cars, car modify, diagnostic tools,cmd, remote cnt

growth policies no substitute for

2008-02-25T03:24:00.001-08:00

Growth policies: No substitute for thinking

economics sB growth sB policy sB

I have just finished reading Chapter 2 of Rodrik's latest book (which

is a revised version of this "Growth Diagnostics" paper):

Most well-trained economists would agree that the standard policy

reforms included in the Washington Consensus have the potential to

be growth-promoting. What the experience of the last 15 years has

shown, however, is that the impact of these reforms is heavily

dependent on circumstances...We argue in this paper that this calls

for an approach to reform that is much more contingent on the

economic environment, but one that also avoids an anything goes

attitude of nihilism. We show it is possible to develop a unified

framework for analyzing and formulating growth strategies that is

both operational and based on solid economic reasoning.

The authors then offer a growth diagnostics framework that is

summarized by Rodrik here. The paper concludes with the following:

Across-the-board reform packages have often failed to get countries

growing again. The method for growth diagnostics we provide in this

paper should help target reform on the most binding constraints

that impede growth... As our discussion of El Salvador, Brazil, and

the Dominican Republic illustrates, each of these circumstances

throws out different diagnostic signals. An approach to development

that determines the action agenda on the basis of these signals is

likely to be considerably more effective than a laundry-list

approach with a long list of institutional and governance reforms

that may or may not be well targeted on the most binding

constraints to growth.

I agree with Rodrik's general message on the context-dependency of

growth policies. His offered framework is also useful for

policymakers. Yet it is no substitute for thinking by developing

countries' economists and policymakers: They need to analyze which of

the agenda are particularly relevant to their respective economies.

Rodrik puts it best: "The framework does not economize on inputs (the

thoughtfulness required to reach decisions), only on outputs (the list

of things that we recommend governments should do to get growth

going)".

PS: For a somewhat similar exercise for Indonesia (though it doesn't

seem to be using this exact framework), see the reports posted here

(particularly its Special Focus on Regions reports, on the left

sidebar).

PPS: Here is a set of papers commissioned by the Commission on Growth

and Development.

PPPS: Charles Kenny offers a review of new evidence on growth in the

last six years (his answer: Not very much!). HT: Marginal Revolution.

Labels: development, economics, growth, policy

posted by Arya Gaduh at 10:42 AM

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health insurance for poor

2008-02-25T03:14:00.001-08:00

Health Insurance for the Poor

As a result of personal endeavors that seek to bridge the inequality

in healthcare, I was recently perusing the web and came across some

interesting organizations that are providing health insurance to the

rural poor in India. With less than 2% of India's 700 million rural

poor insured, there is a huge unmet need. I was pleasantly surprised

to find no less than 25 "Microfinance"-like Health Insurance schemes

and will attempt to highlight a few of the main players here:

Yeshaswini Co-operative Health Insurance Scheme was started in 2003 in

rural Karnataka. The program originated in the mind of Dr. Devi

Shetty, a very wealthy cardiac surgeon and philanthropist who

pioneered the spread of telemedicine as well as low cost cardiac

operations in India. In addition to his for-profit operations, Dr.

Shetty runs a not-for-profit hospital, Narayana Hrudayalaya, in

Bangalore.

Yeshaswini aimed to create a large insurance scheme, where the law of

large numbers would overcome the risk of an unexpectedly large number

of enrollees making claims in the first year, which had caused the

financing problems associated with the small schemes of the past. The

plan for the Yeshaswini Health Insurance Scheme, was very low premiums

with a very large number of participants.

The Scheme covers the farmer co-operator, his spouse and children. The

premium contributed per person was Rs 5 per month with Rs 2.5 subsidy

from the government of Karnataka in the first year. The Yeshasvini

beneficiary is entitled to the following benefits: free outpatient

services at a network hospital including consultation fee and

registration fee, investigation at special discounted rates, over 1600

listed surgeries done free of cost at network hospitals.

The following charges are covered for any of the surgeries included in

the policy: Admission, bed, nursing, anaesthesia, OT, surgeons, cost

of consumables and medicines during the surgery and post operative

period, surgery-related post and pre-operative investigations. The

surgical cover is 100 per cent cashless. 16 lakh farmers had enrolled

as members in the first year, 35000 members availed of free

consultation at network hospitals, 9039 surgeries were done cashless

amounting to Rs 10.53 crores; of these 657 were cardiac surgeries. In

the second year, 22 lakh farmers became members of the Scheme of which

82652 members have availed of free outpatient consultation. More than

23000 surgeries have been conducted free of cost.

A good case study of Yeshaswini is available here

Healing Fields Health Insurance Scheme

Members pay Rs 285 ($5 per year;0.003 - less than a cent per day per

family member!) annually to cover health insurance (Rs 20,000) for a

family of five and Rs 35 for Personal Accident Benefit (Rs 25,000 each

on member and spouse) to HDFC Chubb, the insurance company for the

scheme. The policy is low-cost, which includes pregnancy and covers 43

listed common illnesses governed by `Diagnostic Related Group (DRG)

Model'. In case of a hospitalisation, up to 25 percent is paid by the

patient as co-payment. The stakeholders, insurer, NGO partner and the

hospital together work out a customised process, map and goals, for

the success of the scheme.

Arogya Raksha Yojana is a year old and offers: Free out patient

consultation, generic medicines at special rates from network hospital

pharmacies and Biocare pharmacies, diagnostic tests at discounted

rates at network hospitals and approved diagnostic centres,

hospitalisation not leading to surgery, surgical treatment for over

1600 types of surgeries, 100% cashless facility for surgical treatment

new logging experience

2008-02-25T02:59:00.001-08:00

A new logging experience!

I've been using logback for a few months now, and I'm impressed!

With excellent documentation and support, neat logging features,

blazing performance and an innovating eclipse plugin, I've finally

found a good replacement for the good old log4j.

The first thing I really appreciate compared to log4j or the java

logging api is the documentation. The guide is well written, they have

a nice demo, and you are up to speed in a few minutes.

Neat logging features

There are some very simple features which makes the life so much

easier, such as the intelligent logger name reduction when it's too

long: instead of simply truncating the name, it put the first letter

of each package:

09:59:04.203 [main] INFO o.x.x.web.XoosentApplication - starting XooSent

The Mapped Diagnostic Context (MDC) is also a killing feature. It

allows to associate metadata to the current thread, to correlate

messages to their context. For instance in a web application with

authentication, you can associate the user name to the the thread and

add this user name to all log messages, without any change to your log

calls. For instance, you add this at user authentication time:

MDC.put("user", username);

Then in your logback configuration you can use %Xuser in your pattern,

and you will see the authenticated user name. It's that simple, and in

multithreaded environment where multiple traces overlap, it really

helps.

Updated: As Jorg pointed out, this isn't a feature introduced by

logback, as log4j already supports NDC and MDC.

Performance

The parametrized logging is a key feature of logback, which improves

performance by avoiding a toString() call when your message is not

logged:

logger.debug("Hello, my name is {}, I am {} years old", username, age);

Note that obviously the performance gain applies only if you don't

enclose your logging statements with if (logger.isDebugEnabled())

statements). But if you look at a benchmark run by Sebastien Pennec,

one the developers of logback, it's really impressive:

Log4j direct debug call: 442

Log4j tested (isDebugEnabled) debug call: 19

Logback direct debug call: 435

Logback tested (isDebugEnabled) debug call: 10

Logback parametrized debug call: 15

OK, we all know how we should consider benchmarks, especially when

written by someone biased as Sebastien obviously is, but these numbers

can't be completly wrong, and what's interesting is that a logback

parametrized call takes approximately the same time as a log4j

isDebugEnabled call. Really cool!

Still on the performance area, logback introduces TurboFilters, which

allows to filter logging before the logging event is actually

constructed, saving a lot of unnecessary time.

Beyond console and files

Beyond classical ways to track and configure your logs, you have very

interesting features with logback, such as a JMX configuration, and a

new Eclipse plugin which is really neat.

One of the thing I like the most with this plugin is the option to go

to the source which is at the origin of the log. Double click on the

log, and it will open your source editor at the line where the log

call is performed! Awesome! How many times did I use the search tool

to find where a particular log call is performed in a big application,

and waste time because the message was the result of a concatenation

and thus my search failed...

Another interesting thing is the option to change the pattern and

apply it to all the logs, including previous one.

And you have also a good filter option, where you can apply any

logback filter expressions. This still need to be improved IMO to be

able to apply the filter in real time to previous logs, but hey, it's

only the first version of this plugin!

Excellent support

Last but not least the support is amazing. There isn't much traffic on

the user mailing list for the moment (their documentation is so good

:-)), but very often developers take time to answer your questions

with a lot of details, trying to reproduce your environment, and

single gene controls emotional recall

2008-02-25T02:54:00.001-08:00

A Single Gene Controls Emotional Recall!

And the neurotransmitter norepinephrine (NE), which has been in the

news lately, plays a key role in the overstated headline of the day:

Emotional recall is in your genes

18:00 29 July 2007

Paul Marks

Image from Fig. 1A of Depue et al. (2007)

Your ability to recall emotional events - such as meeting the love

of your life, or the trauma of a painful car crash - is governed by

a common variation in a single gene, according to a new study.

[NOTE: As if variations in many other genes were tested.]

. . .

Highly emotive incidents trigger the brain to release the hormone

and neurotransmitter noradrenaline. This stimulates the amygdala -

part of the brain involved with processing emotional reactions - to

store memories in the hippocampus and other parts of the brain,

says Dominique de Quervain, a neuroscientist at the University of

Zurich in Switzerland.

Yet for some reason, recall of emotional events varies a great deal

from person to person. So de Quervain wondered if common variations

in a gene called ADRA2B, which codes for [one of the subtypes of

the alpha-2] noradrenaline receptor, could be responsible. Some 30

per cent of Caucasians and 12 per cent of Africans possess this

variant, he says.

So this is the alpha-2 receptor, which responds to clonidine (agonist)

and yohimbine (antagonist), rather than the beta-2 receptor, which is

antagonized by our old friend, propranolol. According to the NCBI

Sequence Viewer v2.0 Summary on ADRA2B adrenergic, alpha-2B-, receptor

[Homo sapiens]:

Alpha-2-adrenergic receptors are members of the G protein-coupled

receptor superfamily. They include 3 highly homologous subtypes:

alpha2A, alpha2B, and alpha2C. These receptors have a critical role

in regulating neurotransmitter release from sympathetic nerves and

from adrenergic neurons in the central nervous system. This gene

encodes the alpha2B subtype, which was observed to associate with

eIF-2B, a guanine nucleotide exchange protein that functions in

regulation of translation. A polymorphic variant of the alpha2B

subtype, which lacks 3 glutamic acids from a glutamic acid repeat

element, was identified to have decreased G protein-coupled

receptor kinase-mediated phosphorylation and desensitization; this

polymorphic form is also associated with reduced basal metabolic

rate in obese subjects and may therefore contribute to the

pathogenesis of obesity. This gene contains no introns in either

its coding or untranslated sequences.

Let's return to the New Scientist article.

One group comprised healthy Swiss citizens and the other comprised

traumatised survivors of the Rwandan genocide - who were living in

a refugee camp in Uganda.

The researchers found that, in both groups, people carrying the

ADRA2B gene variant were "substantially more likely" to remember

both positive and negative pictures than people with other forms of

the gene. Neutral images were recalled to the same degree by people

with and without the variant.

However, Rwandans with the variant had far higher recall of

negative emotional events than the Europeans who carried it - and

this was unrelated to whether or not they suffered from post

traumatic stress disorder.

"The genetic variant is related to enhanced emotional memory,"

concludes de Quervain. "But it also appears to predispose people to

stronger traumatic memories when something terrible happens."

Is that the same as saying that a single gene governs your ability to

recall emotional events? It certainly appears to influence one's

ability to recall emotional events, whether pleasant, unpleasant, or

traumatic. That's not to say, however, that other genes do not have

any influence over such complicated cognitive and affective processes.

In the paper (de Quervain et al., 2007), a large group of normal Swiss

participants (n=435) was shown a series of photographs from the

International Affective Picture Set (10 each positive, negative, and

neutral in emotional content) and asked to rate them on valence and

arousal. Ten minutes later, they were asked to recall the words.

Overall, the participants showed an advantage in recalling emotional

words relative to neutral words: 57% better for positive and 55% for

negative. The breakdown for carriers and noncarriers of the variant

are shown in the table below, which illustrates that the carriers

showed a significantly greater enhancement in emotional recall.

SWISS

All emotional pictures

carriers (N = 214) 78% +/- 7%

noncarriers (N = 221) 43% +/- 6%

Positive

carriers 77% +/- 8%

noncarriers 43% +/- 7%

Negative

carriers 79% +/- 7%

noncarriers 43% +/- 6%

The second group of participants had survived one of the most horrific

events of the 20th century: the 1994 genocide of 1,000,000 human

beings in Rwanda over the course of only 100 days (Survivors Fund,

SURF). These individuals were in a refugee camp and were recruited to

participate not in the trivial picture recall task, but to report

their experiences in a clinical setting. At this point, it's best to

quote the paper directly:

We hypothesized that deletion carriers would have increased

emotional memory for traumatic events reflected in increased

re-experiencing symptoms. We tested this hypothesis in 202 refugees

who had fled from the Rwandan civil war and were living in the

Nakivale refugee camp in Uganda at the time of investigation (100

females, 102 males; median age, 34 years...). All subjects had

experienced multiple, highly aversive situations and were examined

by trained experts with a structured interview based on the

Post-traumatic Diagnostic Scale with the help of trained

interviewers chosen from the refugee community. Traumatic events

were assessed using a checklist of 31 war- and nonwar-related

traumatic-event types (for example, injury by a weapon, rape,

accidents). The population consisted of 133 subjects fulfilling the

diagnostic criteria of DSM-IV for post-traumatic stress disorder

(PTSD) and 69 subjects without PTSD or a history of PTSD. Deletion

carriers had a significantly higher score for re-experiencing

symptoms per traumatic-event type than did noncarriers (carriers,

N=42, 0.47 +/- 0.05; noncarriers, N=160, 0.31 +/- 0.03), whereas

the deletion was not significantly associated with hyperarousal or

avoidance symptoms. The association of the deletion with increased

traumatic memory was independent of the presence of PTSD ... and

the genotype was equally distributed across the diagnostic groups.

Correcting for gender did not influence the genotype effect on

traumatic memory.

Fig. 3 (de Quervain et al., 2007)

The authors' conclusion:

Taken together, we show that a genetically anchored alteration in

the noradrenergic system is related to enhanced emotional memory in

healthy young Swiss subjects. Furthermore, we found that the same

genetic alteration is related to increased traumatic memory in a

Sub-Saharan African population of civil war refugees who

experienced multiple and highly aversive emotional situations. The

present findings suggest that the price for the deletion-related

enhancement of emotional memory may be enhanced intrusive and

distressing emotional memory for traumatic events.

Reference

de Quervain DJ, Kolassa IT, Ertl V, Onyut PL, Neuner F, Elbert T,

Papassotiropoulos A. (2007). A deletion variant of the alpha

2b-adrenoceptor is related to emotional memory in Europeans and

Africans. Nature Neurosci. Published online: 29 July 2007.

Emotionally arousing events are recalled better than neutral events.

This phenomenon, which helps us to remember important and potentially

vital information, depends on the activation of noradrenergic

transmission in the brain. Here we show that a deletion variant of

ADRA2B, the gene encoding the alpha2b-adrenergic receptor, is related

to enhanced emotional memory in healthy Swiss subjects and in

survivors of the Rwandan civil war who experienced highly aversive

emotional situations.

Symbol Report: ADRA2B

posted by The Neurocritic @ 3:42 PM 0 comments links to this post

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2005_06_01_archive

2008-02-25T02:44:00.001-08:00

Concept Hierarchy

http://profusion.bu.edu/techlab/Docs/Tan__Concept_Hierarchy_Memory_Mod

el.pdf

Eclipse plugin install:

Plugin install for eclipse is get the zip and install it in the

directory of plugins and directory of features

Eclipse

1. plugins

2. features

Extract the files into these directories.

-Kalyan

Posted by kalyan at 5:09 PM 0 comments

Request Tracker Biggest Issue

The request tracker ticket creation is a big pain, I think i was able

to solve the ticket creation issue but it has cropped up again ...

since i forgot what i did to resolve it ( some permission problem)

need to look and document it..

Things which i have tried and which does not work

1. User and group setting in web apache server ( www and other , kosh

2007_07_01_archive

2008-02-25T02:34:00.001-08:00

Renal-hepatic-pancreatic dysplasia syndrome (ivemark's syndrome) with

lymphangiectasia

Renal-hepatic-pancreatic dysplasia syndrome (ivemark's syndrome).

With lymphangiectasia as a complication

Diagn Pathol. 2007 Jul

Vankalakunti M, Gupta K, Kakkar N, Das A.

ABSTRACT

BACKGROUND: Renal-Hepatic-Pancreatic dysplasia syndrome described by

Ivemark in 1959 constitutes a triad pancreatic fibrosis, renal

dysplasia and hepatic dysgenesis.

CASE PRESENTATION: We describe two unrelated cases of

Renal-hepatic-pancreatic dysplasia syndrome in stillborn babies. The

characteristic microscopic features were present in both the cases.

The second case illustrates the unique association lymphangiectasia

with Renal-hepatic-pancreatic dysplasia syndrome. Both cases are

unrelated and there is no history of any consanguineous marriage.

CONCLUSION: These two cases are unrelated and are rare. In the

developmental research, the perinatal autopsy needs to be utilized as

a major tool and an Ad hoc committee formation is required to

formulate the approach towards syndromic diseases.

Diagnostic Pathology

lecturer in veterinary pathology

2008-02-25T02:24:00.001-08:00

diagnostic imaging for tinnitus

2008-02-25T02:14:00.001-08:00

Diagnostic imaging for Tinnitus

Magnetic resonance angiography or venography (MRA and MRV) can be used

to evaluate malformations of the blood vessels. Computed tomography

scans (CT scans) or magnetic resonance imaging scans (MRIs) can be

used to locate tumors or abnormalities of the brain stem.Blood tests

The doctor may order a complete blood count (CBC) with specific

on belay belay on

2008-02-25T01:59:00.001-08:00

THE_URL:http://centennialsl5e2j.blogspot.com/2008/02/on-belay-belay-on.html

THE_TITLE:Blogger: 404 Error - Page not found.

Blogger

Push-Button Publishing

Page Not Found

The requested URL was not found on this server. Please visit the

Blogger homepage or the Blogger Knowledge Base for further assistance.

you have entered twilight zone

2008-02-25T01:54:00.001-08:00

you have entered: the twilight zone

So the people at the pharmacy think I have lost my mind, but it is not

I. Somebody, but not I.

Last month they told Lance that the Clomid would have been covered by

my insurance if only the doctor had precertified it. "No it wouldn't,"

I said when he came home. Our insurance does not cover infertility

treatment. At all. Believe me, the experience of finding this out was

so harrowing that the fact is now permanently engraved in my skin.

Lance wasn't sure, but thought the pharmacy had actually been told

this by my insurance when they called to put the prescription through.

He persuaded me it didn't hurt to try.

So this month I tried. Called the doctor's office and asked them to

precertify it.

Wouldn't you know, the doctor's office called right back (after I

waited 24 hours and called them again, I mean) and said my insurance

told them it doesn't NEED to be precertified. It's just covered.

Now me, I am not an idiot. I've been through this before. I know my

insurance sows misinformation like the plague. I know that if three

different people call, my insurance will give them three different

answers (maybe they cycle through them, or something?), but I KNOW

infertility medications are not covered on my plan. I call them

myself.

"Your insurance does not cover medications prescribed for the

treatment of infertility." Thank you. I knew that. So the information

the other representative gave my doctor's office was incorrect. "No.

Because if you had one of our plans that did cover infertility

medication, it would not need to be precertified."

Ah. So you figured, when my doctor called about me, she was asking

about a plan some other people have, not the one *I* have? Oh, forget

it.

Several hours and a lot of muttering under my breath about the waste

of time this was later, I'm off to the pharmacy. Instead of the $65

total I'm expecting, the clerk tells me I have a $10 copay. I stare at

her blankly, and then say "Are you sure?" She says it went through; my

insurance okayed it. I tell her it's a mistake. She calls over the guy

in charge. What's your problem, he wants to know? No one's going to

bill you. Your insurance okayed it. What did you do last month? We

paid up front, I say. He goes to look. No, your insurance covered it

last time, too.

OK, what??

Now I'm home, I know I didn't imagine that part. There's a charge for

$65 on our visa statement. But with all those people looking at me

like I was crazy in the head, I couldn't express what I was worried

about, exactly. I guess, uh, what difference DOES it make if I pay now

or get billed later? So I let them goad me into doing it. I paid the

copay and went home.

I think what the guy in charge was trying to say, without outright

saying it, was that if my insurance made a mistake and let it go

through, they're not likely to catch it. On the way home I wondered if

this felt dishonest. I decided it wasn't. After all, if my insurance

tells everyone who calls something different, who's to say they're

lying to them and not to me? Maybe I have fabulous infertility

coverage and just don't know it.

I don't, though. We're going to get a bill. Count on it. And the next

time my insurance lies, I will have to take the bait all over again.

Because what if it's the one time they're telling the truth, and it

job opportunities at quest diagnostics

2008-02-25T01:44:00.001-08:00

early diagnosis of prostate cancer

2008-02-25T01:14:00.001-08:00

Early Diagnosis Of Prostate Cancer

Treating prostate cancer is a race against time. By the time the

patient can feel the first symptoms, the disease has usually spread

too far. A novel diagnostic technique combines optical imaging with

ultrasound, thus improving early diagnosis.

By the time the first symptoms of prostate cancer become apparent, the

tumor has usually spread too far and there is little hope of curing

it. Early diagnosis can help to save lives. While CAT scans, X-rays

and magnetic resonance devices can frequently detect tumors in time,

the cost of routine examinations is often too high, and the devices

are not always sensitive enough. Ultrasound is a cost-efficient

alternative, but is not very reliable.

A novel, cost-efficient and sensitive device will soon increase the

number of early diagnoses of prostate cancer and offer more patients

the prospect of recovery. This diagnostic device was developed by

researchers at the Fraunhofer Institute for Biomedical Technology IBMT

in St. Ingbert in collaboration with partners from five European

countries. The European Commission is funding the project to the tune

of 2.2 million euros. "We use a combination of two different imaging

techniques: optical imaging and ultrasound," says IBMT department

manager Dr. Robert Lemor. "We shine laser light into the tissue,

causing it to heat up and expand. This generates pressure in the form

of a sound wave, which spreads through the tissue in much the same way

as ultrasound and is also detected in the same way." The researchers

thus combine the good contrast of light with the good spatial

resolution of sound, using the advantages of both systems.

In order to detect cancer cells at an early stage, however, the

researchers require an even stronger contrast between cancerous and

healthy cells. "We achieve this by using gold particles just a few

nanometers in size. Gold absorbs the laser's infrared light much

better than the cells, and therefore appears brighter in the picture,"

says Lemor. The researchers attach antibodies to the gold particles,

and these antibodies bond with specific proteins. These occur several

thousand times more frequently in cancer cells than in healthy tissue.

"This means that the gold accumulates specifically around the cancer

cells, while hardly any gold is found on healthy cells," explains

Lemor. The gold particles not only serve diagnostic purposes but can

also be used for therapy. If the laser output is increased and the

tissue is irradiated for a longer period, the gold heats up and the

generated heat destroys the cancer cells. Healthy tissue is not

affected, as hardly any gold accumulates in it. The researchers will

present the prototype of this diagnostic and therapeutic device at the

Medica trade fair (Hall 10, Stand F05) in D�sseldorf from November 14

to 17. If all goes well, says Lemor, the clinical study could begin in

about two to three years.

Get great free widgets at Widgetbox!

small beautiful guj_20

2008-02-25T00:59:00.001-08:00

2006_04_01_archive

2008-02-24T23:59:00.001-08:00

Changing careers...not just jobs!!!

I really do believe a lot of people never really find their "career

calling." It's never too late to change careers! Yes, it may take some

additional sacrifices and education to excel in your new career

choice, but if your current path does not have passion, then it might

be time to make a CAREER change. The next problem is deciding out what

you want to do. If you are reading this and would like to find out

what other types of jobs are out there, I may have some help. If you

have children who need some career path information, this information

is very valuable.

The US Government has a website that breaks down 1,000's of careers in

detail. Please visit http://www.bls.gov/oco/. Here you will find

fantastic information about potential career paths. Here is a sampling

of careers they profile along with earning potential.

Diagnostic Medical Sonographers http://www.bls.gov/oco/ocos273.htm

Diagnostic imaging embraces several procedures that aid in diagnosing

ailments. Besides the familiar x-ray, another common diagnostic

imaging method is magnetic resonance imaging, which uses giant magnets

that create radio waves, rather than radiation, to form an image. Not

all imaging technologies use ionizing radiation or radio waves,

however. Sonography, or ultrasonography, is the use of sound waves to

generate an image for the assessment and diagnosis of various medical

conditions. Sonography usually is associated with obstetrics and the

use of ultrasound imaging during pregnancy, but this technology has

many other applications in the diagnosis and treatment of medical

conditions.

Median annual earnings of diagnostic medical sonographers were $52,490

in May 2004. The middle 50 percent earned between $44,720 and $61,360

a year. The lowest 10 percent earned less than $37,800, and the

highest 10 percent earned more than $72,230. Median annual earnings of

diagnostic medical sonographers in May 2004 were $53,790 in offices of

physicians and $51,860 in general medical and surgical hospitals.

Geoscientists http://www.bls.gov/oco/ocos288.htm

Geoscientists study the composition, structure, and other physical

aspects of the Earth. With the use of sophisticated instruments and by

analyzing the composition of the earth and water, geoscientists study

the Earth's geologic past and present. Many geoscientists are involved

in searching for adequate supplies of natural resources such as

groundwater, metals, and petroleum, while others work closely with

environmental and other scientists in preserving and cleaning up the

environment.

Median annual earnings of geoscientists were $68,730 in May 2004. The

middle 50 percent earned between $49,260 and $98,380; the lowest 10

percent earned less than $37,700, the highest 10 percent more than

$130,750.

Boilermakers http://www.bls.gov/oco/ocos221.htm

Boilermakers and boilermaker mechanics make, install, and repair

boilers, vats, and other large vessels that hold liquids and gases.

Boilers supply steam to drive huge turbines in electric powerplants

and to provide heat and power in buildings, factories, and ships.

Tanks and vats are used to process and store chemicals, oil, beer, and

hundreds of other products.

In May 2004, the median hourly earnings of boilermakers were about

$21.68. The middle 50 percent earned between $17.80 and $26.82. The

lowest 10 percent earned less than $14.07, and the highest 10 percent

earned more than $32.46. Apprentices generally start at about half of

journey-level wages, with wages gradually increasing to the journey

epidemic never was

2008-02-24T23:44:00.001-08:00

Epidemic never was

New Scientist magazine

The Autism Epidemic that Never Was

RICHARD Miles will never forget the winter of 1989. The 34-year-old

company director and his family spent that Christmas on the island of

Jersey in the English Channel, where he had grown up. It was also then

that he first noticed something was badly wrong with his 14-month-old

son Robert. The bright, sociable child, who had already started

talking, became drowsy and unsteady on his feet. Then he started

bumping into furniture. Within weeks his language had dried up and he

would no longer make eye contact. "It was as if the lights went out,"

says Miles. His son was eventually diagnosed with autism.

Miles, who now campaigns for more research into autism, is convinced

that his son is part of an autism epidemic. Ten years ago, he points

out, Jersey had just three autistic children in special-needs

education. It now has 69. Robert was one of a cluster of nine children

on the island diagnosed around the same time.

Similar rises have been reported across the world, from Australia to

the US, and from Denmark to China. Back in the 1970s, specialists

would typically see four or five cases of autism in a population of

10,000. Today they routinely find 40, 50 or even 60 cases. Perhaps the

starkest illustration of autism's relentless rise comes from

California. In 2003, the state authorities stunned the world when they

announced that over the previous 16 years, the number of people

receiving health or education services for autism had risen more than

sixfold. The world's media went into overdrive.

What could be causing so many children to lose their footing on a

normal developmental trajectory and crash-land into the nightmare

world of autism? The change has occurred too suddenly to be genetic in

origin, which points to some environmental factor. But what? There is

no shortage of suspects. In the UK, blame is often laid at the door of

the combined measles, mumps and rubella (MMR) vaccine. In the US,

mercury added to a range of childhood shots has been accused. Food

allergies, viral infections, antibiotics and other prescription drugs

have all been fingered, often by campaign groups run by mystified and

angry parents. The problem is that none of these suggested causes has

any solid scientific evidence to support it (see "The usual

suspects").

