His other car is on Mars.

On Earth, ImageImageImageImageImage drives his red Prius without paying much attention to the San Gabriel Mountains in the distance. He’s lived in the same neighborhood of Pasadena for 18 years, after all.

When he’s driving on Mars, though, every rock he encounters is a new discovery, a step toward humanity’s knowledge of the planet he hopes to visit some day.

Maxwell has the dream job of driving rovers on Mars, and he’s gearing up to take control of the biggest and most sophisticated one yet: Curiosity. He’s one of about a dozen people at NASA tasked with steering the $2.6 billion vehicle from more than 100 million miles away.

“It’s a priceless national asset that happens to be sitting on the surface of another planet,” Maxwell says of the rover, which is set to land on Mars at 1:31 a.m. ET Monday. “You better take that damn seriously.”


As a child, Scott Maxwell dreamed of visiting other planets; now he gets to drive rovers on Mars.

Maxwell loves to talk about how much he loves his job, and his effervescence is infectious, say colleagues at NASA’s Jet Propulsion Laboratory, home to Curiosity’s mission control.

“The thing that always impressed me about Scott was just the passion that he has for what we’re doing. He just loves being a rover driver,” says Steve Squyers, a Mars expert who’s worked closely with Maxwell. “He thinks he’s got the coolest job on the planet, and he’s right, I think.”

The names of the rovers Maxwell has driven so far — Spirit and Opportunity — speak to his upbeat attitude and thirst for immersing himself in what he enjoys doing.

Through his blog and Twitter account @marsroverdriver, Maxwell interacts with all sorts of self-professed “rover-huggers” — people who really love rovers.

Earlier this week Maxwell tweeted, “VIP seats for opening night of @IndyShakes‘s Comedy of Errors! Last chance to see a play before the baby comes Sunday.”

The baby, of course, is the SUV-sized Curiosity, coming to Mars after years of planning and preparation. It’s been more than eight months since it left Earth, and no one can be sure exactly how it will behave, says Maxwell.

Over dinner in Old Pasadena this week, Maxwell and his girlfriend, Kim Lichtenberg — a planetary scientist also working on the rover mission — playfully compared it to having a child, though neither has had children.

“We’re all going to be kind of like new parents,” Lichtenberg says.

“Watch it take its first steps,” Maxwell adds.

Landing Curiosity will be such an amazing feat of engineering that NASA is billing the process “seven minutes of terror.”

Like anxious parents, scientists at the Jet Propulsion Laboratory in Pasadena are eager to see the rover arrive safely, and so are the reporters who have flooded the NASA campus.

Maxwell says he has confidence in the JPL team responsible for the entry, descent and landing of the spacecraft. But if the amazing maneuver goes wrong, the whole effort will have been “all for nothing” for the many people who’ve sacrificing family time and vacations to pour their hearts into it.

“That seven minutes tells you whether the last seven years of your life had a point,” Maxwell says.

A voyage to break down the wall

Maxwell’s eyes widen with joy when he talks about the parts of life he thinks are “awesome”: His girlfriend. His other NASA team members. The Independent Shakespeare Company (@IndyShakes). His first lemon drop cocktail. The Cotswolds.

Something about Maxwell’s thin frame, boyish features and the way he gets giddy over esoteric things resembles Jim Parsons’ character on “The Big Bang Theory,” although Maxwell is more jovial and socially gracious than Sheldon Cooper. His arms seem almost impossibly long as they move about while he explains the rover driving process.

With a youthful complexion and hair that finishes in a short tail on the back of his neck, it’s impossible to guess Maxwell is 41. The first time he ever had lunch with Lichtenberg, she thought, “Aw man, he’s way too young for me. Way too young for me.” Later she found out she’s about six years his junior.

Lichtenberg, fair and blond, grew up with the space program close at hand: Her father is astronaut Byron Lichtenberg, a NASA payload specialist who’s flown on two shuttle missions. She has a Ph.D. in planetary spectroscopy, which deals with the interaction of matter and radiation in planetary environments.

Maxwell, on the other hand, had long assumed that a career in space was out of reach.

He was raised in an economically depressed rural area of eastern North Carolina, although his accent could just as well place him from the Midwest. His parents divorced when he was 7; after his mother moved to Florida, he spent time bouncing between the two states until college.

His father was a railroad engineer for most of his career, although he previously worked as a dean at various colleges.

Carl Sagan was Maxwell’s childhood hero. He adored watching the 13-part TV series Sagan hosted called “Cosmos: A Personal Voyage,” first broadcast in 1980 on PBS.

In one episode, the scientist talked about what it would be like to go to Mars. Only last year, Maxwell watched the episode again and remembered it mentioned a prototype Mars rover, which at that time seemed a futuristic idea.

“I realized in that moment that that’s where I get this sense that I’ve grown up and stepped into this fantasy world that I had when I was a kid, because I have,” he says with excited emphasis.

As a child, Maxwell loved imagining what it would be like to go to other planets. But as an older teen, he assumed he would study hard and end up in a career that seemed more common and attainable than space exploration, such as banking.

“This kind of thing always seemed to me like the kind of thing other people do,” he said. “There’s me. And there’s this big invisible glass wall. And there are people who are doing stuff like that.”

Maxwell believed he could never cross over to the other side of glass wall.


Mission Control for Curiosity at NASA’s Jet Propulsion Laboratory in Pasadena, California.

It wasn’t until he got hired by NASA, after completing his master’s degree in computer science, that he realized the wall never existed.

Maxwell is living his fantasy now, but he hasn’t always had such luck. At age 20, while double-majoring in English and computer science at East Carolina University, he learned that his swollen lymph nodes were a symptom of stage 2 Hodgkin’s lymphoma. The cancer had spread in his neck and chest. He went through nine weeks of radiation treatments and has been cancer-free ever since.

Just days after the treatments ended, he left for graduate school at the University of Illinois at Urbana-Champaign. Going from a state school to a prestigious engineering institution, he was floored on the first day when a professor expected everyone to have already learned the material in the first six chapters of an algorithms textbook. Maxwell had to quickly catch up on his own but says he loved learning so much at once.

And though he feared he couldn’t afford his master’s degree, he found work with the research and development arm of the U.S. Army and left school debt-free.

He had intended to go to Illinois to work toward a Ph.D., but ultimately the cancer changed his priorities.

“I was interested in going out and making tools for people to use,” he says.

JPL came to recruit at his school in fall 1993, and he remembers telling the recruiter how he was fascinated by NASA’s Voyager mission — twin spacecraft that had photographed Jupiter in unprecedented detail. His excitement apparently made an impression: He landed an interview at JPL in January 1994, and started his job that June.

Today, he lives on a quiet Pasadena street, in a cozy house that boasts some of his nerdy treasures, including an extensive collection of science fiction books. “But then my life became science fiction,” he said, explaining why he’s reading more Shakespeare and Dickens these days. As he shows off his collection, his cat Molly purrs, demanding his attention. The brown and black marbling on her otherwise white fur looks somewhat like the Martian landscape, although that’s not why he adopted her.

A glass-paneled cabinet hosts metallic “Star Wars” and Mars rover lunch boxes. There’s a vial of a substance he calls KimSim, a material his girlfriend helped create to figure out how to rescue the Spirit rover after it got stuck in a “sand trap” of alien soil on Mars in 2009.

