and car accidents.

Also, such abuse is often chronic, such that the episode that brings a child to the hospital is only the latest in a series of abusive incidents.

The other study, led by Abend, was aimed at producing a predictive model yielding a risk index score that pediatric centers could use to identify critically ill children who could benefit the most from continuous EEG monitoring. It was based on clinical information to which the attending neurologist would have ready access: age, seizure etiology, presence of clinical seizures prior to beginning continuous EEG, initial EEG background category, and interictal discharge category.

Data to design the model were drawn from a database of 336 patients from 11 centers, and then tested against a separate validation dataset of 222 patients treated at Children's Hospital of Philadelphia.

Normalized scores in the model could range from 0 to 1.0, and Abend and colleagues examined the sensitivity and specificity of various cutoffs. When set at 0.10 in the validation cohort, sensitivity was 86% but sensitivity was only 58% -- the high sensitivity meant that 43% of patients would be identified as candidates for continuous monitoring. At the other end, a cutoff of 0.45 reversed the sensitivity and specificity percentages to 19% and 97%, respectively, such that only 5% of patients would be assigned to monitoring.

Abend said the beauty of this approach is that an individual center could choose its own optimal cutoff depending on the resources it has available to monitor multiple patients at one time. A well-equipped and staffed ICU could thus opt for high sensitivity whereas one with more limited resources could be more restrictive.

Source: www.medpagetoday.com

Jessica Zegre-Hemsey, a cardiac monitoring expert at the University of North Carolina at Chapel Hill, and her colleagues at the University of California San Francisco, revealed more than 2.5 million alarms were triggered on bedside monitors in a single month - the first figure ever reported from a real-world hospital setting.

Alarm fatigue occurs when nurses and other clinicians are exposed to a high number of physiological alarms generated by modern monitoring systems. In turn, alarms are ignored and critical alarms are missed because many alarms are false or non-actionable.

The work, the first of its kind to investigate the frequency and accuracy of alarms, addresses a growing patient safety issue that has gained national attention in recent years when a patient died despite multiple alarms that indicated low heart rate. The issue also addresses hidden downsides to modern monitoring technologies.

"Current technologies have been instrumental in saving lives but they can be improved," said Zègre-Hemsey, who is an assistant professor at the UNC-Chapel Hill School of Nursing. "For example, current monitoring systems do not take into account differences among patients. If alarm settings were tailored more specifically to individuals that could go a long way in reducing the number of alarms health care providers respond to."

Zègre-Hemsey and her colleagues collected alarm data on 461 adults in five intensive care units at the UCSF Medical Center for a period of 31 days. Zègre-Hemsey was one of four scientists who analyzed the alarms and helped to determine if they were true or false.

Investigators analyzed a subset of 12,671 arrhythmia alarms, which are designed to alert providers to abnormal cardiac conditions, and found 88.8 percent were false positives. Most of the false alarms were caused by deficiencies in the computer's algorithms, inappropriate user settings, technical malfunctions, and non-actionable events, such as brief spikes in heart rate, that don't require treatment.

A potential solution the researchers suggested would be to design monitors that could be configured to individual patients. No two bodies are exactly the same, and if the monitors could be adjusted to a patient's unique vital signs, the machines would not mistake a normal condition for an abnormal one. A "gold standard" database of annotated alarms could also help developers create computer algorithms that are less sensitive to artifacts.

According to Zègre-Hemsey, reducing alarm fatigue will ultimately require strong collaborations between clinicians, engineers, and hospital administrators as well as additional research.

"Alarm fatigue is a large and complex problem," she said. "Yet the implications are far-reaching since sentinel events like patient death have been reported. This is a current patient safety crisis."

The study was led by primary investigator Barbara J. Drew at UCSF. Co-authors on the paper include UCSF researchers Patricia Harris, Daniel Schindler, Rebeca Salas-Boni, Yong Bai, Adelita Tinoco, Quan Ding, and Xiao Hu from the UCSF department of physiological nursing and Tina Mammone from the UCSF department of nursing.

Source: www.medicalnewstoday.com

By Elizabeth Kiefer

Brittany Wenger is one seriously smart cookie. In 2012, the then-17-year-old submitted her "artificial brain" technology -- which assesses tissue samples for breast cancer -- to the Google Science Fair and walked away with the grand prize. It was no wonder: Her invention, which uses a type of computer program called neural networks, can identify complex data patterns and make breast cancer detection calls with 99 percent accuracy. But she's not stopping there: Brittany hopes to help wipe out cancer completely.

Since she took home the gold two years ago, she's been named one of Time's 30 Under 30, given a truly inspiring TED Talk, and launched her app, Cloud4Cancer, which allows doctors to enter their own data and fuel continued cancer research. And did we mention she's also holding down a full course load at Duke University? Um, yeah. 

We recently chatted with Brittany about how she got started, her challenges along the way, and how she balances being a college student with breaking the barriers of cancer diagnostics.

How did you get into computer programming?

When I was in 7th grade I took an elective class on futuristic thinking. When we were assigned our final paper, I decided to write mine on technology of the future. The moment I started researching artificial intelligence and its transcendence into human knowledge, I was inspired. I went out and bought a coding textbook, and taught myself how to code. I remember one of the first projects that I ever worked on was an artificial neural network that taught people how to play soccer.

