City Football Group

The City Football Group (CFG) is a holding company that administers association football clubs. The group is owned by three organisations; of which 78% is majority owned by the Abu Dhabi United Group (ADUG), 10% by the American firm Silver Lake and 12% by Chinese firms China Media Capital and CITIC Capital.
The brainchild of CEO Ferran Soriano, CFG's ambition is to be the "first truly global football organisation". Manchester City F.C. of the English Premier League are widely considered the group's flagship team, while CFG also owns stakes in clubs in the United States, Australia, India, Japan, Spain, Uruguay, China, Belgium and France.
History.
Founded in 2013, City Football Group is the realisation of a business vision by former Barcelona Economy Vice President Ferran Soriano. Soriano first conceived of the ideal of a global football entity while at the Catalan club, beginning with the creation of Barca-branded overseas academies. Soriano contacted Major League Soccer Commissioner Don Garber about creating a Barcelona-branded MLS franchise and the pair progressed as far as looking into several locations to place the team, but ultimately these plans were curtailed when Soriano and seven other members of Barcelona's board chose to resign in protest of then-President Joan Laporta's leadership.
After a four-year break from football management, Soriano was hired in late 2012 to replace Garry Cook as CEO of Manchester City following the latter's resignation. Soriano revived his ambitions of creating a global football business entity, beginning by resuming dialogues with Garber. Their discussions resulted in the announcement of New York City FC as MLS' 20th expansion side less than one year later in May 2013. In the process of managing the creation of a second football team City Football Group was created, designed to be the holding company to which both Manchester City and NYCFC belonged. CFG expanded at the start of 2014 when it partnered with Rugby league side Melbourne Storm to acquire a controlling stake in A-League franchise Melbourne Heart for 12 million Australian dollars. The club would subsequently be rebranded to "Melbourne City FC" and their badge changed as part of CFG's early attempts to synergise their investments with Manchester City as a brand, and the club's colours would slowly be changed to sky blue with their red-and-white stripes retained as away colours.
In the weeks following their purchase of Melbourne City, CFG indicated their intentions of investing in women's football by rebranding Manchester City's female affiliate as "Manchester City Women's Football Club" and successfully lobbied for the team to be added to the top tier of the FA Women's Super League, promising to invest in women's football on a scale never before seen in England. Later the following year CFG would grow again with the purchase of a 20% in Japanese side Yokohama F Marinos, the traditional company team of group sponsor Nissan.
In April 2017, after a near three-year spell pause gap in its expansion, City Football Group announced the Uruguayan second-tier side Club Atletico Torque, who would later be renamed Montevideo City Torque. Several months later Torque would be followed in by Spanish second division club Girona, a club with ownership links to incumbent Manchester City manager Pep Guardiola.
2019 saw the beginning of an increase in CFG's activity. The purchase of Chinese third division club Sichuan Jiuniu was followed towards the end of the year by a second venture in Asia, when the group bought a controlling stake in Indian Super League franchise Mumbai City. 2020 similarly would see two club purchases in European football, first of Lommel of Belgium and then of Troyes of France, with both moves notably seeing the purchased clubs rescued from financial difficulties and linked to the economic damages wrought by the COVID-19 pandemic. In the same year they would also expand their business interests by taking sole control of US-based five-a-side football business Goals Soccer Centers, a business they had previously invested in, following the near-collapse of the company's owners due to an internal scandal.
Principles and interests.
Since its inception, commenters have been drawn parallels between City Football Group and Ferran Soriano's ideas spelled out in his 2011 book "Goal: The Ball Doesn't Go In By Chance", in which Soriano remarked that the natural evolution of club brands was to expand globally, and that doing so could include the creation of franchise clubs in foreign leagues. His book continued to expound upon the notion that appealing to foreign fans who had no strongly-ingrained non-domestic allegiances was an important facet of business growth of sporting brands, and that giving those fans a domestic side to support alongside and affiliated to their European club could encourage more loyalty from them. This idea would be termed "Disneyfication" by Professor Simon Chadwick, an expert in Eurasian sport at Emlyon Business School and himself a confidant of Soriano.
Branding and player development.
Early growth in the group focused on teams sharing a common identity and an associated brand, which aligned with the traditional identity of Manchester City and was viewed as a key way of helping the Manchester club build up its foreign support. This also matched Soriano's well-reported interest in placing City Football Group as a lynchpin in the opening-up of national markets in which association football has not previously been able to secure a strong presence, through the operation of and investment in franchises in those countries.
The first entity to join CFG was the newly created New York City FC, with the club announcing that they would sport the familiar sky blue kit with white shorts which Manchester City have traditionally been associated with, and the rebranded Melbourne City (originally named Melbourne Heart) similarly switched to sky blue after defeating challenges from fellow A-League club Sydney FC. With the purchase of Mumbai City and the renaming of Club Atletico Torque to "Montevideo City Torque", five teams in the group feature the word "City" in their name, and similarly all five wear sky blue kits. NYCFC's circular badge style would also be mimicked by Manchester City, Melbourne City and Torque. Following from these changes it was reported that the company's aim was to own a team on each continent with the "City" brand in its name.
Developments within Manchester City's academy would ultimately lead to a shift in strategy and focus of the group. Efforts to continue their success in bringing through youth talent led to the buying of promising players in the early teenage years, many of whom would go on to be sold for a large profit. This prompted Soriano and CFG's executive management to change their ambitions to put more emphasis on purchasing smaller clubs in strong existing football markets, with the intention of turning them into specialists centres for acquiring and training future stars from their local areas. As a result, the emphasis on clubs sharing kit colours and having discernibly similar badges and names has been reduced. Outside of Manchester, the European clubs within CFG in particular have not seen any change to their identities beyond the use of sky blue as a change strip colour in Girona. Similar is true of Asian clubs Yokohama F. Marinos and Sichuan Jiuniu.
Collaboration between clubs.
One of the core philosophies of City Football Group since its inception has been the mutual supporting of clubs through combined scouting and player sharing. While virtually all large European clubs operate an international scouting network, financial demands make it impossible to access local knowledge in foreign countries to the same extent as a domestic club could. CFG clubs therefore provide invaluable services to each other by using their own local scouting networks to share information on players between clubs. With their combined knowledge, the group advertises that it has extensive information on half a million players around the world. Possessing such a network then allows the local clubs to sign players early in their development, safe in the knowledge that the range of clubs CFG owns means that they can be placed at any of a number of sides as their development continues and the need for other challenges arises. The player-sharing element of the City network was first advertised with the high-profile transfer of Aaron Mooy from Melbourne City to Manchester City - an early case of utilising the network to support revenue generation - with the 2020–21 season seeing Manchester City send 14 foreign-sourced youth players out on loan, predominantly to other group clubs.
In addition to internal player movements, CFG has also sought to foster movements of coaching staff within their network also; among the most notable relocations are French manager Eric Mombaerts, who has worked with Yokohama F. Marinos, Melbourne City and Troyes, Manchester City Women manager Nick Cushing transferring to New York and English coach Liam Manning transferring from the NYCFC academy to take over management of Lommel's first team.
The second of CFG's core philosophies regarding club collaboration is on- and off-pitch technical information sharing. Based around the tactics of Manchester City manager Pep Guardiola - long coveted for the Manchester job by Ferran Soriano and Txiki Begiristain after their experience working with him in Barcelona - all of City Football Group's clubs are given access to extensive databases of Manchester City's tactics and coaching methods, enabling them all to follow the group directive to use the same style of football, a style occasionally referred to as "the City Way". This synergy of tactical style extends beyond the their first teams to the academies and women's sections. In addition to this, the clubs also share other information, such as medical, performance monitoring and player management.
Investment in women's football.
Four of City Football Group's ten clubs sport women's teams, with Montevideo City Torque expected to launch a women's team in 2021 and New York City FC having previously held discussions about an affiliation with Sky Blue FC in 2014. In both Manchester and Melbourne, CFG (re)launched new women's sides in 2014 and 2015, promising to invest in women's football in unprecedent ways. In both cities the women's teams would ultimately be given bespoke facilities which, in contrast to the standard for football clubs, shared training locations with their affiliated men's teams. Similarly, both cities would see returns for their investment, with Manchester City Women repeatedly finishing amongst the top two and winning a series of domestic trophies while Melbourne City's unprecedented investment in Australian women's football - an area which had previously been underfunded and largely forgotten in the country - earned the side plaudits for their forward-thinking and would see their female side crowned Grand Final winners four times in five seasons.
Esports.
Looking to capitalise on the growth of esports and for City Football Group to be seen as always being at the forefront of innovation, CFG made their first venture into digital gaming by signing Kieran ""Kez" Brown to represent Manchester City at FIFA tournaments and fan events as well as to make digital content for their social media profiles, in June 2016.
Today, Manchester City is represented by current ePremier League Champion Shaun 'Shellz' Springette, alongside Ryan Pessoa.
In April 2017, New York City FC signed its first professional FIFA player in Christopher "NYC_Chris" Holly, who became the first FIFA player signed to represent a Major League Soccer club. Similarly, Melbourne City became the first team in the A-League to acquire a professional FIFA player, signing Marcus "marcus_7170"" Gomes in August of the same year.
CFG owned clubs.
Manchester City F.C..
The Abu Dhabi United Group was founded in the summer of 2008, as Sheikh Mansour bin Zayed Al Nahyan looked to take over Manchester City Football Club from the former Prime Minister of Thailand Thaksin Shinawatra. The Abu Dhabi United Group was set up in order to facilitate the purchase of the Premier League club.
After its takeover, Manchester City launched into a complete overhaul of all departments, intent on rising to the top as fast as possible. On the pitch, the following seasons saw the team replaced under the management of Mark Hughes and then a second time under Roberto Mancini as the lobbying of established UEFA Champions League clubs in the Premier League forced the Manchester team to act quickly in order to achieve Champions League status before the newly implemented Financial Fair Play Regulations made it inviable for teams to spend outside of their earnings in an attempt to move up the table. Meanwhile, off the pitch City spent £10 million on revamping their Platt Lane academy base as they formulated plans to produce a £100m training and academy facility on land opposite their stadium, studying training facilities around the world in an attempt to create the world's foremost development in its field. This came in conjunction with the announcement in 2014 that they had received planning permission to increase their stadium capacity to over 62,000, making it the second largest club stadium in England. Further investment came in the field of fan engagement, where City committed themselves to a policy of winning the global popularity contest with a mass display of social media. Since the start of the 2016–17 season, Manchester City have been coached by former FC Barcelona player and coach and FC Bayern Munich coach Pep Guardiola.
Under Mansour's leadership, Manchester City Football Club have currently lifted the 2010–11 FA Cup, 2011–12 Premier League, 2012 FA Community Shield, 2013–14 Football League Cup, 2013–14 Premier League, 2015–16 Football League Cup, 2017–18 EFL Cup, 2017–18 Premier League, 2018 FA Community Shield, 2018–19 EFL Cup, 2018–19 Premier League, 2018–19 FA Cup, 2019 FA Community Shield, and 2019–20 EFL Cup. City's best European result in that timespan was a semi-final in the 2015–16 UEFA Champions League.
Manchester City Women.
Although Manchester City Women had existed since 1988 (previously under the name "Manchester City Ladies F.C.") they existed solely as an affiliate of the club until August 2012, with few shared resources and with CFG enjoying no control over the club's management. After four years of control of the men's side in Manchester, the Abu Dhabi United Group – progenitors of City Football Group – elected to bring the women's team under their aegis also, forming a partnership with the club which would effectively make it a department of Manchester City F.C.