And there are stones from the Cotswolds, an area in England he bubbles with excitement over. He says, “Wait, wait,” like a child about to demonstrate a new toy, and runs to get a book filled with images of the region. He likes the views from the ground better than the aerial shots — ground-level is more like what a rover would see, he explains.

The wider, well-manicured street perpendicular to his own, with larger houses and roses growing on front lawns, is the sort of place where he’d always wanted to live, but he says the houses are “wicked, ridiculous, crazy expensive.” Still, he loves the house he bought, with the added bonus of a lemon tree growing at its side.

It’s a bit like how he loves his job driving a vehicle on Mars, even though he dreamed of becoming an astronaut.

“Things in my life aren’t quite how I pictured them,” he said, “but they rhyme.”

At NASA, not just a sojourner

It’s been 18 years, but Maxwell still occasionally interrupts himself to say things like “I can’t get over that I work at a place called the Spacecraft Assembly Facility” when he mentions that building at JPL.


James Wang, test conductor for Curiosity, with the test model of the rover used for experiments on Earth.

For the first couple of months there, Maxwell felt like he was in a foreign country where he didn’t speak the language. He says it was fun to be clueless about the acronyms his colleagues were throwing around. “Now, I’ll use 10 acronyms in a sentence and won’t think twice about it,” he says, “but you kind of have to pick up the culture.”

He started out working on software to decode data from spacecraft. He also wrote software to help coordinate various teams working around the world to get commands to spacecraft.

In the mid-1990s, Maxwell was asked if he wanted to work on a mission called Mars Pathfinder. Maxwell had no idea what that was, and working on the team didn’t appeal to him.

What he didn’t know was that Mars Pathfinder would mark the first time NASA had sent an untethered robotic device to another planet. The 90-day mission was carried out by a rover named Sojourner.

“I just thought that was super cool, that really just captured my imagination, that you could go for a walk on another planet,” he says. “Not with your squishy, frail, human body, but you could design a robot body that would go to Mars for you.”

Although he passed up that opportunity, another chance came in 1999 when Brian Cooper, who’d driven Sojourner, approached Maxwell about developing rover-driving software for the next Mars mission.

“More or less before the words were out of his mouth — like, ‘Do you want to come work on this project?’ — I was like, “YES! Yes! I’d like to come work on this project, that’d be the coolest thing in the world, yes!”

That mission was eventually scrapped, but their efforts were put toward a different endeavor that did take off: Spirit and Opportunity, the twin Mars exploration rovers that launched in the summer of 2003.

Maxwell helped write the software that rover drivers would use for the pair, as well as for Curiosity. He would soon move from writing software to using it to command — and ultimately drive — the rovers.

His first time commanding a rover was on his 33rd birthday, in 2004. Spirit hadn’t started moving across the Mars surface yet, but Maxwell and his colleague were checking out the instruments. Maxwell told the rover to ignore the state of a switch on one of the instruments — not exactly driving, he said, “but by golly, I commanded a Mars rover that day.”

The real drama came about three weeks later when he got behind the wheel, so to speak. He remembers obsessing over what he had to do, checking everything multiple times, before sending the driving instructions.

He remembers going home afterwards: “I’m lying there, looking at the ceiling, realizing there’s a robot on another planet doing what I told it to. And that notion of, ‘I’m getting to do this. I’m not dreaming about this anymore. It’s real for me now.’

“I reach out across 100 million miles of emptiness and move something on the surface of another planet. That feeling has never left me.”

The opportunity to drive

You might think a rover driver would control the vehicle using a joystick and virtual reality interface, much like a video game. That’s not how it works. The reason for that: Signals take at least four minutes to travel from Earth to Mars (it could take up to 20 minutes, depending on where the planets are in their orbits), and then the same amount of time for confirmation data to come back.

So rover drivers don’t tell the vehicle to move forward and then wait several minutes for confirmation that it happened before sending the next command. Instead, drivers spend their days writing directions for what the rover will do the next day, sometimes even a few days if it’s a holiday weekend.

Maxwell and colleagues spend the Martian night generating a single batch of commands, which they send to the rover after the vehicle sees sunrise. Drivers work in overlapping 8- to 10-hour shifts preparing the rover for the day ahead. “It’s as if we’re e-mailing the rover its to-do list for the entire day,” Maxwell explains. And at the end of its day, the rover sends information back saying what it did. During the Martian night, the rover goes to sleep.

That might sound risky, letting a vehicle roam around on a planet for several hours without someone guiding its every move in real time. But safety checks are built in. Curiosity will know how far its wheels are moving up and down, so it will stop if it heads into something deeper or higher than the drivers had planned. In that sense, the rover is more like a boat than a plane — stopping is a fine course of action if additional direction is needed, Maxwell explains.

Curiosity can travel up to about 2.5 meters (8.2 feet) per minute, says rover driver John Wright, but in practice it will go a lot slower because the science team will want it to stop and examine its surroundings. A rover may stop and take photos, or — as will be the case with Curiosity — the scientists will want it to stop to perform chemical analyses.


Scott Maxwell wears 3-D glasses to simulate driving a Mars rover at JPL’s Mission Operations area.

Photos the rover takes of its surroundings help the drivers determine where to send it next. The drivers use a 3-D simulation created from the photos to visualize what the rover is seeing. The virtual model of Mars lets drivers work out which commands to transmit each day. Video games have helped several rover drivers hone their skills, including Maxwell, since driving on Mars requires planning and multidimensional thinking.

Any game that shows a large open world, such as “World of Warcraft,” can hone these skills, says Cooper, the first rover driver and the only person to have driven all three rovers NASA has landed on Mars.

“You’re essentially driving a robot with a keyboard 100 million miles away,” says Maxwell. “You can’t always believe what the simulator tells you. If anything does go wrong, there’s no one there to hit the panic switch.”

Besides being manually controlled, the rover also has the capability to drive by itself, detecting hazards through cameras and driving around them. This autonomous mode takes more time, however, so it’s employed less often.

Curiosity is landing in Gale Crater, where it may find evidence the area once was a lake. It will take at least a year to drive Curiosity to its ultimate destination, Mount Sharp, where the rover will examine layers of sediment for organic molecules, which would be signs — but still not proof — that life may have existed on the planet.

Where the rover is going

Maxwell will see some of the images Curiosity takes before anyone else does, but he loves that the public will get to view them soon after on NASA’s website. “I get to take everybody in the world along in the backseat,” he said.

Beyond rover driving, Maxwell genuinely loves the science of Mars. The rover science team has its own busy agenda, but during the mission involving Spirit and Opportunity, Maxwell would point out rocks that might be interesting to examine further, or suggest photographing the sunset on a given day. Sometimes the science team would take him up on his ideas.

“He’s always looking to try to get as much out of the vehicles as possible,” says Squyers, lead scientist of the Mars Exploration Rover mission, which involved Spirit and Opportunity. “Scott is, within the bounds of safety, one of the most enthusiastic rover drivers there is.”

The spirit of his first car

There’s a special love that Maxwell has for Spirit, the first rover he ever drove. Spirit was only supposed to last about 90 days, but the rover kept operating for more than five years.

When Spirit got stuck in May 2009, Maxwell felt like he was in an Indiana Jones movie, trying to rescue the vehicle. The rover’s wheels broke through a crust and the vehicle fell into a sandy trap called Troy, like a car driving into a pool of flour. Even before the accident, one of its six wheels had quit working.