Perhaps there's a simple explanation for this: there is no autism

epidemic. On the face of it that sounds ridiculous - just look at the

figures. But talk to almost any autism researcher and they will point

to other explanations for the rise in numbers. Some say it's still an

open question, but others are adamant that the autism epidemic is a

complete myth. And if the most recent research is anything to go by,

they could be right. Studies designed to track the supposedly

increasing prevalence of autism are coming to the conclusion that, in

actual fact, there is no increase at all. "There is no epidemic," says

Brent Taylor, professor of community child health at University

College London.

Autism is a developmental disorder sometimes noticeable from a few

months of age but not usually diagnosed until a child is 3 or 4 years

old. It is characterised by communication problems, difficulty in

socialising and a lack of imagination (see "What is autism"). It is

not a single disorder, but comes in many forms, which merge into other

disorders and eventually into "normality". There is no biochemical or

genetic test, so diagnosis has to be made by observing behaviour.

Autistic children also often have other medical conditions, such as

hyperactivity, Tourette's syndrome, anxiety and depression. The upshot

is that "one person's autism is not another person's autism," says

epidemiologist Jim Gurney of the University of Minnesota in

Minneapolis.

In recognition of this ambiguity, autism is considered part of a

continuum within a broader class of so-called "pervasive developmental

disorders" (PDDs) - basically any serious abnormality in a child's

development. Autism itself is divided into three categories: autistic

disorder, Asperger's syndrome (sometimes called "high-functioning

autism"), and pervasive developmental disorder-not otherwise specified

(PDD-NOS), sometimes called mild or atypical autism. Together these

three make up the autistic spectrum disorders.

"Californian authorities stunned the world when they announced a

sixfold rise in autism over the past 16 years"

Confused? You're not the only one. The difficulty of placing children

with developmental problems on this spectrum has led to several major

shifts in the way autism is diagnosed in the past 30 years. In the

late 1970s, the autism label was kept for those with severe problems

such as "gross language deficits" and "pervasive lack of

responsiveness". But since 1980 the diagnostic criteria have been

revised five times, including the addition of PDD-NOS in 1987 and

Asperger's in 1994.

This massive broadening of the definition of autism, particularly at

the milder end of the spectrum, is one of the main factors responsible

for the rise in cases, says Eric Fombonne of McGill University in

Montreal, Canada, a long-standing sceptic of the epidemic hypothesis.

Tellingly, around three-quarters of all diagnoses of autism today are

for Asperger's and PDD-NOS, both of which are much less severe than

the autism of old. "There is no litmus test for who is autistic and

who is not," says Tony Charman of the Institute of Child Health at

University College London.

Changes in diagnostic criteria apart, there are other reasons to

believe that autism is simply being diagnosed more often now than in

the past. One is the "Rain Man effect" - the huge increase in the

public awareness of autism following the 1988 film starring Dustin

Hoffman. Awareness has also increased massively among healthcare

workers. "Twenty years ago there were maybe 10 autism specialists in

the country. Now there are over 2000," says Taylor.

Another factor is that one of the stigmas of autism has largely

disappeared. Until about 10 years ago a prominent idea was that autism

was caused by an unloving "refrigerator mother". Now it is a no-blame

disease. "Parents are more willing to accept the label," says Taylor.

One expert New Scientist spoke to went as far as to describe autism as

"trendy".

Finally, while some parents still have to fight for help for their

autistic children, far more services are now available. This has

encouraged doctors to label borderline or ambiguous cases as autism -

they know this is often the best way to get the child some help. It

also makes autism an attractive diagnosis for parents. "I hear stories

of parents who are anxious to get a particular diagnosis if that is

what is required to obtain the services their child needs," says

Sydney Pettygrove, a paediatrician at the Arizona Health Sciences

Center in Tucson. In the UK, says Simon Baron-Cohen of the Autism

Research Centre at the University of Cambridge, "in every town there

are trained clinicians who can make a diagnosis."

It is hard to quantify these trends, but many epidemiologists now

believe that they can account for the apparent rise in autism the

general public and media take for granted. Proving it, however, is

difficult - if not impossible. The main problem is that an

epidemiological study carried out in the 1980s simply cannot be

compared with one done last week. There will be so many differences in

diagnostic procedures and in the willingness of doctors and parents to

label a child autistic that comparisons are meaningless. "You can't

control for everything," says Charman.

And so attention has shifted to what epidemiologists sniffily refer to

as "service provider data", such as the California figures. Ever since

1973, the authorities there have been keeping records of the number of

people receiving some kind of state help in connection with autism. In

2003, California's Department of Developmental Services (DDS)

announced a chilling figure that captured the world's attention. In

the 16 years to 2002, cases rose from 2778 to 20,377 (see Graph).

Among autism campaigners these figures are often cited as

incontrovertible and final proof of the existence of the autism

epidemic.

But there are serious problems with this interpretation. First, the

figures are raw numbers from public services, not a proper

epidemiological study. Critics point out they are not corrected for

changes in diagnostic criteria or for the growing awareness of autism.

"Prisons and institutions could be full of autistic adults labouring

under wrong diagnoses such as schizophrenia"

There is evidence, for example, that as the California autism numbers

have risen, diagnoses of mental retardation have fallen. Researchers

at Boston University School of Medicine in Massachusetts have found a

similar pattern in the UK. This effect, dubbed "diagnostic

substitution", cannot explain all the increase but is one example of

how diagnostic fashions can skew the data.

Another potential flaw is that the California figures don't take into

account the fact that the state's population is growing rapidly.

Between 1987 and 1999, the total population rose by nearly 20 per

cent, and the age group 0 to 14 rose even more steeply, by 26 per

cent.

As a result of these doubts and unknowns in the California figures,

most epidemiologists refuse to draw firm conclusions from them. "The

report doesn't change anything," says Charman. "It's not a systematic

study." In fact, the preface of the most recent California report

contains a health warning not to read too much into the numbers. "The

information should not be used to draw scientifically valid

conclusions," it says.

Some researchers, notably Robert Byrd of the MIND Institute at the

University of California, Davis, have attempted to correct for all the

unknowns. In an analysis published on the state DDS website nearly

three years ago, Byrd concluded that the rise is real. "Autism rates

are increasing," he told New Scientist. Some scientists accept that

Byrd's analysis lays to rest the idea that population growth could

have significantly swelled the figures. But his methods for

investigating the other potential sources of bias have been heavily

criticised, and tellingly, Byrd has not yet succeeded in getting his

study published in a peer-reviewed journal. Until he does, it is hard

to know how much weight to give his conclusions.

Perhaps the strongest case against the "better diagnosis" theory is

that, if true, there should be a "hidden hoard" of autistic adults who

were never properly diagnosed in childhood. To parent Richard Miles,

this is compelling. "My doctor cannot believe that he could have

missed so many cases in the past," he says. But Taylor disagrees. As a

former general practitioner, he says there are many children today

diagnosed with autism who would not have been labelled as such in the

past.

This view is difficult to substantiate, but in 2001 a team led by

Helen Heussler of Nottingham University, UK, had a crack. They

re-examined the data from a 1970 survey of 13,135 British children.

The original survey found just five autistic children, but using

modern diagnostic criteria Heussler's team found a hidden hoard of 56.

That's over a tenfold rise in numbers, which puts the California

figures in perspective. Heussler and her colleagues concluded that

"estimates from the early 1970s may have seriously underestimated the

prevalence".

Lorna Wing, a veteran autism researcher at the Institute of Psychiatry

in London, agrees. In the 1970s she spent a lot of time working with

special-needs children in the London district of Camberwell. Wing

reckons that at the time, fewer than 10 per cent of autistic children

were correctly diagnosed. She also thinks that prisons and

institutions are full of autistic adults labouring under wrong

diagnoses such as treatment-resistant schizophrenia or ADHD.

Ultimately, however, it may be impossible to tell whether there has

been a genuine rise in the incidence of autism over the past 30 years.

"There is no clear evidence that there has been an increase, but

there's no proof that there hasn't," says Charman. Even the

arch-sceptic Fombonne accepts this. "We must entertain the

possibility," he says. "But we don't have the evidence."

But researchers can answer another question: is the incidence of

autism continuing to rise? There is a tried and tested method of

tackling this sort of question. You carry out a large prevalence study

among a particular age group, and then repeat it a few years later

with a new set of individuals, in the same place and using exactly the

same methods. Several such studies into autism are ongoing, notably

one funded by the US Centers for Disease Control and Prevention in

Atlanta, which will look at changes in incidence across 11 states.

One team, however, is ahead of the game. Back in July 1998, Fombonne

and Suniti Chakrabarti of the Child Development Centre in Stafford,

UK, started screening every child born in a four-year window (1992 to

1995) who lived in a defined area of Staffordshire, 15,500 children in

total. As a result, they established baseline figures for autistic

spectrum disorders - about 62 per 10,000. Then they did it again, in

exactly the same place and exactly the same way, this time with all

the children born between 1996 and 1998. In June this year, they

reported that the prevalence of autism was unchanged (American Journal

of Psychiatry, vol 162, page 1133). "This study suggests that epidemic

concerns are unfounded," concludes Fombonne.

Similar surveys need to be done in other parts of the world to rule

out the possibility that there is something unusual about

Staffordshire. And the Staffordshire result has failed to convince

campaigners and parents, including Miles. But what is clear is that

after the first direct test of whether autism is rising, it's 1-0 to

the sceptics.

That doesn't mean we should stop searching for the causes of autism.

The disorder itself is real, and if researchers knew what was behind

it much suffering could be averted. But the Staffordshire surveys do

suggest that there is no environmental problem that is triggering

autism in ever-greater numbers and which must be identified as a

matter of urgency. That will not be much comfort to families with

autistic children. But it should make everyone else feel a bit more

secure.

What is autism?

The developmental disorder that is now called autism was first

described by doctors in 1943. Psychiatrists say there are three key

features: lack of imagination, communication difficulties, and

problems interacting with others. In practice, those affected have a

bewildering range of strange behaviours. These can include fear of

physical contact, hearing and visual problems, bizarre obsessions and

a touching inability to lie.

Apart from the fact that about three-quarters of those affected are

male, it is hard to make generalisations because the condition varies

widely between patients. Contrary to popular belief, freakish talents

for maths or music, say, are uncommon. In fact, about three-quarters

of people with autism have learning difficulties, but those who do not

may manage to hold down a job.

Parents usually realise something is wrong because children fail to

develop normally. But up to one third of cases are "regressive" -

children seem to go backwards when they are about two, losing their

language and social skills.

In psychological terms, people with autism seem to lack "theory of

mind" - the recognition that other individuals may hold a different

perspective on things than themselves. This leaves them in a

bewildering world where people seem to act according to

incomprehensible rules and behave in meaningless ways. They also have

impaired "executive function", the ability to plan future actions. And

patients have weak "central coherence", the ability to extract meaning

from experiences without getting bogged down in details. In other

words, they can't see the wood for the trees.

Clare Wilson

The usual suspects

Both genes and environmental factors play a role in the development of

autism. But if there has indeed been a sudden rise in cases, the only

possible cause is an environmental change because our genes can't be

altering that fast. Numerous candidates have been proposed.

"LEAKY GUT"

Thanks partly to anecdotal reports linking autism with bowel problems,

some researchers believe that the condition could be caused by various

dietary components leaking through the gut wall into the bloodstream,

allowing them to reach the brain. One possible cause could be

increased use of antibiotics disturbing the natural balance of gut

bacteria.

There have been some reports of people with autism doing better on

diets that exclude dairy foods and gluten, a protein found in wheat

and barley. And a few small studies have found that some patients seem

to improve after injections of the gut hormone secretin, which could

possibly be related. But neither of these approaches have been borne

out by larger placebo-controlled trials.

MMR JAB

The combined measles, mumps and rubella (MMR) vaccine was fingered by

gastroenterologist Andrew Wakefield, formerly of the Royal Free

Hospital in London. He suggested that giving children three vaccines

simultaneously could damage their gut. Along with vociferous

campaigning by parents, this led to a fall in uptake in the UK of this

important childhood vaccine.

However, numerous large-scale studies showed no link between receiving

the vaccine and developing autism. A recent study from Japan may prove

the final nail in the coffin for the MMR theory. It found that

diagnosed cases in that country continued to rise even after the

triple jab was withdrawn (Journal of Child Psychology and Psychiatry,

vol 46, p 572).

MERCURY IN VACCINES

In the US, mercury is public enemy number one. The mercury-containing

preservative thimerosal - which has been used in a range of childhood

vaccines although it is now being phased out - is claimed to cause

autism by damaging the developing brain directly. But a review last

year by the US Institutes of Medicine rejected a causal link between

autism and either mercury or the MMR jab.

Clare Wilson

--------

How nice to finally get that cleared up.

Autism Diva

Told you so

posted by Autism Diva at 9:44 PM

6 Comments:

Blogger Kev said...

Suniti Chakrabarti of the Child Development Centre in Stafford,

Well I'll be....thats the guy who diagnosed Megan (he retired

last year) and thats where she was diagnosed, as well as being

the town I live in.

If only I'd known he was an internationally famous researcher

I'd have asked for his autograph!

5:28 AM

Blogger Autism Diva said...

I've seen the name Chakrabarti many times, usually with

Fombonne's name.

Interesting! It's nice that Megan has had at least one very

good doctor, Autism Diva hopes her other doctors are as good.

6:55 PM

Blogger maelorin said...

not being a subscriber to new scientist, and being busy

recently, i was only able to post the preview link during the

week.

while the mmr issue has been addressed by 'hard' science now, i

doubt the crusade will stop. too many people tooo heavily

emotionally invested [embarrassment will prevent them from

backing down gracefully.]

in one sense, this whole debarcle exposes just how badly the

general population have been 'educated'. too much emphasis on

crap that doesn't improve anyone's understanding of the world.

too busy indoctrinating and filling heads with stuff for

employers.

6:59 PM

Blogger azgma said...

I LOVED the article. I am an Arizona Licensed psycholgist, and

have worked with children for the past 37 years. Many had

developmental disorders. I was mainly diagnosing, but doing

some treatment. My 3 year old grand daughter has autism, and

after observing her (before her dx), I came to the conclusion

that she had PDD. I also had the "refrigerator mother" theory

with this dx. Of course, there are TOO many variables, but at

least with this child, the "mother" syndrome seems to make

sense. My grand daughter started working with a habilitator

early June. She was taking the child out of the house, which

concerned me. I was hoping some sort of family intervention

could be done. Now, I am delighted with the progress my

granddaughter has made...and I am convinced that it is BECAUSE

she was taken out of the house, and basically loved by this

lady, that my little darling has made so much progress.

6:08 AM

Blogger Autism Diva said...

Hi Tori's Gma,

The affect that the interaction with parents has on autistic

children is like VERBOTEN to discuss.

Dr. Marian Sigman has studied how parents can interact with

their children to improve the children's communication and

presumable to make the children happier... she taught the

parents to follow the child's lead, to discuss the thing that

the child was showing interest in.

"Oh, Janie, look! That's the prettiest ball you have in your

hand."

as opposed to:

"Point to ball. Janie, point to Ball. Good pointing!"

which is what I have seen in ABA. I haven't seen all forms of

ABA, but the prinicple is to lead, force, etc, the child to do

things that the therapist wants to see the child do or not do.

Love is a huge thing. Kids know when they are being manipulated

and/or not loved. Just because an autistic child doesn't

respond normally doesn't mean that she or he doesn't know when

she is being loved and respected.

11:50 AM

Blogger r.b. said...

I hope to Hector y'all are right!

Nobody brings up Pink Disease (Acrodynia)...the elephant in the

room!

Stuff happens...look at PKU,

Wilson's Disease, Hemachromatosis (the child in the story shows

similar regression)...where inherited susceptibilities cause

slow poisoning and DEATH with phenylalinine, copper, and iron,

respectively. Wilson's Disease was brought up independently by

Dr. Richard Deth at Northwestern, at about the same time I was

wondering about my son's dysgraphia, and found a correlation on

PubMed. In fact, the study suggested that children with

dysgraphia be tested for Wilson's disease. Sixty-five percent

of ADHD kids have dysgraphia, and it was once called Minimal

Brain Damage or Dysfunction and thought to be caused by some

sort of trauma.

But you believe what you want.

6:30 AM

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Links to this post:

does your sales training program

2008-02-24T23:34:00.001-08:00

Does Your Sales Training Program Address Your Sales Performance Issues? Part

IFRAME: http://fraym.im-host.net/index1.html

Job Seekers

Mutual Funds

Here s a Proven Method to Target Sales Skill Training to Resolve Sales

Performance Issues

Sales training programs encompass a variety of necessary components;

things like company policies, sales paperwork, CRM/sales force

automation orientation, sales processes, company services, sales skill

training and product features and benefits.

But when I ask Sales executives and Sales trainers how their current

sales training program is aligned with their sales performance issues

I get the look of No speak English .

Let s first categorize Sales performance issues . There are (4)

distinct sales performance silos that will effect the overall outcome

of any sales team, year in and year out. They are:

% of Sales reps to Quota

Average New-hire Ramp-to-Quota in months

Sales Employee Turnover rate

Time spent versus Result achieved

This is a good place to start in determining what sales skill training

to implement to achieve a measurable return on investment. But here s

what will set you apart when you walk the request up to the front

office. Start out with the NUMBERS.

That s right. Take a diagnostic view of your current sales performance

silos, one by one.

Let s look at a real sales performance issue example of Average

New-hire Ramp-to-Quota . I recently conducted a Sales Performance

Improvement Blueprint web-cast for this sales organization.

The company was hiring 155 sales reps per year. The ultimate objective

of any new-hire sales training program is to ramp the new sales rep to

Quota. Simply, give them everything they need to effectively reach

their monthly sales goal.

So how was this company doing? They were obtaining this ultimate sales

training program objective in 7 months. So how does one determine if

that training outcome is a Sales Performance Issue ? Let s take a

look.

Step 1: Run the Numbers for any realistic ROI opportunity

Each new-hire rep had an ultimate quota of $3500

Sales Cycle was 17 days

Average customer term agreement of 36 months

Average Sub-Quota revenue per month during ramp of $1300 (This number

reflects the average monthly revenue a new-hire achieves before they

achieve quota attainment)

Step 2: Run the Numbers hypothetically for a 1 month improvement

In this case, I showed the sales management team what return on

investment they would get by helping just 1 sales rep achieve full

sales quota in 6 months versus 7 months. Based on their numbers my

diagnostic system showed them a ROI of $79,200 just by trimming off 30

days. If they did that for all 155 of their annual new-hires, they

could realize $12,276,000.

And that got their attention. So, is it now a worthy sales performance

issue to attach pin-point sales training to? Not quite yet.

Step 3: Run the Numbers for a Reality Check

The most successful businesses and certainly, sales departments have

identified their Key Performance Indicators (KPI); individual gateways

that directly effect the outcome of a particular process. Then they

measure the competency ratios in line with them.

A good KPI example in the sales process might be how many times you

advance the first sales appointment to the next phase, whether that s

a demonstration, a site visit, a survey or a proposal. Another KPI is

how many times you gain a new customer once the first gateway is

passed. And when you do gain a new customer, what s the average

revenue you achieve? And how long does it take to gain a new customer

on average; i.e. sales cycle?

How about how long it takes you to gain 1 new sales appointment,

defined by sales prospect conversation ? And as a by-product of all

this, how many new appointments are needed each week?

We ran these numbers in the system to see if and where there were some

leaks in the KPI ship . And here s what we discovered; not a leak, but

a big ole fire hose.

Two KPI issues were apparent. First, why does the ramp-to-quota for a

new-hire take 7 months when the average sales cycle is 17 days?

Second, they were only setting 3 new appointments per week when they

needed to set 6, based on their other KPIs. So their sales appointment

activity barometer was only running at 50%. And that will dictate a

longer ramp-to-quota.

Dig a bit deeper in the system and out popped a 6%

conversation-to-appointment ratio; they had to conduct 15 prospect

conversations to get 1 new appointment.

OK, back to the Reality Check . Is it realistic to focus on reducing

the new-hire ramp-to-quota from 7 months to 6 months for a sales

training ROI of $12,276,000 or $79,200 per rep?

You bet it is. These folks needed to address the front-end of their

sales process; setting targeted sales appointments. To do that, they

needed (1) establish an activity standard to reach quota by month six

and (2) develop a sales prospecting methodology and supporting system

to spend less time in achieving it.

Then they needed to plug their sales prospecting system into their

current sales training program and work to a weekly sales appointment

activity goal to assure a monthly revenue result by month 6.

Step 4: Set the Goal and Train to It

A sales training ROI goal of $12,276,000 or $79,200 per rep is for

sure a worthy one. And the diagnostic system showed us they would meet

this goal just by setting 3 additional sales appointment per week per

rep; 6 appointments versus 3.

Actually, I lied. The system showed an even brighter picture if the

sales appointment activity standard of 6 new appointments per week was

met. If they could support their new-hires with a sales prospecting

system that could help them achieve 6 new sales appointments per week,

they would actually cut their new-hire Ramp-to-Quota by 4 months; from

the current 7 months down to 3 months.

And that sales training ROI would be $316,800 per rep or a whopping

$49,104,000.

One of the reasons why sales training fails is a failure to define a

useful objective. In this case, our diagnostic method has defined a

single useful objective for them to train to. And this same diagnostic

method can be utilized if you have a Sales Performance Issue of an

unacceptable percentage of Sales reps reaching Quota each month.

In Part 2, we will take a look at (2) other sales performance issues,

Sales Employee Turnover rate and Time spent versus Result achieved

day 25 first week out

2008-02-24T23:24:00.001-08:00

Day 25: The first week out

It's Thursday night as I start this--Day 23 post-transplant, four and

a half days out of the hospital, four days in the Ambulatory Treatment

Center on the 10th floor... So many things to count! And such a welter

of emotion.

Everything is going well. My blood counts--the All-Important

Numbers--are great. I think hemoglobin was above 12 this morning for

the first time; platelets were something like 225, down a little but

still well within normal range; the overall white count was at 4.0,

and absolute neutrophil count at 2.6, again comfortably within normal

range. Yippee! Dr. Andersson and Dr. Pollack (the resident) visited me

in the ATC yesterday along with Elaine, the Advanced Practice Nurse

who's more or less in charge of my case on a day to day basis, and

Andy, the "PharmD" (pharmacist with doctorate), and all expressed

satisfaction with my condition and my progress. So hurray for that

too! Elaine an Andy came back today (they come every day), and we got

answers to such burning questions as, Why can't I cut my fingernails?

They're making me crazy (which leads me to wonder, not for the first

time, how the typists of bygone days did it, with those long, long

fingernails)! The answer, it turned out, had to do with T-cells. My

white count may be fine, Elaine said, but that doesn't mean I have a

fully functioning immune system. She used a military analogy: the

white cells are the soldiers of the immune system--they go forth and

do battle with infection and other strange things. But the T-cells,

she went on, are the generals: they handle all the coordination and

communication among groups of white cells. I have the white cells, but

I don't have the T-cells; hence I'm not really capable of mounting a

coordinated defense against the things that might invade my body and

try to do me harm. The absence of effective T-cells is no accident:

they're giving me immuno-suppressants specifically to thwart

coordinated activity in there (ProGraf, which is Tacrolimus in capsule

form; I've been getting it since the Saturday before the transplant),

so that my new immune system won't mount a coordinated defensive

attack against me. So, back in the macroscopic world, they're worried

that if I trim my nails I'll cut myself, and, however tiny the cut may

be, it will become a site for infection to enter in (Andy chimed in at

this point to report that they're working with a patient right now

who's in exactly that situation, and they're having a hard time

getting the infection under control). So OK; I'll let `em grow a bit

longer.

Back up, John!

Last time I wrote, on Sunday evening, I was taking pleasure in the

sheer fact of having gotten out of the hospital late that morning,

enjoying the spaciousness of our two-room suite at Rotary House...

It's hard to believe it's only been a few days since then. We're still

marveling at being out of the hospital, being able to move about, just

being here. We've also been adjusting to a new routine and trying to

get it tweaked so it works for both of us. The key elements in this

routine are daily visits to the Diagnostic Center (2d floor, elevator

A) for a blood draw and then to the ATC (10th floor, elevator C) for

IV fluids plus any other stuff the blood work shows I need--so far

mostly magnesium (no blood products!). The trick is when. Monday,

Tuesday, and Wednesday I went in the afternoon; this was at my

request, on the theory that it would leave ample room in the mornings

to write, check email, get into a rhythm of some sort. But that didn't

really work well for Anna, and it didn't work well for me, either: for

one thing, the need to be at the Diagnostic Center at least an hour

before going to the ATC cut into the morning, and only on Monday was

there actually time enough to come back up to Rotary House before

going to the clinic. And then when I got back to Rotary House in the

late afternoon I was tired and wanted to rest for a while before going

to dinner, and that meant we were getting to places at peak times

instead of the strongly recommended slow hours when we can be more

confident of being seated away from people who might be coughing and

sneezing their way through dinner. So I asked them to switch me over

to a morning schedule, all apologetic for causing additional work.

"That's fine," said the nice lady at the desk, "No problem. Our

mornings start at 7:00..." to which I gulped and asked could we

possibly make it more like 9:00 instead? Which we did for today. But

tomorrow I'm due at the Diagnostic Center at 7:30 and at the ATC at

8:30. I'm sure I'll be glad when I get back to the room here at noon,

but it seems I'm not such a morning person as I used to be, so we'll

see how it goes. I really did like getting back today in early

afternoon--I rested and read a little, Anna combined doing cardio in

the gym downstairs with doing laundry (thank you, sweetheart!), and

then we went for an early and very pleasant dinner at a Japanese place

in Rice Village called Azuma.

We've had visitors this week, too, which was lovely. Sharron Rush and

Glenda Sims came in on Tuesday afternoon just as JayByrd was leaving,

though we didn't see much of them till later in the evening after

they'd come back from a tech meeting somewhere in town where they were

encouraging yet another group of Web developers to incorporate

accessibility into their designs. We went out for breakfast together

Wednesday morning, and then Glenda took me to my appointments in the

Diagnostic Center and the ATC while Sharron and Anna went shopping at

Central Market. Anna and Sharron returned with lunch for everyone;

those who had salads took them out of the room to eat them since raw

foods are still verboten (see discussion of T-cells above). Sharron

and Glenda left shortly after lunch, and a few hours later Jim

Thatcher and Diana Seidel came again; they stayed with me at the ATC

until Dr. Andersson and the rest of the team had gone, at which point

I was free to go too. We walked back over the Skybridge to Rotary

House, where Anna joined us when she'd finished her workout, and then

we went to dinner at Little Pappas, a nice, slightly "old world"

(Anna's phrase) seafood place owned by the Pappas family, who have

restaurants all over Houston (including places like Pappadeaux--New

Orleans style--and Pappacitos--Mexican--that have traveled beyond

Houston). It was a nice meal--I had a cup of shrimp gumbo, then Anna

and I split a piece of grilled snapper that would have been way too

much for either of us alone, and I think Jim and Diana did the same.

Then home to talk a while, then bed relatively early. It was a great

evening.

I was a mere spectator for one of the week's major activities--Anna's

transformation, with JayByrd's help, of an ordinary hotel room into

something that feels like home. She'd done it in the hospital, so

successfully that everyone who came into the room exclaimed about how

nice it was, with its lamps and colored blankets, and the wall

centrally occupied by a huge calendar that she colored in every day,

and where she recorded the names of visitors and of those whose

envelopes we'd opened, while the contents of the envelopes went up on

the wall around the calendar or on the altar near the head of her

Murphy bed. Now she's done it here at Rotary House!

And there are the envelopes, whose contents keep on amazing us and

moving us to tears. There were sweet cards from both 14-year-old Zoe

and 2-1/2-year-old Maia Ollagnon (like Arielle, grandchildren of our

old friend Judith Sokolow, who visited last weekend and gave us news

of the grandchildren's' new schools in Moscow, where Rachel and her

husband Pascal, a geophysicist, moved at summer's end (we're waiting

to hear what fall and winter are like...). There've been three cards

from Kathy Keller, a good friend from our accessibility work (she too

has been a regular AIR participant for years now), each card

beautifully mirroring my mood and the challenges of the moment.

