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Ebola may not be a deadly disease for everyone

Ebola may not be deadly for everyone: Study
A newly developed mouse model suggests that genetic factors are behind the mild-to-deadly range of reactions to the Ebola virus.
  • WASHINGTON: Ebola may not be a deadly disease for everyone, suggests a new study that found the virus affects different people differently.
A newly developed mouse model suggests that genetic factors are behind the mild-to-deadly range of reactions to the Ebola virus.

People exposed to Ebola vary in how the virus affects them. Some completely resist the disease, others suffer moderate to severe illness and recover, while those who are most susceptible succumb to bleeding, organ failure and shock.

In the new study, scientists led by the Katze Laboratory at the University of Washington Department of Microbiology described strains of laboratory mice bred to test the role of an individual’s genetic makeup in the course of Ebola disease.

Health workers of the International Federation of Red Cross and medical charity Medecins Sans Frontieres take part in a pre-deployment training for staff heading to Ebola areas on October 29, 2014 at the IFRC headquarters in Geneva. (AFP photo)

The scientists examined mice that they infected with a mouse form of the same species of Ebola virus causing the 2014 West Africa outbreak.

Interestingly, conventional laboratory mice previously infected with this virus died, but did not develop symptoms of Ebola hemorrhagic fever.

In the present study, all the mice lost weight in the first few days after infection. Nineteen per cent of the mice were unfazed.

They not only survived, but also fully regained their lost weight within two weeks. They had no gross pathological evidence of disease. Their livers looked normal.

Eleven per cent were partially resistant and less than half of these died. Seventy per cent of the mice had a greater than 50 per cent mortality, researchers found.

The Spanish Red Cross is training doctors, nurses and engineers to fight Ebola in Western Africa during a two day pre-deployment course at a mock field hospital resembling the Ebola treatment center the organization has in Kenema, Sierra Leone. (Reuters photo)

Nineteen per cent of this last group had liver inflammation without classic symptoms of Ebola, and thirty-four per cent had blood that took too long to clot, a hallmark of fatal Ebola hemorrhagic fever in humans.

Those mice also had internal bleeding, swollen spleens and changes in liver colour and texture.

The scientists correlated disease outcomes and variations in mortality rates to specific genetic lines of mice.

“The frequency of different manifestations of the disease across the lines of these mice screened so far are similar in variety and proportion to the spectrum of clinical disease observed in the 2014 West African outbreak,” said virologists Angela Rasmussen.

While acknowledging that recent Ebola survivors may have had immunity to this or a related virus that saved them during this epidemic, researcher Michael Katze said, “our data suggest that genetic factors play a significant role in disease outcome.”

In general, when virus infection frenzied the genes involved in promoting blood vessel inflammation and cell death, serious or fatal disease followed.

On the other hand, survivors experienced more activity in genes that order blood vessel repair and the production of infection-fighting white blood cells.

High Milk Intake Associated With Mortality Risk? by Larry Hand

Swedish researchers have found that a high intake of milk may be associated with higher mortality and fracture risks in women and higher mortality risk in men, but they caution against basing any dietary recommendations on their findings, which were published online October 28 in BMJ.

Karl Michaëlsson, MD, PhD, professor in medical epidemiology and senior consultant in orthopedic surgery at Uppsala University in Sweden, and colleagues analyzed data on two large Swedish cohorts: one with 61,433 women aged 39 to 74 years and another with 45,339 men aged 45 to 79 years. Through food frequency questionnaires, the researchers obtained data on common foods and beverages consumed on a daily and weekly basis.

They analyzed outcomes from enrollment (from 1987 to 1990 for the women and January 1998 for the men) through December 2010. During a median of 22 years of follow-up, 15,541 women died and 17,252 women had a fracture. During a median of 13 years of follow-up, 10,112 men died and 5379 men had a fracture.

The researchers found that women who drank three or more glasses (680 g) of milk a day had almost twice the risk for death compared with women who drank less than one glass a day (hazard ratio [HR], 1.93, 95% confidence interval [CI], 1.80 – 2.06). Women who drank more milk also had a higher risk for any type of fracture (HR, 1.16; 95% CI, 1.08 – 1.25) and forhip fracture specifically (HR, 1.60; 95% CI, 1.39 – 1.84).

