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Archive for November 17, 2013

Convertible

convertible

Convertible: The Perfect Converter (4.5 stars with 178 Ratings) 
Universal App
$0.99 Free

 

Now with new flat design to match iOS 7!

I’m not very good with math and conversions, so of course when I saw today’s iPhone app, I took notice. It’s a nice little conversion app called Convertible, and it’s worth checking out. Convertible will convert standard units of measure and currency, as well as a number of non-standard, real-world units. It’s well designed, and easy to navigate. You can also present arbitrary data in a real world context for comparison, such as comparing a building’s floor space with parking spaces or comparing a weight to AAA batteries, Apple devices or even the Titanic. It’s a unique conversion tool to have, so grab it today.

App Screenshots

– See more at: http://appsaga.com/convertible-convert-a-unit-to-real-world-objects-such-as-the-iphone-ipad-or-the-titanic/#sthash.jJpr1jH1.dpuf

via Convertible: New Flat Design! Convert a Unit to Real World Objects, such as the iPhone, iPad, or the Titanic | AppSaga.

Turkey with Lemon-Sage Butter

sage-butter-roasted-turkey-940x600

INGREDIENTS

1/2 cup (1 stick) unsalted butter, room temperature, plus 1/4 cup (1/2 stick), melted, for basting

1/4 cup finely chopped fresh sage

2 teaspoons freshly grated lemon zest

1 teaspoon paprika

1 12–14 pound turkey, patted dry

Kosher salt and freshly ground black pepper

2 lemons, quartered

PREPARATION

Set a rack inside a large heavy roasting pan. Mash 1/2 cup butter, sage, lemon zest, and paprika in a bowl to combine.

Starting at neck end of turkey, loosen the skin of the breast by gently sliding your fingers underneath. Work half of lemon-sage butter under skin. Loosen skin around legs and thighs; work remaining lemon-sage butter under skin. Season turkey inside and out with salt and pepper and stuff with lemons. Transfer turkey, breast side down, to prepared pan and refrigerate, uncovered, overnight.

Let turkey stand at room temperature for 1 hour. Preheat oven to 375°. Pour hot water into pan to a depth of 1/4”. Roast turkey, basting occasionally with remaining 1/4 cup butter, for 1 hour. Using paper towels, flip turkey; roast, basting occasionally, until an instant-read thermometer inserted into the thickest part of the thigh registers 165°, 1–1 1/2 hours longer. Transfer to a platter. Let rest for at least 20 minutes before carving.

via Turkey with Lemon-Sage Butter – Bon Appétit.

‘Kangaroo care’ key for premature babies

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Mothers carrying babies skin-to-skin could significantly cut global death and disability rates from premature birth, a leading expert has said.

Prof Joy Lawn says “kangaroo care”, not expensive intensive care, is the key.

The 15 million babies every year born at or before 37 weeks gestation account for about 10% of the global burden of disease, and one million of them die.

Of those who survive, just under 3% have moderate or severe impairments and 4.4% have mild impairments.


Unless there are those breathing problems, kangaroo care is actually better ”

Prof Joy LawnLondon School of Hygiene & Tropical Medicine

Prof Lawn, from the London School of Hygiene and Tropical Medicine (LSHTM), said: “The perception is you need intensive care for pre-term babies,

“But 85% of babies born premature are six weeks early or less. They need help feeding, with temperature control and they are more prone to infection.

“It’s really only before 32 weeks that their lungs are immature and they need help breathing,

She added: “Unless there are those breathing problems, kangaroo care is actually better because it promotes breastfeeding and reduces infection.”

Speaking ahead of World Prematurity Day on Friday, UN Secretary General Ban Ki-moon, who leads the Every Woman Every Child movement, which promotes improvements to healthcare for women and children, said: “Three-quarters of the one million babies who die each year from complications associated with prematurity could have been saved with cost-effective interventions, even without intensive care facilities.”

Duncan Wilbur, from the UK charity Bliss, said, “While kangaroo care saves lives in countries such as Africa, it is also incredibly important for babies born too soon all over the world.

