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Viewing: Blog Posts Tagged with: health, Most Recent at Top [Help]
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1. Stem cell therapy for diabetes

This month, it was reported that scientists at Harvard University have successfully made insulin-secreting beta cells from human pluripotent stem cells. This is an important milestone towards a “stem cell therapy” for diabetes, which will have huge effects on human medicine.

Diabetes is a group of diseases in which the blood glucose is too high. In type 1 diabetes, the patients have an autoimmune disease that causes destruction of their insulin-producing cells (the beta cells of the pancreas). Insulin is the hormone that enables glucose to enter the cells of the tissues and in its absence the glucose remains in the blood and cannot be used. In type 2 diabetes the beta cells are usually somewhat defective and cannot adapt to the increased demand often associated with age and/or obesity. Despite the availability of insulin for treating diabetes since the 1920s, the disease is still a huge problem. If the level of blood glucose is not perfectly controlled it will cause damage to blood vessels and this eventually leads to various unpleasant complications including heart failure, stroke, kidney failure, blindness, and gangrene of limbs. Apart from the considerable suffering of the affected patients, the costs of dealing with diabetes is a huge financial burden for all health services. The prevalence of type 2 diabetes in particular is rising in most parts of the world and the number of patients is now counted in the hundreds of millions.

To get perfect control of blood glucose, insulin injections will never be quite good enough. The beta cells of the pancreas are specialised to secrete exactly the correct amount of insulin depending on the level of glucose they detect in the blood. At present the only sources of beta cells for transplantation are the pancreases taken from deceased organ donors. However this has enabled a clinical procedure to the introduced called “islet transplantation”. Here, the pancreatic islets (which contain the beta cells) are isolated from one or more donor pancreases and are infused into the liver of the diabetic patient. The liver has a similar blood supply to the pancreas and the procedure to infuse the cells is surgically very simple. The experience of islet transplants has shown that the technique can cure diabetes, at least in the short term. But there are three problems. Firstly the grafts tend to lose activity over a few years and eventually the patients are back on injected insulin. Secondly the grafts require permanent immunosuppression with drugs to avoid rejection by the host, and this can lead to problems. Thirdly, and most importantly, the supply of donor pancreases is very limited and only a tiny fraction of what is really needed.

Syringe, by Blausen.com staff. “Blausen gallery 2014″. CC-BY-3.0 via Wikimedia Commons

This background may explain why the production of human beta cells has been a principal objective of stem cell research for many years. If unlimited numbers of beta cells could be produced from somewhere then at least the problem of supply would be solved and transplants could be made available for many more people. Although there are other potential sources, most effort has gone into making beta cells from human pluripotent stem cells (hPSC). These resemble cells of the early embryo: they can be grown without limit in culture, and they can differentiate into most of the cell types found in the body. hPSC comprise embryonic stem cells, made by culturing cells directly from early human embryos; and also “induced pluripotent stem cells” (iPSC), made by introducing selected genes into other cell types to reprogram them to an embryonic state. The procedures for making hPSC into beta cells have been designed based on the knowledge obtained by developmental biologists about how the pancreas and the beta cells arise during normal development of the embryo. This has shown that there are several stages of cell commitment, each controlled by different extracellular signal substances. Mimicking this series of events in culture should, theoretically, yield beta cells in the dish. In reality some art as well as science is required to create useful differentiation protocols. Many labs have been involved in this work but until now the best protocols could only generate immature beta cells, which have a low insulin content and do not secrete insulin when exposed to glucose. The new study has developed a protocol yielding fully functional mature beta cells which have the same insulin content as normal beta cells and which secrete insulin in response to glucose in the same way. These are the critical properties that have so far eluded researchers in this area and are essential for the cells to be useful for transplantation. Also, unlike most previous procedures, the new Harvard method grows the cells as clumps in suspension, which means that it is capable of producing the large number of cells required for human transplants.

These cells can cure diabetes in diabetic mice, but when will they be tried in humans? This will depend on the Food and Drug Administration (FDA) of the USA. The FDA has so far been very cautious about stem cell therapies because they do not want to see cells implanted that will grow without control and become cancerous. One thing they will insist on is extremely good evidence that there are absolutely none of the original pluripotent cells left in the transplant, as they would probably develop into tumours. This highlights the fact that the treatment is not really “stem cell therapy” at all, it is actually “differentiated cell therapy” where the transplanted cells are made from stem cells instead of coming from organ donors. The FDA will also much prefer a delivery method which will enable the cells to be removed, something which is not the case with current islet transplants. One much discussed possibility is “encapsulation” whereby the cells are enclosed in a semipermeable membrane that can let nutrients in and insulin out but will not allow cells to escape. This might also enable the use of immunosuppressive drugs to be avoided, as encapsulation is also intended to provide a barrier against the immune cells of the host.

Stem cell therapy has been hyped for years but with the exception of the long established bone marrow transplant it has not yet delivered. An effective implant which is easy to insert and easy to replace would certainly revolutionize the treatment of diabetes, and given the importance of diabetes worldwide, this in itself can be expected to revolutionize healthcare.

Featured image credit: A colony of embryonic stem cell. Public Domain via Wikimedia Commons

The post Stem cell therapy for diabetes appeared first on OUPblog.

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2. 11 Kids’ Books on Dealing with Loss, Grief, Illness and Trauma

Here is a list of 11 books that address a wide range and variety of emotions that young readers may experience when faced with serious illness, loss, grief or trauma.

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3. A taxonomy of kisses

Where kissing is concerned, there is an entire categorization of this most human of impulses that necessitates taking into account setting, relationship health and the emotional context in which the kiss occurs. A relationship’s condition might be predicted and its trajectory timeline plotted by observing and understanding how the couple kiss. For instance, viewed through the lens of a couple’s dynamic, a peck on the cheek can convey cold, hard rejection or simply signify that a loving couple are pressed for time.

A kiss communicates a myriad of meanings, its reception and perception can alter dramatically depending on the couple’s state of mind. A wife suffering from depression may interpret her husband’s kiss entirely differently should her symptoms be alleviated. Similarly, a jealous, insecure lover may receive his girlfriend’s kiss of greeting utterly at odds to how she intends it to be perceived.

So if the mind can translate the meaning of a kiss to fit with its reading of the world, what can a kiss between a couple tell us? Does this intimate act mark out territory and ownership, a hands-off-he’s-mine nod to those around? Perhaps an unspoken negotiation of power between a couple that covers a whole range of feelings and intentions; how does a kiss-and-make-up kiss differ from a flirtatious kiss or an apologetic one? What of a furtive kiss; an adulterous kiss; a hungry kiss; a brutal kiss? How does a first kiss distinguish itself from a final kiss? When the husband complains to his wife that after 15 years of marriage, “we don’t kiss like we used to”, is he yearning for the adolescent ‘snog’ of his youth?

Engulfed by techno culture, where every text message ends with a ‘X’, couples must carve out space in their busy schedules to merely glimpse one another over the edge of their laptops. There isn’t psychic space for such an old-fashioned concept as a simple kiss. In a time-impoverished, stress-burdened world, we need our kisses to communicate more. Kisses should be able to multi-task. It would be an extravagance in the 21st-century for a kiss not to mean anything.

And there’s the cultural context of kissing to consider. Do you go French, Latin or Eskimo? Add to this each family’s own customs, classifications and codes around how to kiss. For a couple, these differences necessitate accepting the way that your parents embraced may strike your new partner as odd, even perverse. For the northern lass whose family offer to ‘brew up’ instead of a warm embrace, the European preamble of two or three kisses at the breakfast table between her southern softie of a husband and his family, can seem baffling.

The context of a kiss between a couple correlates to the store of positive feeling they have between them; the amount of love in the bank of their relationship. Take 1: a kiss on the way out in the morning can be a reminder of the intimacy that has just been. Take 2: in an acrimonious coupling, this same gesture perhaps signposts a dash for freedom, a “thank God I don’t have to see you for 11 hours”. The kiss on the way back in through the front door can be a chance to reconnect after a day spent operating in different spheres or, less benignly, to assuage and disguise feelings of guilt at not wanting to be back at all.

Couple, by Oleh Slobodeniuk. CC-BY-2.0 via Flickr.
Couple, by Oleh Slobodeniuk. CC-BY-2.0 via Flickr.

While on the subject of lip-to-lip contact, the place where a kiss lands expresses meaning. The peck on the forehead may herald a relationship where one partner distances themselves as a parental figure. A forensic ritualized pattern of kisses destined for the cheeks carries a different message to the gentle nip on the earlobe. Lips, cheek, neck, it seems all receptors convey significance to both kisser and ‘kissee’ and could indicate relationship dynamics such as a conservative-rebellious pairing or a babes-in-the-wood coupling.

Like Emperor Tiberius, who banned kissing because he thought it helped spread  fungal disease, Bert Bacarach asks, ‘What do you get when you kiss a guy? You get enough germs to catch pneumonia…’ Conceivably the nature of kissing and the unhygienic potential it carries is the ultimate symbol of trust between two lovers and raises the question of whether kissing is a prelude or an end in itself, ergo the long-suffering wife who doesn’t like kissing anymore “because I know what it’ll lead to…”

The twenty-first century has witnessed the proliferation of orthodontistry with its penchant for full mental braces. Modern mouths are habitually adorned with lip and tongue piercings as fetish wear or armour. Is this straying away from what a kiss means or a consideration of how modern mores can begin to create a new language around this oldest of greetings? There is an entire generation maturing whose first kiss was accompanied by the clashing of metal, casting a distinct shadow over their ideas around later couple intimacy.