Although the researchers found that men who drank three or more glasses of milk had a slightly higher risk for death compared with those who drank less than one glass (HR, 1.10, 95% CI, 1.03 – 1.17), men did not have the excess risk for fracture seen in women.

The researchers adjusted the hazard ratio calculations for a wide variety of covariates, including but not limited to age, smoking status, body mass index, height, educational level, calcium and vitamin D supplementation, ever use of cortisone, physical activity, and Charlson’s comorbidity index.

In a sensitivity analysis, adjusting for nutrients associated with osteoporosis or fracture risk, the researchers found an even stronger association between high milk intake and outcomes. They also found an association between high milk intake and oxidative stress and inflammation.

Not Yogurt and Cheese

In contrast, the authors found no similar association between fermented milk products, including yogurt and cheese, and adverse outcomes.

The researchers did not distinguish among fat levels in milk, such as skim and whole, but lumped all milk consumption into one category.

“One potential candidate for the discrepant results for different types of dairy products is D-galactose content,” the researchers write. “The intake of D-galactose from non-fermented milk is considerably higher than that from other food sources, including cheese and fermented milk products.” They cite animal studies that have linked D-galactose to premature aging.

“Our results may question the validity of recommendations to consume high amounts of milk to prevent fragility fractures. The results should, however, be interpreted cautiously given the observational design of our study,” they conclude.

In an accompanying editorial, C. Mary Schooling, PhD, a professor of epidemiology at Hunter College in New York City, writes that Dr Michaëlsson and colleagues “raise a fascinating possibility,” but she too urges caution in interpreting the findings.

“As milk consumption may rise globally with economic development and increasing consumption of animal source foods, the role of milk in mortality needs to be established definitively now,” she says.

This research was supported by grants from the Swedish Research Council. The authors, editorialist, and commenter have disclosed no relevant financial relationships.

BMJ. Published online October 28, 2014

Doctors’ year end financial and business planning

Dear Doctor,

I am a financial advisor at Harding Financial which specialize in strategic tax planning strategies using a combination of corporate structuring and financial planning.   In working with new clients, we find that doctors are paying unnecessary taxes due to improper corporate structure and improper pay and financial structure.  With proper corporate, financial and pay structure, we can often eliminate large amounts of unnecessary taxes that you are currently paying to the Federal and State Governments.  If you have not sat down with a knowledgeable financial advisor who works hand in hand with your CPA to implement strategies that align your corporate, pay, and financial planning structures, you are paying unnecessary taxes.  CPAs are excellent in finding tax deductions through accounting, Harding Financial Partner advisors are excellent in finding deductions through an integration of corporate structure and financial planning.

Our planning and analysis goes beyond what typical financial advisors, and even CPAs, do for clients.  Additionally, our research and experience indicates that Dr. personal assets are exposed to litigation due to improper personal asset protection planning and strategies that are not in sync with their practice corporate structure.  If you would like to hear more about what we do for private practices and Doctors, please let me know and I will schedule a short, 30 minute, introductory call to see if our planning process and models interest you and are a fit for your situation.    There is still time to implement our strategies for tax year 2014, but that window is closing rapidly.  Talk to you soon.

Regards,

Connie Dello Buono

Financial Advisor

408-854-1883

conniedbuono@gmail.com

Harding Financial

Nature is the great inventor

biomimicry

Biologist Janine Benyus likes to tell stories about using nature to solve our problems. For instance, a company called Arnold Glas was concerned about all the birds killed when they fly into windows. The company’s scientists asked, How has nature solved this kind of problem? The answer, Benyus says, is spiders. “Spiders build webs for bugs,” she explains. “But birds obviously would destroy the webs, so spiders weave in strands of silk that reflect UV light. Birds can see it, but bugs and humans can’t.” So the company includes UV-reflective material in its Ornilux glass. “Now it sells bird-safe windows,” says Benyus.