You're a self-taught coder who went on to create a potentially game-changing cancer detection tool. How did that happen?

Well, it definitely didn't happen overnight. I spent over five years working with neural networks, starting with an entire year of research to try and recognize patterns and connect breast cancer to artificial intelligence. I faced a lot of roadblocks along the way, as this was a very complicated program with no predefined solution. I went through thousands of pages of coding and data that was available through public domains, and performed over 7.6 million test trials. I two failed projects before finally succeeding on my third attempt, taking what didn't work the first few times to optimize the code that helped build the Cloud4Cancer app.

Why did you decide on developing breast cancer detection technology?

When I was 15, my cousin was diagnosed with breast cancer. I have a very close-knit family, so seeing the impact that the disease can have on a woman and her family, firsthand, was so real to me. When I learned that one in eight women will be diagnosed with breast cancer in their lifetime, I knew that I wanted to get involved in making the process better for patients. Now, the coding that I first used to help detect breast cancer has been extended into diagnosing other types of cancers, including blood-based diseases like leukemia.

What's been the most rewarding part of the process?

The people. I've already had the opportunity to work with real patients and breast cancer survivors, as well as talk with kids who are interested in doing research or coding in the future. Knowing that my cloud application has the potential to save lives and expedite the process of discovery is so rewarding. I still get chills thinking about how, a couple of years down the line, my research can actually contribute to finding the cure for cancer.

You've got a lot on your plate these days, between Cloud4Cancer and school. How do you balance everything?

The great thing about where I am with school right now is that my schedule is entirely what I make it. I can attend classes during the week and then travel over some weekends. School is not something that I will ever bend on, as I'm actually going for my MD, PhD in pediatric oncology. At the same time, my initiative is so important to me, I don't want either one to ever outweigh the other. Luckily, I think they complement each other well and what I'm learning in my classes helps me improve Cloud4Cancer.

What's one thing you want other young women to know if they're thinking about going the tech route?

If you're interested, go for it! There have never been so many available resources or opportunities -- for women, and for society as a whole -- to pursue a career in the field. I love how technology allows you to make new things by putting together the little pieces and working towards something bigger that can really benefit the world. There's no greater feeling than solving a problem and seeing your code come to life.

Source: www.huffingtonpost.com

By GILLIAN MOHNEY

A Colorado family welcomed a larger-than-expected bundle of joy when their newborn daughter was born weighing almost 14 pounds.

Mia Yasmin Hernandez tipped the scales at 13 pounds, 13 ounces after her delivery Monday at San Luis Valley Hospital in Alamosa, Colorado. The newborn’s father, Francisco Garcia, said doctors had estimated the baby would weigh 8 pounds at birth.

Mia didn't seem especially large when she was born, Gracia said.

“She was swollen and everything” after delivery, he said. “I thought she was going to [weigh] 10 or 11 pounds.”

But after weighing Mia, the nurse told Garcia the infant’s weight.

“I was like, ‘Whoa, she’s the biggest baby I’ve ever seen,’” Garcia told ABC News.

Even hospital personnel agreed. Garcia said the nurse told hi she’d never seen “a baby that big.”

Dr. Robert Barbieri, chief of obstetrics and gynecology at Brigham and Women’s Hospital in Boston, said in a previous interview about one out of 1,000 babies could weigh 11 pounds, and one out of every 100,000 could weigh 14 pounds. A 14-pound baby, he said, is extremely rare, because usually a doctor will induce labor if a baby appears oversize.

While Mia’s delivery via Caesarean section went smoothly, the infant developed breathing problems and was eventually moved to Children’s Hospital of Colorado in Aurora, Colorado, according to Garcia.

Garcia said Mia is on oxygen and doing well, although they’re not sure when she will get home.

Garcia said the couple has another four daughters at home, which might come in handy for new baby clothes.

“We bought her a lot of stuff like a newborn cap and pampers,” Garcia said. “They don't fit her. She’s too big.”

Source: http://abcnews.go.com

By Dennis Thompson

Already-strong public support for right-to-die legislation has grown even stronger in the days since the planned death of 29-year-old brain cancer patient Brittany Maynard, a new HealthDay/Harris Poll has found.

An overwhelming 74 percent of American adults now believe that terminally ill patients who are in great pain should have the right to end their lives, the poll found. Only 14 percent were opposed.

Broad majorities also favor physician-assisted suicide and physician-administered euthanasia.

Only three states -- Oregon, Washington and Vermont -- currently have right-to-die laws that allow physician-assisted suicide.

"Public opinion on these issues seems to be far ahead of political leadership and legislative actions," said Humphrey Taylor, chairman of The Harris Poll. "Only a few states have legalized physician-assisted suicide and none have legalized physician-administered euthanasia."

People responded to the poll in the weeks after Maynard took medication to end her life in early November.

Maynard moved from California to Oregon following her diagnosis with late-stage brain cancer so she could take advantage of the state's "Death With Dignity Act." Her story went viral online, with a video explaining her choice garnering nearly 11.5 million views on YouTube.

A "poster child for the movement," Maynard helped spark conversations that allowed people to put themselves in her shoes, said Frank Kavanaugh, a board member of the Final Exit Network, a right-to-die advocacy group.

