Rabies Vaccine and Immunization Information

Rabies is an acute and deadly disease caused by a viral infection of the central nervous system. The rabies virus is most often spread by a bite and saliva from an infected (rabid) animal (e.g., bats, raccoons, skunks, foxes, ferrets, cats, or dogs). In the United States, rabies is most often associated with bat exposures. However, there have been rare cases in which laboratory workers and explorers in caves inhabited by millions of bats were infected by rabies virus in the air.

Virtually 100% of those infected with rabies who do not receive the vaccine will die. Rabies illness includes rapidly progressing central nervous system symptoms such as anxiety, difficulty swallowing, and seizures.

Although less than ten human rabies fatalities occur in the United States annually, as many as 40,000 Americans receive the vaccine each year after contact with animals suspected of being rabid. An additional 18,000 people get the vaccine before exposure as a preventative measure.

Worldwide, at least 4 million people are vaccinated each year for rabies. The number of deaths that rabies causes each year is estimated to be at least 40,000, and as high as 70,000 if higher case estimates are used for densely populated countries in Africa and Asia where rabies is epidemic. India, with a very large population of stray, ownerless dogs, has about half of all cases of rabies worldwide. Between 30-60% of human rabies cases occur in children under 15 years of age.

Prompt wound care and the administration of rabies immune globulin (RIG) plus vaccine are highly effective in preventing human rabies following exposure.

Available Vaccines

The rabies vaccine is available as:

  • Human diploid cell vaccine (HDCV)
  • Purified chick embryo cell vaccine (PCECV)

Product: Imovax Rabies (HDCV for pre or post-exposure)
Manufacturer: Sanofi Pasteur
Year Licensed: 1980

Product: RabAvert (PCECV for pre or post-exposure)
Manufacturer: Novartis
Year Licensed: 1997

History of the Vaccine

The first rabies vaccine was developed in the early 1960’s. All rabies vaccines currently available for humans are made from killed rabies virus.

Who Should and Should Not Receive the Vaccine

Who should receive the vaccine pre-exposure?

  • Vaccination before exposure (pre-exposure) should be offered to people in high risk groups such as veterinarians, animal handler/caretakers, or laboratory workers who may be exposed to the rabies virus.

Pre-exposure vaccination may be considered for:

  • People whose activities bring them into frequent contact with rabies virus or potentially rabid animals (e.g., bats, raccoons, skunks, ferrets, cats, dogs).
  • Travelers who will spend more than one month in countries with a high rate of rabies infection, if they are likely to come in contact with rabid animals and immediate access to appropriate medical care is limited.

Who should receive the vaccine post-exposure?

  • Vaccination after exposure (post-exposure) is recommended for all individuals who have had contact with an animal (e.g., bites or abrasions) that they believe may be, or which is proven to be, rabid. Vaccination should be initiated as soon after exposure as possible and should be accompanied by proper wound management and the administration of Rabies Immune Globulin, human (HRIG).

Pregnant women who are exposed to rabies may receive the vaccine.


Who should not receive the vaccine?

  • The rabies vaccines are not recommended for routine use.
  • People who are moderately or severely ill should consult with their physician before receiving any vaccine.

Dose Schedule

Pre-exposure rabies vaccines are administered by a series of three injections:

  • The first dose may be given at any time
  • The second dose should be given seven days later
  • The third dose should be given 21 or 28 days after the first dose
  • Booster doses of vaccine are recommended every two years for those individuals who continue to be at increased risk of contracting rabies to maintain protective antibody levels. People that work with live rabies virus in laboratory settings should be tested every six months to ensure that they have adequate antibody levels, and receive boosters as necessary.

When post-exposure rabies vaccines are administered:

  • The number of doses required is determined by the previous immunization status of the individual
  • Previously unvaccinated people should receive the vaccine intramuscularly at 0, 3, 7, and 14  days. For adults the vaccine is given in the deltoid area; for children, it may be given in the anterolateral aspect of the thigh. In addition to rabies vaccine, these people should also receive rabies immune globulin (HRIG) at the same time as the first dose of the vaccine to provide rapid protection that persists until the vaccine works.
  • Previously vaccinated people should receive two doses of the vaccine intramuscularly—the first immediately, the other three days later. RIG is unnecessary and should not be given. An immunized person is anyone who has received a complete series of vaccine, or a person who has received a pre-exposure or post-exposure series of any rabies vaccine who has an adequate rabies antibody level.

Effectiveness of the Vaccine

There are no controlled trials of rabies vaccine. Among persons who had been bitten by an animal that was proven to be rabid and who received both HRIG and a full course of one of these modern rabies vaccines there have been no cases of rabies. Previously immunized people still must receive two additional doses of the vaccine if exposed to the virus, and the vaccine is almost 100% effective in these cases as well.

Although all rabies vaccines licensed in the U.S. induce protective antibody levels after three doses in nearly 100% of recipients, it is important to complete the dose schedules recommended for individual circumstances (see Dose Schedule). Previously, a 5-dose vaccine schedule was recommended but the dose that was given at 28 days is no longer felt to be necessary.

Known Side Effects

Mild reactions such as pain, redness, swelling, or itching at injection site are reported among 30%-74% of those vaccinated. Headache, nausea, abdominal pain, muscle aches, and dizziness are reported in 5-40% of those vaccinated.