With that, she illustrates the big idea behind “biomimicry” (the term she coined in 1997): that humans can borrow the best ideas from the natural world. Her consulting firm, Biomimicry 3.8, works with major corporations, like Nike, GE, and Boeing, as they look to the earth to create smarter products and services.

You’ve said, “If something can’t be found in nature, there’s probably a good reason for its absence.” Can you explain this?

Ninety-nine percent of all species that existed on earth are extinct. The 1 percent here are the ones that work best. Think of our planet as a research-and-development lab in which the best ideas have moved forward, and the ones that used too much energy or materials or were toxic were dropped. What you wind up with are organisms that are efficient.

Do those organisms include humans?

No. Humans have been around for only 200,000 years, as opposed to the 3.8 billion years that life has existed on earth. I see us as toddlers with matches. We’re experimental; we try a lot of things because we can. But at this point, we have to ask ourselves as a species: Do we want to be here 1,000 generations from now? If so, we need to choose things that are good for life. I think we can invent things that don’t have negative consequences. Other people are more pessimistic than I am; I’m optimistic by choice because I believe that pessimism doesn’t do a whole heck of a lot of good. I work with large companies, and they’re all trying to figure out how to do what they do and make profits without penalties and harmful consequences.

What’s an example of how businesses are using biomimicry?

Continental Tires uses a tread that enables drivers to stop on a dime. It comes from cat paws.

The company uses actual cat paws to make them?!

No, but good question. In biomimicry, we borrow the blueprints and ideas rather than use nature itself. One cool example is a new paint that helps a building clean itself with rainwater. The product is called Lotusan, as in lotus leaves. Even though lotuses grow in the mud, they stay pristine. Scientists found that microscopic bumps on the leaves cause rain to form balls like beads of mercury. As these balls of water roll off the leaves, they pick up the dirt. GE is making bottles based on the leaves so that if you have ketchup or mustard in them, you can pour out every single drop.

fungi plant

What one plant or animal do you consider the star, the one that we can learn from the most?

Mycorrhizal fungus. It’s everywhere, and without it, we couldn’t exist. If you look at the roots of plants and trees, you’ll often see this white cobwebby stuff. This fungus works in partnership with plants and trees. It can’t get sunlight, since it’s underground, but trees can, and they use the sun to produce sugars, which they send down to the fungi. Trees can’t get phosphorous, but the fungi can, so they give it to the trees. In forests, this fungus creates an interconnected network—the Wood Wide Web, it’s been called—and trees and plants can share nutrients, sugars, and water with others a half acre away.

How would an ordinary person use biomimicry?

I’ll give you an example. I wanted to plant willow trees around my pond in Montana, and I wondered, How far back from the water’s edge should they go? I went online for the answer, and then I realized, I’m surrounded by ponds. Why don’t I look at where the willows are doing well and see where I should plant mine?

I would’ve Googled it too.

But isn’t that crazy? The thing with biomimicry is to think functionally. When I built my house, I looked at how the ground squirrels on my property ventilated their dens. They build these long underground chambers. There’s a mound with an entrance on one end and a taller mound with an entrance at the other end. The wind zips through the taller mound, creating a vacuum that pulls air through the chambers, ventilating them. I told our architect I wanted to do this, and he put a cupola with windows at the top of the house. When I open the doors, the breezes go through the cupola and suck the air through the house, ventilating it.

What’s your holy grail?

I’d like us to become a species that not only fits in but contributes. Forests clean the water for cities, but whom do cities clean the water for? Nobody. No species gets to live here for long without figuring out how to create conditions conducive to the life of the whole ecosystem. And it’s doable. The Bank of America building in New York has a filtration system that leaves the air cleaner than when it enters. Cities could build permeable sidewalks so rainwater would seep into the pavement and into the soil, cleaning it. It’s about mimicking the wild land next door. The cool thing about nature’s technologies is that they don’t come from outer space. They’re here because they work well on earth.

Is there one ability you’d personally like to borrow from the natural world?

I’d love to run off the mountains, spread my wings, and fly. And you know what else I wish I could do? Swim deep underwater without a tank and just take air out of the water like a fish. I’d love that: to fly in the air and to fly in the water!

