Carly Manning

Carly Manning is a fictional character on the NBC soap opera "Days of Our Lives". Crystal Chappell portrayed the character from June 12, 1990 to October 18, 1993. After a sixteen-year absence, she reprised the role on October 2, 2009 to September 22, 2011. In between her first and second stints, Chappell played the role of businesswoman Olivia Spencer on the CBS soap opera "Guiding Light" from 1999 until its final episode in 2009. Chappell's most memorable storyline on the show was in 1993 when her longtime rival Vivian Alamain (Louise Sorel) buried her alive, which has become one of the show's most notorious plots. Along with Vivian, most of Carly's stories revolve around her ex-husband Bo Brady (Peter Reckell) and late husband Lawrence Alamain (Michael Sabatino).
Casting.
Following the departure of Kristian Alfonso as heroine Hope Williams Brady in 1990, "DAYS" sought an actress for the newly created role of Carly Manning. Crystal Chappell joined the cast after her short-term role as drug dealer Jane Kingsley on another NBC soap opera, "Santa Barbara" when she was approached by the show's casting director Doris Sabbagh. Chappell studied acting at the University of Maryland, Baltimore and with legendary acting coach Sanford Meisner before she pursued the art professionally in 1989 after being cast as a day player on the ABC soap opera "All My Children". By the time she began to appear as a regular on "DAYS", she felt accomplished to have booked such a prominent role on a major show. After spending three years on the soap, Chappell left and eventually took roles on "One Life to Live" as Maggie Carpenter from 1995-1997 and "Guiding Light" as Olivia Spencer from 1999-2009, where she won a Daytime Emmy Award for Outstanding Supporting Actress in a Drama Series in 2002. After 16 years away, Chappell returned to the show in October 2009 following the cancellation of "GL", which ended its run less than a month earlier. While meeting with executives of another show, Gary Tomlin, the co-executive of "DAYS" at the time called Chappell and asked her to return. After nearly two years back, Chappell's contract was not renewed and she exited the show in September 2011. Following her exit, Chappell joined the cast of CBS' "The Bold and the Beautiful" as Danielle in the show's first lesbian storyline.
Storylines.
1990–93.
Dr. Carly Manning arrived in Salem after she got the idea to move there from the vacationing Adrienne Johnson Kiriakis and Justin Kiriakis. Carly believed Salem would a suitable town to live in because no one knew her. After arriving in town, she was shocked to run into not one but two people from her past. First, there Jennifer Horton with whom she had attended boarding school and then Bo Brady who had intervened in a fight between her and her then-boyfriend, Lawrence Alamain. Luckily for Carly, Bo did not remember her and the two do not get along. Eventually, Bo and Carly developed feelings as she cared for his son Shawn-Douglas Brady. Carly discovered her brother Frankie Brady was being held captive by Lawrence Alamain., who agreed to release Frankie if Carly handed over her family fortune and his enemy Bo. Carly had recently been revealed to be Katerina, a member of the powerful European Von Leuschner family and was torn between saving her brother and the man she began to have feelings for. Meanwhile, Jack Deveraux found Frankie and Jennifer who was held captive. Carly and Bo continued to grow closer but he was unable to fully commit to her. Carly accepted a marriage proposal to marry his biological father Victor Kiriakis.
Carly was severely unhappy during her marriage to Victor and he knew she loved his son. Victor faked his death and move to Mexico, but after he was found the marriage was annulled and Carly accepted Bo's proposal but they never went through with a legal marriage following their symbolic ceremony. Carly began to remember her son whom died shortly after birth and told Bo what was on her mind. Bo learned that Carly became pregnant with the child of her boyfriend James, who was using an alias and was really Lawrence Alamain. She sought the help of his aunt Vivian Alamain, who secretly faked the child's death after he was born when it was believed he died of hydrocephalus. Vivian actually raised him as her own son, Nicholas Alamain. Vivian was unhappy at Carly and Nicholas' reunion and attempted to ruin Carly's life by framing her for the deaths of her own patients at the hospital to make Carly seem like an angel of mercy serial killer. Vivian injected cleaning fluid into the systems of Carly's terminally ill patients and Carly was considered the culprit. Vivian used a herbal medical treatment to place Carly into a coma to appear dead. In one of the most stunning plot lines ever to be featured on a daytime soap, Carly awoke in her coffin which was complete with enough essentials after she had been buried alive. Eventually, Vivian overcomes her own lapsed reality from the herbs and has Lawrence release her. After everyone learned Carly was alive, Lawrence told her that he wanted to have a life together with their son. Bo and Carly agreed that they could no longer make their relationship work and so Carly, Lawrence and Nicholas left town to begin a new life in France.
2009–11.
Almost sixteen years later, Carly and Lawrence are seen together in a hotel room in Monaco, where they are arguing. The altercation results in Carly stabbing her husband in the stomach with a letter opener as he mumbles his final words being "You'll never find..." Carly secretly left the country to come to Salem in hopes of getting help from Bo, the only person she ever trusted. While separated from his wife, Carly broke into Bo and Hope's house to ask for his help and he agreed to hide her in his house since the Alamains were looking for her. Soon after, Victor suspected that Carly was back in Salem and reported her to the police and she was arrested but later released back into the custody of Bo. Vivian then cleared Carly's name in order to get revenge on her rather than have her in punished in prison for Lawrence's murder. Vivian soon learned that Carly had a daughter living in town, which turns out to be Melanie Layton, whom Lawrence gave up for adoption due to Carly's affair with another man. Carly accidentally shot Melanie on her wedding day to Philip Kiriakis when trying to stop Vivian from killing her out of revenge. After being released from prison, revisiting her relationship with Bo and repairing her relationships with Melanie and her daughter's father Daniel Jonas, Carly eventually got involved in keeping the secret of Chloe Lane's son. The child turned out to be the son of Chloe's ex-boyfriend Philip and not her husband Daniel (but later this was revealed to be untrue and the result of Caroline Brady switching the DNA results). After ruining the bonds she shared with everyone around her, including Bo who got back together with his wife Hope, Carly turned to drugs after falling in love with Daniel, and being distraught about his relationship with her best friend, Jennifer, and eventually entered rehab under the care of Dr. Norman. Following a reunion with Nicholas and renewing her relationships with those she hurt, Carly left town to travel Europe with her son. In late 2012, her daughter, Melanie, went to live with her in Europe.
Reception.
Throughout the character's run, Carly has remained one of the show's most popular characters, which is largely due to the storyline that saw her buried alive, which is attributed to the rise in ratings at the time the storyline aired. The storyline is often considered to be one of the most shocking plot lines in popular culture history. Chappell's popularity in the role led to her win the "Hottest Female Star" award at the 9th Soap Opera Digest Awards ceremony in 1993, at the 39th Daytime Emmy Awards she earned a daytime Emmy nomination for Outstanding Lead Actress in a Drama Series in 2012. The character is also considered to be "the one true viable threat to super-duo Bo and Hope," played by Peter Reckell and Kristian Alfonso, because her relationship with Bo has generated a large following and notable storylines and rivals that of the supercouple. When she made her long-awaited return in 2009, Chappell was thrust into a story surrounding Carly's biological daughter Melanie Jonas, played by Molly Burnett. Off-screen, Chappell became a friend and mentor to Burnett and at the time of her co-star's exit, Burnett said, "Crystal brings her A game every time she films a scene. So you want to bring yours to stay with her. She always inspired me to work really hard." Chappell's professionalism is often noted by her colleagues on the shows she has appeared on, including "Days of Our Lives" actor Wally Kurth, "Guiding Light" and "One Life to Live" actress Jessica Leccia and writer Claire Labine who was instrumental in the creation of Chappell's storylines on "GL" and "OLTL".