Serious events after vaccination are rare. However, allergic reactions including swelling and mild difficulty breathing developed in 6% of patients who received booster doses of Human Diploid Cell Rabies Vaccine. In addition, three cases of neurologic illness resembling Guillain-Barré Syndrome, a progressive disorder affecting the nervous system, have been reported in people who received the Human Diploid Cell Rabies Vaccine. In these cases, all patients recovered within three months.

This vaccine is recommended by:

  • Advisory Committee of Immunization Practices of the Centers for Disease Control and Prevention
  • American Academy of Pediatrics
  • American Thoracic Society

What should you do if bitten by a rabid or suspicious animal?

1) Wash all bites and scratches immediately and thoroughly with soap and water and a solution that kills viruses (such as a povidone-iodine solution). Wound cleansing alone will markedly reduce the chances of getting rabies.
2) Go to a health care provider for a medical assessment regarding the need for a tetanus shot (if it needs to be updated), rabies vaccination, and administration of RIG, human. Two rabies immune globulins are licensed for use in the U.S. Each year approximately 18,000 people in the U.S. receive vaccination and immune globulin, and none of them has developed rabies.
3) Notify the state or local health department.

Vaccination and appropriate immune globulin therapy can protect you after you have been bitten. Vaccination before exposure merely simplifies therapy by eliminating the need for RIG and decreasing the number of vaccine doses needed.

Effective rabies control measures include routine immunization of dogs, cats, and ferrets, and control of stray dogs and selected wildlife. A fully vaccinated dog or cat is unlikely to become infected or to transmit rabies.

Key References and Sources of Additional Information

  • Centers for Disease Control and Prevention (CDC). (2008). Human rabies prevention—United States,2008: Recommendations of the Advisory Commission on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report, 57(RR-3).
  • Centers for Disease Control and Prevention (CDC). (2010). Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: Recommendations of the Advisory Commission on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report, 59(RR-2) .

Guide for post-exposure prophylaxis

The recommendations given here are intended as a general guide. It is recognized that, in certain situations, modifications of the procedures laid down may be warranted. Such situations include exposure of infants or mentally disabled persons and other circumstances where a reliable history cannot be obtained, particularly in areas where rabies is enzootic, even though the animal is considered to be healthy at the time of exposure. Such cases may be treated as category II or III.

Post-exposure treatment, which consists of local treatment of the wound, followed by vaccine therapy (with or without rabies immunoglobulin) should be initiated immediately with contacts of categories II and III. Treatment may be discontinued if the animal involved (dog or cat) remains healthy throughout an observation period of 10 days; or if the animal is killed humanely and found to be negative for rabies by laboratory examination. Any biting animal suspected of being rabid should be immediately killed humanely and tissues examined using appropriate laboratory technique(s). Modification of the recommended procedures would be indicated in a rabies-free area where animal bites are encountered. In areas where canine or wildlife rabies is epizootic, adequate laboratory and field experience, indicating that there is no infection in the species involved, may justify local health authorities in not recommending specific anti-rabies treatment.

The indication for post-exposure vaccination with or without rabies immune globulin depends on the type of contact with the rabid animal.

Types of contact are:
  • category I – touching or feeding animals, licks on the skin
  • category II – nibbling of uncovered skin, minor scratches or abrasions without bleeding, licks on broken skin
  • category III – single or multiple transdermal bites or scratches, contamination of mucous membrane with saliva from licks; exposure to bat bites or scratches

For category I no treatment is required, whereas for category II immediate vaccination and for category III immediate vaccination and administration of rabies immune globulin are recommended in addition to immediate washing and flushing of all bite wounds and scratches. Depending on vaccine type, the post-exposure schedule prescribes intramuscular doses of 1 ml or 0.5 ml given as four to five doses over four weeks. For rabies-exposed patients who have previously undergone complete pre-exposure vaccination or post-exposure treatment with cell-derived rabies vaccines, two intramuscular doses of a cell-derived vaccine separated by three days are sufficient. Rabies immune globulin treatment is not necessary in such cases. The same rules apply to persons vaccinated against rabies who have demonstrated neutralizing antibody titres of at least 0.5 IU/ml.

In order to reduce the cost of post-exposure treatment, intradermal multi-site regimens using a fraction of the intramuscular volume per intradermal inoculation site have been developed. Purified Vero cell vaccine has been given intradermally to more than 70 000 recipients in Thailand, where it has been in routine use for several years. Intradermal rabies vaccination is also recommended by the ministries of health of Sri Lanka (since 1995) and the Philippines (since 1997). In each of these countries the introduction of this route for post-exposure treatment has permitted the discontinuation of the local production of vaccines prepared on brain tissue. Only the cell-derived vaccines that meet the WHO requirements regarding safety, potency and efficacy for this application may be considered for intradermal use. Although rabies vaccines are usually administered under qualified medical supervision, field experience from routine infant immunization programmes with other intradermally injected vaccines highlights the potential difficulties in assuring proper delivery. This emphasizes the need for appropriate staff training to ensure correct storage, reconstitution and injection. Provided that a correct sterile technique is used, the remaining doses may be kept in the vial at 2–8°C and used for another patient within six hours after reconstitution.

Tissue-culture or purified duck-embryo vaccines of potency at least 2.5 IU per single intramuscular immunizing dose should be applied according to the following schedules.