Very soon after taking control of the club, ADUG announced their intention to support their women's department as they had supported the men, relaunching the club as "Manchester City Women's Football Club" and successfully lobbying for the team to be added to the top tier of the FA Women's Super League when it was expanded, fuelled by promises of levels of support and funding not usual in women's football in the UK. Their support was rapidly repaid, with their radically reshaped team producing a first major trophy in the 2014 FA WSL Cup before narrowly missing out on a league triumph the following season.
New York City FC.
When Ferran Soriano was appointed Manchester City CEO in August 2012, Don Garber reached out to him about a New York City FC team, having previously held discussions with him in his former capacity as Vice President of Barcelona. In December 2012, unnamed sources told the media that Manchester City were close to being announced as the new owners of the 20th team of Major League Soccer (MLS), and the brand name "New York City FC" was trademarked, although the club quickly denied the report. Garber announced in March 2013 that he was almost ready to unveil the new expansion team and on 21 May New York City FC was officially announced as the 20th MLS franchise. Linking the club to its English parent, the new MLS side hired as its first employee former Manchester City, MLS and US national team player Claudio Reyna to serve as Director of Football, while a statement of intent was made with the signing of home-grown rising star manager and MLS Cup winner Jason Kreis to serve as the team's first head coach. In 2016, Manchester City's academy manager Patrick Vieira moved to New York City FC to manage NYCFC.
Melbourne City FC.
The group's ownership of the club was announced on 23 January 2014, with the news that Manchester City had acquired the then-named Melbourne Heart for $12 million. After several days of talks in Melbourne and Sydney, City's senior executives completed the deal which saw them own 80% of the Australian club. City Football Group bought the other 20% that was held by a consortium of businessmen allied to Australian rugby league club Melbourne Storm.
The takeover of the Australian A-League club came only days after an application to trademark the name "Melbourne City Football Club" was lodged on 16 January. Melbourne Heart's minority shareholders also registered the business name "Melbourne City FC" with the Australian Securities and Investments Commission (ASIC) and bought the domain name "MelbourneCityFC.com.au". In August 2015, City Football Group bought out the sports consortium to acquire 100% ownership of the club.
Melbourne City Youth.
As part of the expansion of the National Premier Leagues Victoria 1 (now known as NPL Victoria 2), Melbourne City had an application accepted to field a team based around their now-defunct Youth side in the competition along with five additional new entrants. On 6 December 2014 they announced the creation of their NPL team, which began competition in the 2015 season.
Melbourne City Women.
Following the success of their investment in Manchester City's women's team, CFG announced their continued support of women's football with the creation of a women's department in Melbourne in 2015 which was accepted as an expansion team in the W-League.
Facing a league bereft of meaningful investment, CFG's support of their team produced a clean sweep of the board, with their women's team going unbeaten as they won both the league and the play-off series at the first time of asking in the 2015–16 W-League, setting a series of club and player records as they went.
Yokohama F. Marinos.
On 20 May 2014, it was announced that City Football Group had invested in a minority share of Yokohama F. Marinos, creating a partnership with both the football club and car manufacturer Nissan. City Football Group is estimated to hold 20 percent of Yokohama F. Marinos' existing shares, but through the establishment of a Japan-based subsidiary may seek to eventually own a controlling stake in the club.
Montevideo City Torque.
On 5 April 2017, CFG announced that it had acquired Club Atletico Torque, a club in Montevideo currently playing in the Uruguayan Primera División.
Name change and return to the Primera División.
On 22 January 2020 it was announced that Club Atletico Torque had changed their club name to Montevideo City Torque, with an accompanying change in team badge. The name and badge were chosen to be reflective of their links to Manchester City and the other clubs of the City Football Group. At the same time it was announced that the club would begin work on the construction of a new academy and administrative complex, intended to be one of the most advanced academy centres in South America.
Girona.
On 23 August 2017, it was announced that the City Football Group had acquired 44.3% of La Liga side Girona. Another 44.3% was held by the Girona Football Group, led by Pere Guardiola, brother of Manchester City manager Pep Guardiola. Girona had previously been loaned a number of players by Manchester City while they were in the Segunda División, in what was seen by some as an attempt to attract Pep Guardiola to Manchester City. In August 2018, Girona had two loanees, both 21 years old, from Manchester City.
Girona B.
In line with the Spanish standard of major teams operating B-teams as development squads for younger players, Girona owns a subsidiary team named simply "Girona B", following the incorporation in 2011 of the formerly independent side CF Riudellots. At the time of the purchase of Girona by CFG, the club operated in the Segona Catalana division, the sixth level of football in Spain. As an official B-team Girona B is ineligible for promotion to a higher division than any other Girona-affiliated side above them in the leagues. Nor is it eligible to play in any cup competition in which Girona themselves already compete.
Girona additionally operated a primary B-team – CF Peralada-Girona B – although this team was merely in partnership with Girona and neither Girona nor CFG had any ownership stake in the club. In 2019, the affiliation with Peralada was terminated as they were relegated to the Tercera División.
Girona FC Femení A.
Though they had operated a women's side since 2017, Girona Femení A only came into being in 2020, when Girona purchased the women's section of local club Sant Pere Pescador, renaming them to match the club's identity.
Girona FC Femení B.
Although Girona FC operated a senior women's team for a number of years, financial constraints had forced them to cease operations at the senior level in 2013 and by 2017 the Catalan club operated just 3 junior teams with a total of 41 youth players in their system. Barely two months before CFG bought into the ownership of Girona FC, the club announced an expansion of its female set-up, including the restoration of the senior women's team, to start competing in the fifth tier of women's football in Spain.
Sichuan Jiuniu.
On 20 February 2019, it was announced that the City Football Group as well as UBTECH and China Sports Capital had acquired Sichuan Jiuniu F.C..
Mumbai City FC.
City Football Group was announced as majority stakeholder of Mumbai City on Thursday 28 November 2019 after acquiring 65% of the club. Mumbai City FC is a professional football club based in Mumbai, competing in the Indian Super League.
Mumbai City FC Reserves.
Mumbai City FC Reserves were announced to be competing for the first time in the I-League 2nd Division, the third tier of Indian football.
Lommel SK.
City Football Group was announced as majority stakeholder of Lommel SK on Monday 11 May 2020 acquiring the majority (unspecified) of the shares of the club. Lommel S.K. is a professional football club based in Lommel, competing in the Belgian First Division B (second tier).
Troyes AC.
On 3 September 2020, City Football Group announced that they had purchased the shares of the former owner of Ligue 2 club Troyes AC Daniel Masoni, making them the majority shareholder of the Ligue 2 French club.
Troyes AC Reserves.
The development side of Troyes AC, known variously as Troyes AC Reserves and Troyes AC 2, play in Group F (Grand Est) of the Championnat National 3, the fifth tier of the French football league system.
Troyes AC Féminine.
ESTAC Troyes are represented in the women's game by Troyes AC Féminine, a senior side who compete in Grand Est Regional 1 (the third tier of women's football in France), having been denied promotion to Division 2 Féminine by the early closing of the 2019–20 season due to the COVID-19 pandemic.
Future clubs.
When addressed in interviews both internal and external, senior City Football Group personnel have made no secret of their continued plans for the expansion of the group, with group chairman Khaldoon Al Mubarak commenting that "I would say that when the opportunity arises – and we are looking at opportunities – you can expect us to add to the number of clubs we have already within that organisation". Although those personnel will rarely be drawn on the exact locations in which they are looking, it has been commented that CFG aim at the least to have one team on each continent, with links to a potential Chinese team particularly strong following a £265m investment in the group by two Chinese companies, while India has been suggested by Tom Glick, the group's chief commercial officer. City Football Group were courted for investment by John Comitis, owner of Cape Town City F.C. and previous engineer of the working relationship between Ajax and Ajax Cape Town, though CFG themselves did not comment on the link and no such partnership ultimately emerged.
CFG have previously been linked with investment into European sides AS Saint-Étienne, Estoril and Boavista.
It was reported on 13 July 2017 that Ecuadorian Serie A club River Ecuador F.C. had been bought by CFG following the club announcing that they had rebranded as Guayaquil City F.C. No statement of confirmation was issued by CFG themselves, and after several days the main source advocating the link – MKT Esportivo – deleted their article following a wave of journalists denying the link on social media.
Shortly after investing in Chinese club Sichuan Jiuniu, Ferran Soriano admitted in March 2019 that CFG were considering investing in an Indian club by the end of the year, and that it was likely that a further two or three clubs could join the group within the next decade. In the same press conference, however, he also admitted that CFG were not considering any further acquisitions of European clubs as their focus was on long-term investment in countries where football was likely to grow in popularity, such as in India, as opposed to established markets.
On 24 May 2019, it was reported that CFG have expressed an interest to buy a Malaysia Super League club after Ferran Soriano visited Malaysia Sports Minister Syed Saddiq at his office in Putrajaya This was refuted in the following days.
In May 2020, it was reported that CFG also has expressed an interest to buy a Russian Premier League club.
Honours achieved under CFG ownership.
The following senior-level trophies have been won by City Football Group teams while under the ownership and control of the group. Trophies won before inclusion in the City Football Group are not counted in this section:
Table of honours won.
1 Includes lower league titles plus any cups not available to top division clubs, but does not include cups considered non-competitive for statistics purposes (such as pre-season competitions or local FA tournaments habitually contested by reserve sides).<br>
2 Includes titles won while under control of City Football Group personnel, but before the creation of the company itself.<br>
3 Girona were acquired by CFG in 2017 and have operated a women's team for the whole of their time in CFG. However, the Femení A team only came into existence in 2020 when local team FC Sant Pere Pescador sold their women's team to Girona, allowing Girona to operate a women's team at a more professional level.<br>
4 Although MCWFC have been affiliated to Manchester City since their creation in the 1980s, they only came under CFG control when the two clubs merged in 2014.<br>
5 Although the EDS have operated as Manchester City's reserve team for considerably longer than CFG have owned the club, they only began competing in a senior competition in 2017–18 when they were given a place in the EFL Trophy.
Intra-Group matches.
Though City Football Group has existed for a number of years, competing schedules and priorities have limited the number of occasions on which CFG teams have been able to contest matches against each other. The following record lists the games played between CFG teams while both have been under common ownership:
CFG partner clubs.
Club Bolivar.
It was announced on 12 January 2021 that Club Bolivar had become the first "partner" club for the group. Club Bolivar is the most successful Bolivian club having won 29 domestic titles since it was founded in La Paz on 12 April 1925. The owner of the club Marcelo Claure is also part of the ownership group of Inter Miami CF alongside David Beckham as well as being COO of SoftBank Group with Masayoshi Son (CEO of Softbank) as well as Jorge Mas and Jose Mas from MasTec respectively.
Vannes OC.
It was announced on 17 February 2021 that French fourth tier side Vannes had become the latest partner club for the group. The two club were already linked after Vannes' President Maxime Ray had joined CFG to become a minority shareholder in Troyes AC as part of the 2020 purchase, though he agreed to have no operational role at Troyes as part of the takeover.
Businesses.
Goals Soccer Centers.
On 25 July 2017, City Football Group signed a joint venture partnership with Goals Soccer Centres, a 5-a-side football pitch operator, to invest capital into the US operations of the company in order to expand across North America. On 3 February 2020, CFG purchased the remaining 50% to take full ownership of the joint venture – operating under the Americanised name "Goals Soccer Centers" – following the near-collapse of their partner as a result of historic fraud allegations.
Controversies.
Financial Fair Play.
On 7 March 2019, UEFA began an investigation on City Football Group and Manchester City over allegations of Financial Fair Play violations.
In July 2020, CAS (Court of Arbitration for Sport) declared that "Manchester City FC did not disguise equity funding as sponsorship contributions but did fail to cooperate with the UEFA authorities" which meant that City were cleared of funnelling money from their owner, into the club via their sponsors. However, as City failed to comply with UEFAs demands to see every document relating to their finances, they were still fined £10m.