Scott Maxwell, top, Kim Lichtenberg, left, and Pauline Hwang test how to get Spirit out of a Martian “sand trap.”

Maxwell and his colleagues were almost able to pull Spirit out, but not quite. They had figured out a technique, but with the Martian winter coming, the solar panels were tilted away from the sun. Plus a second wheel malfunctioned during escape tactics. Over the winter, something broke — Maxwell says humanity may never know what.

The Opportunity rover, which Maxwell has also had a hand in driving, is still operating. Still, he is nostalgic about the Spirit.

“It’s very much the way you feel about your first car,” Maxwell says. “Spirit was my first car. She was just on Mars. That was the emotional closeness that I felt to her.”

Even after it stopped moving, Spirit was able to continue scientific operations until March 2010, when NASA lost communication with it. The place it got stuck turned out to be extremely interesting — while trying to escape, the rover found soil rich in minerals called sulfates, a component of steam, suggesting that there may have once been conditions on Mars able to support life.

It — or rather “she,” says Maxwell — accomplished this with an attitude of “persistence and determination and never say die.”

Scientists kept trying to communicate until May 2011, when they gave up.

“Spirit will be there for a million years, but I sure hope that there are Martian cities surrounding her,” Maxwell says. He envisions trails commemorating the rovers’ paths and hopes people someday will be “walking the Spirit trail.”

Loving to be curious

Given the busy schedule and odd hours, it helps to be in love with someone who works on Mars, too.

Maxwell and Lichtenberg had been hearing each other as disembodied voices on NASA conference calls for years, while Lichtenberg was a graduate student at the University of Washington in St. Louis. She visited JPL with her adviser on the five-year anniversary of the Spirit and Opportunity mission.

They met in person at a group lunch; each thought the other was attractive. Maxwell spent a couple days working up the nerve to ask her out and finally did on the day beloved science fiction author Ray Bradbury gave a surprise speech at NASA. Maxwell began by asking her, “Is anybody doing anything tonight?” She said a group was going out; he replied that he wanted to go out with a cute girl he’d just met. After she realized he meant her, she said yes — much to Maxwell’s astonishment.

This week, just days before the Curiosity landing, the couple had dinner with me at a quaint Mediterranean restaurant in Pasadena’s Old Town. When they weren’t holding hands, Maxwell was putting his arm around the back of her chair. As they said goodnight for the evening, they kissed three times — and both said they planned to stay up late and sleep in to practice shifting to Mars time.

Part of the fun of working on Curiosity will be living on Mars time for about the first 90 days, Maxwell says. The days on Mars are 40 minutes longer than on Earth. That means Maxwell might start at 8 a.m. Monday, 8:40 a.m. Tuesday, 9:20 a.m. Wednesday and so on. Before long, he’ll be working overnights.

“I like to say I sleep 40 minutes more, I actually work 40 minutes [more],” he said.

Lichtenberg is the co-lead on the science planning team for the Curiosity mission. That means she helps other scientists decide what they will do with the rover every day, given how much power and time the tasks will take and how much data will be required.

On their first date about three and half years ago, Lichtenberg was sold when Maxwell told her that while healing from a martial arts-induced shoulder injury, he decided he would read all of Shakespeare’s plays. And he did.

“He really sticks to his convictions, and I really, really like that about him,” Lichtenberg says. “Being around him makes me want to be a better person.”

Maxwell insists that Lichtenberg did not move to Southern California for him. She agrees that she wanted to work at JPL anyway, but Maxwell was at least “a small bit” of the decision. These days they work down the hall from each other, and although they are on the same operations team, they are assigned to different shifts.


Scott Maxwell and Kim Lichtenberg have been dating for more than three years; both work on Mars rover missions.

The affectionate, happy partners share a love of Mars and, if possible, would both like to go some day.

“If NASA set up a flight tomorrow, I’d be the first one. They wouldn’t have to bring me back,” Maxwell says.

He’d be gone in a snap, even if there were just one seat. Lichtenberg, although she likes the idea of visiting Mars, is not sure she’d just pack up and go by herself.

“I totally understand that you would,” she tells him. “It’s OK, I accept that. Totally.”

“It’s not that I like Mars better than I like you,” he assures her. They peck each other on the lips.

But there is something powerful that draws Maxwell to Mars. It’s partly the idea of being on the surface of another world. There’s also his own mortality. He believes the radiation treatments he had in his 20s will ultimately lead to a different form of cancer (he actually had a possible thyroid cancer a few years ago, which turned out to be benign). Maxwell estimates — without a hint of regret in his voice — that he has about 20 years left to live.

“I’ve only got so long anyway, you might as well make it something really good. Right? You might as well make it count,” he tells me and Lichtenberg. “And what am I going to do that’s going to be better than actually going to Mars? Go on, name three things I’m going to do that are better than that.”

“Drive a Mars rover,” says Lichtenberg.

Maxwell agrees his job is “awesome” but says going to Mars would be “even better.”

With that level of passion and spirit, Maxwell may one day indeed follow his Curiosity.

Mars rover captures Martian panorama

Complete coverage: Mars

Source: CNN

What is IPPNW?

What is IPPNW?

In 1980, in the face of a harrowing nuclear arms-race, two physicians from two very different parts of the world, Dr. Bernard Lown from the US and Dr. Evgeni Chazov from the USSR, got together and decided that the threat of a Nuclear War was too great for this world and that it was the responsibility of physicians to highlight this threat. Together, they founded IPPNW.

Today, IPPNW has broadened its mission and seeks to prevent all wars, to promote non-violent conflict resolution, and to minimize the effects of war and preparations for war on health, development, and the environment.

IPPNW works for:

  • the abolition of all nuclear weapons
  • the demilitarization of the global economy and an end to the arms trade
  • the re-allocation of resources from military to civilian needs, especially to basic health care and human necessities
  • Sustainable and ecologically sound economic development

IPPNW is the only international medical organization dedicated to the abolition of nuclear weapons. Our principal program areas beyond the core mission of nuclear abolition include projects to end the threats posed by landmines, small arms and light weapons, chemical and biological weapons, and the burden of debt on developing nations.

We are the student movement of this organisation – the Medical Students for Peace and Social Responsibility.

Worldwide, IPPNW-Affiliates and Student Chapters are working to advance these goals with diverse and imaginative programs.

Click here to view the structure of the IPPNW Student Movement.

The IPPNW Student Movement is in good contact with the International Federation of Medical Student Associations IFMSA. Click here to read the joint IPPNW-IFMSA declaration.

A brief history of IPPNW

The beginning

Founded in 1980, IPPNW was an inspiration born of the Cold War. With the world divided into two militarized camps poised on the brink of nuclear war, a small group of Soviet and American doctors took a leap of faith. They reasoned that their common interest in survival was more powerful than the ideological divides between them. They believed that their obligation as physicians included a common commitment to the prevention of nuclear war.

Led by co-founders Drs. Bernard Lown of the US and Evgeni Chazov of the Soviet Union, they organized a team to conduct meticulous scientific research based on data collected by Japanese colleagues who had studied the effects of the atomic bombs dropped on Hiroshima and Nagasaki.

And they drew upon their knowledge of the medical effects of burn, blast, and radiation injuries. The doctors sounded a medical warning to humanity: that nuclear war would be the final epidemic; that there would be no cure and no meaningful medical response. Their message reached millions of people around the world. In the words of former New Zealand Prime Minister David Lange, “IPPNW made medical reality a part of political reality.”