"I think it is just a natural evolution over a period of time," Kavanaugh said of the HealthDay/Harris Poll results. "There was a time when people didn't talk about suicide. These days, each time conversations occur, people think it through for themselves, and more and more are saying, 'That's a reasonable thing to me.'"

The poll also found that:

• Support for a person's right to die has increased to 74 percent, up from 70 percent in 2011. Those opposed decreased to 14 percent from 17 percent during the same period.
• Physician-assisted suicide also received increased support, with 72 percent now in favor, compared with 67 percent in 2011. Opposition declined from 19 percent to 15 percent.
• Sixty-six percent of respondents said doctors should be allowed to comply with the wishes of dying patients in severe distress who ask to have their lives ended, up from 58 percent in 2011. Opposition decreased from 20 percent in 2011 to 15 percent now.

"The very large -- more than 4-to-1 and increasing -- majorities in favor of physician-assisted suicide, and the right of terminally ill patients to end their lives are consistent with other liberal social policy trends, such as support for same-sex marriage, gay rights and the decriminalization of marijuana, seen in the results of referendums and initiatives in the recent mid-term elections," Taylor said.

Support for the right-to-die movement cut across all generations and educational groups, both genders, and even political affiliation, the poll found.

Democrats tended to be more supportive of right-to-die legislation, but 56 percent of Republicans said they favor voluntary euthanasia and 63 percent favor physician-assisted suicide.

Kavanaugh was not surprised. "People think of this as a liberal issue. But I find that as I talk to [conservatives], you can appeal to them on the basis of 'get the government the hell out of my life,'" he said.

But the public is split over how such policies should be enacted, with 35 percent saying that the states should decide on their own while 33 percent believe the decision should be made by the federal government, the poll found.

"Most of the people I know in the field whose opinion I put stock in don't feel there's ever going to be federal movement on it," Kavanaugh said. "You're just going to have to suffer through a state-by-state process."

Kavanaugh does believe this overwhelming public support will result in steady adoption of right-to-die laws.

"I think this will become the ultimate human right of the 21st century, the right to die with dignity," he said. "There are good deaths and bad deaths, and it is possible to have a good death."

Despite increasing public support for assisted suicide, stiff opposition remains in some quarters.

"Assisted suicide sows confusion about the purpose of life and death. It suggests that a life can lose its purpose and that death has no meaning," Rev. Alexander Sample, archbishop of the Archdiocese of Portland in Oregon, said in a pastoral statement issued during Maynard's final days.

"Cutting life short is not the answer to death," he said. "Instead of hastening death, we encourage all to embrace the sometimes difficult but precious moments at the end of life, for it is often in these moments that we come to understand what is most important about life. Our final days help us to prepare for our eternal destiny."

Todd Cooper, a spokesman for the Portland archdiocese, said the debate over assisted suicide touches him on a very deep level because of his wife, Kathie.

About 10 years ago, she also was diagnosed with terminal brain cancer. She endured two brain surgeries, two years of chemotherapy and six weeks of radiation therapy, and remains alive to this day.

"If she'd given up the fight for life, she wouldn't be here," Cooper said. "That doesn't necessarily happen in every case, but it gives hope for those who struggle to the very end."

source: www.medicinenet.com

Nursing students with previous caring experience are less likely to perform better academically and clinically than those who have none, research shows.

A study assessing the criteria for selecting nursing students found that high emotional intelligence did not mean students performed better on their courses.

Researchers also found that of the students who have withdrawn from their studies, nearly 60 per cent had previous caring experience.

The ongoing study, led by the University of Edinburgh, is tracking performance and emotional intelligence - the ability to recognise your own and other people's feelings and act accordingly - of nearly 900 nursing and midwifery students from the University of the West of Scotland and Edinburgh Napier University.

Researchers found, however, that performance improved with age and that female trainees scored significantly better than male counterparts.

The findings come after the 2013 Frances Report - which highlighted care failings at the Mid Staffordhire NHS Foundation Trust - recommended an emphasis on creating a more compassionate end empathetic culture in nursing.

As a result, aspiring nurses in England could potentially be required to spend a placement year as a carer before undertaking their training.

Lead researcher Rosie Stenhouse, lecturer in Nursing Studies at the University of Edinburgh, said: "The research should sound a note of caution to such pilot schemes. They are potentially expensive, politically motivated and not backed up by evidence."

Source: www.medicalnewstoday.com

By  Kimberly Yam

This young girl is truly benevolent beyond her years.

Three-year-old Ariana Smith from Winterport, Maine watched a video from Extra Life, a charity that raises money for Children’s Miracle Network Hospitals through video gaming, that featured a girl who didn't have any hair. The curious kid then decided to ask her parents about what she saw, Josh Smith, Ariana's father, told the Huffington Post in an e-mail.

"She asked why the little girl had no hair. We explained that she was sick and that the medicine they were using made her hair fall out," Smith said.

The chat left a strong impression on Ariana. 

“Without a second thought, Ariana said ‘Oh, well she can have some of my hair,’” Smith told ABC News.

So, on November 21st, the toddler received her first cut, and with the help of her parents, donated her hair to Locks Of Love. The pictures from the milestone, which were posted on Imgur, have since gone viral with over 500,000 views -- an ode to the 3-year-old's generosity. 

"She could be so selfless like that," Smith told ABC News. "Her first reaction is ‘How about I give up something that I have so a little girl can feel pretty'."