USMLE score

The United States Medical Licensing Examination score (USMLE score) is given to test takers as a 3-digit score. This score is commonly used by hospitals to determine eligibility for residency and fellowship. The three-digit score is based on a theoretical maximum of 300, but this has not been documented by the NBME / FSMB. Previously, a 2 digit score was also provided, but has since been eliminated. The two-digit score was normalized to the three-digit score such that a 75 was equal to the minimum passing score (currently 194) for the USMLE Step 1. Contrary to popular opinion, the two-digit score does not represent a percentile.
Three-digit USMLE score.
The NBME / FSMB have never clearly stated that the three-digit score is based on an absolute scale with a maximum of 300. However, this is the assumption stated by NBME with regard to their Comprehensive Basic Science Self-Assessment (CBSSA). The minimum passing level for the three-digit score is 194 effective since January 1, 2018 The average score varies by year and tends to be near 230.
Two-digit USMLE score.
The two-digit scoring system has been deleted from USMLE Transcripts effective from April, 2013.
USMLE score calculator.
There are a number of score calculators and converters available for the USMLE. A free calculator and converter is available at https://usmle-score-correlation.blogspot.com/ and permits the conversion between the three-digit score and two-digit score.


Swiss Institute for Experimental Cancer Research

The Swiss Institute for Experimental Cancer Research (ISREC, French: "Institut suisse de recherche expérimentale sur le cancer") is a not-for-profit institution founded in 1964 and located in Épalinges, Switzerland.
Since 1 January 1, 2008, it is organized into two distinct entities:
History.
The ISREC has its origins in the history of the "Centre anti-cancéreux romand" (CACR) which was founded in 1924 in Lausanne. Initially, the CACR was composed of three main departments: pathology, experimental research and a therapeutic service. The appointment of Alfredo Vannotti (1907–2002) as Head of the experimental research service in 1947 and the appointment one year later of Serge Neukomm (born 1917), led to the development of experimental research. In the 1950s, the medico-social activities were maintained, but in 1957, they were taken up by the cantonal leagues. The CACR then limited its activities to experimental research on cancer.
Under the leadership of Rudolf Stadler (Chairman since 1951) and Henri Isliker (Director), ISREC was created on June 18, 1964 as a Swiss foundation. Initially, the ISREC was situated next to the University Hospital of Lausanne (CHUV). The ISREC was growing steadily. In 1970, the collaboration of the ISREC with the Institute of Biochemistry of the University of Lausanne, the WHO Immunology Research and Training Centre and the Lausanne branch of Ludwig Cancer Research constituted a critical mass of over 150 scientists. The space in the building on the rue du Bugnon became totally inadequate. The ISREC built a new research center in Epalinges and moved there in autumn 1976. In 1978, Henri Isliker handed the direction of ISREC to Bernhard Hirt who headed the Institute for 18 years. In 1996, Michel Aguet took over as director.
In 2008, the research groups of the Institute were integrated into the EPFL – School of Life Sciences and in 2009, Douglas Hanahan was nominated director of the Institute.
The ISREC Foundation (President Yves J. Paternot) continues to seek and to provide resources to support projects having a broad potential of diagnostic or therapeutic innovation in cancer research.
Research.
The Swiss Institute for Experimental Cancer Research has, for over 40 years of its existence as an independent institute, been devoted to cancer related basic research. Since its integration as an institute into the EPFL School of Life Sciences on January 1, 2008 and the renewal of a substantial part of its scientific staff, its research focuses on areas including genome stability, cell proliferation and differentiation, and the role of developmental pathways in tumorigenesis and tumor progression.
Publications.
Between 1964 and today more than 2,000 articles were published by ISREC researchers in various scientific journals, notably in Cell, Nature and Science.
Honors (Selection).
The research conducted by ISREC members has been distinguished by major awards. These include:


Inferior tibiofibular joint

The distal tibiofibular joint (tibiofibular syndesmosis) is formed by the rough, convex surface of the medial side of the distal end of the fibula, and a rough concave surface on the lateral side of the tibia.
Below, to the extent of about 4 mm, these surfaces are smooth and covered with cartilage, which is continuous with that of the ankle joint.
The ligaments are:
The inferior transverse ligament of the tibiofibular syndesmosis is included in older versions of "Gray's Anatomy", but not in "Terminologia Anatomica". However, it still appears in some anatomy textbooks.
It should not be confused with the superior tibiofibular joint, which is the only synovial tibiofibular joint, and is sometimes simply called the "tibiofibular articulation".


Henry Stanley Plummer

Henry Stanley Plummer, M.D. ( – ) was an American internist and endocrinologist who, along with William Mayo, Charles Mayo, Stinchfield, E. Starr Judd, Christopher Graham, and Donald Balfour founded Mayo Clinic. Plummer is also immortalized as the driving force behind the Plummer Building, which still stands as a part of the Clinic he helped establish.
Biography.
Early life and education.
Plummer was born in Hamilton, Fillmore County, Minnesota. He earned his medical degree from Chicago's Northwestern University in 1898 and then returned to Racine, Minnesota to assist his father Albert Plummer in private practice.
Career.
Plummer became a partner in the Clinic practice in 1901, and William Mayo would later quip that hiring Plummer was the best day's work he had ever done.
Plummer's work in internal medicine and endocrinology led to several important advances in the specialty, including: Plummer-Vinson syndrome, Plummer's nails, treatment of goiters with iodine, Plummer's disease (second-most common cause of hyperthyroidism after Graves' disease), and Plummer's sign (used for diagnosis of Graves' disease).
In 1917, construction began on the Plummer House, the English Tudor mansion where Plummer and his family lived. The house was designed by Ellerbe & Round, and boasted many innovations that were rare at the time. Daisy Plummer gave the furnished house and property to the Rochester Art Center in 1971. Her wish was that the house and grounds would be used by the people of Rochester and Clinic guest as a Center for the Arts. This remarkable gift was later transferred to the Rochester Park and Recreation Department and is now used as a house museum and rental facility for special events.
Plummer was also a successful scientist and inventor. Traditionally, doctors kept patient notes in journals and were highly inconsistent in the amount of information written down. Plummer invented the modern "dossier" system that assigns each patient an ID and stores all that patient's information in a single folder chronologically. He, along with Frederick Maass of Maass & McAndrew, developed many highly innovative systems in the 1914 and 1927 Clinic buildings. Under the guidance of Plummer, the 1914 building allowed the integrated group medical practice concept to be fully expressed. Many highly innovative medical systems, tools, and equipment were incorporated into the building design. This was groundbreaking work, and the first building designed to facilitate the integrated group medical practice. Plummer worked closely with Frederic Maass, of Maass & McAndrew, to design and fabricate many of the building systems innovations like the steam sterilization rooms, metal surgical tools and equipment, pneumatic tube system, knee operated sinks, and a state of the art HVAC system. The air exchange rate for the building was three minutes. One intriguing innovation was the Rookwood fountain in the main lobby that was designed to clean and humidify air from the outside. It also heated and humidified air in the winter, and provided cool air in the summer. To fight infection, steam sterilizer rooms were designed to hold much of the operating rooms metal surgical furniture, tools and equipment. These and other aseptic procedures helped bring the overall patient infection rates down - which in turn helped grow the Mayo Clinic practice, along with its well earned reputation for innovation, into what it is today. In 1928, the Plummer Building was completed with considerable input from Clinic staff, and again under the guidance of Plummer. Maass again worked closely with Plummer and staff on system design. After this project was complete, Plummer was hired as the "Chief Engineer" for the Clinic. Working hand in hand with physicians, scientists and other Mayo Clinic staff, the engineering department developed unique medical devices and systems, many designed to meet the needs of individual patients.
He also directed the development of Mayo's clinical laboratories, as well as bringing in Louis B. Wilson in 1907 to develop and manage the diagnostic and research labs, and was the first to utilize X-ray machines as a diagnostic tool at the Clinic. Will Mayo called Plummer "a pioneer in the development of X-ray diagnosis and therapy". But, perhaps one of his greatest contributions to medicine was the development and implementation of the integrated private medical group practice.
Plummer is considered by many to be the "architect of the modern medical practice." His innovative contributions to medical systems and building designs, as well as his early understanding of the importance of the diagnostic and research aspects of the clinical practice, allowed for the creation of the integrated group practice, as well as medical specialization.
Death.
Plummer died in Rochester, Minnesota.
Legacy.
Plummer was known to many as a diversified genius.
The Plummer–Vinson syndrome is named after him and Porter Paisley Vinson. Plummer's nail refers to the separation of the nail from the nailbed which occurs in thyrotoxicosis and psoriatic arthritis.
Personal life.
His wife, the former Daisy Berkman, was the niece of the Mayo Brothers, and they had two adopted children, Robert and Gertrude. Henry Plummer's younger brother, William Albert Plummer, was also a prominent Mayo physician. The two Plummer brothers represented the next generation of medical practitioner, and helped usher in the modern medical age with innovations such as the integrated group practice and specialization.