Peter Krukenberg

Peter Krukenberg (14 February 1787 – 13 December 1865) was a German pathologist who was a native of Königslutter. He was son-in-law to anatomist Johann Christian Reil (1759–1813), and grandfather to pathologist Friedrich Ernst Krukenberg (1871-1946) and surgeon Hermann Krukenberg (1863-1935).
He studied at the Collegium Carolinum in Braunschweig and at the Universities of Göttingen and Berlin. In 1814 he became an associate professor of pathology and therapy at the University of Halle, and from 1822 to 1856 was a full professor of pathology and director of the university clinic. In 1816 Krukenberg founded an ambulatory clinic at Halle. Two of his better known assistants were dermatologist Friedrich Wilhelm Felix von Bärensprung (1822-1864) and ophthalmologist Karl Ernst Theodor Schweigger (1830-1905).
Krukenberg was a pioneer of scientific knowledge-based medicine, and was considered one of the leading clinicians of his era. He was responsible for integrating clinical training into the fields of surgery, gynecology, psychiatry, et al., and is credited for helping to establish the University of Halle as a primary center of medical learning in 19th-century Germany.
In 1840, he was elected a foreign member of the Royal Swedish Academy of Sciences. He was author of "Jahrbücher der ambulatorischen Klinik in Halle" (Yearbook of the ambulatory clinic at Halle; 1820–24, 2 volumes).


Janelia Research Campus

Janelia Research Campus is a scientific research campus of the Howard Hughes Medical Institute that opened in October 2006. The campus is located in Loudoun County, Virginia, near the town of Ashburn. It is known for its scientific research and modern architecture. The current Executive Director of the laboratory is Ronald Vale, who is also a vice-president of HHMI. He succeeded Gerald M. Rubin in 2020. The campus was known as "Janelia Farm Research Campus" until 2014.
Research.
Most HHMI-funded research supports investigators working at their home institution. However, some interdisciplinary problems are difficult to address in existing research settings, and Janelia was built as a separate institution to address such problems in neurobiology. As of November 2011, it has 424 employees and room for 150 more.
They specifically address the identification of general principles governing information processing by neuronal circuits, and the development of imaging technologies and computational methods for image analysis. In 2017, it announced a new research area, mechanistic cognitive neuroscience.
There are also several other ongoing projects: high-throughput characterizing of behavioral phenotypes on genetically defined small neural lesions in "Drosophila", the development of large-scale neuroanatomical data for "Drosophila" (at the light and electron microscopy levels), and improving the technology so even larger anatomical projects can be approached in the future. In July 2018, this yielded the first entire full-brain image of "Drosophila" with neuronal resolution.
The center was designed to emulate the unconstrained and collaborative environments at AT&T Bell Laboratories and Cambridge's Laboratory of Molecular Biology. Researchers are on six-year contracts and fully internally funded, independent of traditional research grant funding.
Gerald M. Rubin was the first executive director of Janelia, and saw it from concept through construction to operation. Ronald Vale took over as director in early 2020. There are roughly 50 research laboratories headed by senior researchers including Jennifer Lippincott-Schwartz, Gerry Rubin, Eric Betzig, Karel Svoboda and Barry Dickson. Previous lab heads include Sean Eddy, Tamir Gonen, Lynn Riddiford, James W. Truman, and Robert Tjian.
Campus.
The original Janelia Farm house is listed on the National Register of Historic Places, and the property was purchased by HHMI from the Dutch software maker Baan Companies in December 2000. The campus features a 900-foot (270 m) long, arc-shaped laboratory known as the Landscape Building. The building, designed by Rafael Viñoly, deep at the ground floor, is built into a hill and designed to be the primary research facility. Site and landscape design were completed by Dewberry in 2006 and include over four acres of green roof meadow plantings which blend the building into the surrounding site. Additional landscape enhancements were designed by Lewis Scully Gionet, Inc., and were completed in fall 2008 (and won an Honor Award from the Maryland and Potomac chapters of the American Society of Landscape Architects). This work includes an architectural water feature, expanded path network, and siting of multiple pieces of artwork, as well as comprehensive planting additions constructed by Ruppert Nurseries.
Community involvement.
Together with the Loudoun Academy of Science, HHMI donates approximately $1 million annual support for science education through the Loudoun County Public School District. Janelia also hosts a quarterly public lecture series for the public.


Pulmonary shunt

A pulmonary shunt refers to the passage of deoxygenated blood from the right side of the heart to the left without participation in gas exchange in the pulmonary capillaries. It is a pathological condition that results when the alveoli of the lungs are perfused with blood as normal, but ventilation (the supply of air) fails to supply the perfused region. In other words, the ventilation/perfusion ratio (the ratio of air reaching the alveoli to blood perfusing them) is zero.
A pulmonary shunt often occurs when the alveoli fill with fluid, causing parts of the lung to be unventilated although they are still perfused.
Intrapulmonary shunting is the main cause of hypoxemia (inadequate blood oxygen) in pulmonary edema and conditions such as pneumonia in which the lungs become consolidated. The shunt fraction is the percentage of blood put out by the heart that is not completely oxygenated.
In pathological conditions such as pulmonary contusion, the shunt fraction is significantly greater and even breathing 100% oxygen does not fully oxygenate the blood.
Anatomical shunt.
If every alveolus was perfectly ventilated and all blood from the right ventricle were to pass through fully functional pulmonary capillaries, and there was unimpeded diffusion across the alveolar and capillary membrane, there would be a theoretical maximum blood gas exchange, and the alveolar PO2 and arterial PO2 would be the same. The formula for shunt describes deviation from this ideal.
A normal lung is imperfectly ventilated and perfused, and a small degree of intrapulmonary shunting is normal. Anatomical shunting occurs when blood supply to the lungs via the pulmonary arteries is returned via the pulmonary veins without passing through the pulmonary capillaries, thereby bypassing alveolar gas exchange. Capillary shunting is blood that passes through capillaries of unventilated alveoli or deoxygenated blood flowing directly from pulmonary arterioles to nearby pulmonary veins through anastomoses, bypassing the alveolar capillaries. In addition, some of the smallest cardiac veins drain directly into the left ventricle of the human heart. This drainage of deoxygenated blood straight into the systemic circulation is why the arterial PO2 is normally slightly lower than the alveolar PO2, known as the alveolar–arterial gradient, a useful clinical sign in determining the cause of hypoxia.
Pathophysiology.
While in a pulmonary shunt, the ventilation/perfusion ratio is zero, lung units with a V/Q (where V = ventilation, and Q = perfusion) ratio of less than 0.005 are indistinguishable from shunt from a gas exchange perspective.
Pulmonary shunting is minimized by the normal reflex constriction of pulmonary vasculature to hypoxia. Without this hypoxic pulmonary vasoconstriction, shunt and its hypoxic effects would worsen. For example, when alveoli fill with fluid, they are unable to participate in gas exchange with blood, causing local or regional hypoxia, thus triggering vasoconstriction. This vasoconstriction is triggered by a smooth muscle reflex, as a consequence of the low oxygen concentration itself. Blood is then redirected away from this area, which poorly matches ventilation and perfusion, to areas which are being ventilated.
Because shunt represents areas where gas exchange does not occur, 100% inspired oxygen is unable to overcome the hypoxia caused by shunting. For instance, if there is a certain alveolus that is not being ventilated, blood will still flow through the capillary which irrigates it instead of going elsewhere, as the problem does not reside in the perfusion. The rest of capillaries will be working as normal, being saturated of oxygen at the 100% of their capacity. Therefore, there is no use in providing 100% inspired oxygen to the patient, as the blood that is not being oxygenated will not still be able to catch this oxygen, and the other capillaries cannot get it either because they are already 100% saturated.
A decrease in perfusion relative to ventilation (as occurs in pulmonary embolism, for example) is an example of increased dead space. Dead space is a space where gas exchange does not take place, such as the trachea; it is ventilation without perfusion.A pathological example of dead zone would be a capillary blocked by an embolus. Although ventilation at that area is unaffected, blood will not be able to flow through that capillary; therefore, at that zone there will be no gas exchange. Dead zones may be corrected by supplying 100% inspired oxygen; when a capillary is blocked, the blood inside of it goes backwards and distributes between other capillaries that are exchanging gases without problem. The resulting blood that flows through them will not be 100% saturated, as it contains some unoxygenated blood (the one that came from the blocked capillary). For this reason, blood will actually be able to obtain the extra oxygen we supply to the patient.
Pulmonary shunting causes the blood supply leaving a shunted area of the lung to have lower levels of oxygen and higher levels of carbon dioxide (i.e., the normal gas exchange does not occur).
A pulmonary shunt occurs as a result of blood flowing right-to-left through cardiac openings or in pulmonary arteriovenous malformations. The shunt which means V/Q = 0 for that particular part of the lung field under consideration results in de-oxygenated blood going to the heart from the lungs via the pulmonary veins.
If giving pure oxygen at 100% for five-ten minutes doesn't raise the arterial pressure of O2 more than it does the alveolar pressure of O2 then the defect in the lung is because of a pulmonary shunt. This is because although the PO2 of alveolar gas has been changed by giving pure supplemental O2, the PaO2 (arterial gas pressure) will not increase that much because the V/Q mismatch still exists and it will still add some de-oxygenated blood to the arterial system via the shunt.