Throughout history, from Judas to Marilyn Monroe, a kiss has communicated submission, domination, status, sexual desire, affection, friendship, betrayal, sealed a pact of peace or the giving of life. There is public kissing and private kissing. Kissing signposts good or bad manners. It is both a conscious and unconscious coded communication and can betray the instigator’s character; from the inhibited introvert to the narcissistic exhibitionist. The 16th-century theologian Erasmus described kissing as ‘a most attractive custom’. Rodin immortalized doomed, illicit lovers in his marble sculpture, and Chekhov wrote of the transformative power of a mistaken kiss. The history and meaning of the kiss evolves and shifts and yet remains steadfastly the same: a distinctly human, intimate and complex gesture, instantly recognizable despite its infinite variety of uses. I’ve a feeling Sam’s ‘You must remember this, a kiss is just a kiss’ may never sound quite the same again.

Headline image credit: Conquered with a kiss, by .craig. CC-BY-NC-2.0 via Flickr.

The post A taxonomy of kisses appeared first on OUPblog.

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4. Death at a Distance

I saw someone’s Facebook status today:

 

a

And I was immediately struck with anger.

At first, I wasn’t sure quite why. I get what they meant. It seems like Ebola’s everywhere! It’s constantly on the news, all over the internet, and everyone’s talking about it. It makes sense to be sick of hearing about it.  We’re bound to get sick of hearing about anything that much!

But still, I couldn’t shake the discomfort that rung in my head over that status. Ebola seems far away, after all, it’s only been diagnosed four times in the US. It’s easy to tuck it away in your mind as something distant that doesn’t affect you and forget why it’s a big deal.

It’s even become a hot topic for jokes on social media:

b c

de

 

Because so many see this very real disease as a far away concept, we find safety in our distance and it’s easy to make light of it.

But guys….

f

 

4,877 deaths. 9,935 sufferers. That’s not funny. That’s not something to ask to “omg shut up.”

The idea of disease never really hit home for me until my little sister was diagnosed with cancer. Yes, Ebola and cancer are two very different things. But I know what it’s like to watch someone I love very dearly suffer. I know what it’s like to hold my sister’s hand while she cries because she can’t escape the pain or the fear that comes with her disease. I know what it’s like to cry myself to sleep begging God to take her illness away. And I can’t help but imagine a sister somewhere in Africa in a situation very similar to my own, watching her loved one suffer, hearing her cries, and begging for it to all be over- but without the blessings of medicine and technology that my sister has access to.

We are quick to throw on our pink gear for breast cancer awareness and dump ice on our head for ALS because that kind of awareness is fun and easy. I’m not trying to diminish those causes- they are great causes that deserve promotion. But I mean to make note of the fact that when another very real disease with very real consequences is brought to light and gains awareness, people groan that it’s in the news again and make jokes about it on the internet. Because Ebola doesn’t have the fun and cute promotional package, we complain and make light of it and its need for awareness and a solution.

People are suffering and dying from Ebola. Just because that suffering seems far away, doesn’t make it any less significant.

 

This is a guest post from my oldest daughter, Meredith. I begged her to let me post it. 


Filed under: Don't Blog Angry

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5. Jay Asher Discusses Thirteen Reasons Why | 50 States Against Bullying

A conversation between Jay Asher and Trudy Ludwig the 50 States Against Bullying tour, bullying, teen suicide and how to create kinder and more caring communities.

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6. Celebrating World Anaesthesia Day 2014

World Anaesthesia Day commemorates the first successful demonstration of ether anaesthesia at the Massachusetts General Hospital on 16 October 1846. This was one of the most significant events in medical history, enabling patients to undergo surgical treatments without the associated pain of an operation. To celebrate this important day, we are highlighting a selection of British Journal of Anaesthesia podcasts so you can learn more about anaesthesia practices today.

Fifth National Audit Project on Accidental Awareness during General Anaesthesia

Accidental awareness during general anaesthesia (AAGA) is a rare but feared complication of anaesthesia. Studying such rare occurrences is technically challenging but following in the tradition of previous national audit projects, the results of the fifth national audit project have now been published receiving attention from both the academic and national press. In this BJA podcast Professor Jaideep Pandit (NAP5 Lead) summarises the results and main findings from another impressive and potentially practice changing national anaesthetic audit. Professor Pandit highlights areas of AAGA risk in anaesthetic practice, discusses some of the factors (both technical and human) that lead to accidental awareness, and describes the review panels findings and recommendations to minimise the chances of AAGA.
October 2014 || Volume 113 – Issue 4 || 36 Minutes

 

Pre-hospital Anaesthesia

Emergency airway management in trauma patients is a complex and somewhat contentious issue, with opinions varying on both the timing and delivery of interventions. London’s Air Ambulance is a service specialising in the care of the severely injured trauma patient at the scene of an accident, and has produced one of the largest data sets focusing on pre-hospital rapid sequence induction. Professor David Lockey, a consultant with London’s Air Ambulance, talks to the BJA about LAA’s approach to advanced airway management, which patients benefit from pre-hospital anaesthesia and the evolution of RSI algorithms. Professor Lockey goes on to discuss induction agents, describes how to achieve a 100% success rate for surgical airways and why too much choice can be a bad thing, as he gives us an insight into the exciting world of pre-hospital emergency care.
August 2014 || Volume 113 – Issue 2 || 35 Minutes

 

Fluid responsiveness: an evolution in our understanding

Fluid therapy is a central tenet of both anaesthetic and intensive care practice, and has been a solid performer in the medical armamentarium for over 150 years. However, mounting evidence from both surgical and medical populations is starting to demonstrate that we may be doing more harm than good by infusing solutions of varying tonicity and pH into the arms of our patients. As anaesthetists we arguably monitor our patient’s response to fluid-based interventions more closely than most, but in emergency departments and on intensive care units this monitoring me be unavailable or misleading. For this podcast Dr Paul Marik, Professor and Division Chief of Pulmonary Critical Care at Eastern Virginia Medical Center delivers a masterclass on the physiology of fluid optimisation, tells us which monitors to believe and importantly under which circumstances, and reviews some of the current literature and thinking on fluid responsiveness.
April 2014 || Volume 112 – Issue 4 || 43 Minutes

 

Post-operative Cognitive Decline

Post-operative cognitive decline (POCD) has been detected in some studies in up to 50% patients undergoing major surgery. With an ageing population and an increasing number of elective surgeries, POCD may represent a major public health problem. However POCD research is complex and difficult to perform, and the current literature may not tell the full story. Dr Rob Sanders from the Wellcome Department of Imaging Neuroscience at UCL talks to us about the methodological limitations of previous studies and the important concept of a cognitive trajectory. In addition, Dr Sanders discusses the risk factors and role of inflammation in causing brain injury, and reveals the possibility that certain patients may in fact undergo post-operative cognitive improvement (POCI).
March 2014 || Volume 112 – Issue 3 || 20 Minutes

 

Needle Phobia – A Psychological Perspective

For anaesthetists, intravenous cannulation is the gateway procedure to an increasingly complex and risky array of manoeuvres, and as such becomes more a reflex arc than a planned motor act. For some patients however, that initial feeling of needle penetrating epidermis, dermis and then vessel wall is a dreaded event, and the cause of more anxiety than the surgery itself. Needle phobia can be a deeply debilitating disease causing patients not to seek help even under the most dire circumstances. Dr Kate Jenkins, a hospital clinical psychologist describes both the psychology and physiology of needle phobia, what we as anaesthetists need to be aware of, and how we can better serve out patients for whom ‘just a small scratch’ may be their biggest fear.
July 2014 || Volume 113 – Issue 1 || 32 Minutes

 

For more information, visit the dedicated BJA World Anaesthesia Day webpage for a selection of free articles.

Headline image credit: Anaesthesia dreams, by Tc Morgan. CC-BY-SA-2.0 via Flickr.

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7. Childhood obesity and maternal employment

It is well known that obesity rates have been increasing around the Western world.

The American obesity prevalence was less than 20% in 1994. By 2010, the obesity prevalence was greater than 20% in all states and 12 states had an obesity prevalence of 30%. For American children aged 2 – 19, approximately 17% are obese in 2011-2012. In the UK, the rifeness of obesity was similar to the US numbers. Between 1993 and 2012, the commonness of obesity increased from 13.2% to 24.4% for men and for women from 16.4% to 25.1%. The obesity prevalence is around 18% for children aged 11-15 and 11% for children aged 2-10.

Policy makers, researchers, and the general public are concerned about this trend because obesity is linked to an increase likelihood of health conditions such as diabetes and heart disease, among others. The increase in the obesity prevalence among children is of concern because of the possibility that obesity during childhood will increase the likelihood of being obese as an adult thereby leading to even higher rates of these health conditions in the future.