Intramuscular schedules

One dose of the vaccine should be administered on days 0, 3, 7, 14 and 30. All intramuscular injections must be given into the deltoid region or, in small children, into the anterolateral area of the thigh muscle. Vaccine should never be administered in the gluteal region.

Abbreviated multisite schedule

In the abbreviated multisite schedule, the 2-1-1 regimen, one dose is given in the right arm and one dose in the left arm at day 0, and one dose applied in the deltoid muscle on days 7 and 21. The 2-1-1 schedule induces an early antibody response and may be particularly effective when post-exposure treatment does not include administration of rabies immunoglobulin.

Intradermal schedule

WHO recommended the following intradermal regimen and vaccines for use by the intradermal route:

  • 2-site intradermal method (2-2-2-0-1-1) for use with PVRV (Verorab TM, Imovax TM, Rabies vero TM, TRC Verorab TM) and PCECV (Rabipur TM)
For 2-site intradermal method (2-2-2-0-1-1)

The volume per intradermal site is:

  • 0.1 ml for PVRV (Verorab TM, Imovax TM, Rabies vero TM, TRC Verorab TM)
  • 0.1 ml for PCECV (Rabipur TM)

Brain-tissue vaccines

The use of brain-tissue vaccines should be discontinued. WHO does not recommend any schedule using brain-tissue vaccine. National authorities should recommend a schedule of immunization that has been shown to induce an adequate level of protection when brain tissue vaccines are available in that country.

Combined immunoglobulin-vaccine

Combined immunoglobulin-vaccine treatment was considered in the eighth report of the WHO Expert Committee as the best specific systemic treatment available at that time for the post-exposure prophylaxis of rabies in humans, although experience indicated that vaccine alone was sufficient for minor exposures (category II). Immunoglobulin should be given in a single dose of 20 IU per kg of body weight for human anti-rabies immunoglobulin, and 40 IU per kg of body weight for heterologous (equine) immunoglobulin; the first dose of vaccine should be inoculated at the same time as the immunoglobulin, but in a different part of the body. Sensitivity to heterologous immunoglobulin must be determined before it is administered. The physician should be prepared to deal with anaphylactic shock reactions. Administration of rabies immunoglobulin (RIG) should be infiltrated into the depth of the wound and around the wound as much as anatomically feasible. Any remainder should be injected at an intramuscular site distant from that of vaccine inoculation e.g. into the anterior thigh.

Treatment should be started as early as possible after exposure, but in no case should it be denied to exposed persons whatever time interval has elapsed.

Local treatment of wounds

Local treatment of wounds involving possible exposure to rabies – recommended in all exposures.

Virtual galleries open new markets for art

Art on display at Art Basel

Every year in December, Miami Beach becomes the epicentre of the art world. Tens of thousands of people flock to Art Basel where sales of art reportedly top $3bn (£1.9bn).

In the hyper-party atmosphere billionaires rub shoulders with struggling artists and serious collectors vie with amateurs to spot a potential masterpiece. Thanks to the internet, art has never been more accessible and new markets are opening up around the world.

“China is a really exciting opportunity for us,” says Carter Cleveland, the 28-year-old founder of Artsy, an online database featuring works by 25,000 artists and more than 2,000 galleries around the world.

Officially launched in 2012, Artsy has attracted $26m in funding and has some big name backers such as Paypal cofounder Peter Thiel. The site makes money by charging galleries a monthly subscription to list their art.

Carter Cleveland and friends
Carter Cleveland, pictured with Wendi Murdoch, Ivanka Trump and Lauren Remington Platt at Art Basel

The company has an office in Hong Kong but has yet to establish a presence in mainland China. In an effort to make contacts and pave the way for expansion, Artsy hosted a celebrity bash where the star of the party was Chinese choreographer and artist Shen Wei.

“China is a lot more challenging because they have their own infrastructure and their own social media and their own search engines,” says Cleveland. “So when you want to expand into mainland China it takes a much more thoughtful approach.”

Art on display at Art Basel
Art on display at Art Basel
Art on display at Art Basel

China’s contemporary art market didn’t exist much before 2000. It has now overtaken the US, according to Berlin-based Artnet, another online platform that specialises in art auctions. In fact, growth in China appears to be driving the global art industry, which is worth an estimated $66bn.

Underscoring the boom in sales, several Chinese galleries staged exhibitions at Art Basel in Miami Beach, including newcomer Beijing Commune. Director Lu Jingjing says the gallery is considering joining Artsy but is still weighing the benefits.

“Search engines are very well developed too so you have to measure whether it’s worth the investment,” she says.

Beijing Commune currently uses WeChat – a mobile messaging app that has 438 million users, mainly in China.

Lu Jingjing
Beijing Commune director Lu Jingjing is currently weighing her options as to what platforms she uses

“It’s not a selling tool like Artsy or Artnet. But you can make your own newsletter about your exhibitions and you know how many people have read it,” says Lu Jingjing.

Hsinke Lee is head of exhibitions at Long March Space, another Chinese gallery at Art Basel. She thinks digital platforms are a “positive” development and predicts they will have a greater role in the Chinese art market.

She says many people already buy most things through Taobao, the Chinese equivalent of Amazon, and art is no different.

“I’ve noticed a lot of collectors purchase works without viewing them first in person. I myself have clients like that. Even when the work is worth close to a million dollars, they don’t need to see it,” she says.

