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heartcarepa · 2 years ago

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Heart attacks affect more than your health

The Public Health Agency of Canada reports that a third of heart attacks and strokes occur in Canadians who are mid-career. The Canadian Medical Association Journal published a study that tallied the economic impact. A heart attack or stroke has a high financial cost. Get top cardiologist philadelphia at Heart Care Consultants. Heart Care Consultants is the best cardiology center philadelphia.

Researchers from the Universities of Manitoba and Toronto, Michigan and the Massachusetts Institute of Technology, as well as Statistics Canada, examined a database which linked hospitalization records and income tax records for the years 2005-2013.

Researchers studied more than 24 000 people aged 40-61 who suffered a stroke, heart attack or cardiac arrest. Participants had to be employed in the past two years to be eligible for the study. The participants were compared with healthy people of similar age.

The annual income loss for those who suffered a cardiac arrest was $3,834 (Canadian dollars, 2012). The financial impact on those who survive a cardiac arrest witnessed by others was $11,143. People who suffered a stroke experienced the biggest financial loss. The financial loss for them was $13,278.

These figures represent a range of losses between 8 and 31%.

Researchers identified a number of factors that contributed to income loss. Unsurprisingly, loss of employment was the biggest factor. After three years, the employment rate of those who suffered a heartattack dropped by five percent. The fall-off in employment rates was almost 13 percent for those who survived a cardiac arrest and just under 20 percent for those who suffered a stroke.

After the onset, heart disease caused a five to twenty percent drop in earnings for those who continue to work.

Other factors were involved. Patients with lower incomes initially suffered the greatest loss in income. The longer a patient stays in the hospital, the more income and employment are lost. Other illnesses, such as chronic kidney diseases and chronic obstructive lung disease, also increase the amount of earnings lost.

The authors claim that other studies have produced similar results but this is the largest study of its type.

There were a few surprises, though the findings were not completely unexpected. The biggest surprise for me was the fact that factors which had no effect on income after a stroke or heart attack turned out not to be the case. I thought that women would suffer more than men in terms of income loss, but both men and women suffered the same. I thought that being married would protect me from income loss. However, married patients also suffered the same losses as those who were divorced, widowed, or single.

I also thought that patients who are employed would have less income than those who are self-employed, because I assumed employment was more likely associated with short-term disability coverage. Also, I was wrong.

Declare bankruptcy

Researchers found that the massive loss of income has major consequences. Families who borrow money in order to stay afloat can end up declaring bankrupt. Stress from a precarious income may lead to depression and anxiety, which can negatively affect blood pressure and heart disease.

It's not only the patient that is affected. The family is also affected. Loss of income makes healthy family members pick up the slack. Losing income can affect career plans for the patient's kids. Let's also not forget that those aged 40-61 are at their highest earning years. It is during this time that people tend to pay off their mortgages and save money for retirement. An illness that is serious can derail your retirement plans.

According to the authors, more research is required to better understand the economic impact of heart disease and stroke. It's easy to see how to help patients. The biggest income drop is experienced by those who have suffered a stroke. This is due to the disability strokes cause. As we learned this season in White Coat Black Art stroke rehabilitation is slow and insufficient in many rural and distant parts of Canada. This needs to be addressed.

I also believe that the federal government could use other methods to address income disparities caused by catastrophic illnesses. Tax credits are one option. It can provide income supplements to those who are unemployed, or underemployed after a stroke or heart attack.

Some may say this is rewarding patients who have a lifestyle that increases the risk of developing heart disease. I believe that addressing the income loss up front will reduce the need to access government pensions early. This will save provinces and territorial governments the costs of dealing with health problems that are exacerbated by income loss.

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heartcareconsultants · 4 months ago

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Best Heart Doctors & Vascular Treatment in Philadelphia

Do you need an experienced top cardiologist or a Best Heart Doctor in Philadelphia? Look no further.

Heart and Vascular Care Consultants is a specialized clinic that provides accurate diagnosis and superior techniques to treat from deep within the heart.

We are pleased to be a team of Philadelphia's most respected cardiologists and cardiac specialists. However, our care does not just end with the spaciousness of your heart. We also give you all-inclusive primary care services, regarding all the aspects of your health. This is why we aim to bring the highest levels of medical practice together with true care for the patient.

#best heart doctor #lower extremity intervention

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jovanhomecarebusiness · 2 years ago

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A Pennsylvania home health agency provides the best senior care.

In the space of modernization, we are truly occupied with our calling and own life; we are now and again bungled to commit the referenced an open door to our inclined toward bones.

Work strain in office and the agitated timetable are the starting purposes for our ideal strategy for letting the created individuals from the family be at home. To guarantee internal serenity you genuinely ought to quit whining about your created guardians while you are working. You search for experts who offer a full time sponsorship to them. It's focal that you ensure that they yield the tolerant love they secure from individuals you select for them. To give the sponsorship these experts ought to be sufficient prepared.

Organized experts of Home Idea Relationship in Philadelphia are reasonable to express the impression, love and sponsorship that your kin need. They are told and truly win the conviction of seniors through their straightforwardness and kind disposition. They offer them fitting admiration. They give nutritive and incredible food and follow a specific eating ordinary as suggested by croakers.

Notwithstanding, dressing, taking medication, on the off chance that your old watchmen are not reasonable to do express things and require moving in their standard effort; Home Clinical advantages Firm in Pennsylvania offers assists that with uniting washing. The staff individuals have a central impact in aiding the created individuals in playing out this enormous number of tries effectively and permit them to keep their sureness. Sometimes they give rub helps that give the more prepared individuals a help from routine torment in joints. They beyond question brief little activities, which influence in updating the genuine show. The parental figures go with you in a short walk that can expand the strength of muscles and stretch ligaments and joints as well. Promise you close the ideal areas reasonable to offer remedy on opportunity to your old guardians.