In its first five years, IPPNW, working closely with its US affiliate Physicians for Social Responsibility and IPPNW-Russia, educated health professionals, political leaders, and the public about the medical and environmental consequences of nuclear warfare. For this effort, which united physicians across the Cold War divide, IPPNW was awarded the UNESCO Peach Education Prize in 1984 and the 1985 Nobel Peace Prize in 1985.

Throughout the 1980s and the 1990s, IPPNW comprehensively documented the health and environmental effects of the production, testing, and use of nuclear weapons. In a series of well-researched, authoritative books and numerous articles and op-ed pieces in medical journals and the popular press, IPPNW spelled out the tremendous price nuclear weapons states are paying in their pursuit of nuclear weaponry.

From uranium mining to nuclear testing and production, from Nevada to Moruroa and Hanford to Chelyabinsk, IPPNW and its affiliates collected and analyzed data that provides the public with a frightening assessment of the health and environmental costs of pursuing security through nuclear weapons.

IPPNW and its affiliates not only educated the public, they also organized citizens in the nuclear states to protest and change their governments’ policies. IPPNW believes that the active involvement of millions of people is essential if we are to prevent war and abolish nuclear weapons.

Physician-activists were instrumental in the campaigns to ban atmospheric and underground nuclear test explosions and in helping to shut down nuclear weapons testing sites and production facilities.

As the Cold War came to an end, IPPNW had grown to comprise some 200,000 physicians, health care workers, and concerned citizens every region of the world.

Major Accomplishments

When IPPNW mobilizes its vast network of medical organizations throughout the world in support of a campaign, a great deal gets accomplished. IPPNW physician-activists:

  • Created an international medical movement to disseminate factual information about the consequences of nuclear warfare worldwide, receiving the 1985 Nobel Peace Prize for this effort.
  • Promoted Soviet-American dialogue at the height of the Cold War by organizing Soviet and American doctors to bring a non-partisan anti-nuclear message to the people of both countries, reaching millions.
  • Helped stop underground nuclear testing by influencing the Soviet Union to initiate and extend a unilateral moratorium on nuclear testing from 1985-1987.
  • Organized the International Citizens Congress for a Nuclear Test Ban in Kazakhstan, a key event that led to the 1991 closing of the Soviet Union’s principal test site at Semipalatinsk.
  • Helped lead an international lobbying effort in support of a nuclear test ban.
  • Created SatelLife, a health development project that provides state-of-the-art communications technology to exchange critically needed medical information between the North and the South.
  • Established an International Commission to Investigate the Health and Environmental Effects of Nuclear Weapons Production and Testing and worked with the Institute for Energy and Environmental Research to document these effects.
  • Worked with INFACT to organize medical professionals in the GE Boycott, which successfully moved the multinational corporation out of the nuclear weapons industry
  • Helped document with the Harvard Study Team the health effects of the Gulf War.
  • Co-founded the World Court Project with the International Association of Lawyers Against Nuclear Arms and the International Peace Bureau that secured a landmark ruling from the International Court of Justice confirming the illegality of the threat and use of nuclear weapons.
  • Helped spearhead the launch of Abolition 2000, a global campaign to build worldwide support for a signed agreement that sets a firm timetable for nuclear abolition.
  • Participated in the Canberra Commission on the Elimination of Nuclear Weapons.
  • Organized with IPPNW-Russia and the International Campaign to Ban Landmines the first conference on landmines in Russia, a major manufacturer of landmines.
  • Helped launch the Middle Powers Initiative to mobilize key non-nuclear weapons states to encourage the leaders of the nuclear weapons states to commit themselves to the elimination of nuclear weapons.
  • Submitted a revised Model Nuclear Weapons Convention to the United Nations. The treaty was drafted by the Lawyers Committee for Nuclear Policy, the International Network of Engineers and Scientists Against Proliferation, and IPPNW.
  • As this list of accomplishments shows, IPPNW successfully partners with other leading professional and grassroots organizations to further our goals of nuclear abolition and prevention of war.

Milestones – IPPNW’s First Two Decades


  • Drs. Bernard Lown, James Muller, and Eric Chivian from the US meet in Geneva with Drs. Evgeni Chazov, Leonid Ilyin, and Mikhail Kuzin from the Soviet Union and agree to organize an international physicians movement to combat the nuclear threat.


  • IPPNW’s First World Congress is held in Airlie, Virginia, and is attended by 80 physicians from 12 countries. The Congress attracts press coverage, generates scientific research, and provides the foundation for building an international movement.


  • The Second World Congress is held in Cambridge, UK, and is attended by 200 physicians from 31 countries.
  • Soviet and U.S. physicians from IPPNW appear on Soviet television for an unprecedented live, unedited discussion on the consequences of nuclear war. Seen by 100 million Soviet viewers, the program is later broadcast in the US.
  • IPPNW publishes Last Aid: the Medical Dimension of Nuclear War. The book is translated into several languages and is used at leading medical schools worldwide.


  • The Third World Congress is held in Amsterdam, the Netherlands, and is attended by more than 300 physicians from 43 countries.


  • The Fourth World Congress is held in Espoo, Finland, and is attended by 500 physicians from 53 countries. The Impact of Nuclear War on Children and Adolescents, an international research study co-sponsored by IPPNW, is presented.
  • UNESCO honors IPPNW with its Peace Education Prize, citing “especially remarkable activity to inform public activity and mobilize the conscience of mankind for peace.”


  • During the first tour of IPPNW’s new East-West Physicians Campaign, a team of Soviet and US physicians visits five US cities to educate the public about the medical consequences of nuclear war and to promote East-West relations.
  • The Fifth World Congress of IPPNW is held in Budapest, Hungary, and is attended by 800 physicians from 60 countries. The federation now represents more than 135,000 physicians in 41 national affiliates. New emphasis is placed on the relationship between development and disarmament and the need for a nuclear test ban.
  • IPPNW formulates a “Medical Prescription,” calling for a moratorium on nuclear testing. Weeks later, the USSR announces that it will discontinue its testing program for the rest of the year. IPPNW launches an international campaign for a mutual moratorium.
  • In December, IPPNW receives the 1985 Nobel Peace Prize in Oslo. The Nobel Committee commends IPPNW for “considerable service to mankind by spreading authoritative information and in creating an awareness of the catastrophic consequences of atomic warfare.”
  • IPPNW Co-Presidents Lown and Chazov meet with Mikhail Gorbachev and help persuade him to extend the Soviet Union’s unilateral moratorium on nuclear weapons testing.


  • Fifteen hundred physicians from 65 countries examine the moral and ethical aspects of nuclear weapons at IPPNW’s Sixth World Congress in Cologne, Germany.
  • IPPNW leaders travel through the USSR, China, and Japan on the first leg of IPPNW’s Global Campaign. Subsequent legs take IPPNW leaders through five continents on their mission to educate physicians and build the movement.


  • The Seventh World Congress is held in Moscow, USSR, and is attended by more than 2,000 physicians from 70 countries. Representing more than 175,000 physicians, IPPNW is now the fasting growing medical organization in the world.