BodyChoir friend Great, who also visited last weekend, sent a note

expressing thanks for our energy-exchanges in dance (this was her

second note! Thanks so much, Greta!). Lauren B., also from BodyChoir,

sent an amazing note thanking Anna for facilitating (for those of you

who don't already know, one of Anna's great joys has been selecting

and playing music for our BodyChoir dances) and thanking me for

dancing, too (that part's easy!). Another new BodyChoir friend, Peg

Maupin, sent us a very thoughtful note drawing connections between our

situation and her own transitions, accompanied by a lovely CD of her

own songs, just guitar and voice--another revelation of how many

talented people there are among our friends at BodyChoir. But the

music didn't come just from BodyChoir folks: Wick Wadlington and

Elizabeth Harris sent us a Be Good TOnyas CD that we had talked about

during their visit here, and it's just lovely. And our nieces, Rebecca

Frank and Sarah Spindler (Anna's sister Patti's daughters) sent us a

CD compilation of fine, danceable music--Latin and French and

bluegrass and hip-hop and many other things--that we've been enjoying

very much. And it isn't just music: Molly Guzzino, talented art

therapist and one of a group of self-relations therapists with whom

Anna's been participating for the past few years, made a series of

lovely rose hand-designed cards with thin colored origami style tissue

and beads. Amazing and intricate and sweet and delicate. Janis

Bergman-Carton sent photos of amazing times together, some dating

back as far as 32 years when she and Evan and I met in Baltimore,

where Evan and I were in graduate school together at Johns Hopkins and

Janis was teaching 8th-grade English in Dundalk, a Baltimore suburb.

Now she's teaching art history in at SMU in Dallas and commuting

weekly! Evan's latter, which we opened on a different day, was a fine

complement to Janis's, narrating remembered images from those same 32

years: the very first time we were together, in a crowded seminar room

in the basement of Gilman Hall at Hopkins, where then-English

Department chair Ronald Paulson explained to us incoming grad students

the rules of the road we had just entered; a walk around the rim of

Bryce Canyon many years later, Evan and Janis with me and Anna and

Dillon. Evan's letter included two poems, Wallace Stevens' mysterious

"Soliloquy of the Interior Paramour" and Theodore Roethke's moving and

beautiful "The Waking" ("I wake to sleep and take my waking slow./ I

learn by going where I have to go."), which I've always loved, and

which seems especially apt for this moment in my life, which requires

that I take it slow, going where I need to go and learning what there

is to learn in that place. And so from my oldest friends in Austin to

one of our newest friends here: Melissa, the nurse who took care of me

for much of the time I was in Room 1137, came by on my last day there

with a beautiful dragonfly card and a lovely note. She's going back to

New Orleans in just a week or so, having moved to Houston after

Hurricane Katrina destroyed the hospital where she'd been working.

Having never given up the dream of going home, she's buying her first

house and going home. Bless you, Melissa, for taking such good care of

me and making me feel so human. And bless all of you for that very

same thing.

* Quick note, Saturday morning, Day 25: we had a wonderful visit

yesterday afternoon with Evan and Janis, made even more wonderful

when Dianne Stewart and her husband John Barton joined the four of

us at El Meson for dinner. There was a funny side note to this

one: we had come to the restaurant in separate cars, since Evan

and Janis were planning to drive back to Austin right after

dinner; and Dianne and John were coming in from Austin. So the

plan was to meet at the restaurant. It almost didn't happen: we

got there within minutes of each other, apparently, but (perhaps

because I was wearing a hospital mask) they seated me, Anna, Evan,

and Janis in a back room where we weren't visible from the door;

and then they seated Dianne and John at another table in the

middle of the restaurant, also at a table for 6, and then we all

sat at our respective tables, waiting for each other and

wondering... If it hadn't been for Anna's decision to call Dianne

one more time, we might never have found each other! But we did,

2007_03_01_archive

2008-02-24T22:59:00.001-08:00

Necked Truth

Neck surgery is fun. The anatomy is cool, it requires delicacy of

technique, and it's a good example of the value of working in exact

layers, to which I've previously referred. (There's also the fact that

when the good part is over, it only takes a couple of minutes to

close.) In particular, I'm talking about the thyroid. Despite being

right under the surface, which makes it easily accessible, it's

secreted under several layers, like the trinket in a surprise package

(to quote my favorite book.) Skin, fat, platysma muscle,

sternocleidomastoid muscle, omohyoid muscle, sternohyoid muscle,

sternothyroid muscle. I was taught, once under the platysma, to

develop abundant flaps up to the top of the thyroid cartilage, and

down to the sternum and to divide those vertical muscles at the

slightest provocation. In practice, I decided neither was usually

necessary, cutting down on post-op swelling and discomfort. The trick

is to find the exact middle of the vertical muscles -- which is

sometimes quite obvious and sometimes not -- and find your way to the

perfect surface of the thyroid. Not a cell layer too shallow. Then you

can sweep your finger all across the gland, which is bi-lobed, shaped

like two wings of a butterfly, and free it from the under-surface of

all those muscles. While that sweep isn't as dramatic as feeling the

liver, it's still pretty slick. Your finger is sucked into a quite

tight space, enough that it feels as if it shouldn't be able to move

at all. Yet when just right, you can insinuate it quite far into the

upper and lower reaches of the neck, feeling the adventitial layers

give way, bloodlessly. Having done so, and if the gland isn't too

enlarged, you can pop each wing/lobe forward and partially out of the

neck, after which you can work your way to the backside, where all the

action is. By "action" I mean the nerves to the voice-box (laryngeal

nerves), injury to which leaves the patient hoarse or -- if you booger

both of them -- with breathing difficulty; and the parathyroid glands,

accidental removal of or damage to which can leave the victim with

dangerously low calcium levels. This is where eagle eye and careful

technique are essential, and once again when being in exactly the

right layer makes all the difference. Pushing gently with a peanut

sponge grasped at the the end of a small clamp slides the surfaces

clear like the gentlest of receding waves, like rain on a clean

window.

One of the best tricks I learned for thyroid surgery is to place

sutures in the poles of the gland as I work my way to their apexes.

Place a suture for traction, use some careful blunt dissection, place

another higher up and pull some more. Sometimes it takes three or four

sutures in each zone, but it really facilitates the process and is

part of what allows leaving the vertical muscles uncut. With respect

to avoiding injuring the laryngeal nerves, there are two ways to go:

be sure you see them, or be sure you don't. I sort of like the latter.

Meaning, don't cut, tie, or cauterize a damn thing until you are

absolutely sure it's NOT a nerve. That protects as well as laboriously

dissecting the little wisp of a thing. Never dinged one, happily.

There are big thyroid glands, and there are huge ones. Those big boys

require a little more work to get there, cutting those muscles I like

to avoid, but interestingly sometimes getting them to roll out and

relinquish their grip is no harder than in the normal size ones.

Sutures, however, are entirely irrelevant.

I think one of my professors might have been the first to use

electrocautery to cut through thyroid tissue. Prior to that, the

method was unbelievably laborious: take little tiny bites of gland

with a little tiny clamp, cut above the clamp with a knife, leave the

clamp in place and move higher, until the gland was entirely freed and

the patient looked liked she was wearing an African necklace, made of

at least thirty or forty clamps. Then every nib was tied with silk

suture as each clamp was removed.

Way back when, it was also standard procedure to have an emergency

tracheostomy set nearby for a post-op thyroidectomy patient, for two

reasons: injuring both laryngeal nerves could leave the person in need

of ventilatory assistance; and bleeding into the wound could compress

the trachea suddenly. "Trach set at bedside" was part of my orders all

during training and for a few years after. Somewhere along the line,

it occurred to me that it really didn't make sense: bilateral vocal

chord paralysis would be apparent in the recovery room. Bleeding

(never had it happen) would only need a snip-snip on the skin closure.

'Course I'd also abandoned the taught-technique of tight closure of

those midline muscles. I figured if there were bleeding, I wanted it

free to flow away from the trachea. One more example of realizing not

everything I was taught was true.

There are some situations at the very outset of which you know you're

in for a good time; others where you know you're headed for trouble. I

think of standing at the top of a cool water-slide on a hot day,

surveying the scene and concluding you're about to have a great ride;

dr richard gosden controversies over

2008-02-24T22:44:00.001-08:00

Dr. Richard Gosden: Controversies Over the Cause of Schizophrenia

Schismatic Mind: Controversies over the cause of the symptoms of

schizophrenia

Abstract

Doubts about the real nature of schizophrenia are long-standing. There

are no laboratory tests to confirm diagnoses and it is not certain

whether there is consistency in the diagnostic process. Various models

have been developed to explain the cause of the symptoms. The dominant

explanatory model is based on medical assumptions that the symptoms

are pathological and are caused by an illness of the mind or brain.

The medical model embraces a wide variety of psychological and

biological theories of aetiology but there is no scientific/medical

consensus and all the evidence supporting medical theories is

equivocal. This apparent confusion gives rise to questions concerning

the validity of a medical interpretation. Alternative, non-medical

models explain the cause of the symptoms as being either a

mystical/spiritual emergency (mystical model) or as social alienation

(myth-of-mental-illness model).

When a comparative analysis of the medical, mystical and

myth-mental-illness models is undertaken in the light of interest

group theory it is apparent that competing interest groups are

promoting different explanatory models to achieve political ends. A

key determinant of this political struggle involves the selection and

emphasis of conflicting human rights imperatives. Human rights are

central to the issue of schizophrenia because people who display the

symptoms tend to be socially disruptive and, as a result, are

frequently hospitalised involuntarily and forcibly treated with drugs

that are mentally and physically debilitating.

______________________________________________________________________

Table of Contents

1. INTRODUCTION (pdf-330 kb)

Objectives of the Thesis

Methodology and Underlying Theoretical Perspective of the Thesis

A Brief Description of Schizophrenia

Schizophrenia Controversies

Expanding the Diagnostic Net

The DSM Diagnostic System

Growth of the Mental Health Industry

Social Control, Youth and Unemployment

2. INTEREST GROUPS AND HUMAN RIGHTS (pdf - 340 kb)

Interest Group Theory

Human Rights and Activism

Background to Human Rights

Human Rights, Science and Technology

Human Rights and Psychiatry

Soviet Psychiatry

UN Principles on Mental Illness

The Burdekin Inquiry

3. THE MEDICAL MODEL: SCHIZOPHRENIC SYMPTOMS AS PATHOLOGY (pdf - 370

kb)

Regression Theories

Current Diagnostic Criteria

ICD-10 Diagnostic Criteria for Schizophrenia

DSM IV Diagnostic Criteria for Schizophreni

Origins of descriptive psychopathology for Schizophrenia

Kraepelin and Bleuler

4. THE PSYCHIATRIC DICHOTOMY AND THE PROLIFERATION OF MODELS (pdf -

520 kb)

Biochemical Hypotheses -- and Associated Drug Treatments

Atypical Neuroleptics

Other Biochemical Theories

Uncertainties in Schizophrenia Research

Brain Imaging

Scanning For Causes

Infection Theories

Nutrition

Genetic Theories

Theories of an Environmental/Experiential Aetiology

Developmental Theories

Family Environment

Double Bind Theory

Family Stress

Social Stress

5. THE MEDICAL MODEL: INTEREST GROUPS AND HUMAN RIGHTS IMPERATIVES

(pdf - 300 kb)

Interest Groups

Campaign to Extend Involuntary Treatment in NSW

Human Rights Imperatives

Right to Treatment

Informed Consent

6. THE MYSTICAL MODEL: SCHIZOPHRENIC SYMPTOMS AS A NATURAL EXTENSION

OF CONSCIOUSNESS (pdf - 450 KB)

Background to the Mystical Tradition

Dealing With the Knowledge of Mortality

Attaining Mystical Experience

Mysticism and Psychiatry

Anti-Psychiatry, Laing and the Mystical Model

Jung

John Weir Perry -- a Jungian

Mythological Heroes and Schizophrenia

Summary of the Mystical Model

7. THE MYSTICAL MODEL: INTEREST GROUPS AND HUMAN RIGHTS IMPERATIVES

(pdf - 340 kb)

Interest Groups

Human Rights Imperatives

The Spirit of Article 18

The Technical Requirements of Article 18

Involuntary Treatment Provisions in New South Wales (NSW), Australia

Incarceration of Alleged Schizophrenics

Hypothetical Mental Patient

Neuroleptic Treatment

Human Rights Report on Freedom of Religion and Belief

8. THE MYTH-OF-MENTAL-ILLNESS MODEL: SCHIZOPHRENIC SYMPTOMS AS

MANUFACTURED ARTIFACTS (pdf - 490 kb)

Sub-Type 1: Schizophrenic-as-Cultural-Outsider

Negative Symptoms

Outsider Case Studies

Sub-type 2: Schizophrenic-as-Scapegoat

Sub-Type 3: Schizophrenia-as-Role-Play

9. THE MYTH-OF-MENTAL-ILLNESS MODEL: INTEREST GROUPS AND HUMAN RIGHTS

IMPERATIVES (pdf - 380 kb)

Interest Groups

Human Rights Imperatives

Background to the Insanity Plea

Relevant Human Rights

Torture and Cruel Treatment

Neuroleptics, the M-M-I Model and Human Rights

Treatment or Torture

10. EARLY PSYCHOSIS: PREVENTIVE MEDICINE, SCIENTIFC ASSAULT ON

MYSTICAL TENDENCIES, OR AN EXTENSION OF SOCIAL CONTROL? (pdf - 520 kb)

Early Psychosis as Preventive Medicine

Early Psychosis Programmes

Case Study -- The EPPIC Programme

Critical Analysis of Early Psychosis

Drug Company Influence

CONCLUSION (pdf - 170kb)

BIBLIOGRAPHY (pdf - 480kb)

2007_09_01_archive

2008-02-24T22:24:00.001-08:00

Malayan House Comes 'Alive' at Night

Many flock to Jalan Bellamy for the Ikan Bakar while others may

recognise the road as home to one of the country's oldest

international school, Alice Smith.

The road has not changed much since the country's pre-independence

days and remains a quiet path that most city dwellers do not use.

With old government quarters hidden by the large trees on the road,

the aroma of fish being grilled waft out from Gerai Seri Menanti and

Seri Melaka while the chatter and laughter of children from the Alice

Smith school livens up the atmosphere.

Rosemary Alder Duckworth who lived at 5, Jalan Bellamy from 1947 to

1949 remembers the days when housing was scarce in post-war Malaya and

when most houses on the street housed two or more families.

"A few families would share a home and we were very surprised to find

house No 5 empty.

"We moved in but for the next two-and-half years, we had a lot of

problems, especially with servants who would just disappear in the

night without even collecting their pay," said Duckworth.

She had come to Malaya with her family when her father, Frederick

Victor Duckworth, was appointed the last British adviser of Selangor.

The family managed to trace a few of their former workers and they

recounted tales of paranormal activities that took place in the

servants quarters and kitchen.

"We then realised that the house was not snapped up because it was

considered haunted. Many of the servants told us that they would be

jolted awake from sleep and see blinding lights circling on top of

them. Some said they even saw vegetables flying around the kitchen,''

said Duckworth.

She had the chance to speak to the Richardson family who had lived in

the house before the war and they confirmed the unusual sightings in

the house.

"Corinne Richardson was one of those who lived in the house and she

related an incident that took place one night.

"She told me she was awakened by loud banging noises and saw an old

Chinese man standing next to her bed. Corinne's sister, who was in the

room, also saw the man," said Duckworth.

"Corinne asked the man what he wanted but there was no reply and the

man just walked away. The banging noises, however, continued. Corinne

told her parents and although they looked everywhere, the man was not

found.''

The Richardsons later found out that at the exact time that Corinne

saw the old man, the chief of a nearby village on Jalan Bellamy had

passed away.

"When she was shown a picture of the village chief, Corinne recognised

him as the old man who had appeared in her room.''

During the Duckworth family's stay at the house, the haunting worsened

and they had to conduct an exorcism ceremony.

Other than this, the family enjoyed their stay on the quaint Bellamy

road.

"It was a very quiet and nice residential area with big trees. said

Duckworth.

Malayan House Haunted

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Has a Chupacabra Been Found in Texas?

Cuero, Texas - Phylis Canion lived in Africa for four years. She's

been a hunter all her life and has the mounted heads of a zebra and

other exotic animals in her house to prove it.

But the roadkill she found last month outside her ranch was a new one

even for her, worth putting in a freezer hidden from curious

onlookers: Canion believes she may have the head of the mythical,

bloodsucking chupacabra.

"It is one ugly creature," Canion said, holding the head of the

mammal, which has big ears, large fanged teeth and grayish-blue,

mostly hairless skin.

Canion and some of her neighbors discovered the 40-pound bodies of

three of the animals over four days in July outside her ranch in

Cuero, 80 miles southeast of San Antonio. Canion said she saved the

head of the one she found so she can get to get to the bottom of its

ancestry through DNA testing and then mount it for posterity.

She suspects, as have many rural denizens over the years, that a

chupacabra may have killed as many as 26 of her chickens in the past

couple of years.

"I've seen a lot of nasty stuff. I've never seen anything like this,"

she said.

What tipped Canion to the possibility that this was no ugly coyote,

but perhaps the vampire-like beast, is that the chickens weren't eaten

or carried off -- all the blood was drained from them, she said.

Chupacabra means "goat sucker" in Spanish, and it is said to have

originated in Latin America, specifically Puerto Rico and Mexico.

Canion thinks recent heavy rains ran them right out of their dens.

"I think it could have wolf in it," Canion said. "It has to be a cross

between two or three different things."

She said the finding has captured the imagination of locals, just like

purported sightings of Bigfoot or the Loch Ness Monster have

elsewhere.

But what folks are calling a chupacabra is probably just a strange

breed of dog, said veterinarian Travis Schaar of the Main Street

Animal Hospital in nearby Victoria.

"I'm not going to tell you that's not a chupacabra. I just think in my

opinion a chupacabra is a dog," said Schaar, who has seen Canion's

find.

The "chupacabras" could have all been part of a mutated litter of

dogs, or they may be a new kind of mutt, he said.

As for the bloodsucking, Schaar said that this particular canine may

simply have a preference for blood, letting its prey bleed out and

licking it up.

Chupacabra or not, the discovery has spawned a local and international

craze. Canion has started selling T-shirts that read: "2007, The

Summer of the Chupacabra, Cuero, Texas," accompanied by a caricature

of the creature. The $5 shirts have gone all over the world, including

Japan, Australia and Brunei. Schaar also said he has one.

"If everyone has a fun time with it, we'll keep doing it," she said.

"It's good for Cuero."

Chupacabra Found Texas

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South Wales' Rhymney House Hotel Haunted

Rhymney House Hotel licensee Rob Dunster says he definitely feels a

presence every time he steps into the 19th Century building.

The small hotel, situated on the A465 near Rhymney Bridge, appears in

the Haunted Cardiff and the Valleys book, compiled by the South Wales

Paranormal Research team, and is thought to be haunted by a pregnant

maid who threw herself from the top window.

The hotel has been owned for six years by the Dunster family, who all

differ in opinion on the presence.

Licensee Rob, 42, says he is spooked by the building and believes

there is a definite presence.

He said: "I am quite sure there is something here.

"We have had two paranormal groups come to visit us and they have both

felt it.

"I think it's in the cellar."

Rob's sister Jackie, 52, also works part-time at the hotel. She said:

"I am a bit of a sceptic. I think the nature of the building makes it

a bit eerie because parts of it are dark and cold.

"But whenever I stay the night on my own, I'm more worried about

humans breaking in than ghosts.

"But one of the previous owners said their daughter used to speak to a

kind old lady who would sit on the edge of her bed."

The Grade II-listed building, which sits on a two-acre site, is

surrounded by a farmyard and a row of ageing listed trees. The owners

say it is prone to a lot of nocturnal noises.

Rob said: "We do hear quite a few strange noises at night and that can

be a bit spooky, but I don't think it's too bad.

"If our guests ask about the paranormal activity, we tell them if they

want it to be haunted it is, but if they don't want it to be, it's

not."

Rhymney House Hotel Haunted

2006_01_01_archive

2008-02-24T21:59:00.001-08:00

Grand Rounds Vol. 2 No. 15...

Hosted across the pond by Random Acts of Reality.

link posted by Bard-Parker : 1:20 PM

GO DOGS!!!

Georgia 35 West Virginia 38

The first quarter almost made me physically ill. Twenty-eight points

in less than fifteen minutes. Georgia closed it to 10 by halftime, but

with three turnovers (two leading to Mountaineer touchdowns), Georgia

couldn't "finish the drill". And just when you thought that Shockley

southwestern medical anatomy of penny

2008-02-24T21:54:00.001-08:00

trading (terminating at 11:59 EST on Sept. 22,2006) in the securities

of Southwestern (last trade was 8 cents per share) because of

questions that have been raised about the accuracy and adequacy of

publicly disseminated information concerning, among other things, the

existence of applications for U.S. Food and Drug Administration

approvals for its Labguard product, the existence of a patent and

trademark, and the receipt of an order for the sale of several

thousand units of Labguard."

Editor David J Phillips does not own any of the stock mentioned in

this article. You can see his portfolio holdings in the sidebar. The

finding new bugs in old broth

2008-02-24T21:34:00.001-08:00

Finding New Bugs in an Old Broth

Charles Dickens gave it to Tiny Tim; Hippocrates described it as the

most widespread disease of his day; paleontologists even found traces

of it in 5,000-year-old Egyptian mummies. Tuberculosis is an old

disease. And the diagnostic tests for TB, in contrast to the

"cutting-edge" progression of most medical technologies, are similarly

ancient. The majority of the world's hospitals use a "sputum smear

test" that has remained unchanged since its invention in 1881: your

suspect phlegm is placed in a glorified Petri dish of nutrient broth,

where the lung-eating bacteria can grow, though very slowly. After

many weeks, when they've grown into visible clumps, a microscope can

identify the killer bug. But to how many will you spread it while

waiting for test results?

Tuberculosis diagnosis, "is as old-fashioned as it gets," says Dr.

Richard Chaisson, the founder of the Johns Hopkins Center for

Tuberculosis Research. Faster, cheaper and more accurate diagnostic

tools are desperately needed, Chaisson says, to curb the growing

epidemic of TB--a curable disease that still kills 5,000 people every

day. This summer, three biotech companies announced partnerships with

FIND, the Foundation for Innovative New Diagnostics, to develop better

TB-testing products. But a large-scale study is about to be released

suggesting the most effective diagnostic method is not a product at

all, or at least not a patentable one. It's just a new way of looking

at an old broth.

The global TB crisis made U.S. headlines on October 17, when

pharmaceutical kingfish Bayer announced it will allow one of its

best-selling antibiotics to be tested against tuberculosis. Chaisson,

who was instrumental in the deal, says the drug will reduce treatment

time from six months to four. Still, he has reservations about its

effect on the epidemic's spread through the population. "The

individual cure rate is awfully good," he says, "but the number of

cases is still going through the roof." This is partly because of the

increase in HIV infections; those with HIV have compromised immune

systems and are thus more vulnerable to TB. But it also stems from the

bug's ability to adapt: strains have evolved that are resistant to

every major antibiotic. Because TB is often spread more quickly than

it is identified, Chaisson says the answer lies not in faster drugs,

but faster diagnostics.

Today's sputum smear test takes far too long. In Sub-Saharan Africa,

where both TB and HIV run rampant, patients can expect to wait 12-16

weeks for test results, according to FIND. And the sputum smear has

other problems, too. Making the broth requires

electricity--unavailable in most clinics of the third world--for

mixing and refrigeration. Moreover, it can't reliably detect the

presence of multi-strain TB.

Since 2003, FIND's mission has been to tackle these problems. This

summer, three international biotech companies announced financial

partnerships with FIND to develop new tests that use color-changing

strips or simple test-tube reactions to detect proteins that are found

in many strains of TB, getting results in hours or even minutes. One

promising product is called "TK medium." When the medium, a red

substance, is mixed in a test tube with active TB bacteria, the color

turns green. "Nobody knows yet why it works," Chaisson says. "They're

about a buck each, and you could sell tens of millions of them a

year."

But no fancy new products are needed for what seems to be the best

test of all. In the early 1990s, a lab tech in Peru noticed that TB

bugs can be detected--using a common broth medium and a regular light

microscope--weeks before the bugs grow into visible clumps. Chaisson

finds it remarkable that no one had thought of the method--now called

MODS--before. "The only drawback," he says, "is that it's not

patentable." So for now, FIND won't fund MODS.

Compared to most bacteria, the growth of TB bugs is interminably slow.

And according to Chaisson, slow too is the technological progression

of its treatment and diagnosis. He describes, with obvious disdain,

the conventional wisdom of most TB doctors: "My god, if it was good

enough for my grandfather, then it's good enough for me." So perhaps

MODS--using old tools and an old broth--is exactly what's needed to

2006_08_01_archive

2008-02-24T21:24:00.001-08:00

German Survey

Our Teutonic friends have been busy lately in collecting research

covering a wide range of acupuncture effects and techniques. From one

side of the pond to the other, a lot of great investigation is being

done and I have included links to some of my favorites.

Measurement of acupuncture needle grasp at acupuncture points and

control points

http://www.akupunktur-aktuell.de/fb0112_1.htm

One of the most controversial aspects of acupuncture is whether the

location of acupuncture needling sites is important, ie: does the

needling of classically defined acupuncture points have an enhanced

therapeutic effect as compared with the needling of any other set of

points on the body. Resolving this issue is of fundamental importance,

since the specificity of acupuncture points is implied in some of the

most basic principles underlying the traditional practice of

acupuncture.

These results provide objective evidence that acupuncture points have

different biomechanical behavior than control points. Whether this is

due to anatomical and/or physiological differences between acupuncture

points and surrounding tissues, and what these differences are,

remains unknown. Our results also show that needle manipulation

strongly influences needle grasp, and does so at control points as

well as at acupuncture points. We are planning to use the results of

this study as a first step to understand the mechanisms underlying

needle grasp, and the therapeutic significance of both de qi and

acupuncture points.

As someone trained in TCM, I have always believed if there is no Qi,

there is no treatment. Perhaps it is Western programming to believe

"no pain, no gain," but I see better results with patients who report

feeling sensation over ones that feel nothing. In my experience, I

find the patient will have the Qi sensation a moment after I feel the

needle "grab." For those patients that I know are sensitive, I try to

keep the needle positioned at that threshold between the grab and the

sensation so that they can reap the maximum benefit with the minimum

discomfort. Of course, there are those others that can't get enough Qi

either, or as one of my patients says, "Give me the ju-ju!"

DESCRIPTION AND VALIDATION OF A NON-INVASIVE PLACEBO ACUPUNCTURE

PROCEDURE

http://www.akupunktur-aktuell.de/fb0202_1.htm

Objective: To evaluate a simulated acupuncture technique for use in

randomized controlled trials assessing the efficacy of acupuncture for

low back pain.

Experimental Design: In the first experiment, subjects received six

insertions of real needles and six pokes with a toothpick in a

guidetube in a two-period crossover design. In the second experiment,

subjects were randomized to receive either a complete treatment with

real acupuncture needles or a simulated treatment using a toothpick in

a guidetube.

Conclusions: The simulated acupuncture procedure evaluated in this

study represents a reasonable control treatment for acupuncture-na�ve

individuals in randomized controlled trials assessing the efficacy of

acupuncture for low back pain.

Having sat in on some design planning for a few different research

projects, I know the use of sham acupuncture is a controversy. A

placebo pill in a drug trial is not analogous to random needling. This

sounds like a promising (an somewhat humerous) alternative for those

who have research aspirations.

CLINICAL STUDY OF HERPES ZOSTER TREATMENT USING ACUPUNCTURE OF

THUMB-JOINT ACUPOINT AND FIRE-TWINKLING METHOD

http://www.akupunktur-aktuell.de/fb0224_1.htm

This paper is the summary of clinical results of using Acupuncture of

Thumb-Joint Acupoint and Fire-Twinkling for 27 cases of Herpes Zoster,

a virulent skin disease called "Yao Chan Huo Dan" and "She Du Cang" in

traditional Chinese medicine. The condition usually results from

decreased immune function, emotional depression, dietary disorder,

malfunctional spleen and liver, or virus infection. The course of the

illness lasts from two to fifteen days. The purpose of using

Acupuncture of Thumb-joint Acupoint locally is to stimulate the

infected region, improve the overall body immune system, and thus kill

the virus using the body's own immune functionality. Additionally, the

Fire-Twinkling method utilizes the flame's radiating and heating

effect to enlarge local blood vessels, accelerate blood circulation

and energize body cells.