While Ariana's act of kindness is a noble one, her father says that he wasn't surprised when she expressed her desire to donate her hair. He told HuffPost that she loves helping others -- even when she's playing.

"I think she’s just a caring person," he wrote. "She has a little play set of medical devices which she uses often. I’ve had my blood pressure and heart rate 'checked' hundreds of times this year."

As for Ariana's new hairstyle, the toddler seems to be adjusting quite nicely to her fashion statement. 

"She loves it," Smith says of her daughter's new hairdo. "She can eat her breakfast without worrying about her hair drooping into it."

Source: www.huffingtonpost.com

Researchers have developed a new device that may result in more comfortable mammography for women. According to a study being presented next week at the annual meeting of the Radiological Society of North America (RSNA), standardizing the pressure applied in mammography would reduce pain associated with breast compression without sacrificing image quality.

Compression of the breast is necessary in mammography to optimize image quality and minimize absorbed radiation dose. However, mechanical compression of the breast in mammography often causes discomfort and pain and deters some women from mammography screening.

An additional problem associated with compression is the variation that occurs when the technologist adjusts compression force to breast size, composition, skin tautness and pain tolerance. Over-compression, or unnecessarily high pressures during compression, is common in certain European countries, especially for women with small breasts. Over-compression occurs less frequently in the United States, where under-compression, or extremely low applied pressure, is more common.

"This means that the breast may be almost not compressed at all, which increases the risks of image quality degradation and extra radiation dose," said Woutjan Branderhorst, Ph.D., researcher in the Department of Biomedical Engineering and Physics at the Academic Medical Center in Amsterdam.

Overall, adjustments in force can lead to substantial variation in the amount of pressure applied to the breast, ranging from less than 3 kilopascals (kPa) to greater than 30 kPa.

Dr. Branderhorst and colleagues theorized that a compression protocol based on pressure rather than force would reduce the pain and variability associated with the current force-based compression protocol. Force is the total impact of one object on another, whereas pressure is the ratio of force to the area over which it is applied.

The researchers developed a device that displays the average pressure during compression and studied its effects in a double-blinded, randomized control trial on 433 asymptomatic women scheduled for screening mammography.

Three of the four compressions for each participant were standardized to a target force of 14 dekanewtons (daN). One randomly assigned compression was standardized to a target pressure of 10 kPa.

Participants scored pain on a numerical rating scale, and three experienced breast screening radiologists indicated which images required a retake. The 10 kPa pressure did not compromise radiation dose or image quality, and, on average, the women reported it to be less painful than the 14 daN force.

The study's implications are potentially significant, Dr. Branderhorst said. There are an estimated 39 million mammography exams performed every year in the U.S. alone, which translates into more than 156 million compressions. Pressure standardization could help avoid a large amount of unnecessary pain and optimize radiation dose without adversely affecting image quality or the proportion of required retakes.

"Standardizing the applied pressure would reduce both over- and under-compression and lead to a more reproducible imaging procedure with less pain," Dr. Branderhorst said.

The device that displays average pressure is easily added to existing mammography systems, according to Dr. Branderhorst.

"Essentially, what is needed is the measurement of the contact area with the breast, which then is combined with the measured applied force to determine the average pressure in the breast," he said. "A relatively small upgrade of the compression paddle is sufficient."

Further research will be needed to determine if the 10 kPa pressure is the optimal target.

The researchers are also working on new methods to help mammography technologists improve compression through better positioning of the breast.

Source: www.sciencedaily.com

U.S. health officials are poised to endorse circumcision as a means of preventing HIV and other sexually transmitted diseases.

The U.S. Centers for Disease Control and Prevention on Tuesday released its first-ever draft guidelines on circumcision that recommend that doctors counsel parents and uncircumcised males on the health benefits of the procedure.

The guidelines do not outright call for circumcision of all male newborns, since that is a personal decision that may involve religious or cultural preferences, Dr. Jonathan Mermin, director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, told the Associated Press.

Discussion board is open for inputs on this subject.

But "the scientific evidence is clear that the benefits outweigh the risks," Mermin said.

Circumcision involves the surgical removal of the foreskin covering the tip of the penis. Germs can collect and multiply under the foreskin, creating issues of hygiene.

Clinical trials, many done in sub-Saharan Africa, have demonstrated that circumcision reduces HIV infection risk by 50 percent to 60 percent, the CDC guidelines note. The procedure also reduces by 30 percent the risk of contracting herpes and human papilloma virus (HPV), two pathogens believed to cause cancer of the penis.

The guidelines do point out that circumcision has only been proven to prevent HIV and sexually transmitted diseases in men during vaginal sex. The procedure has not been proven to reduce the risk of infection through oral or anal sex, or to reduce the risk of HIV transmission to female partners.

The scientific evidence is mixed regarding homosexual sex, the guidelines say, with some studies having shown that circumcision provides partial protection while other studies have not.

Circumcision does reduce the risk of urinary tract infections in infants, according to the CDC guidelines.

The most common risks associated with the procedure include bleeding and infection.

Male circumcision rates in the United States declined between 1979 and 2010, dropping from almost 65 percent to slightly more than 58 percent, according to a CDC report issued last year.

The new draft guidelines mirror an updated policy on circumcision released by the American Academy of Pediatrics in 2012.