Researchers have investigated many possible causes for this trend including lower rates of participation in physical activity and easier access to fast food. Anderson, Butcher, and Levine (2003) identified maternal employment as a possible culprit when they noticed that in the US the timing of these two trends was similar. While the prevalence of obesity was increasing for children so was the employment rate of mothers. Other researchers have found similar results for other countries – more hours of maternal employment is related to a higher likelihood of children being obese.

What could be the relationship between a mother’s hours of work and childhood obesity? When mothers work they have less time to devote to activities around the home, which may mean less concern about nutrition, more meals eaten outside of the home or less time devoted to physical activities. On the other hand, more maternal employment could mean more income and an ability to purchase more nutritious food or encourage healthy activities for children.

Child playing with dreidels, by Dana Friedlander for Israel Photo Gallery. CC-BY-SA-2.0 via Flickr
Child playing with dreidels, by Dana Friedlander for Israel Photo Gallery. CC-BY-SA-2.0 via Flickr

We looked at this relationship for Canadian children 12-17 years old – an older group of children than studied in earlier papers. For youths aged 12 to 17 in Canada, the obesity prevalence was 7.8% in 2008. We analysed not only at the relationship between maternal employment and child obesity, but also the possible reasons that maternal employment may affect child obesity.

We find that the effect of hours of work differs from the effect of weeks of work. More hours of maternal work are related to activities we expect to be related to higher rates of obesity – more television viewing, less likely to eat breakfast daily, and a higher allowance. On the other hand, more weeks of maternal employment are related to behaviour expected to lower obesity – less television viewing and more physical activity. This difference between hours and weeks of work raises some interesting questions. How do families adapt to different aspects of the labour market? When mothers work for more weeks does this indicate a more regular attachment to the labour force? Do these families have schedules and routines that allow them to manage their child’s weight?

Unlike other studies that focus on younger children, we do not find a relationship between maternal employment and likelihood of obesity for adolescents. Does the impact of maternal employment at younger ages not last into adolescence? Is adolescence a stage during which obesity status is difficult to predict?

The debate over appropriate policy remedies should not focus on whether mothers should work, but rather should focus on what children are doing when mothers are working. What can be done to reduce the obesity prevalence in adolescents? Some ideas include working with the education system and local communities to create an environment for adolescents that fosters healthy weight status, supporting families with quality childcare, provision of viable and high-quality alternative activities, or flexible work hours. Programs or policies that help families establish a healthy routine are important. It may not be a case of simply providing activities for adolescents, but that these activities are easy for families to attend on a regular basis.

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8. Surviving a Stroke at 33 (and Blogging About It)

Christine Hyung-Oak Lee suffered a stroke when she was 33, and she has written about her experience in an inspiring personal essay for BuzzFeed.

Before that, she was using a pseudonym on WordPress.com to blog about her experiences, share details about her life, and practice her writing. In 2007, shortly after New Year’s Day, Lee wrote the following in a blog post:

something in my brain burped. most of what i want to do is just out of my grasp. i feel like i know how to do them, but then when i go to do them, i just…CAN’T. day by day, i’m regaining my abilities, so i hope this is just temporary.

Lee’s commenters urged her to see a doctor, and the next day, she responded to them from a hospital bed: “I had a stroke! Will be better.”

I spoke with Lee about her experience, and what she has learned about herself and her writing.

* * *

christine-lee-crop

It’s amazing that you could go through something so profound health-wise and chart a new path for yourself coming out of it. What’s the response been to your essay?

I’ve been blown away. As life-changing as my stroke was, the response, too, will probably go down in my life history as a turning point.

I had a blog — and I’ve been blogging since before it was called “blogging,” back when it was called “web journaling,” back in the days when Justin Hall was on links.net and when I wrote my posts in HTML. But before I spun up my anonymous blog, I was asked to stop blogging by a few family members. I was putting them at risk, they said, I was not to make myself so public.

Bottom line, I didn’t want to stop blogging, so I started up a blog under a pseudonym. I never told them about the blog. A few months later, I had my stroke.

The blog was one of the first places to which I turned when I had my stroke, before I knew I’d had a stroke. I wrote in my journal, too — but I turned to my blog in the wake of my stroke, which for me was a largely isolating event. I made some great friends. Got support that way. It was my village, for a time.

Also, my blog has always been a place to do some “low-stakes writing” — writing without the intention of publication, writing that is more therapeutic. That said, blogging has always been a venue for me to refine my writing voice — because after all, it is still a public space with readers.

What are the odds that a person could suffer a stroke at 33?

According to the New York Times, about 10 to 15 percent of strokes happen to people under the age of 45. That’s supposed to be about 1 in 1,000. And oftentimes, young people who have had a stroke are misdiagnosed and sent home.

I was the youngest person in the DCU (aka “stroke unit”) in the hospital by about 30 years during my stay. Most doctors were astonished by my age. They certainly didn’t suspect I’d had a stroke until they saw the MRI and its uncontested results. I could see how I could have been sent home and had to shoulder a mysterious ailment. I was lucky in that they figured it out and I got the care I needed to ensure the recovery I eventually had.

Can you talk about some specific posts that led you on a path both during and after your stroke?

Definitely, the post during which readers told me to go to the hospital!

I’m not sure where I found my voice after the stroke, really. I think there were people out in the internet reading — Carolyn Kellogg, who writes for the LA Times, had a blog called Pinky’s Paperhaus at the time, and she linked to me as a writer recovering from stroke. So there was definitely interest in my story and situation.

I really don’t think I found my voice regarding my stroke until years later. I wasn’t able to write about it until my post for Nova Ren Suma, who did a Turning Point series on her blog, to which I contributed with a reference to my stroke.

Not only has blogging my stroke experience refined my voice, it was also life-saving. And anonymity provided sanctuary.

What is your life like now?

It is as normal as I imagine it to be. It’s, honestly, better than my life pre-stroke. I’m following my dreams and choosing very carefully what it is I want to do each day, each month, each year. While in recovery, I had very limited energy, and had to be particular about my priorities; I decided to keep doing that, go forward.

And what about your writing?

Once you go through something like that, when so many of your abilities are taken away, your life is pared down to what it is you really want to get back.

I went through a very dark place at some point in my recovery — and although I don’t look upon that phase with fondness, I did learn what was most important to me, and what it is I most desired out of my life. And my writing became a front-and-center goal. I’d always known writing was important to me, but after the stroke, I knew I would channel everything I had to get back to writing.

Now that I’m writing again, I’ve more a sense of structure with regard to my writing projects; in fact, I’m obsessed with structure, because recovery is so much about stages and regaining structure. Because my brain was injured, I understood how writing happens, in my brain at least — that stories are modular, that I need quiet, that layers come with each retelling.


Filed under: Community, Reading, WordPress.com

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9. She Doesn’t Live Here Anymore

And so, the wheel turns. My eldest has moved to college. Although my Lovely Wife (LW) tells me we have to keep her room intact because she will still come home, I remember that I never lived at home after I left for college. I am somewhat sad about that, but we’ve been prepping for this and hoping she would take flight someday. It’s just hard to watch the baby condor drop off the ledge knowing the perilous plunge that awaits.

I’m taking it pretty well, actually. LW, not so much. Everything in the house seems to remind her that one of her babies has left the nest. Tears, oh there have been tears. I don’t understand tears, nor do I deal with them very well. I remind LW that she’s always got me… forever…  Somehow, that doesn’t seem to help.

After moving our collegian, we had to take our little patient in for treatment where she and mom stayed a few days. While they were gone, I happened into the pantry and realized LW must not have been there since baby condor left. If food packaging could form a face, every piece of junk food in there conspired to draw our missing daughter – even to me and I’m oblivious to the most obvious of things.

This was bad! I couldn’t let LW see this, she would cry for days. It all had to go, but the cheapskate in me said I also couldn’t throw out all of the food. Only one option remained. A 24 hour binge of Munchos and Dr. Pepper.

Have you ever read the nutrition label on those things? DON’T! You can gain 3 pounds just from holding the bag too long. They don’t list things by proportion, otherwise the label would read something like this:

Lard 70%image

Air 27%

Salt 2.5%

Potatoes 0.5%

How they bond the ingredients I will never know. Anyway, I polished off the first bag for breakfast and washed it down with three Dr. Peppers. I checked the remaining inventory and was disheartened to discover that LW must have decided to stock up to try to lure the girl to forsake college and stay with us. Either that or she suspected a Y2k15 disaster and wanted to be prepared. Our pantry was like a saferoom.

This is where having many offspring should pay off! I enlisted the help of the remaining children. When I explained the dilemma, I got more “Oh, Dad” eye rolls than the average game of nine-ball. One took a Dr. Pepper before she left, so I was down to hoarder’s surplus minus one. Alone, I dug in for the day.

In the late evening, I was sure a trip the emergency room was in order. The pantry was reverting back to a faceless state, and my stomach was screaming something in Idahoan. I was sweating a substance that looked like maple syrup, which can’t be good. I put in a call to Poison Control where a kind gentleman told me there was no known toxicity in the combination, but urged me to go to the hospital if I felt light-headed. That’s the last thing I remember before passing out amongst the crumbs of the last bag.