Brian Keighley

Brian Douglas Keighley (21 May 1948 – 9 November 2015) was a Scottish medical doctor who worked as a general practitioner (GP) and was the chair of the Scottish Council of the British Medical Association (BMA) from 2009 to December 2014.
Early life.
Keighley was born in 1948 and grew up in Bishopbriggs. His childhood holidays were spent on Inchmurrin, an island in Loch Lomond. He was educated at the Glasgow Academy, then studied at the University of Glasgow graduating with a medical degree in 1972.
Career.
In 1974, as a GP trainee, he joined a medical practice in Balfron, Stirlingshire. He became a partner at the practice the following year, then a trainer in 1978. He retired from clinical practice in November 2013.
He was a member of representative bodies throughout his clinical career. He was an elected member of the Council of the General Medical Council (GMC) 1994−2008.
From 1997 to 2000 Keighley was Chairman of the Joint Committee on Postgraduate Training for General Practice (JCPTGP)- the organisation that regulated GP training in the UK. In 1998 amendments were introduced that he described as ”stiletto powers”, allowing remedial action at the correct level.
He was chair of the Scottish General Practitioners Committee (SGPC) 1995−1998. He was deputy chair of BMA’s Scottish council from July 2007, then elected as chair in August 2009. During his time in these positions he faced issues such as public sector pension reform and NHS contractual change. As the outgoing chair in 2014, Keighley delivered a speech to the BMA’s annual conference in which he directly confronted the issue of the level of taxation needed for adequate healthcare; this generated much comment from politicians.
He was a champion of minimum pricing for alcohol.
He was member of the council of the Royal College of General Practitioners (RCGP) from 2000−2008. In 2010 he became the first chair of the RCGP’s Audit Committee.
In 1997 he published a book "Guide to Postgraduate Medical Education" with Stuart Murray.
Honours and awards.
He became a Fellow of the Royal College of General Practitioners (FRCGP) in 1990, then became a Fellow of the Royal College of Physicians of Edinburgh (FRCPEd) in 2015.
In 2006, the BMA awarded Keighley their Association medal.
He received a MBE in the 2015 New Year Honours for services to healthcare.
Personal life.
His first marriage was to Ruth Maguire and they had two sons together. After this was dissolved, his second marriage was to Lesley Stirling Away from medicine and politics, he enjoyed angling.


Allergic inflammation

Allergic inflammation is an important pathophysiological feature of several disabilities or medical conditions including allergic asthma, atopic dermatitis, allergic rhinitis and several ocular allergic diseases. Allergic reactions may generally be divided into two components; the early phase reaction, and the late phase reaction. While the contribution to the development of symptoms from each of the phases varies greatly between diseases, both are usually present and provide us a framework for understanding allergic disease.
The early phase of the allergic reaction typically occurs within minutes, or even seconds, following allergen exposure and is also commonly referred to as the immediate allergic reaction or as a Type I allergic reaction. The reaction is caused by the release of histamine and mast cell granule proteins by a process called degranulation, as well as the production of leukotrienes, prostaglandins and cytokines, by mast cells following the cross-linking of allergen specific IgE molecules bound to mast cell FcεRI receptors. These mediators affect nerve cells causing itching, smooth muscle cells causing contraction (leading to the airway narrowing seen in allergic asthma), goblet cells causing mucus production, and endothelial cells causing vasodilatation and edema.
The late phase of a Type 1 reaction (which develops 8–12 hours and is mediated by mast cells) should not be confused with delayed hypersensitivity Type IV allergic reaction (which takes 48–72 hours to develop and is mediated by T cells). The products of the early phase reaction include chemokines and molecules that act on endothelial cells and cause them to express Intercellular adhesion molecule (such as vascular cell adhesion molecule and selectins), which together result in the recruitment and activation of leukocytes from the blood into the site of the allergic reaction. Typically, the infiltrating cells observed in allergic reactions contain a high proportion of lymphocytes, and especially, of eosinophils. The recruited eosinophils will degranulate releasing a number of cytotoxic molecules (including Major Basic Protein and eosinophil peroxidase) as well as produce a number of cytokines such as IL-5. The recruited T-cells are typically of the Th2 variety and the cytokines they produce lead to further recruitment of mast cells and eosinophils, and in plasma cell isotype switching to IgE which will bind to the mast cell FcεRI receptors and prime the individual for further allergic responses.


Lack of Moral Fibre

Lack of Moral Fibre or LMF was a punitive designation used by the Royal Air Force during the Second World War to stigmatize aircrew who refused to fly operations.
By early 1940, RAF commanders were concerned about mounting psychological casualties in Bomber Command and Coastal Command.
A letter circulated to commands on 22 April 1940 recommended that squadron commanders identify men who had forfeited their confidence, distinguishing medical cases from those "lacking moral fibre".
By the summer of 1940, senior commanders became concerned that medical officers were removing too many men from flying duty.
More detailed guidance was given in the "Memorandum on the Disposal of Members of Air Crews Who Forfeit the Confidence of Their Commanding Officers" S.61141/S.7.C(1) issued on 28 September 1940, signed by Charles Evans, Principal Assistant Secretary for Personnel in the Air Ministry. This "LMF memorandum" was revised in 19 September 1941, 3 February 1943 and 1 March 1945.
Under this procedure, aircrew refusing to fly operations were to be classified as (i) medically fit, (ii) medically unfit on nervous grounds (introduced in the 1941 revision) or (iii) medically unfit for other reasons.
Aircrew would not be placed in the first two categories if they had been subject to "exceptional flying stress", and to be assigned to category (i), they "had to be proved to be lacking in moral fibre". From February 1943, aircrew on their second tour (30 operations in Bomber Command) could not be classified LMF, though commanders were urged not to publicize this provision.
According to Wing Commander James Lawson, the Air Ministry officer who handled all cases under the "Memorandum", 746 officers and 3,313 non-commissioned officers were referred. Of these, 2,726 cases (including 2,337 NCOs) were classified as LMF.
A man classified in categories (i) or (ii) would lose his flying badge, "to prevent his getting a lucrative job as a pilot in civil life".
The service records of those classified LMF were stamped with large red "W" (for "waverer").
Officers would lose their commissions and be refused ground jobs in the RAF, while NCOs would be reduced to aircraftman second class and assigned menial tasks, such as latrine duty, for at least three months.
From 1944, men released as LMF could be called for the coal mines or drafted into the army.
Contemporary opinion of the system was divided.
Though severe, it was less harsh than a court martial.
Senior commanders such as Air Vice-Marshals Keith Park (11 Group) and Arthur Harris (5 Group and later Bomber Command) considered it essential.
Squadron commanders such as Leonard Cheshire viewed it as justified in a desperate situation.
RAF psychiatrists, while acknowledging the deterrent effect, considered it harsh and deficient in failing to take account of individual situations.
Many Commonwealth countries resented the application of this procedure to their personnel scattered throughout the RAF.
Canadian Air-Vice Marshal Harold Edwards was particularly critical.
As the end of the war approached, the LMF procedure became politically sensitive, and was officially dropped in 1945.
However, the term remained in popular use in the RAF until the 1960s. Veterans continue to discuss lack of moral fibre as part of a victim narrative.
References.
Works cited


List of medical schools in South Africa


Evidence-Based Nursing (journal)

Evidence-Based Nursing is a peer-reviewed healthcare journal covering the field of evidence-based nursing. It is published quarterly by the BMJ Publishing Group and RCN Publishing. It is abstracted and indexed by Index Medicus (MEDLINE), Scopus and Excerpta Medica/EMBASE.
The journal performs systematically searches of nursing and medical journals. The selection of content is determined upon the validity and relevance related to nursing science. Submissions are not accepted and are only commissioned.


Immunoproliferative disorder

Immunoproliferative disorders, are disorders of the immune system that are characterized by the abnormal proliferation of the primary cells of the immune system, which includes B cells, T cells and natural killer (NK) cells, or by the excessive production of immunoglobulins (also known as antibodies).
Classes.
These disorders are subdivided into three main classes, which are lymphoproliferative disorders, hypergammaglobulinemia, and paraproteinemia. The first is cellular, and the other two are humoral (however, humoral excess can be secondary to cellular excess.)