Individuals you select can give your kin relentless sponsorship. senior occupants will most obviously have two or three clinical issues. The master places will drive them to the croaker

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philadelphiahospital · 2 years ago

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Who should consult a preventive cardiologist?

Preventive cardiology is a branch of cardiology that helps you reduce risk factors for heart disease before they worsen. Cardiology is an internal medicine specialty that focuses on the heart and blood vessels. As a result, preventive cardiology focuses on early detection and intervention to keep your heart and blood arteries healthy. It is a type of preventative medicine that can have a significant impact on your overall health and well-being.

Types of preventive cardiology

Primary prevention

A series of examinations and advice are referred to as primary prevention in this context.

Secondary prevention

If you already have heart issues or have had heart surgery, preventive cardiology will help you stay healthy, maintain your rehabilitation, and lower your risk of developing new cardiac events.

Who should consult a preventive cardiologist

Personal experience with heart illness at a young age

It’s unusual to experience a heart attack or stroke when you’re young. Heart attacks in adults under the age of 60 are not expected. Doctors see a lot of cardiac disease in people in their 30s, 40s, and 50s as these folks create a family history of heart disease.

We must use novel approaches to stop future heart disease and damage in these young individuals.

Because

“The most deadly disease truly is the failure of the heart.” — Oscar Arias

Heart disease can have a wide range of underlying reasons, thus each patient should receive individualized care. Since their heart problems don’t manifest in a typical way, the “normal” strategy for managing them — standard medicines and testing — is insufficient.

Several unregulated dangerous elements

The typical risk factors for heart disease are present in this group of people, including uncontrolled high blood pressure, high blood sugar or diabetes, obesity, smoking, a poor diet, and inactivity. Each is a risk factor in and of itself, but when they combine, it is more difficult for patients to prevent and manage heart disease.

So if you come under these two groups then you need to consult a preventive cardiologist as soon as possible.

Philadelphia Hospital is the best hospital in Ambala city where you can get the best treatment in cardiology. You can learn more about our services by visiting our website.

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datascraping001 · 2 years ago

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corrieluscardiology · 4 years ago

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Corrielus Cardiology provides comprehensive cardiology consultations that identify the risk factors for heart disease and help patients reduce their chances of experiencing serious cardiac problems.

Take charge of your heart health and consult one of the best Cardiologists in Philadelphia. We are committed to providing a comfortable, integrative, and an environment that fosters overall wellness. Patients from all walks of life can find trusted, comprehensive care at Corrielus Cardiology. Book an appointment now.

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socially-awkward-skeleton · 3 years ago

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The Unplanned Variable Ask Meme had some questions left on it that went unasked so I thought I’d fill them out.

2. What are their attributes, perks, and flaws?

Attributes: avg strength, avg dexterity, very high intelligence, high perception, very high charm, high temperance

Perks: toughness, slow the world, strider, cheetah, traveler, pack mule, quick and the dead, speed demon, The Reaper, Soliloquy, and Don’t go dyin’ on me.

Flaws: No flaws given

3. What do they believe in?

At the start of her story Ava doesn't believe in very much, she is very practical and realistic, she has a background in science so she is quite the skeptic (which often puts her at odds with Max and the OSI teachings)

As the story progresses she does start to wonder if what has happened to her is a long-line of coincidences or whether fate or destiny does have something to do with it all. She isn't willing to believe in the Plan or the Architect but she does start to question everything that has happened in her life since arriving in Halcyon.

By the end of her story Ava readily accepts that while coincidences happen, most of her life has been chaos. She accepts Max’s view of her “courting chaos” and is rather proud of the fact that she won’t let any Plan tell her what she can or can’t do. She is the Unplanned Variable after all.

5. What was their life like before being iced?

Ava was a medical resident living in Philadelphia. She worked at a hospital and had hopes of becoming a prenatal doctor. However, considering the corporations had their place on Earth just the same and standardized testing was commonplace for education and career, she was assigned to become a cardiologist or neurologist based on her standing. She had no interest in that.

When the option to travel to Halcyon came to her she was all too ready to drop everything and start a life of adventure. She had grown tired of the routine her life had become and wanted a chance to be someone else, to go somewhere where no one knew her and didn't have certain ideas about her.

She didn't have a lot of friends, no romantic relationship to speak of, the only thing she would be leaving behind would be her family. However, her brothers and her have a very close bond. They were all married to their work in one way or another and decided to go with her for the opportunity to do something more with their lives.

7. What’s their fighting style? Who do they bring along?

Ava is not a fighter, she had never even held a gun before coming to Halcyon and the only way she had seen one was in the movies.

She knows just enough self-defense to get herself out of a scrape, but she is certainly not the type to “throw down”.

Most of her fighting style is hiding behind cover and hoping for the best. She does want to improve however, so she asks Max to start training her on how to handle a weapon and sparring.

12. Did they save The Hope?

Absolutely, yes. Everything she did in Halcyon was to get her brothers back and to save the other colonists on that ship.

13. What do they want to do afterwards? - but do they get a happy ending?

Once she saves the Hope and frees Phineas from Tartarus she takes on the near impossible job of saving Halcyon. Working with Phineas to revive the colonists, and Minister Clarke and Sanjar in Byzantium to remove the Board’s control and improve the lives of all of Halcyon’s citizens. It takes three years of Ava working non-stop to make it happen, but improvements are made. Though her relationship with Max does suffer for it.