  • IPPNW co-sponsors the International Scientific Symposium on a Nuclear Test Ban in Las Vegas, Nevada. The Soviet Union conducts the first nuclear test of 1988, triggering protests from IPPNW affiliates as part of the new Cease-Fire campaign. Affiliates continue to protest every single nuclear test.
  • The Eighth World Congress is held in Montreal, Canada, and is attended by 2,500 physicians from nearly 80 countries.
  • Crosby, Stills and Nash and Bruce Cockburn, together with musicians from the USSR and Canada perform at IPPNW’s Concert for Peace. IPPNW’s Concert Tour for Peace begins in Berlin (West). Under the direction of the late Antal Dorati, an international orchestra and chorus perform Beethoven’s “Missa Solemnis” in four cities in five days.
  • In response to a growing crisis created by nuclear weapon manufacture, IPPNW creates the International Commission to Investigate the Health and Environmental Effects of Nuclear Weapons Production.
  • In December, an earthquake devastates parts of Soviet Armenia. IPPNW secures millions of dollars worth of medical supplies and arranges for medical teams to enter the quake-stricken region.


  • SatelLife is incorporated under the auspices of IPPNW to develop programs using space technology for medical purposes with an emphasis on the developing world.
  • A new IPPNW publication, Medicine and Nuclear War: A Model Curriculum, helps medical school faculty include information on medicine and nuclear war in their programs.
  • At IPPNW’s Ninth World Congress in October, 3,000 physicians meet in the two cities victimized by the atomic bombs: Hiroshima and Nagasaki.


  • Together with the Soviet grass-roots movement “Nevada-Semipalatinsk-Moruroa,” IPPNW convenes the International Citizens Congress for a Nuclear Test Ban in Alma-Ata and Semipalatinsk, USSR. The historic event revitalizes the Comprehensive Test Ban campaign.
  • SatelLife plans next year’s launch of a communications satellite that would provide vital information services to medical communities in the developing world.


  • IPPNW releases Radioactive Heaven and Earth, the first formal report of IPPNW’s International Commission to Investigate the Health and Environmental Consequences of Nuclear Weapons Testing and Production.
  • SatelLife creates HealthNet, an inexpensive, reliable communication system providing physicians in both hemispheres a means of solving problems together.
  • More than 1,300 IPPNW activists from 80 nations assemble in Stockholm, Sweden for IPPNW’s Tenth Anniversary World Congress.
  • During the Gulf War, IPPNW sends investigators, publicizes the health effects of the war, advocates for peace, and delivers tons of medical and nutritional supplies.


  • The second volume of research by the International Commission, Plutonium: Deadly Gold of the Nuclear Age, is published.
  • Medical supplies and equipment are delivered to the former Soviet Union in response to shortages following its breakup.
  • To help persuade the new nuclear states Belarus, Kazakhstan, and Ukraine to give up the nuclear arsenals they inherited from the Soviet Union, IPPNW works with its Russian affiliate on a broad educational and media campaign.
  • The World Court Project is launched in conjunction with the International Peace Bureau and the International Association of Lawyers Against Nuclear Arms. The goal of the project is to have the International Court of Justice issue an advisory opinion on the illegality of nuclear weapons.
  • African affiliates aid refugees from the war in Somalia and help document the health effects of the war.


  • The Eleventh World Congress takes place in Mexico City, the first in the developing world.
  • At IPPNW’s urging, the World Health Organization votes to petition the World Court for an advisory opinion on the legality of nuclear weapons use.
  • Demonstrations and letter writing help lead to an extension of the nuclear testing moratorium.
  • Russian and Japanese affiliates lead the federation’s protest against Russian dumping of liquid radioactive waste in violation of a ten year moratorium. This was followed by a world ban on nuclear and industrial waste dumping at sea by the London Convention.
  • IPPNW works with Medipaz, our Nicaraguan affiliate, to produce a study on The War in Nicaragua: The Effects of Low-Intensity Conflict on an Underdeveloped Country.


  • The United Nations General Assembly requests an advisory opinion from the World Court on the legality of the threat or use of nuclear weapons; 34 national governments submit legal arguments to the Court. IPPNW joins in presenting 110 million citizens’ signatures to the Court in opposition to nuclear weapons.
  • An unprecedented tour by Russian Physicians for the Prevention of Nuclear War (RPPNW) to four principal nuclear weapons sites in the U.S. takes place as part of RPPNW’s continuing public education campaign on the nuclear threat.
  • The Abolition 2000 campaign is launched with the goal of building worldwide support for a signed global agreement by the year 2000 that sets a firm timetable for nuclear abolition.


  • At a top-level NPT symposium, IPPNW’s case for nuclear abolition is received enthusiastically by an audience that included diplomats, disarmament experts, and the public.
  • A senior IPPNW delegation travels to Paris to meet in person with high-level French officials to protest planned nuclear tests in the South Pacific.
  • The release of Nuclear Wastelands, the magnum opus of IPPNW’s International Commission, is publicly lauded as the most comprehensive and authoritative reference on the devastating health and environmental effects of fifty years of nuclear weapons production.
  • Chinese physicians join IPPNW, giving it an affiliate in every nuclear weapons state. Abolition 2000 — Handbook for a World Without Nuclear Weapons is released to help physician-activists develop their dialogue and non-confrontational communication skills for use with governments and decision-makers.


  • IPPNW releases the first report of a new information series: Global Health Watch. Crude Nuclear Weapons: Proliferation and the Terrorist Threat evaluates the risks and potential consequences of nuclear terrorism in a world where fissile materials could fall into the hands of terrorists.
  • The 12th World Congress is held at the College of the Holy Cross in Worcester, Massachusetts (USA). The theme of the Congress is Peace Through Health: Agenda for the New Millennium.
  • Dr. R. S. McCoy, IPPNW Co-President, sits on the prestigious Canberra Commission on the Elimination of Nuclear Weapons.
  • IPPNW helps push through a final agreement on the long-awaited Comprehensive Test Ban Treaty.


  • IPPNW produces the comprehensive report Landmines: A Global Health Crisis, the second in the Global Health Watch series.
  • IPPNW joins commission of Nobel Peace Laureates to promote an International Code of Conduct on Arms Transfers.
  • As part of the International Campaign to Ban Landmines, IPPNW celebrates the award of the 1997 Nobel Peace Prize to Jody Williams and the ICBL.
  • Medicine & Global Survival and Medicine, Conflict and Survival are designated IPPNW journals.


  • Efforts to secure an international agreement on the elimination of nuclear weapons by the year 2000 were advanced in a Geneva meeting among NGOs, including IPPNW, and dozens of state representatives to the UN Conference on Disarmament.
  • With IPPNW support, the Middle Powers Initiative is launched — an effort by several NGOs to mobilize the influence of key non-nuclear states to press the nuclear powers on disarmament issues.
  • IPPNW organizes its first ever North Asia regional meeting to address critical nuclear security issues among Japan, China, and the Koreas.
  • IPPNW organizes a major conference on landmines in Moscow with the International Campaign to Ban Landmines. This is the first such forum held in Russia, a major manufacturer of landmines.