“Here in the UK our medical technology is extremely advanced but simply giving a baby kangaroo care or skin-to-skin can help make a baby’s breathing and heart rate more regular, it can help a baby’s discomfort during certain medical procedures and importantly can benefit breastfeeding and bonding between the baby and parents.”

Pregnancy risks

Studies to be published this weekend in the Pediatric Research journal show boys are 14% more likely to be born prematurely – and boys who are premature are more likely to die or experience disability than girls.

Common disabilities include learning disorders and cerebral palsy.

Prof Lawn said: “One partial explanation for more preterm births among boys is that women pregnant with a boy are more likely to have placental problems, pre-eclampsia, and high blood pressure, all associated with preterm births.”

She added: “Baby boys have a higher likelihood of infections, jaundice, birth complications, and congenital conditions, but the biggest risk for baby boys is due to preterm birth.

“For two babies born at the same degree of prematurity, a boy will have a higher risk of death and disability compared to a girl.

“Even in the womb, girls mature more rapidly than boys, which provides an advantage, because the lungs and other organs are more developed.”

via BBC News – ‘Kangaroo care’ key for premature babies.

How the work of family doctors has changed

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GPs have seen many changes in the way they work over the years

 

The rules that govern how GPs work have been amended yet again after negotiations between doctors’ leaders and the government.

What changes have family doctors seen over the past 20 years – and how do they think patients have been affected?

Dr Rob Barnett is a GP in south Liverpool. He is one of five partners in his practice and the only male GP.

“My work has changed dramatically since I started as a GP in 1987.

I used to practise from a mid-terrace house. I did a morning, afternoon and evening surgery, was on call two nights a week and occasionally did weekends too.


GP contract changes in England

These will come into effect next April:

  • GPs will no longer have to offer appointments that last a minimum of 10 minutes. This should mean GPs have greater flexibility over how they organise their appointments.
  • One million of the frailest patients in England are to be identified and given a named GP to co-ordinate their care. across the NHS and social care sectors.
  • Around four million over-75s will be given a named GP rather than just registered to a practice. The idea is that this will lead to greater continuity of care for those patients who visit GPs the most.
  • Removal of some targets that GPs previously had to meet by asking patients questions about their lifestyle.
  • GP practices will have to make it possible for patients to book appointments and order repeat prescriptions online.

British Medical Association

Now I work in purpose-built premises. I don’t do out-of-hours work any more but my surgeries are longer and we are open all day from 8am till 6.30pm. I try to finish my paperwork by 12.30, then do home visits and then more paperwork before the afternoon surgery, which starts at 3.15 and usually doesn’t finish before 6.30 or 7pm.

In some respects, the changes have been for the good.

There is much more job satisfaction now. We are working longer hours but not working impossible hours.

When I started, GPs didn’t take responsibility for the all-round care of patients. Now I see my role as close to that of the general consultant physician, dealing with more and more complex patients, with multiple problems.

Going back to the Eighties, much of that care was done in secondary care, in hospitals. But patients are in hospital much less often now and we are expected to pick up the pieces when they come out of hospital.


In my practice, no one works full-time… We can maintain our sanity that way”

Dr Rob Barnett

In my practice, no one works full-time. Everyone does five or six surgeries a week, rather than eight. We can maintain our sanity that way.

Another major change is that we don’t do out-of-hours care any more. That was the right thing to do, for the vast majority of GPs, but the way out-of-hours care was subsequently organised wasn’t good.

If I’m honest, the goodwill went out of the system in the Nineties. Our work became target-driven and we were being measured on doing things which some bureaucrat thought was important, but GPs didn’t. Some of the questions I had to ask patients were just stupid.


Past changes in GP contract

Elements of performance-related pay were introduced in the 1990s when GPs began to take on responsibilities for commissioning services on their patients’ behalf.

In 2004, a new contact was introduced for GPs. There were some major changes in it, including:

  • out-of-hours responsibility ending
  • 25% of GP pay linked to performance

This led to pay rises for many GPs.

