Surgeons at the University of Kentucky are the first in medical history to perform two procedures in tandem to bridge a lung transplantation. The procedures were performed first on Wanda Craig, 68, who is now the oldest person to be "bridged to transplant using an artificial lung device, also known as an extracorporeal membrane oxygenation," reports research-reporting service Newswise. (Photo of Wanda Craig and Dr. Enrique Diaz by Julia Meador)
Craig, of Lexington, had chronic obstructive pulmonary disease and emphysema for which she has been treated for the past 10 years. In November 2010, she took a turn for the worse. "I was so out of breath from walking to the kitchen ... I didn't have enough energy to even scoop ice cream out of the carton," she said. Pulmonary hypertension, from which she also suffered, had caused the right half of her heart to fail, which prevented blood from going through the lungs to fill the left side of the heart, explained Dr. Charles Hoopes, director of UK's heart and lung transplant program.
To fix the problem, Hoopes and Dr. Enrique Diaz, the program's medical director, performed a procedure called an atrial septostomy, in which a small hole is created between the upper two chambers of the heart. This procedure, along with the extracorporeal membrane oxygenation procedure, saved Craig's life, the news release says. "These procedures are novel in terms of a bridge to transplantation, and the use of an artificial lung together with an atrial septostomy for cases of respiratory and right ventricular failure have not been performed together until now," Diaz said.
Three days later, Craig underwent a double lung transplant, and has been healing since. "More than anything I am looking forward to doing those normal everyday things like going to the grocery store and watching my grandson's T-ball games," she said. "And scooping my own ice cream." (Read more)
Having bought the rules and painted up enough French units to give my Prussians a game all progress with the Naps seemed to grind to a halt as I shifted focus to painting the 15mm. But with Barry building his Brits up it gave us enough of a push to get round to getting a game in. In fairness both of us have wanted to play but with both of us busy this last three weeks we have not had the chance.
At last we now had time, figures and rules, so what about venue? As we were both free in the day we decided to use one of the tables at a local shop. More on this in a future post once I get their permission to advertise the fact. What I will say though is that the tables are all set up and you have free use of any terrain you could wish for (though they have little in the way of 6mm they have plenty for 15+mm) this was not a problem as I had took plenty with me. All this for no charge, what a great service.
I had already had a short few turn primer play with both forces and this put me at a rather large advantage for the day. I had set the minimum number of units at 24 which I hit on the nail for the French and went over by about 6 for the Prussians. This just tells part of the story though as troop type, quality and number of formations can make the smaller force more powerful. I as the French had just three commands to the Prussian 4 which in real terms means the Prussian has a 1 pip advantage pre-roll (1D6) each Tempo round. Something that came into play later. Rather than plan out battle lines we each just placed as we felt fit and then looked at what the other guy was doing. After all this is supposed to be all about learning the rules as both of us had reservations regarding parts of the rules and another rather more experienced Naps player had played them once and threw his copy away, though he is prepared to try again.
Ready to go, Prussians to the left are spread in an almost single line along the whole frontage whilst I was using the two woods at each end of the battlefield as flank protection and had units in reserve to counter any move around them. The rules will reward a reserve as they should and Barry did start to generate one as the game progressed.
The tricky bit (and bit I liked before the game and loved after) is the Tempo Points. Nothing moves without Tempo and you get a single point per sub-general + 1D6. Given that I had three and Barry four sub-generals this meant that D6 could really swing it and indeed it did. But it is how you deal with the swing that makes the difference. Once you have your Tempo you then bid some of them for the honour of moving first. Early rounds mean nothing but later on you may really want to go first, especially if you went last on the previous turn. Who ever had the first move the previous turn wins a tie so once Barry had the initiative he sat effectively on a two point cushion. But on the other hand Barry had spread so wide that he was forced to pay double Tempo to order his flanks. Not an issue early on but as the battle developed he had to choose which flank to leave hanging. The great thing is early on you seem to have plenty to go round but once the battle fragments suddenly you just never have enough. This will reward the player who keeps a reserve of fully formed units and the player who will take the time to re-form groups of units back into linked units (groups of three are most economical). So with all set up in we dived.
