4 April 2015 — Total Lunar Eclipse – Where and when to see


This Total Lunar Eclipse or “Blood Moon”, is on April 4, 2015 and will be visible in most of North America, South America, Asia and parts of Australia. The Moon will be totally eclipsed (totality) for about 5 minutes. From beginning to end, it will last for 3 hours and 29 mins. This is the third eclipse in the 2014–2015 tetrad.

What this lunar eclipse looked like

The animation shows approximately what the eclipse looked like from the night side of earth.

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Where eclipse could be seen

Regions seeing at least some parts of the eclipse: Much of Asia, Australia, Much of North America, Much of South America, Pacific, Atlantic, Indian Ocean, Arctic, Antarctica.

100% visible (start to end).

More than 75% of the event was visible

Less than 75% of the event was visible

Less than 50% of the event was visible

Eclipse was not visible at all

Note: Percentage values (%) are of the overall eclipse event. Lighter shadings left (West) of center will experience the eclipse after moonrise/sunset. Shadings right (East) will experience until moonset/sunrise. Actual eclipse visibility depends on weather conditions and line of sight to the Moon.

When the eclipse happened worldwide

Lunar eclipses look approximately the same all over the world and happen at the same time.

The times displayed might be a minute or two off actual times.

Event UTC Time Time in Washim* Visible in Washim
Penumbral Eclipse began 4 Apr, 09:01 4 Apr, 14:31 No, below horizon
Partial Eclipse began 4 Apr, 10:15 4 Apr, 15:45 No, below horizon
Full Eclipse began 4 Apr, 11:57 4 Apr, 17:27 No, below horizon
Maximum Eclipse 4 Apr, 12:00 4 Apr, 17:30 No, below horizon
Full Eclipse ended 4 Apr, 12:02 4 Apr, 17:32 No, below horizon
Partial Eclipse ended 4 Apr, 13:44 4 Apr, 19:14 Yes
Penumbral Eclipse ended 4 Apr, 14:59 4 Apr, 20:29 Yes

* The Moon was below the horizon in Washim some of the time, so that part of the eclipse was not visible.

CDC Findings Suggest Hemophilia Carriers Vulnerable to Joint Damage.


CDC Findings Suggest Hemophilia Carriers Vulnerable to Joint Damage

In a newly highlighted study, the US Centers for Disease Control and Prevention (CDC) concluded that hemophilia carriers showed evidence of joint abnormalities as early as the pre-teen years regardless of the severity of bleeding symptoms. Results of the study were first published in “ Females with FVIII and FIX Deficiency have Reduced Joint Range of Motion,” in August 2014 in the American Journal of Hematology. The lead author was Robert Sidonio, MD, MS, Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt University Medical Center in Nashville, TN.

To learn whether hemophilia carriers reported joint bleeding and showed physical signs of joint damage or destruction, CDC looked at joint abnormalities among 451 women presumed to be hemophilia carriers aged 2-69 years. The women were enrolled in a national public health tracking project called the Universal Data Collection (UDC) system. The UDC was created in 1998 by the CDC, in cooperation with the federally funded hemophilia treatment center (HTC) network, to collect vital health information on individuals with bleeding disorders in the US.

Data for the study were gathered by either an HTC physical therapist or other trained healthcare provider, who collected information on specific participant characteristics, such as race/ethnicity, income and educational level (demographic information), as well as information on bleeding and infectious disease history, and range of movement measurements in five joints (right and left shoulders, elbows, hips, knees and ankles).

CDC’s most prominent findings were:

  • The proportion of female hemophilia carriers reporting at least one joint bleed in the last six months increased as the severity of hemophilia worsened
  • Approximately one in seven females with mild hemophilia reported at least one joint bleed in the last six months. Mild hemophilia means they have 6% to 40% of normal clotting ability.
  • Approximately one in three females with moderate hemophilia reported at least one joint bleed in the last six months. Moderate hemophilia means they have 1% to 5% of normal clotting ability.
  • Approximately half of females with severe hemophilia reported at least one joint bleed in the last six months. Severe hemophilia means they have less than 1% of normal clotting ability.

Hemophilia carriers showed signs of joint abnormalities as reflected by reduced joint range of movement, which worsened with increasing levels of severity of hemophilia.

These findings suggest that joint bleeding might be occurring even before a carrier’s adolescent years. Sidonio and his co-investigators also acknowledge that this research is preliminary and that the next step is to document joint disease with X-rays and other tools.