When I came to, it was time to go and pick up LW and the youngest. I used the shower squeegee to remove the syrup-sweat and when I arrived, they were ready to go. The trip home was uneventful, I successfully hid the tick and slurred speech caused by sugar intake. While I was unloading the car, LW stopped me.

“Where are the snacks for the party?”

I shrugged my shoulders and grunted. I didn’t ask ‘what party’, I’m sure I’d been told.

“The pantry was full of them.”

“I dunno,” I replied without making eye contact.

“Well, we need more for the party Saturday. Can you go to the store?”

“Uh, sure.”

They say never go to the store hungry. I went full! And I bought $57 worth of Dr. Pepper and Munchos, feeling bloated and quite resentful. Even after all the sweets, this was a bitter pill to swallow.


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10. She Doesn’t Live Here Anymore

And so, the wheel turns. My eldest has moved to college. Although my Lovely Wife (LW) tells me we have to keep her room intact because she will still come home, I remember that I never lived at home after I left for college. I am somewhat sad about that, but we’ve been prepping for this and hoping she would take flight someday. It’s just hard to watch the baby condor drop off the ledge knowing the perilous plunge that awaits.

I’m taking it pretty well, actually. LW, not so much. Everything in the house seems to remind her that one of her babies has left the nest. Tears, oh there have been tears. I don’t understand tears, nor do I deal with them very well. I remind LW that she’s always got me… forever…  Somehow, that doesn’t seem to help.

After moving our collegian, we had to take our little patient in for treatment where she and mom stayed a few days. While they were gone, I happened into the pantry and realized LW must not have been there since baby condor left. If food packaging could form a face, every piece of junk food in there conspired to draw our missing daughter – even to me and I’m oblivious to the most obvious of things.

This was bad! I couldn’t let LW see this, she would cry for days. It all had to go, but the cheapskate in me said I also couldn’t throw out all of the food. Only one option remained. A 24 hour binge of Munchos and Dr. Pepper.

Have you ever read the nutrition label on those things? DON’T! You can gain 3 pounds just from holding the bag too long. They don’t list things by proportion, otherwise the label would read something like this:

Lard 70%image

Air 27%

Salt 2.5%

Potatoes 0.5%

How they bond the ingredients I will never know. Anyway, I polished off the first bag for breakfast and washed it down with three Dr. Peppers. I checked the remaining inventory and was disheartened to discover that LW must have decided to stock up to try to lure the girl to forsake college and stay with us. Either that or she suspected a Y2k15 disaster and wanted to be prepared. Our pantry was like a saferoom.

This is where having many offspring should pay off! I enlisted the help of the remaining children. When I explained the dilemma, I got more “Oh, Dad” eye rolls than the average game of nine-ball. One took a Dr. Pepper before she left, so I was down to hoarder’s surplus minus one. Alone, I dug in for the day.

In the late evening, I was sure a trip the emergency room was in order. The pantry was reverting back to a faceless state, and my stomach was screaming something in Idahoan. I was sweating a substance that looked like maple syrup, which can’t be good. I put in a call to Poison Control where a kind gentleman told me there was no known toxicity in the combination, but urged me to go to the hospital if I felt light-headed. That’s the last thing I remember before passing out amongst the crumbs of the last bag.

When I came to, it was time to go and pick up LW and the youngest. I used the shower squeegee to remove the syrup-sweat and when I arrived, they were ready to go. The trip home was uneventful, I successfully hid the tick and slurred speech caused by sugar intake. While I was unloading the car, LW stopped me.

“Where are the snacks for the party?”

I shrugged my shoulders and grunted. I didn’t ask ‘what party’, I’m sure I’d been told.

“The pantry was full of them.”

“I dunno,” I replied without making eye contact.

“Well, we need more for the party Saturday. Can you go to the store?”

“Uh, sure.”

They say never go to the store hungry. I went full! And I bought $57 worth of Dr. Pepper and Munchos, feeling bloated and quite resentful. Even after all the sweets, this was a bitter pill to swallow.


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11. Why are sex differences frequently overlooked in biomedical research?

By Katie L. Flanagan


Despite the huge body of evidence that males and females have very different immune systems and responses, few biomedical studies consider sex in their analyses. Sex refers to the intrinsic characteristics that distinguish males from females, whereas gender refers to the socially determined behaviour, roles, or activities that males and females adopt. Male and female immune systems are not the same leading to clear sexual dimorphism in response to infections and vaccination.

In 2010, Nature featured a series of articles aimed at raising awareness of the inherent sex bias in modern day biomedical research and, yet, little has changed since that time. They suggested journals and funders should insist on studies being conducted in both sexes, or that authors should state the sex of animals used in their studies, but, unfortunately, this was not widely adopted.

Even before birth, intrauterine differences begin to differentially shape male and female immune systems. The male intrauterine environment is more inflammatory than that of females, male fetuses produce more androgens and have higher IgE levels, all of which lead to sexual dimorphism before birth. Furthermore, male fetuses have been shown to undergo more epigenetic changes than females with decreased methylation of many immune response genes, probably due to physiological differences.

The X chromosome contains numerous immune response genes, while the Y chromosome encodes for a number of inflammatory pathway genes that can only be expressed in males. Females have two X chromosomes, one of which is inactivated, usually leading to expression of the wild type gene. X inactivation is incomplete or variable, which is thought to contribute to greater inflammatory responses among females. The immunological X and Y chromosome effects will begin to manifest in the womb leading to the sex differences in immunity from birth, which continue throughout life.

MicroRNAs (miRNAs) regulate physiological processes, including cell growth, differentiation, metabolism and apoptosis. Males and females differ in their miRNA expression, even in embryonic stem cells, which is likely to contribute to sex differences in the prevalence, pathogenesis and outcome of infections and vaccination.

man woman

Females are born with higher oestriol concentrations than males, while males have more testosterone. Shortly after birth, male infants undergo a ‘mini-puberty’, characterised by a testosterone surge, which peaks at about 3 months of age, while the female effect is variable. Once puberty begins, the ovarian hormones such as oestrogen dominate in females, while testicular-derived androgens dominate in males. Many immune cells express sex hormone receptors, allowing the sex hormones to influence immunity. Very broadly, oestrogens are Th2 biasing and pro-inflammatory, whereas testosterone is Th1 skewing and immunosuppressive. Thus, sex steroids undoubtedly play a major role in sexual dimorphism in immunity throughout life.

Sex differences have been described for almost every commercially available vaccine in use. Females have higher antibody responses to certain vaccines, such as measles, hepatitis B, influenza and tetanus vaccines, while males have better antibody responses to yellow fever, pneumococcal polysaccharide, and meningococcal A and C vaccines. However, the data are conflicting with some studies showing sex effects, whereas other studies show none. Post-vaccination clinical attack rates also vary by sex with females suffering less influenza and males experiencing less pneumococcal disease after vaccination. Females suffer more adverse events to certain vaccines, such as oral polio vaccine and influenza vaccine, while males have more adverse events to other vaccines, such as yellow fever vaccine, suggesting the sex effect varies according to the vaccine given. The existing data hint at higher vaccine-related adverse events in infant males progressing to a female preponderance from adolescence, suggesting a hormonal effect, but this has not been confirmed.

If male and female immune systems behave in opposing directions then clearly analysing them together may well cause effects and responses to be cancelled out. Separate analysis by sex would detect effects that were not seen in the combined analysis. Furthermore, a dominant effect in one of the sexes might be wrongly attributed to both sexes. For drug and vaccine trials this could have serious implications.

Given the huge body of evidence that males and females are so different, why do most scientific studies fail to analyse by sex? Traditionally in science the sexes have been regarded as being equal and the main concern has been to recruit the same number of males and females into studies. Adult females are often not enrolled into drug and vaccine trials because of the potential interference of hormones of the menstrual cycle or risk of pregnancy; thus, most data come from trials conducted in males only. Similarly, the majority of animal studies are conducted in males, although many animal studies fail to disclose the sex of the animals used. Analysing data by sex adds the major disadvantage that sample sizes would need to double in order to have sufficient power to detect significant sex effects. This potentially means double the cost and double the time to conduct the study, in a time when research funding is limited and hard to obtain. Furthermore, since the funders don’t request analysis by sex, and the journals do not ask for it, it is not a major priority in today’s highly competitive research environment.

It is likely that we are missing important scientific information by not investigating more comprehensively how males and females differ in immunological and clinical trials. We are entering an era in which there is increasing discussion regarding personalised medicine. Therefore, it is quite reasonable to imagine that females and males might benefit differently from certain interventions such as vaccines, immunotherapies and drugs. The mindset of the scientific community needs to shift. I appeal to readers to take heed and start to turn the tide in the direction whereby analysis by sex becomes the norm for all immunological and clinical studies. The knowledge gained would be of huge scientific and clinical importance.

Dr Katie Flanagan leads the Infectious Diseases Service at Launceston General Hospital in Tasmania, and is an Adjunct Senior Lecturer in the Department of Immunology at Monash University in Melbourne. She obtained a degree in Physiological Sciences from Oxford University in 1988, and her MBBS from the University of London in 1992. She is a UK and Australia accredited Infectious Diseases Physician. She did a PhD in malaria immunology based at Oxford University (1997 – 2000). She was previously Head of Infant Immunology Research at the MRC Laboratories in The Gambia from 2005-11 where she conducted multiple vaccine trials in neonates and infants.