Julius Althaus

Julius Althaus (31 March 183311 June 1900) was a German-English physician. He conducted early electrical treatment of patients at King's College Hospital and he was mainly instrumental in creating the Maida Vale Hospital for Nervous Diseases.
Biography.
Born in Lippe-Detmold, Germany, on 31 March 1833, Althaus was the fourth and youngest son of Friedrich Althaus and Julie Draescke. His father was general superintendent of Lippe-Detmold, a Protestant dignity equal to the Anglican rural dean; his mother was a daughter of the last Protestant bishop of Magdeburg. He received his classical education at the University of Bonn, and began his medical studies at Göttingen in 1851 continuing in Heidelberg and graduated M.D. at Berlin in 1855, with a thesis "de Pneumothorace". He then visited Sicily with Professor Johannes Peter Müller to study zoology. He worked under Professor Jean Martin Charcot in Paris.
Althaus moved to London, where as an assistant to Robert Bentley Todd he carried out the treatment of patients at King's College Hospital using electricity. In 1866, he was largely responsible for creating the Hospital for Epilepsy and Paralysis. This facility in Regent's Park later became the Maida Vale Hospital for Nervous Diseases and it is now part of National Hospital for Neurology and Neurosurgery. In 1877, Althaus unsuccessfully tried to rename the disease multiple sclerosis "Charcot's disease" after the disease's first descriptor, Jean-Martin Charcot. He gave two lectures on spinal cord sclerosis in 1884 and noted that the meaning of the term "sclerosis" varied from country to country.
Althaus was the physician at the "Hospital for Epilepsy and Paralysis" until 1894, when he was appointed to the honorary office of consulting physician. Althaus married Anna Wilhelmina Pelzer in June 1859, and had two sons and a daughter, of whom the latter survived him. He was admitted a member of the Royal College of Physicians of London in 1860. At the time of his death he was a corresponding fellow of the New York Academy of Medicine, and he was awarded the Order of the Crown of Italy. He died in London on 11 June 1900 as the result of damaging his knee in Switzerland on holiday the year before which was complicated by gout, followed by gastroenteritis and peritonitis.
Althaus and his wife were the centre of a social circle and they were both musically talented. Althaus has been called a "cultural polymath" and he was a talented linguist which allowed him to understand the latest developments in neurology on an international basis. He was greatly interested in the therapeutic effects of electricity.
Works.
Following Althaus' death, an obituarist described him as "a voluminous writer, and published many books and papers on various aspects of nervous disease." A modern biography called this an understatement, acknowledging his works in the wider field of medicine throughout his lifetime. Some of his works include:


Ashwin Porwal

Ashwin Porwal is a Pune-based procto-surgeon and the founder of Healing Hands Clinic. He has developed a technique - Distal Laser Proximal Ligation (DLPL), to cure anal fistulas. Porwal completed his M.B.B.S. from B.J. Medical College, Pune and did his specialization in proctology. He launched the Healing Hand Clinic in 2008. In 2017, his organisation was recognised by the Maharashtra University of Health Sciences to impart training to doctors in proctology. He has trained 180 surgeons in the field from various countries through short private courses. Only ten percent among those trained were able to perform the surgeries on large scale independently.
He has also performed the pelvic organ prolapse suspension surgery (POPS) and stapled trans anal rectal resection surgery (STARR). His research paper n DLPL earned him several accolades at the World Congress on Proctology, WorldCon 2017.


Enrique Paris

Oscar Enrique Paris Mancilla (born 3 September 1948) is a Chilean physician and politician currently serving as Minister of Health.


Samuel Jessner

Samuel Jessner (5 January 1859 - 7 December 1929) was a German dermatologist known for his work on the skin and hair symptoms of patients suffering from syphilis.
Jessner was born in Dorbian (now Darbėnai), Lithuania, and studied medicine at the University of Königsberg. After completing his doctorate, he habilitated there as well. He dealt mainly with skin and venereal diseases. He was chairman of the Königsberg branch of the free-religious Deutschen Gesellschaft für ethische Kultur (German Society for Ethical Culture). His sons were the dermatologist Max Jessner and the theater director and director Fritz Jessner.


Robert Salus

Robert Salus (18 September 1877 in Plzeň - 1961 in Milan) was an Austrian ophthalmologist known for describing Salus's sign. He studied at the German University in Prague, gaining his M.D. in 1902. He was habilitated in ophthalmology in 1909 and became professor of ophthalmology in Prague in 1916. He described rubeosis iridis in 1928, and vascular changes in hypertension in 1939.