"The American public should take confidence that these are pretty much converging guidelines. There is no doubt that it [circumcision] does confer health benefits and there is no doubt it can be performed safely, with a less than 1 percent risk of complications," Dr. Susan Blank, chair of the task force that authored the AAP policy statement, said Tuesday. "This is one thing a parent can do to protect the future health of their children."

In its policy statement, the AAP declared that the health benefits are great enough that infant male circumcision should be covered by insurance, which would increase access to the procedure for families who choose it, said Blank, who is also assistant commissioner of STD Control and Prevention at the New York City Department of Health and Mental Hygiene.

"The push from the academy's point of view is to really have providers lay out for parents what are the risks, what are the benefits, and give the parents the information they need to make a decision," Blank said. "And the academy feels strongly that since there are proven health benefits, the procedure should be covered by insurance."

The guidelines are expected to spur a response from anti-circumcision groups.

"There are certainly groups that are troubled by circumcision of an individual who is not in a position to provide their own consent," Blank said.

The public can comment on the draft guidelines through Jan. 16, according to the CDC.

Source: www.nlm.nih.gov

By Honor Whiteman

Cancer is one of the leading causes of morbidity and mortality worldwide. In 2012, there were around 14 million new cases of cancer and around 8.2 million deaths from the disease. But despite such alarming numbers, a new study by researchers from the UK finds that most people ignore cancer warning signs, attributing them instead to symptoms of less serious illnesses.

Lead study author Dr. Katriina Whitaker, senior research fellow at University College London in the UK, analyzed the responses of 1,724 people aged 50 and over to a health questionnaire that was sent to them in April 2012.

The questionnaire asked participants whether they had experienced any of 17 symptoms, 10 of which are defined as cancer "alarm" symptoms by Cancer Research UK. These symptoms include unexplained cough, changes in mole appearance, unexplained bleeding, persistent change in bowel habits, unexplained weight loss, difficulty swallowing and unexplained lumps. 

Participants were not told which symptoms are cancer warning signs.

The respondents were also asked what they thought was the cause of any symptoms they experienced, whether they deemed the symptoms to be serious and whether they visited their doctor as a result of their symptoms.

Only 2% of respondents considered warning symptoms to be cancer-related

Results of study - published in the journal PLOS ONE - revealed that 53% of participants reported that they had experienced at least one cancer warning sign over the past 3 months.

The most common cancer warning symptoms reported were persistent cough and persistent change in bowel habits, while unexplained weight loss and problems swallowing were the least common.

However, the researchers were surprised to find that of the respondents who reported cancer warning symptoms, only 2% considered cancer to be a potential cause.

What is more, Dr. Whitaker says that of participants who reported the most obvious signs of cancer - such as unexplained lumps or changes in mole appearance - most did not consider them to be cancer-related.

"Even when people thought warning symptoms might be serious, cancer didn't tend to spring to mind," adds Dr. Whitaker. "This might be because people were frightened and reluctant to mention cancer, thought cancer wouldn't happen to them or believed other causes were more likely."

On a positive note, respondents did deem the cancer warning signs to be more serious than symptoms not linked to cancer - such as shortness of breath, fatigue and sore throat- and 59% of those who experienced cancer warning signs visited their doctor.

But the researchers say their findings show that the majority of people are dismissing potential warning signs of cancer, which could be putting their health at serious risk. Dr. Whitaker says:

"Most people with potential warning symptoms don't have cancer, but some will and others may have other diseases that would benefit from early attention. That's why it's important that these symptoms are checked out, especially if they don't go away. But people could delay seeing a doctor if they don't acknowledge cancer as a possible cause."

"Most cancers are picked up through people going to their general practitioner (GP) about symptoms, and this study indicates that opportunities for early diagnosis are being missed," adds Sara Hiom, director of early diagnosis at Cancer Research UK. "Its results could help us find new ways of encouraging people with worrying symptoms to consider cancer as a possible cause and to get them checked out straight away with a GP."

Source: www.medicalnewstoday.com

By Barry Hoffman

Paul Alexander's most impressive accomplishment is something most people never think about.

He taught himself how to breathe.

Alexander, 67, is a victim of the worst that polio had to offer children in the late 1940s and early 1950s. At the age of 6, he was completely paralyzed by the disease, his lungs stopped working, and he was literally thrown into an iron lung.

Alexander has been in that iron lung for 61 years because he remains almost totally paralyzed, able to move only his head, neck and mouth. He is one of an estimated seven people in the United States who are still living in an iron lung, and yet he has had a long and successful career as a lawyer. 

"Over the years, I've been able to escape this machine for a few hours at a time by teaching myself voluntary breathing," Alexander said recently as he lay in the iron lung at his home in Dallas, Texas. "I have to consciously push air into my lungs, something that's done involuntarily by just about everyone else. It's hard work, but it allows me to escape this infernal device, if only for a little while."

Alexander "escapes" the machine most often when he is litigating a case -- his specialty is family law -- or gives a speech.

While he sometimes condemns the contraption that keeps him alive, Alexander is most grateful for his iron lung, whose machinery is essentially unchanged from the first ones that were put in use in the late 1930s. His machine, in fact, is the same one he entered 61 years ago.

"It is my cage, but it's also my cocoon," he said, as the iron lung issued a noticeable whishing sound, an almost uncanny replication of normal breathing.