Dr Katie Flanagan’s editorial, ‘Sexual dimorphism in biomedical research: a call to analyse by sex’, is published in the July issue of Transactions of the Royal Society of Tropical Medicine and Hygiene. Transactions of the Royal Society of Tropical Medicine and Hygiene publishes authoritative and impactful original, peer-reviewed articles and reviews on all aspects of tropical medicine.

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12. What are the costs and impacts of telecare for people who need social care?

By Catherine Henderson


In these times of budgetary constraints and demographic change, we need to find new ways of supporting people to live longer in their own homes. Telecare has been suggested as a useful way forward. Some examples of this technology, such as pull-cord or pendant alarms, have been around for years, but these ‘first-generation’ products have given way to more extensive and sophisticated systems. ‘Second-generation’ products literally have more bells and whistles – for instance, alarms for carbon monoxide and floods, and sensors that can detect movement in and out of bed. These sensors send alerts to a call-centre operator who can organise a response, perhaps call out a designated key-holder, organise a visit to see if there is a problem, or ring the emergency services. There are even more elaborate systems that continuously monitor a person’s activity using sensors and analyse these ‘lifestyle’ data to identify changes in usual activity patterns, but these systems are not in mainstream use. In contrast to telehealth – where the recipient is actively involved in transmitting and in many cases receiving information – the sensors in telecare do not require the active engagement of participants to transmit data, as this is done automatically in the background.

Take-up of telecare remains below its potential in England. One recent study estimated that some 4.17 million over-50 year olds could potentially use telecare, while only about a quarter of that figure were actually using personal alarms or alerting devices. The Department of Health has similarly suggested that millions of people with social care needs and long term conditions could benefit from telecare and telehealth. To help meet this need, it launched the 3-Million Lives campaign in partnership with industry to promote the scaling-up of telehealth and telecare.

Senior woman on phone

The hope held by government and commissioners in the NHS and local authorities is that these new assistive technologies not only promote independence and improve care quality but also reduce the use of health and social care services. To decide how much funding to allocate to these promising new services, these commissioners need a solid evidence base. In 2008, the Department of Health launched the Whole Systems Demonstrator (WSD) programme in three local authority areas in England engaged in whole-systems redesign to test the impacts of telecare (for people with social care needs) and telehealth (for people with long-term conditions).

The research that accompanied the WSD programme was extensive. It included quantitative studies investigating health and social care service use, mortality, costs, and the effectiveness of these technologies. Parallel qualitative studies explored the experiences of people using telecare and telehealth and their carers. The research also examined the ways in which local managers and frontline professionals were introducing the new technologies.

Some results from these streams of research have been published with more to come. From the quantitative research, three articles were published in Age and Ageing over the past year. Steventon and colleagues report on the use of hospital, primary care and social services, and mortality for all participants in the trial – around 2,600 people – based on routinely collected data. Two papers report the results of the WSD telecare questionnaire study (Hirani, Beynon et al. 2013; Henderson, Knapp et al. 2014). The questionnaire study included participants from the main trial who filled out questionnaires about their psychological outcomes, their quality of life, and their use of health and social care services.

The most recent paper to be published in Age and Ageing is the cost-effectiveness analysis of WSD telecare. Participants used a second-generation package of sensors and alarms that was passively and remotely monitored. On average, about five items of telecare equipment were provided to people in the ‘intervention’ group. The whole telecare package accounted for just under 10% of the estimated total yearly health and social care costs of £8,625 (adjusting for case mix) for these people. This was more costly than the care packages of people in the ‘usual care’ group (£7,610 per year) although the difference was not statistically significant. The extra cost of gaining a quality-adjusted life year (QALY) associated with the telecare intervention was £297,000. This is much higher than the threshold range – £20,000 to£30,000 per QALY – used by the National Institute for Health and Care Excellence (NICE) when judging whether an intervention should be used in the NHS (National Institute for Health and Clinical Excellence 2008). Given these results, we would, therefore, caution against thinking that second-generation telecare is the cure-all solution for providing good quality care to increasing numbers of people with social care needs while containng costs.

As with any research, it is important to understand how to best use the findings. The telecare tested during the pilot period was ‘second generation’, so conclusions from this research cannot be applied, for instance, to existing pendant alarm systems currently in widespread use. And telecare systems have continued to evolve since this research started. Moreover, while the results summarised here relate to the telecare participants and do not cover any potential impacts on family carers, there is some evidence that telecare alleviates carer strain.

These findings inevitably raise further questions. What are the broader experiences of those using telecare? What makes a telecare experience positive? And what detracts from the experience? Who can benefit most from telecare? Some answers will emerge as we look across all the findings from the WSD research programme. We also need to look forward to findings from new research, such as the current trial of telecare for people with dementia and their carers (Leroi, Woolham et al. 2013). The ‘big’ question is not whether we should implement a ‘one-size fits all’ solution to meet the increasing demands on social care but for whom do these new assistive technologies work best and for whom are they most cost-effective response.

Catherine Henderson is a researcher at the London School of Economics. She is one of the authors of the paper ‘Cost-effectiveness of telecare for people with social care needs: the Whole Systems Demonstrator cluster randomised trial’, which is published in the journal Age and Ageing.

Age and Ageing is an international journal publishing refereed original articles and commissioned reviews on geriatric medicine and gerontology. Its range includes research on ageing and clinical, epidemiological, and psychological aspects of later life.

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13. The Meaning of Maggie by Megan Jean Sovern | Book Review

Readers will instantly fall in love with Maggie. Her narrative voice is smart, funny and clever, which makes her a highly entertaining, endearing, complex, triple threat.

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14. A revolution in trauma patient care

By Simon Howell


Major trauma impacts on the lives of young and old alike. Most of us know or are aware of somebody who has suffered serious injury. In the United Kingdom over five-thousand people die from trauma each year. It is the most common cause of death in people under forty. Many of the fifteen-thousand people who survive major trauma suffer life-changing injuries and some will never fully recover and require life-long care. Globally it is estimated that injuries are responsible for sixteen-thousand deaths per day together with a large burden of people left with permanent disability. These sombre statistics are driving a revolution in trauma care.

A key aspect of the changes in trauma management in the United Kingdom and around the world is the organisation of networks to provide trauma care. People who have been seriously hurt, for example in a road traffic accident, may have suffered a head injury, injuries to the heart and lungs, abdominal trauma, broken limbs, and serious loss of skin and muscle. The care of these injuries may require specialist surgery including neurosurgery, cardiothoracic surgery, general (abdominal and pelvic) surgery, orthopaedic surgery, and plastic surgery. These must be supported by high quality anaesthetic, intensive care, radiological services and laboratory services. Few hospitals are able to provide all of the services in one location. It therefore makes sense for the most seriously injured patients to be transported not to the nearest hospital but to the hospital best equipped to provide the care that they need. Many trauma services around the world now operate on this principle and from 2010 these arrangements have been established in England. Hospitals are designated to one of three tiers: major trauma centres, trauma units, and local emergency hospitals. The most seriously injured patients are triaged to bypass trauma units and local emergency hospitals and are transported directly to major trauma centres. While this is a new system and some major trauma centres in England have only “gone live” in the past two years, it has already had an impact on trauma outcomes, with monitoring by the Trauma Audit and Research Network (TARN) indicating a 19% improvement in survival after major trauma in England.

Young attractive female doctor looking x-ray photos

Not only have there been advances in the organisation of trauma services, but there have also been advances in the immediate clinical management of trauma. In many cases it is appropriate to undertake “early definitive surgery/early total care” – that is, definitive repair of long bone fractures within twenty-four hours of injury. However, patients who have suffered major trauma often have severe physiological and biochemical derangements by the time they arrive at hospital. The concepts of damage control surgery and damage control resuscitation have emerged for the management of these patients. In this approach resuscitation and surgery are directed towards stopping haemorrhage, performing essential life-saving surgery, and stabilising and correcting the patient’s physiological state. This may require periods of surgery followed by intervals for the administration of blood and clotting factors and time for physiological recovery before further surgery is undertaken. The decision as to whether to undertake early definitive care or to institute a damage control strategy can be complex and is made by senior clinicians working together to formulate an overview of the state of the patient.

Modern radiology and clinical imaging has helped to revolutionise modern trauma management. There is increasing evidence to suggest that early CT scanning may improve outcome in the most unstable patients by identifying life-threatening injuries and directing treatment. When a source of bleeding is identified it may be treated surgically, but in many cases interventional radiology with the placement of glue or metal coils into blood vessels to stop the bleeding offers an alternative and less invasive solution.

The evolution of the trauma team is at the core of modern trauma management. Advances in resuscitation, surgery, and imaging have undoubtedly moved trauma care forward. However, the care of the unstable, seriously injured patient is a major challenge. Transporting someone who is suffering serious bleeding to and from the CT scanner requires excellent teamwork; parallel working so that several tasks are carried out at the same time requires coordination and leadership; making the decision between damage control and definitive surgery requires effective joint decision-making. The emergence of modern trauma care has been matched by the development of the modern trauma team and of specialists dedicated to the care of seriously injured patients. It is to this, above all, that the increasing numbers of survivors from serious trauma owe their lives.