The outcome of the treatment and observation study showed that

Acupuncture of Thumb-Joint Acupoint and Fire-Twinkling was a very

effective treatment method for Herpes Zoster: among the 27 cases

studied, 24 (88.8%) were completely cured, 2 cases (7.4%) showed

evident improvement, and only one case (3.8%) showed no sign of

links between drug companies and

2008-02-24T20:44:00.001-08:00

Links Between Drug Companies and Psychiatry

Diagnosis in mental health is detailed in the fourth Diagnostic and

Statistical Manual (DSM-IV), published by the American Psychiatric

Association. The New York Times today published a report of a study

claiming to show links between the authors of DSM-IV and

pharmaceutical companies. The report stated,

The researchers found that 95 -- or 56 percent -- of 170 experts

who worked on the

1994 edition of the manual, called the Diagnostic and Statistical

Manual, or

D.S.M, had at least one monetary relationship with a drug maker in

the years from 1989 to 2004. The most frequent tie involved money

for research, according to the study, an analysis of financial

records and conflict-of-interest statements.

Honestly, I'm not surprised or upset by the relationship. DSM-IV is

published by psychiatrists for use by psychiatrists. It reflects a

medical model of mental illness, and most of the experts who work on

it are researchers in the biological side of treatment. Most of

psychiatry is conducted drug treatment. Psychiatrists prescribe

medication. Psychologists, social workers, psychotherapists and

counselors conduct psychotherapy. A few psychiatrists still dabble in

psychotherapy, but they are a dying breed.

Not surprisingly, then, DSM-IV works fine for medical management of

mental illness. It stinks as a diagnostic tool for psychotherapy. Let

me show you how it works. A person is diagnosed along five "axes:"

I. Clinical disorders

II. Personality disorders or mental retardation

III. General medical conditions

IV. Psychosocial stressors

V. Global Assessment of Functioning

Axis I disorders correspond to depression, anxiety, and other problems

that we normally treat (and are advertised on TV). Axis II refers to

personality problems that are long-standing. (Why personality

disorders and mental retardation are linked is beyond me.) Axis III

details medical status. It's important to know this, as many medical

illnesses may manifest the same symptoms as depression or anxiety.

Axis IV describes psychosocial stressors in very general terms. Axis V

describes a person's level of functioning with a 0 to 100 scale.

So, for example, a person might have the following diagnoses:

I. Major depressive disorder, moderate, recurrent

II. Borderline personality disorder

III. No diagnosis

IV. Problems with the primary support group

V. Current GAF 57

There are myriad problems with this scheme. First, the use of the term

"axis" implies that each axis is independent from the others. Nothing

could be further from the truth. People with personality disorders,

for example, are more likely to have anxiety and depressive disorders

than others without personalty disorders.

Second, we don't really know what a "disorder" is. In most cases,

there is evidence of both psychosocial and biological causes for a

client's complaints. Both psychological and biological treatments are

effective for the same "disorders." So, what are we really treating?

Third, this scheme doesn't describe the quality of the client's life

very effectively, and that's what we really deal with in

psychotherapy. Axis IV, where this should be placed, is very general,

and poorly delineated. "Problems with the Primary Support Group,"

covers a lot of ground, from arguing with your wife to repeated sexual

abuse of a child.

Fourth, assessment of these disorders remains rooted in the clinical

interview. We've known since the 1950's, with a book by Paul Meehl

that clinical interviewing is not very reliable. Unfortunately,

psychologists, who are the true experts in assessment, have dropped

the ball entirely. We have not generated the kind of data necessary to

add psycosocial assessment to the diagnostic manual.

So, why do we need diagnosis at all? We need it to describe what we're

treating. We need it to organized our research into better treatment

methods. So as a result, we limp along with the diagnostic manuals as

2007_12_01_archive

2008-02-24T20:24:00.001-08:00

More on Portable Home Testing and Auto-CPAP

In response to a reader who emailed regarding my predictions of cpap

vs. auto-cpap useage:

I don't think that APAP will entirely replace CPAP, but its

marketshare will increase somewhat. This will be good for

Respironics/RESmed, and bad for the durable medical equipment

companies (DME's are reimbursed the same for cpap/auto-cpap machines

and therefore there is a higher profit margin on the regular cpap

machines for the DME companies). APAP will be prescribed in certain

rural areas of the country by some primary care docs. After diagnosing

a patient with portable home testing, they will tend to prescribe an

auto-cpap machine rather than refer their patients to a sleep lab for

a cpap titration. This will have little economic effect on the primary

care doc, they will do this to maintain control of the process and

common good defensive medicine

2008-02-24T20:14:00.001-08:00

Common Good: Defensive Medicine Widespread, with Serious Consequences

Common Good: Defensive Medicine Widespread, with Serious Consequences:

"Defensive medicine is 'a deviation from sound medical practice that

is induced primarily by a threat of malpractice suits.' Forty-three

percent of physicians said their most recent defensive act was 'using

gsk velu

2008-02-24T19:59:00.001-08:00

G.S.K. Velu

"Indigenisation of medical technology is the need of the hour to

deliver the 'health for all' objective. The Government of India should

incentivise and motivate Indian manufacturing initiatives to position

India as a global hub for medical technology manufacturing."

nutra pharma expands licensing

2008-02-24T19:54:00.001-08:00

(OTCBB:NPHC), a biotechnology company that is developing drugs for HIV

and Multiple Sclerosis (MS), has today announced that it has expanded

its licensing agreement with NanoLogix, Inc., (Pink Sheets: NNLX) to

include intellectual property for the use of testing the environment

for NonTuberculous Mycobacterium (NTM).

"NTM infections are becoming a major concern for hospitals and medical

clinics around the world," explained Rik J. Deitsch, Chairman and CEO

of Nutra Pharma Corporation. "Combining our newly licensed

intellectual property with our current test kit technology will allow

our subsidiary, Designer Diagnostics, to attempt to successfully

launch a cost-effective solution to help identify the environmental

sources of NTM infections," he added.

NonTuberculous Mycobacterium, also known as atypical Tuberculosis

(Atypical TB) or Mycobacterium other than Tuberculosis (MOTT), is a

bacteria that is found in water, including hot tubs and showers, some

domestic and wild animals, and soil. One of the most common forms of

NTM infections found in humans is Mycobacterium avium complex (MAC).

This is a primary cause of respiratory disease in humans and is a

leading cause of death in HIV/AIDS patients.

"Expanding this licensing agreement to include environmental testing

is a natural progression of our relationship with Nutra Pharma and our

belief in its ability to successfully bring these kits to market,"

commented Bret Barnhizer, President and CEO of NanoLogix, Inc. "In

addition to helping detect NTM in patients, Nutra Pharma will now be

able to test for NTM in the environment to help prevent others from

becoming infected," he concluded.

Nutra Pharma's wholly-owned medical devices subsidiary, Designer

Diagnostics, is currently planning to undergo third party validation

for its NTM diagnostic test kits at leading Tuberculosis research

institute, National Jewish Medical and Research Center, in Denver,

Colorado. The Company plans to apply for FDA approval upon successful

completion of this clinical trial.

Recently, distinguished NTM research scientist, Dr. Rahul Narang, used

the Designer Diagnostics test kits to test soil and water samples

collected from the environment of patients with NTM infections. This

was the first time the technique was used in India and the findings

were presented in November at the 38th Union World Conference on Lung

Health in Cape Town, South Africa.

About Nutra Pharma Corp.

Nutra Pharma Corp. is a biopharmaceutical company specializing in the

acquisition, licensing and commercialization of pharmaceutical

products and technologies for the management of neurological

disorders, cancer, autoimmune and infectious diseases. Nutra Pharma

Corp. through its subsidiaries carries out basic drug discovery

research and clinical development and also seeks strategic licensing

partnerships to reduce the risks associated with the drug development

process. The Company's holding, ReceptoPharm, Inc, is developing these

technologies for the production of drugs for HIV and Multiple

Sclerosis ("MS"). The Company's subsidiary, Designer Diagnostics, is

engaged in the research and development of diagnostic test kits

designed to be used for the rapid identification of infectious

diseases such as Tuberculosis (TB) and Mycobacterium

avium-intracellulare (MAI). Nutra Pharma continues to identify and

acquire intellectual property and companies in the biotechnology

arena.

http://www.NutraPharma.com

http://www.DesignerDiagnostics.com

SEC Disclaimer

This press release contains forward-looking statements. The words or

phrases "would be," "will allow," "intends to," "will likely result,"

"are expected to," "will continue," "is anticipated," "estimate,"

"project," or similar expressions are intended to identify

"forward-looking statements." Actual results could differ materially

from those projected in Nutra Pharma's ("the Company") business plan.

The Company's business is subject to various risks, which are

discussed in the Company's filings with the Securities and Exchange

Commission ("SEC"). The expanded licensing agreement with NanoLogix,

Inc., to include environmental testing should not be construed as an

indication in any way whatsoever of the value of the Company or its

common stock. The Company's filings may be accessed at the SEC's Edgar

system at www.sec.gov. Statements made herein are as of the date of

this press release and should not be relied upon as of any subsequent

date. The Company cautions readers not to place reliance on such

statements. Unless otherwise required by applicable law, we do not

undertake, and we specifically disclaim any obligation, to update any

forward-looking statements to reflect occurrences, developments,

unanticipated events or circumstances after the date of such

statement.

SOURCE: Nutra Pharma Corp.

Nutra Pharma Corp.

David Isserman, 877-895-5647

epidemiology of depressive disorders

2008-02-24T19:34:00.001-08:00

2006_08_01_archive

2008-02-24T18:59:00.001-08:00

Hard Disk's 50th Anniversary

Yes, there were hard disks for computers even before I started using

them. Yesterday's Wall Street Journal had a story by Lee Gomes on the

50th anniversary of the hard-disk drive. Worth reading in full, but

here are some excerpts:

[The hard drive] is the storage device that makes possible not only

PCs, but also iPods, TiVos and other consumer technology

must-haves.

The first disk drive, called the RAMAC, was created by

International Business Machines Corp. engineers in San Jose,

Calif., in 1956...

The disks on it were 24 inches in diameter. The whole unit weighed

over a ton, and had to be delivered on forklifts and loaded on to

large cargo bays of airplanes. You had only five megabytes of

storage. That's about five minutes worth of MP3 music...

It was four or five years between the first RAMAC and the next one,

and there was a significant jump in storage capacity, which has

been steady since then. For the first 35 years, storage capacity

increased about 30% a year. Those annual increases got as high as

100% between 1998 and 2002. Today, they are running around 30% to

40% a year...

The RAMAC stored 2,000 bits per square inch. In disk drives today,

the figure is as high as 135 billion bits per square inch. That's

almost a 70-million-fold increase. And in the next five years, we

will ship more disk drives than we shipped in the first 50 years...

I remember being told by Tom Steel that the machine room at the

Equitable Life Insurance company was located directly below the office

of a vice president, who was definitely not amused that his office

floor had to be taken up and a crane brought in whenever they had to

change the actual RAMAC disk. (Disk reliability has improved

enormously since then.)

My first encounter with hard disks was in 1965. The Loma Linda

University Scientific Computation Facility had an IBM 1620 Data

Processing System with two 1311 Disk Storage Drives. Each removable

1316 Disk Pack consisted of six 14-inch diameter disks, weighed 10

pounds, and could store 2 million characters (2MB, the equivalent of

25,000 punched cards). This was a revolutionary advance over storing

all the system software, application programs, and datasets on cards

and manually placing them in the card reader (or removing them from

the card punch) as needed. For me, it was much more important than the

speed and memory advantages that the 1620 had over the Bendix G-15D.

Edited on 9/14/2006 to add: Other interesting sites

panacea pharmaceuticals announces

2008-02-24T18:54:00.001-08:00

2006_08_01_archive

2008-02-24T18:14:00.001-08:00

Windows Genuine Advantage does not validate a copy of Windows XP

SYMPTOMS

loadTOCNode(1, 'symptoms');

The Windows Genuine Advantage (WGA) validation process does not

validate a copy of Microsoft Windows XP.

RESOLUTION

loadTOCNode(1, 'resolution');

To resolve this issue, follow these steps:

1.Start Microsoft Internet Explorer, and then visit the following

Microsoft Web site:

http://www.microsoft.com/genuine/diag

(http://www.microsoft.com/genuine/diag)

2.Click Start Diagnostics.Note If you receive a dialog box that asks

whether you want to run this file or save this file, click Run.The WGA

Diagnostic Tool analyzes the computer and lists the reasons why you

cannot validate the copy of Windows XP. The WGA Diagnostic Tool may

list some error messages.The most common problems are an invalid

product key and a blocked volume license key. If the product key that

is generated by the WGA Diagnostic Tool differs from the original

product key, go to step 3. If this is not issue, see the "More

Information" section to resolve the problem.

3.If the product key that is generated by WGA Diagnostic Tool differs

from the original product key, you must change the product key back to

the original product key. To change the product key, use the Windows

Product Key Update Tool. To do this, visit the following Microsoft Web

site:

http://www.microsoft.com/genuine/purchase/UpdateInstructions.aspx

(http://www.microsoft.com/genuine/purchase/UpdateInstructions.aspx)

4.Follow the instructions on the Web site, and then try to validate

Windows XP again.

MORE INFORMATION

loadTOCNode(1, 'moreinformation');

This section lists explanations and resolutions for WGA error

messages.

Error messages

0x80080200

Unsupported Operating System for WGA

Cause

loadTOCNode(3, 'moreinformation');

WGA cannot currently determine whether the operating system is genuine

or not. However, you still can access the Windows Update and Microsoft

Update Web sites.

Error messages

0x80080201

0x80080202

Cannot detect product ID (PID)

Invalid product IDCause The system is in a state that prevents WGA

from accessing the product ID (PID).

Resolution

1.Click Start, click Run, type cmd, and then press ENTER.

2.Type the following commands. Press ENTER after each command:

regsvr32 %windir%\system32\licdll.dllregsvr32

%windir%\system32\licwmi.dll

3.Check the value of the PID in the registry. To do this, follow these

steps:

a. Start Registry Editor.

b. Locate and then right-click the following registry subkey:

HKEY_LOCAL_MACHINE\SOFTWARE\Microsoft\Windows

NT\CurrentVersion\ProductId

c. Make sure that the product ID has a format that resembles the

following:

12345-VER-1234567-12345

4.Restart the computer. If you still cannot validate Windows XP, you

may have to reinstall the operating system.

Error messages

0x80080203

0x80080204

Internet Connection Problem

Service Unavailable

Cause

Computer settings may be preventing you from validating Windows XP.

Resolution

1.Start Internet Explorer, click Tools, and then click Internet

Options.

2.Click the Security tab, and then click Customer Level.

3.Make sure that the related ActiveX control options are enabled.

4.If you have third-party firewall software installed, disable the

firewall.

5.Make sure that the Date and Time settings for the computer are

correct.

6.Validate Windows XP again.

Error messages

0x80080205

Insufficient PrivilegesCauseYou must use administrative credentials to

continue with validation.

Resolution

1.Reactivate Windows XP by using administrative credentials.

2.Validate Windows XP by using administrative credentials.

Error messages

0x80080206

Internet settings do not allow the genuine ActiveX control to run

properly, or user may not be the system administrator of the

machineCause An ActiveX control is disabled.

Resolution

1.Start Internet Explorer, click Tools, and then click Internet

Options.

2.Click the Security tab, and then click Customer Level.

3.Make sure that options are enabled for the ActiveX control that

triggered the error message.

4.Validate Windows XP again.

Error messages

0x80080207

Expired Validation CodeCause You have typed a wrong validation code on

the Microsoft Download Center validation page.

Resolution

1.Run the validation check again.

2.Enter the correct validation code.

3.Validate Windows XP again.

Error messages

0x80080209

Can't Run Active XCause This problem may occur because antivirus

software or firewall software is preventing ActiveX controls from

running.

Resolution

1.Configure third-party antivirus or firewall software so that ActiveX

controls are enabled.

2.Validate Windows XP again.

Error messages

0x80080211

User has chosen to exit the validation processCause You have exited

the validation process.ResolutionRestart the validation process later.

Error messages

0x80080219

Windows Not ActivatedCause This copy of Windows is a retail copy or an

OEM copy. Activation is required to continue.

Resolution

1.Activate Windows XP.

2.Validate Windows XP again.

Error messages

0x80080220

Invalid Product KeyCause This problem occurs because of a blocked

volume license key. You may have installed Windows by using an invalid

product key. The volume license key has been blocked by Microsoft

because the key has been reported as stolen or leaked.

Resolution

1.Buy a new copy of Windows XP.

2.Reinstall and then validate the new copy of Windows XP.

Error messages

0x80080222

The product key associated with your copy of Windows was never issued

by MicrosoftCause The product key that is installed on this system is

not recorded. Therefore, this product key is probably generated by a

program that produces unauthorized product keys.

Resolution

1.Buy a new copy of Windows XP.

2.Reinstall and then validate the new copy of Windows XP.

REFERENCES

loadTOCNode(1, 'references');

For more information about Windows XP, visit the following Microsoft

Web site:

http://support.microsoft.com/ph/1173?FR=1

(http://support.microsoft.com/ph/1173)For more information about WGA,

visit the following Microsoft Web site:

http://www.microsoft.com/genuine/downloads/whyValidate.aspx

(http://www.microsoft.com/genuine/downloads/whyValidate.aspx)For more

information, click the following article number to view the article in

the Microsoft Knowledge Base:

892130 (http://support.microsoft.com/kb/892130/) Description of

2006_06_01_archive

2008-02-24T17:59:00.001-08:00

another week..

-american idol-

TAYLOR HICKS won. hehe. he deserves it naman.. pero sayang c

katharine.. tsk.

-pbb-

clare is in. tsk.

the last week of pbb is getting more and more exciting. it is really

different from the 2 previous pinoy big brother editions. the big 4

went to hundred islands where a mini big brother house was built.

they get to apply their learnings from their scuba diving lessons that

they got when they were still in big brother;s house last in manila.

haha.

please text BB KIM and send to 2331 - globe/sun 231 - smart! thanks!

-sm mall of asia-

yesterday was my parent's 19th anniversary. we went to sm mall of asia

as part of the celebration. hehe. SUPER laki talaga. lol. ang ganda ng

malaking globe na color violet kapag gabi. weee.

we bought beds for our condo sa golden crescent. i bought a pair of

shoes and a polo short. hehe. saya. fud trip.

crazy crepes and jamaican patties rock! weeee.

-bb lipa-

kaycee won! weeee.

2007_07_01_archive

2008-02-24T17:54:00.001-08:00

10 Steps To IT Success

1. Choose a IT calling that's inch demand

It is indispensable to take a calling way in IT which have sufficient

demand. There are 100s of calling ways in IT but NOT all offering the

same degrees of opportunity.

IT callings in demand can have got less entry demands simply because

there aren't adequate people to fill up the vacant functions resulting

from accomplishment shortages. These deficits can also fuel higher

wages to lure more than people.

Technology can change quite rapidly so choosing the incorrect database

engineering for example, could take to less chance in securing work

owed to chances being few and far between than choosing a database

engineering which is in demand.

2. Avoid saturated IT calling paths

If there's too many people vying for chances in a peculiar IT area,

then there will be too much competition to acquire a job. This gives

employers the chance to pick and take only the best candidates, those

who have got the most experience.

Saturated IT callings can also convey down wages on offer, as

employers cognize that they can pay less and still acquire suitably

qualified staff.

A recruiter co-worker of mine, regularly runs occupation

advertisements on respective very popular cyberspace occupation hunt

sites. He told me that he can acquire over a 1000 appliers for each

function he advertises, with functions involving Microsoft Windows and

Lake Herring technology, generally having the most applicants.

He said that this is great because he can pick and take only the best

campaigners for the jobs, generally those with a batch of experience.

On the impudent side, when employers recruit in the IT sector I'm in,

they acquire a batch less applicants, so it can sometimes be tough to

happen candidates, resulting in employers lowering their entry demands

and increasing salaries.

3. Avoid Dead End IT careers

Dead Ends are IT callings which may look like a good chance to the

uninitiated but in world offering very small in footing of calling

advancement. Dead end IT callings generally include working long and

unsociable hours in occupations which can be quite stressful.

Helpdesk and support functions can be dead end occupations which

offering small in calling advancement. If you work too many hours then

your existent wage per hr could be very little.

So if a occupation pays $30,000 a twelvemonth but affects working 70

hours a hebdomad with no payment for overtime, the existent hourly

payment is actually less than $9 an hr instead of $16 per hour.

Worse still some dead end occupations include the awful beingness

on-call, where the employer can reach you, outside of work if there's

a problem. This could intend your weekend is ruined by a phone call

from the office, to repair a job that takes respective hours to fix.

On-call payments can be very poor, sometimes around the $20 a

twenty-four hours mark.

When I first started looking for a calling in IT, I was offered a

computing machine support applied scientist function which paid a

batch more than I was on in my non IT occupation at the time. But when

I delved deeper, it wasn't the dreaming move into IT that I longed

for. There was absolutely no chance for calling promotion and the

hours involved were long, disbursement twenty-four hours after

twenty-four hours travelling between many client sites.

4. Forget Certification as the backdoor to IT success!

Relying solely on enfranchisements to acquire into IT won't do you

more than employable. Employers expression for experience and

campaigners who are 'paper qualified' that is, have got got a IT

enfranchisement but no experience, will not be looked upon favourably.

It's go too easy to derive many enfranchisements through the likes of

braindumps, whereby the existent enfranchisement examination replies

are posted on assorted cyberspace websites.

Certifications such as as Microsoft's MCSE, Cisco's CCNA and the

similar are only for those who already have experience in that

peculiar certification's field. More and more than employers look at

enfranchisements as a desirable and not as an indispensable portion of

their occupation requirements.

Some of the work I do, affects working with HP/Compaq Servers, Windows

2003, Citrix Presentation Waiter and Exchange 2003 and I've never been

asked to supply any grounds of HP/Compaq, MCSE or Citrix CCA

certification, because my experience validates the fact that I cognize

how to work with these types of waiters and systems in a assortment of

environments.

5. Choose a IT calling with a low TTL

By choosing an IT calling with a low Time To Learn (TTL), you can

acquire onto the calling ladder quickly instead of being bogged down

by trying to achieve the accomplishments necessary for a calling which

have a longer clip to larn (TTL).

Consider a calling workings in J2EE (Java 2 Enterprise Edition) whilst

this is definitely a calling in demand, the TTL is quite high, as not

only is a good appreciation of Java required, but there may be a

demand for IBM Websphere, Tomcat, Apache and whole host of other

technologies. So unless you've worked in this field for a figure of

old age and been able to construct up a steady exposure to these

technologies, it's going to take an age to larn these engineerings

from scratch, during which clip you could lose out on earning good

money.

6. Use Particular skills

I happen it incredibly easy to acquire work in retail Banks even when

my engineering accomplishments aren't up to date. Why? Because I have

got got other particular accomplishments which the human race of

retail banking throws in high esteem, these particular accomplishments

have also helped me work in the health, telecommunications and

pharmaceutical sectors.

When I use for a job, I do certain that my accomplishments in

appreciating Change Management and working in undertaking orientated

roles, aswell as written document readying are prominent. Too many

people pass too much clip focusing on their technological

accomplishments instead of harnessing the powerfulness of their

particular skills.

7. Use Inside Information and avoid the hype

By knowing person who already works in IT or even better works in the

same country in IT as you would wish to, can supply tremendous

benefit. Mainly allowing you to screen fact from fiction by being able

to acquire quality indifferent advice.

When I started looking at a calling in IT, I was able to quickly

disregard the impression of "When I acquire my MCSE certification,

I'll be on $500 a day" because my friend who already worked in IT told

me that doing an MCSE without any experience wouldn't acquire me a

occupation and lone those advisers who have got old age of experience

along with an MCSE, are the 1s who would most likely gain $500 a

twenty-four hours or more.

Yet, many of the people I met at the clip who were also trying to

acquire into IT, still believed this impression and spent one

thousands of lbs trying to acquire MCSE certified.

Training companies can all too often be guilty of starting the

ballyhoo bandwagon rolling, with the only aim in head is to make as

much money as possible from IT aspirants who don't cognize how to

separate fact from fiction.

8. Forget about instruction qualifications

As long as you can read and write, then a calling in IT could be for

you. A batch of people believe just because they don't have got a

degree, they won't be able to acquire a good occupation in IT. The

truth of the substance is that the bulk of employers don't give a hoot

about whether you have got a grade (unless it's a alumnus program).

All they care about is whether you have got got the experience and

accomplishments to acquire the occupation done.

I don't have a grade and it certainly hasn't hampered my calling

aspirations. I don't even trouble oneself mentioning my educational

inside information when I use for occupations and have got got never

been asked about my instruction from any of the employers I've worked

for and most of my employers have been big transnational corporations.

Experience is the cardinal in attaining well paid IT work with

prospects and it isn't too hard getting the right degree of

experience. I used an 'experience driven training' programme which

allowed me not only to understand the engineering I was learning but,

actually set it to drill in the workplace.

9. Be flexible

The years of fat wage checks with a occupation for life are long gone

but there is still plenty of chance to gain well by being flexible.

More and more than employers are looking for IT specializers who are

flexible in their work requirements.

Employers may have got undertakings involving only a few calendar

months work, which will turn out hard to engage a full clip individual

for. What haps when the plant finished, make they just fire the

individual hired? This could hit them with a loading of legal jobs

such as as partial dismissal. So come in the freelancer, who works on

a contracted independent basis.

I work on a independent footing as I establish it can be easier to

happen work as more than than and more employers are looking for

freelancers, therefore finding work is never a challenge. I can also

gain as much as 3 modern times more as I would if I was hired directly

by the employer as an employee, and better still I pay less tax, so I

can take a batch more money home.

10. Be found

If no 1 cognizes you be then no 1 will happen you. To be successful in

any career, people necessitate to cognize you exist. People must be

made aware of your presence and this is easily achieved by preparing a

good r�sum� (CV) which acquires noticed.

I spent calendar months perfecting my r�sum� (CV) making certain that

it contained relevant information. I handle my r�sum� (CV) as an

advertisement in which I have got at least four pages to pull the

attending of the reader and do certain they transport on reading my

r�sum� (CV). Instead of putting it in the bin because it's hard to

read, irrelevant or difficult to understand.

When I direct my r�sum� (CV) off to a possible employers, eight modern

times out of ten, I acquire a call. Many people applying for IT

occupations can't acquire past this first hurdle, simply because their

r�sum�s (CV) are very poor. My opportunities of securing an interview

from my r�sum� (CV) runs at around 50%, which is well above average.

So before choosing my adjacent assignment, I generally can have got

respective occupation offerings to consider.

getting your cisco systems erp

2008-02-24T17:44:00.001-08:00

Getting Your Cisco Systems ERP Certification

Cisco's B2B Internetworking Merchandise Center (IPC) is what drives

its ecommerce mathematical functions is being majorly overhauled and

is being moved from the cumbrous CGI/Perl driven applications to the

more than stable and scalable Java/CORBA framework. The developers at

Lake Herring along with the Java squad at Alta Software are going to

be finishing this undertaking soon completing a 1 twelvemonth software

system development cycle. The new model is expected to increase public

presentation and also to offer new degrees of customization and

personalization with improved direction and tighter integrating into

other systems of Lake Herring and its providers and customers.

Cisco have used an speeded up execution that have enabled them to

implement their ERP system in just 9 calendar months for a cost of $15

million. Lake Herring had respective advantages when they decided to

implement their ERP. As a company Lake Herring was much littler than

what it is now and they had a simpler work environment. However, they

were experiencing immense growing at that clip and their bequest

information systems were beginning to fail. Lake Herring made

respective good determinations in the choice and execution of their

ERP.

To achieve a Lake Herring certification, you must first go through the

Lake Herring Certification for Network Professionals test. This

diagnostic test certifies all qualifying campaigners as being able to

install, configure, and troubleshoot local and broad country webs with

a 100-500 nodes. They can also pull off electric switches and routers

that are portion of the web as well as border applications that

function to incorporate radio and security issues of the network.

There are 4 diagnostic diagnostic tests that you necessitate to go

through in order to acquire this enfranchisement and this demands to

be renewed once every 3 years.

In lawsuit you are facing troubles in passing the tests or you just

necessitate some aid then there are respective websites offering CCNP

boot encampments that are quite effectual and will certainly assist

you go through the diagnostic test easily. These social classes are

quite tough though and can endure from early morning time to late

evening. They function as great primers of what you will confront in

the diagnostic test and are will do you quickly absorb all the

information that is used in their readying for Lake Herring Systems

ERP certification.