Rhonda Long-Sharp with picture of Muhammed Ali
Rhonda Long-Sharp learnt from her own experience of buying a Picasso online that turned out to be a fake

But the international art market is largely unregulated and other experts warn that buying online poses hazards for the unwary.

“You’re only as safe and secure as the ethics of the particular dealer you’re dealing with,” says Rhonda Long-Sharp, a former lawyer who now owns an eponymous gallery in Indianapolis. She was exhibiting at Scope, another art fair timed to coincide with Art Basel in Miami Beach. Ironically, she switched careers after buying a fake Picasso online.

“From that I learned a great deal about the art market and the art world,” she says.”When a collector looks online and says he wants a Warhol, he’s going to find hundreds of galleries that purport to handle Warhol.

“But you don’t know if they’re a legitimate gallery, you don’t know if the piece is authentic and you don’t know if the condition is outstanding or if it’s been restored so much that the value is really a smidgen of what it should be.”

Galerie Karsten Greve
Art on display at Art Basel

Nevertheless, she pays Artnet “a fair amount of money” for a gallery page. She says it is an important marketing tool for Long-Sharp Gallery and good for collectors who want to learn more about a piece.

“Online impacts fairs like this because if you see something here that you like you can go online and look at other works by the artist. People often come here with their cameras, snap a shot of the piece and snap a shot of the name tag. You’ll hear from them maybe two months later.”

Far from competing with physical fairs such as Art Basel, digital and social media have become an integral part of the event. In addition to 73,000 visitors, Art Basel Miami has 300,000 Facebook followers, 150,000 Twitter followers and 100,000 on Instagram.

Organisers also tapped into that online community to launch a crowdfunding campaign for non-profit art organisations that generally don’t attract major investment but are seen as essential incubators for emerging talent.

Hirschl Adler Modern

Big businesses are also entering the digital art world. The Swiss bank UBS, a major sponsor of Art Basel, hopes to meet the surging demand for information with the launch of Planet Art, an app that aggregates news about contemporary art.

Peter Dillon, head of global art platforms at UBS, says it cuts through the clutter in a complicated market. “It expands access to the art world and the art market. For somebody who is new to it, this is a great way to get real-time information,” he says.

“It’s data led so it’s objective. It’s based on an algorithm that uses the facts in articles to index and organise them. It’s applying a skill set that we have as a bank to the art world.”

Art on display at Art Basel

But although UBS has a massive corporate art collection, Dillon says the bank does not advise clients on buying art as an investment. A sentiment echoed by Art Basel director Marc Spiegler.

“The whole issue of art as an investment makes me somewhat queasy,” he says. “A lot of people have tried to do art funds, almost all of them have failed. Historically the collections that appreciated the most are the ones that went against the market. There is always a speculative market, there’s always a bubble – but it’s small.

“Our fair is not about monetising mini-bubbles; our fair is about building a sustainable support base for the careers of artists and their galleries. I think people should buy work that they like.”

When you lose weight, where does the fat go?

Despite a worldwide obsession with diets and fitness regimes, many health professionals cannot correctly answer the question of where body fat goes when people lose weight, a new study shows. The most common misconception among doctors, dieticians and personal trainers is that the missing mass has been converted into energy or heat. The correct answer is that most of the mass is breathed out as carbon dioxide and goes into thin air.

Despite a worldwide obsession with diets and fitness regimes, many health professionals cannot correctly answer the question of where body fat goes when people lose weight.

Despite a worldwide obsession with diets and fitness regimes, many health professionals cannot correctly answer the question of where body fat goes when people lose weight, a UNSW Australia study shows.

The most common misconception among doctors, dieticians and personal trainers is that the missing mass has been converted into energy or heat.

“There is surprising ignorance and confusion about the metabolic process of weight loss,” says Professor Andrew Brown, head of the UNSW School of Biotechnology and Biomolecular Sciences.

“The correct answer is that most of the mass is breathed out as carbon dioxide. It goes into thin air,” says the study’s lead author, Ruben Meerman, a physicist and Australian TV science presenter.

In their paper, published in the British Medical Journal today, the authors show that losing 10 kilograms of fat requires 29 kilograms of oxygen to be inhaled and that this metabolic process produces 28 kilograms of carbon dioxide and 11 kilograms of water.

Mr Meerman became interested in the biochemistry of weight loss through personal experience.

“I lost 15 kilograms in 2013 and simply wanted to know where those kilograms were going. After a self-directed, crash course in biochemistry, I stumbled onto this amazing result,” he says.

“With a worldwide obesity crisis occurring, we should all know the answer to the simple question of where the fat goes. The fact that almost nobody could answer it took me by surprise, but it was only when I showed Andrew my calculations that we both realised how poorly this topic is being taught.”

The authors met when Mr Meerman interviewed Professor Brown in a story about the science of weight loss for the Catalyst science program on ABC TV in March this year.

“Ruben’s novel approach to the biochemistry of weight loss was to trace every atom in the fat being lost and, as far as I am aware, his results are completely new to the field,” says Professor Brown.

“He has also exposed a completely unexpected black hole in the understanding of weight loss amongst the general public and health professionals alike.”

If you follow the atoms in 10 kilograms of fat as they are ‘lost’, 8.4 of those kilograms are exhaled as carbon dioxide through the lungs. The remaining 1.6 kilograms becomes water, which may be excreted in urine, faeces, sweat, breath, tears and other bodily fluids, the authors report.