But we're getting ahead of the story.

This year marks the 60th anniversary of the nation's first mass polio vaccine inoculations, a time when hundreds of thousands of grade school students -- many of them throughout the South -- lined up in school gymnasiums, stuck out their arm and gritted their teeth as a nurse gave them Dr. Jonas Salk's experimental vaccine.

The shot was literally a game-changer. Most of these children had seen at least one or two classmates come to school on crutches, paralyzed by the ravages of polio. More than a few knew other students and friends who had died from the disease. 

So 1954 signified their liberation during the summer -- they could return to public swimming pools and play in the rain and eat in restaurants and not be afraid that they would wake up the next day with a fever and terrible leg pains, which could rapidly lead to paralysis.

That's what happened to 6-year-old Paul Alexander in 1952, two years too early for the Salk vaccine.

"I remember it was really hot and raining, something that is sort of rare for Dallas in August," he recalled, "and my brother and I had been outside playing, running around and getting wet when the rain started.

"Our mother called for us to come in for dinner, and I remember her taking one look at me -- hot and wet and feverish -- and she cried out, 'Oh my God!' She ripped my clothes off and threw me onto her and my dad's bed and called the doctor.

"She knew right away that I had polio. I don't know how she knew, but she knew. I remember feeling hot and feverish, and for the next few days, I stayed in the bed and didn't move. I remember I had this coloring book, and I felt this compulsion to color as much as I could, sort of like maybe I wouldn't be able to do it in the future."

Why didn't Alexander's parents take him to the hospital? "Our family doctor said that all the kids with polio were at Parkland (Dallas' big municipal hospital), and he didn't want me there with the other kids because maybe I had a better chance to recover at home," Alexander said.

But all of that became moot about six days later when he could no longer move and found it difficult to breathe: "I remember having terrible pains in my legs, and breathing became really laborious. So they finally took me to Parkland."

And that's when the most horrifying event occurred before Alexander's long battle with polio could even begin: "I had become immobile; I don't think I could even talk, so the hospital staff put me on a gurney in a long hallway with all the other hopeless polio kids. Most of them were dead."

That would have been Alexander's fate, too, if not for Dr. Milton Davis, a well-known pediatric cardiologist who was examining all of the children in the hallway. "He took one look at me, gathered me up in his arms, and I think he performed a tracheotomy on me almost immediately so I could breathe," Alexander said. "And the next thing I remember, I was inside an iron lung."

And then he blacked out.

Alexander woke up weeks later still in the iron lung: "The pain was still there, although it seemed much less to me, and the iron lung pumped hot steam through a thick plastic water pump into my chest. This kept the mucuous loose enough so I could breathe." 

He couldn't see through the steam at first, and he couldn't talk. But Alexander said he found some sort of determination within himself as strong as the iron in the device that was keeping him alive. "I decided I was going to fight this," he said. "I was going to have a life."

Eighteen months later, his parents brought him home. They stayed with him in shifts, fed him, helped him with school work (he was still enrolled in elementary school) and encouraged him to keep up his curiosity and enthusiasm for learning.

"My mother lobbied the school district for home-school learning, something very rare in the 1950s," he said. His dad fashioned a writing implement for him, similar to a T-square, which Alexander would put in his mouth and move around with his neck muscles in order to write.

Through their efforts and his own fierce determination, Alexander graduated high school as the class salutatorian. "I would have been valedictorian but the biology teacher gave me a B because I couldn't take lab," he joked.

Scholarships to Southern Methodist University in Dallas and the University of Texas in Austin allowed Alexander, with the help of a paid health aide, to get an undergraduate degree and then a law degree. He returned to the Dallas area and became associated with an Arlington law firm for a while, but eventually established a private practice that still handles everything from family law to financial cases.

"With help from a medical aide or one of my friends, I can get out of the lung and attend functions in a wheelchair or argue a case for a few hours," he said. "But I always have to remember to tell myself to inhale, exhale, inhale."

Alexander came to the attention this year of the leaders of the Dallas area's Rotary clubs through one of his doctors, Alexander Peralta, Jr., who is a Rotarian from Duncanville, Texas. 

Rotary International has been working with the Bill and Melinda Gates Foundation to eliminate polio worldwide, just as smallpox has been eradicated.

"One of our clubs, which is well-versed in modern technology (the Dallas e-Club) went to Paul's house and made a four-minute video with him," said Bill Dendy, District Governor of District 5810, which has 65 local Rotary clubs in the north Texas area.

"What none of us realized at first is what a compelling story this is, not only Paul's triumphs under difficult circumstances, but also what a terrifying experience it can be, just sitting in the presence of that machine that keeps him alive. The iron lung personalizes the horror all those thousands of kids went through a little more than half a century ago," Dendy said. The video they made has been submitted to the local PBS station in Dallas. 

Since making contact with Alexander, various district Rotary clubs have volunteered to make improvements to his house -- an old ramp leading to the front door was replaced -- and to be available to take him to his appointments. Throughout his life, Alexander has had a combination of help from health aides provided through the government and friends who pitch in.

Alexander said his iron lung is no longer supported by any company on an ongoing basis. The last company to service his machine, Philips Respironics, no longer does so. "So now, we have to strip spare parts from other discarded iron lungs to keep us going," he said. So far, it hasn't been a problem, he added: "There are only seven iron lung users left, so I don't think this is going to be a big problem of supply and demand."