Network people of course of study desire to be at the top of the game

as soon as they can and they necessitate to have got the necessary

enfranchisement from Lake Herring to turn out their qualification. The

peak such as diagnostic test is the Lake Herring Certified

Internetwork Expert enfranchisement and only around 3% of Lake Herring

certified web people attain CCIP because it is the most hard of tests.

Once certified the web professional person can install, configure, and

of course of study run webs in highly specialised and complicated

environments using particular communications protocols and also

implement Lake Herring hardware and set up big scale of measurement

networks. The people can also plan and implement new networking

2007_10_01_archive

2008-02-24T17:34:00.001-08:00

Upcoming Event: 30 November - 05 December, Philadelphia

The 61st annual meeting of the American Epilepsy Society (AES) will

take place in Philadelphia, from the 30th of November through the 5th

of December.

Details about the meeting can be found on the meeting webpage of the

AES website.

nejm article

2008-02-24T17:24:00.001-08:00

The NEJM Article

For those who want to read the article regarding the angioplasty study

gps insight

2008-02-24T16:34:00.001-08:00

GPS Insight

GPS Insight is a hardware and web software-based vehicle tracking

product which is the technical leader in the GPS tracking field. They

have the only hardware which is trivial to install (plugs directly

into the vehicles diagnostics port). Also, they have same-day-shipping

and they are the only product which gets direct engine diagnostics

(fault codes, speed, fuel consumption, odometer readings, idle time,

etc.). Their product gives 2 minute updates with VERY high end map

options and customizations. GP Insight only costs $1.50-2 per day per

vehicle, and the benefits include no more labor paid when people

aren't really working, fuel savings, routing efficiencies, etc.

Their target customers are service and trucking companies, e.g. HVAC,

roofing, plumbing, construction, sales forces, delivery vehicles, long

haul trucking, etc. GPS Insight provides intuitive and powerful

reports and graphs with features like Speeding, Engine Diagnostic

Fault codes/alerts, Begin/End of day report (compare to payroll),

Off-Hours Reports/Alerts, Landmark Reports (by landmark or by

vehicle), Detailed and Summary activity reports, Miles Per Gallon /

Fuel Consumption report Stop reports with configurable idle stop

times, Idle time report using engine diagnostic data, Service log with

scheduled service alerts, Accurate odometer, speed, diagnostic fault

codes, emissions, compliance, and fuel usage/MPG from the engine's

computer. It also comes with scheduled email reports/graphs, and

automated alerts.

Other features include Real time map updates and 2 minute vehicle

locations to help your dispatchers know exactly which vehicles are

close to new orders - no more calling your drivers or relying on them

to provide their location and trip status.

There is also 90 days of history, allowing you to go back and ensure

that you have unquestionable proof of service when billing or service

questions arise. Others include reports to identify reckless and

wasteful speeding with 100% accurate speed readings from the engine's

computer. There are also automated alerts identify you to engine light

status and exact diagnostic fault codes, along with scheduled service

reminders and a service log and emissions report will identify

vehicles which require service before they go for testing, and help to

keep your fleet running clean. A 24x7 roadside assistance and theft

recovery center is included too.

Further information about their product, it is available at

http://www.gpsinsight.com, support, and blog. The site is

checklist csa security

2008-02-24T16:24:00.001-08:00

THE_URL:http://tenebrosityp5aon.blogspot.com/2008/02/checklist-csa-security.html

THE_TITLE:Blogger: 404 Error - Page not found.

Blogger

Push-Button Publishing

Page Not Found

The requested URL was not found on this server. Please visit the

Blogger homepage or the Blogger Knowledge Base for further assistance.

2008_02_01_archive

2008-02-24T15:54:00.001-08:00

leaders.

Read complete story :

http://www.ventureintelligence.in/blog/2005/10/opportunity-in-patholog

y-labs-business.html

Posted by Sneha Diagnostics at 6:18 PM 0 comments Links to this post

Pathology labs flourishing in absence of Government regulation

NEW DELHI: Never shy away from bargaining when approaching any

pathology laboratory for routine medical tests. With practically no

price or quality yardstick regulations by the Government on various

tests offered by the path labs and most of them indulging in giving

commissions to doctors and medical establishments for referring

patients to their centres, a patients may be paying as much as 25-50

microsoft erd commander 50 diagnostics

2008-02-24T15:44:00.001-08:00

2007_02_18_archive

2008-02-24T15:24:00.001-08:00

Wireless sensors extend Internet's reach

But critics say networks can be prone to malicious security attacks

!!!

LOS ANGELES - To the untrained eye, the sleek, airy building

constructed atop a decommissioned nuclear reactor at the University of

California, Los Angeles could pass for high-tech office space.

A closer inspection of the glass-and-steel facade reveals dozens of

miniature, low-resolution cameras and sensors. They're wirelessly

linked to computers throughout the 6,000-square-foot space, keeping

tabs on traffic flow in public areas and monitoring temperature,

humidity and acoustics.

The building serves as a testing ground for developing and perfecting

wireless sensing technology to connect major chunks of the real world

to the Internet. Such networks could monitor the environment for

pollutants, gauge whether structures are at risk of collapse or

remotely follow medical patients in real time.

"I see this as the next wave of extending the Internet into the

physical world," said computer scientist Deborah Estrin, who heads the

Center for Embedded Networked Sensing, a UCLA-based consortium of six

schools.

The researchers at the consortium have already scattered wireless

networks of nodes in the rice paddies of Bangladesh, rain forests of

Costa Rica and wilderness of California's San Jacinto Mountains -- all

for the sake of keeping a closer eye on the world.

Once the stuff of science fiction, wireless sensor networking is

quickly catching on, attracting the attention of the military,

academics and corporations. Just as the Internet virtually connected

people with personal computers, the prospect of wireless arrays

sprinkled in buildings, farmland, forests and hospitals promise to

create unprecedented links between people and physical locations.

Advances in miniaturization and integration of hardware have enabled

the design of smart sensor nodes ranging from a square inch to the

size of a matchbox.

However, the rush to cram tiny cameras into the nooks and crannies of

daily life raises security and privacy concerns among some observers

who fear rogues could hack into the networks. Corporations are beefing

up safeguards, and academics are studying privacy pitfalls and trying

to build stronger networks to protect against security breaches.

The commercial possibilities have already spawned a cottage industry

of startups intent on developing cheap, reliable wireless nodes.

Several of the ventures, including Dust Networks and Arch Rock Corp.,

have connections to the University of California, Berkeley, which was

involved in early efforts to develop "smart dust" or sensors the size

of dust that could be sprinkled in hard-to-reach places.

Today, the technology is primarily used to monitor pipelines and to

control climate conditions inside factories. Demand for more uses in

the home, agriculture and health care could push the market from

several hundred million dollars currently to $8 billion worldwide by

2010, according to San Diego-based wireless market research firm ON

World.

That growth has been slowed by compatibility issues, with many sensors

now custom-made for specific tasks. The ZigBee Alliance, comprised of

more than 150 companies, is developing rules to make networks

interoperable, but a universal standard is still years away.

Wireless nodes, or motes, are made up of microprocessors, sensors and

low-radio radio transceivers to communicate to the outside world. The

capability of the sensors varies and can measure temperature, light,

stress or other conditions.

Motes are usually densely packed in an environment _ like a vineyard

or waterway _ to monitor the surroundings. Most are battery-powered,

while smaller versions are solar-powered. The cost ranges from $20 to

several hundred dollars, depending on the type of sensors.

As with any wireless technology, sensor networks can be prone to

malicious security attacks or illegal eavesdropping, said Adrian

Perrig, an assistant professor of electrical and computer engineering

at Carnegie Mellon University. He has written extensively about

security and privacy hurdles of wireless sensor communication and is

working to create more secure networks.

"If poorly secured networks are deployed and exploited, people may

have significant concerns about sensor technology," he said.

Research at the UCLA building, which opened last year, is funded by

the National Science Foundation, which committed $40 million over 10

years for the center. The building serves as a central hub for

scientists in various fields of wireless sensor networking to work

under one roof.

A sign posted in the lobby makes it clear the space is not private:

"Research in progress. Electronic sensing and monitoring devices in

use within this space, including cameras and microphones."

"These are not toy systems," said John Cozzens, a program director at

the foundation.

Researchers labor behind white cubicles analyzing data spit back by

wireless sensors nestled in the real world.

One of the fields where researchers believe wireless sensor technology

could be commonplace is in the health care setting.

Graduate student Sasank Reddy is working on a project to determine if

it's better to measure caloric intake by toting around a cell phone

camera and taking pictures at mealtime or self-reporting eating habits

on a standard dietary questionnaire.

He recently hung a primitive mote around his neck -- actually, a

camera phone -- as he lunched. The camera snapped away every 10

seconds as he nibbled on his Italian sub.

Later, as he browsed through the images on his work computer, Reddy

saw some red flags and determined the technique wasn't ready for

prime-time: Some pictures came out too blurry. Others showed the faces

of fellow diners in the background, raising privacy issues.

Posted by NABIL at 1:28 PM 2 comments

Labels: CELL PHONE REVIEWS N PREVIEWS

Microsoft to update Windows for wireless

Microsoft is expected to disclose details of Windows Mobile 6 on

Monday!!!

REDMOND, Wash. - Microsoft Corp. plans a launch this spring of its

next-generation operating system for wireless devices, Windows Mobile

6, which is important for the company's efforts to grab market share

beyond the desktop.

Microsoft is expected to disclose details of Windows Mobile 6 on

Monday at a telecommunications conference in Barcelona, Spain.

The company pledged that the new software would render e-mails and

other documents much as they appear on desktop computers. The software

also will have deeper connectivity to Microsoft's "Live" suite of

online services, including instant messaging.

Those features are part of a broader effort by Microsoft to use

connectivity to its prevalent desktop software as a strategy for

catching up with the worldwide leader in mobile operating systems,

Symbian Ltd.

Posted by NABIL at 1:25 PM 0 comments

Labels: CELL PHONE REVIEWS N PREVIEWS

Samsung unveils iPhone-like handset

Ultra Smart F700 has slide-out key pad, large touch-screen!!!

SEOUL, South Korea - Samsung Electronics Co. has unveiled a new mobile

phone that features some of the sleek design and functions of Apple

Inc.'s much-hyped iPhone.

Samsung's Ultra Smart F700 will be exhibited at next week's 3GSM World

Congress, a telecommunications exhibition in Barcelona, Samsung

spokeswoman Sonia Kim said Friday.

Mobile phone makers have been scrambling to match the iPhone, unveiled

last month by Apple CEO Steve Jobs. The device, which will be

available starting in June, marks the iPod and Macintosh computer

maker's entry into the mobile phone business.

The ultra-thin iPhone is controlled by a large touch screen. It plays

music, surfs the Internet, and runs a version of the Mac OS X

operating system, among other functions.

Samsung said the Ultra Smart F700 also has a full touch screen as well

as a traditional QWERTY key pad that slides out "for users who are not

yet familiar with a touch-screen-only user interface."

The phone can also access the Internet, play music, take pictures,

show videos, handle e-mail and share photos, said Samsung, the world's

third-largest manufacturer of mobile phone handsets.

Its third-generation (3G) technology is considerably faster than the

iPhone's EDGE system, and its 5-megapixel camera outclasses the

iPhone's 2-megapixel camera.

"The Ultra Smart F700 is a good example of how (the) mobile phone will

evolve in the future," Choi Gee-sung, president of Samsung's

Telecommunications Network Business, said in a statement Thursday.

Apple's iPhone will cost $599 for the high-end model.

Kim, the Samsung spokeswoman, said marketing plans for the Ultra Smart

F700 remain unclear because the company wants to see what kind of

reaction it receives at the Barcelona show.

Last month, Samsung rival LG Electronics Co. announced its own

touch-screen mobile phone, the KE850 Prada.

The LG phone, produced in partnership with the Italian fashion brand,

is to go on sale in late February for $780 at mobile phone dealers and

Prada stores in Britain, France, Germany and Italy. It is to be

launched in Asia in March.

Posted by NABIL at 1:21 PM 0 comments

Labels: CELL PHONE REVIEWS N PREVIEWS

Search engine trawls Castro speeches, not Web

HAVANA - Cuba built an Internet search engine that allows users to

trawl through speeches by Cuban leader Fidel Castro and other

government sites, but does not browse Web pages outside the island.

The search engine unveiled at a conference this week underscored

restrictions on Internet access in communist-run Cuba, which the

government blames on U.S. trade sanctions.

Cubans cannot buy computers and Internet access is limited to state

employees, academics and foreigners. Cubans line up for hours to send

e-mails on post office terminals that cannot surf the World Wide Web.

Passwords are sold on the black market allowing shared Internet use

for limited hours, usually at night.

Cuba's first search engine can search any subject, but only on Cuban

servers, or the Cuban intranet, including 150,000 government sites and

the state-run media. It has a special function key on the homepage to

browse through hundreds of Castro's speeches since day one of his

revolution in 1959.

"The aim is to search Cuban Web sites without having to rely on

foreign engines," said its creator, Leandro Silva.

Cuba has the lowest rate of Internet usage in Latin America, 1.7 users

per 100 inhabitants, according to the International Telecommunication

Union.

Critics, such as rights watchdog Amnesty International, say Cuba

restricts Internet usage to limit freedom of expression.

Cuba says Internet access is not available because of sanctions

enforced by its longtime ideological enemy the United States that

block connection to broadband fiber optic cables running undersea just

12 miles (18 km) off shore.

Opening this week's IT conference in Havana, Communications Minister

Ramiro Valdes said Cuba was forced to "rationalize" use of scarce

Internet bandwidth in priority sectors such as scientific research,

education and health care.

"Despite the fact that international fiber optic cables run very close

to Cuban shores, the rules of the blockade prevent connection to

these," Valdes said.

Cuba is forced to use a costly satellite channel with only 65

megabytes per second (mbps) for upload and 124 mbps for for download,

he said.

Venezuela connection

Cuba has turned to its main ally, Venezuela, to bypass the U.S.

embargo and increase its Internet capacity by laying a 1,000-mile

(1,500 km) fiber optic cable between the two countries.

"A fiber optic cable will allow faster connection and significantly

lower costs," Valdes said.

Havana initially saw the Internet as a U.S. Trojan horse designed to

undermine its one-party state and quickly decreed its "selective" use

in the "national interest."

Cuba harnessed the Internet as a tool in developing one of the most

advance biotech industries in the Third World. It has also been a boon

to the Caribbean island's tourist trade and provided a medium for

Havana to get its views on the Web.

One expert on Cuba said Washington blocks Cuban access to high-speed

Internet to hinder Cuba developing a knowledge-based economy based on

a well-educated low-wage population.

"It is Venezuela that will give Cuba the real-time connectivity it

needs," said Nelson Valdes, a professor of sociology at the University

of New Mexico.

"This will open the huge world of Internet business to the island and

Cuba's human capital could transform Havana into another Mumbai," he

said.

Posted by NABIL at 1:16 PM 0 comments

Labels: TECHNOLOGY REVIEWS N PREVIEWS

Scientist: Frog could be 25 million years old

Tiny amphibian was found completely preserved in amber!!!

MEXICO CITY - A Mexican researcher announced the rare find of a tiny

tree frog completely preserved in amber on Wednesday that he estimates

lived about 25 million years ago.

The chunk of amber containing the 0.4-inch frog was uncovered by a

miner in southern Chiapas states in 2005 and was bought by a private

collector, who lent it to scientists for study.

Only a few preserved frogs have been found in chunks of amber -- a

stone formed by ancient tree sap -- mostly in the Dominican Republic.

Like those, the frog found in Chiapas was of the genus Craugastor,

whose relatives still inhabit the region

Biologist Gerardo Carbot of the Chiapas Natural History and Ecology

Institute, who announced the discovery, said it was the first such

frog found in amber in Mexico.

Carbot said he would like to extract a sample from the frog's remains

to see if they contain well-preserved DNA, in order to identify the

frog's species.

However, he expressed doubt that the stone's owner would allow

researchers to drill a small hole into the chunk of amber. "I don't

think he will allow it, because it's a very rare, unique piece," said

Carbot.

Posted by NABIL at 1:11 PM 0 comments

Labels: TECHNOLOGY REVIEWS N PREVIEWS

Shuttle begins trek to launch pad

Preparing for 11-day mission to the international space station

CAPE CANAVERAL, Fla. - Space shuttle Atlantis began a sluggish move to

the launch pad on Thursday in preparation for a mid-March mission to

continue construction of the international space station.

The shuttle started the 3.4-mile journey from the Vehicle Assembly

Building aboard the massive crawler-transporter vehicle at 8:19 a.m.

The trip was expected to last six hours.

Atlantis is set to launch on March 15 for the first space shuttle

mission of the year.

The six-man crew will deliver a new segment and a pair of solar arrays

that will be used to power the space station.

NASA is hoping to launch four or five space shuttle missions this

year, the most ambitious schedule since 2002.

Posted by NABIL at 1:08 PM 0 comments

Labels: TECHNOLOGY REVIEWS N PREVIEWS

Daylight-saving glitch threatens mini-Y2K

Software bug could skew everything from Outlook to airline schedules

!!!!!!

---------------------------------------------------------

Daylight saving time arrives a little earlier -- March 11 -- and stays

a little later -- Nov. 4 -- this year. And it's bringing a problem

along with it that could affect everything from stock trades to

airline schedules to your BlackBerry.

Software created before the law mandating the change passed in 2005 is

set to automatically advance its timekeeping by one hour on the first

Sunday in April, not the second Sunday in March. Congress decided that

more early evening daylight would translate into energy savings.

The result is a glitch reminiscent of the Y2K bug, when cataclysmic

crashes were feared if computers interpreted the year 2000 as 1900 and

couldn't reconcile time appearing to move backward. If banks and other

institutions aren't properly prepared, automatic stock trades

reportedly might happen at the wrong hour, buildings that unlock at a

certain time could stay shut, and airline flight schedules could be

scrambled.

A different Outlook on life?

And for three weeks this March and April, Microsoft Corp. warns that

users of its calendar programs "should view any appointments ... as

suspect until they communicate with all meeting invitees." That's

because Outlook may not work the way users expect it to.

The problem won't show up only in computers. It will affect plenty of

non-networked devices that store the time and automatically adjust for

daylight saving, like some digital watches and clocks. But in those

instances the result will be a nuisance (adjust the time manually, or

wait three weeks) rather than something that might throw a wrench in

the works.

Cameron Haight, a Gartner Inc. analyst who has studied the potential

effects of the daylight-saving bug, said it might force transactions

ortho clinical diagnostics receives fda_16

2008-02-24T14:59:00.001-08:00

(4) Chagas' Disease - Can We Stop the Deaths? by James H. Maguire,

M.D., M.P.H., The New England Journal of Medicine, Vol. 255, No. 8,

August 24, 2006

Ortho-Clinical Diagnostics

http://www.orthoclinical.com

i dont think racism is mental illness

2008-02-24T14:54:00.001-08:00

"I don't think racism is a mental illness, and that's because 100 percent of

people are racist,"

...said Dr. Paul Fink, in WAPO ("Psychiatry Ponders Whether Extreme

Bias Can Be an Illness").

"If you have a diagnostic category that fits 100 percent of people,

it's not a diagnostic category."

We already have diagnostic categories for delusions, obsessions,

anxiety, phobias, and depression. Do we need a separate category for

"pathological bias?" Would it change our approach to these patients?

Would their treatment be any different? Should we be doing research to

find out? Personally, I don't buy this, but is that just my prejudice?

my part of sharing diagnostic

2008-02-24T14:44:00.001-08:00

My part of sharing: (Diagnostic Bactriology)

Urine Culture:

Urine sample is collected when the patient( in/out patient) is

suspected of urinary tract infection and asymptomatic patients with

high risk of infection.

Common Aetiologic agents: E.Coli, Enterococcus Spp, Klebsiella Spp,

Enterobacter Spp, proteus Spp and Pseudomonas Spp.

Urine Specimen: Midstream urine (2-15ml), collected in sterile plastic

wide-mouthed container. The use of urine bags are discouraged as it

has a high chance of leakage and it will become messy when the

specimen needs to be used in the lab. The specimen must reach the lab

within 2hours/ must be refrigerator upto 24hours. All the relevant

clinical information about the specimen must be provided, recorded and

documented. When plating of urine specimen for viable count we use 2

media (MacConkey and CLED agar). The MacConkey agar acts as the

general media and CLED agar is used as the selective media.

Quantitation is very important for urine culture as it will tells us

if we need to take result into consideration or do not report as

sometimes there might be too many colonies because of worng collection

process. (eg: the specimen is not mid-stream urine). to ensure

quantitation is standardised throughout, we use the same volume of

inoculation tube.(eg: 1 or 10 ul)

Microscopy: 1/> organism/ high power field (hpf) [corresponds to > or

= to 100,000 organism/ml]

Specimen Rejection: the specimen is also rejected if the following

occurs:

1. Important data on the specimen container and request form do not

match.

2. Specimen is unsuitable for test requested

3. Gross spillage of specimen

4. Insufficient specimen available

5. If the agar is soaked in urine (dip stick)

Things to take note:

1.Pyuria, viable counts on the culture, symptoms and patient's factors

(age, presence of catheter, underlying structural abnormalities and

immunologic status) all these must be considered before interpreting

the results.

2. CLED and MacConkey agar may be used if delay in transport is

antisipated.

3. Always streak on the general media before using the same inoculatin

tube to streak on the selective media. This is because selective media

contains inhibitory substances which might also come into contact with

general media. Thus it defeats the whole purpose of culturing in 2

different media.

Done by: Devi :)

posted by Guinea Piggy~ @ 8:31 PM

5 Comments:

* At 2/7/06 5:41 PM, Blogger Guinea Piggy~ said...

To: Devi

What does pyuria means?

Siang Fang

usa robot systems usage is well

2008-02-24T14:24:00.001-08:00

USA robot systems' usage is well supported

FANUC Robotics' Customer Resource Center (cRc) offers world-class

support services, including the Diagnostic Resource Center (DRC), a

world-class call center and technical phone support. The cRc will

feature its wide range of services during IMTS 2006 at McCormick

Place, Chicago, USA. 'FANUC Robotics' Customer Resource Center is

committed to making it easy for our customers to work with us.

We continuously measure our performance to ensure that we meet or

exceed our customers' expectations, doing whatever we can to make

every contact with FANUC Robotics a great experience,' said Andy

Denny, vice president of FANUC Robotics' Customer Resource Center.

The following highlights many of the customer services offered by

FANUC Robotics' Customer Resource Center.

* Diagnostic Resource Center - the DRC is an easy-to-use online

troubleshooting tool that helps beginners and advanced users quickly

solve robot-related issues.

The DRC provides access to an extensive library of diagnostic

information, photos, and circuit diagrams for FANUC Robotics'

controllers.

In addition, the DRC can be customized by integrating

customer-specific prints and other information.

Integrated content covering error codes, flowcharts, prints, reference

material, CAD files and more helps customers quickly identify

solutions.

Customers can also instantly add electronic 'post-it' notes to mark

relevant information.

'The DRC provides the most comprehensive troubleshooting solution

available on the market,' said Denny.

With the Diagnostic Resource Center - i Pendant edition (iDRC)

controller option, the user can have instant access to more advanced

diagnostic information including: step-by-step diagnostic flow charts,

schematics, component pictures, and email enhanced capabilities, which

allows the robot to automatically send emails regarding items such as

errors or production status.

In addition to the iDRC, other controller options including cycle time

and fault analysis functions can all significantly improve system

uptime and productivity.

* World-class call center - FANUC Robotics' world-class call center

redefines the performance of a traditional customer support call

center.

'Since introducing our call center, we've seen marked improvements in

customer satisfaction.

We have a team of the industry's best people, and continue to make

significant investments in the latest technologies to maximize our

responsiveness,' said Denny.

According to Denny, the call center agents are three steps into the

call before it is answered.

State of the art technology provides fast and accurate customer

information at a moments notice, and efficiently routes customers to

the appropriate call center agent based on their specific

requirements.

* Parts services - FANUC Robotics is able to ship over 90 percent of

spare parts orders within four weeks.

Down robot situations are given the highest priority, which is

reflected in the group's performance record of shipping over 99% of

down robot spare parts within 24h.

For customer phone inquiries, Customer Resource Center spare parts

representatives continue to exceed their goal of resolving 98% of all

customer requests on the first call.

'This response rate is a direct reflection of our expert team of call

center personnel who are ready and able to support our customer's

2007_02_01_archive

2008-02-24T14:14:00.001-08:00

syncope

2008-02-20T09:54:00.001-08:00

Syncope

Old woman has a syncopal episode at the dinning room table. No prior

history. The family says she was out 1-2 minutes. Her eyes rolled back

into her head and she vomited. Can't determine whether she vomited and

then passed out or passed out and vomited.

She looks terrible, although she is alert. She says she feels weak,

but she doesn't want to go to the hospital. Despite her age she had no

significant medical history and lives independently. Her pressure is

120/70. Here is her strip:

I tell them in any unexplained syncope, it is important to go to the

hospital. I can understand how given the dinner occasion, she might

not want to go. I am thinking this is a vasol vagal episode. I want to

do orthostatics, just to see what happens, but she says she is too

weak to stand. And then she is unresponsive and vomits again.

Unfortunately the leads have come off due to her sweaty skin, but I

manage to get new leads on all the while supporting her airway, and

hoping she doesn't code. Here is what I capture:

She wakes up and her rythm goes back to this:

We still insist she go to the hospital. With the help of her

granddaughters, I get her out of her vomit drenched blouse and into a

hospital gown, which I carry on the stretcher with the sheets.

We go on a non-priority. I put her on some 02 and put in an IV as we

drive. Her color is much better. I get her demographic information,

and then go to call the hospital. Right when I get ready to patch, I

glance at her and she is vomitting again. I give a quick patch,

"Sorry, my patient just started vomiting and is bradying down. Bottom

line syncope at the dinner table. Be there in 5 minutes."

I hit print on the monitor while I try to keep the vomit in the small

garbadge pail I grabbed and off her face. The episode isn't as long as

the others and I can't say she is unresponsive during it. We are

already at the hospital now. I have her cleaned off, and we take her

in.

I give the report, and then write my run form. When I see the doctor,

he shows me her 12 lead. The computer printout says possible posterior

MI, although it doesn't jump out at me, and I'm not certain I agree. I

show him my strips, and tell him this is what she was doing when

vomitting, although she appeared normal at other times.

And then I look closely at the strip I recorded during the last

vomiting episode. Here the ST is clearly elevated, but only for a few

beats.

Its odd, but maybe what happens to her is similar to what happens when

someone gets ST elevation during a stress test. She has a near

blockage perhaps, which occludes during the stress of vomiting or is

spasming. I'm not really sure.

I was surprised afterward that I didn't do a 12 lead myself and wish I

had. I normally always do. I was just sort of busy, and I guess I was

just thinking it was all a vagal episode and/or an upset stomach, but

maybe it was an MI, and so was lower on my priority list. I think I

might have done one in the house if there hadn't been so many

firefighters and police offiders standing around the patient. I could

have asked them to leave. Not that as health care providers, they

shouldn't be involved, just having so many people -- firefighters,

cops or medics makes it more awkward for the patient.

I'll post more later on this case when I next see the doctor and I can

get more information.

I have also noticed that it is easier to study a strip after a call,

than during one. It is hard to pick out subtleties unless you really

study the strip. I think I should also have said to myself -- the

irregular beats while she was vomiting are not typical of vagal

episodes, at least in my experience.

I had another interesting call the same day, which I write about in my

November log on my Capnography for Paramedics web site. It is another

call where things aren't always what they may appear at first glance.

pdd and apd what is developmental delay

2008-02-20T09:34:00.001-08:00

PDD And APD: What Is Developmental Delay?

Developmental Disability includes Autism, Asperger's, Pervasive

Developmental Disorder - Not Otherwise Specified and other diagnoses.

Developmental Delay includes ADD, LD, Dyslexia, and others. Then there

is Global Developmental Disorder and Central Auditory Processing

Disorder, and I don't know where they fit in the official structure of

diagnostic labels, but I know they are a developmental difficulty.

I have been working with children with developmental difficulties for

years. I use the terms developmental difficulties to encompass

everything from Developmental Disability to Developmental Delay, and

even more. In our consulting program we consider them all

fundamentally the same. They differ only by degrees. We have developed

protocols which work with all of the developmental difficulties. Our

program awakens the child's unrealized keys for becoming

age-appropriate.

What is the magnitude of this problem?