“None of this is obvious to people because the carbon dioxide gas we exhale is invisible,” says Mr Meerman.

More than 50 per cent of the 150 doctors, dieticians and personal trainers who were surveyed thought the fat was converted to energy or heat.

“This violates the Law of Conservation of Mass. We suspect this misconception is caused by the energy in/energy out mantra surrounding weight loss,” says Mr Meerman.

Some respondents thought the metabolites of fat were excreted in faeces or converted to muscle.

“The misconceptions we have encountered reveal surprising unfamiliarity about basic aspects of how the human body works,” the authors say.

One of the most frequently asked questions the authors have encountered is whether simply breathing more can cause weight loss. The answer is no. Breathing more than required by a person’s metabolic rate leads to hyperventilation, which can result in dizziness, palpitations and loss of consciousness.

The second most frequently asked question is whether weight loss can cause global warming.

“This reveals troubling misconceptions about global warming which is caused by unlocking the ancient carbon atoms trapped underground in fossilised organisms. The carbon atoms human beings exhale are returning to the atmosphere after just a few months or years trapped in food that was made by a plant,” says Mr Meerman, who also presents the science of climate change in high schools around Australia.

Mr Meerman and Professor Brown recommend that these basic concepts be included in secondary school curricula and university biochemistry courses to correct widespread misconceptions about weight loss among lay people and health professionals.

Story Source:

The above story is based on materials provided by University of New South Wales.Note: Materials may be edited for content and length.

Journal Reference:

  1. R. Meerman, A. J. Brown. When somebody loses weight, where does the fat go? BMJ, 2014; 349 (dec16 13): g7257 DOI: 10.1136/bmj.g7257

Genes Play Role in Baby’s Sleep at Night

Parents who are having difficulty getting their babies to sleep through the night may be somewhat relieved by a new study showing that a large determinant of an infant’s nighttime sleep is simply the luck of the genetic draw.
Researchers in Canada studied sleep records from nearly 1,000 identical and fraternal twins in Quebec, and found that genes largely determine whether children sleep through the night. However, children’s ability to nap during the day is controlled more by their environment.
While some parents may find themselves fortunate in having a sound sleeper, the researchers said there are also ways to help a child along.

“The genetic influence is only part of the equation that controls sleep duration. One should not give up on trying correcting inadequate sleep duration or bad sleep habits early in childhood,” said study author Evelyne Touchette, a psychology researcher at Laval University in Quebec.
The researchers found there is a particularly sensitive time for the influence of parental interventions, at around 18 months, Touchette said. “This is a good time to implement sleep strategies in order to improve the child’s nighttime sleep habits if they are not already in place,” she said.
Parents should not assume that a child who doesn’t seem to sleep enough doesn’t need more sleep, Touchette said.
Only 5 percent of children in the study were considered “short-persistent sleepers,” meaning they seemed to need less than 10 hours of sleep nightly. “One should use caution before concluding that their child is truly a short-sleeper. More often than not, children do not get sufficient sleep for other reasons,” she said.
In the study, the researchers did not look for specific genes associated with sleep, rather they looked at whether identical twins were more likely than fraternal twins to share sleep patterns.
While children can vary in their sleep habits, there are some milestones to look for, said Dr. Dennis Rosen, associate medical director of the center for pediatric sleep disorders at Boston Children’s Hospital and author of “Successful Sleep Strategies for Kids” (Harvard University, 2012).
At 6 weeks old, infants begin napping two to three times a day, moving to two daily naps by age 6 months, he said. At 18 months, a toddler should be down to one nap during the day.
“Most children are finished with daytime naps by the time they’re about 5, but many children stop napping earlier,” he said.
In the Quebec study, 4 percent of children had stopped napping by age 4, but that number was 68 percent in a similar study from Italy, showing culture has some impact on nap times.
It’s key to find balance between spending enough time in bed but not too much time, Rosen said.
Children not given enough time to sleep will often become irritable and cranky, but children who stay in bed longer than they need will often not stay asleep, or will wake up multiple times throughout the night.
Both Rosen and Touchette said it is important to establish a routine that allows the child autonomy in getting themselves to sleep.
“From about [6 months], I recommend putting children to bed when they are drowsy but still awake, so that they can develop appropriate sleep-onset associations and learn to fall asleep on their own,” Touchette said, adding that this also helps children to fall back asleep quickly when they wake up at night.
Parents should look for possible sleep problems, such as loud snoring, gasping or pauses in breathing. But even other issues that have a child consistently waking parents up can be problematic.
“These are things that are not medical issues but they can be quite disruptive,” Rosen said. “The parents need to sleep as well.”
“Speaking to somebody who is knowledgeable about sleep in children, a pediatrician or sleep specialist, can be very beneficial.”

Britain’s first cannabis e-joint is now available to buy and is completely legal*

*Legal according to claims by KanaVape

This cannabis e-joint is now available to buy in Britain and it is completely legal*

When the first cannabis e-cigarette was launched back in June – it was only available overseas.

But now, one company has gone a step further and started selling an e-joint that is available to buy in Britain.

KanaVape, a device similar to electronic cigarettes but with cannabinoids, will be available to buy online from Thursday next week, Metro.co.uk can reveal.