Ultimately, she does get her happy ending. Her and Max get back together, quickly marrying once she is free from her duties as “chairman”. They have three children who they raise in Stellar Bay, and Ava is able to live out her dream of running her own medical clinic.

14. What do they think of the companions? Friendships, crushes, dislikes, etc.

Parvati - Ava immediately took to Parvati, her kindness and gentle nature reminded her of her brother William who she was always closest to. Ava is also extremely grateful for Parvati’s idea to speak to the vicar. Without that she never would have met the man she loves.

Felix - Felix isnt always the brightest, but he means well and Ava will always love him for his loyalty and the heart he brought to her crew. Despite their differences, Ava always felt like she understood Felix having had to deal with abandonment issues herself. She understood why he wanted to get away and seek adventure. She takes him under her wing and tries to steer him in the right direction, giving him a focus. Once the hard work of saving the Hope is over and done with, she takes Felix with her while running the Board as she sees him as a compass of sorts as his mind is always on the little guy. He still doesn’t understand why she hates tossball though.

Nyoka - Ava turns to Nyoka for advice nearly as often as she does Max. Ava trusts her completely, and looks to her like an aunt. When Ava can’t quite make sense of a problem (especially if the problem is Max) Nyoka is happy to help. They have a great respect for one another. Though Ava wishes she could get the huntress to cut back on her drinking.

Ellie - Ellie and Ava never really get along. They have a mutual respect for one another as they are both medical professionals, but Ava has a strong dislike for Ellie’s overall selfishness. Ellie does come to appreciate Ava’s kindness and does start to adopt it herself, but they are never what you would call friends.

Max - Ava and Max have an interesting dynamic with one another. When they first meet they are both attracted to one another, but as they first spend time on the ship together they prove to be oil and water. Arguing however becomes friendly debates as they get closer and become more like friends, even so far as confidantes. As they grow closer, those initial feelings of interest and attraction begin to grow and open flirtation begins to happen. Ava and Max circle one another for a long time until finally they act on their feelings.

Ava finds Max to be charming, and she loves his sarcastic wit, so few people can match her own. She quickly learns he can be as stubborn as she is, if not more so. But she wouldn’t have him any other way.

Sam - Ava’s not very fond of automechanicals, especially since most of them have tried to kill her at one time or another. He does makes for a good maid and a nice way to keep Max in line by threatening to burn his books.

15. How do the companion quests go?

Parvati - Ava bends over backwards to grant Parvati her every request. You need to get to Byzantium to buy new clothes even though we’re on Monarch which is halfway across the solar system? You betcha! Seeing Parvati happy with Junlei is Ava’s way of living vicariously through them and seeing romance bloom and succeed.

Felix - Ava’s heart broke for Felix when she had to help him take down his mentor, Harlow. Felix never had many people he could trust and that was a feeling Ava knew all too well. Ultimately, it did help Ava and Felix grow closer and helped him to realize he needed to be more careful about who he put his trust in.

Nyoka - After completing Nyoka’s mission, taking down the Mantiqueen in the caves and burying her family, Nyoka came to realize that she had found a new one on board the Unreliable, as dysfunctional as it may be.

Ellie - Ava wasn’t too fond of having to con her way to helping Ellie get her financial freedom, but after seeing the way her parents treated her, Ava began to realize she and Ellie were more alike than she thought. While they still didn't become friends, her and Ellie were able to relate to one another a lot more.

Max - Max’s quest is as big a part of Ava’s life as it is his. Finding out that he had lied to her to drag her across the colony to kill a man was a major act of betrayal and one Ava had significant problems dealing with. Max was someone who she trusted completely, and who she thought understood her considering they were in a relationship at that point (even if it was still a secret to most of the crew). Killing in cold-blood is something Ava will not stand for, it goes against everything she believes. She stops Max from killing Reginald Chaney but it puts a major strain in their relationship. After weeks of the silent treatment, Ava and Max manage to reconcile but it takes her a long time to forgive him.

When they go to Scylla to meet the hermit, Ava and Max go together. Their drug trips result in some major life changing moments. Max realizes the Plan and the Architect are a falsehood (however, in my stories Max does NOT become a stoner hippie)

17. Are they in a relationship? Do they want to be?

Yes, Ava is in a relationship with Vicar Max.

Links to my other answers here, here, here, here, here, and here,

#unplanned variable asks #ava mueller #my oc #tow #the outer worlds

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chalkegg9-blog · 6 years ago

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Amish Broccoli Cauliflower Salad Recipe with Bacon

This post may contain affiliate links which won’t change your price but will share some commission. Full Disclosure

Invited to a pitch-in or pot-luck party but don’t want to spend a lot of time preparing a healthy dish? Then try this quick and easy Amish broccoli cauliflower salad recipe.

My mother is from Philadelphia, which is only about an hour or so away from Lancaster County, Pennsylvania.

Lancaster is home to one of the largest populations of Amish. In fact, Lancaster’s approximately 30,000 Amish residents is second only to Holmes County, Ohio.

While visiting my grandmother in Coopersburg, PA (which is close to Allentown, PA), who moved closer to Amish country, the family would go to a lot of Amish restaurants.

We used to do buffet restaurants and this Amish broccoli cauliflower salad recipe is similar to a dish we would often order.

The Amish grow all their vegetables. Maybe the tender care in which they cultivate their crops is the reason this often bland veggie tastes so good.