Due to setting up to far apart the early turns zipped by in a series of moves, this was good for two reasons, first it got us used to Tempo and the bidding (not to mention how each of us bid) but also allowed for us to make changes to plans etc. I was expecting the Prussians to come out and fight to use their greater numbers and when they were slow to do this I moved my left flank infantry off the hill to try and temp the Prussians down off theirs whilst moving my 4 regiments of Hussars from my right, across the front of my whole army to join the forces on my left. Meanwhile the extreme flank force was moved behind the wood to attack the Prussian right flank which was now using the same woods as myself to pin a flank. The idea really was just to get Barry to weaken his forward force by forcing him to react to this force as all I had up front was a couple of raw Battalions. Due to the slow running of the game to this point though I decided it was worth closing especially as I had two more fresh units to take over once the fight had started and Barry just had these two units in position. On the other flank I had offered up a lone Battalion to the Prussian Ulans but Barry was at first refusing to engage then as the opposite flank was under attack he just did not have the Tempo to react. Mixed results on the first engagement. Barry closed to firing range as the second player then won Tempo and blastered off with his muskets. I had really made a mess trying to get Tempo and did not have the two required to attack anyway (I was out of command radius) so not only was I shaken by his first volley but unable to fire back!! Barry gets Initiative again and blasts away again but by now he no longer has the first shot bonus but scrapes a second shaken. I drop back and have his commander join them to steady them. Meanwhile I had failed to have any effect with musket fire back and so threw in a charge at my next opportunity routing his raw regiment and setting off in hot pursuit which had the effect of getting a very lonely Batt behind the Prussian line but not half as lonely as the now surrounded French Batt that had been successful to this point, now Barry was falling back with these guys as fast as possible, his flank was now turned.
The price of failure, a Prussian Batt is routing away, routers never come back in these rules and with only two levels of shaken you need to consider pulling back units with one level if it's likely they will receive more levels in the coming rounds. By this point I had by Cav in the middle and charged just one regiment, the idea being once it had been repulsed I could charge the same Batt with a fresh regiment breaking the first line up and follow up with the Infantry and by then recovered Cav. Well it did not go that way, the Infantry rolled badly in reaction to the charge becoming shaken. The shaken level made their fire ineffective (by the one pip for being shaken!!) allowing the charge to go in. The Inf Batt broke, routing through another Regiment causing this to become shaken but somehow my Cav did not pursue (rolled a 1). I still lost Inactive the following turn but with nothing but the shaken infantry able to fire Barry was not able to harm my Cav who then charged the shaken Inf Batt.
The Inf on the left turned to be able to fire on my Cav but my charge went home before they could fire hitting the shaken Batt and putting this unit to rout. I caught up with them and dispersed them on the field. The centre right of the Prussians was now looking a little ragered as I was still poised for more attacks.
By no means was the game over, Barry had plenty of troops to plug the gap but he was outflanked on his right and his lack of a real reserve would effectively have caused him a few problems which was compounded by my being behind his right flank and able to reduce his ability for that wind to withdraw. In the picture above the one Regiment behind the long line is French, as is the units in small clusters. The long line is Prussian and is likely to be very badly mauled. We called it at that point as we had got what we needed from the game.
The rules seem to work right and gave a flavour of the game. I would say 24 units is about right for this part of the rule book but jumping to the larger battle rules seems to triple the required figures which is a big jump. I still have issues with the fact that units are on the rectangular strips and long to see French columns and would be happy to rebase all to the larger square bases and just allow lines on some columns on others, but that is for another day I guess. The rule concerns were for the most part smoothed out with play and we will certainly give them more goes and I think stick with them unless someone shows us something better. On the flip side of the coin the figures I have yet to paint most of the infantry will go on double bases as I feel I have enough infantry to fight under these rules but given Lee has a massive Allied Army I can see the need for some double bases added to the collection.
Next up Barry and I plan to try out his 20mm Roman V Dacian or Gaul using Impetus Light, stay tuned.
"Switch and quit" is the theme of an advertising campaign being promoted by a prominent cancer center in Kentucky, in which smokers are advised to lay off the cigarettes in favor of smokeless tobacco such as chew or snuff. "Supporters say smokers who switch are more likely to give up cigarettes than those who use other methods such as nicotine patches, and that smokeless tobacco carries less risk of disease than cigarettes do," The Associated Press reports.
AP reports the program is partly funded with grants from the tobacco industry, though program director Brad Rodu, a University of Louisville professor of medicine, said the industry has "absolutely no influence whatsoever." Smokeless tobacco has been linked to oral cancer.
"We need something that works better than what we have," said Dr. Donald Miller, an oncologist and director of the James Graham Brown Cancer Center, which is co-sponsoring the campaign with the university. "This is as reasonable a scientific hypothesis as anybody has come up with and it needs to be tried."
The campaign is being pushed in Owensboro using print, radio, billboard and other advertising. Residents of Owensboro and the surrounding area reportedly consume about 3 million cigarettes a week. "That amounts to well over a pack for every man, woman and child in the community of about 115,000 people," AP reports.