What would you say to a skeptic who asks, “What’s so great about nature anyway?”

We are nature, but we’re really young. Our biological elders are wise. I tip my hat to anything that has lived on earth for the long haul and succeeded.
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Does Cancer Grow More Aggressively at Night? by Dr Michael Breus

Scientists studying relationships between different types of cells have encountered some new and potentially important information about how — and when — cancerous tumors grow most aggressively. According to a new study, cancerous tumors may grow faster at night, during the hours typically taken up by sleep. Their discovery may point the way toward new, circadian-aligned strategies for treating cancer.

Researchers at Israel’s Weizmann Institute of Science have found evidence that suggests some cancers may grow more quickly during nighttime, resting hours than during the waking day.

The finding came as a surprise to researchers, who originally set out to examine the relationships between cell receptors, molecules that are involved in cell-to-cell communications. In particular, researchers were investigating the relationship between two types of cell receptors. The first receptor, EGFR (epidermal growth factor receptor), assists in cell growth and division. EGFR is involved in normal cell growth, and also in the growth of cancer cells. High levels of EGFR are found in many cancer cells, and one type of current cancer treatment works to fight cancer by inhibiting EGFR levels.

The second receptor involves a type of steroid hormone known as glutocorticoids (GC). Glutocorticoids perform a number of essential functions, one of which is a role in supporting daytime energy and alertness. When the body is under stress, levels of glutocorticoids rise sharply, heightening and sharpening a sense of alertness. Cortisol, often referred to as the “stress hormone,” is one important glutocorticoid.

Glutocorticoid hormone levels rise and fall in alignment with a 24-hour, circadian cycle. During active daytime hours, GC levels are at their highest, when we need to be alert and energized. GC levels plummet to their lowest levels at night during sleep, before rising again as morning arrives.

Scientists investigated how the circadian changes in GC hormone levels might affect the activity of EFGR, the receptor involved in cell growth. Using mice, they discovered that EGFR is significantly more active at night (when GC levels are low), and less active during the day (when GC levels are high).

EGFR stimulates not only normal cell growth, but also the growth and spread of cancer cells. Having discovered this basic relationship between EFGR and GC, researchers next wanted to explore the possible effects of targeting cancer treatments using this new information. Using mice with a form of cancer influenced by EFGR, researchers gave the mice a cancer-drug that works by inhibiting EFGR. They administered the drug at different times throughout the mice’s circadian day and night. Researchers discovered significant differences in tumor size after treatment. Mice treated during sleeping hours showed much smaller tumors than mice treated during waking hours.

These results suggest that the varying levels of GC, which rise and fall in a circadian rhythm, are involved in the degree of tumor growth in cancers that involve EFGR. The findings also suggest that aligning cancer treatment with the right circadian timing — in this case during sleep, when GC levels are lowest — may enhance the effectiveness of the treatment.

These findings are preliminary, and need further testing and examination in follow-up research. But they represent a potentially significant step forward in our understanding of one way 24-hour circadian rhythms may influence cancer growth — and how we might time delivery of anti-cancer therapies to maximize their impact.

Science has been pursuing an understanding of the relationship between circadian rhythms and cancer for some time. Increasingly, evidence indicates that disruption to circadian rhythms — and a lack of sufficient sleep — may increase the risk of cancer occurring, and may contribute to more aggressive forms of the disease:

• A growing body of research indicates that disruptions to circadian rhythms may lead to abnormal cell behavior and changes to DNA cell function, opening pathways to the development of cancer.

• There’s evidence that poor quality, fragmented sleep compromises the immune system’s ability to fight cancer, enabling tumor growth to become more aggressive. In one study, mice with cancer than experienced disrupted sleep for four weeks showed dramatically larger tumor growth than mice that were allowed to sleep normally. Researchers further traced the more aggressive tumor growth in mice to changes in immune system cells, which turned the cells from cancer fighters to actually helping cancer cells to grow.