Bronchopulmonary dysplasia

Bronchopulmonary dysplasia (BPD; part of the spectrum of chronic lung disease of infancy) is a chronic lung disease in which premature infants, usually those who were treated with supplemental oxygen, require long-term oxygen. The alveoli that are present tend to not be mature enough to function normally. It is more common in infants with low birth weight (LBW) and those who receive prolonged mechanical ventilation to treat respiratory distress syndrome (RDS). It results in significant morbidity and mortality. The definition of BPD has continued to evolve primarily due to changes in the population, such as more survivors at earlier gestational ages, and improved neonatal management including surfactant, antenatal glucocorticoid therapy, and less aggressive mechanical ventilation.
Currently the description of BPD includes the grading of its severity into mild, moderate and severe. This correlates with the infant's maturity, growth and overall severity of illness. The new system offers a better description of underlying pulmonary disease and its severity.
Presentation.
Complications.
Feeding problems are common in infants with BPD, often due to prolonged intubation. Such infants often display oral-tactile hypersensitivity (also known as oral aversion).
Physical findings:
Cause.
Prolonged high oxygen delivery in premature infants causes necrotizing bronchiolitis and alveolar septal injury, with inflammation and scarring. This results in hypoxemia. Today, with the advent of surfactant therapy and high frequency ventilation and oxygen supplementation, infants with BPD experience much milder injury without necrotizing bronchiolitis or alveolar septal fibrosis. Instead, there are usually uniformly dilated acini with thin alveolar septa and little or no interstitial fibrosis. It develops most commonly in the first 4 weeks after birth.
Diagnosis.
Earlier criteria.
The classic diagnosis of BPD may be assigned at 28 days of life if the following criteria are met:
Newer criteria.
The newer National Institute of Health (US) criteria for BPD (for neonates treated with more than 21% oxygen for at least 28 days) is as follows:,
Management.
Infants with bronchopulmonary dysplasia are often treated with diuretics that decrease fluid in the alveoli where gas exchange occurs and bronchodilators that relax the airway muscles to facilitate breathing. Viral immunization is also important for these children who have a higher risk of infections in the respiratory tract.
There is evidence to show that steroids given to babies less than 8 days old can prevent bronchopulmonary dysplasia. However, the risks of neurodevelopmental sequelae may outweigh the benefits. It is unclear if starting steroids more than 7 days after birth is harmful or beneficial. It is thus recommended that they only be used in those who cannot be taken off of a ventilator. Evidence suggests that vitamin A in LBW babies is associated with a reduction in mortality and bronchopulmonary dysplasia.Oxygen therapy at home is recommended in those with significant low oxygen levels.
Hypercarbia (too much carbon dioxide in the blood) may contribute to the development of bronchopulmonary dysplasia. Monitoring the level of carbon dioxide in neonatal infants to ensure that the level is not too high or too low (hypocarbia) is important for improving outcomes for neonates in intensive care. Carbon dioxide can be monitored by taking a blood sample (arterial blood gas), through the breath (exhalation), and it can be measured continuously through the skin by using a minimally invasive transcutaneous device. The most effective and safest approach for measuring carbon dioxide in newborn infants is not clear.
Epidemiology.
The rate of BPD varies among institutions, which may reflect neonatal risk factors, care practices (e.g., target levels for acceptable oxygen saturation), and differences in the clinical definitions of BPD.


Charles Hastings (Canadian physician)

Charles John Colwell Orr Hastings (23 August 1858 in Markham Township, Canada – 17 January 1931 in Toronto) was an obstetrician and public health pioneer.
Biography.
Dr. Hastings lost his daughter to typhoid because of contaminated milk. At that time, Toronto also had no sewage treatment, and used unchlorinated water from Lake Ontario. In middle age, Hastings switched from a normal career in obstetrics to an outstanding one in public health.
As Toronto's Medical Officer of Health (1910–29) Hastings crusaded to make Toronto the first city in Canada to pasteurize milk. He introduced a safe water supply, eliminated privies, helped establish the public-health nursing system, medical and dental inspection in public schools, neighborhood baby clinics, childhood immunizations, and health inspections for homes and restaurants. The improvements lowered Toronto's death rate from communicable diseases from 15.3 per 1000 in 1909 to 10.3 per 1000 in 1925. Hastings became president of the Canadian Public Health Association in 1916 and the American Public Health Association in 1918.


Gordon MacRae

Albert Gordon MacRae (March 12, 1921 – January 24, 1986) was an American actor, singer and radio/television host who appeared in the film versions of two Rodgers and Hammerstein musicals "Oklahoma!" (1955) and "Carousel" (1956) and who played the leading man of Doris Day in "On Moonlight Bay" (1951) and sequel "By The Light of the Silvery Moon" (1953).
Early life.
Born in East Orange in Essex County in northeastern New Jersey, United States, to Scottish parents, MacRae graduated in 1940 from Deerfield Academy in Deerfield, Massachusetts, and he thereafter served as a navigator in IX Troop Carrier Command in the United States Army Air Forces during World War II. Before this, he attended Nottingham High School in Syracuse, New York. Gordon was descended from the Clan MacRae.
Career.
Singer.
Winning a contest enabled MacRae to sing at the 1939 New York World's Fair with the Harry James and Les Brown orchestras.
Broadway.
He made his Broadway debut in 1942, acquiring his first recording contract soon afterwards. Many of his hit recordings were made with Jo Stafford.
He was a replacement performer on "Junior Miss".
Radio.
On radio in 1945, his talents were showcased on the "Gordon MacRae Show" on the CBS network in collaboration with the conductor Archie Bleyer. The show featured emerging musical talent, including the accordionist John Serry Sr.. MacRae was also the host and lead actor on "The Railroad Hour", a half-hour anthology series made up of condensed versions of hit Broadway musicals. The programs were later released as popular studio cast albums, most of which have been reissued on CD.
In 1946, he was in the revue "Three to Make Ready", which ran for 326 performances.
Movie star.
MacRae signed a contract with Warner Bros in 1947. In 1948, he appeared in his first film, "The Big Punch", a drama about boxing. He followed this with a film noir with Virginia Mayo, "Backfire" (made in 1948, released 1950).
MacRae's first on-screen musical was "Look for the Silver Lining" (1949), a biopic of Marilyn Miller (June Haver), where MacRae played Frank Carter. David Butler directed. MacRae was reunited with Haver and Butler in "The Daughter of Rosie O'Grady" (1950). Warners put him in a Western, "Return of the Frontiersman" (1950). Then he starred with Doris Day in "Tea for Two" (1950), a reworking of "No, No, Nanette", also for Butler. Public response was enthusiastic. MacRae and Day were teamed again in "The West Point Story" (1951) starring James Cagney and Mayo, "On Moonlight Bay" (1951), and the all-star Korean War tribute, "Starlift" (1951).
MacRae was in a military school musical, "About Face" (1952) with Eddie Bracken, then he and Day did a sequel to "On Moonlight Bay", "By the Light of the Silvery Moon" (1953). That same year, he starred opposite Kathryn Grayson in the third film version of "The Desert Song" and teamed with Jane Powell in "Three Sailors and a Girl" (1953). MacRae's best known film role was Curly in the big screen adaptation of "Oklahoma!" (1955) alongside Shirley Jones. He and Jones were used on another Rodgers and Hammerstein adaptation, "Carousel" (1956), at 20th Century Fox. MacRae played Buddy De Sylva in "The Best Things in Life Are Free" (1956) for 20th Century-Fox.
Television.
MacRae appeared frequently on television, on such variety programs as "The Ford Show, Starring Tennessee Ernie Ford".
He also appeared on drama shows such as "Lux Video Theatre".
During Christmas 1958, MacRae and Ford performed the Christmas hymn "O Holy Night". Earlier in 1958, MacRae guest-starred on the short-lived NBC variety series "The Polly Bergen Show".
He starred in the TV musical "The Gift of the Magi" (1958). Thereafter, MacRae appeared on "The Ed Sullivan Show", "The Dinah Shore Chevy Show", "The Pat Boone Chevy Showroom", and "The Bell Telephone Hour".
Stage.
He continued his musical stage career, often performing with his wife, as in a 1964 production of "Bells Are Ringing", also performing as Sky Masterson in the popular musical "Guys and Dolls", with his wife playing the role of Miss Adeleide, reprising her Broadway role at the Gammage Memorial Auditorium in Tempe, Arizona.
In the late 1960s, he co-hosted for a week on "The Mike Douglas Show". He also toured in summer stock and appeared in nightclubs.
In 1967, he replaced Robert Preston in the original Broadway run of the musical "I Do! I Do!", starring opposite Carol Lawrence, who had taken over the role from Mary Martin.
Later career.
MacRae guest starred on "McCloud". He had supporting roles in the films "Zero to Sixty" (1978) and "The Pilot" (1980).
Personal life.
He was married to Sheila MacRae from 1941 until 1967; the couple were the parents of four children: actresses Heather and Meredith MacRae, and sons William Gordon MacRae and Robert Bruce MacRae. Sheila divorced Gordon in order to marry producer Ronald Wayne.
MacRae’s second marriage was to Elizabeth Lambert Schrafft on September 25, 1967, and together they had one daughter, Amanda Mercedes MacRae born in 1968. They remained married until his death. He battled alcohol problems for many years, but overcame them by the late 1970s.
Death.
MacRae suffered from cancer of the mouth and jaw. He died in 1986 of pneumonia, at his home in Lincoln, Nebraska, aged 64. He was buried at the Wyuka Cemetery in Lincoln, Nebraska.
Radio.
MacRae replaced Frank Sinatra on a radio program in 1943, but he soon had to leave for military service. In 1946, he was the "singing emcee" of "The Teentimers Club", a Saturday morning program. From 1945 to 1948 he also hosted and performed on "The Gordon MacRae Show" for the CBS radio network.
He also appeared in programs as shown in the table below.
Discography.
This is Gordon Macrae Capitol Records


Quadrate bone

The quadrate bone is a skull bone in most tetrapods, including amphibians, sauropsids (reptiles, birds), and early synapsids.
In most tetrapods, the quadrate bone connects to the quadratojugal and squamosal bones in the skull, and forms upper part of the jaw joint. The lower jaw articulates at the articular bone, located at the rear end of the lower jaw. The quadrate bone forms the lower jaw articulation in all classes except mammals.
Evolutionarily, it is derived from the hindmost part of the primitive cartilaginous upper jaw.
Function in reptiles.
In certain extinct reptiles, the variation and stability of the morphology of the quadrate bone has help paleontologists in the species-level taxonomy and identification of mosasaur squamates and spinosaurine dinosaurs.
In some lizards and dinosaurs, the quadrate is articulated at both ends and movable. In snakes, the quadrate bone has become elongated and very mobile, and contributes greatly to their ability to swallow very large prey items.
Function in mammals.
In mammals, the articular and quadrate bones have migrated to the middle ear and are known as the malleus and incus. Along with the stapes, these are known as the ossicles and are a defining characteristic of mammals.
Development.
In pig embryos, the mandible ossifies on the side of Meckel's cartilage, while the posterior part of that cartilage is ossified into the incus. In later development, this portion detaches from the rest of the cartilage and migrates into the middle ear.