The makers of Britain’s first e-joint – Antonin Cohen and Sebastien Beguerie – claim their product is entirely legal as it contains no THC – the chemical in marijuana responsible for mind-bending highs.


(Picture: KanaVape)

The product uses hemp with 5 per cent cannabidiol, meaning that it apparently gives users the same effect  – especially the relaxed feeling – as cannabis but without the psychotic side-effects.

The e-joint will mean users can inhale cannabis vapour without the usual smell of smoke.

Drug charities dismissed the product as no more than a gimmick, but did suggest it was likely the product would be legal under British law due to its lack of THC.

Sophie Macken, at the Independent Scientific Committee on Drugs, told Metro.co.uk: ‘CBD is legal and has some theraputic and neuroprotective properties.

‘It is not usually something that would be used recreationally though so this sounds like a bit of a gimmick.

The hemp used in the e-joint is grown in France, Czech Republic and Spain without the use of synthetic pesticides and chemicals.

The cannabis e-cigarette will also go on sale in France, where it is legal, but the health minster immediately moved to ban the product.

KanaVape makers Antonin and Sebastien said: #We made KanaVape to give millions of people a legal and tasteful way of using cannabinoids. We craft our production with love, care and scientific research. KanaVape is good for our customers and good for the planet.’

Metro.co.uk has contacted the Home Office for clarity on whether the e-joint would be legal under British law but had not received a response at time of publishing.

Gutka ban helped many kick the habit: WHO study

A study conducted by the World Health Organisation country office for India in collaboration with the Johns Hopkins Bloomberg School of Public Health across seven States in India shows that banning gutka, a form of chewing tobacco, helps users kick the habit.

A study conducted by the World Health Organisation country office for India in collaboration with the Johns Hopkins Bloomberg School of Public Health across seven States in India shows that banning gutka, a form of chewing tobacco, helps users kick the habit.

India is estimated to be the world’s largest consumer of smokeless tobacco; WHO estimates indicate that 26 per cent of adults use smokeless tobacco, a major cause of death and disease. Nearly one million people die in India every year because of tobacco use.

The new study conducted across Assam, Bihar, Gujarat, Karnataka, Madhya Pradesh, Maharashtra, Odisha and the National Capital Region, shows that there are “strong indications” that State-level laws banning gutka have a positive impact owing to reduced product availability and a decrease in its consumption.

It also shows as many as 92 per cent of the respondents support a gutka ban while 99 per cent agreed that a ban is good for the health of India’s youth. A substantial proportion of respondents in each State (from 41-88 per cent) reported that they quit using gutka because of the ban.

“These findings have a strong message that regulatory mechanisms are effective and can have a positive impact on the consumption pattern,” said Dr. Nata Menabde, WHO Representative to India.

According to her, the study revealed that product ban did impact use. “Of the respondents who continue to use pre-packaged gutka, half (49 per cent) reported they consume less since the ban. I am also happy to learn that there was high degree of unanimity (90 per cent of the respondents) that the government should ban the manufacturing, sale and distribution of other forms of smokeless tobacco,” she said.



When You Lose Weight, Where Does It Go?

Wobbly and out of breath, you jab at the button on the treadmill that makes the machine come to a stop. Finally, it’s over. You completed your workout and can now retreat home to grab a shower and complete the ritual of stepping onto the bathroom scale — your fate all but sealed in the buckets of sweat released over the last hour.

The read-out confirms your hopeful anticipation: You lost 3 pounds. But being your curious self, you begin to wonder where those 3 pounds went. There’s no way you lost 3 pounds of water weight, you think, so how else could it have escaped? Where did the weight go?

1.Breathe In, Breathe Out

As we try to settle in to the complicated and mind-numbing cycle of eating well and exercising regularly, it’s easy to forget the simple fact that our bodies are fuel-burning machines. Like cars that thirst for gasoline, they run on the energy and nutrients in the food we eat. A series of complex chemical reactions turns an entire pizza (you monster) into various forms of energy that get released and burned off, depending on the food’s nutritional make up and how much of a demand you put on your body.

“So, if we are riding a bike, we are essentially transferring some of ‘our’ energy to the bike, which is what propels the pedals around against a resistance,” explains Dr. Beau Greer, director of the Exercise Science and Nutrition M.S. Program at Sacred Heart University. “However, the majority of energy used in a biking session — or any exercise session — is lost as heat.”

More specifically, you can thank the citric acid cycle, or, the Krebs cycle (as my inner biology student somehow remembers it), for this energy expenditure. As you take in food, the various fats and carbohydrates composed in the food sliding down your gullet get digested and turned into a form of chemical energy called adenosine triphosphate, or ATP. ATP does lots of different things. It helps cellular metabolism, respiration, and locomotion. It’s also what lets your muscles, both the internal and external ones, contract. (It’s so versatile and essential that scientists call it the “molecular unit of currency.”)

At the tail end of this energy burn are certain forms of waste, similar to the exhaust spewed out by your car. Only, your body isn’t giving off pollutant gas, but steady emissions of urine, feces, and, to a lesser extent, sweat. But there’s something else going on there, too. In addition to the tangible act of breathing — a sure sign of a well-oiled Krebs cycle — your body is giving off heat. That, Greer says, is where the weight goes.