"The worst that you can say about smokeless tobacco is that it's the lesser of two evils," said Dr. Randall Thomas, an oncologist at the Owensboro Medical Health System. "I don't think we have any problem in telling a person that drinks a six-pack a day that if they could cut it back to two beers a day or two drinks a day that their health risks are greatly reduced ... Finding a way to let people have their nicotine that carries less risk, it's the realistic solution."
But there are opponents to the program, including Matthew Myers, president of the Campaign for Tobacco-Free Kids, who called it "a giant experiment with the people of Owensboro without rules or guidance designed to protect individuals from experimental medicine." The theme of the program does seem to run counter to warnings by the Centers for Disease Control and the National Cancer Institute at the National Institutes of Health, whose websites say the use of all varieties of tobacco products "should be strongly discouraged" and that there is "no scientific evidence that using smokeless tobacco can help a person quit."
Owensboro is an old tobacco town, and in the face of falling cigarette sales, tobacco companies are marketing more smokeless tobacco and other cigarette alternatives. (Read more)
Focusing on issues like hospital- and health care-acquired infections, the impact of medical errors and infections on patients, and the importance of transparency, the Health Care Transparency and Patient Advocacy Conference will be held Nov. 11 in Lexington.
Speakers include John Santa, director of the Health Ratings Center for Consumer Reports, who will discuss the principles of transparency; author Maryn McKenna, who will present the history of MRSA; Dr. Keith Sinclair, medical director of Bluegrass Oakwood in Somerset, who will speak of how transparency has nearly eliminated pressure sores at his institution; and Frances Griffin, a faculty member at the Institute for Healthcare Improvement, who will present on the IHI global trigger tool.
The gathering is from 8:30 a.m. to 5 p.m. at Embassy Suites in Lexington. Registration is $50 and includes a box lunch. Physicians, physician assistants, nurse practitioners, nurses, physical therapists and human resource managers attending the conference will receive 6.5 hours of continuing education credits. To register, click here.
Children in rural areas face more health challenges than those in urban parts of the country, and are more likely to be poor, more vulnerable to death from injuries, and more likely to use tobacco. Rural families also have more difficulty in gaining access to health care. But the majority of parents, regardless of whether they live in urban or rural communities, say their kids are healthy.
These findings are from a report entitled "The Health and Well-Being of Children in Rural Areas: A Portrait of the Nation 2007," compiled by the U.S. Department of Health and Human Services' Health Resources and Services Administration. The report's results are based on the National Survey of Children's Health, conducted in 2007.
The survey classified children as living in an urban area, a large or well-populated rural area or a small or isolated rural area. Large rural areas include large towns with populations of 10,000 to 49,999. Small rural areas include small towns with populations of 2,500 to 9,999. Survey results were not broken down by state.
The report found children's overall health status does not vary substantially according to location. Four-fifths of parents said their children are in excellent or very good health, regardless of where they live.
But the analysis found rural children, as a whole, face more health risks than their urban counterparts. Only 67.6 percent of children in large rural areas and 69.8 percent in small rural areas are breast-fed, compared to 77 percent of urban children. (About 59 percent of new mothers breast-feed in Kentucky, compared to 75 percent nationwide.)
Rural children are also more likely to be overweight or obese — 34.6 percent of children in large rural areas and 35.2 percent in small rural areas compared to 30.9 percent of urban children. Rural children are also more likely to live with someone who smokes — one in three children in large rural areas and 35 percent in small rural areas do. Only one in five urban children do.
Though about 90 percent of children surveyed had health insurance, those in rural areas were more likely to have public coverage like Medicaid or CHIP. Urban children were more likely to have private insurance. Access to health care also remains a factor. Of the 2,052 non-metropolitan counties identified in 2010, 704 were designated as health professional shortage areas. Of those, 467 had shortages for dental care and 521 lacked adequate mental health services. To find if a Kentucky county is in a health professional shortage area, click here.
There are some advantages for rural children, however. They tend to be better protected and more connected to their families and communities. More than half of children in small rural areas shared a meal with their families every day in the past week. Children in small rural areas are also more likely to get physical activity every day (34.7 percent), though they are less likely to have access to community centers, parks or playgrounds. However, rural children are more likely to spend more than an hour each weekday watching television or videos — 60.9 percent of children in large rural areas did so, compared to 53 percent in small rural areas and 53.9 percent of urban children.
The data for the National Survey of Children's Health was generated using a random telephone survey, in which 2.8 million telephone numbers were randomly generated. After non-working and non-residential numbers were eliminated, the remaining numbers were called and surveyors spoke to respondents to see if children less than 18 years of age lived in the household. From each of those households, one child was randomly selected to be the focus of the interview and parents responded to the survey questions. Surveys were conducted in English, Spanish, Mandarin, Cantonese, Vietnamese and Korean.