And perhaps it’s how Amish cooks come up with creative ways to serve it in cold tasty salads.

After you try my version, I hope you’ll find my creation worthy of preparing for the next dinner party you’re invited to.

Amish broccoli cauliflower salad recipe

This recipe will yield enough salad for about a dozen people. If you’re preparing it for a pot-luck and there’s going to be more people, simply increase the ingredient sizes accordingly.

Normally, I only eat cold salads in the warm summer months. In the winter, I prefer warming foods.

But even though this salad is usually served cold, it can also be popped in the microwave for about 30 seconds. So keep that in mind if you want the salad warm.

The first thing you’ll need to do is steam the broccoli and cauliflower. (photos 1 & 2) You can steam them together.

And all it takes for the two veggies to achieve the desired consistency (crisp yet tender) is a couple minutes of steaming.

When the veggies seem like they’re perfectly crunchy with a slight softness, drain and cool them.

You can place the veggies in a glass salad bowl and let them continue to cool. (photo 3)

Making The Dressing

Next, in a separate mixing bowl, you’re going to create the dressing for the broccoli cauliflower salad.

To make the dressing, first place the 1/2 cup of avocado mayo into a small bowl. (photo 4)

If you’re not familiar with avocado mayo, it’s not mayonnaise mixed with avocado. Rather, it’s a Paleo-safe, egg-free topping containing vinegar and beets, that’s whipped into a rich, mayo-like consistency.

Then, you’ll want to add the 1/2 cup of sour cream. (photo 4) If you want to make it super healthy, see if you can buy some raw sour cream.

Raw sour cream contains lots of probiotics. But depending on which state you live, you may or may not be able to buy it in stores. If not, try to get organic sour cream.

Also add a few tablespoons of apple cider vinegar. (photo 5) For the healthiest apple cider vinegar, I suggest unfiltered apple cider vinegar with “the mother.”

To sweeten the dressing, I use stevia powder. Start off with a small amount (just an 1/8th of a teaspoon). (photo 6) That’s because stevia is 500 times sweeter than table sugar (even though it has virtually no carbs).

You don’t want to overdo the stevia and have the sweetness overpower the tanginess of the dressing. If you feel like the dressing can be a tad bit more sweet, you can always add more.

What’s a Salad Without Bacon?

This recipe is similar to my sweet broccoli salad supreme. But one thing it doesn’t contain that this recipe does is bacon.

Why bacon in a salad? Well, why not?

Contrary to what most people think and what you’re cardiologist would likely tell you, eating bacon is not an artery-clogging death sentence. (For most people anyways; some people have the genetic predisposition to not be able to break down fats like bacon.)

But bacon is only healthy if it’s organic. Organic bacon is free of nitrites, the chemical that’s used to keep deli meats from spoiling. There’s an association between these kinds of nitrite-rich meats and cancer.

So if it’s organic bacon, as a treat once in a while, no worries. And the crunch and fat of it just goes perfectly in the Amish broccoli cauliflower salad recipe.

I use about a dozen well-cooked strips of bacon and chop them in small pieces. You can start cooking the bacon before making the dressing to maximize time.

Once the bacon and dressing are ready, in a large bowl, combine all the ingredients. (photos 10 & 11) Mix well and then place it in the fridge so it gets chilled.

Your guests (or the host’s guests) will think that you slaved away in the kitchen. Let them think that; it’ll be your secret that you spent only a handful of minutes on this (besides waiting for the bacon to cook).

I like to serve the broccoli cauliflower salad on special summer days like 4th of July. If you have any guests that are dairy-free, they will be very surprised that this dish doesn’t contain any dairy.

Maybe you will introduce avocado mayo to them and they will be very grateful to learn about it. I hope you enjoy the Amish broccoli cauliflower salad recipe.

Amish Broccoli Cauliflower Salad Printable Recipe

Amish Broccoli Cauliflower Salad

Need a healthy dish to bring to a pitch-in or pot-luck party but don't want to spend a lot of time making it? Then try this easy salad recipe.

Ingredients

10 ounces broccoli chopped

1 small head cauliflower chopped

1/2 cup avocado mayonnaise

1/2 cup sour cream

3 tablespoons apple cider vinegar

1/8 teaspoon stevia powder or more to taste

12 slices bacon cooked crisp and chopped

Instructions

Steam broccoli and cauliflower for a couple minutes to crisp tender. Drain and cool slightly.

In small bowl, combine mayonnaise, sour cream, apple cider vinegar, and stevia to form a dressing.

In large bowl, blend broccoli, cauliflower, bacon and dressing until well combined. Chill and serve.

Recipe Notes

The vegetables can be added raw, but we find it best to steam them slightly before adding to the salad.

For dairy-free, try adding in a non-dairy yogurt in place of the sour cream.

Nutrition Facts

Amish Broccoli Cauliflower Salad

Amount Per Serving (1 cup)

Calories 188 Calories from Fat 153

% Daily Value*

Total Fat 17g 26%

Saturated Fat 5g 25%

Cholesterol 23mg 8%

Sodium 227mg 9%

Potassium 197mg 6%

Total Carbohydrates 3g 1%

Dietary Fiber 1g 4%

Sugars 1g

Protein 4g 8%

Vitamin A 4.4%

Vitamin C 38.5%

Calcium 2.8%

Iron 2.2%

* Percent Daily Values are based on a 2000 calorie diet.