How did he accomplish so much -- and keep his sense of humor -- while being virtually immobile for more than 60 years?

"It all starts with love," Alexander said. "My parents raised me in love. They taught me never to give up. They taught me the importance of relationships. They were always there for me.

"So, naturally, I had to reciprocate. And you know what? They were right. Anything is possible."

Source: www.medicinenet.com

Researchers are using computed tomography (CT) and 3-D printing technology to recreate life-size models of patients' heads to assist in face transplantation surgery, according to a study presented today at the annual meeting of the Radiological Society of North America (RSNA).

Physicians at Brigham and Women's Hospital in Boston performed the country's first full-face transplantation in 2011 and have subsequently completed four additional face transplants. The procedure is performed on patients who have lost some or all of their face as a result of injury or disease.

In the study, a research team led by Frank J. Rybicki, M.D., radiologist and director of the hospital's Applied Imaging Science Laboratory, Bohdan Pomahac, M.D., lead face transplantation surgeon, and Amir Imanzadeh, M.D., research fellow, assessed the clinical impact of using 3-D printed models of the recipient's head in the planning of face transplantation surgery.

"This is a complex surgery and its success is dependent on surgical planning," Dr. Rybicki said. "Our study demonstrated that if you use this model and hold the skull in your hand, there is no better way to plan the procedure."

Each of the transplant recipients underwent preoperative CT with 3-D visualization. To build each life-size skull model, the CT images of the transplant recipient's head were segmented and processed using customized software, creating specialized data files that were input into a 3-D printer.

"In some patients, we need to modify the recipient's facial bones prior to transplantation," Dr. Imanzadeh said. "The 3-D printed model helps us to prepare the facial structures so when the actual transplantation occurs, the surgery goes more smoothly."

Although the entire transplant procedure lasts as long as 25 hours, the actual vascular connections from the donor face to the recipient typically takes approximately one hour, during which time the patient's blood flow must be stopped.

"If there are absent or missing bony structures needed for reconstruction, we can make modifications based on the 3-D printed model prior to the actual transplantation, instead of taking the time to do alterations during ischemia time," Dr. Rybicki said. "The 3-D model is important for making the transplant cosmetically appealing."

The researchers said they also used the models in the operating room to increase the surgeons' understanding of the anatomy of the recipient's face during the procedure.

"You can spin, rotate and scroll through as many CT images as you want but there's no substitute for having the real thing in your hand," Dr. Rybicki said. "The ability to work with the model gives you an unprecedented level of reassurance and confidence in the procedure."

Senior surgeons and radiologists involved in the five face transplantations agreed that the 3-D printed models provided superior pre-operative data and allowed complex anatomy and bony defects to be better appreciated, reducing total procedure time.

"Less time spent in the operating room is better for overall patient outcomes," Dr. Pomahac added.

Based on the results of this study, 3-D printing is now routinely used for surgical planning for face transplantation procedures at Brigham and Women's Hospital, and 3-D printed models may be implemented in other complex surgeries.

Source: www.sciencedaily.com

By Meera Senthilingam

"It only takes one virus to get through for a person to be infected," explained Dr. John Mascola. This is true of any viral infection, but in this instance, Mascola is referring to HIV and his ongoing efforts to develop a vaccine against the virus. "It's been so difficult to make an HIV/AIDS vaccine."

Those were the words of many working in HIV vaccine development until the results of a 2009 trial in Thailand surprised everyone. "The field is energized," said Mascola, director of the Vaccine Research Center at the U.S. National Institute of Allergy and Infectious Diseases, describing the change in atmosphere in the vaccine community.

The trial included over 16,000 volunteers and was the largest clinical trial ever conducted for a vaccine against HIV. It was also the first to show any protection at all against infection.

Two previously developed vaccines, known as ALVAC-HIV and AIDSVAX, were used in combination, with the first priming an immune response against HIV and the second used as a booster once the immunity waned. The duo reduced the risk of contracting HIV by 31.2% -- a modest reduction, but it was a start.

To date, only four vaccines have made it as far as testing for efficacy to identify their levels of protection against HIV. Only this one showed any protection.

"That trial was pivotal," Mascola said. "Prior to that, it wasn't known whether a vaccine could be possible."

In recent years, there have been parallel findings of an equally pivotal nature in the field of HIV prevention, including the discovery that people regularly taking their antiretroviral treatment reduce their chances of spreading HIV by 96% and that men who are circumcised reduce their risk of becoming infected heterosexually by approximately 60%.

Both improved access to antiretrovirals and campaigns to increase male circumcision in high-risk populations have taken place since the discoveries, and although numbers of new infections are falling, they're not falling fast enough.

In 2013, there were 35 million people estimated to be living with HIV globally. There were still 2.1 million new infections in 2013, and for every person who began treatment for HIV last year, 1.3 people were newly infected with the lifelong virus, according to UNAIDS. A vaccine remains essential to control the epidemic.

A complex beast

Scientists like Mascola have dedicated their careers to finding a vaccine, and their road has been tough due to the inherently complicated nature of the virus, its aptitude for mutating and changing constantly to evade immune attack, and its ability attack the very immune cells that should block it.