Maria Siemionow

Maria Siemionow (born 1950 in Krotoszyn, Poland) is a Polish transplant surgeon and scientist who led a team of eight surgeons through the world's first near-total face transplant at the Cleveland Clinic in 2008. The patient, Connie Culp, a 45-year-old woman from a small town in Ohio, was exceedingly disfigured by a close range shotgun blast in 2004. The procedure took 22 hours.
Siemionow practiced in Cleveland until 2014 when she was appointed Professor of Orthopedics and Director of Microsurgery Research at The University of Illinois, Chicago, Il, where she practices today. She is regarded as a world leader in nerve regeneration enhancement and in developing minimal immunosuppression regimens following transplantation.
Education.
Born in Krotoszyn, Poland, in 1950, she earned her medical degree from Poznan Medical Academy in 1974, Poznan, Poland, and completed a residency in orthopedics there. She earned her Ph.D. in microsurgery from the same institution in 1985 and "habilitation" in medical sciences in 1992. In 2007 the president of Poland, Lech Kaczyński, honored her with the title of professor. She specializes in microsurgery, hand surgery, peripheral nerve surgery, transplantation and microsurgery research.
Career.
Dr. Siemionow worked as an Associate Professor of Surgery at the University of Utah in 1990. Siemionow was named Director of Plastic Surgery Research and Head of Microsurgical Training in the Cleveland Clinic's Department of Plastic Surgery in 1995 and served in that capacity until 2013. She was appointed Professor of Surgery in the Department of Surgery at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University in 2005.
In 2003 Siemionow completed the first facial transplant on rats paving the way for the first US human face transplant which she undertook in 2008. That same year she received an honorary academic appointment as Professor of Surgery at the Karol Marcinkowski University of Medical Sciences in Poznan, Poland.
She is President of the American Society for Reconstructive Transplantation and is past president of the International Hand and Composite Tissue Allotransplantation Society and the American Society for Peripheral Nerve. She is a member of the Warrior Restoration Consortium, an academic-industry team focused on developing new treatments for wounded soldiers.
Awards.
Siemionow has received the Commander's Cross of the Order of Merit of the Republic of Poland (presented by Ambassador Robert Kupiecki) for her contribution to the development of microsurgery and transplantation medicine. She was twice honored with the James Barrett Brown Award for best publication in a plastic surgery journal in 2004 and 2007. She also received the Folkert Belzeer Award in Transplantation for her work on transplantation and tolerance at the 6th Congress of the International Society for Organ Sharing in 2001. She is a recipient of the 2009 Cleveland Clinic Learner Research Award for Excellence for her transplantation research. Recent awards include the Polish Order of Merit (2009), the Commander's Cross Polonia Restituta award given by the President of Poland (2009), the American Association of Plastic Surgeons' Clinical Researcher of the Year Award (2010) and the Outstanding Achievement in Clinical Research Award from the Plastic Surgery Educational Foundation (2010).
Siemionow's international awards include the SAPIENTI SAT Medal endorsed by the Ministry of Education of Poland (2012), the Casimir Funk National Science Award (2013), and the Honoris Causa Doctorat given by the Poznan University of Medical Sciences (2013). In 2014, she received the Great Immigrants Award from the Carnegie Foundation of New York. In 2015 she was awarded the Golden Hipolit statue by the Hipolit Cegielski Foundation, Poznan, Poland. She is a member of the Kosciuszko Foundation Collegium of Eminent Scientists of Polish Origin and Ancestry (2014).
In May 2020, Siemionow was featured on "The Times" 'Science Power List'.
Bibliography.
Siemionow has over 330 scientific publications. She has edited multiple plastic surgery textbooks, one popular science book, and has contributed to 90 published book chapters. She is on the editorial board of nine professional society journals and is an ad hoc reviewer for six professional society journals. Some of her contributions are:


Joseph W. Eschbach

Joseph Wetherill Eschbach (January 21, 1933 – September 7, 2007) was an American doctor and kidney specialist whose twenty years of research starting in the 1960s led to an improvement in the treatment of anemia.
Dr. Eschbach graduated from Jefferson Medical College in 1959. Eschbach was married to MaryAnn Eschbach for 51 years, they had 3 children; 5 grandchildren.
Anemia Research.
When his mentor, Dr. Belding H. Scribner, challenged Dr. Eschbach, at the time a young nephrology researcher at the University of Washington, to find a way to correct the anemia in kidney dialysis patients, Dr. Eschbach accepted the challenge. Working with a hematologist, Dr. John W. Adamson, Eschbach looked at various forms of renal failure and the role a natural hormone, erythropoietin, had in preventing anemia. By studying the urine of sheep and other animals in the 1970s, the two scientists helped establish that erythropoietin did stimulate the bone marrow to produce red blood cells.
In the 1980s, Dr. Eschbach helped lead a clinical trial at the Northwest Kidney Centers studying whether an artificial erythropoietin hormone, Epogen, manufactured by Amgen, could replace or supplement the naturally occurring hormone. The trial was successful, and its results were published in The New England Journal of Medicine in 1987: Administering artificial erythropoietin did reverse anemia in kidney patients. His research helped to inform and lead to the Food and Drug Administration's 1989 approval of the replacement hormone Epogen. Epogen and its derivative Erythropoietin Stimulating Agents remain in use throughout the world.
Affiliations.
Dr. Eschbach career at the University of Washington began in 1965, first as a clinical instructor, in 1975 Eschbach was named a clinical professor of nephrology. Eschbach worked as a senior research associate at the Northwest Kidney Centers in Seattle, and he served as chair of the Northwest Kidney Centers non-profit board of trustees 1985-1987. On September 26, 2007 the Northwest Kidney Centers based in Seattle, WA and Kirin-Amgen announced an honorary gift to the University of Washington Division of Nephrology to establish the Joseph W. Eschbach Endowed Chair in Kidney Research. "This is the greatest honor of my career," said Dr. Eschbach in August 2007 upon learning of the endowed $1.5 million chair in his name. "I am particularly pleased that NKC and the UW have put emphasis on kidney research since the future well-being of our patients depends on research applied to their needs."
Medical Practice.
A private practice nephrologist at Minor and James Medical clinic in Seattle, WA. Eschbach did his pioneering research on anemia while in private practice. From 1965 to 1972 Eschbach served as Director of the NKC home hemodialysis program, the first home dialysis training center in the United States.
Awards.
Eschbach was the recipient of David M. Hume Memorial Award, National Kidney Foundation (1995), and the Haviland Award of Excellence, Northwest Kidney Centers Foundation (1991). He is a member of the Institute of Medicine of the National Academy of Sciences (1990). In 2005 Eschbach was awarded the International Society of Nephrology Amgen International Prize. He was an emeritus board member of the Northwest Kidney Centers.