George William Balfour

George William Balfour FRSE (2 June 1823 – 9 August 1903) was a Scottish physician, known as a heart specialist.
Life.
Born at the manse of Sorn, Ayrshire, on 2 June 1823, he was sixth son and eighth of the thirteen children of Rev Lewis Balfour DD (1777-1860), by his wife Henrietta Scott, third daughter of George Smith, D.D., minister of Galston; James Balfour was a brother, Thomas Stevenson was a brother-in-law, and Robert Louis Stevenson was a nephew. After education at Colinton, he planned first to study veterinary science and settle in Australia; but entered the Medical School of Edinburgh. In 1845 he graduated M.D. at the University of St. Andrews, and was licensed by the Royal College of Surgeons of Edinburgh.
After acting as house surgeon to the Edinburgh Royal Maternity Hospital, Balfour in 1846 went to Vienna, where he studied under Joseph Škoda, Carl Ludwig Sigmund, and Wilhelm Fleischmann the homeopath.
Balfour was a general practitioner in Midlothian from 1846 till 1857, when he returned to Edinburgh, and practised as a physician on becoming F.R.C.P. Edinburgh in 1861. In 1866 he was appointed physician to the Royal Hospital for Sick Children, and from 1867 he was physician to the Royal Infirmary, being appointed consulting physician in 1882, on the expiry of his term of office. During this time he was a lecturer in medicine at the Edinburgh Extramural School of Medicine.
Balfour specialised in diseases of the heart and circulation, and became a leading figure of his time in this area together with Sir William Tennant Gairdner in Glasgow, and Charles Hilton Fagge in London. He was librarian to the College of Physicians of Edinburgh from 1873 to 1882 and from 1887 to 1899. He was president of the college 1882-4, and was a member of the University Court of St. Andrews for many years. He received the honorary degree of LL.D. at Edinburgh in 1884, and at St. Andrews in 1896. He was appointed physician in ordinary to Queen Victoria in 1900 and honorary physician to King Edward VII in 1901.
In 1899 Balfour retired from the town centre of Edinburgh to live in Colinton, on the south-west outskirts of the city, where he died on 9 August 1903. He is buried in the Balfour vault on the north side of Colinton Parish Church. His obituary was written by his colleague James Ormiston Affleck.
Works.
On his return from Austria, in 1846, Balfour published papers on "The Treatment of Pneumonia as practised by Skoda"; "Necrosis of the Jaw induced by Phosphorus as taught by Sigmund"; and "The Homœopathic Treatment of Acute Diseases by Fleischmann". For the New Sydenham Society he translated (1861-5) the "Hand-book of the Practice of Forensic Medicine", by Johann Ludwig Casper. In 1865 he published "An Introduction to the Study of Medicine".
In 1868, following a suggestion of his father-in-law, Dr. James Craig of Ratho, he wrote two papers on "The Treatment of Aneurysm by Iodide of Potassium". His standing as a cardiologist rested on "Clinical Lectures on Diseases of the Heart and Aorta" (1876) and "The Senile Heart" (1894).
Family.
Balfour married three times:
Notes.
Attribution


J. M. Pahwa

Jagdish Mitra Pahwa was an Indian ophthalmologist, social worker and a specialist in Retinal Detachment and Photocoagulation who was reported to have conducted several charitable eye camps in India. Born on 4 July 1922 in Multan in the erstwhile British India (now in Pakistan), he graduated in medicine from the King Edward Medical University, Lahore. He was a 1969 elected fellow of the National Academy of Medical Sciences and a recipient of the NAB Rustom Merwanji Alpaiwalla Memorial Award from the National Association for the Blind (India) in 1944. The Government of India awarded him the fourth highest Indian civilian award of Padma Shri in 1973.


Pulmonology

Pulmonology (, , from Latin "pulmō, -ōnis" "lung" and the Greek suffix "study of") or pneumology (, built on Greek πνεύμων "lung") is a medical specialty that deals with diseases involving the respiratory tract. It is also known as respirology, respiratory medicine, or chest medicine in some countries and areas.
Pulmonology is considered a branch of internal medicine, and is related to intensive care medicine. Pulmonology often involves managing patients who need life support and mechanical ventilation. Pulmonologists are specially trained in diseases and conditions of the chest, particularly pneumonia, asthma, tuberculosis, emphysema, and complicated chest infections.
History of pulmonology.
One of the first major discoveries relevant to the field of pulmonology was the discovery of pulmonary circulation. Originally, it was thought that blood reaching the right side of the heart passed through small 'pores' in the septum into the left side to be oxygenated, as theorized by Galen; however, the discovery of pulmonary circulation disproves this theory, which had previously been accepted since the 2nd century. Thirteenth-century anatomist and physiologist Ibn Al-Nafis accurately theorized that there was no 'direct' passage between the two sides (ventricles) of the heart. He believed that the blood must have passed through the pulmonary artery, through the lungs, and back into the heart to be pumped around the body. This is believed by many to be the first scientific description of pulmonary circulation.
Although pulmonary medicine only began to evolve as a medical specialty in the 1950s, William Welch and William Osler founded the 'parent' organization of the American Thoracic Society, the National Association for the Study and Prevention of Tuberculosis. The care, treatment, and study of tuberculosis of the lung is recognised as a discipline in its own right, phthisiology. When the specialty did begin to evolve, several discoveries were being made linking the respiratory system and the measurement of arterial blood gases, attracting more and more physicians and researchers to the developing field.
Pulmonology and its relevance in other medical fields.
Surgery of the respiratory tract is generally performed by specialists in cardiothoracic surgery (or thoracic surgery), though minor procedures may be performed by pulmonologists. Pulmonology is closely related to critical care medicine when dealing with patients who require mechanical ventilation. As a result, many pulmonologists are certified to practice critical care medicine in addition to pulmonary medicine. There are fellowship programs that allow physicians to become board certified in pulmonary and critical care medicine simultaneously. Interventional pulmonology is a relatively new field within pulmonary medicine that deals with the use of procedures such as bronchoscopy and pleuroscopy to treat several pulmonary diseases. Interventional pulmonology is increasingly recognized as a specific medical specialty.
Diagnosis.
The pulmonologist begins the diagnostic process with a general review focusing on:
Physical diagnostics are as important as in other fields of medicine.
As many heart diseases can give pulmonary signs, a thorough cardiac investigation is usually included.
Procedures.
Clinical procedures.
Pulmonary clinical procedures include the following pulmonary tests and procedures:
Surgical procedures.
Major surgical procedures on the heart and lungs are performed by a thoracic surgeon. Pulmonologists often perform specialized procedures to get samples from the inside of the chest or inside of the lung. They use radiographic techniques to view vasculature of the lungs and heart to assist with diagnosis.
Treatment and therapeutics.
Medication is the most important treatment of most diseases of pulmonology, either by inhalation (bronchodilators and steroids) or in oral form (antibiotics, leukotriene antagonists). A common example being the usage of inhalers in the treatment of inflammatory lung conditions such as asthma or chronic obstructive pulmonary disease. Oxygen therapy is often necessary in severe respiratory disease (emphysema and pulmonary fibrosis). When this is insufficient, the patient might require mechanical ventilation.
Pulmonary rehabilitation has been defined as a multidimensional continuum of services directed to persons with pulmonary disease and their families, usually by an interdisciplinary team of specialists, with the goal of achieving and maintaining the individual's maximum level of independence and functioning in the community. Pulmonary rehabilitation is intended to educate the patient, the family, and improve the overall quality of life and prognosis for the patient. Interventions can include exercise, education, emotional support, oxygen, noninvasive mechanical ventilation, optimization of airway secretion clearance, promoting compliance with medical care to reduce numbers of exacerbations and hospitalizations, and returning to work and/or a more active and emotionally satisfying life. These goals are appropriate for any patients with diminished respiratory reserve whether due to obstructive or intrinsic pulmonary diseases (oxygenation impairment) or neuromuscular weakness (ventilatory impairment). A pulmonary rehabilitation team may include a rehabilitation physician, a pulmonary medicine specialist, physician assistant and allied health professionals including a rehabilitation nurse, a respiratory therapist, a physical therapist, an occupational therapist, a psychologist, and a social worker among others. Additionally, breathing games are used to motivate children to perform pulmonary rehabilitation.
Education and training.
Pulmonologist.
In the United States, pulmonologists are physicians who, after receiving a medical degree (MD or DO), complete residency training in internal medicine, followed by at least two additional years of subspeciality fellowship training in pulmonology. After satisfactorily completing a fellowship in pulmonary medicine, the physician is permitted to take the board certification examination in pulmonary medicine. After passing this exam, the physician is then board certified as a pulmonologist. Most pulmonologists complete three years of combined subspecialty fellowship training in pulmonary medicine and critical care medicine.
Pediatric pulmonologist.
In the United States, pediatric pulmonologists are physicians who, after receiving a medical degree (MD or DO), complete residency training in pediatrics, followed by at least three additional years of subspeciality fellowship training in pulmonology.
Pulmonology Physician Assistant.
Physician Assistants commonly work in collaboration with physicians in the field of pulmonology.
Scientific research.
Pulmonologists are involved in both clinical and basic research of the respiratory system, ranging from the anatomy of the respiratory epithelium to the most effective treatment of pulmonary hypertension. Scientific research also takes place to look for causes and possible treatment in diseases such as pulmonary tuberculosis and lung cancer.