– See more at: http://www.hemophilia.org/Newsroom/Medical-News/CDC-Findings-Suggest-Hemophilia-Carriers-Vulnerable-to-Joint-Damage#sthash.MCPwbBmk.dpuf

The New Digital Stethoscope with Advanced Audio Features


Thinklabs Medical (Centennial, CO), a company that’s been focusing on producing high-end electronic stethoscopes, has unveiled its latest flagship model, the Thinklabs One. The device itself fits entirely into the chestpiece and works with any headphones of your choice. It can amplify sounds by more than 100x and provides a variety of audio filtering options to better hear heart murmurs, diastolic rumbles, lungs sounds, etc, etc. The device can connect to tablets and smartphones to visually display the waveform of the audio using a matching app, which can also record and let you zoom in on specific spots in the recordings. Additionally, the iMurmur app from Thinklabs provides a library of pre-recorded heart sounds that can be used to learn and maybe even compare against one’s own patients. The standard package comes with a set of in-ear headphones, and for the stylish physician there’s also the Beats Package that comes with Dr. Dre’s Executive headphones that feature noise canceling technology.

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Cold-shock protein protects against neurodegeneration.


In the adult brain, communication between neurons is constantly remodeled by the elimination of old synapses and the formation of new ones; this turnover of synapses is called structural plasticity. Patients with neurodegenerative diseases such as Alzheimer’s disease have fewer synapses compared to normally aging adults, suggesting that their brains have decreased structural plasticity. While it is difficult to analyze this plasticity across aging in humans, research on hibernating animals provides an important model to study structural plasticity at a molecular level.

During hibernation, mammals such as bears and hedgehogs cool their bodies temporarily, and this cooling induces a temporary loss of synapses. Synapses are reformed when body temperature warms. To mimic hibernation in a laboratory setting, Peretti and colleagues developed a model based on artificial cooling and re-warming of lab mice. They analyzed changes in synapse number in this model to study structural plasticity. Their results showed that the same number of synapses that were lost upon cooling, reformed after warming the animals.

The researchers then analyzed whether differences in plasticity were present in two mouse models of human neurodegeneration: Alzheimer-type mice (called 5XFAD mice) or prion-infected mice.  In both the prion-infected and Alzheimer-type mice, synapse number decreased after cooling, but these synapses did not reform after warming, indicating a loss of structural plasticity.

The investigators examined a protein that is expressed after cooling or hibernation, the cold-shock RNA-binding protein RBM3. They found that in healthy mice, RBM3 was expressed after cooling. However, in both prion-infected and Alzheimer-type mice, cooling failed to induce expression of RBM3. Enhancing RBM3 in both of the mouse models either by early cooling prior to disease onset, or by over-expressing RBM3 with virus prior to cooling, rescued the loss of structural plasticity. The effect was dramatic: not only were synapses reformed after cooling in prion-infected and Alzheimer-type mice, but also fewer neurons were lost. Additionally, these mice performed better on a memory task, and overall survival was increased compared to prion-infected or Alzheimer-type mice that did not receive these early interventions. Loss of RBM3 exacerbated symptoms and decreased survival in both models of neurodegeneration. The investigators then examined whether RBM3 alone, in the absence of cooling, was neuroprotective, and found that in both prion-infected mice and Alzheimer-type mice, early over-expression of RBM3 resulted in fewer synapses lost, decreased memory deficits, and better survival.

Understanding protective mechanisms of neurodegeneration may ultimately lead to the development of therapeutic targets or interventions for patients with early stage neurodegenerative disorders.

– See more at: http://www.neuroscientistnews.com/publications/cold-shock-protein-protects-against-neurodegeneration#sthash.pospPjbU.dpuf

Dialectical Behavior Therapy for High Suicide Risk in Individuals With Borderline Personality Disorder: A Randomized Clinical Trial and Component Analysis.


Abstract

IMPORTANCE:

Dialectical behavior therapy (DBT) is an empirically supported treatment for suicidal individuals. However, DBT consists of multiple components, including individual therapy, skills training, telephone coaching, and a therapist consultation team, and little is known about which components are needed to achieve positive outcomes.

OBJECTIVE:

To evaluate the importance of the skills training component of DBT by comparing skills training plus case management (DBT-S), DBT individual therapy plus activities group (DBT-I), and standard DBT which includes skills training and individual therapy.