Dr Simon Howell is on the Board of the British Journal of Anaesthesia (BJA) and is the Editor of this year’s Postgraduate Educational Issue: Advances in Trauma Care. This issue contains a series of reviews that give an overview of the revolution in trauma care. The reviews expand on a number of presentations that were given at a two-day meeting on trauma care organised by the Royal College of Anaesthetists in the Spring of 2014. They visit aspects of the trauma patient’s journey from the moment of injury to care in the field, on to triage, and arrival in a trauma centre finally to resuscitation and surgical care.

Founded in 1923, one year after the first anaesthetic journal was published by the International Anaesthesia Research Society, the British Journal of Anaesthesia remains the oldest and largest independent journal of anaesthesia. It became the Journal of The College of Anaesthetists in 1990. The College was granted a Royal Charter in 1992. Since April 2013, the BJA has also been the official Journal of the College of Anaesthetists of Ireland and members of both colleges now have online and print access. Although there are links between BJA and both colleges, the Journal retains editorial independence.

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15. Body Mind Therapies for the Bodyworker

Body Mind Therapies for the Bodyworker
Author: Kathy Gruver, PhD, LMT
Publisher: Infinity Publishing
Genre: Health
ISBN: 978-0-7414-8142-9
Pages: 198
Price: $15.95

Author’s website
Buy it at Amazon

Massage therapy is a wonderful way to pamper and nurture our bodies. But what if there are ways to incorporate deeper levels of healing during a session? Kathy Gruver explores these options in Body Mind Therapies for the Bodyworker.

A massage session doesn’t only have to work on the body. Massage therapists can also use stress reduction, affirmations, and visualization with a client, as well as many other healing techniques such as Reiki and aromatherapy, which can be used simultaneously. And should the client be open-minded, other non-massage therapies may be used.

Traditional medicine often ignores the powerful alternative healing options we have available to us, but Gruver reminds us that these should always be used with caution. Serious medical conditions are best treated by a doctor, and there are quacks selling snake oil to the unwary. But this book shows how to carefully use these remedies which often help in the healing process. Although some techniques are only discussed briefly, websites are provided for the practitioner who is looking for more information. Body Mind Therapies for the Bodyworker provides a nice overview of options available to any massage therapist interested in expanding her healing practice.

Reviewer: Alice Berger


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16. Is the past a foreign country?

By Eugene Milne


My card-carrying North London media brother, Ben, describes himself on his Twitter feed as a ‘recovering Northerner’.

In my case the disease is almost certainly incurable. Despite spending a good deal of last year in cosmopolitan London — beautiful, exciting and diverse as it is — I found myself on occasions near tears of joy as my feet hit the platform at King’s Cross.

“I need to know I can be at the coast or in miles of open countryside within 20 minutes,” I told Ben.

“I need to know I can get Vietnamese food at 3.00 a.m.,” he replied.

While mine is clearly the healthier individual craving, the gulf in population health outcomes between the North and South of England, or, perhaps more accurately, between the provinces and the capital and its South Eastern sprawl, remains as wide as ever.

On examining the distribution of age-standardised mortality for Nomenclature of Territorial Units for Statistics regions, the United Kingdom remains the most starkly unequal of European nations. This is starkly illustrated in our new analyses of the North South divide in England, when compared with the experience of East and West Germany following the fall of the Berlin Wall. After that great political upheaval, notably for women, life expectancy in East Germany began to climb rapidly. Twenty years on, it is indistinguishable from that of the former West Germany.

In contrast, the gap between the North East of England and London, which in 1990 was similar to that between East and West Germany, remains just as wide in the most recent figures. Of course, life expectancy has risen markedly in both countries and their regions; modern North East English life expectancy is significantly higher than that which obtained in 1990 for West Germany. But the English failure to narrow its inequality gap despite overt national efforts signals that those efforts are simply too light-touch to be effective.

600px-Angel_of_the_north,_Gateshead

As Johan Mackenbach has commented, in reflecting on the English strategy from 1997-2010:

“it did not address the most relevant entry-points, did not use effective policies and was not delivered at a large enough scale for achieving population-wide impacts. Health inequalities can only be reduced substantially if governments have a democratic mandate to make the necessary policy changes, if demonstrably effective policies can be developed, and if these policies are implemented on the scale needed to reach the overall targets.”

Of course, fundamental to this problem is economics. The wealth of London and the South East in comparison to, well just about anywhere else in the UK, is now extraordinarily stark. London now feels more alien to my Northern sensibilities than much of Europe, and the reason is not people but cash.

The difference is illustrated rather well by the contrasting artistic expectations of the South Bank Centre — close by the Waterloo offices of Public Health England, for whom I worked last year — and the Culture budget of the City of Newcastle — for whom I now work as Director of Public Health.

On consecutive days in 2013, the Guardian and BBC reported the Southbank Centre’s unveiling of its £100m redevelopment plans (6 March), having made a successful first stage bid for £20m from the Arts Council, and Newcastle City Council was reported (7 March) as having cut its £2.5m culture budget by 50%. This comparison could equally be drawn in many other ways: for transport and infrastructure, investment in business, development of academic institutions (why did the Crick Institute need to be in King’s Cross?). And it all matters because, despite the cleaner air and wide open spaces, the English provinces and in particular the North, are losing out — on culture, mobility, urban environment, jobs, and crucially on health.

The English North has many charms, both for its natives and many who come upon its joys by accident (see this delightful, recent New York Times piece). For too many, however, it remains a place of shorter and poorer lives. The German experience suggests that it need not be so.

Prof. Eugene Milne became Director of Public Health for Newcastle upon Tyne earlier this year, after working nationally for Public Health England as Director for Adult Health and Wellbeing. He is an Honorary Professor in Medicine and Health at the University of Durham, and joint-editor, with his colleague Prof. Ted Schrecker, of the Journal of Public Health. He has research interests in health improvement, inequalities and ageing.

The Journal of Public Health invites submission of papers on any aspect of public health research and practice. We welcome papers on the theory and practice of the whole spectrum of public health across the domains of health improvement, health protection and service improvement, with a particular focus on the translation of science into action. Papers on the role of public health ethics and law are welcome.

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Image credit: Angel of the North, Gateshead, by NickyHall5. CC-BY-SA-3.0 via Wikimedia Commons.

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17. Inequalities in life satisfaction in early old age

By Claire Niedzwiedz


How satisfied are you with your life? The answer is undoubtedly shaped by many factors and one key influence is the country in which you live. Governments across the world are increasingly interested in measuring happiness and well-being to understand how societies are changing, as indicators such as GDP (gross domestic product) do not seem to measure what makes life meaningful. Indeed, some countries, such as Bhutan, have measured national happiness for many years. In the World Map of Happiness below, the countries in green (such as Sweden) have the highest satisfaction. The blue countries are less happy than the green, followed by the pink and orange, and finally the red countries (such as Russia) have the lowest satisfaction. The map conjures up all sorts of interesting questions, like what would the map look like if only older or younger people were included or does happiness vary much within a country?

World of Happiness map

A U-shaped relationship between age and life satisfaction is often reported, meaning that people are happiest in their 20s and their 60s. But what are the factors that help older people achieve high life satisfaction? Research in this area is particularly important as a result of increasing life expectancy and growth in the proportion of older people. Measuring average well-being is only one side of the story, however. Countries which have high levels of overall life satisfaction may have large inequalities between the richest and poorest in society.

What type of country fosters a more equitable distribution of well-being? This is the focus of our paper recently published in Age and Ageing. We studied the influence of socioeconomic position on life satisfaction in over 17,000 people aged 50 to 75 years old from 13 European countries participating in the Survey of Health, Ageing, and Retirement in Europe (SHARE). To measure socioeconomic position, we used a number of different measures that reflected their position in society at different stages of their life. By looking at their relative position in their own country’s social hierarchy, we created a scale that enabled comparison between countries and across the life course measures. From childhood, we looked at the number of books people reported they had when they were aged 10 years old, a measure of the family’s cultural and economic resources. Education level was used as a measure of early adulthood social position and current wealth was taken as a measure of economic position at the time of the survey. We grouped countries into four categories based on the characteristics of their welfare policy and looked at whether socioeconomic inequalities in life satisfaction varied by the type of welfare state a country fits into.

Intriguingly, we found that Scandinavian (Sweden and Denmark) followed by Bismarckian countries (Germany, Belgium, Switzerland, the Netherlands, Austria, and France) had both higher life satisfaction and narrower differences in well-being between those at the top and bottom of society. Scandinavian countries are traditionally characterised by their high levels of welfare provision, universalism, and the promotion of social equality. Bismarckian countries are characterised by welfare states that maintain existing social divisions in society, in which social security is often related to one’s earnings and administered via the employer. Southern (Greece, Italy, and Spain) and Post-communist (Poland and the Czech Republic) countries, which tend to have less generous welfare states, had lower life satisfaction and larger social inequalities in life satisfaction. The number of books in childhood was a significant predictor of quality of life in early old age in all welfare states, apart from the Scandinavian type, and the relationship was particularly strong among women in the Southern countries. On the whole, however, inequalities in life satisfaction were largest by current wealth across the majority of welfare states.