Hypoxic pulmonary vasoconstriction

Hypoxic pulmonary vasoconstriction (HPV), also known as the Euler-Liljestrand mechanism, is a physiological phenomenon in which small pulmonary arteries constrict in the presence of alveolar hypoxia (low oxygen levels). By redirecting blood flow from poorly-ventilated lung regions to well-ventilated lung regions, HPV is thought to be the primary mechanism underlying ventilation/perfusion matching. The process might initially seem counterintuitive, as "low" oxygen levels might theoretically stimulate "increased" blood flow to the lungs to increase gas exchange. However, the purpose of HPV is to distribute bloodflow "regionally" to increase the overall efficiency of gas exchange between air and blood. While the maintenance of ventilation/perfusion ratio during "regional" obstruction of airflow is beneficial, HPV can be detrimental during "global" alveolar hypoxia which occurs with exposure to high altitude, where HPV causes a significant increase in total pulmonary vascular resistance, and pulmonary arterial pressure, potentially leading to pulmonary hypertension and pulmonary edema. Several factors inhibit HPV including increased cardiac output, hypocapnia, hypothermia, acidosis/alkalosis, increased pulmonary vascular resistance, inhaled anesthetics, calcium channel blockers, positive end-expiratory pressure (PEEP), high-frequency ventilation (HFV), isoproterenol, nitric oxide, and vasodilators.
Molecular mechanism.
The classical explanation of HPV involves inhibition of hypoxia-sensitive voltage-gated potassium channels in pulmonary artery smooth muscle cells leading to depolarization. This depolarization activates voltage-dependent calcium channels, which increases intracellular calcium and activates smooth muscle contractile machinery which in turn causes vasoconstriction. However, later studies have reported additional ion channels and mechanisms that contribute to HPV, such as transient receptor potential canonical 6 (TRPC6) channels, and transient receptor potential vanilloid 4 (TRPV4) channels. Recently it was proposed that hypoxia is sensed at the alveolar/capillary level, generating an electrical signal that is transduced to pulmonary arterioles through gap junctions in the pulmonary endothelium to cause HPV. This contrasts with the classical explanation of HPV which presumes that hypoxia is sensed at the pulmonary artery smooth muscle cell itself.
High altitude pulmonary edema.
High-altitude mountaineering can induce pulmonary hypoxia due to decreased atmospheric pressure. This hypoxia causes vasoconstriction that ultimately leads to high altitude pulmonary edema (HAPE). For this reason, some climbers carry supplemental oxygen to prevent hypoxia, edema, and HAPE. The standard drug treatment of dexamethasone does not alter the hypoxia or the consequent vasoconstriction, but stimulates fluid reabsorption in the lungs to reverse the edema. Additionally, several studies on native populations remaining at high altitudes have demonstrated to varying degrees the blunting of the HPV response.


Congenital constriction bands


Spire Healthcare

Spire Healthcare plc is the second largest provider of private healthcare in the United Kingdom. It is listed on the London Stock Exchange.
History.
Spire Healthcare was formed from the sale of Bupa Hospitals to Cinven in 2007, followed by the purchase of Classic Hospitals and Thames Valley Hospital in 2008. It was the subject of an initial public offering in July 2014.
Facilities.
Spire Healthcare operates a network of 38 private hospitals and ten clinics across the UK, as well as the London Fertility Centre.
Ian Paterson.
Ian Paterson, a breast surgeon who worked at Bupa hospitals in Solihull and Sutton Coldfield, latterly run by Spire Healthcare, was convicted of 17 counts of wounding with intent to cause grievous bodily harm and three counts of unlawful wounding in respect of 10 patients. 350 patients who had been treated privately at Spire clinics are pursuing civil action against him and against the company. According to Thompsons Solicitors, Spire had allowed him to operate well after 2012, when he had been suspended by the General Medical Council. Spire's statement was "What Mr Paterson did in our hospitals, in other private hospitals, and in the NHS absolutely should not have happened, and today justice has been done." He has been jailed for 20 years and £37 million allocated for compensation.
Spire initiated litigation in August 2017 against Heart of England NHS Foundation Trust claiming the trust’s failure to warn it of concerns about Paterson’s conduct was negligent and that the company relied on the NHS, as the primary employer, to tell it whether doctors were competent or whether there were patient safety concerns.
Spire and the NHS.
The company alleged in 2013 that a block contract agreed between Blackpool Teaching Hospitals NHS Foundation Trust and the Clinical Commissioning Groups in Blackpool, and Fylde and Wyre offered a “clear incentive” for GPs to refer patients to the foundation trust and that this was anti-competitive behaviour. The contract provided the trust with a guaranteed income regardless of the number of patients that chose to use its services. Monitor conducted an investigation and decided that there was no evidence to support the claim though they did conclude that Blackpool CCG’s plans did not “go far enough” to ensure patients would be offered choice, or that the right to choice would be “publicised and promoted”.
Its NHS business grew from £262 million in 2015 to £293 million in 2016. 20% is directly commissioned by NHS trusts and 80% comes from patients using the NHS e-Referral Service. Income from medical insurers reduced 1.3% to £429 million. Direct payments by patients increased 9% to £170 million. In 2017 turnover increased 0.6% to £932 million, but NHS-funded income fell 1.9% to £287.8 million. The company's pre-tax profit in 2018 fell by 64% because of lower NHS income and higher costs.
It was accused by the Royal College of Anaesthetists of being “extremely uncooperative” in facilitating the training of young clinicians during the COVID-19 pandemic in the United Kingdom.
Awards.
In 2008 Spire Healthcare won the Independent Healthcare Award for Best Healthcare Outcomes and followed this in 2009 with the Nursing Practice award for their approach to infection prevention and control. In 2010, Spire won the Nursing Practice award for the second year in succession, together with the award for Excellence in Risk Management. Spire won the Innovation Award in 2011, before going on to win the Medical Practice award in 2012.


Association of Medical Superintendents of American Institutions for the Insane

The Association of Medical Superintendents of American Institutions for the Insane, also known as The Superintendents' Association, was organized in Philadelphia in October, 1844 at a meeting of 13 superintendents, making it the first professional medical specialty organization in the U.S.
The objectives of the Association were "to communicate their experiences to each other, cooperate in collecting statistical information relating to insanity, and assist each other in improving the treatment of the insane." The name of the organization was changed in 1892 to "The American Medico-Psychological Association" to allow assistant physicians working in mental hospitals to become members. In 1921, the name was changed to the present American Psychiatric Association.
The original thirteen.
At a meeting in 1844 in Philadelphia, thirteen superintendents and organizers of insane asylums and hospitals formed the Association of Medical Superintendents of American Institutions for the Insane (AMSAII). The group included Thomas Kirkbride, creator of the asylum model which was used throughout the United States.
It was chartered to focus "primarily on the administration of hospitals and how that affected the care of patients", as opposed to conducting research or promoting the profession.
At the meeting they passed the first proposition of the new organization: "It is the unanimous sense of this convention that the attempt to abandon entirely the use of all means of personal restraint is not sanctioned by the true interests of the insane."
The list of the "original thirteen" members and their organizations provide a good index to well-established psychiatric institutions in the U.S. as of 1844. They included:
"The American Journal of Insanity".
"The American Journal of Insanity" ("AJI") was first published in June, 1844, by Amariah Brigham, Superintendent of the Utica (N.Y.) State Hospital. He was said to have been the author of the entire first issue, which included six articles, a list of existing mental asylums in the U.S., and notes on insanity from France. His aim for The Journal was to acquaint its readers with the nature and varieties of mental illness and with methods of prevention and care for patients.
"The AJI" remained the property of the Utica State Hospital, though it served as the official publication of the Superintendents’ Association. In 1892, the journal was bought by The Association, and in 1921, the name was changed to the present American Journal of Psychiatry by The American Psychiatric Association.
Relations with the American Medical Association.
The American Medical Association (AMA) was organized in 1847 in Philadelphia through the efforts of Nathan Davis and Nathaniel Chapman primarily to deal with the lack of regulations and standards in medical education and medical practice. Some mental hospital superintendents became active members. Cordial relations between the two groups continued, and members of each attended the others’ meetings.
In 1854, the AMA established a Committee on Insanity which ended in 1867, when a psychology section was organized. Merger of the AMA and the Superintendents’ Association was considered frequently over the years. In 1871, the Superintendents' Association delegated Dr. John Curwen to attend the AMA meeting in San Francisco and explain The Association's rejection of the invitation to a merger. The reasons were that the Superintendents held their annual meeting in a venue where an asylum was located both to assure citizen interest in the care of the insane and to allow the superintendents to visit the asylum. Also, the Association's meetings were devoted solely to topics relating to the care of the mentally ill, an area of limited interest to general practitioners, and the Association included only psychiatric hospital superintendents.
Over the years, the relationship between the two organizations has waxed and waned. In the 21st century, the APA is an active participant in AMA activities.
The neurologists, S. Weir Mitchell, and The Superintendents' Association.
The American Neurological Association, organized in 1875, grew out of the Civil War experiences of physicians who had been involved in caring for soldiers with traumatic injuries of the brain and nerves. The neurologists were mainly in private practice and considered mental illness within their purview because the brain was involved. Relations between the neurologists and the Superintendents' Association were marked by mistrust and hostility. Believing that the asylums were mismanaged and providing inadequate care to patients, in some places, the neurologists called on state legislatures to investigate the asylums.
In 1894, to mark the 50th anniversary of its founding, The Superintendents' Association invited Dr. S. Weir Mitchell, a prominent Philadelphia neurologist to address the annual meeting. After querying a number of his colleagues, Dr. Mitchell delivered a scathing address to the superintendents. He said that they had isolated themselves from medicine and they sought no new scientific information through their work, their medical records were inadequate, and their educational efforts among the profession were minimal. The superintendents made little reply to the address.
In 1897, Dr. Bernard Sachs, a New York neurologist, was invited to address the Association's annual meeting. He gave a placating speech saying that both professional groups should be working together in the interest of patients.