DESIGN, SETTING, AND PARTICIPANTS:

We performed a single-blind randomized clinical trial from April 24, 2004, through January 26, 2010, involving 1 year of treatment and 1 year of follow-up. Participants included 99 women (mean age, 30.3 years; 69 [71%] white) with borderline personality disorder who had at least 2 suicide attempts and/or nonsuicidal self-injury (NSSI) acts in the last 5 years, an NSSI act or suicide attempt in the 8 weeks before screening, and a suicide attempt in the past year. We used an adaptive randomization procedure to assign participants to each condition. Treatment was delivered from June 3, 2004, through September 29, 2008, in a university-affiliated clinic and community settings by therapists or case managers. Outcomes were evaluated quarterly by blinded assessors. We hypothesized that standard DBT would outperform DBT-S and DBT-I.

INTERVENTIONS:

The study compared standard DBT, DBT-S, and DBT-I. Treatment dose was controlled across conditions, and all treatment providers used the DBT suicide risk assessment and management protocol.

MAIN OUTCOMES AND MEASURES:

Frequency and severity of suicide attempts and NSSI episodes.

RESULTS:

All treatment conditions resulted in similar improvements in the frequency and severity of suicide attempts, suicide ideation, use of crisis services due to suicidality, and reasons for living. Compared with the DBT-I group, interventions that included skills training resulted in greater improvements in the frequency of NSSI acts (F1,85 = 59.1 [P < .001] for standard DBT and F1,85 = 56.3 [P < .001] for DBT-S) and depression (t399 = 1.8 [P = .03] for standard DBT and t399 = 2.9 [P = .004] for DBT-S) during the treatment year. In addition, anxiety significantly improved during the treatment year in standard DBT (t94 = -3.5 [P < .001]) and DBT-S (t94 = -2.6 [P = .01]), but not in DBT-I. Compared with the DBT-I group, the standard DBT group had lower dropout rates from treatment (8 patients [24%] vs 16 patients [48%] [P = .04]), and patients were less likely to use crisis services in follow-up (ED visits, 1 [3%] vs 3 [13%] [P = .02]; psychiatric hospitalizations, 1 [3%] vs 3 [13%] [P = .03]).

CONCLUSIONS AND RELEVANCE:

A variety of DBT interventions with therapists trained in the DBT suicide risk assessment and management protocol are effective for reducing suicide attempts and NSSI episodes. Interventions that include DBT skills training are more effective than DBT without skills training, and standard DBT may be superior in some areas.

Doctors find ‘boiled egg’ inside patient.


Picture Courtesy: New England Journal of Medicine
A man, 62, was found to have a giant ‘boiled egg’ inside him, pressing on his bladder and causing him to constantly to go to the loo, The DailyMail reported. The man came to hospital complaining he had felt a frequent urge to urinate for more than 20 years. Doctors found a ‘free-floating, smooth, firm and rubbery’ lump near his abdomen. The mass measured an incredible 10cm in length and 7.5cm wide.
What the doctors discovered inside a 62-year-old patient looks like a giant egg, and parts of it had a “firm and rubbery” texture similar to a hard-boiled egg. But this was no egg. It’s called a peritoneal loose body, and according to one of the doctors that had it surgically removed, this is the largest specimen of its kind reported in medical literature to date.
In this case, because of gravity, the mass sat on top of the patient’s bladder in his pelvis.  This led to increased urinary frequency, which he reported over a course of 20 years. After it was removed, frequency turned to normal according to the article published in the New England Journal of Medicine.

Lessons from the East — China’s Rapidly Evolving Health Care System


At first glance, China might seem unlikely to offer useful health care lessons to many other countries. Its health system exists within a unique geopolitical context: a country of more than 1.3 billion people, occupying a huge, diverse landmass, living under authoritarian single-party rule, and making an extraordinarily rapid transition from a Third-World to a First-World economy.

But first impressions can be misleading. Since its birth in 1949, the People’s Republic of China has undertaken a series of remarkable health system experiments that are instructive at many levels. One of the most interesting lessons from the Chinese experience concerns the value of an institution that many countries take for granted: medical professionalism.

Because the changes in China’s health care system have been so rapid and profound, it is helpful to briefly review its recent history.1 What might be seen as the first of four phases began when the Chinese Communist Party took power in 1949. The new government created a health system similar to those of other communist states such as the Soviet Union and its Eastern European allies. The government owned and operated all health care facilities and employed the health care workforce. No health insurance was necessary, because services were nearly free. A distinctive accomplishment of this phase was the system’s successful use of community health workers, so-called barefoot doctors, to provide basic public and personal health services at the village level. Between 1952 and 1982, China’s infant mortality rate fell from 200 to 34 per 1000 live births, and age-old scourges such as schistosomiasis were largely eliminated.2

In 1984, a second phase began: China turned its health system on its head, almost as an afterthought to dramatic free-market reforms in the rest of its economy. Led by Communist Party leader Deng Xiaoping, China converted to a market economy and reduced the role of government in all economic and social sectors, including health care. Government funding of hospitals dropped dramatically, and many health care professionals, including barefoot doctors, lost their public subsidy. The government continued to own hospitals but exerted little control over the behavior of health care organizations, which acted like for-profit entities in a mostly unregulated market. Many health care workers became private entrepreneurs. Physicians working for hospitals received hefty bonuses for increasing hospital profits.