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Source: https://lowcarbyum.com/amish-broccoli-cauliflower-salad-recipe/

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heartcarepa · 2 years ago

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Take Action Now: Heart Attacks are Rising in Young People

In the recent past we have been hearing many high profile cases of young celebrities getting a heart attack. If we look around in the community each one of us has heard a case of cardiac arrest, heart complications amongst young people.

In a recent article in economic times, Top Cardiologist Philadelphia USA have warned USA People have 2 – 3 times more chances of developing heart condition than western countries owing to genes and lifestyle. As per data published by NCRB (National Crime Records Bureau) heart attacks have increased by mind boggling 53% in the last 5 years.

USA is regarded as a nation for one of the best cardiologist philadelphia in the world but still the increasing numbers are of grave concern. It is high time that as IUSA citizen we take appropriate measures of ourselves and our family to ensure no untoward incident happens in our own family. This blog is to not only raise awareness about heart attack complications and cases amongst young adults but also mentions key measures to avoid it.

Your risk of getting heart disease is influenced by a number of things. At least one of the

Three most common risk factors for the condition is present in more than 50% of all people in USA:

High cholesterol

Smoking: Although statistics in the past suggested that men smoke more than women, the gender gap in cigarette consumption has become closer over the years and today has become a major reason for developing cardiovascular complications.

High blood pressure: Stress, Hectic lifestyle, Junk food, Improper sleep are some of the major contributors to CAD amongst young people of USA. Women who take birth control pills & smoke carry a very high risk of CAD.

Some of the other factors also include:

Sedentary lifestyle

Obesity

Family history of cardiovascular disease

Diabetes

Heavy alcohol intake

Some top tips for maintaining healthy heart for healthy-life:

Exercise frequently: A regular exercise program can improve your heart health. Set a goal for at least 150 minutes of outdoor activity or more each week. Brisk 40 minute walk to cover 4 km is good enough for a healthy heart.

Keeping a healthy weight: Being overweight or obese raises your chance of developing heart disease. Follow a diet that is good for your heart: Home cooked meals are the best and the safest. Limit your intake of processed meals and sweets.

Managing stress: Growing evidence suggests that you should minimize the effects of stress on your heart health.

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heartcareconsultants · 4 months ago

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Best Heart Doctors & Cardiologists in Philadelphia

Heart and Vascular Care Consultants is focused on giving optimal care to patients with cardiac issues. Our lead cardiologist Dr. Haytham Albizem is Board certified in five sub-specialties, that is, cardiology, interventional cardiology, electrophysiology, nuclear cardiology, and internal medicine. Dr. Haytham Albizem has practiced for 15 years and is dedicated to improving circulation through the most advanced technology available.

From the information gathered concerning Dr. Haytham Albizem, his learning background and experience making him a professional with ability to Conduct various operations with a lot of precision and care. No matter if you are coming in for a simple examination or for a more intensive procedure, you can be sure that Dr. Albizem and our team are here to provide you with the best care possible.