In 2007, roles for nurses and other practice staff were expanded, and there was more emphasis put on the use of information technology in practices.

Patients’ attitudes have changed too. They tend to come in now with their own idea of what’s wrong with them and because they know more about what’s available, they expect more now.

But at the same time, patients are also taking less responsibility for their own care. They want prescriptions, even for tablets that can be bought in a chemist, and I’ve known people to go to walk-in centres then come and see me just to check they are getting the right treatment.

Overall, I think GPs are paid well for what they do. It’s a responsible and difficult job and we were underpaid in the Eighties and Nineties.

The pressure and demands on GPs are greater now. The number of decisions we make every hour is quite phenomenal.”

Dr Laurence Buckman is a full-time GP in Barnet, north London. He works on his own.

“As a single-handed GP, the main issue for me is the bureaucracy. We’ve got to get rid of it.

Meaningless paperwork has been introduced over the years and it is such a waste of time. I have to ask patients impertinent questions and it doesn’t play well.

None of the targets that were introduced were good. Getting rid of all that would be welcome.


Meaningless paperwork has been introduced over the years and it is such a waste of time”

Dr Laurence Buckman

Over the years, technology has made GPs’ jobs easier – but the issue of access to medical records is risky. What happens if that information is passed onto other people like employers or insurers? That’s a concern.

Getting your prescriptions online is a great idea. Booking appointments online is great too if you are internet-savvy, but not so good for elderly people who don’t have PCs, and we need to cater for them too.

I am the named doctor for all my patients. I have always been responsible for them because I work on my own, so the latest changes don’t affect me.

My patients can contact me round the clock and get hold of me whenever they like. There’s about a week’s waiting time for a non-urgent appointment.

The government is always talking about a crisis in A&E caused by waiting times at doctors’ surgeries, but the only way to keep people out of hospitals is to lie down across the door of A&Es.

A patient using the automatic appointment check-in screen
Advances in IT have changed the way GPs and patients access information

People regularly go to A&E because they don’t try to see their GP first. We need to be more blunt about telling people who go to A&E that they don’t need to be there.

And we don’t emphasise enough how patients can help themselves before running to us.

But, in the end, the GP is the ultimate backstop for everyone. What we need is better social care alongside GPs to help care for people in the community.”

Dr Buckman is former chairman of the British Medical Association’s GP committee.

Dr Dean Marshall is a GP in Dalkeith, Midlothian. He helped negotiate the contract changes for GPs on behalf of the BMA.

“I started as a GP in 1994 and I’ve seen lots of changes in that time.

I work fewer hours than before, when I worked weekends and nights too, but that wasn’t sustainable. Being a full-time GP still isn’t good for general health.


I have never had a free appointment in 20 years as a GP”

Dr Dean Marshall

Instead, the work is now incredibly intense and we’re looking after a different kind of patient, who was previously looked after in hospital. For example, we care for patients with diabetes and other chronic disease, although nurses help with much of this work too.

It is normal to see one complicated patient after another now.

The way GPs have been micromanaged over in recent years isn’t good. I want to be allowed to structure my practice the way I want to rather than justifying my time to someone else.

That has created a huge morale problem among GPs. Most still enjoy the job but they feel they are doing a job someone else is telling them to do.

Patients aren’t one homogenous group. They’re a variety of groups and it’s impossible to design a service that is everything to everyone.

Some people want a named doctor and value seeing the “family doctor”, but others want instant access and they don’t care which doctor they see.

Patients getting appointments when they want is a huge issue. There is a large proportion of the population that doesn’t have regular contact with their GP and, when they do call up, they find they can’t get an appointment.

But the public has to realise it’s difficult. I have never had a free appointment in 20 years as a GP.”

via BBC News – How the work of family doctors has changed.

Cancer diversity has ‘huge implications’

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A single tumour can be made up of many separate cancers needing different treatments, say researchers.

 

A team at the Institute of Cancer Research, London, have developed a new technique for measuring the diversity within a cancer.