• Research also links moderate and severe obstructive sleep apnea with significantly higher risks for cancer. These studies showed people with sleep apnea developing cancer at rates 2-4 times higher than people without sleep apnea. Mortality rates for people with cancer and sleep apnea are also shown to be higher than for people without sleep apnea.

There are so many important reasons to protect normal circadian function, and to make high quality sleep a daily priority. Our increasing understanding of the circadian influence over cancer is yet another very good one. As this latest study suggests, we may find that circadian timing has an important role to play in battling back against cancer as well.

Sweet Dreams,

Sports Medicine Guide for young Athletes

Sports_Medicine_Handbook_4th_Edition_March_31_2011

stretching

effects of caffeine on athletes

balance diet for young athletes

athletes meals

concussion

dehydration

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Energy drink vs Sports drink by Dr Demorest

As a member of the Sports Medicine Advisory Committee for the California Interscholastic Federation on High School Sports, we had our semi-annual meeting in Los Angeles this week.

One active discussion topic was energy drink use in athletes. What an energy drink is and how we define it was a surprisingly challenging topic for the group. With all the marketing strategies manufacturers use today, it may be easier to define what is not an energy drink. We know anecdotally that excessive energy drink use may be related to heart problems and even sudden cardiac death. Overuse of these products is a (relatively) easy problem to prevent in my mind and simple education should do the trick.

What is an energy drink?

Energy Drinks are beverages that contain varying amounts of caffeine, guarana, taurine, vitamins, carbohydrates (sugar) and other supplements. Marketed to improve energy, concentration, stamina, athletic performance, and weight loss, manufacturers are not required to list the caffeine content in Energy Drinks. There is no regulation of the amount of caffeine in Energy Drinks unlike the FDA regulation of soft drinks (maximum of 71 mg of caffeine per 12 fl oz. soda). Energy Drinks may contain 3-5x the amount of caffeine when compared to cola products. The total amount of caffeine in an Energy Drink can exceed 500 mg/ Energy Drink.

The big issue: Many athletes do not differentiate between sports drinks and energy drinks.

Sports drinks and energy drinks are different. Sports Drinks are flavored beverages containing carbohydrates, minerals, electrolytes (sodium, potassium, calcium, magnesium) and other vitamins or nutrients. Sports Drinks are intended to replenish water and electrolytes lost through sweating during exercise.

Why do we care?

Kids, especially athletes, are using these “energy drinks” as hydration tools and performance enhancers. Some athletes are mistaking energy drinks for sports drinks. I have heard of football players taking upwards of 5 energy drinks before a game to “rev them up.” I have also seen teens drink beverages touted as “healthy” only to later find out that these beverages have an amazingly high caffeine content.

What can go wrong?

Athletes should not use excessive caffeine or caffeine substitutes for hydration or performance enhancement. The more caffeine you ingest the more side effects may occur which are NOT performance enhancing or hydrating (headache, nausea, jitteriness, racing heart, agitation, abdominal pain, vomiting, and sleep disorders.) That does not even include the serious side effects (liver damage, kidney failure, respiratory disorders, agitation, seizures, psychotic conditions, muscle breakdown, increased heart rate, heart dysrhythmias, high blood pressure, heart failure, stroke, and sudden death.)

Marketing Bias?

Don’t be fooled. Manufacturers market to young people with their labels and promises just to make more money. They think that you will believe anything they tell you. Show them that you are smarter than that.

Read the labels. Ask your kids what they drink. Be aware and involved.

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7 Things to Review During Medicare Open Enrollment by Emily Brandon

Medicare beneficiaries will get an opportunity to make changes to their Medicare Part D coverage between Oct. 15 and Dec. 7, 2014. Many retirees will experience premium increases, changes in covered drugs and new cost-sharing requirements if they don’t switch plans. Here’s what you should review during the annual open enrollment period so you can select a new prescription drug plan if necessary.

Covered medications. Prescription drug plans are permitted to tweak the roster of medications they cover each year, and it’s important to double-check that your current medications and any new prescription drugs you expect to use in the coming year will be covered. “The first thing people should look at is whether all of their prescriptions are on the formulary,” says Casey Schwarz, policy and client services counsel at the Medicare Rights Center, an advocacy organization. “A plan can have very low premiums, but if the drug you would like to take is not on the formulary and not covered, then it is not such a good deal.”