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orbemnews · 4 years ago

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Kati Kariko Helped Shield the World From the Coronavirus She grew up in Hungary, daughter of a butcher. She decided she wanted to be a scientist, although she had never met one. She moved to the United States in her 20s, but for decades never found a permanent position, instead clinging to the fringes of academia. Now Katalin Kariko, 66, known to colleagues as Kati, has emerged as one of the heroes of Covid-19 vaccine development. Her work, with her close collaborator, Dr. Drew Weissman of the University of Pennsylvania, laid the foundation for the stunningly successful vaccines made by Pfizer-BioNTech and Moderna. For her entire career, Dr. Kariko has focused on messenger RNA, or mRNA — the genetic script that carries DNA instructions to each cell’s protein-making machinery. She was convinced mRNA could be used to instruct cells to make their own medicines, including vaccines. But for many years her career at the University of Pennsylvania was fragile. She migrated from lab to lab, relying on one senior scientist after another to take her in. She never made more than $60,000 a year. By all accounts intense and single-minded, Dr. Kariko lives for “the bench” — the spot in the lab where she works. She cares little for fame. “The bench is there, the science is good,” she shrugged in a recent interview. “Who cares?” Dr. Anthony Fauci, director of the National Institutes of Allergy and infectious Diseases, knows Dr. Kariko’s work. “She was, in a positive sense, kind of obsessed with the concept of messenger RNA,” he said. Dr. Kariko’s struggles to stay afloat in academia have a familiar ring to scientists. She needed grants to pursue ideas that seemed wild and fanciful. She did not get them, even as more mundane research was rewarded. “When your idea is against the conventional wisdom that makes sense to the star chamber, it is very hard to break out,” said Dr. David Langer, a neurosurgeon who has worked with Dr. Kariko. Dr. Kariko’s ideas about mRNA were definitely unorthodox. Increasingly, they also seem to have been prescient. “It’s going to be transforming,” Dr. Fauci said of mRNA research. “It is already transforming for Covid-19, but also for other vaccines. H.I.V. — people in the field are already excited. Influenza, malaria.” ‘I Felt Like a God’ For Dr. Kariko, most every day was a day in the lab. “You are not going to work — you are going to have fun,” her husband, Bela Francia, manager of an apartment complex, used to tell her as she dashed back to the office on evenings and weekends. He once calculated that her endless workdays meant she was earning about a dollar an hour. For many scientists, a new discovery is followed by a plan to make money, to form a company and get a patent. But not for Dr. Kariko. “That’s the furthest thing from Kate’s mind,” Dr. Langer said. She grew up in the small Hungarian town of Kisujszallas. She earned a Ph.D. at the University of Szeged and worked as a postdoctoral fellow at its Biological Research Center. In 1985, when the university’s research program ran out of money, Dr. Kariko, her husband, and 2-year-old daughter, Susan, moved to Philadelphia for a job as a postdoctoral student at Temple University. Because the Hungarian government only allowed them to take $100 out of the country, she and her husband sewed £900 (roughly $1,246 today) into Susan’s teddy bear. (Susan grew up to be a two-time Olympic gold medal winner in rowing.) When Dr. Kariko started, it was early days in the mRNA field. Even the most basic tasks were difficult, if not impossible. How do you make RNA molecules in a lab? How do you get mRNA into cells of the body? In 1989, she landed a job with Dr. Elliot Barnathan, then a cardiologist at the University of Pennsylvania. It was a low-level position, research assistant professor, and never meant to lead to a permanent tenured position. She was supposed to be supported by grant money, but none came in. She and Dr. Barnathan planned to insert mRNA into cells, inducing them to make new proteins. In one of the first experiments, they hoped to use the strategy to instruct cells to make a protein called the urokinase receptor. If the experiment worked, they would detect the new protein with a radioactive molecule that would be drawn to the receptor. “Most people laughed at us,” Dr. Barnathan said. One fateful day, the two scientists hovered over a dot-matrix printer in a narrow room at the end of a long hall. A gamma counter, needed to track the radioactive molecule, was attached to a printer. It began to spew data. Their detector had found new proteins produced by cells that were never supposed to make them — suggesting that mRNA could be used to direct any cell to make any protein, at will. “I felt like a god,” Dr. Kariko recalled. She and Dr. Barnathan were on fire with ideas. Maybe they could use mRNA to improve blood vessels for heart bypass surgery. Perhaps they could even use the procedure to extend the life span of human cells. Dr. Barnathan, though, soon left the university, accepting a position at a biotech firm, and Dr. Kariko was left without a lab or financial support. She could stay at Penn only if she found another lab to take her on. “They expected I would quit,” she said. Universities only support low-level Ph.D.s for a limited amount of time, Dr. Langer said: “If they don’t get a grant, they will let them go.” Dr. Kariko “was not a great grant writer,” and at that point “mRNA was more of an idea,” he said. But Dr. Langer knew Dr. Kariko from his days as a medical resident, when he had worked in Dr. Barnathan’s lab. Dr. Langer urged the head of the neurosurgery department to give Dr. Kariko’s research a chance. “He saved me,” she said. Updated April 8, 2021, 11:48 a.m. ET Dr. Langer thinks it was Dr. Kariko who saved him — from the kind of thinking that dooms so many scientists. Working with her, he realized that one key to real scientific understanding is to design experiments that always tell you something, even if it is something you don’t want to hear. The crucial data often come from the control, he learned — the part of the experiment that involves a dummy substance for comparison. “There’s a tendency when scientists are looking at data to try to validate their own idea,” Dr. Langer said. “The best scientists try to prove themselves wrong. Kate’s genius was a willingness to accept failure and keep trying, and her ability to answer questions people were not smart enough to ask.” Dr. Langer hoped to use mRNA to treat patients who developed blood clots following brain surgery, often resulting in strokes. His idea was to get cells in blood vessels to make nitric oxide, a substance that dilates blood vessels, but has a half-life of milliseconds. Doctors can’t just inject patients with it. He and Dr. Kariko tried their mRNA on isolated blood vessels used to study strokes. It failed. They trudged through snow in Buffalo, N.Y., to try it in a laboratory with rabbits prone to strokes. Failure again. And then Dr. Langer left the university, and the department chairman said he was leaving as well. Dr. Kariko again was without a lab and without funds for research. A meeting at a photocopying machine changed that. Dr. Weissman happened by, and she struck up a conversation. “I said, ‘I am an RNA scientist — I can make anything with mRNA,’” Dr. Kariko recalled. Dr. Weissman told her he wanted to make a vaccine against H.I.V. “I said, ‘Yeah, yeah, I can do it,’” Dr. Kariko said. Despite her bravado, her research on mRNA had stalled. She could make mRNA molecules that instructed cells in petri dishes to make the protein of her choice. But the mRNA did not work in living mice. “Nobody knew why,” Dr. Weissman said. “All we knew was that the mice got sick. Their fur got ruffled, they hunched up, they stopped eating, they stopped running.” It turned out that the immune system recognizes invading microbes by detecting their mRNA and responding with inflammation. The scientists’ mRNA injections looked to the immune system like an invasion of pathogens. But with that answer came another puzzle. Every cell in every person’s body makes mRNA, and the immune system turns a blind eye. “Why is the mRNA I made different?” Dr. Kariko wondered. A control in an experiment finally provided a clue. Dr. Kariko and Dr. Weissman noticed their mRNA caused an immune overreaction. But the control molecules, another form of RNA in the human body — so-called transfer RNA, or tRNA — did not. A molecule called pseudouridine in tRNA allowed it to evade the immune response. As it turned out, naturally occurring human mRNA also contains the molecule. Added to the mRNA made by Dr. Kariko and Dr. Weissman, the molecule did the same — and also made the mRNA much more powerful, directing the synthesis of 10 times as much protein in each cell. The idea that adding pseudouridine to mRNA protected it from the body’s immune system was a basic scientific discovery with a wide range of thrilling applications. It meant that mRNA could be used to alter the functions of cells without prompting an immune system attack. “We both started writing grants,” Dr. Weissman said. “We didn’t get most of them. People were not interested in mRNA. The people who reviewed the grants said mRNA will not be a good therapeutic, so don’t bother.’” Leading scientific journals rejected their work. When the research finally was published, in Immunity, it got little attention. Dr. Weissman and Dr. Kariko then showed they could induce an animal — a monkey — to make a protein they had selected. In this case, they injected monkeys with mRNA for erythropoietin, a protein that stimulates the body to make red blood cells. The animals’ red blood cell counts soared. The scientists thought the same method could be used to prompt the body to make any protein drug, like insulin or other hormones or some of the new diabetes drugs. Crucially, mRNA also could be used to make vaccines unlike any seen before. Instead of injecting a piece of a virus into the body, doctors could inject mRNA that would instruct cells to briefly make that part of the virus. “We talked to pharmaceutical companies and venture capitalists. No one cared,” Dr. Weissman said. “We were screaming a lot, but no one would listen.” Eventually, though, two biotech companies took notice of the work: Moderna, in the United States, and BioNTech, in Germany. Pfizer partnered with BioNTech, and the two now help fund Dr. Weissman’s lab. ‘Oh, It Works’ Soon clinical trials of an mRNA flu vaccine were underway, and there were efforts to build new vaccines against cytomegalovirus and the Zika virus, among others. Then came the coronavirus. Researchers had known for 20 years that the crucial feature of any coronavirus is the spike protein sitting on its surface, which allows the virus to inject itself into human cells. It was a fat target for an mRNA vaccine. Chinese scientists posted the genetic sequence of the virus ravaging Wuhan in January 2020, and researchers everywhere went to work. BioNTech designed its mRNA vaccine in hours; Moderna designed its in two days. The idea for both vaccines was to introduce mRNA into the body that would briefly instruct human cells to produce the coronavirus’s spike protein. The immune system would see the protein, recognize it as alien, and learn to attack the coronavirus if it ever appeared in the body. The vaccines, though, needed a lipid bubble to encase the mRNA and carry it to the cells that it would enter. The vehicle came quickly, based on 25 years of work by multiple scientists, including Pieter Cullis of the University of British Columbia. Scientists also needed to isolate the virus’s spike protein from the bounty of genetic data provided by Chinese researchers. Dr. Barney Graham, of the National Institutes of Health, and Jason McClellan, of the University of Texas at Austin, solved that problem in short order. Testing the quickly designed vaccines required a monumental effort by companies and the National Institutes of Health. But Dr. Kariko had no doubts. On Nov. 8, the first results of the Pfizer-BioNTech study came in, showing that the mRNA vaccine offered powerful immunity to the new virus. Dr. Kariko turned to her husband. “Oh, it works,” she said. “I thought so.” To celebrate, she ate an entire box of Goobers chocolate-covered peanuts. By herself. Dr. Weissman celebrated with his family, ordering takeout dinner from an Italian restaurant, “with wine,” he said. Deep down, he was awed. “My dream was always that we develop something in the lab that helps people,” Dr. Weissman said. “I’ve satisfied my life’s dream.” Dr. Kariko and Dr. Weissman were vaccinated on Dec. 18 at the University of Pennsylvania. Their inoculations turned into a press event, and as the cameras flashed, she began to feel uncharacteristically overwhelmed. A senior administrator told the doctors and nurses rolling up their sleeves for shots that the scientists whose research made the vaccine possible were present, and they all clapped. Dr. Kariko wept. Things could have gone so differently, for the scientists and for the world, Dr. Langer said. “There are probably many people like her who failed,” he said. Source link Orbem News #coronavirus #Helped #Kariko #Kati #shield #World