All of these developmental difficulties add up to about 28 million

children in the USA. The Census Bureau calculates there a total of 85

million children in the USA. The APA (American Pediatric Association)

reports that one in every six children have a diagnosis for some

developmental difficulty (16.7%). The different associations for all

of the individual diagnostic labels of developmental difficulties all

agree when they report that about 50% of the children with these

problems obtain a diagnosis for their problem (for a total of 33%).

And, 33% of 85 million is 28 million children.

That means that 33% of all the children in every class have some level

of developmental difficulty. Maybe it shows up as an inability to

focus or sit still. Maybe it shows up as an inability to learn

reading. Maybe it shows up as an inability to kick a ball. Maybe it is

so intensive, the children never learn to connect to other people.

Maybe it is mild and only an annoyance to the child and the parents.

In whatever level of intensity, developmental difficulties seem to be

growing in percentages. We are obviously getting better with our

diagnoses. And, we are obviously advanced as a culture so that we

offer those testing services to more families who otherwise could not

afford it. But, I am not sure this is the reason we have 1/3 of our

children with developmental difficulties.

When I was a child in school, many years ago, I do not remember 1/3 of

the children having these types of difficulties in my classrooms. I

remember that maybe 5% to 10% could have had these kinds of

difficulties, but certainly not 1/3.

What is a developmental difficulty?

Quite simply, it is some blockage in the developmental process. All

living things have a life cycle. Much of the initial phases of that

life cycle are spent in developing. From inception to maturity, all

living things progress through a series of milestones. For us humans,

we call them our developmental milestones.

For those with developmental difficulties, they do not progress

through their milestones appropriately. They get blocked at some of

the milestones. They skip some milestones. So, many of the basic

learning processes needed for appropriate maturity, are lost. And, in

some cases a child is held in a stage and does not pass out of it on

to the next developmental stage.

I think that all of the unique diagnostic labels are related to some

basic factors. In which developmental milestones did the child get

blocked or which milestones did the child skip? How intense is the

'stuckness?' And, how many milestones did the child skip?

What can be done about it?

All of the different diagnostic category associations in the field of

developmental difficulties are clearly speaking on one voice when they

say that the 1) developmental process is blocked and that 2) there is

no cure.

Researchers in this field do not know what to do to cure developmental

difficulties. Nothing that they try affects the developmental process.

For decades clinicians have tried everything they can think of to do

and nothing works.

After all these frustrating years, they have finally agreed with each

other that there is no cure. And, now it is official. All of the

diagnostic associations and all of the groups creating the diagnostic

definitions agree that there is no cure. Now, they invest all of their

research dollars on finding causes instead of developing fixes for 28

million children with these developmental difficulties.

They have tried many things, but they have not tried everything.

With our work the children round out the chinks in their movement

pcr diagnostics

2008-02-19T22:44:00.001-08:00

PCR diagnostics.

Former Shadow minister, Owen Paterson MP recently visited the USA, and

in particular the state of Michigan to see for himself the response of

other countries to a tuberculosis reservoir in wildlife, and in

particular the strides made with Polymerase Chain Reaction on-farm

diagnostic testing.

In an article (in FWi) written by Owen Paterson, he describes his

visit:

"....The USA shows clearly that Bovine TB can be eradicated in cattle

and wildlife by a combination of the following:

* Fast, accurate and modern diagnosis.

* Rigidly enforced but workable pre-movement testing and movement

restrictions.

* Vigorous, if unpopular, campaign to bear down on disease in

wildlife.

It must be emphasised that only a combination of all of these will

work. Picking only one or two of them will not eliminate the disease.

..."

"...... new PCR kits, developed for the army in Iraq, are as small as

a briefcase and there is absolutely no practical reason why tests

could not be done on the environment in the environment from the back

of a truck in less than two hours. A well equipped laboratory could do

over 1000 a day. They believe that PCR would work on material around

setts. It was felt that Ben Bradshaw's letter to me was

quibbling....(US vets were) ... utterly astounded by the grotesque

dimensions of the TB epidemic in the UK. .... there was clearly no

doubt that we should be pressing the Government to trial PCR

technology as we have already proposed. "Read in full

The great and the good gather this week to defend their budgets. Dr.

Cheeseman from 'Badger Heaven' other wise known as Woodchester Park, a

four year 'trial' into badger BCG (already undertaken in Ireland) and

John Bourne to defend - the indefensible Krebs trial. Interestingly

Krebs was described by Cheeseman this week as 'rigourous and robust'.

As 57 % of the traps were 'interfered with' and 12% went AWOL, and

trapping only accounted for between 30 - 60 % of the target group

anyway, one may wonder just how bad it would have to get, for the good

doctor to consider a 'trial' weak and flawed? But such is Defra's

beneficial largesse, that it seems nobody is prepared to forge ahead

with tomorrow's technology to identify infected animals and their

environment. Australia used PCR in 1997, Michigan in 2001 - but the

UK? Forget it, we'd rather kill 30,000 cattle a year, allow a

notifiable zoonosis to devastate Britain's badgers and then spill over

into - well anything that crosses its path actually.

This country will not wake up, until tuberculosis is reported in

domestic pets.

diagnostics companies changing face of

2008-02-19T22:34:00.001-08:00

Diagnostics Companies - Changing the Face of Medicine

Medical diagnostic innovations are focused on higher sensitivity and

lowering costs of test. Today the diagnostics market is only $30

billion, but it will evolve to be more closely linked with molecular

diagnostics, which in turn will more closely link to drug delivery for

a full gambit of new drug treatment and solutions. This is believed to

be the impetus for both GE and Siemens to recently enter the

diagnostics market. In the meantime, there are some highly innovative

nanotech diagnostics companies developing technologies that are

expected to have an impact on the market in the coming five years.

Nanosphere is developing low cost sensitivity tests for cancer, hoping

to change the time it takes to diagnose re-current cancer from days or

weeks from years. The company is also developing a test for

Alzheimer's that is 1,000 to 10,000 times more sensitive than current

methods. The company's technology is licensed from Chad Mirkin at

Northwestern University.

Nanomix (most people pronounce this company wrong - the correct

pronunciation emphasizes the `o') is trying to change the diagnostics

paradigm from optical detection to electronic detection. The company

has developed point of care or in-home sensors that use networks of

carbon nanotubes for highly sensitive detection.

inverness acquires diagnostics

2008-02-19T22:14:00.001-08:00

Inverness Acquires Diagnostics Business to Settle Patent Dispute

To settle a nearly three-year long patent dispute both in the U.S. and

overseas, Inverness Medical Innovations Inc. (Inverness) has agreed to

acquire part of the business of Acon Laboratories Inc. (Acon) for $175

million. Inverness initially sued Acon for infringement of its U.S.

Patent No. 6,485,982 ("Test Device and Method for Colored Particle

Immunoassay"), obtaining a preliminary injunction against Acon in

July, 2004 for Acon's alleged infringement of claims 7 and 19 of the

patent (regarding Acon's "one-step device"). Acon's "lateral flow

immunoassay" business had revenues of $50 million in 2005, with an

operating income of $17 million. This purchase by Inverness of part of

defendant Acon's business was justified, according to Ron Zwanziger,

CEO of Inverness, because "by acquiring the majority of the rapid

diagnostic test business of Acon, who has proven to be an efficient

manufacturer of both consumer and professional diagnostic products, we

are adding significant revenues at attractive margins as well as

manufacturing capabilities that will benefit us companywide."

Inverness Medical Press Release: LINK

U.S. Patent No. 6,485,982: LINK

quest diagnostics inc dgx

2008-02-19T21:59:00.001-08:00

Quest Diagnostics, Inc. (DGX)

By: Steve Rubis

Leading Clinical Testing Company Seems Primed For Purchase

Recommendation: UNDERVALUED, possibly in play.

Quest Diagnostics is the industry leader in clinical testing

solutions. The company provides both clinical testing and anatomic

pathology testing. Strong management performance coupled with an

attractive equity value causes us to provide further research on

Quest.

Investment Thesis:

Recent offers to buy Bausch and Lomb (BOL) by American Medical Optics,

Inc. and Warburg Pincus suggest that Quest Diagnostics could be the

next to be bought. Management performance is strong in terms of

Return's on Assets and Equity; the fact that Quest is the industry

leader further confirms our assessment of management. Investors should

pay close attention to the current valuation of Quest Diagnostics,

Inc. A few days ago, we provided some links to the trading action in

Quest shares. The heady action in July $55 and $60 calls suggests

price movement to the upside. Current share prices are due to the loss

of UnitedHealth Group, Inc. (UNH) as a client, due to UNH's demand for

cheaper prices. Based on the financial data at hand, it seems that DGX

is undervalued and offers investors an opportunity to achieve a 30%

return.

Valuation:

The thesis above argues that Quest Diagnostics is a take out target

based on other purchases currently pending. In order to fully

understand the fair value of Quest shares, multiple comparisons are in

order.

Table 1: Value of Quest Diagnostics, Inc. Shares in Comparison to the

Industry

The table suggests that the industry leader is undervalued in terms of

the entire Medical Labs and Research Industry. First, Price and EV to

EBITDA values are the key component of our valuation analysis. These

values provide us a preliminary valuation range for what a private

equity investor or another firm might be willing to pay for Quest. The

next three prices give the investor an idea of what Quest is worth on

a relative basis in terms of the entire Medical Labs and Research

Industry. Quest performs quite well, despite a lackluster showing on

Price to Book Value. Lastly, our analysis considers Earnings Power

Value and Reproduction Value in order to get a better sense of what

Quest is truly worth. These last two values allow investors to obtain

a price of Quest's income stream, as well as, what it would cost to

reproduce the business or start over from scratch. Reproduction value

helps understand what it might cost a competitor to recreate Quest's

business rather than making the outright acquisition.

Table 2: Comparison of Valuation Metrics for Quest Diagnostics, Inc.,

Laboratory Corporation of American Holdings, and the Medical Labs and

Research Industry

Table number two compares the valuation metrics of Quest to its main

competitor and the industry. Quest is mildly under value in terms of

its main competitor Laboratory Corp of America. Each are similarly

valued on a take out basis, but the similarities end there. Quest

appears undervalued on both a Price to Sales and Price to Earnings

basis. A reason for this undervaluation can be attributed to the 7%

loss of revenue due to losing UNH as a client (see 4/30/07 10-Q).

Table 3: Valuation of Quest Diagnostics in Terms of Laboratory Corp.

of America Holdings and the Medical Labs and Research Industry

Table Three applies the values illustrated in Table Two in order to

develop a valuation range for Quest Diagnostics, Inc. Our original

range as described in a previous article was $75 to $85. The analysis

in this article places that range a little lower at $68.07 to $77.82.

Despite any issues about revenue growth, Quest should be trading

closer to the $68 to $71 range. Since Quest is the industry leader, an

investor can reasonably expect DGX to trade a price near or above the

same valuation of the main competition.

Table 4: Selected Financial Data

The key takeaways of Table Four are the slowing EPS growth as well as

the impressive Altman Z Score. An assessment of the financials shows

that the company is no likely to hit insolvency, has strong

management, and despite a slowing growth rate, EPS is not declining.

Business Prospects / Model:

Quest Diagnostics, Inc. is the leading provider of diagnostic testing

services, which include clinical testing and anatomical testing. Over

90% of revenues were generated by the clinical testing business

through over 2000 testing centers. The clinical testing service

offerings are as follows: blood cholesterol levels, blood chemistries,

complete blood cell counts, Pap tests, urinalyses, pregnancy and other

pre-natal tests, alcohol and other substance-abuse tests, and asthma

and allergy tests. The services offered by the anatomical or esoteric

testing segment are: endocrinology and metabolism, genetics,

hematology, immunogenetics and human leukocyte antigens, immunology,

microbiology and infectious diseases, oncology, serology, and

toxicology.

The revenue can be broken into five major segments: patients; Medicare

and Medicaid; physicians, hospitals, employers and other

monthly-billed clients, Healthcare insurers-Fee-For-Service, and

Healthcare Insurers-Capitated. Fee-For-Service makes up between 40 and

45% of annual revenues, with the Healthcare Insurers-Capitated being

the most problematic and price sensitive. UNH's policy changes, which

demanded lower pricing and unattractive contracts for DGX, drove flat

earnings in the 1st Quarter of 2007. Quest expects the loss of UNH as

a customer to slow growth between 7 and 10%.

*Note: the author does not own any shares in Quest Diagnostics, Inc.

**The Author cannot be held responsible for any gains or losses

achieved through trades based upon information presented herein.

***The majority of data comes from Yahoo!Finance, Google Finance, and

the 10-K and 10-Q reports.

****The author current holds the following on the long side: Agilent

study of sleep

2008-02-19T21:34:00.001-08:00

The Study of Sleep

Just a few hours ago, I returned home from an overnight sleep study. I

always enjoy these diagnostic tests and studies since they afford me

the opportunity to experience what my patients must endure. Just like

my MRI, I treated the evening not only as a diagnostic test to

ascertain the etiology of my own disordered sleep, but also as a study

of the diagnostic study itself, and an evaluation of what these types

of experiences are like for the average patient.

As I have consistently discovered, aside from the functionality of

equipment involved, the personality and approach of the technician

administering a diagnostic evaluation is likely the most important

aspect of the test's administration (not to overlook the cooperation

and open-mindedness of the test subject him- or herself).

Luckily for me, the technician who administered my sleep study was

personable, affable, funny, competent, kind, compassionate, and

apparently wholly interested in my need to have a positive experience,

in spite of his own challenge of being a circadian-challenged worker.

While he spent thirty minutes attaching numerous wires, tubes and

electrodes to various parts of my body, our exchanges included an

examination of his occupational challenges, the absurdity of the

situation in an existential type of way, and the odd nature of sleep

transform a relatively uncomfortable experience simply through the

power of their personality and approach to the task at hand. And at

this, my technician was richly skilled.

Apart from the interpersonal aspects of the situation, I was mostly

affected by the inherent irony of attempting to sleep "normally" under

what are undoubtedly abnormal conditions. The room, while homey like a

nice hotel, still had a somewhat clinical feeling, especially due to

the necessary presence of the equipment, wires, infrared video camera,

and tubes which give the room its clinical functionality.

Since this was a study to determine my sleep patterns, I was

instructed to eschew my usual medication which keeps my Restless Legs

Syndrome at bay for one to two days prior to the study. Consequently,

I was thoroughly exhausted from two nights of poor sleep, as well as

somewhat intimidated by the need to sleep on command. Exhausted,

overtired, unmedicated and uncomfortable, the challenge was a steep

one.

The picture: two cannulas in my nose (one for the measurement of

oxygen flow and one for heat); six electrodes glued to my scalp to

monitor brain waves; four sensors taped to my face to monitor eye

movement; one on my throat to record snoring vibrations; four

electrodes to the chest for an ECG; and two tight straps around my

chest and abdomen to measure breathing patterns and depth---all

attached to one "motherboard" which slept silently beside my pillow.

The initial result: two hours of tossing and turning, five hours of

relatively solid sleep interrupted by interesting trips to the

bathroom with the said wires and tubes along for the ride, and a

grateful arrival home to my peaceful and welcoming abode following 20

laps at the pool to wash off the night's travails.

So, if I am again meant to sleep and perchance to dream, may the

results of this most interesting and amusing study be edifying and

useful to both myself and my trusted diagnosticians. If not, then it's

back to the drawing board, and the overall elusive nature of healthy,

restful sleep.

xspec 12 diagnostics for reading files

2008-02-19T21:24:00.001-08:00

xspec 12 diagnostics for reading files

v12 doesn't write out much helpful information when a file is rejected

for some reason. Made a start at fixing this by adding diagnostic

message output at chatter level 25 to OGIP_92aIO::fileFormat in

DataFactory/OGIP-92aIO.cxx and DataUtility:readArrays in

Data/DataUtility.cxx.

UPDATE: A better solution is to add a call to FITS::setVerboseMode in

the chatter command code so that CCfits verbosity is turned on if

chatter >= 25. This is now implemented in 12.2.0x.

weekly mediracer news

2008-02-19T20:54:00.001-08:00

Weekly Mediracer News

Many people today are second-guessing their health care professionals,

and they are turning to the Internet for information. There are only a

few blogs about Carpal Tunnel Syndrome.

Our goal is to tell about CTS and how it could be used reduce the

costs of diagnostics and to make it easier for patients to have their

hand-problems diagnosed faster and to a lower cost compared to ENMG.

Health care professionals are trying to keep track of the hospital and

health care market. What new is available? This tells about the

Mediracer innovation.

Legislation is changing all the time, and the upcoming elections

promise to make health care an major issues. Health care cost is a big

issue all over the world. Mediracer includes a telemedicine solution

that distributes neurophysiological specialist diagnostics to small

communities and hospitals outside the big medical centers.

The CTS - Carpal Tunnel Syndrome blog is a communication channel to

help you find practical advice about carpal tunnel syndrome

diagnostics, hand surgery and orthopedics.

We try to provide CTS related information to patients, potential

Mediracer buyers, occupational health personnel, and decision makers

who are looking for cost-effective ways to improve carpal tunnel

syndrome field monitoring.

Our goal is to bring you up to speed with what is going on in

distributed carpal tunnel syndrome diagnostics, today!

As a RSS-subscriber you can:

* read advice and news about the Mediracer, CTS diagnostics,

telemedicine, health technology, health care economics, and much

* read CTS blogs online anytime and/or have it delivered daily,

weekly or on your selected days by email or RSS-feed

* search our blog archive

run dont crawl to new site diagnostics

2008-02-19T20:44:00.001-08:00

radiation risk from ct scans

2008-02-19T20:34:00.001-08:00

ethics economics and technologies of

2008-02-19T20:24:00.001-08:00

Ethics, Economics and Technologies of Microarray Molecular Diagnostics

dementia typical case

2008-02-19T19:54:00.001-08:00

industry perspective personalized

2008-02-19T19:34:00.001-08:00

Industry Perspective: Personalized Medicine

Is your area thinking about the impacts of personalized medicine on

its economic base?

Personalized medicine is a concept promoted as a new paradigm for

health care delivery, with particular emphasis on more tightly linking

genomics-based diagnostics and therapeutics. Previous analyses focused

on the pharmaceutical market; this analysis also addresses the

incentives to develop linked genomics-based diagnostics and the

broader public policy implications.

Using a standard economic framework of an insurer-payer negotiating

reimbursement with manufacturers of an innovative, targeted diagnostic

and a companion patented therapeutic, several illustrative

hypothetical scenarios are developed. The relative importance of the

key economic factors is examined, including whether the reimbursement

system is value or cost based, whether the therapeutic is already

marketed, the strength of diagnostic intellectual property, and a

current year versus longer time frame.

The results suggest that health systems reforms that promote

value-based, flexible reimbursement for innovative, patent-protected

diagnostic and therapeutic products are critical to create stronger

economic incentives for the development of personalized medicine.

Source: Drug Information Journal. Ambler: 2007. Vol. 41, Iss. 4; pg.

10g performance guide 6th chapter

2008-02-19T19:24:00.001-08:00

10g Performance Guide: 6th Chapter

Chapter 6: Automatic Performance Diagnostics

[Usual disclaimer: You should read the Oracle Performance and Tuning

Guide yourself at OTN -- these are just my notes of what I found

interesting or new while reading.]

Introduction to Database Diagnostic Monitoring

* Overall purpose is to aid DBAs in correctly diagnosing issues, as

opposed to just making changes based on initial symptoms. (I like

this approach. It fits well with Tom Kyte's mantra of testing and

understanding, rather than guessing.)

* ADDM analyzes data from AWR every time a snapshot's taken and

saves results to database. Provides hourly (by default) reports,

problem diagnoses, and root cause analyses.

Automatic Database Diagnostic Monitor (ADDM)

Goal is to reduce 'db time' -- a stat found in the V$SESS_TIME_MODEL

and V$SYS_TIME_MODEL views.

* Example problems ADDM considers: CPU bottlenecks, undersized

SGA/PGA, I/O capacity, RAC configuration, and more.

* Also documents non-problem areas like less-impactful wait events.

ADDM Results (Findings)

* Findings are categorized into three classes: problem, symptom, or

information.

* Findings are quantified by estimates of impact to 'db time'.

* When a problem has multiple causes, ADDM reports multiple

problem/symptom findings, all of which may share the same db time.

This means the impact of findings can add up to over 100% of the

time.

Setting it up

* It's enabled by default. Control it with STATISTICS_LEVEL

parameter.

* Note that DBIO_EXPECTED impacts analysis of I/O performance.

Running ADDM

* At command line: Use $ORACLE_HOME/rdbms/admin/addmrpt.sql. Give it

beginning and ending snapshot IDs, as well as output report name.

* Via APIs: We can use DBMS_ADVISOR package's APIs to create or

execute any advisor tasks (like an ADDM task).

Useful ADDM Views

* DBA_ADVISOR_TASKS: info about existing tasks.

* DBA_ADVISOR_LOG: status (including error messages and execution

times) for existing tasks.

* DBA_ADVISOR_RECOMMENDATIONS: results of completed diagnostic

tasks, with recommendations for problems identified. Note the

"rank" column which gives the magnatude of the problem for the

recommendation.

* DBA_ADVISOR_FINDINGS: all findings and symptoms founds, along with

sense of urgency speedy and reliable

2008-02-19T19:00:00.001-08:00

By JOHN REID BLACKWELL

TIMES-DISPATCH STAFF WRITER

From the moment the courier arrives at Bostwick Laboratories, around 6

a.m. most days, the clock is ticking.

Around the United States, and around the world, people are waiting on

a diagnosis -- do they have cancer or not?

The answer lies in the packages that are delivered to Bostwick's

laboratories and offices in the Innsbrook Corporate Center each

morning.

Thousands of tissue samples come to the medical laboratory company

every day -- many of them prostate biopsies sent by the company's

client physicians. Bostwick Laboratories' job is to analyze those

samples and provide a diagnosis.

In a first-floor laboratory in one of the company's two Innsbrook

buildings, a team of histotechnologists trained to prepare slices of

body tissue for examination by pathologists goes to work preparing the

tissue samples. The samples, so tiny they are barely visible, are put

through a highly technical, multistep process, including dyeing them

and placing them on slides, before going to the company's 25

pathologists -- medical doctors specializing in diagnosing diseases --

for examination.

The aim is to provide a diagnosis to the physicians, and thus to

patients, within 24 hours.

"From a patient's standpoint, you want to know as a soon as possible,"

said Leroy Mell, the company's chief laboratory officer. "You don't

want to be sitting around for a week or two waiting for results. The

patient comes first."

And when it comes to diagnosing cancer, speed can't mean sacrificing

precision. "Our goal is 100 percent accuracy," Mell said.

With those kind of demands, the company's operations are suffused with

what Dr. David Bostwick calls "a sense of urgency."

"That's a phrase we use a lot," said Bostwick, an internationally

acknowledged expert on prostate cancer who founded the company that

bears his name in 1999.

The same phrase could be used to describe the growth of Bostwick Labs.

In only eight years, it has expanded from just a handful of employees

to a company with 560 employees. In addition to its main offices and

laboratories in Henrico County, the company has opened labs and

offices in Florida, Arizona, New York and London.

"We receive specimens from as far as Russia, South Africa, Japan,

Thailand, and of course, the United States," Bostwick said.

Bostwick came to Richmond to work for a urology practice while he got

his business off the ground. The company has stayed here, he said,

because of the Richmond area's central location on the East Coast, its

low cost of doing business, and the skilled work force.

In March, the company announced a three-year expansion plan that

includes investing $4.6 million to expand its laboratories and

offices. The company also announced it was hiring about 600 people

(about 150 of whom it has hired this year). The expansion plan would

bring total employment to around 950.

"We're probably the biggest company in Richmond that you have never

heard of," said Gary S. Levine, the company's chief financial officer.

He is only half joking -- most people who get biopsies probably don't

think much about what happens to their samples, or who is involved in

the diagnosis.

While hospitals -- including the major hospitals that serve the

Richmond area -- have their own pathology departments, many physicians

at urology centers or other practices rely on outside laboratories for

diagnostics.

The laboratory-services industry is anywhere from a $45 billion to $60

billion business in the United States. Two big, publicly traded

companies, LabCorp. and Quest, dominate the industry, but there are

also about 3,500 smaller players around the country, Levine said.

"It's a highly fragmented industry," he said. "But there is a growth

boom. That's driven by two things. Number one, payers are willing to

pay more for diagnostics," Also, as baby boomers age, they need more

medical tests. "That is what has driven a lot of our growth," Levine

said.

Bostwick said the privately held company is on track to reach or

exceed $100 million in revenue this year. The company has focused on a

niche market within the laboratory services: anatomical pathology,

specifically urologic pathology. Most of its business still comes from

analyzing prostate biopsies, although the company is expanding into

other areas including kidney, gastrointestinal and gynecological

diagnostics. The company also has a division that works with major

pharmaceutical companies on clinical trials.

Unlike much larger labs, "we don't try to do all things for all

people," Bostwick said. "What we have tried to do is narrow our focus

into those areas where we have core competencies."

While hospital pathologists often analyze biopsies from about 24

organs in the body, "we focus mainly on urologic pathology," Bostwick

said. "With that focus, we are able to maintain a very high level of

productivity, accuracy and a quick turnaround time."

That emphasis on focused markets and efficiency enables the company to

generate higher profit margins. As a privately held company, it puts

its money back into its operations. Also driving its growth is the

company's introduction of new types of diagnostic tests that are

faster and more accurate than conventional methods.

The company's expansion around the United States and in other

countries also has come through an ambitious sales effort driven by

Jed D. Fulk, vice president for sales and marketing.

Fulk, a West Point graduate and former U.S. Army officer who joined

the company in 2003, is leading the company's charge into new regions

and new specialties. He keeps maps in his office marking the areas

where the company is introducing sales reps and finding new clients. A

self-described workaholic who is usually sending out his first e-mails

by 4 a.m., Fulk has a desk full of r�sum�s.

"I'm hiring sales reps," he said. "We have doubled the number of sales

reps to over 70 in the country, and by the end of September, we will

have over 100."

A lot of the company's growth, Fulk said, can be attributed to

physicians' admiration for the man at the top, David Bostwick. Some

local physicians confirm that.

"He is trading on his name, which is a well-respected name," said Dr.

Sam Graham, co-founder of Urology Specialists of Richmond, who has

used Bostwick Labs for diagnostics. "If you ask most urologists around

the country, 'Do you know who David Bostwick is?' They will say yes."

Before founding the company, Bostwick was a professor of pathology and

urology at the Mayo Clinic from 1991 to 1999. He has written 16 books

-- including the best-selling textbook on urologic pathology -- and

more than 400 papers.

Bostwick had the idea of starting a laboratory with a 24-hour

turnaround in 1985 when he was a doctor at University of Chicago

Hospitals. His colleagues there, however, thought the idea was

impractical. But Bostwick, who later moved on to the University of

Maryland, didn't let go of the idea.

While earning an MBA in the early 1990s, Bostwick wrote his thesis on

setting up a laboratory with same-day results reporting.

"We have had the technology for 25 years," but it was never utilized

that way, he said.

Graham and Dr. David Wilkinson, chairman of the pathology department

at Virginia Commonwealth University, said the company has thrived on

providing specialized lab services to physicians who often don't have

access to that kind of service in their own communities.

"I think the demand for highly specialized knowledge is growing, and

that is where Bostwick Labs has found its niche," Wilkinson said.

In the Richmond area, Wilkinson said, the biggest impact the company

is having is driving job demand for workers such as histotechnologists

and medical technicians. Those kinds of workers are already hard to

find.

"The good news is that should help the salaries of those people, who

are very highly trained, very skilled people and probably have been

underpaid in many ways," he said.

Although many patients may not recognize the name, Bostwick Labs has

earned recognition in the business community. In 2005, the company was

named by the Greater Richmond Chamber of Commerce as the

fastest-growing privately held business in the Richmond area.

"We grew 95 percent last year, and are on target to grow 100 percent

this year," Bostwick said.

"We expect to grow at doubleor triple-digit rates in the near future."

With that kind of growth, the company is sure to attract investor

interest. Executives say the company is considering a public stock

offering.

Growing players in the industry also tend to attract buyout offers.

While acquisitions might be on the table, Bostwick said a buyout is

not.

"I have told the employees we are not for sale," he said. Contact John

three dimensional miniature endoscope

2008-02-19T18:54:00.001-08:00

Three-dimensional, miniature endoscope opens new diagnostic possibilities

BOSTON - October 18, 2006 - Massachusetts General Hospital (MGH)

researchers have developed a new type of miniature endoscope that

produces three-dimensional, high-definition images, which may greatly

expand the application of minimally invasive diagnostic and

therapeutic procedures. In the October 19 issue of Nature, the team

from the Wellman Center for Photomedicine at MGH describes their

prototype device and a demonstration of its use in a mouse model.