  • IPPNW works with IALANA, the International Peace Bureau, and other peace, disarmament, and human rights groups to help organize the Hague Appeal for Peace; IPPNW members conduct workshops and IPPNW medical students organize a 10-day training session on peace and disarmament issues.
  • IPPNW publishes Is Everything Secure? Myths and Realities of Nuclear Disarmament.
  • The Australian affiliate holds the 13th World Congress in Melbourne.
  • Security and Survival: The Case for a Nuclear Weapons Convention is produced by IPPNW in cooperation with the Lawyers Committee for Nuclear Policy and the International Network of Engineers and Scientists Against Proliferation. The book, released at the UN during the Non-Proliferation Treaty PrepCom, is a valuable organizing tool in the campaign for nuclear abolition.
  • IPPNW leaders meet with India’s Prime Minister to call for nuclear abolition. Bombing Bombay: The Effects of Nuclear Weapons and a Case Study of a Hypothetical Explosion is released in South Asia to help activists campaign for nuclear abolition.

Official Statement of the Nobel Committee Upon Awarding the 1985 Nobel Peace Prize to IPPNW:

“The Norwegian Nobel Committee has decided to award the Nobel Peace Prize for 1985 to the organization International Physicians for the Prevention of Nuclear War.

It is the committee’s opinion that this organization has performed a considerable service to mankind by spreading authoritative information and by creating an awareness of the catastrophic consequences of atomic warfare. The committee believes that this in turn contributes to an increase in the pressure of public opposition to the proliferation of atomic weapons and to a redefining of priorities, with greater attention being paid to health and other humanitarian issues.

Such an awakening of public opinion as is now apparent both in the East and the West, in the North and in the South, can give the present arms limitation negotiations new perspectives and a new seriousness. In this connection, the committee attaches particular importance to the fact that the organization was formed as a result of a joint initiative by Soviet and American physicians and that it now draws support from the physicians in over 40 countries all over the world.

It is the committee’s intention to invite the organization’s two founders, who share the title of president — Professor Bernard Lown from the USA and Professor Evgeni Chazov from the Soviet Union — to receive the Peace Prize on behalf of their organization.”

Working to Abolish Nuclear Weapons

IPPNW continues to unite and activate people across political divides to prevent nuclear war. The global threat posed by nuclear weapons is more acute, immediate and entrenched than ever, as even the head of IAEA, Mr. El Baradei recently pointed out. IPPNW works to bring the nuclear weapons states (the US, Russia, the UK, France, China, India and Pakistan) to disarm their huge arsenals. Our understanding of the devastating potential of these weapons is rooted in the terrible experience of the people of Hiroshima and Nagasaki. Still – the weapons used in 1945 were tiny compared to most of the approximately 30,000 weapons in today’s arsenals. A single modern weapon, exploded either intentionally or accidentally over a large city, is capable of slaughtering millions.

If a larger number of weapons are exploded, in form of an uncontrollable chain-reaction, the overall consequences will include not only short- and medium-term medical injuries in the billions, but also severe environmental effects, disruption of transportation, delivery of food, fuel, and basic medical supplies as well as famine and mass starvation on a global level.

The effects of a nuclear explosion are so devastating that many people today are in denial about the continued threat. At the same time, a succession of arms control agreements and the end of the Cold War have combined to create a popular myth that the threat of nuclear war has ended. IPPNW works to dispel this dangerous misconception that has lessened public pressure for the steps needed to end the nuclear threat. The myth is also dangerous because it underestimates the capacity and willingness of nations to wage war when their perceived interests are at stake and to use whatever weapons are necessary to secure those interests. Finally, it is dangerous because it perpetuates the system of nuclear double standards that grants the powerful states permission to maintain nuclear arsenals.

Click here to view some interesting facts of Nuclear Weapons in today’s world.

Promoting peace and development

Because of our concern for global health in the broadest sense, IPPNW expanded its mission in 1991 to include the prevention of all forms of warfare and the promotion of alternate means of conflict resolution. Conventional warfare is responsible for human suffering and death on a pandemic scale. The 20th century has been the most violent in history, killing at least 110 million people. Since the fall of the Berlin wall, more than four million people, many of them women and children, have died in violent conflicts. Right now, more than 35 million people were refugees or had been displaced by war.

For many IPPNW affiliates – especially those in the developing world – the effects of war on public health are a reality of every day life. In war-torn countries, doctors work to heal the physical and psychological wounds of violent conflict. Because prevention of war is essential in ensuring health, IPPNW physicians travel to areas of worsening conflict to promote peaceful means of conflict resolution. This idea finds it concrete realization in the concept of “Peace through Health”. Members of IPPNW’s affiliates have been active in promoting peace in the Middle East, Africa, Latin America, and the former Yugoslavia. Teams of IPPNW doctors also conduct fact-finding missions to assess and publicize the effects of conventional war and so-called low-intensity conflict on health. IPPNW medical students focus on the effects of war on children, raise awareness of the health effects of war, violence and nuclear arms amongst their peers, organize visits to refugee camps and are active in the landmines campaign, amonsgt other things.

IPPNW recognizes that war and militarism rob both rich and poor societies – especially the poor – of the resources needed to protect and promote health. In a world armed to the teeth, precious resources are poured into the military while billions go without food and health care. Accordingly, IPPNW advocates a readjustment of global priorities that will lead to a just and lasting peace. Whether delivering antibiotics and vitamins to famine victims in North Korea, speaking out on behalf of brutalized physicians in Nicaragua, conducting needs-assessment of AIDS-orphans in Kenya, or introducing a “War and Health” curriculum in Cuban medical schools, IPPNW physicians are working to counteract the overwhelming culture of violence and change it into one of peace.

IPPNW is also aware that environmental degradation, inequitable use of the world’s scarce resources and population growth are potential sources of future conflicts. Freedom from war is a prerequisite to the global cooperation that will be needed to redress the environmental crisis. IPPNW sees opposition to war and militarism as an essential contribution to restoring and protecting the global environment.

Educational Outreach

As community, national and regional leaders, IPPNW physicians, medical students and other health professionals reach millions with the message of peace and health for all. Through speaking tours, symposia and media campaigns, IPPNW is helping to create a new way of thinking about global security. Our activists help educate decision makers, students and the general public about the continuing nuclear threat and the enormous costs of war to public health.

IPPNW publishes books and reports on its core issues as well as the newsletter Vital Signs and the journal Medicine and Global Survival. IPPNW experts frequently publish articles in newspapers and medical journals and appear on television or radio around the world. IPPNW World Congresses bring thousands of physicians, medical students, scientists, world leaders and activists together to share new scientific information on IPPNW issues and to express their common commitment to ending nuclearism and militarism. IPPNW has held Congresses in the US, the UK, the Netherlands, Finland, Hungary, Germany, the Russia, Canada, Japan, Sweden, Mexico and China. The latest World Congress was held in Finnland in 2006.

Source: IPPNW

Medical Voices – Dr. Abhinav Singh on Fukushima

Curiosity Rover Just Hours from Mars Landing.

NASA’s Mars Science Laboratory spacecraft is healthy and right on course for a landing in several hours that will be one of the most difficult feats of robotic exploration ever attempted.

Emotions are strong in the control room at NASA’s Jet Propulsion Laboratory, Pasadena, Calif., as the hours and miles race toward touchdown of the car-size Curiosity at about 10:31 p.m. PDT tonight (about 1:31 a.m. Aug. 6, EDT).

“Excitement is building while the team is diligently monitoring the spacecraft,” said Mission Manager Brian Portock of JPL. “It’s natural to get anxious before a big event, but we believe we are very well prepared.”