High-deductible health plan

In the United States, a high-deductible health plan (HDHP) is a health insurance plan with lower premiums and higher deductibles than a traditional health plan. It is intended to incentivize consumer-driven healthcare. Being covered by an HDHP is also a requirement for having a health savings account. Some HDHP plans also offer additional "wellness" benefits, provided before a deductible is paid. High-deductible health plans are a form of catastrophic coverage, intended to cover for catastrophic illnesses. Adoption rates of HDHPs have been growing since their inception in 2004, not only with increasing employer options, but also increasing government options. As of 2016, HDHPs represented 29% of the total covered workers in the United States; however, the impact of such benefit design is not widely understood.
Minimum and maximum deductibles.
Participation in a qualifying HDHP is a requirement for health savings accounts and other tax-advantaged programs. A qualifying plan must have a minimum deductible and out-of-pocket maximum which the Internal Revenue Service may modify each year to reflect change in cost of living. According to the instructions for IRS form 8889, "this limit does not apply to deductibles and expenses for out-of-network services if the plan uses a network of providers. Instead, only deductibles and out-of-pocket expenses for services within the network should be used to figure whether the limit is reached."
Impact on preventive services and utilization.
When a consumer purchases a health insurance policy, there is a moral hazard risk because the consumer may utilize too much medical care because the full cost of care is defrayed (i.e. he/she has a lower marginal cost for care than the open market). Advocates of Consumer-driven healthcare (CDHC) such as HDHPs operate on the premise that imprudent choices made by patients may be avoided if they are held financially responsible through high copayments and deductibles. However, in practice, studies show that HDHP may actually promote behavior such as avoiding preventive care visits and reducing much needed ambulatory care, especially for those with chronic conditions or low socioeconomic status.
Personal finance implications.
To qualify for an HDHP, an individual plan must have a deductible of at least $1,350 and family plans must have a deductible of at least $2,700. An HDHP's total yearly out-of-pocket expenses (including deductibles, copayments, and coinsurance) can't be more than $6,650 for an individual or $13,300 for a family (This limit doesn't apply to out-of-network services). Because of the relatively high cost of HDHPs, the increased out-of-pocket costs can be burdensome especially for low income families. As a way to try and offset the cost of care, HDHP policy holders may contribute to a health savings account (HSA) with pre-tax income. HSA contributions, unlike other tax-advantaged investment vehicles, offer a triple tax benefit – tax-deductible contributions, tax-free growth, and tax-free withdrawals for qualified medical expenses. The maximum contribution limits policy holders may make to their HSA in 2019 are $3,500 (individual) and $7,000 (family) with a $1,000 catch-up contribution for people age 55 or older.
Emerging issues.
The number of people enrolled in HDHPs is increasing, but this is likely due to the rising cost of health care and cost-shifting to consumers – not due to the fact that HDHPs necessarily provide better care.
Growth of HDHPs.
High deductible health plans (HDHPs) have much lower premiums but high deductibles, co insurance and out of pocket maximums. Due to low upfront costs HDHPs are increasing in popularity with employers, with 24% offering some form of HDHP in 2013 (up from 5% in 2007). In this model, the individual assumes all medical costs until the minimum deductible is met. The Affordable Care Act (ACA), passed in 2010, has led to a significant expansion of HDHPs.
Cost-sharing and price shopping and consumer demand.
The economic principle behind HDHPs is 'cost–sharing', a "method of financing health care that require some direct payments for services by patients." Increasing deductibles is one perceived way to cut health care costs by decreasing its overall usage. As out-of-pocket expenses shift from insurers and employers to individuals and employees, consumers will become more discriminant in their insurance products and engage in a higher degree of price shopping. Consumers will also compare the value of medical services provided at one site compared to another in deciding where to pursue health care services. Taken together, HDHPs should decrease health care utilization and stem the increase in national health care costs. Success of this theory depends on ability of patients to make informed decisions on their health care purchase similar to what they do for goods and services. With high deductibles, consumers face incentives to consider price when choosing health care providers and medical services. This economic model however remains unproven. A 2016 survey has shown members of HDHP and traditional plans to be equally likely to price shop for medical care. Consumers choose health care for a variety of reasons and not all of health services and amenities are amenable to price shopping. Researchers have defined five situations which are more suitable for effective price shopping than others.
Unintended effects of cost sharing.
While HDHPs are useful vehicles for the right consumer, there are concerns that patients may delay care due to high costs, often to their own detriment. When patients postpone necessary or preventative care (outpatient visits, screening and diagnostic testing), they may end up in hospitals' emergency rooms or wards for treatment. The tradeoff of forgoing care early for acute, resource-intensive hospitalizations later ultimately increases overall health care costs. Up to 43% of insured patients said that they delayed or skipped physician-recommended tests or treatments because of high associated costs.
An additional economic principle commonly linked to HDHPs is a Health Savings Account (HSA). HSAs are tax-exempt accounts that individuals with HDHPs fund in order to pay for future medical expenses/costs for which they are now responsible. "Introduced in 2003 as a part of the Medicare prescription drug benefit legislation, the HSA is a less-restrictive medical savings account, owned by the employee, and open to anyone enrolled in a [HDHP] and not already covered by public or private insurance" 5 . HSAs are designed to offset financial burden of increased cost-sharing related to HDHPs, but enrollment in HSA has been limited. A 2016 study showed 61.6% of enrollees in HDHP lacked an HSA.
Impact on physician, hospital and clinical supply.
As stated above, individuals with HDHPs often forgo or delay care due to increased cost sharing, and this often leads to patients presenting to health care providers and institutions later on in much worse condition. This pattern has a significant effect on the supply side of health care. Hospitals and health care institutions take on increasing amounts of bad debt with the advent of HDHP as patients exhaust their deductibles soon after being admitted for care and default on outstanding balances. With rise in cost sharing, hospitals are collecting more money directly from the patients; from 2011 to 2014, the number of consumer payments to health care providers increased 193 percent according to a study by to the "Trends in Healthcare Payments Fifth Annual Report: 2014" from InstaMed. From a physician/hospital supply, HDHP have forced institutions to become more consumer conscious as patients (due to price shopping) do their own research and understand their options. If patients with HDHPs forgo primary care, this lessens the volume and revenue they are able to generate. It also means that, later on, the burden and intensity of care per episode is much greater. The same goes for specialists as well who see less patients undergoing preventative screening and maintenance care (colonoscopies, mammograms, routine laboratory testing, etc.) and then end up with serious (and preventable) conditions. In the long term, the cost and burden is invariably greater. Physicians struggle with having cost become a greater reason for opting for or against a medical interaction or procedure than the health benefits for the individual.


Friedrich Ernst Krukenberg

Friedrich Ernst Krukenberg (1 April 1871 – 20 February 1946) was a German physician who was a native of Halle an der Saale. He was a brother to orthopedic surgeon Hermann Krukenberg (1863–1935) and Georg Heinrich Peter Krukenberg (1856–1899), who was a professor of gynecology at the University of Bonn.
Krukenberg originally studied in his native city of Halle, and continued his medical education at the University of Marburg, where he was a student of ophthalmologist Theodor Axenfeld (1867–1930). At Marburg he also studied under pathologist Felix Jacob Marchand (1846–1928), in whose department he described a fibrosarcoma of the ovary that was to become known as a Krukenberg tumor. In 1896 he published his findings in an article called " Über das Fibrosarcoma ovarii mucocellulare (carcinomatodes)".
Later, his interest turned to ophthalmology, and eventually he returned to Halle where he opened a private practice. The ophthalmic term "Krukenberg's spindle" is named after him, which is a vertical, fusiform deposition of melanin pigmentation in the deep layers of the cornea.
Krukenberg was an avid skier throughout his life. In a late life interview, Krukenberg reflected fondly on frequent weekend trips to Fallbachhang Oberhof with his father; A ski resort two hours south-west of his home town of Halle (Saale), Germany.
Following retirement in 1928, Krukenberg moved to Lake Geneva, Switzerland with his wife and teenage daughters to pursue his retirement dream of skiing in the Swiss Alps. Krukenberg skied primarily at Les Portes du Soleil resort, a major skisports destination to this day.
Krukenberg befriended Gustav Lantschner, a future silver medalist at the 1936 Winter Olympics, and began training together in 1933. The 1936 Winter Olympics was the first time Alpine skiing was arranged in the Olympics.


Edme Joachim Bourdois de La Motte

Edme-Joachim Bourdois de La Motte (14 September 1754 – 7 December 1835) was a French doctor.
Biography.
Edme-Joachim Bourdois de La Motte was born at Joigny, Burgundy, the son of a famous doctor. He studies at the College of Auxerre then goes to Paris in order to do his medical education. He defends his thesis in 1777-1778 and becomes doctor at the age of 24. He begins his career in 1778 at the hospital of Charity. The next year, he becomes doctor of the Count of Provence.
Suspected in 1793, he is jailed but soon released thanks to his wife and to his friend the surgeon Dubois. In 1794, he is chief medical officer of the army of the Alps where he has to face an epidemic of Typhus. When he returns to Paris, he narrowly misses to be arrested by the Directory. This time, he owes his freedom to Talleyrand.
He meets Napoleon Bonaparte during this period and the two men become friends. But their relation falls back when Bourdois refuses to participate in the Campaign of Italy. They will not meet again before 1811.
During these years, Bourdois faces some epidemics and goes on an academic career.
In 1811, Napoleon gives him the charge of the first physician to King of Rome, with the recommendation of Corvisart, an old friend of Bourdois from medical school. Soon after, in 1812, Bourdois is made baron.
In 1820, he becomes an early member of the Royal Academy of Medecine, which he chairs in 1822, 1823 and 1829.
Bourdois dies on December 7, 1835, at the age of 81, just after having completed a report on Corvisart and his titles for the Academy.


Graduate medical education

Graduate Medical Education (GME) refers to any type of formal medical education, usually hospital-sponsored or hospital-based training, pursued after receipt of the M.D. or D.O. degree in the United States This education includes internship, residency, subspecialty and fellowship programs, and leads to state licensure and board certification.