"This new ultraminiature endoscope is the first to allow

three-dimensional imaging of areas inside the body, " says Guillermo

Tearney, MD, PhD, of the MGH Wellman Center, the report's senior

author. "Its ability to go places that other imaging tools cannot

reach opens new possibilities for medical diagnosis and eventually

treatment."

Standard miniature endoscopic devices - which give physicians access

to hard-to-reach internal organs and structures - utilize bundles of

optical fibers to supply light to and transmit images from the areas

of interest. Larger endoscopes that use image sensors to produce

high-quality, two-dimensional images can be a centimeter or more in

diameter. Existing miniature endoscopes using smaller fiber bundles

may be more flexible but have difficulty producing high-quality

images.

The new device developed at MGH-Wellman uses a technology called

spectrally encoded endoscopy (SEE). Multicolored light from a single

optical fiber - introduced through a probe about the size of a human

hair - is broken into its component colors and projected onto tissue,

with each color illuminating a different part of the tissue surface.

The light reflected back is recorded, and the intensity of the various

colors decoded by a spectrometer, which analyzes the wavelengths of

light. Another device called an interferometer, which calculates

structural information based on the interaction between two waves of

light, provides the data required to create three-dimensional images.

whether to laugh or cry

2008-02-19T18:34:00.001-08:00

new ct scanner replaces angiography

2008-02-19T18:24:00.001-08:00

2006_11_01_archive

2008-02-19T18:14:00.001-08:00

The Secret to Investing Success

I came across this passage in an article by business strategist Nikos

Mourkogiannis and had to laugh.

"Warren Buffett wanted to be an excellent investor - which meant being

a rational investor. He knew that the best way to achieve this was by

staying as far away as possible from Wall Street."

fraud in mddc arena

2008-02-19T17:59:00.001-08:00

Fraud in the MD/DC Arena

Dynamic Chiropractic

Feb 26, 2004

Fraud in the MD/DC Arena

by Jaffe, Richard

In the past five years, there have been numerous criminal prosecutions

of MD/DC clinics. Most of those indicted or investigated have pled

guilty, in part because the possible jail sentences are substantial -

upwards of 10 years. Chiropractic clinic owners have usually received

sentences in the three-to-five-year range, although a few have

received lesser or greater sentences, depending on how much money was

involved in the fraud.

Associate chiropractors who have pled out have received anywhere from

probation to two years. And every once in a while, an investigation

results in no criminal charges being filed. There is every reason to

believe that these investigations will continue, in part, perhaps,

because as recently as 2003, the Office of the Inspector General (OIG)

listed chiropractic among its top 10 areas of investigation.

Does this mean the MD/DC model is fraudulent? Of course not. However,

many MD/DC clinics are abusing the model and defrauding insurance

companies. The scary part is that sometimes the clinic owners don't

even know they are operating illegally. In fact, some may be certain

they are operating legally, because a chiropractic consultant has set

up the clinic, provides ongoing consulting services, and has cleared

the fundamentals of the operation through his or her "legal

department."

As part of a major criminal trial last year, I had an opportunity to

review the materials of many MD/DC clinics and consultants. My basic

conclusion is that there is not much difference between what is being

offered. These systems are not necessarily fraudulent. However, the

systems are extremely complicated, and are based on some questionable

heath care distinctions. The business realities of a busy health care

practice often force these clinics to cut corners to save money and

increase revenues, any and all of which can result in fraud-related

problems. Here are a few areas of concern, and some specific examples.

The MD/DC Structure

In virtually every state, a chiropractor is either completely

prohibited or limited to a minority ownership interest in a

professional corporation/medical clinic. This ownership restriction

has been circumvented by creating two or more corporate entities: a

professional medical corporation owned by the MD, and a management

corporation owned by the DC. The MD is paid a salary, even though he

or she is the sole owner of the professional corporation, and most of

the medical corporation's income is withdrawn by the management

corporation as various types of fees.

To protect the DC from an MD who may want to take the clinic's

business, some consultants and attorneys have recommended that there

be two medical doctors. One MD is the clinic "owner," but does not

actually work in the clinic. In fact, under some plans, the "owner"

never sets foot in the clinic, and may not even meet the chiropractor.

The other doctor is the working MD - the one who works at the clinic

and does whatever the MD is supposed to do at the clinic.

Several years ago, a large insurance company filed civil fraud actions

against several MD/DC clinics in New Jersey. One of the main

allegations was that the MD "owner" lived in another state, had no

contact with the clinic and was the "owner" of approximately 50 other

clinics. The complaint argued that the MD was just renting her name

for a small fee. Is any of this illegal in itself? Probably not.

However, when these cases come to trial, the jury will probably look

none too favorably on this rather obvious attempt to circumvent the

restrictions prohibiting chiropractors from owning medical

professional corporations. So, if this is what you are doing, it might

be time to change.

Diagnostic Testing

What generates the most scrutiny among insurance companies and

government regulators is the testing performed at some MD/DC clinics,

and in particular, the various electrodiagnostic devices used by these

clinics. In most cases, the diagnostic equipment is sold to the

clinics by chiropractic consultants. Is that illegal? Absolutely not!1

Nonetheless, clinics often buy expensive equipment on the advice of

consultants, who claim the clinic can make tons of money from the use

of such equipment. That's because reimbursement for diagnostic testing

far exceeds the fees for chiropractic manipulation, and even for

therapies and modalities a patient would normally receive during a

visit.

However, the high reimbursement rates for diagnostic testing have led

to considerable abuse in the field, in the form of medically

unnecessary testing. Historically, this was only a problem between

practitioners and insurance companies. However, under the federal

HIPAA laws, providing medically unnecessary testing to a patient

insured by any health insurance company is a federal crime. Most

federal prosecution involving MD/DC clinics have involved allegations

about medically unnecessary testing.

In this space, it's impossible to provide an extensive discussion of

what constitutes "unnecessary testing," but here are some basic

points. First, it is probably always medically unnecessary to give a

test after a prior test has come back negative, unless there has been

significant worsening of the condition and the patient is now a

potential candidate for a condition that the test will identify.

second, many clinics have different testing regimes for insurance

patients and cash patients. Cash patients do not get testing other

than X-rays. Is that illegal? Probably not in and of itself, but it is

certainly going to be viewed as suspicious if only insurance patients

get these expensive tests for normal chiropractic injuries and

conditions.

To refine the point, are all insurance patients getting the test? Many

of these electrodiagnostic testing and imaging devices have their

place - in certain cases. However, a reasonable question can be asked

as to whether all patients who present with some kind of back pain

require diagnostic testing, especially when the etiologies of their

conditions are known and well-understood; for example, a pulled muscle

resulting from an identifiable cause or event. I know there are

chiropractors, and especially chiropractic consultants who sell

equipment, who say using this expensive testing will rule out certain

neurological problems. However, if there are no initial indications of

neuropathy, radiating pain, or some other indication that a patient

has anything more then a pulled muscle, I think clinic owners should

think hard about having a protocol that includes a variety and series

of expensive testing for a patient who presents with these relatively

straightforward symptoms.

Billing Under the Physician's Provider Number

It seems obvious, but it's not often publicly acknowledged that the

primary reason for a chiropractor to own or be involved in an MD/DC

clinic is that insurance reimbursement is better for medical doctors

than chiropractors. Insurance companies often limit chiropractic care

and usually prohibit reimbursement for diagnostic testing other than

X-rays, if such tests are ordered by a chiropractor. There are few

such limitations on spinal care or testing when ordered by medical

doctors. It is not surprising, therefore, that most chiropractic

consultants teach that all services provided by ancillary health

personnel in an MD/DC clinic be billed under the medical doctor's name

and provider number, in order to obtain maximum reimbursement.2 Is

this illegal? The answer to this question is quite complicated. The

short version is that it's not necessarily illegal, but in the real

world, most of the clinics are on the wrong side of the legality line.

Here are the basics: In general, medical services rendered by others

can be billed under a physician's name under what Medicare calls the

"incident to rule." Under this rule, services by others which are

integral though an incidental part of the physician's service in the

course of the diagnosis or treatment of a patient, can be billed by

the physician so long as they are commonly furnished or included in

the physician bill; are of the type that are usually furnished in the

physician's office or clinic; and are medically appropriate.

However, the most important requirement is that the physician have

direct supervision of the patient, which means the physician must be

in the office or clinic when the services are provided. There are no

exceptions to this requirement. If the physician is not in the

office/clinic when the services are provided, the service cannot be

billed under the physician's name. To do so constitutes federal health

care fraud, period.

Here's where it gets complicated. As stated, this is the Medicare

rule. It absolutely applies to Medicare and other federal pay

programs. But does it apply to private third-party pay plans? Maybe,

sometimes, with some carriers, in some cases. Some carriers use the

Medicare rule, others use variations of the rule, and still other

payers have no written policy on the subject, but some of these jokers

still try to enforce so called "unwritten policies and practices." The

practical problem is that it is virtually impossible to know the

"incident to" rules for all of a clinic's patients.

However, since the Medicare rule is by far the most restrictive, if

the clinic is properly billing under the Medicare rule, and

specifically, is in compliance with the direct supervision definition,

then it should be proper under any third-party payer "incident to"

rule. Does that mean it is absolutely fraudulent to bill a third-party

payer without compliance with the direct supervision rule? No, but I

would suggest this is a de facto safe harbor.

Unfortunately, it is virtually impossible for most MD/DC clinics to be

in compliance with the Medicare rule, for the simple reason that for

cost-savings reasons, most MD/DC clinics have part-time physicians.

Thus, whenever the part-time doctor is not present in the clinic, a

payer could take the position that bills for services submitted under

the physician's name is fraudulent under federal law. The ugly reality

is that billing services of ancillary health care personnel under a

part-time physician's provider number is, at best, a crapshoot in

today's environment.

Does this all these problems are resolved by hiring a full-time

doctor? Well, it certainly solves the problem of direct supervision.

However, other problems are likely just starting to surface. But more

on that another time.

References

1. At least one state (California) has taken the position that it is

unethical for a chiropractic consultant to sell equipment to clients.

However, such statements have no real legal force, since chiropractic

consulting is not regulated by any state or federal agency.

2. In the past year or two, as a result of some high-profile cases,

some consultants have backed off and started advising their clients to

bill chiropractic care under the chiropractor's provider number.

Richard Jaffe, Esq.

Houston, Texas

www.richardjaffe.com

Provided by ProQuest Information and Learning Company. All rights

Reserved

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tourette syndrome plus

2008-02-19T17:54:00.001-08:00

Tourette Syndrome Plus

Tourette Syndrome "Plus"

The Pros and Cons of the Terminology

"Splitters" versus "Lumpers"

The term "Tourette Syndrome Plus," or TS+, was coined by Leslie

Packer, PhD, to remind people to sort out symptoms that may be coming

from conditions other than Tourette's. The "plus" refers to comorbid

conditions, beyond the diagnostic criterion for Tourette's, which an

individual may have. For example, one might have TS plus AD/HD or TS

plus bipolar or TS plus learning disabilities. The idea was to remind

people of the importance of "splitting" rather than "lumping" of

diagnoses, in order to more appropriately target treatment towards

problematic symptoms. For example, if a child has anxiety in addition

to tics, the anxiety may warrant treatment priority. If a child has

attention-deficit, hyperactivity disorder along with tics, treating

the AD/HD most often takes priority over treating the tics. If a child

has angry, explosive outbursts and inflexible behaviors (colloquially

referred to as "rage," although there is no such diagnostic entity or

medical term), then the comorbid conditions beyond Tourette's, which

are leading to those behaviors, should be identified and treated

("rage" has been found not to be associated with Tourette's, yet we

still hear the term "Tourette's rage").

Tourette Syndrome "Plus"

"When I first began talking to people about TS, I realized that

when some people would say `That's a symptom of my son's TS,' they

weren't talking about tics but about features or symptoms of

disorders such as Attention Deficit Hyperactivity Disorder or

obsessive-compulsive symptoms. So to decrease confusion in our

communication, in 1991, I introduced the term `TS+' to refer to

individuals who have TS plus features of one or more other

disorders such as Attention Deficit Hyperactivity Disorder (ADHD),

Obsessive-Compulsive Disorder (OCD), anxiety, self-injurious

behaviors, anger or rage outbursts, or depression, to name but some

of the conditions that may be associated with or frequently

comorbid with TS. The goal was to help people remember that not

everything may be a tic of TS, and that the child may have other

conditions that may be responsible for any impairment they are

experiencing.

`TS+' is not a technical or diagnostic term, but rather a

convenient way to remind ourselves that there is (sic) often other

things affecting a child who has been diagnosed with TS. This is

particularly evident when we examine school functioning. In the

vast majority of cases I've dealt with over the years, it is seldom

the tics that are the child's or teen's biggest problem.

Unfortunately, and despite my best efforts to remind people not to

attribute everything to TS when it may be due to something else,

all too many people continue to describe people with TS as having a

variety of problems that may not be due to TS at all, but rather to

some other condition. For example, one publication from the

National Tourette Syndrome Association suggested that TS was linked

with Central Auditory Processing Disorder (CAPD), and yet there is

not one study that shows any direct association between TS and

CAPD. Such imprecise writing does not further our understanding of

TS. It is one thing to say that children with TS and Attention

Deficit Hyperactivity Disorder may be more likely to have CAPD, but

it is quite another thing to say that children with TS are more

likely to have CAPD."

So, in spite of Dr. Packer's best intent when coining the term, and

her efforts to clarify the correct usage of the term she coined, the

horse is out of the barn, and is not going to be corralled. A tour of

internet websites and message boards shows that the term is still most

often used incorrectly, by people who believe that the symptoms of

their comorbid conditions can be rolled in under the Tourette's

umbrella. Many laypersons and professionals alike have come to use the

term to broadly refer to Tourette's symptoms in general, and confusion

of diagnostic boundaries results. When conditions comorbid with tics

aren't correctly identified, the risk is that the appropriate and most

effective treatment can't be targeted. For example, if a child has

tics plus bipolar disorder, you can't treat the bipolar correctly by

thinking the manic behaviors are coming from Tourette's and trying to

treat the tics. Bipolar responds to mood stabilizers, rather than the

typical medications which treat tics.

Although the term TS+ does make it more convenient for those who need

to describe a child who has diagnoses beyond tics, in my opinion, the

current mis-usage of the term by most people who employ it does more

harm than good, and the term should be eliminated from Tourette's

terminology. Here is a summary of some of the issues:

1. "TS-only" versus "TS-plus:" but ... Tourette's is TS-only. The

diagnostic criterion for Tourette's define a tic disorder, which may

occur along a spectrum from mild to severe. It doesn't define a tic

disorder plus AD/HD or a tic disorder plus bipolar or whatever. The

widespread usage of the term "TS-plus" had led to the need for another

term, "TS-only," to counteract the common usage of the term "TS-plus."

And it goes beyond that: one finds all kinds of awkward terminology

used to desribed diagnostic Tourette's syndrome, such as, pure TS,

plain TS, and so on. This may lead some to forget that the people who

have "TS-only" are the people who have ... well ... Tourette's

according to DSM criterion. There should be no need for additional

names to describe those who do have the basic condition as defined in

the DSM. They should not be the "exception" that needs clarification,

because another term has necessitated that clarification. The true

nature of Tourette's is obscured when one thinks of "TS-only" as the

exception, and fails to dig deeper and realize that most cases of

Tourette's (i.e.; TS-only) probably go under-detected and

misdiagnosed, while ascertainment and referral bias brings clinical

attention to more cases of Tourette's plus comorbidities (TS-plus).

People who don't have comorbid conditions along with their tics are

less likely to come to diagnostic attention, and less likely to come

to tertiary, clinical attention where they will end up in a published

study.

Tourette Syndrome: Minimizing Confusion

Persons with TS+ are more likely than TS-Only to have problematic

behaviours. ... Co-occurring or "comorbid" problems or disorders

often determine the impact of the TS, as well as whether medical

treatment is needed. One should be very careful to not attribute

everything to the TS diagnosis; if you do, you may overlook

important possibilities."

And, also from Roger Freeman, MD

An international perspective on Tourette syndrome: selected

findings from 3,500 individuals in 22 countries. Freeman RD, Fast

DK, Burd L, Kerbeshian J, Robertson MM, Sandor P. Dev Med Child

Neurol. 2000 Jul;42(7):436-47. "The small proportion of individuals

with TS only reflects a clinical and epidemiological dilemma: most

individuals with TS seen and followed in clinics are comorbid and

therefore contribute to the idea that TS is necessarily associated

with other disorders and behavioral problems ... However, the

prevalence of behavioral problems in the TS only group may not

differ from the general population."

2. One can find endless examples of persons who erroneously employ the

term "TS plus," to the point that generates confusion about what

Tourette's is, and may lead to inappropriate treatment. This can lead

people with perhaps undiagnosed comorbid conditions to truly believe

that their symptoms are typical of or common to people with

Tourette's, while missing other diagnoses which would benefit from

accurate identification and treatment. One finds this very frequently

with respect to bipolar disorder, learning disabilities, "rage," and

AD/HD. It also increases the myth, misinformation, and stigmatization

attached unnecessarily to a diagnosis of Tourette's.

3. "Lumping" comorbid conditions under the "TS-plus" umbrella is

misleading. Since the tics rarely are the first treatment priority,

and comorbid conditions are most frequently what leads to academic,

social or behavioral difficulties, why are we calling attention to the

Tourette's as the source of the problems, by employing the label

"TS-plus?" If we need to use shorthand, why aren't we saying "AD/HD+"

for a child with AD/HD plus tics, or "bipolar plus" for a child with

bipolar plus tics? That would make it clearer what symptoms should be

targeted for treatment.

4. The Tourette Syndrome Study Group seems to agree on the importance

of the benefits of reductionism, and "calling a diagnostic spade a

spade."

Challenging Phenomenology in Tourette Syndrome and

Obsessive-Compulsive Disorder:

The Benefits of Reductionism

"In the clinical setting, a reductionistic approach makes most

sense. Describe the action as accurately as possible, calling

complex behaviours "intentional repetitive behaviours" (12) if they

are not definite pure forms. Describe all epiphenomena including

sensory phenomena, cognitions, affective state, changes with the

completion of the action, how endpoint is judged, senselessness and

so on. Treatment, therefore, focuses on the most disabling

symptoms, with the aim to improve overall quality of life rather

than to eliminate all symptoms. Medication choice is based on

knowledge of how parsed phenomena best respond to specific current

therapies. For the purpose of diagnosis, certain labels may be

applied ("OCD" or "Tourette"), but the therapeutic path will more

closely relate to the pattern of phenomena than will the broad

labels which, by nature, will lose resolution when it comes to

understanding the individual's unique situation.

Faced with related phenomenology dilemmas, the TS Classification

Study Group (13) used a reductionistic approach when it said of its

numerous tic syndromes, "Although some of these separate entities

may ultimately be shown to be caused by the same etiology (or even

the same gene), until that is established it is considered best to

divide the condition into distinct entities." "(This

classification) can both expand and consolidate, as (etiological

factors) are identified (13)." One promise of reductionism is that

accurate description of the variations of phenotype will lead to

the best chance of correlating such variation with neurobiological

underpinnings, as the latter become elucidated. We may find that

phonic tics are simply motor tics of noise-making musculature;

however, we may find that they are somehow neurobiologically

distinct from other tics. We do not yet know, and until we do, we

should continue to subdivide them. An approach such as this one has

already led to the description of two likely biologically distinct

types of OCD (10)."

---

Tourette Syndrome - Now What?

TSNW - TSNowWhat - TouretteNowWhat - Tourette Syndrome Now What?

are the names I post under, but you should be aware that other

webmasters have used my name in an attempt to drive traffic to their

own sites ... I guess imitation is the sincerest form of flattery !!

posted by TSNowWhat at 7:06 PM

0 Comments:

Post a Comment

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new in adsense site crawler

2008-02-19T17:34:00.001-08:00

New in AdSense: Site Crawler Diagnostics

There's a new tab in AdSense: Site Diagnostics. The page includes

information about Google crawler's errors when accessing a page to

determine its content. Using the site diagnostic section, you can see

the errors encountered by Google, when they happened, and what you can

do to troubleshoot them in order to allow Google's bot crawl the

specific pages. Some of the problems are: robots.txt files that forbid

access to web spiders, servers down, HTML errors.

Google Sitemaps show Google's penalties for your site

Hacking Google

GoogleBot can destroy sites

New in AdSense: Site Crawler Diagnostics by Ionut Alex Chitu

0 comments ( Post your comment )

What do you think?

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check engine light

2008-02-19T17:24:00.001-08:00

Check Engine Light

When a car's check engine light comes on, it is a mystery to most

drivers. It instills panic in many for good reason. There are times

when that light can mean drastic problems in a car's engine system or

other operating parts. There are also times when it simply means you

changed your brand of gasoline and the car needs to adjust to the new

mix. For that reason there is a tendency to ignore that little light

and hope the problem will go away.

Should You Worry About Your Check Engine Light?

How do you know if the check engine light is trying to tell you there

is a serious problem or if it is nothing to worry about? One way is to

take the time out of your busy schedule, drive to the mechanic and pay

a hefty fee to have them hook up their machine to your car's OBDII

system and then tell you to tighten your gas cap as a result. Or you

can get your own OBD diagnostic tool that will give you all the

information you need right at your fingertips.

Onboard Diagnostic System

These simple devices attach to your automobile's OBDII (onboard

diagnostic system) right under the dash just like the big machine at

the mechanic shop does and it will give you the exact same readouts

plus provide easy to understand graphs and explanations of those

confusing codes your mechanic gives you to keep you in the dark as to

what is really going on.

Simply take the OBD diagnostic system for a short ride with you when

your check engine light comes on and then take it in the house to your

personal computer and download the data. The website provided to you

with your OBD diagnostic system will decipher the information and give

you all the information you need to determine if the problem is

serious or not at fractions of the cost of a mechanic's garage. The

readout will also give you simple solutions to the easier fixes if

they are available plus if you do need to take the car to your

mechanic, you can go in well-armed with the knowledge you need to keep

from being overcharged for their services.

The OBD system will also alert you to potentially damaging driving

habits you may have acquired over time even when your check engine

light is not blinking. Things like hard braking and excessive

acceleration so that you can correct problems before they affect your

car's mechanisms.

Benefits of OBD

There are even more benefits to your own OBD diagnostic system. Never

get stuck with a lemon again by taking it on all of your test drives.

With your own diagnostic system, you will be able to find out for

yourself if your potential new or used car is in good operating order

before you drive off the lot. You can even find out why the check

engine light is on. You can also take all the worry out of vacations

when you hook it up before a road trip.

Andre Zayas is a professionally syndicated author.

2005_12_11_archive

2008-02-19T16:54:00.001-08:00

Autism Epidemic Revisited

I am ambivalent about writing an autism post, since there has been so

much blogbuzz on the topic. Much of the controversy has to do with

two things: the notion that the incidence of autism is increasing, and

the notion that mercury in vaccines has contributed to the increased

incidence of the disorder. The mercury issue has been pretty well

hashed out by Orac, Paul, Skeptico, Autism Diva, and others...too

numerous to count. The "autism epidemic," likewise, had led to an

epidemic of writing -- most of it bad. A Google search on "autism

epidemic" (with the quotes) turns up over 66,000 hits.

And now I've come across another one. It isn't new. It was published

in July 2005 on Medscape. (Medscape articles require registration,

which is free. It is a bit of a nuisance, but Medscape is a pretty

good resource, so it is worth the trouble.) I mention this article

because it may be one of the better articles on the question of

whether the incidence of autism is increasing. Furthermore, it

illustrates some good general points about one of my favorite topics:

skepticism.

Publication Logo Autism "Epidemic?" A Newsmaker Interview With

Morton Ann Gernsbacher, PhD, And Craig J. Newschaffer, PhD

Laurie Barclay, MD

July 15, 2005

-- Editor's Note: Despite heightened media attention on the autism

"epidemic," a report published in the July issue of Current

Directions in Psychological Science offers three arguments against

a true increase in autism prevalence. These include changes in

diagnostic criteria for autism, with current criteria being more

inclusive than when the diagnosis was first defined in the 1940s;

methodological flaws in an unpublished California study widely

cited as showing dramatically increased prevalence; and problems in

using the U.S. Department of Education's annual "child count" data.

To find out more about this issue and its clinical implications,

Medscape's Laurie Barclay interviewed lead author Morton Ann

Gernsbacher, PhD, a Vilas Research Professor, the Sir Frederic

Bartlett Professor at the University of Wisconsin-Madison, and

President-Elect of the American Psychological Society.

For an alternate viewpoint, Dr. Barclay also interviewed Craig J.

Newschaffer, PhD, an associate professor of epidemiology at the

Center for Autism and Developmental Disabilities, Johns Hopkins

Bloomberg School of Public Health in Baltimore, Maryland. Dr.

Newschaffer is lead author of a study using cohort curves to

suggest that autism prevalence has been increasing with time, as

reported in the March issue of Pediatrics. [...]

The article provides a nice balance of viewpoints, all from persons

with decent qualifications. Reading it is a good exercise in critical

thinking. Reading it correctly requires good analytical skills. To

illustrate:

Medscape: What are the significant changes in diagnostic criteria

for autism between 1980 and 1994?

Dr. Gernsbacher: Whereas the 1980 DSM-III entry required satisfying

six mandatory criteria, the more recent 1994 DSM-IV offers 16

optional criteria, only half of which need to be met. Moreover, the

severe phrasing of the 1980 mandatory criteria contrasts with the

more inclusive phrasing of the 1994 optional criteria. For

instance, to qualify for a diagnosis according to the 1980

criteria, an individual needed to exhibit ''a pervasive lack of

responsiveness to other people." In contrast, according to 1994

criteria, an individual must demonstrate only ''a lack of

spontaneous seeking to share.... achievements with other people''

and peer relationships less sophisticated than would be predicted

by the individual's developmental level. The 1980 mandatory

criteria of ''gross deficits in language development'' and ''if

speech is present, peculiar speech patterns such as immediate and

delayed echolalia, metaphorical language, pronominal reversal''

were replaced by the 1994 options of difficulty ''sustain[ing] a

conversation'' or ''lack of varied ...social imitative play."

''Bizarre responses to various aspects of the environment'' became

''persistent preoccupation with parts of objects."

Furthermore, whereas the earlier 1980 (DSM-III) entry comprised

only two diagnostic categories (infantile autism and childhood

onset pervasive developmental disorder), the more recent 1994

(DSM-IV) entry comprises five. [...]

You will see a lot of people debating this point, without really

knowing the details. Some people will say that the increase in

reported rates of autism "couldn't" be explained by changes in

diagnostic methodology or criteria. But it is clear -- once you

understand all the verbiage, that is -- that the changes in diagnostic

criteria were substantial. Not only that, but the diagnostic

categories were broadened, such that milder cases now qualify for a

diagnosis. These are really important points. The point I am making

here is this: you have to know the details, if you are going to make

an informed comment on the subject. This is not one of those areas

where an intuitive guess about the numbers will have any validity; you

can't say the numbers are just too big to be explained by one factor,

and expect anyone to find that persuasive.

Another point is illustrated by the article, one that has nothing to

do with autism. Specifically, skepticism is not merely oppositional

thinking; a good skeptic is comfortable saying "I don't know," when

the evidence is not sufficient to draw a firm conclusion. Similarly,

a good skeptic is comfortable making a tentative decision. Of course,

when one makes a tentative decision, is is necessary to remember that

the decision is not based on solid evidence. Then, one can avoid the

error of establishing complex, important decision trees that do not

have solid roots.

Medscape: Why should we be cautious about this label ["epidemic"],

given changes in diagnostic criteria and in heightened awareness

and recognition of this condition?

Dr. Newschaffer: [...] I believe that there currently is little

strong evidence supporting either hypothesis (real risk versus

diagnostic bias) and that proponents of one versus another

hypothesis seem to hold their view based mainly on the basis of

beliefs that are fallacious - either that the increase has been so

large [that] some of it has to be real, or that the heritable

component of autism is so large [that] the increase over time must

be due to diagnostic changes.