There are nine subtypes of HIV circulating in different populations around the world, according to the World Health Organization, and once inside the body, the virus can change continuously.

"Within an individual, you have millions of variants," explained Dr. Wayne Koff, chief scientific officer for the International AIDS Vaccine Alliance.

HIV invades the body by attaching to, and killing, CD4 cells in the immune system. These cells are needed to send signals for other cells to generate antibodies against viruses such as HIV, and destroying those enables HIV to cause chronic lifelong infections in those affected.

Measles, polio, tetanus, whooping cough -- to name a few -- all have vaccines readily available to protect from their potentially fatal infections. But their biology is seemingly simple in comparison with HIV.

"For the older ones, you identify the virus, either inactivate it or weaken it, and inject it," Koff said. "You trick the body into thinking it is infected with the actual virus, and when you're exposed, you mount a robust immune response."

This is the premise of all vaccines, but the changeability of HIV means the target is constantly changing. A new route is needed, and the true biology of the virus needs to be understood. "In the case of HIV, the old empirical approach isn't going to work," Koff said.

Scientists have identified conserved regions of the virus that don't change as readily, making them prime targets for attack by antibodies. When the success of the Thai trial was studied deep down at the molecular level, the protection seemed to come down to attacking some of these conserved regions. Now it's time to step it up.

In January, the mild success in Thailand will be applied in South Africa, where over 19% of the adult population is living with HIV. The country is second only to bordering Swaziland for having the highest rates of HIV in the world.

"The Thai vaccine was made for strains (of HIV) circulating in Thailand," said Dr. Larry Corey, principal investigator for the HIV Vaccine Trials Network, which is leading the next trial in South Africa. The strain, or subtype, in this case was subtype B. "For South Africa, we've formed a strain with common features to (that) circulating in the population." This region of the world has subtype C.

An additional component, known as an adjuvant, is being added to the mix to stimulate a stronger and hopefully longer-lasting level of immunity. "We know durability in the Thai trial waned," Corey said. If safety trials go well in 2015, larger trials for the protective effect will take place the following year. An ideal vaccine would provide lifelong protection, or at least for a decade, as with the yellow fever vaccine.

A broad attack

The excitement now reinvigorating researchers stems not only from a modestly successful trial but from recent successes in the lab and even from HIV patients themselves.

Some people with HIV naturally produce antibodies that are effective in attacking the HIV virus in many of its forms. Given the great variability of HIV, any means of attacking these conserved parts of the virus will be treasured and the new found gold comes in the form of these antibodies -- known as "broadly neutralizing antibodies." Scientists including Koff set out to identify these antibodies and discover whether they bind to the outer coat of the virus.

The outer envelope, or protein coat, of HIV is what the virus uses to attach to, and enter, cells inside the body. These same coat proteins are what vaccine developers would like our antibodies to attack, in order to prevent the virus from entering our cells. "Broadly neutralizing antibodies" could hold the key because, as their name suggests, they have a broad remit and can attack many subtypes of HIV. "We will have found the Achilles heel of HIV," Koff said.

Out of 1,800 people infected with HIV, Koff and his team found that 10% formed any of these antibodies and just 1% had extremely broad and potent antibodies against HIV. "We called them the elite neutralizers," he said of the latter group. The problem, however, is that these antibodies form too late, when people are already infected. In fact, they usually only form a while after infection. The goal for vaccine teams is to get the body making these ahead of infection.

"We want the antibodies in advance of exposure to HIV," explained Koff. The way to do this goes back to basics: tricking the body into thinking it is infected.

"We can start to make vaccines that are very close mimics of the virus itself," Mascola said.

Teams at his research center have gained detailed insight into the structure of HIV in recent years, particularly the outer coat, where all the action takes place. Synthesizing just the outer coat of a virus in the lab and injecting this into humans as a vaccine could "cause enough of an immune response against a range of types of HIV," Mascola said.

The vaccine would not contain the virus itself, or any of its genetic material, meaning those receiving it have no risk of contracting HIV. But for now, this new area remains just that: new. "We need results in humans," Mascola said.

Rounds of development, safety testing and then formal testing in high-risk populations are needed, but if it goes well, "in 10 years, there could be a first-generation vaccine." If improved protection is seen in South Africa, a first-generation vaccine could be with us sooner.

Making an Impact

When creating vaccines, the desired level of protection is usually 80% to 90%. But the high burden of HIV and potentially beneficial impact of lower levels of protection warrant licensing at a lower percentage.

"Over 50% is worth licensing from a public health perspective," Koff said, meaning that despite less shielding from any contact with the HIV virus, even a partially effective vaccine would save many lives over time.

The next generations will incorporate further advancements, such as inducing neutralizing antibodies, to try to increase protection up to the 80% or 90% desired.

"That's the history of vaccine research; you develop it over time," Corey said. He has worked in the field for over 25 years and has felt the struggle. "I didn't think it would be this long or this hard ... but it's been interesting," he ponders.

But there is light at the end of tunnel. Just.

"There has been no virus controlled without a vaccine," he concluded when explaining why, despite antiretrovirals, circumcision and increased awareness, the need for a one-off intervention like a vaccine remains strong.

"Most people that transmit it don't even know they have it," he said. "To get that epidemic, to say you've controlled it, requires vaccination."

Source: www.cnn.com