“We expend energy at all times,” he says. “Rest, exercise, and all times in between — the difference is solely the rate of expenditure.” When you get your heart pumping like mad during aerobic exercise, very little of the energy you produce gets directed toward the specific activity. “For reference, if you burn 100 calories in a biking session, only about 20 calories of energy was needed to actually move the pedals. The remaining 80 calories expended went to heat production.”

Heat isn’t the only factor, however. As you exercise, you are constantly taking in air to bring oxygen to your muscles. The end result of this is the equal and opposite act of expelling carbon dioxide. With every lumbering stride on the treadmill, you exhale a plume of carbon dioxide whose molecules are heavier than the oxygen molecules your body consumed during energy production. So, at the same time you’re burning the energy, you’re literally also exhaling your weight.

2.Clean Eating For Calorie Burns

This should make sense if we reverse-engineer common health advice. We do cardio because it “burns fat.” But the reason it burns more fat than doing nothing is that our bodies undergo aerobic respiration to produce more ATP for energy, rather than something else, like sulfate or nitrate.

In this sense, metabolic functions don’t really need exercise at all. Most of the energy we burn throughout the day is done while we’re at rest anyway, Greer says. “This is why I love the Men’s Health-type snippets that show some 500-calorie junk food and then say how many minutes of stair-climbing you would have to do to burn it off.  It’s true, but you could just lie on the couch for seven and a half hours and achieve the same effect!” It all depends on how quickly you’d like to burn off those 500 calories.

Gaining or losing weight is the difference between how many calories you take in versus how many you use. Partially influencing this second number is a person’sbasal metabolic rate, or BMR. It refers to the number of calories someone will burn over a given period without any special energy expenditure. Some people, like the string beans who can eat all day and not gain a single pound, have very high BMRs. As machines, their bodies burn through their fuel a lot faster than everyone else’s, meaning that to maintain a certain weight, they have greater caloric demands.

For most people, or at least the 69 percent of the U.S. who are obese or overweight, the goal is to increase their BMR. Exercise is one option, and anaerobic exercises like weightlifting in particular because they build lean muscle mass. When we are at rest, most of our energy comes from fat-burning, rather than the carbohydrate stores we recruit during aerobic exercise. The more we can build lean muscle, in other words, the greater our BMR will be.

Eating cleaner also helps, says Marissa Lippert, a New York-based dietitian. “If you’re eating whole fresh foods versus more processed foods, your body works more efficiently and it’s going to burn calories the right type of way, meaning it can burn energy consistently at a slower, steadier pace.” With a more refined diet, calories get used up much more quickly and your blood sugar drops, sending your metabolism, as Lippert says, “out of whack.”

This is why both diet and exercise are important. You can’t just kill yourself on the treadmill. Without the right food to power the machine that is your body, the whole system runs worse and you won’t have to wonder where the weight went, because it never left.

New technology directly reprograms skin fibroblasts for a new role

As the main component of connective tissue in the body, fibroblasts are the most common type of cell. Taking advantage of that ready availability, scientists from the Perelman School of Medicine at the University of Pennsylvania, the Wistar Institute, Boston University School of Medicine, and New Jersey Institute of Technology have discovered a way to repurpose fibroblasts into functional melanocytes, the body’s pigment-producing cells. The technique has immediate and important implications for developing new cell-based treatments for skin diseases such as vitiligo, as well as new screening strategies for melanoma. The work was published this week in Nature Communications.

The new technique cuts out a cellular middleman. Study senior author Xiaowei “George” Xu, MD, PhD, an associate professor of Pathology and Laboratory Medicine, explains, “Through direct reprogramming, we do not have to go through the stage, but directly convert fibroblasts to melanocytes. So these cells do not have tumorigenicity.”

Changing a cell from one type to another is hardly unusual. Nature does it all the time, most notably as cells divide and differentiate themselves into various types as an organism grows from an embryo into a fully-functional being. With , medicine is learning how to tap into such cell specialization for new clinical treatments. But controlling and directing the process is challenging. It is difficult to identify the specific transcription factors needed to create a desired cell type. Also, the necessary process of first changing a cell into an induced pluripotent stem cell (iPSC) capable of differentiation, and then into the desired type, can inadvertently create tumors.

Xu and his colleagues began by conducting an extensive literature search to identify 10 specific cell transcription factors important for melanocyte development. They then performed a transcription factor screening assay and found three transcription factors out of those 10 that are required for melanocytes: SOX10, MITF, and PAX3, a combination dubbed SMP3.

“We did a huge amount of work,” says Xu. “We eliminated all the combinations of the other and found that these three are essential.”

The researchers first tested the SMP3 combination in mouse embryonic fibroblasts, which then quickly displayed melanocytic markers. Their next step used a human-derived SMP3 combination in human fetal dermal cells, and again melanocytes (human-induced melanocytes, or hiMels) rapidly appeared. Further testing confirmed that these hiMels indeed functioned as normal melanocytes, not only in cell culture but also in whole animals, using a hair-patch assay, in which the hiMels generated melanin pigment. The hiMels proved to be functionally identical in every respect to normal melanocytes.

Xu and his colleagues anticipate using their new technique in the treatment of a wide variety of skin diseases, particularly those such as vitiligo for which cell-based therapies are the best and most efficient approach.