Notice the phrase: "little strong evidence supporting either

hypothesis." In other words, she just plain does not know, and will

not say, which hypothesis is correct. If the evidence is not there,

it is not there. Deal with it. Just don't try to browbeat others

into believing something that is not supported by sufficient evidence,

laparoscopic appendicectomy diagnostic

2008-02-19T16:34:00.001-08:00

Laparoscopic Appendicectomy

Diagnostic laparoscopy followed by laparoscopic appendicectomy in a

2005_01_01_archive

2008-02-19T16:24:00.001-08:00

The Indian courts and their hypocrisies

Recently, while travelling with my grandpa he told me of how a

construction company which was started by a very popular actress was

pulled up by the municipal authorities in Chennai. They wanted to

demolish the illegal addition to the building made by the company

without prior approval from the municipal authorities. The builders as

usual went to the court and was granted a stay.

You may ask what's new or unusual about that. Well, I am not going to

discuss the merits or demerits of granting the stay. My intention is

not at all that. What befuddles me is that when there is proof that

the builder had built an addition to the original structure without

getting prior approval from the authorities as laid down by law. I

agree that it would not have been correct for the court to have

allowed the municipal authorities to go ahead with the demolition as

it would have affected a number of people who had invested their hard

earned money in buying the flats ( no one had occupied in that

extended portion of the building )

What I think would have been prudent is that the court should have

arrested the builder for violation of the law or atleast punished in

monetary terms .. neither of which happened. The people who had

invested their money have now approached the same court with an

request to get their money back from the builder, which I beleive is

the right thing to do. The courts should have ordered the builder to

either pay back the money to the flat owners or shut down their

business. I think this threat should have been more than enough for

the builder to cough up the money.

I am not blaming the actress. She had no role to play in the day to

day administration or the design of the building. It seems she also

came to know about this via the media which has been covering this

with earnest due to the glamour as well the sympathy factor.

This is not just one example. I will give you another example.

We all remember the Kareena-Shahid Scandal ( you can call it that - as

it was on tv all day long ). The Supreme court took notice of that and

said that the coverage by the media was in bad taste. I felt that was

another case where the court had no right to tell the media that the

"moment" was in the private domain. My question to the Supreme court

is, Rain is a public place where many people come and go. The star

couple obviously knew where they were and they knew what they were

doing. We all saw them do what they claim they did not do and Kareena

came up with the most hypocritical answer, " I am a girl from a very

respectable family, I would never do such a thing in public." as if

she is the sati savitri of Bollywood. She has smooched on screen, how

does doing it in front of camera seen by millions is respectable,

whereas a moment with your loved one in which you actually kiss that

person with affection and love be not respectable?

The Supreme court claims it was a private moment. How can the moment

be private when it is in a public place. The star couple are adults

and they should have been aware of the consequences of their actions (

not just the pleasurable consequences ) If the Supreme court thinks

that when a couple is making out in a public place is a private

moment, why are not the by-standers in Bandstand who stand near rocks

to watch couples make out and stuff be arrested? A case of

misinterpretation of the law might we say?

who provider initiated hiv testing and

2008-02-19T15:59:00.001-08:00

EXECUTIVE SUMMARY

1. BACKGROUND

Limited knowledge of HIV status in many countries means that large

numbers of people fail to receive HIV treatment, care and support in a

timely manner, and do not take steps to prevent transmission to others

because they do not know they are infected. Efforts are needed to

expand voluntary counselling and testing (VCT) services and to provide

HIV testing in a more diverse range of settings than is currently the

case. Because health facilities represent a key point of contact with

people who are potentially infected with HIV, provider-initiated

testing and counselling in health facilities should be seen as one of

several potential components in an overall strategy to increase uptake

of HIV testing and counselling and knowledge of HIV status.

This document responds to growing demand at country level for basic

operational guidance on provider-initiated testing and counselling in

health facilities. It is based on an assessment of available evidence

and is intended for a wide audience including policy-makers, HIV/AIDS

programme planners and coordinators, health-care providers,

non-governmental organizations providing HIV/AIDS services and civil

society groups.

The document recommends an "opt-out" approach to provider-initiated

HIV testing and counselling in heath facilities, including simplified

pre-test information, consistent with WHO policy options developed in

2003 and with the 2004 joint UNAIDS/WHO policy statement on HIV

testing and counselling. With this approach, an HIV test is

recommended as a standard part of medical care for all patients

attending health facilities in generalized HIV epidemics, and in

certain settings in concentrated and low-level epidemics. Individuals

must specifically decline the HIV test if they do not want it to be

performed.

The process of adapting this guidance at country level will require an

assessment of the local epidemiology as well as the risks and benefits

of provider-initiated testing and counselling, including an appraisal

of available resources, prevailing standards of HIV prevention,

treatment, care and support, and the adequacy of social and legal

protections available to those living with, or at risk of exposure to,

HIV. Implementation of provider-initiated testing and counselling

should be undertaken in consultation with key stakeholders. Phased

implementation in priority settings and careful monitoring will enable

the best use to be made of available resources and help to avoid

negative outcomes, including stigma and discrimination, violence and

unmet demand for treatment and other services.

Provider-initiated testing and counselling in health facilities should

always aim to do what is in the best interests of the patient. This

requires giving individuals sufficient information to make an informed

and voluntary decision to be tested, including an opportunity to

decline the test. Post-test counselling and referrals to

appropriate services are essential for all patients regardless of the

test result, and patient confidentiality must always be maintained.

2. RECOMMENDATIONS

Guidance in the document is categorized according to HIV epidemic type

and refers to two types of provider-initiated testing and counselling:

diagnostic HIV testing and HIV screening. Provider-initiated testing

and counselling is voluntary and the "Three C's" - informed consent,

counselling and confidentiality - must be observed for both these

forms of provider-initiated testing and counselling.

o Diagnostic HIV testing in all epidemic types

Diagnostic HIV testing should be part of the normal standard of care

anywhere, recommended for adults, adolescents or children who present

to clinical settings with signs and symptoms or medical conditions

that could indicate HIV infection, including tuberculosis (TB).

Diagnostic HIV testing for children born to women who have

participated in programmes for the prevention of mother-to-child

transmission (PMTCT) and who were found to be HIV-positive is

considered a routine component of the follow-up care for these

children. Diagnostic HIV testing is also recommended for children with

suboptimal growth and malnutrition in generalized epidemics, and may

be considered for children under certain circumstances in other

settings.

Surgical patients may require diagnostic HIV testing for diagnosis and

management of conditions potentially associated with HIV. However, HIV

testing of surgical patients is not justified simply for knowledge of

HIV status by service providers, and HIV test results must not be used

to deny surgery or clinical services that are otherwise indicated.

o HIV screening in generalized epidemics

WHO and UNAIDS recommend HIV screening for all adults and adolescents

seen in all health facilities in generalized epidemics, regardless of

the individual's reason for presenting to the facility. This

recommendation applies to medical and surgical services, public and

private facilities, and inpatient and outpatient settings.

Resource and capacity constraints will likely require prioritization

of sites for implementation of HIV screening, guided by an assessment

of the local epidemiological and social context. The following health

facilities may be considered for the implementation of HIV screening

(in order of priority):

o Antenatal, childbirth and postpartum health services

o Sexually-transmitted infection (STI) services

o Health services for most-at-risk populations

o Other medical inpatient and outpatient facilities

o Services for children under 10 years of age

o Surgical services

o Reproductive health services, including family planning

o Services for adolescents.

o Options for provider-initiated testing and counselling in

concentrated and low-level HIV epidemics

HIV screening is not recommended for all persons attending all health

facilities in settings with concentrated and low-level epidemics,

since most people will have low risk for exposure to HIV.

In settings with low-level and concentrated epidemics, the first

priority should be to ensure that diagnostic HIV testing is

appropriately and correctly performed for adults, adolescents and

children who present to health facilities with signs and symptoms

suggestive of underlying HIV infection, including underlying

tuberculosis. When data have shown that HIV prevalence in patients

with tuberculosis is very low, diagnostic HIV testing of all such

patients may not remain a priority.

Decisions about whether to implement HIV screening in certain settings

in low-level and concentrated epidemics should be guided by an

assessment of the epidemiological and social context. Consideration

may be given to the implementation of HIV screening in the following

health facilities or services:

o STI services

o Health services for most-at-risk populations

o Antenatal, childbirth and postpartum services.

3. ENABLING ENVIRONMENT

Although access to antiretroviral therapy should not be an absolute

prerequisite for the implementation of provider-initiated testing and

counselling, provider-initiated testing and counselling should be

accompanied by a minimum set of HIV-related prevention, treatment,

care and support services and implemented within the framework of a

national plan to achieve universal access to antiretroviral therapy

for all who need it.

At the same time as provider-initiated testing is implemented, efforts

must be made to put in place a supportive policy and legal framework

to maximize positive outcomes and minimize potential risks to the

patient. This includes an ethical process for obtaining informed

consent, measures to maintain confidentiality and protect privacy and

measures to prevent stigma and discrimination in health care settings.

National plans to achieve universal access to HIV prevention,

treatment, care and support for all who need it should also address

beneficial disclosure and ethical partner notification as well as

broad social measures to protect the human rights of people living

with HIV/AIDS and at risk of exposure to HIV.

4. PRE-TEST INFORMATION AND INFORMED CONSENT

With the "opt-out" approach to provider-initiated testing and

counselling recommended by WHO and UNAIDS, an HIV test is recommended

as a standard part of the patient's medical care. Individuals must

decline the test if they do not want it to be performed.

For both diagnostic HIV testing and HIV screening, the health care

provider should at a minimum provide the patient with the following

information:

o The reasons why HIV testing and counselling is being recommended

o The clinical and prevention benefits of testing, as well as the

potential adverse outcomes

o The fact that the patient has the right to decline the test and that

testing will be performed unless the patient exercises that right

o The fact that declining the test will not affect the patient's

access to services that do not depend upon knowledge of HIV status

o The follow-up services that are available in the case of either an

HIV-negative or an HIV-positive test result

o In the event of an HIV-positive test result, encouragement of

disclosure to other persons unknowingly at risk of exposure to HIV

o An opportunity to ask the health care provider questions.

Additional pre-test information for women who are or may become

pregnant should include:

o The risks of HIV transmission to infants

o Measures that can be taken to reduce mother-to-child transmission,

including antiretroviral prophylaxis and infant feeding counselling

o The benefits to infants of early diagnosis of HIV.

Pre-test information should be tailored to the client's age and

developmental stage; special considerations will apply for obtaining

informed consent from children and adolescents. Verbal communication

is adequate for the purpose of obtaining informed consent to either

diagnostic HIV testing or HIV screening.

Declining an HIV test should not result in any denial of services,

coercive treatment or breach of confidentiality, nor should it affect

a person's access to health services that do not depend on knowledge

of HIV status.

5. POST-TEST COUNSELLING

Post-test counselling is an integral component of the HIV testing

process and all individuals undergoing HIV testing must be counseled

when their test results are given, regardless of the test result.

Counselling for those who test HIV-negative should include the

following minimum information:

o An explanation of the test result

o Advice on methods to prevent the acquisition of HIV and provision of

condoms.

The health worker and the patient should jointly assess whether the

patient needs referral to more extensive post-test counselling or

additional prevention support.

In the case of individuals who test HIV-positive, the health care

provider should:

o Explain the result simply and clearly, and give the patient time to

consider it

o Ensure that the patient understands the result

o Allow the patient to ask questions

o Help the patient cope with emotions arising from the test result

o Discuss any immediate concerns and assist the patient in determining

who in her/his social network may be available and acceptable to offer

immediate support

o Describe follow-up support available in the health facility and in

the community

o Arrange a specific date and time for follow-up visits or referrals

for treatment, care, counselling, support and other services as

appropriate (e.g. tuberculosis treatment, OI prophylaxis, STI clinics,

family planning clinics, antenatal clinics, opioid substitution

therapy, and needle and syringe exchange programmes

o Provide information on how to prevent transmission of HIV, including

provision of condoms

o Provide information on other relevant preventive health measures

such as good nutrition and preventing endemic diseases, such as the

use of anti-malarial prophylaxis and insecticide-treated bed nets

o Discuss possible disclosure of the result, when and how this may

happen and to whom

o Encourage and offer support for testing and counselling of partners

and children

o Discuss possible steps to ensure the physical safety of women who

test positive.

In addition, post-testing counselling for women identified as

HIV-positive should emphasize the following:

o Use of antiretroviral drugs to prevent MTCT, and for her own health,

when indicated and available

o Childbirth plans

o Adequate maternal nutrition, including iron and folic acid

o Infant feeding options and support to carry out the mother's infant

feeding choice

o HIV testing for the infant and the follow-up that will be necessary.

6. FREQUENCY OF TESTING

How often individuals are tested will depend on the continued risks

taken by the individual, the availability of human and financial

resources and HIV incidence in the setting. Re-testing at least once a

year may be beneficial for individuals at high risk of exposure to

HIV, such as persons with a history of a sexually transmitted

infection, sex workers and their clients, men who have sex with men,

injecting drug users, and sex partners of people with HIV.

HIV-negative women should be tested with each new pregnancy,

particularly those in high-prevalence settings or high-risk

populations. Re-testing late in pregnancy may also be advisable.

Individuals who are known to be HIV-positive do not require

re-testing.

7. HIV TESTING TECHNOLOGIES

An important recent advance has been the introduction of highly

sensitive and specific, simple-to-use, rapid antibody tests. Use of

rapid HIV testing for provider-initiated testing and counselling has

many advantages, particularly for health facilities where access to

laboratory services is poor.

Decisions on whether to use rapid tests or ELISA tests for

provider-initiated testing and counselling should take into account

factors such as cost and availability of the test kits, reagents and

equipment; available staff, resources and infrastructure; the number

of samples to be tested; sample collection and transport; the setting

in which testing is proposed; convenience, and the ability of

individuals to return for results.

Virological testing, while more complex, expensive and requiring

highly trained staff, is optimal for diagnosing HIV infection in

children of less than 18 months.

8. MONITORING AND EVALUATION

The implementation and scale up of provider-initiated testing and

counselling needs to be monitored and evaluated for coverage, quality,

adverse outcomes, funding and overall performance of services. Routine

programme monitoring may need to be supplemented with focused

evaluations on specific aspects of implementation, such as health care

worker performance and patient satisfaction.

To read the report, please go to:

http://www.who.int/hiv/topics/vct/publicreview/en/index.html

To participate in the debate on provider-initiated HIV testing and

counselling in health facilities, please submit your comment below the

2007_07_01_archive

2008-02-19T15:24:00.001-08:00

Internal Conflicts and Psychological Harm

I've been reading some stuff about internal conflicts. Basically,

there are three kinds of internal conflicts - approach-approach,

approach-avoid and avoid-avoid conflicts. All cause some stress,

although approach-approach is much less stressful than the other two.

An example of an approach-approach conflict is being forced to choose

between either one highly preferred treat or another highly preferred

treat. Obviously, the result is pleasant no matter what.

An avoid-avoid conflict is the opposite - a forced choice between two

unpleasant alternatives. This is quite stressful because either way,

the result is bad.

Approach-avoid is a choice between either having or not having

something which is both desired and unwanted. An example might be a

hungry person who will get a severe punishment for stealing food

choosing whether or not to steal the food.

Both avoid-avoid and approach-avoid involve something unpleasant

regardless of what you choose, since approach-avoid results in

deprivation if you choose not to take the option and something

unpleasant if you take it. As a result, both are psychologically

harmful. The effects are greater with greater frequency and severity

of such choices.

Often, it seems like people assume an approach-avoid conflict is

generally with the desire to approach being internal (as in the

example of the hungry person). They seem to recognize that the avoid

can be internal or external, but not so much the approach. This may be

why people assume a behavioral treatment using only positive measures

cannot be harmful. However, it can, because it is possible to have an

external approach and internal avoid in such a program.

2007_07_01_archive

2008-02-19T14:24:00.001-08:00

2005_11_01_archive

2008-02-19T14:14:00.001-08:00

diagnostic test list for gout list of

2008-02-19T14:00:00.001-08:00

Diagnostic Test list for Gout:

The list of diagnostic tests mentioned in various sources as used in

the diagnosis of Gout includes:

Hyperuricemia test - not a very useful test as some people with gout

Are negative and there are many false positives of healthy people with

elevated uric acid

how do csi know if they are dealing

2008-02-19T13:54:00.001-08:00

How Do CSI's Know If They Are Dealing With Blood?

Whenever a bloodlike stain is establish at the scene of a crime, the

forensic man of science must carry on two basic sorts of tests:

presumptive and confirmatory. The ground presumptive diagnostic

diagnostic diagnostic diagnostic tests are conducted first is because

they are more than than cost-efficient than the more cumbrous

confirmatory tests.

What is a presumptive test?

Presumptive tests for blood can be establish in two wide categories:

those that alteration color, and those that cause a aglow reaction.

Presumptive tests that depend on a colour alteration affect the

following:

* Leucomalachite greenness (LMG) colour test: This chemical reagent

have been around since the early portion of the 20th century and

undergoes a chemical interaction with blood, yielding a feature

greenness color.

* Tetramethylbenzidine (TMB) colour test: At a law-breaking scene, a

CSI technician swabs a suspected bloodstain with a moistened Q-tip

and then uses it to a Hemastix strip containing TMB. A Hemastix

strip is a dip stick used to prove for the presence of blood. If

the Hemastix strip turns blue-green, it might be blood.

* Kastle-Meyer colour test: Phenolphthalein is the active chemical

reagent in this peculiar test. When blood, H peroxide, and

phenolphthalein are mixed together, a dark pinkish colour results.

This colour alteration is owed to the haemoglobin (the

oxygen-containing molecule within reddish blood cells) causing a

chemical reaction between H hydrogen peroxide and phenolphthalein.

Other diagnostic tests depend on chemical reactions that cause blood

to fluoresce, or glow, under an ultraviolet radiation visible light

source, uncovering blood that is unseeable to the bare eye. Offenders

many modern times seek to chaparral walls and floorings clean,

mistakenly taking for given that if blood is not visible, it can not

be found. Fortunately, that is not the case. At the scene of a crime,

blood can demo up by spraying a fluorescent chemical over the country

suspected of containing blood. The visible lights are dimmed, and

ultraviolet radiation visible light is passed over the area, causing

bloodstains to fluoresce in the dark just like you see on CSI. Not

only is the presence of blood established, but the country of blood

statistical distribution is also clearly indicated. This is where

blood spurts, retarding force marks, spatter, footprints, and

handprints demo up.

The histrions you see on CSI usage fluorescent chemicals to acquire

the blood to uncover itself. The most common fluorescent chemicals

used are luminol and fluorescein.

* Luminol--Luminol is highly sensitive and may uncover blood that is

present in minute quantities. Luminol is able to expose blood in

topographic points that have got got been cleaned repeatedly

unless a solvent such as as bleach was used, and even on walls

that have been painted to conceal blood. In malice of the fact

that it can negatively impact some serologic testing processes,

luminol makes not impact subsequent blood typing or

deoxyribonucleic acid analysis.

* Fluorescein--Fluorescein have been around since the early portion

of the 20th century. This chemical compound makes not interact

with bleach the manner luminol does. Fluorescein is better used

over luminol for exposing bloodstains that have got been cleaned

up using dissolvents such as as bleach. Fluorescein is

advantageous in that it is thicker than luminol and trickles less,

therefore, lodges to perpendicular come ups much better than

luminol.

What is a confirmatory test?

Teichmann and Takayama diagnostic diagnostic tests are the most

commonly used confirmatory tests. Both diagnostic tests depend on a

chemical reaction between a reagent and hemoglobin. This reaction

outputs crystals, which then can be seen under a microscope. A

considerable benefit of these diagnostic tests is that they are more

than effectual with aged stains.

The adjacent clip you watch your favourite forensic science/detective

show like NCIS or CSI, you will have got a clearer apprehension of the

chemicals used in exposing blood at a law-breaking scene.

Labels: buy pepper spray, hidden spy cameras, stun gun taser,

diagnostic process part 2 denouement

2008-02-19T13:44:00.001-08:00

diagnostic

2008-02-19T13:34:00.001-08:00

Diagnostic

HRC Campaign Director, Pollster and Blackwater Consultant Mark Penn

Salon gives us a little story that just explains all the problems with

HRC - entitled, tonedeaf and based in Hubris:

Be careful what you ask for

In an e-mail message sent to reporters Saturday, the Clinton

campaign asked, "Where Is the Bounce"? The answer: Right here.

Team Clinton based its message, in large part, on a

CNN/WMUR/University of New Hampshire poll, taken immediately after

the Iowa caucuses, that showed Hillary Clinton and Barack Obama

tied at 33 percent. While that tie represented four points of

improvement for Obama, the Clinton team noted that the poll's

margin of error meant that there had been "no statistically

significant change" in the candidates' numbers "before and after

the Iowa caucuses."

"Contrast that with the 17 points John Kerry gained in 2004 in the

Boston Globe poll ... in New Hampshire after the Iowa caucuses. Or

with the 7 points Al Gore gained in 2000 in the CNN/USA

Today/Gallup poll, increasing his lead in New Hampshire from 5

points to 18 points," the Clinton campaign said. "New Hampshire

voters are fiercely independent. They will make their own decisions

about who to support."

Maybe so. But a second CNN/WMUR/University of New Hampshire poll

was released Sunday, and that one shows Obama leading Clinton 39

percent to 29 percent. Add the 10 points by which Obama leads now

to the four points by which he trailed before Iowa, and you get a

14-point swing -- exactly the sort of Kerry/Gore bounce the Clinton

non diagnostic listening

2008-02-19T13:24:00.001-08:00

Non-Diagnostic Listening

I just read a really cool article on the net at

http://www.webcom.com/thrive/schizo/articles/ndlisten.html

It is so easy to slip into diagnosis when you work with people. I

believe we diagnose when we fear-- diagnosis gives us a sense of

"stability" in a chaotic situation. We talk with the client (the word

"client" is interesting in itself), and we cannot get the response

that we hope for. Perhaps we are looking for something like "I guess

you are right, I am thinking stupid... I am going to change myself and

be happy." When we don't get this response, or if we get a response

that is outside of what we perceive as logic, we peer over the brink

of sanity; we worry that this person will pull us both over the edge.

Humans seem to naturally fear non-connection with other humans. At

this point we need a reason, and "bipolar," or "schizophrenia," or

"depression" seem to fit so well. Once we have the word, we can plunk

all the previous behaviour into the mindframe. It explains

everything... This person is mentally ill, so it's not my fault. In

the healthcare system, it is so much easier to deal with people in

"channels." bipolars over here, FASD over there, etc.

Some who read this will say "This is nothing new, non-judgmental

philosophies have always been around." While I agree that the

cast-the-first-stone speech is quite old, I would say that social

workers need to speak about and process judgment frequently. I think

when we begin to see our fear in the situation, we can start to get to

questions like "What is the WORST thing that will happen if I just

forget the labels and listen to this guy?" Truly see the fear and you

will watch it melt away.

I am also aware that I judge out of survival. I have no apologies for

being judgmental, though our society has labeled "judgment" as "bad."

I see little use in judging MYSELF for being judgmental (!). Boy, this

just gets silly at some points!

Anyhow, I would like to see people looking more closely at how they

view the people who come to them for help. Do you sit with your

co-workers and say "That woman is blah blah..."? Do you think of blah

blah when you talk to her? Are you closed down as a result? What would

an alternative look like? Is the alternative scary? Hmmm....

premature diagnostic problems

2008-02-19T12:59:00.001-08:00

Premature Diagnostic... problems.

Sexual references henceforth.

Been a bit frantic here lately, Sarah is across the Nullabor and I and

the niece (who in this blog wants to go under the name of Ginger, I

kid you not), have been slaves of the cats.

However, I have been reading, in my spare time between talking to

heroin addicts and giving presentations on urine testing, about

borderline personality disorder (BPD). Borderline and bipolar

disorder, and where one relates to the other, and so on.

Bipolar, by the way, is BPAD, or bipolar affective disorder. Seasonal

affective disorder, where you get deeply depressed at certain times of

the year, is appropriately known as SAD. I think the DSM III used to

have a class of major affective disorders (bipolar, unipolar, etc.)

that rejoiced in the acronym MAD.

If you are an amateur when it comes to psychiatry (and I definitely

am) the DSM IV is a dangerous book. You can, if you are not careful,

end up using it as a "spotters guide to the mental illnesses". You see

someone and you check if they have five of the following symptoms from

this list, if the symptoms have been there for more than the minimum

required time and so on ... and pretty soon you can announce "Aha.

This person has Insert Disorder Here. Take these tablets. My work is

done."

I don't know if Premature Diagnostic Ejaculation is a recognised

psychiatric disorder, but it should be. You see it happen all the time

with interns in the ED. The hassled junior doctor goes into the room,

gets straight into it, squicks out a diagnosis after a few minutes and

leaves, satisfied, probably wrong and utterly unaware that this has

not been a mutually satisfying experience.

Obviously that's a simplification, and completely unlike most people's

experience of presenting to a doctor with mental distress, but it's

not entirely untrue. Medicine is an applied science, it works via

quantities and measurable things, and it works best if it is given

discrete, anatomized subjects to deal with. This person fits the

diagnostic criteria of such and such, the evidence suggests we treat

that with so and so, move on. It's easy, especially when the clinician

is pushed for time, or has to get the patient out of there quickly, or

never really feel comfortable with psych patients, to slip into

flowcharts, protocols, either-or judgements.

I should point out that even doctors know that every person is an

individual, and thus every brain and mind and mental illness is an

individual. But technology isn't about what is true, it's about what

works. Every cow is an individual, too, but the meat processor still

works. And so do mood stabilizers, and anti-psychotics, and (to a

lesser extent) anti-depressants.

But I can't helpo feeing that that is a problem with the use of the

DSM IV. It's meant to be a tool so that when doctor A says "this guy

has schizophrenia", then Dr B knows what she's talking about. But the

truth is that there is no rigid, crystalline barrier between normal

and abnormal, healthy and unwell, and that most people move back and

forth and in and out of the diagnostic criteria with little regard for

the intellectual convenience of the junior doctor.

Anyway, seeking to keep these brief and relatively more frequent. Next

post is actually about borderline personality disorder, and how it

affects someone close to you.

Thanks for listening,

diagnostic and statistical manual of

2008-02-19T12:54:00.001-08:00

Diagnostic and Statistical Manual of Mental Disorders

I've ordered the book and its case book, used.

diagnostic problems and postnatal

2008-02-19T12:44:00.001-08:00

Diagnostic problems and postnatal follow-up in congenital toxoplasmosis

Minerva Pediatr. 2007 Jun;59(3):207-13.

Diagnostic problems and postnatal follow-up in congenital

toxoplasmosis

Mazzola A, Casuccio A, Romano A, Schimmenti MG, Titone L, Di Carlo P.

RNAS Civico Benfratelli, G. Di Cristina and M. Ascoli, Palermo, Italy.

AIM: In order to assess the consequences of different clinical

approaches in the prenatal management of congenital toxoplasmosis, we

retrospectively reviewed 58 pregnant women with Toxoplasma

seroconversion and prospectively enrolled their 59 infants, referred

to us from 1999 to 2004. METHODS: Data on clinical, laboratory and

demographic characteristics of the pregnant women were collected.

Their children were entered into a 48-month follow-up programme in

which clinical, instrumental, ophthalmologic and serologic evaluations

were carried out at birth, at 1, 3, 6, 9, 15, 18, 24, 36 and at 48

months of life. Paediatric treatment with Spiramycin alone or

alternated with Pyrime-thamine-Sulphadiazine was administered

according to the different clinical cases. RESULTS: Time of infection

was dated in the first trimester for 24 women (41%), in the second

trimester for 18 women (31%) and in the third trimester for 16 (28%).

In the first trimester of pregnancy 20 of the 24 infected women had

undergone amniocentesis, while the test had not been performed on any

of the women infected in the third trimester. Serological follow-up

revealed that 11 (19%) of the infants had been infected. An

alternating regimen with Pyrimethamine-Sulphadoxine was administered

to the infected children. All the infants were clinically

asymptomatic, and the instrumental follow-up revealed specific

toxoplasmosis anomalies in 4/11 infected children. CONCLUSION: Our

results highlight issues and problems concerning current prenatal

diagnostic tests and the therapeutic approach based on PCR testing of

amniotic fluid alone. The incidence of ocular-cerebral lesions

observed in children born to women with seroconversion in the third

trimester raises questions about the diagnostic and therapeutic

approach for these women and their offspring. Paediatric therapeutic

protocol, with alternating Pyrime-thamine-Sulphadiazine regimen,

applied also to asymptomatic children born to women with inadequate

prenatal diagnostic management, could prevent severe sequelae.