Descent from the top of Mars’ atmosphere to the surface will employ bold techniques enabling use of a smaller target area and heavier landed payload than were possible for any previous Mars mission. These innovations, if successful, will place a well-equipped mobile laboratory into a locale especially well-suited for this mission of discovery. The same innovations advance NASA toward capabilities needed for human missions to Mars.

Controllers decided Sunday morning to forgo the sixth and last opportunity on the mission calendar for a course-correction maneuver. The spacecraft is headed for its target entry point at the top of Mars’ atmosphere precisely enough without that maneuver.

Later today, mission controllers will choose whether or not to use a last opportunity for updating onboard information the spacecraft will use during its autonomous control of the entry, descent and landing. Parameters on a motion tracker were adjusted Saturday for fine-tuning determination of the spacecraft’s orientation during the descent.

At the critical moment of Curiosity’s touchdown, controllers and the rest of the world will be relying on NASA’s Mars Odyssey orbiter to provide immediate confirmation of a successful landing. Odyssey will turn to point in the right direction beforehand to listen to Curiosity during the landing. If for any reason that turn maneuver does not work, a successful landing cannot be confirmed until more than two hours later.

The landing will end a 36-week flight from Earth and begin at two-year prime mission on Mars. Researchers will use Curiosity’s 10 science instruments to investigate whether Martian environmental conditions have ever been favorable for microbial life.

Source: http://mars.jpl.nasa.gov


The Efficacy of Cap-Assisted Colonoscopy in Polyp Detection and Cecal Intubation: A Meta-Analysis of Randomized Controlled Trials.

The role of cap-assisted colonoscopy (CAC) in polyp detection and cecal intubation is unclear. We conducted a meta-analysis to compare the efficacy of CAC vs. standard colonoscopy (SC).


Publications in English and non-English literatures (OVID, MEDLINE, and EMBASE) and abstracts in major international conferences were searched for controlled trials comparing CAC and SC. Outcome measures included the proportion of patients with polyps or adenomas detected, cecal intubation rate, cecal intubation time, and total colonoscopy time. The statistical heterogeneity of trials was examined and the effects were pooled by random-effects model. The risk of bias was evaluated by the assessment tool from the Cochrane Handbook. Subgroup analyses were performed for possible clinical and methodological heterogeneities.



From 2,358 citations, 16 randomized controlled clinical trials were included consisting of 8,991 subjects (CAC: 4,501; SC: 4,490). Mean age of subjects was 61.0 years old and 60% were males. CAC detected a higher proportion of patients with polyp(s) (relative risk (RR): 1.08; 95% confidence interval (CI): 1.00–1.17) and reduced the cecal intubation time (mean difference: −0.64 min; 95% CI: −1.19 to −0.10). Cecal intubation rate (RR: 1.00; 95% CI: 0.99–1.02) and total colonoscopy time (mean difference: –0.97 min; 95% CI: −2.33 to 0.40) were comparable between the two groups. In subgroup analyses, a short cap (≤4 mm) was associated with improved polyp detection, whereas a long cap (≥7 mm) was associated with a shorter cecal intubation time.



CAC demonstrated marginal benefit over SC for polyp detection and shortened the cecal intubation time.

Source: American Journal of Gastroenterology.

Capnographic Monitoring Reduces the Incidence of Arterial Oxygen Desaturation and Hypoxemia During Propofol Sedation for Colonoscopy: A Randomized, Controlled Study (ColoCap Study).

The aim of this randomized study was to determine whether intervention based on additional capnographic monitoring reduces the incidence of arterial oxygen desaturation during propofol sedation for colonoscopy.


Patients (American Society of Anesthesiologists classification (ASA) 1–3) scheduled for colonoscopy under propofol sedation were randomly assigned to either a control arm with standard monitoring (standard arm) or an interventional arm in which additional capnographic monitoring (capnography arm) was available. In both study arms, detection of apnea or altered respiration induced withholding propofol administration, stimulation of the patient, chin lift maneuver, or further measures. The primary study end point was the incidence of arterial oxygen desaturation (defined as a fall in oxygen saturation (SaO2) of ≥5% or <90%); secondary end points included the occurrences of hypoxemia (SaO2 <90%), severe hypoxemia (SaO2 ≤85%), bradycardia, hypotension, and the quality of sedation (patient cooperation and patient satisfaction).



A total of 760 patients were enrolled at three German endoscopy centers. The intention-to-treat analysis revealed a significant reduction of the incidence of oxygen desaturation in the capnography arm in comparison with the standard arm (38.9% vs. 53.2%; P<0.001). The numbers of patients with a fall in SaO2 <90% and ≤85% were also significantly different (12.5% vs. 19.8%; P=0.008 and 3.7 vs. 7.8%; P=0.018). There were no differences regarding the rates of bradycardia and hypotension. Quality of sedation was similar in both groups. Results of statistical analyses were maintained for the per-protocol population.



Additional capnographic monitoring of ventilatory activity reduces the incidence of oxygen desaturation and hypoxemia during propofol sedation for colonoscopy.

Source: American Journal of Gastroenterology.

Endoscopic Clip-Assisted Feeding Tube Placement Reduces Repeat Endoscopy Rate: Results from a Randomized Controlled Trial.

To determine whether endoscopic clip-assisted nasoenteral feeding tube placement is more effective than standard feeding tube placement with transnasal endoscopy.



Between August 2009 and February 2011, 143 patients referred for endoscopic nasoenteral feeding tube placement were randomized between clip-assisted and standard nasoenteral tube placement. Endoscopies were performed in the endoscopy unit and intensive care unit in a tertiary referral center in the Netherlands. For the clip-assisted procedure, the feeding tube was introduced with a suture fixed to the tip, picked up in the stomach with an endoclip and attached (as distal as possible) to the duodenal wall. In the standard group, a guide wire was placed in the duodenum using a transnasal endoscope, followed by blind insertion of a feeding tube over the guide wire. Primary end point was a repeat endoscopy for incorrect tube placement or spontaneous retrograde tube migration. Secondary end points were incorrect tube placement, spontaneous migration of feeding tube, directs medical costs, and procedure-related (serious) adverse event (SAE).



Of the 143 patients included, 71 were randomly assigned to clip-assisted tube placement, and 72 to standard tube placement. Four (5.6%) repeat endoscopies were performed in the clip-assisted group vs. 19 (26.4%) in the standard group (relative risk reduction (RRR) 0.79; 95% confidence interval (CI) 0.40–0.92). The number needed to clip to avoid one repeat endoscopy was 4.8 (95% CI 3.1–11.3). Repeat endoscopies were mostly performed for incorrectly placed tubes, 3 (4.2%) in the clip-assisted group vs. 16 (22.2%, RRR 0.81; 95% CI 0.38–0.94) in the standard group. Spontaneous retrograde tube migration occurred in one (1.4%) clip-assisted placement and three (4.2%) standard tubes. Median costs were higher for clip-assisted tube placement (519 vs. 423, P<0.01). Four (5.6%) SAEs occurred after clip-assisted feeding tube placement vs. one (1.4%) after standard feeding tube placement (P=0.21).



Clip-assisted endoscopic nasoenteral feeding tube placement results in fewer repeat endoscopies than standard endoscopic nasoenteral tube placement, due to a higher success rate of initial placement. When tubes are adequately placed, retrograde tube migration rarely occurs.

Source: American Journal of Gastroenterology.

Colorectal Endoscopy, Advanced Adenomas, and Sessile Serrated Polyps: Implications for Proximal Colon Cancer.