The method could also provide a new way to study melanoma. By generating melanocytes from the fibroblasts of melanoma patients, Xu explains, “we can screen not only to find why these patients easily develop melanoma, but possibly use their cells to screen for small compounds that can prevent melanoma from happening.”

Perhaps most significantly, say the researchers, is the far greater number of fibroblasts available in the body for reprogramming compared to tissue-specific adult stem , which makes this new technique well-suited for other cell-based treatments.

5 Amazing Brain Surgery Innovations.

The brain, with its delicate twists and turns, can be a mine field for surgeons and their teams working to remove tumors. Medical technologies have evolved in creative, exciting ways to treat tumors while conserving the healthy, normal surrounding tissue. Here are five important innovations that have extended the lives of brain tumor patients.

1. Destroying cancer cells with laser-directed heat

When cancer is located in hard-to-reach brain areas or areas that control a person’s vital functions, it can be too risky to perform traditional surgery.

Laser interstitial thermal therapy transmits heat to coagulate, or “cook,” brain tumors from the inside out. A medical innovation called NeuroBlate® offers precise positioning of the laser to target, heat and destroy brain tumors. It integrates it with intra-operative magnetic resonance imaging (MRI) technology, producing detailed images of internal organs without using radiation.

This innovation offers an option for tumors once considered inoperable. Surgeons can reference high-resolution images as they are operating. They can see and direct the progress of tumor destruction as it happens, which increases the likelihood that tumors will be completely treated.

5 Amazing Brain Surgery Innovations

2. Making tumors ‘glow’ to help surgeons remove them

Often, surgeons must be conservative when removing brain tumors. They may need to leave some of a brain tumor behind to avoid damaging a person’s healthy tissue – especially if the tumor is located near areas that control important functions. The challenge comes in locating the edges of the tumor. The edges of a tumor can look just like healthy tissue.

During a traditional surgery, surgeons will remove all that they can and patients are later treated with chemotherapy and radiation to kill the remaining cancer. For aggressive brain tumors, called glioblastomas, doctors are working on a way to get more of the tumor during surgery: making them glow a pinkish-red color when exposed to blue light. The technique is still experimental but it allows surgeons to more clearly see the margins of a tumor. This can make a big difference in the cancer fight by offering a better prognosis for patients.

How it works: Before surgery, a patient will drink a liquid that contains 5-aminolevulinic acid (5 ALA), a substance that causes the tumor, and only the tumor, to glow. This allows for more precise removal during surgery.

5 Amazing Brain Surgery Innovations

3. Performing brain surgery without a cut

Today, it’s possible to have brain surgery in the morning and be home later that day with Gamma Knife surgery. This is a minimally invasive, targeted therapy that delivers radiation into a specific area of the brain.

In a single treatment, 201 beams of gamma rays are focused at multiple points which are designed to deliver radiation that matches the shape of the tumor. Because of this precise focusing ability, aggressive, high-dose gamma radiation can be delivered to stabilize, shrink, or destroy some lesions – even those deep in the cerebral hemispheres or brain stem.

Most patients don’t feel anything during the treatment or recovery. Being able to treat some brain tumors without making any cuts is a huge step forward for patients. The most common use for this treatment is brain metastases – or cancer that originated in some other part of the body but which has spread to the brain.

Experts say Gamma Knife is often equal or superior to regular brain surgery in effectiveness, is virtually painless and has fewer complications.

5 Amazing Brain Surgery Innovations

4. Using electric fields to slow tumor growth

It’s interesting that very low-intensity, intermediate-frequency alternating electric fields can slow growth of some recurring tumors. Called tumor treating fields (TTFields), they can inhibit the growth of tumor cells. These tumor treating fields are particularly useful in treating glioblastoma, an incurable malignancy with overall survival of 15-18 months.

How it works: As these aggressive tumor cells try to grow, the electric fields disrupt them. One system, the Novo TTF-100A®, involves a patient wearing what looks like a very thin swimming cap on his head. This “cap” contains electrically insulated surface transducer arrays that deliver TTfields generated by a device that he can wear on his back.

This noninvasive treatment works to stop the tumor cells from dividing and keep them from growing. TTFields therapy is frequency tuned to specific cancer cell types.

One study compared the use of TTFields with chemotherapy in recurrent glioblastoma patients and found that TTFields therapy is associated with minimal toxicity, better quality of life, and comparable effectiveness to chemotherapy. Researchers have ongoing and future studies planned to evaluate TTFields in newly diagnosed glioblastoma, solid tumor brain metastases, nonsmall cell lung cancer, and ovarian and pancreatic cancers.

5 Amazing Brain Surgery Innovations

5. Team approach for lesions in the base of the skull

Lesions located in or around the base of the skull are very difficult to treat surgically. It’s a challenge for surgeons to reach and remove deep-seated intra- and extra-cranial skull base lesions while protecting healthy brain tissue.

When it comes to skull base tumors, a team effort is instrumental to success. It can require the highly specialized techniques of specialists in interventional neuroradiology, otolaryngology (ear, nose, throat), neurosurgery, ophthalmology, plastic surgery, and neuroanesthesiology. The main goal of skull base surgery is to allow surgeons access to difficult-to-reach lesions by moving (anatomic displacement) or removing parts of the base of the skull. These techniques reduce or eliminate the need for pushing back or moving brain tissue, which helps protect injury to the brain, cranial nerves, and blood vessels.

5 Amazing Brain Surgery Innovations