As they responded to these new economic imperatives, Chinese physicians had little history or tradition of professionalism or independent professional societies to draw on. China had transitioned from a society organized according to Confucian principles (which did not envision the existence of a modern, independent profession such as medicine) to a communist country (in which clinicians were state employees owing their primary allegiance to the Communist Party) to a quasi-market environment. At no point along this journey did physicians have the opportunity or support to develop the norms and standards of medical professionalism or the independent civic organizations that could promote and enforce them. Indeed, the Chinese language has no word for “professionalism” in the Western sense.

To make China’s experiment with free-market health care even more dramatic, the Chinese reforms left the vast majority of the population uninsured, since the government did not provide coverage and no private insurance industry existed. As of 1999, a total of 49% of urban Chinese had health insurance, mostly through government and state enterprises, but only 7% of the 900 million rural Chinese had any coverage.2 Thus, a population largely unprotected against the cost of illness confronted a health care delivery system intent on economic survival and a health-professional workforce that had never had the opportunity to develop as independent professionals. Indeed, prevailing new economic rules and incentives strongly encouraged physicians to operate like entrepreneurs in a capitalist economy.

The government kept its hand in one major aspect of health care: pricing. Presumably to ensure access to basic care, it limited the prices charged for certain services, such as physicians’ and nurses’ time. However, it allowed much more generous prices for drugs and technical services, such as advanced imaging. The predictable result: hospitals and health care professionals greatly increased their use of drugs and high-end technical services, driving up costs of care, compromising quality, and reducing access for an uninsured citizenry.

By the late 1990s, this market-reform experiment had resulted in public anger and distrust toward health care institutions and professionals, and even in widespread physical attacks on physicians. Discontent with lack of access to health care fueled public protests, especially in less affluent rural areas, that threatened social stability and the political control of the Communist Party.

In 2003, a third phase began, when the Chinese government took a first step toward mitigating popular discontent with health care by introducing a modest health insurance scheme covering some hospital expenses for rural residents. The focus on hospital care reflected the fact that hospital services were expensive and therefore drove many patients into poverty.

But this hospital orientation also reflected limitations in the leadership’s understanding of the critical role that competent primary care plays in managing health and disease and controlling the costs of care. Chinese authorities were also preoccupied with relieving the financial burden created by much more expensive hospital services. Not surprisingly, the 2003 reforms proved insufficient to ameliorate China’s deep-seated health care problems.

By 2008, China’s leaders had concluded that major reforms in both insurance and the delivery system were necessary to shore up the system and ensure social stability. In a fourth and ongoing phase of evolution, they officially abandoned the experiment with a health care system based predominantly on market principles and committed to providing affordable basic health care for all Chinese people by 2020. By 2012, a government-subsidized insurance system provided 95% of the population with modest but comprehensive health coverage .

Selected Characteristics of the Health Care System and Health Outcomes in China. and case histories; to compare this country with others, see the interactive graphic).3 China also launched an effort to create a primary care system, including an extensive nationwide network of clinics.3

Though China’s extensive 2008 reforms are still in process, a number of problems, mostly concerning tertiary hospital care, continue to challenge its leadership. First, many of the country’s publicly owned but profit-driven tertiary hospitals successfully resisted the latest reform efforts — a reality that probably reflects the hospitals’ power within China’s political system. As a result, frustrated authorities sought to use market forces once again to bring the hospital sector into line. In 2012, the leadership announced that they would invite private investors to own up to 20% of China’s hospitals by 2015, double the preexisting rate.4

Second, major inequities continue between the health care available in poor rural areas and that in more affluent cities.5 Third, China continues to struggle with creating a high-quality, trusted, professionalized physician workforce. One legacy of China’s market experiment is a widespread perception that physicians put their economic welfare ahead of patients’ interests.

Though China’s health care system is still rapidly evolving, several potentially useful lessons emerge from its recent history. The first is that in low-income countries, and perhaps high-income ones as well, community health workers such as China’s barefoot doctors can significantly improve the health status of local populations.