They showed “extraordinary” differences between cancerous cells and say new targeted drugs may fail as they may be unable to kill all the mutated tissue.

Experts said the findings would have “profound implications” for treatments.

A tumour starts as a single cell, which acquires mutations and eventually divides uncontrollably. But that is not the end of the process.

Cancerous cells continue to mutate and become more aggressive, move round the body and resist drugs.


Every patient has a completely new tree and doesn’t have one cancer, they have multiple cancers”

Prof Mel GreavesInstitute of Cancer Research

This process is chaotic and results in a “diverse” tumour containing cancerous cells that have mutated in different ways.

“This has huge implications for medicine,” researcher Prof Mel Greaves told the BBC.

His team at the Institute of Cancer Research investigated cancer diversity in five children with leukaemia. They compared mutations in individual cancerous cells with a known database of mutations.

Their results, published in the journal Genome Research, showed patients had between two and 10 genetically distinct leukaemias.

Prof Greaves said: “Every patient has a completely new tree and doesn’t have one cancer, they have multiple cancers.

“This is really a technical advance to get at this extraordinary complex diversity, it helps explain why we have such difficulty with advanced diseases.”

Tree of cancer

Scientists compare cancer diversity to a tree. The initial mutations – the trunk – will be common to all cancer cells. But then the tumour branches out.

Tree
Drugs need to target the trunk of a tumour say researchers

It means a treatment that targets one “branch” or sub-clone of the cancer might slow the disease, but they will never stop it.

Prof Charles Swanton, who researches diversity at the University College London Cancer Institute, told the BBC: “We call it pruning the branches not cutting down the tree, targeted therapies will remove some of the sub-clones, but chopping down the tree is hard to do.”


The bottom line is we need to understand cancer diversity to limit further adaptations, reduce the pace of evolution and prolong the activity of drugs”

Prof Charles SwantonUCL

The study investigated leukaemia as it is less diverse than other types of cancer. Other tumours such as melanoma could feasibly be made of hundreds of branches.

Prof Greaves says one implication of the research is that therapies need to be developed which target the trunk of the tumour and that current targeted therapies being researched may not tackle advanced cancers.

Another idea he suggests is focusing on the cancer’s surroundings as well.

“If it is diversifying like species in a habitat, why not target the habitat – the blood vessels supplying oxygen or inflammation. There’s a lot of interest in that,” he said.

The research also emphasises the importance of catching cancers early before they have become too diverse to treat.

Prof Charles Swanton argues: “The bottom line is we need to understand cancer diversity to limit further adaptations, reduce the pace of evolution and prolong the activity of drugs.”

Prof Chris Bunce, the research director at Leukaemia and Lymphoma Research, commented: “We are beginning to understand how unique and complex each patient’s cancer is and the profound implications that this can have on the success of treatment.

“This study significantly advances our understanding of how cancers start and evolve.”

via BBC News – Cancer diversity has ‘huge implications’.

Face Ache: The woman who lost teeth for nothing

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The searing pain of trigeminal neuralgia is normally felt on one side of the face

 

Having your teeth pulled is one thing. Having them pulled because of a misdiagnosis is quite another.

But this is what happened to Ann Eastman, who suffers from a rare condition which inflicts excruciating pain that mimics toothache but is in fact related to damaged nerves in the face.

At its worst, the pain of trigeminal neuralgia – on the right hand side of her face, from her temple to her lower jaw – seriously affected her life.

“I was just standing there, screaming and screaming, the pain was unbelievable. My husband said ‘Be quiet! The neighbours will call the police!”

Ann can laugh about it now but when she first experienced overwhelming facial pain she was petrified.


I was just standing there, screaming and screaming, the pain was unbelievable. My husband said ‘Be quiet! The neighbours will call the police!”

Ann Eastman

According to Professor Joanna Zakrzewska – Professor Zak to her patients – this is all too common a story. A frightened patient, often misdiagnosed for months, or even years, in terrible and unremitting pain.

At her clinic at the Eastman Dental hospital in London she sees patients and carries out research into this little-understood condition.