Our findings have important implications, especially given the welfare policy changes taking place across Europe and the growth in wealth inequalities. It raises questions about how future generations of people are going to experience their early old age. Will average well-being and inequalities between the richest and poorest change as less welfare support is available? What will be the impact of increases in the retirement age? It is clear that these are urgent questions which affect us all and that the policies governments pursue are likely to shape the answers.

Claire Niedzwiedz (@claire_niedz) is a final year doctoral researcher at the University of Glasgow’s Institute of Health and Wellbeing and is part of the Centre for Research on the Environment, Society and Health (CRESH). They tweet at @CRESHnews. She is the author of the paper ‘The association between life course socioeconomic position and life satisfaction in different welfare states: European comparative study of individuals in early old age’, published in the journal Age and Ageing.

Age and Ageing is an international journal publishing refereed original articles and commissioned reviews on geriatric medicine and gerontology. Its range includes research on ageing and clinical, epidemiological, and psychological aspects of later life.

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Image credit: Satisfaction with Life Index Map coloured according to The World Map of Happiness, Adrian White, Analytic Social Psychologist, University of Leicester. Public domain via Wikimedia commons

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18. Poking Fun at the Enemy

One can learn so much from children. Too often, in our haste to exercise control of every situation, we grown-ups unfortunately root out their innate curiosity and creativity. We drive from point A to point B without noticing the roadside art, whim, and fancy of the trip that is not lost on the childish mind. There is joy to be had in every journey.

I have recently learned you can poke fun at even the vilest of enemies. If you haven’t had a run with my current foe, hold on – cancer will find you somewhere. I don’t wish it on anyone, but unfortunately it worms its way into everyone’s life at some point whether through family or acquaintance. The Myers clan is relatively new at this contest. There is no rule book or instruction manual that I can find. No article 7, subsection 34b that tells us we can’t fight this demon with a joke and a smile.

Sometimes, you have to laugh to keep from drowning in tears. While my bald, frail daughter lays in what was formerly my bed, at times, she seems to find ways to make us smile.

Take for instance a little wresting match with her sister when she attempted to apply a surprise atomic wedgie, but was blocked by the classic counter: the roll onto the back. Rather than move to a frontal assault, she poked her lip out and meekly proclaimed, “But I have cancer.”

With that, her sister waved the white flag, accepted defeat, and soon left the room to repair the damage to her drawers in private.

*****

Just the other day while urging her to drink more water to avoid dehydration and the inevitable trip back to the hospital, I declared, “If you don’t take a drink I’m going to sit on you.”

Her immediate response, “The doctor says you can’t sit on chemo patients.”

Touche, young one! Touche!

*****

 

Yes, we might be behind shoddy castle walls with little defense besides a catapult and barnyard animals, but we have our smiles and cheery hearts. The enemy can’t take that away.

Now leave before I taunt you a second time!

 


Filed under: Learned Along the Way

6 Comments on Poking Fun at the Enemy, last added: 7/10/2014
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19. Hospital 101 for the Incurably Immature

My girls have grown accustomed to it, but their friends constantly remark on my maturity level, which isn’t high. My personal favorite was a comment from a friend of the eldest, who said, “Your dad is like, 7!” Very true. So with all of the time we are spending at the hospital now, I have developed a list of things my childish mind WANTS to do.

1. Every day we walk past a sleep study area to get to our room. I yearn to yell, beat on the walls, and bang pots and pans to wake everyone up.

2. My daughter has a bright-red diode sometimes hooked to her finger that measures her blood oxygen level. I am literally dying to turn the lights off and stick it in my nose and play Rudolf the Red-Nosed Reindeer. She has told me in no uncertain terms that this is unacceptable and her word is law right now.

_MG_13173. I want to drape a stethoscope around my neck and diagnose someone. I don’t really want to barge into a room and play doctor. I just want to find someone, take their vital signs, and prescribe rest and that they lose five pounds before I ask for my co-pay.

4. There are so many things to ride around her that it is killing me. With the wide halls and automatic doors, an epic race seems in order. I picture it a little bit like Mario Kart.Operation_Room,_Kitchener_Hospital_Brighton,_searching_for_a_bullet_(Photo_24-7)

5. I want to run out of our room and yell something like, “Code Blue! Stat!” I don’t know what would happen, but everyone seems to fly into a dither on TV.

6. Get a lab coat and join the doctors on their rounds. I could be some travelling expert from Albania and mutter things that make no sense when it is my turn to examine the patient.

 

 

I haven’t done any of these things yet. Every time I get a 7 year-old notion, my 46 year-old mind overrules it. Thus far. While this wonderful place heals the sick, there is no hope of them helping me, the incurably immature.

 

Photo credit: By Alex Proimos (Flickr: The Stethoscope) & H. D. Girdwood

 


19 Comments on Hospital 101 for the Incurably Immature, last added: 4/29/2014
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20. The Ebola virus and the spread of pandemics

By Peter C. Doherty


A recent New York Times editorial by author David Quammen highlighted the seriousness of the current Ebola outbreak in Guinea, but made the point that there is no great risk of any global pandemic. That’s been generally true of the viruses that, like Ebola, cause exudative diathesis, or bleeding into the tissues, and present with horrific symptoms. There’s a whole range of such infections caused by a spectrum of different virus types. These pathogens are generally maintained asymptomatically in wildlife “reservoir” species, including fruit and insectivorous bats, monkeys, field mice, and various other rodent species. Breathing dust contaminated with dried mouse feces can lead, for example, to infection with the Sin Nombre hantavirus that caused a recent outbreak in Yellowstone National Park. Others (like Ebola) may “jump” across to us from bats and are then transmitted between people following contact with contaminated human blood and other secretions.

Ebola virus.

Ebola virus virion.

From the pandemic aspect, the most dangerous we’ve seen to date is the SARS coronavirus that, in 2002, came out of nowhere to kill some 800 people in the Asia/Pacific region and also caused cases in Toronto. Spread via the respiratory route or by hand-to-face transmission following contact with contaminated surfaces this virus would, if it had emerged prior to the 19th century development of the germ theory of infectious disease, have gone on to cause a continuing human problem. As it was, once the virologists had identified the virus and worked out its mechanism of spread, instituting rigorous sanitation procedures (especially hand washing) and practicing  “barrier nursing” (latex gloves, face masks, disposable gowns) with afflicted patients led to the disease essentially “burning out” in humans. Authorities in the Middle East are, though, keeping a close watch on the closely related MERS coronavirus, which has caused a few human cases and may be maintained in nature as an asymptomatic infection of Egyptian tomb bats and camels. Could the MERS-CoV be the source of  “The Curse of the Mummy’s Tomb”?

Even in the absence of specific antiviral drugs and vaccines, modern science protects us by defining the problem so that public health and medical professionals can take appropriate counter-measures. Still, though such viruses do not generally change their mode of transmission to spread readily by the dangerous respiratory route (we can’t choose when and where to breathe!), the basic message is that the price of freedom (from such infections) is constant vigilance. That’s why government agencies like the CDC and the US Public Health Service are so important for our defense. So far, the “worst-case” pandemic scenario for any hemorrhagic fever virus is that portrayed in the movie Contagion. Hopefully, a catastrophe of such magnitude will remain in the realm of fiction, but we do need to keep our guard up.  The much more immediate and likely pandemic danger is always, so far as we are aware, from the influenza A viruses.

Peter C. Doherty is Chairman of the Department of Immunology at St. Jude’s Children’s Research Hospital, and a Laureate Professor of Microbiology and Immunology at the University of Melbourne. He is the author of The Beginner’s Guide to Winning the Nobel Prize: Advice for Young Scientists, Their Fate is Our Fate: How Birds Foretell Threats to Our Health and Our World, published in Australia as Sentinel Chickens: What Birds Tell us About Our health and the World, A Light History of Hot Air and Pandemics: What Everyone Needs to Know.

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Image: Ebola virus virion. Public domain via Wikimedia Commons.

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21. Survive! Inside the Human Body | Series Review

Combining science and graphic novels is a fantastic way to capture and satisfy the natural curiosity and interest of early and middle readers. The Survive! Inside the Human Body trilogy presents a fun and practical way to introduce complex human biology concepts to readers interested in learning more about the digestive, circulatory and nervous systems.

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22. You Deserve a Vacation

There’s no reason not to take a vacation when you can book Cheap Bahamas Cruises From Fort Lauderdale.

Did you know that 87% of Americans say that if they had the time and money they would take a vacation? But in reality, they have a problem when it comes right down to taking it even though they have earned paid time off from work.

According to a study put on Marketplace, in 2012, most working Americans never took 9 of the total vacation days that they earned. Cruise and Tours Center in Miami Beach, FL, offers such affordable vacation packages that money should not be an excuse.

Cruise and Tours Center offers Bahamas For Fun discount vacation packages to the popular destinations of the Grand Bahamas Islands in the Caribbean. Choose one of our day cruises, overnight and multi day accommodations in the Grand Bahamas, or Bahamas split cruises.