Premium prices. The average Medicare Part D monthly premium will increase by 4 percent to $38.83 in 2014, assuming beneficiaries remain in their current plan, according to an analysis of 2015 Part D plans by researchers at Georgetown University, the University of Chicago and the Kaiser Family Foundation. However, beneficiaries in six of the most popular Part D plans will see their premiums increase by at least 10 percent, and one Part D plan increased premiums by 52 percent. About 1.5 million beneficiaries (8 percent) will experience a premium increase of $10 per month or more, while 985,000 beneficiaries (5 percent) will experience a premium decline of at least $10. “You have to weigh the amount of the change in premiums versus the inconvenience of making a shift,” says Jack Hoadley, a health policy analyst at Georgetown University and co-author of the report. “We know that some people are looking at premium increases that can be as much as $20 a month or more. In those kinds of situations, the payoff for making a switch can be substantial. If the change in your premiums is only a dollar or two, it may not be worth making a change.”

Cost-sharing changes. Prescription drug plans change the copayments and coinsuranceassociated with covered drugs each year. For the first time in 2015, all Part D plans will use tiered cost-sharing. Most plans have five tiers, including two for generic drugs, two for brand-name drugs and one for high-cost specialty drugs. Medications in each tier have different out-of-pocket costs, ranging from copayments to passing along a percentage of the bill to beneficiaries. “There are likely to be changes in the cost-sharing amounts that plans charge for drugs, drugs taken off the formulary and new utilization management tools like prior authorization,” says Juliette Cubanski, a policy analyst at the Kaiser Family Foundation. “Even if people are happy with the coverage that they have now, it does make sense to take a little bit of time to look at your coverage and see how it might be changing and see how your needs have changed.”

Deductibles. Most part D plans (58 percent) charge a deductible, which is typically a standard amount of $320 (44 percent). However, 14 percent of plans will charge a smaller deductible next year, up from 4 percent in 2014. “Plans that do lower or eliminate the deductible typically make other changes that might actually translate into higher costs for people,” Cubanski says. “While it might look appealing not to have that deductible, if the premium is so much more expensive that you end up paying more on an annual basis, that might not be a very good value payoff for people to be making.”

Preferred pharmacies. The majority of prescription drug plans (87 percent) now offer beneficiaries lower cost-sharing requirements if they fill their prescriptions at selected network pharmacies, up from 72 percent in 2014 and just 7 percent in 2011. For example, the AARP MedicareRx Saver Plus prescription drug plan charges a $20 copayment for a preferred brand drug at a preferred pharmacy, but the cost jumps to $45 at another in-network pharmacy that is not preferred. And beneficiaries enrolled in the Humana Walmart Rx prescription drug plan pay $1 for preferred generic drugs and $4 for non-preferred generics at a preferred pharmacy, versus $10 and $33, respectively, at other in-network pharmacies. “It’s important to understand if the pharmacy where you go to fill your prescriptions is part of the network of plans with the preferred cost-sharing,” Cubanski says.

Medication restrictions. Some Part D plans require beneficiaries to get prior authorization before they will cover certain drugs, require patients to try a lower-cost drug before paying for an expensive medication or limit the amount of medication you can buy at one time. “It may be worth paying a little bit more to get the one that doesn’t include the restrictions,” Hoadley says.

Consider other options. There will be just over 1,000 prescription drug plans offered nationwide in 2015, and Medicare beneficiaries will have a choice between an average of 30 plans. You can view the coverage options in your area using the Medicare Plan Finder at medicare.gov/find-a-plan. “Each year, plans make adjustments to their premiums, their formularies and whether they have prior authorization or other restrictions on use, and what worked for a person who was taking a particular array of drugs last year may not work for them this year,” Hoadley says. “It’s worth seeing if there is money to be saved or better coverage to be acquired.”

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Connie Dello Buono, Medicare Specialist AHIP Certified 408-854-1883 motherhealth@gmail.com helping Medicare families with Medicare planning.