Ann is 71 and the average age when trigeminal neuralgia starts is in the fifties or sixties – but it can affect teenagers and even children.

The trigeminal nerve – we have one on each side of the face – is responsible for sensation in the face as well as movements like biting and chewing. It is thought that, as we get older, nearby blood vessels can squash it.

“Compression of the nerve causes the myelin sheath – which is the protective cover of nerves of different types – to get worn away,” says Professor Zak, “and as a result of that you get crosstalk between strands of the nerve that transmit ‘light touch’ and those that transmit sharp pain.”

Ann Eastman saw her dentist.

Ann Eastman
Ann Eastman had two teeth removed before the real cause of her pain was discovered.

“He said come in straight away. He looked at it and gave me x-rays and he said I can’t really see anything but you’ve got a crown there, I’ll remove the crown just in case there’s something going on underneath the crown.”

Days later and still in pain, Ann returned to her dentist who suggested she see another specialist with a very powerful microscope. His verdict after looking closely at her tooth: that there was a problem with its nerves and the tooth needed to be extracted.

“I went back to the dentist and he took the remainder of the tooth out because it was like a stump underneath the crown. I went home and waited for the pain to wear off. But the pain was still there – there was no tooth but it was still there in the exact spot.”

Like many people in search of answers, Ann turned to the internet.

“I started googling… It took me straight to trigeminal neuralgia. I read this and I said to myself ‘I have not got that because it said it’s incurable.'”

After yet another painful episode over Christmas, a new dentist extracted another tooth.

Two teeth down, and seven months after her first attack, Ann’s dentist called her. He said he’d found an expert at the Eastman dental hospital.

She saw one of Professor Zak’s colleagues.


SOME OF THE SIGNS OF TRIGEMINAL NEURALGIA

  • The pain often scores 10/10, sometimes described as “suicidal”
  • Pain ranges from sudden, severe, stabbing, constant, burning or aching
  • Triggers can include contact with the cheek such as shaving or applying make up
  • Pain rarely occurs at night when the patient is sleeping
  • Attacks stop for a period and then return, usually worsening over time with fewer and shorter pain-free periods

“Just as I walked through the door I had the most terrible episode. She was sitting there holding my hand saying ‘Classic case, classic case.’ And I was put on anti-convulsants – a drug called carbamazepine.”

This drug can have significant side effects so patients are advised to start with a low dose and increase it slowly.

“When it controls the pain then you stay at that level,” says Ann.

“When you feel it has suddenly stopped you still get little jabs, particularly when you eat. Prior to that you can’t eat, just puree and shovel it in with a teaspoon at one side. The chewing action just triggers the pain.”

Patients are advised to carry the medication with them even when on holiday, so they can start taking it again straight away if the pain returns.

Some patients notice a seasonal pattern for their pain: Keith Ireland has only ever had trigeminal neuralgia attacks in winter. So far this year he remains in remission.

“There are a few triggers: hot and cold food and drink; and for me, a powerful electric toothbrush I started using triggered a particularly bad episode. I have switched back to the old one again.”

Keith Ireland
Keith Ireland only suffered attacks in winter.

He too struggled to get a diagnosis for the pain that centred just in front of his ear but his symptoms were eventually controlled by the drug neurontin gabapentin. “When I found the effective dose it did control the pain considerably, though never completely.”

The surgical option is quite a serious undertaking, according to Professor Zakrzewska.

“The biggest operation which gives the longest pain relief is a big neurosurgical procedure that done in the right hands can render a patient pain-free – 70% of patients will be pain-free 10 years later – if we get the diagnosis right and we find a vessel that’s pressing on the nerve.”

Scans should also be done on the patient to rule out much more rare causes – like tumours.

Other options include those which destroy the nerve – a better option for patients who cannot undergo a general anaesthetic for surgery according to Professor Zakrzewska.

“These try and destroy that nerve, transmitting information and hence stop the pain. These are much smaller procedures, they include – as I call it – ‘cooking’ the nerve – what’s called radiofrequency thermo-coagulation, bathing it in glycerol – or even now we’ve got the new gamma knife.”