Adelson Foundation

The Adelson Foundation is an American private charitable foundation founded by business magnate Sheldon and Miriam Adelson. The organization is based in Los Angeles.
Background.
The foundation is divided into two branches, including the Adelson Family Foundation, which was established in 2007, and the Adelson Medical Research Foundation. The former works to strengthen the State of Israel and the Jewish people, while the latter focuses on healthcare.
Noteworthy donations of the organization include: $50 million to the Dr. Miriam and Sheldon G. Adelson Educational Campus, another $67 million in total was donated to their Medical Research Foundation, and $33 million to the Birthright Israel Foundation, and $13 million toward paying for the promotional trips to Israel, Jerusalem and the Golan Heights that the nonprofit organizes for young Jewish people.
In addition, the couple have pledged $3 million to Hebrew SeniorLife for housing facilities and a program to bring together older people and elementary-school students for education programs; $2 million to Gateways: Access to Jewish Education for programs for children with special needs; and $1 million to the Chelsea Jewish Foundation for specialized housing for patients with amyotrophic lateral sclerosis and multiple sclerosis. Those pledges will be paid over five years, and since 2007, the Adelson Family Foundation has made contributions totalling $140 million to Birthright Israel, which finances Jewish youth trips to Israel.
The Adelson Foundation gives $200 million annually to Jewish and Israeli causes, the largest by far of any existing private foundation with that aim.
The foundation funds the Maccabee Task Force, which claims to combat alleged antisemitism on college and university campuses in the United States.


Thomas Hamilton, 6th Earl of Haddington

Thomas Hamilton, 6th Earl of Haddington KT FRCPE ( baptised 5 September 1680 – 29 November 1735) was a Scottish politician and nobleman.
Life.
The son of Charles Hamilton, 5th Earl of Haddington and Margaret Leslie, 8th Countess of Rothes, he was christened on 5 September 1680 at Tyninghame House, East Lothian.
His elder brother John Hamilton-Leslie, 9th Earl of Rothes succeeded to the Earldom of Rothes in 1700.
He took up residence at the family estate of Tyninghame following his marriage to Helen Hope. They found the estate to be in poor condition and began replanting. His wife is largely responsible for the layout of the parks which survives today, including avenues, plantations, and the Binning Wood. The Earl later wrote a book, "A Treatise on the Manner of Raising Forest Trees" which was published posthumously. An obelisk was erected in the parks in 1856 which commemorated the couple's work.
Haddington was a supporter of the Acts of Union 1707, and further joined with John Campbell, 2nd Duke of Argyll's forces when they met the Jacobites under John Erskine, Earl of Mar at the Battle of Sheriffmuir in 1715. Haddington was wounded and had his horse shot from beneath him.
Installed as Lord Lieutenant of Haddingtonshire in 1716, he was created a Knight of the Thistle in 1717 and sat as a Scottish representative peer from 1716 until 1734.
Lord Haddington died on 29 November 1735 at Newhailes House, Inveresk, and was succeeded by his grandson, Thomas Hamilton, 7th Earl of Haddington.
Marriage and issue.
Lord Haddington was wed in 1696 to his first cousin Helen Hope, daughter to John Hope of that ilk and Lady Margaret Hamilton, both being grandchildren of John Hamilton, 4th Earl of Haddington. They had issue:
His grand-daughter, Margaret Hamilton (daughter of John), married James Buchanan of Drumpellier twice Lord Provost of Glasgow.


Tashkent Medical Academy

Tashkent Medical Academy is the leading medical university located in Tashkent, Uzbekistan was founded by Decree of the President of the Republic of Uzbekistan I.A. Karimov N-3629. General Medicine, pedagogical, and nursing faculties are among the first to be developed at the academy, which has a capacity of 4662 students. The institute educates approximately 765 postgraduates and 205 physicians. The medical academy offers 6 bachelor's degrees, 33 master's degree specialisations, and 43 postgraduate programmes are available. About 70 institution-partners from around the world.
History.
On July 19, 2005, I.A. Karimova, President of the Republic of Uzbekistan, issued Decree No. UP-3629, creating the current Tashkent Medical Academy.
On April 13, 1919, Turkestan State University announced the establishment of a provincial faculty of medicine in Tashkent, laying the groundwork for the new Tashkent Medical Academy.
The Cabinet of Ministers of the Republic of Uzbekistan founded two medical institutes in Tashkent in 1990, on the basis of the old and new Tashmi buildings: the first Tashkent State Medical Institute and the second Tashkent State Medical Institute, which were demolished to create the current Tashkent Medical Academy.
Faculty.
Tashkent Medical Academy is a new, innovative university dedicated to preserving the best practices of traditional medical education. Its campuses are located in Tashkent, Urgench, Fergana, and Termez.