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hmsusa · 4 years ago

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Some Americans Cannot Access Telemedicine, A Study Shows

Telemedicine rapidly expanded during the COVID-19 pandemic as people turned to their phones and computers rather than leave their homes for health care.

But some groups of people were left behind in the telemedicine boom, a new study reports. Doctors and hospital owners can contact us through HMS Medical Billing official website for handling all their Medical Billing-related issues.

Middle-aged and older folks are much less likely to complete their scheduled telemedicine visits, as well as Medicaid recipients, and those whose first language is not English, the researchers said.

Many groups are also unable to take part in video visits, including middle-aged folks and seniors, women, Black and Hispanic people, and those with a lower household income, according to the study authors.

The Pandemic Evaluation

The pandemic has revealed a digital divide in telemedicine care, with some people unable to take full advantage of the service because they either lack access to the technology or find it too daunting, said lead researcher Dr. Srinath Adusumalli.

He is a cardiologist and assistant professor of clinical medicine with the Hospital of the University of Pennsylvania, in Philadelphia.

"Lots of the care we have historically delivered in person can be done via telemedicine, and therefore I do think telemedicine is here to stay," Adusumalli said. "Our goal now is to start refining that process."

For this study, Adusumalli and his colleagues surveyed records for nearly 150,000 patients who scheduled telemedicine visits with Penn Medicine between mid-March and mid-May, 2020, at the height of the pandemic's first wave.

Only 54% of those who scheduled a telemedicine visit followed through and completed it, the researchers found.

Further, only about 46% of those who used telemedicine had a visit conducted via video, which is generally considered the best, Adusumalli said. The rest had phone visits. Visit HMS website and contact us for better Medical Billing and Credentialing experience.

Age played a large part in whether a person would complete a telemedicine visit or use video during their visit:

· People aged 55 to 64 were 15% less likely to complete a visit and 21% less likely to use video.

· Those aged 65 to 74 were 25% less likely to complete the telemedicine consultation and 22% less likely to use video.

· Seniors aged 75 and older were 33% less likely to successfully participate in telemedicine and 51% less likely to try video.