Pain relief normally lasts for up to 4 years after these procedures but they can be repeated. Patients can experience a numbness or loss of sensation in the face.

“We really still are struggling with trying to find out what causes this dreadful condition,” says Professor Zakrzewska.

But there could be hope on the horizon, she adds.

“I’m doing a major international drug trial using a brand new sodium channel blocker that we hope will mean we can have a drug that’s more effective in controlling this pain with fewer side effects – and so far initial things seem to suggest that it may be a breakthrough.”

via BBC News – Face Ache: The woman who lost teeth for nothing.

薯條含致癌丙烯醯胺?每月勿逾2次

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美國食品藥物管理局FDA近日再度建議民眾應減少攝取薯條與洋芋片,主要是這一些食物中都含毒性化學物質「丙烯醯胺」。

 

喜歡吃炸薯條的人注意,美國食品藥物管理局FDA近日再度建議民眾應減少攝取薯條與洋芋片,主要是這一些食物中都含毒性化學物質「丙烯醯胺」(acrylamide),尤其以洋芋片和薯條含量最多。已故林口長庚毒物科主任林杰樑也曾經呼籲,喜愛吃洋芋片、油條等食物的消費者,1個月最多不要超過2次。

衛生福利部過去也曾針對洋芋片等高溫油炸類食品,進行丙烯醯胺調查,樣品包括294種市售零食,有穀類、根莖類、海鮮、堅果、豆類和乾果等,利用氣相層析質譜法,分析零食中的丙烯醯胺含量高低。

國內研究:馬鈴薯零食的丙烯醯胺含量最高

結果發現,馬鈴薯等根莖類零食的丙烯醯胺含量最高(每公斤435微克),但同樣是根莖類零食則有差別,馬鈴薯的丙烯醯胺是芋頭的5倍;其次是穀類零食(每公斤299微克),小麥粉其次、米類零嘴含量則最低(每公斤25微克)。

在所有的零食類別中,以海鮮與乾果類的丙烯醯胺平均含量最低,每公斤都在25微克以下;水果乾則是所有零嘴中最低的,每公斤只有9微克。

高溫120℃或以上,會形成丙烯醯胺

食物在高溫烹調下會產生丙烯醯胺,但產生過程仍未確實知道,可能會由碳水化合物、蛋白質、脂肪、胺基酸或其他食物成份中形成。丙烯醯胺的產生和烹調溫度和時間有強烈關係,只會在120℃或以上才會形成,另外烹調時間越長,產生數量越多。科學家亦發現食物澱粉質含量越高,所產生的丙烯醯胺越多。

在溫度120℃時會出現丙烯醯胺,恐對人體健康有危害。

在溫度120℃時會出現丙烯醯胺,恐對人體健康有危害。

 

丙烯醯胺過量,使四肢麻痺肌肉無力

長期接觸丙烯醯胺會令腦部受損,產生昏睡、幻覺、記憶力衰退、顫抖等症狀,丙烯醯胺亦會使四肢麻痺、出汗和肌肉軟弱無力。在動物實驗有致癌的可能性,尤其是對婦女同胞,可能導致卵巢癌、子宮內膜癌症。已故林口長庚毒物科主任林杰樑曾經表示,丙烯醯胺是動物確定致癌物與人類疑似致癌物,而且還具有神經毒性,會破壞周邊神經。

【小辭典/丙烯醯胺】:

丙烯醯胺(Acrylamide)通常被用來合成聚丙烯醯胺,這種聚合物可做為水溶性增稠劑,用在污水處理、造紙、礦石處理、布料之免燙處理。含碳水化合物的食物在經油炸之後,恐會產生丙烯醯胺,在溫度120℃時會出現丙烯醯胺,超過160℃更會大量出現,顯現丙烯醯胺有致癌風險,但是仍未有充分證據顯示丙烯醯胺對人類為致癌物。

via 薯條含致癌丙烯醯胺?每月勿逾2次 | 20131117 | 華人健康網.

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