Colonoscopy is associated with a decreased risk of colorectal cancer but may be more effective in reducing the risk of distal than proximal malignancies. To gain insight into the differences between proximal and distal colon endoscopic performance, we conducted a case–control study of advanced adenomas, the primary targets of colorectal endoscopy screening, and sessile serrated polyps (SSPs), newly recognized precursor lesions for a colorectal cancer subset that occurs most often in the proximal colon.



The Group Health-based study population included 213 advanced adenoma cases, 172 SSP cases, and 1,704 controls aged 50–79 years, who received an index colonoscopy from 1998–2007. All participants completed a structured questionnaire covering endoscopy history. Participants with polyps underwent a standard pathology review to confirm the diagnosis and reclassify a subset as advanced adenomas or SSPs. Logistic regression analyses were conducted to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association between endoscopy and advanced adenomas and SSPs separately; site-specific analyses were completed.



Previous endoscopy was inversely associated with advanced adenomas in both the rectum/distal colon (OR=0.38; 95% CI: 0.26–0.56) and proximal colon (OR=0.31; 95% CI: 0.19–0.52), but there was no statistically significant association between previous endoscopy and SSPs (OR=0.80; 95%CI: 0.56–1.13).



Our results support the hypothesis that the effect of endoscopy differs between advanced adenomas and SSPs. This may have implications for proximal colon cancer prevention and be due to the failure of endoscopy to detect/remove SSPs, or the hypothesized rapid development of SSPs.

Source: American Journal of Gastroenterology.

Influence of Acupuncture Treatment on Cerebral Activity in Functional Dyspepsia Patients and Its Relationship With Efficacy.

Acupuncture is a commonly used therapy for treating functional dyspepsia (FD), although the mechanism remains unclear. The objectives of this study were to investigate the differences in cerebral glycometabolism changes evoked by acupuncture and sham acupuncture and to explore the possible correlations between brain responses and clinical efficacy.



In all, 72 FD patients were randomly assigned to receive either acupuncture or sham acupuncture treatment for 4 weeks. Ten patients in each group were randomly selected for fluorine-18 fluorodeoxyglucose positron emission tomography computed tomography scans to detect cerebral glycometabolism changes. The Nepean Dyspepsia Index (NDI) and Symptom Index of Dyspepsia (SID) were used to evaluate the therapeutic effect.



(i) The clinical data showed that after treatment the decrease in SID score in the acupuncture group was significantly greater than that in the sham acupuncture group (P<0.05). The increase in NDI score between the two groups did not differ (P>0.05), and only the improvement in NDI score in the acupuncture group was clinically significant. (ii) The neuroimaging data indicated that after treatment the acupuncture group showed extensive deactivation in cerebral activities compared with the sham acupuncture group. In the acupuncture group, the deactivations of the brainstem, anterior cingulate cortex (ACC), insula, thalamus, and hypothalamus were nearly all related to the decrease in SID score and the increase in NDI score (P<0.05, corrected). In the sham acupuncture group, the deactivations of the brainstem and thalamus tended to be associated with the increase in NDI score (P<0.1, corrected).



Acupuncture and sham acupuncture have relatively different clinical efficacy and brain responses. Acupuncture treatment more significantly improves the symptoms and quality of life of FD patients. The more remarkable modulation on the homeostatic afferent network, including the insula, ACC, and hypothalamus, might be the specific mechanism of acupuncture.

Source: American Journal of Gastroenterology.

The Incidence and Risk of Celiac Disease in a Healthy US Adult Population.

Celiac disease (CD) is an increasingly common disease that may affect as many as 1% of the North American population. Recent population-based data suggest a substantial increase in the prevalence of CD over the last several decades. Several factors are hypothesized as possible disease triggers including intercurrent illnesses, such as gastroenteritis, surgeries, and trauma. We used the active duty US military, a unique healthy worker population with essentially complete medical diagnostic coding, as an opportunity to describe trends in CD and deployment-related risk factors.



Using electronic medical encounter data (1999–2008) on active duty US military (over 13.7 million person-years), a matched, nested case–control study describing the epidemiology and risk determinants of CD (based on ≥2 ICD-9 medical encounters) was conducted. Incidence and duration of CD-related medical care were estimated, and conditional logistic regression was utilized to evaluate CD risk following infectious gastroenteritis (IGE) occurring within 3 years before CD diagnosis while controlling for other risk factors.



A total of 455 incident cases of CD were identified and age, gender, and time matched to 1,820 controls. The incidence of CD increased five-fold from 1.3 per 100,000 in 1999 to 6.5 per 100,000 in 2008, with the highest rates of increase among those over 34 years of age (average annual increase of 0.8 cases per 100,000). A total of 172 IGE episodes, predominately of “viral etiology” (60.5%), were documented. In multivariate models, a significant association between IGE and CD was found (Odds ratio (OR): 2.06, 95% confidence interval (CI) 1.43, 2.97). Risk generally increased with temporal proximity to, and non-viral etiology of, exposure. Other notable risk factors for CD in multivariate models were Caucasian race (OR: 3.1, P<0.001), non-Army service (OR: 1.5, P=0.001), and greater than a high-school education (OR: 1.3, P=0.05).



Incidence of CD diagnosis in the US military is increasing, particularly among those in the fourth and fifth decades of life and appears higher than other population-based estimates. An association between antecedent IGE and risk of CD was noted, but the potential for exposure misclassification cannot be ruled out and further study is needed to link pathogen-specific exposure to incident CD anti-gluten antibody development or symptom onset.

Source: American Journal of Gastroenterology.

Improving Time to Antibiotics for Pediatric Neutropenic Patients.

A multidisciplinary effort decreased mean time to antibiotics by 50 minutes.

Investigators conducted a multidisciplinary quality improvement effort to reduce time to antibiotics for pediatric oncology patients presenting to a pediatric emergency department (ED) with fever (axillary temperature 38.3°C once or 38.0°C for more than 2 hours in a 24-hour period) and either neutropenia (absolute neutrophil count 500 cells/mm3) or possible neutropenia. Target goals were ceftazidime delivery within 60 minutes for patients with known neutropenia and ceftriaxone within 90 minutes for patients with possible neutropenia.

The investigators identified areas for improvement and corresponding action plans. ED nurses and physicians teamed with ED quality nurse leaders, hospital staff nurses, ED pharmacists, ED administrators, security directors, oncology clinicians, and hospital quality improvement experts. Families of children receiving chemotherapy were given bright orange placards that acted as a visual alert for security personnel and triage staff to expedite patients into the ED. Additional measures included clinician reeducation on electronic ordering, pharmacist prioritization of antibiotic preparation, nurse education on Port-a-Cath® access, real-time clinician coaching and feedback with monthly progress reports, and monthly root cause analyses of patients who did not reach target goals.

The study involved 137 children (mean age, 8.9 years) who presented before implementation and 288 children (mean age, 8.4 years) who presented after. Mean time to antibiotics decreased from 99 minutes to 49 minutes for patients with neutropenia and from 90 minutes to 81 minutes for patients with possible neutropenia (60% were ultimately found to be neutropenic). The proportion of patients meeting the target time increased from 50% to 89%.

Comment: This study clearly demonstrates that a structured multidisciplinary process improvement initiative can have a significant impact on emergency department processes and delivery of care.

Source: Journal Watch Emergency Medicine.