Health insurance premiums for employer-sponsored family plans shot up by 9 percent from 2010 to 2011, but the bulk of the hike is due to the increase in health care costs, not the federal health-care reform law, non-partisan FactCheck.org has found.
The law is responsible for about 1 to 3 percent of the increase, however, in large part because the law requires an increase in benefits, including: covering preventive care without co-pays or deductibles; allowing adult children to stay on parents' policies until age 26; increasing annual coverage limits; and covering children regardless of preexisting conditions.
"On the other hand, the fact that the law caused any increase at all casts more doubt on Obama's promise that the law 'could save families $2,500 in the comings years.' We've been calling that claim into question for several years now," Factcheck.org stares. "The plan fact is that — so far — the law has caused an increase in premiums, though not so large an increase as some Republicans claim." (Read more)
In an effort to keep health-care costs down, companies across the country, including Walmart, are opting to charge workers who smoke or are obese higher premiums than their more healthy colleagues. (Reuters photo by Lucas Jackson)
The move is the follow-up to a strategy many companies have already tried: to encourage workers to take better care of their health by offering benefits like weight-loss programs or smoking-cessation classes. But with few signs of the health-care landscape changing, "They're replacing the carrot with a stick and raising costs for workers who can't seem to lower their cholesterol or tackle obesity," reports Jillian Mincer of Reuters.
One example is Walmart, which in 2012 will start charging its smoking workers higher premiums. It will also offer cessation classes. A company spokesman said people who use tobacco use about 25 percent more health-care services than people who don't: "These decisions aren't easy, but we need to balance costs and provide quality coverage."
Critics say the move will limiting people's freedoms, create employee resentment and hut the lowest-paid workers hardest. "It's not inherently wrong to hold people responsible," said Lewis Maltby, president of the National Workrights Institute. "But it's a dangerous precedent."
Though well-intentioned, these policies can create bitterness. Mark A. Rothstein, a lawyer and professor at the University of Louisville School of Medicine, said having a colleague call to ask about a person's weight loss can be seen as intrusive. That's part of the reason why the janitors at the school participate, but "the professors on campus consider it a privacy tax, so we don't get some stranger calling us about how much we weigh."
Nevertheless, many companies are moving forward with the option. In 2012, almost 40 percent of large and mid-size companies will start using penalties to control unhealthy behavior. That's up from 19 percent this year and just 8 percent in 2009, an October survey by consulting firm Towers Watson and the National Business Groupon Health shows. "Nothing else has worked to control health trends," said NBGH Vice President LuAnn Heinen. "A financial incentive reduces that procrastination."
Cleveland Clinic, with a staff of 40,000, has implemented a comprehensive program and seen its health-care costs grown just 2 percent this year. "The effort began several years ago when it banned smoking at the medical center and then refused to hire smokers," Mincer writes. "It later recognized that having a gym and weight -oss classes wasn't enough to get people to participate. It made these facilities and programs free and provided lower premiums to workers who maintained their health or improved it." Paul Terpeluk, medical director of occupational health at the clinic, said employers have to develop a program and change the culture: "You don't do this overnight." (Read more)
Surgeons at the University of Kentucky are the first in medical history to perform two procedures in tandem to bridge a lung transplantation. The procedures were performed first on Wanda Craig, 68, who is now the oldest person to be "bridged to transplant using an artificial lung device, also known as an extracorporeal membrane oxygenation," reports research-reporting service Newswise. (Photo of Wanda Craig and Dr. Enrique Diaz by Julia Meador)
Ready to go, Prussians to the left are spread in an almost single line along the whole frontage whilst I was using the two woods at each end of the battlefield as flank protection and had units in reserve to counter any move around them. The rules will reward a reserve as they should and Barry did start to generate one as the game progressed.
Due to setting up to far apart the early turns zipped by in a series of moves, this was good for two reasons, first it got us used to Tempo and the bidding (not to mention how each of us bid) but also allowed for us to make changes to plans etc. I was expecting the Prussians to come out and fight to use their greater numbers and when they were slow to do this I moved my left flank infantry off the hill to try and temp the Prussians down off theirs whilst moving my 4 regiments of Hussars from my right, across the front of my whole army to join the forces on my left. Meanwhile the extreme flank force was moved behind the wood to attack the Prussian right flank which was now using the same woods as myself to pin a flank.
Mixed results on the first engagement. Barry closed to firing range as the second player then won Tempo and 
The Inf on the left turned to be able to fire on my 