· Non-English speakers were 16% less likely to complete a telemedicine visit, and people on Medicaid were 7% less likely, the results showed.

Lower video use was also observed among women (8% less likely), Black people (35%), Hispanics (10%), and low-income families (43% less likely for household income less than $50,000).

Video allows doctors to visually examine a patient, check out their surroundings, and look directly at either medication they are taking or the results from self-monitoring devices like blood pressure cuffs or glucometers, Adusumalli said.

"The common wisdom is that video is always best, but I think its best in certain clinical situations," Adusumalli said. "Having conducted many home medicine visits myself, I do agree video makes the encounter richer. It allows you to connect more with the patient."

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corrieluscardiology · 2 years ago

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lauramalchowblog · 5 years ago

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COVID-19: The Nursing Home Tragedy

By ANISH KOKA, MD

Our strategy with nursing homes in the midst of the current pandemic is bad. Nursing homes and other long term care facilities house some of our sickest patients in and it is apparent we have no cogent strategy to protect them.

I attempted to reassure an anxious nursing home resident a few weeks ago. I told him that it appeared for now that the community level transmission in Philadelphia was low, and that I was optimistic we could keep residents safe with simple maneuvers like better hand hygiene, restricting visitors, as well as stricter policies with regards to keeping caregivers with symptoms home. I was worried too, but optimistic.

I figured the larger medical community would be on the same page if someone did get COVID. It made sense to me to be aggressive about testing staff and residents and quickly getting COVID-positive patients out of the nursing home. So when I heard of the first patient that was positive in the nursing home, my heart sank, but it fell even further when I found out the COVID-positive patient was sent back from the hospital because they weren’t “sick enough” to be admitted.

This is exactly what we do with the general public when they arrive in the ER. If you’re not sick enough, the best place for you to recover from COVID is at home, not the hospital. But treating nursing home patients like everyone else is really not smart. Long term care facilities are not designed with pandemics in mind. They are basically converted dormitories with care staff ratios of 1:10. Isolating patients in these facilities is close to impossible. There are usually no flexible spaces in which to isolate residents, and the staff at these facilities are relatively lower-paid, poorly trained and ill-equipped to suddenly handle a patient with COVID that requires a significantly higher level of care than usual.

This is a recipe for disaster. We were unable to even get the local Department of Health to cohort COVID positive patients in another part of the nursing home because it was a common area that would not have enough privacy. Keeping these patients where they are means the entire nursing home is likely to get infected. Even without the benefit of common sense or imagination, how this story plays out is relatively obvious from the very first outbreak of COVID in the US which took place at a skilled nursing facility in Washington state. In a 130 bed facility, 101 residents, 50 personnel, and 16 visitors were ultimately infected. As of March 26th, 35 residents and staff have died. Double-digit mortality rates. An expected outcome of a virus with a special predilection for the most infirm among us.

There are a number of considerations here, and they are not easy. If your city is in the midst of a massive outbreak, like the New York/NJ metro area was with a total of 11,000 new cases/day at last count, the hospital system simply does not have the capacity to keep patients until they are no longer shedding virus. If the nursing home residents are unwell enough to make attempts at resuscitation not worthwhile, it is certainly best to discuss goals of care with patients or their proxies. Severely ill coronavirus patients who end up on a mechanical ventilator have a poor prognosis even under the best of conditions. It certainly does not make sense to transfer every patient from a nursing home in the throes of an arrest or an impending arrest given the significant issues that relate to the transmissibility of this virus to first responders.

But none of these considerations mean the status quo is the best strategy if it leads to a much bigger problem down the road. The point here is to attempt to intensively isolate and manage initial cases in high resource settings like hospitals so the Health System doesn’t have to deal with the entire nursing home being infected later.

Philadelphia, which so far has seemed to escape the type of surge New York is facing, is now facing an uptick in hospitalizations from nursing homes precisely because of the stay in your home strategy applied to nursing home residents two weeks prior. As an epidemic spreads in the nursing home, staffing concerns become even more and more difficult as caregivers themselves get sick, or require quarantines. The ability of this virus to spread even with minimal symptoms or perhaps no symptoms also means that nursing homes become a significant mode for community transmission as healthcare workers return to their homes every night.

Remarkably, a very different approach in the city has been taken towards the homeless who contract COVID. Recognizing the problems with sending these patients back to homeless shelters, the city contracted with an empty hotel to house patients there. An operation to sort out how to sequester COVID positive nursing home patients in COVID-only facilities is clearly more complicated given the significant staffing needs for this population, but they certainly aren’t insurmountable.

It’s important we get this right because this virus is likely to be with us for some time before a vaccine or herd immunity develops. There is likely to be a second wave to deal with as the country eventually but inevitably starts to open. Clearly the best strategy is one that allows for aggressive surveillance testing of nursing home workers to keep these sites COVID-free. But even with all the testing in the world available, the virus just has to win once. Unless we can rapidly make consequential moves to effectively quarantine residents in nursing homes early on, I fear our most vulnerable will continue to pay a heavy price and we will continue to see larger outbreaks that result in larger, more costly mitigation efforts.

Anish Koka is a cardiologist in Philadelphia. He loves his nursing home residents. He can be found on twitter @anish_koka.

The post COVID-19: The Nursing Home Tragedy appeared first on The Health Care Blog.

COVID-19: The Nursing Home Tragedy published first on https://venabeahan.tumblr.com

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kristinsimmons · 5 years ago

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COVID-19: The Nursing Home Tragedy