Bundled payment

Bundled payment is the reimbursement of health care providers (such as hospitals and physicians) "on the basis of expected costs for defined episodes of care." It has been described as "a middle ground" between fee-for-service reimbursement (in which providers are paid for each service rendered to a patient) and capitation (in which providers are paid a "lump sum" per patient regardless of how many services the patient receives), given that risk is shared between payer and provider. Bundled payments have been proposed in the health care reform debate in the United States as a strategy for reducing health care costs, especially during the Obama administration (2009–2016). Commercial payers have shown interest in bundled payments in order to reduce costs. In 2012, it was estimated that approximately one-third of the United States healthcare reimbursement used bundled methodology.
Terminology.
Also known as episode-based payment, episode payment, episode-of-care payment, case rate, evidence-based case rate, global bundled payment, global payment, package pricing, or packaged pricing.
History.
In the mid-1980s, it was believed that Medicare's hospital prospective payment system with diagnosis-related groups may have led to hospitals' discharging patients to post-hospital care (such as skilled nursing facilities) more quickly than was appropriate to save money. It was therefore suggested that Medicare bundle payments for hospital and posthospital care; however, despite favorable analyses of the idea, it had not been implemented, as of 2009.
Bundled payments began as early as 1984, when The Texas Heart Institute, under the direction of Denton Cooley, began to charge flat fees for both hospital and physician services for cardiovascular surgeries. Authors from the Institute claimed that its approach "maintain[ed] a high quality of care" while lowering costs (in 1985, the flat fee for coronary artery bypass surgery at the Institute was $13,800 as opposed to the average Medicare payment of $24,588).
Another early experience with bundled payments occurred between 1987 and 1989, involving an orthopedic surgeon, a hospital (Ingham Regional Medical Center), and a health maintenance organization (HMO) in Michigan. The HMO referred 111 patients to the surgeon for possible surgery; the surgeon would evaluate each patient for free. The surgeon and the hospital received a predetermined fee for any arthroscopic surgery performed, but they also provided a two-year warranty in that they promised to cover any post-surgery expenses (for example, four re-operations) instead of the HMO. Under this arrangement, "all parties benefitted financially": the HMO paid $193,000 instead of the $318,538 expected; the hospital received $96,500 instead of the $84,892 expected; and the surgeon and his associates received $96,500 instead of the $51,877 expected.
In 1991, a "Medicare Participating Heart Bypass Center Demonstration" began in four hospitals across the United States; three other hospitals were added to the project in 1993, and the project concluded in 1996. In the demonstration, Medicare paid global inpatient hospital and physician rates for hospitalizations for coronary artery bypass surgery; the rates included any related readmissions. Among the published evaluations of the project were the following:
By 2001, "case rates for episodes of illness" (bundled payments) were recognized as one type of "blended payment method" (combining retrospective and prospective payment) along with "capitation with fee-for-service carve-outs" and "specialty budgets with fee-for-service or 'contact' capitation." In subsequent years, other blended methods of payment have been proposed such as "comprehensive care payment", "comprehensive payment for comprehensive care", and "complete chronic care" which incorporate payment for keeping people as healthy as possible in addition to payment for episodes of illness.
The St. Joseph Hospital in Denver held an acute-care episode (ACE) demonstration project in 2003, administered by Deirdre Baggot. Based on the Medicare Prescription Drug Improvement and Modernization Act, the ACE demonstration bundled Parts A and B of Medicare for episodes of care.
In 2006-2007, the Geisinger Health System tested a "ProvenCare" model for coronary artery bypass surgery that included best practices, patient engagement, and "preoperative, inpatient, and postoperative care [rehospitalizations] within 90 days... packaged into a fixed price." The program received national attention including articles in "The New York Times"
 and the "New England Journal of Medicine" in mid-2007. An evaluation published in late 2007 showed that 117 patients who received "ProvenCare" had a significantly shorter total length of stay (resulting in 5% lower hospital charges), a greater likelihood of being discharged to home, and a lower readmission rate compared with 137 patients who received conventional care in 2005.
The Robert Wood Johnson Foundation gave grants beginning in 2007 for a bundled payment project called PROMETHEUS ("Provider payment Reform for Outcomes, Margins, Evidence, Transparency, Hassle-reduction, Excellence, Understandability and Sustainability") Payment. With support of the Commonwealth Fund, the project developed "evidence-informed case rates" for various conditions that are adjusted for severity and complexity of a patient's illness. The "evidence-informed case rates" are used to set budgets for episodes of care. If actual quarterly spending by health care providers is under budget, the providers receive a bonus; if actual quarterly spending is over budget, payment to the providers is partially withheld. The model is currently being tested in three pilot sites which are scheduled to end in 2011.
In mid-2008, the Medicare Payment Advisory Commission made several recommendations along "a path to bundled payment." For one, it recommended that the Secretary of Health and Human Services examine approaches such as "virtual bundling" (under which providers would receive separate payments, but could also be subject to rewards or penalties based on the levels of expenditures). In addition, it recommended that a pilot program be established "to test the feasibility of actual bundled payment for services around hospitalization episodes for select conditions."
Just before the Medicare Payment Advisory Commission report was released, the Centers for Medicare and Medicaid Services announced a "Medicare Acute Care Episode (ACE) Demonstration" project for bundling payments for certain cardiovascular and orthopedic procedures. The bundling includes only hospital and physician charges, not post-discharge care; by 2009, five sites in Colorado, New Mexico, Oklahoma, and Texas had been selected for the project. In the project, hospitals give Medicare discounts of 1%-6% for the selected procedures, and Medicare beneficiaries receive a $250–$1,157 incentive to receive their procedures in the demonstration hospitals.
Bundled payments for Medicare were a major feature of a November 2008 white paper by Senator Max Baucus, chair of the Senate Finance Committee. The white paper recommended that the Medicare ACE Demonstration "expand to other sites," "focus on other clinical conditions if certain criteria are met," and "include services that are provided post-hospitalization."