Second, relying largely on markets to fund and distribute health services creates risks that need careful consideration. Though government price setting created market distortions, these do not fully explain the problems with quality, access, and cost that China experienced in the second phase of its recent history. Health care is subject to serious market failures. Asymmetries in information between patients and health care providers make it difficult for patients to make sound choices in free health care markets, and patients’ lesser knowledge may be exploited by clinicians. Patients’ resulting vulnerability, resentment, and distrust can be socially destabilizing — and may intensify when patients are heavily exposed to the costs of care, as they were until recently in China.

Third, physician professionalism may be underappreciated as a foundation for effective modern health care systems. The inculcation of professional norms during and after training and the existence of professional institutions that reinforce these norms certainly do not guarantee that professionals will act only in the interest of their patients and the public. But there seems little question that the lack of a widely shared tradition of professionalism has complicated China’s efforts to create a health care workforce that its leaders and the public trust to do the right thing.

Finally, China’s health care experience shows that it may be easier to reform health insurance than delivery systems and that in creating effective delivery systems, primary care seems to play a vital role.

A review of China’s health care journey reveals that its leadership has made significant errors but has also acted with flexibility and decisiveness in correcting its mistakes. China’s willingness to undertake major health care experiments will make its system an interesting one to continue to observe in the future.

PREGNANCY AND CHILDBIRTH

A healthy 23-year-old woman is pregnant for the first time.
Ms. Wang lives in rural China. Her perinatal care, which is relatively uniform throughout China, relies on the country’s three-tiered system for essential health services: village or neighborhood clinics provide preventive and basic primary care services, township or subdistrict health centers staffed by primary care physicians provide more advanced outpatient services and have beds for observing patients who are not very ill, and county hospitals provide basic specialty care and inpatient services.
Ms. Wang registers with the village clinic as required to receive the maternity services covered by China’s rural insurance: five prenatal visits, various routine prenatal and postnatal tests, hospital delivery, and four postnatal visits. Though routine tests are free, she must pay the full charge for some services considered elective, such as advanced three- or four-dimensional ultrasound. She has to pay a 10 to 20% copayment ($35 to $70) for her delivery in the 300-bed county hospital; she would pay 10 times as much at a tertiary care hospital.
At weeks 12 and 28 of her pregnancy, Ms. Wang visits the township health center 3 miles away for examinations by a physician with 3 to 4 years of medical training. She receives prenatal screening tests, a routine ultrasound, and counseling. Starting at week 29, Ms. Wang visits the township health center every 3 to 4 weeks for monitoring of blood pressure, weight, and fundal height. The village doctor does regular follow-up after these visits.
Ms. Wang would stay at the county hospital 3 days for a normal delivery. However, China has a high incidence of cesarean section, partly because it is more lucrative for physicians. When she’s discharged, she will be visited by the village doctor three times in the first month. After 42 days, she’ll return to the hospital for examination and tests.

MYOCARDIAL INFARCTION

A 55-year-old man with no serious health conditions has a moderately severe myocardial infarction.
Management of myocardial infarction in China varies considerably between rural and urban areas, and Mr. Li lives in a rural area, where he’s covered by rural health insurance. He develops chest pain around midday. An hour later, he calls the village doctor, who arrives at his home about 30 minutes later and administers nitroglycerin tablets. When the pain is not alleviated, the doctor calls a senior internist at the county hospital, who advises the patient to call an ambulance to transport him to the hospital, which is 30 minutes away. As is customary in China, however, Mr. Li waits for his daughter to come home from work so she can accompany him. He arrives at the hospital around 7 p.m.
There, electrocardiography and myocardial-enzyme tests confirm that he’s having a myocardial infarction. He has two treatment options: intravenous thrombolysis at the county hospital or cardiac catheterization at a tertiary care hospital. His doctor recommends the latter, since it’s too late for thrombolysis to be effective.
Mr. Li hesitates because of the added expense of care at the tertiary facility: treatment at the county hospital requires a $300-to-$600 copayment, as compared with $2,000 to $2,500 at the tertiary facility. His family’s annual income is only $6,000. Nevertheless, he opts for the tertiary hospital.
Mr. Li undergoes angiography and receives two stents. He stays in the hospital for 2 weeks, spending half that time in the cardiac intensive care unit. He is discharged on aspirin, clopidogrel, an angiotensin-converting–enzyme inhibitor, a beta-blocker, spironolactone, and a statin. His insurance pays 60% of the cost of these medicines up to a maximum of $800, leaving him with out-of-pocket medication expenses of $700 to $800 per year.
Mr. Li receives very little counseling about preventive measures such as smoking cessation or hypertension or lipid management. He returns to his village with no arrangements for primary care follow-up.