As Americans continue to feel pressured to stay at work instead of taking their due vacations, Bahamas For Fun Vacation Packages are ready for booking to relieve them of the stress that being over worked puts on them.

The fact of the matter is that vacations benefit the employee and their employer. It has been proven time and again that employees that take time off are better employees. A vacation allows them downtime to relax and get refreshed. They return to work recharged, happy, and ready to go. Employee productivity is higher when vacation time is taken on a regular basis.

There are a variety of venues in the magnificent resort islands throughout the Grand Bahamas for everyone—families, couples, and singles. No matter which package you choose, Cheap Bahamas Cruises From Fort Lauderdale ensures your experience is positive.

Bahamas For Fun makes it so easy and affordable for any resident or tourist of Miami or Fort Lauderdale. Your complete vacation is arranged and reserved. We even provide transportation to and from your location or hotel to the port.

You can customize an island escape and book a 2 to 5 night stay on land. Upon arrival, unwind on the white sand beaches, enjoy a water attraction like parasailing or deep sea diving, or select one of the many available tours.

Call a tour operator at Cruise and Tours Center at 305.397.8170 (toll free 1.888.300.9565). You can also book right online at bahamas4fun.com, or email us at info@Bahamas4Fun.com

Book your Cheap Bahamas Cruises From Fort Lauderdale today and become a happy employee by taking the vacation that you deserve.

 

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23. The Art of Adding Humor. Even When You Probably Shouldn’t.

We owe the same kind of hilarious grace to our characters and our young readers. We ask so much of them and it’s only right to give them every emotion in equal measure.

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24. Stepping Outside

DSC_0083

I just put a second coat of stain on half of my deck. It’s been three years since I moved into this place, and until this summer, my backyard remained unfurnished and unused, which is a shame because it was one of my favorite features of my townhouse. This summer I committed and purchased patio furniture from IKEA, but once I laid everything out, I realized that the deck floor was coated with years of mucky grime and algae. After giving it a much needed scrubbing; once the wood dried, the deck also needed staining and sealing. My virgo sun couldn’t let the work go unfinished.

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Oddly enough, I always tend to begin big manual projects at the end of a book. Right now I am putting the finishing touches on my next project with Lee and Low, and like my deck, now that the spreads are completed, I am noticing little things that need adjusting (this is of course before I turn it in and have my editor and art director notice other little things that need tweaking). Fortunately, this book is 80% digital, so unlike my other books, making changes won’t mean completely redoing spreads. On the opposite side of that coin, I can tweak until the cows come home if I let myself.

Working on books is not always fun for me. It’s work, and like all jobs, you have great days and really sucky days (when you wish you had become an accountant). I find that exercise and manual labor give me more good days than bad. When I was finishing work on Bird, I compulsively decided to paint my half of my Brooklyn apartment. Now, with this new project, I am creating a backyard oasis. There’s something to be said about getting outside of my head (which is often messy and filled with cobwebs and dark spooky shadows) and completing a small to medium-sized project to help propel me through the end of a book. I wish I could channel that energy into cleaning my house, but that is never a small project.

The virgo in me loves to work, loves to complete things, loves to help people, and loves to be good at stuff. I was born under a productive and communicative sign –  along with Michael Jackson (MJ FOREVER!!!), Beyonce, soccer champion Ronaldo, and Mother Teresa. When I am not allowing myself time to go outside and play, I become paranoid, stressed, and a bit depressed. I also indulge heavily in sugar (honeybuns give me life!) which leads to weight gain, which leads to lethargy, which kills productivity, which then makes me a crazy person. Summer is a time for renewal. I run and do yoga 5-6 times a week, put down the carbs (okay, most of the carbs) and celebrate the outdoors. It’s also the time when I can fully focus on my art and finish projects. This cycle of growth, productivity, and then self-destruction is one that I am vehement about changing for myself.

As I get older, I aim to be active throughout the year. Many of us artists, though wonderful and creative, can fall into cycles of sadness, self-doubt, and inactivity easily. We work in isolation sometimes also live in isolation. Stepping outside of our heads and selves is key to staying positive and creative. Taking care of our physical bodies is crucial to keeping things in balance. Namaste homies!

Welcome to my blog SCBWI members! I hope you find some of these posts to be of use~

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25. How to prevent workplace cancer

By John Cherrie


Each year there are 1,800 people killed on the roads in Britain, but over the same period there are around four times as many deaths from cancers that were caused by hazardous agents at work, and many more cases of occupational cancer where the person is cured. There are similar statistics on workplace cancer from most countries; this is a global problem.  Occupational cancer accounts for 5 percent of all cancer deaths in Britain, and around one in seven cases of lung cancer in men are attributable to asbestos, diesel engine exhaust, crystalline silica dust or one of 18 other carcinogens found in the workplace. All of these deaths could have been prevented, and in the future we can stop this unnecessary death toll if we take the right action now.

In 2009, I set out some simple steps to reduce occupational exposure to chemical carcinogens.  The basis was the recognition that the overwhelming majority of workplace cancers from dusts, gases and vapours are caused by exposure to just ten agents or work circumstances, such as welding and painting  (see chart). Focusing our efforts on this relatively short priority list could have a major impact.

Many of these exposures are associated with the construction industry. Almost all are generated as part of a process and are not being manufactured for industrial or consumer uses, e.g. diesel engine exhaust and the dust from construction materials that contain sand (crystalline silica).

The strategies to control exposure to these agents are well understood and so there is no need to invent new technological solutions for this problem. Use of containment, localized ventilation targeted at the source of exposure and other engineering methods can be used to reduce the exposures. If further control is needed then workers can wear personal protective devices, such as respirators, to filter out contaminants before they enter the body.

There are also robust regulations to ensure employers understand their obligations to employees, contractors and members of the public, both in Britain through the Control of Substances Hazardous to Health  (COSHH) Regulations and in the rest of Europe via the Carcinogens and Mutagens Directive.

We know that as time goes on, most exposures in the workplace are decreasing by between about 5% and 10% each year. This seems to be true for many dusts, fibres, gases and vapours, and it is a worldwide trend.  There is every reason to believe this is also true for the carcinogenic exposures we are discussing. This means that over a ten-year period the risk of future cancer deaths is may drop by about half.  If we could increase the rate of decrease in exposure to 20% per annum then after 10 years the risk of future disease should have decreased by about 90%.

However, during the five years since my article was published, very little has been done to improve controls for carcinogens at work. Recent evidence from the Health and Safety Executive (HSE), the regulator in Britain, shows widespread non-compliance at worksites where there is exposure to respirable crystalline silica. Most people are still unaware of the cancer risks associated with being a painter or a welder and so no effective controls are generally put in place. There have been no effective steps taken to reduce exposure to diesel engine exhaust, or most of the other “top ten” workplace carcinogens. What is the barrier preventing change?

In my opinion, the main issue is that we don’t perceive most of these agents or situations as likely to cause cancer.  For example, airborne dust on construction sites, which often contains crystalline silica and may contain other carcinogenic substances, is considered the norm. Diesel soot is ubiquitous in our cities and we all accept it even though it is categorized as a human carcinogen. In my paper I complained that there were ‘no steps taken to reduce the risk from diesel exhaust particulate emission for most exposed groups and no particular priority given to this by regulatory authorities.’ Nothing has changed in this respect. We need an agreed commitment from regulators, employers and workers to change for the better.  Perhaps we need to consider requiring traffic wardens to wear facemasks and encourage painters to work in safer healthier ways. At least we should take a fresh look at what can reasonably be done to protect people.

We know that since 2008 the number of road traffic deaths in the United Kingdom has decreased by about a third and downward time trend seems relentless.  Road traffic campaigners have envisaged a future of zero harm from motor vehicles. Similarly we know that the level of exposure to most workplace carcinogenic substances is decreasing. Can we not also consider a future world where we have eliminated occupational cancer or at least reduced the health consequences to a tiny fraction of today’s death toll? It will be a future that our children or their children will inhabit because of the long lag between exposure to the carcinogens and the development of the disease, but unless we act the danger is that we never see an end to the problem.

As a first step we need to have en effective campaign to raise awareness of the problem of workplace cancers and to start to change attitudes to the most pernicious workplace carcinogens.

John Cherrie is Research Director at the Institute of Occupational Medicine (IOM) in Edinburgh, UK, and Honorary Professor at the University of Aberdeen. He has been involved in several studies to estimate the health impact from carcinogens in the workplace. He is currently Principal Investigator for a study that will estimate the occupational cancer and chronic non-malignant respiratory disease burden in the constructions sector in Singapore. In 2014 he was awarded the Bedford Medal for outstanding contributions to the discipline of occupational hygiene. He is the author of the paper ‘Reducing occupational exposure to chemical carcinogens‘, which is published in the journal Occupational Medicine.

Occupational Medicine is an international peer-reviewed journal, providing vital information for the promotion of workplace health and safety. Topics covered include work-related injury and illness, accident and illness prevention, health promotion, occupational disease, health education, the establishment and implementation of health and safety standards, monitoring of the work environment, and the management of recognised hazards.

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