As of 2008, Geisinger's ProvenCare program had "attracted interest from Medicare officials and other top industry players" and had been expanded or was in the process of being expanded to hip replacement surgery, cataract surgery, percutaneous coronary intervention, bariatric surgery, lower back surgery, and perinatal care. Interest in Geisinger's experience intensified in 2009 when newsmedia reports claimed that it was a model for health care reforms to be proposed by President Barack Obama and when Obama himself mentioned Geisinger in two speeches.
In July 2009, a Special Commission on the Health Care Payment System in Massachusetts distinguished between episode-based payments (i.e., bundled payments) and "global payments" that were defined as "fixed-dollar payments for the care that patients may receive in a given time period... plac[ing] providers at financial risk for both the occurrence of medical conditions and the management of those conditions." The Commission recommended that global payments "with adjustments to reward provision of accessible and high quality care" (not bundled payments) be used for Massachusetts health care providers. Among the reasons for selecting global payment were its potential to reduce episodes of care and previous experience with this payment method in Massachusetts.
As of 2010, provisions for bundled payments are included in both the Patient Protection and Affordable Care Act and the Affordable Health Care for America Act. The former bill establishes a national Medicare pilot program starting in 2013 with possible expansion in 2016, which is consistent with the Obama proposal. The latter bill requires "a plan to reform Medicare payments for post-acute services, including bundled payments." 450 healthcare organizations participated in the Bundled Payments for Care Improvement (BPCI) initiative held by the Centers for Medicare & Medicaid Services. The program tested the ability of bundling payments for services as a method for improving quality and lowering costs. In June 2016, CMS announced it would be extending the program for two more years.
In July 2015, Centers for Medicare & Medicaid Services announced its proposal to mandate a 90-day bundled payment model as a new program for Medicare beneficiaries undergoing joint replacement called the Comprehensive Care for Joint Replacement initiative. The initiative is based on the Bundled Payments for Care Improvement program launched in 2011 and research from the Acute Care Episode demonstration project. The new program will improve cost efficiencies, patient outcomes, and collaboration among providers for an episode of care. Bundled payments will eliminate the demand for unnecessary testing and treatments. In July 2016, CMS announced three new bundles, referred to as episode payment models (EPMs) aimed at cardiovascular care procedures including acute myocardial infarction (AMI), coronary artery bypass graft (CABG) and hip/ femur fractures. The new model will go into effect on July 1, 2017.
In January 2018, The Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (CMMI) introduced the successor to the BPCI program, BPCI Advanced, which is a voluntary episode payment model that will start on October 1, 2018 and run through December 31, 2023.
According to CMS’ FAQ on the program, “There are two categories of Participants under BPCI Advanced: Convener Participants and Non-Convener Participants. A Convener Participant is a type of Participant that brings together multiple downstream entities referred to as “Episode Initiators”—which must be either Acute Care Hospitals (ACHs) or Physician Group Practices (PGPs)—to participate in BPCI Advanced, facilitates coordination among them, and bears and apportions financial risks.”
Advantages.
Advocates of bundled payments note:
Considerations.
Before practices choose to participate in bundled payments, they need to be diligent in researching potential episodes of care that would be amenable to this type of reimbursement. Traditionally, physician’s quality monitoring and improvement is managed by the hospital’s nursing sector. Transitioning to a bundled payment methodology shifts accountability back to physicians, thus considerations for their delivery in an acute care episode is essential as well as realigning strategic nursing priorities to enable the needed capacity for care delivery transformation. Once they have selected and defined an episode of care, they should:
According to a February 2018 "Health Affairs" article, Government As Innovation Catalyst: Lessons From The Early Center For Medicare And Medicaid Innovation Models, “The [BPCI] initiative also highlighted business and operational barriers to implementing this approach. These included managing cash flows, developing budgets for episodes paid prospectively (rather than retrospectively), and reliably tracking providers’ enrollment in a bundled payment model. Convening organizations (such as Premier or Remedy Partners, which brought multiple providers together to support implementation and sometimes shouldered some financial risk), could bring bundles to scale faster but introduced the additional complexity of a three-way arrangement among payer, convener, and provider.”
In Case study: Delivery and payment reform in congestive heart failure at two large academic centers, published in the July 2014 edition of "Healthcare: The Journal of Delivery Science and Innovation", the authors state, “Convening organizations play a key role in providing technical assistance and implementation support. Clinical leaders and health systems do not always have a complete set of tools for payment reform. Thus, conveners contracted by CMMI, played a helpful role in catalyzing payment reform for their members.”
Design options.
Implementation of bundled payments can take many different forms. Several of the key design dimensions include:
Disadvantages.
The drawbacks of a bundled payment approach include:


Richard Sissons

Richard Sissons (1819–1893) was a notable New Zealand doctor and Anglican lay reader. He was born in Kingston upon Hull, Yorkshire, England in 1819.


National Health Service Act 2006

The National Health Service Act 2006 (c 41) is an Act of the Parliament of the United Kingdom. It sets out the structure of the National Health Service in England.
It was altered and completely renumbered by the Health and Social Care Act 2012 (c 7).
Contents.
Sections 1(1) and (2) replace the corresponding provisions in section 1(1) of the National Health Service Act 1977. Section 1(3) replaces section 1(2) of that Act.


Type VI secretion system

The type VI secretion system (T6SS) is molecular machine used by a wide range of Gram-negative bacterial species to transport proteins from the interior (cytoplasm or cytosol) of a bacterial cell across the cellular envelope into an adjacent target cell. While often reported that the T6SS was discovered in 2006 by researchers studying the causative agent of cholera, "Vibrio cholerae", the first study demonstrating that T6SS genes encode a protein export apparatus was actually published in 2004, in a study of protein secretion by the fish pathogen "Edwardsiella tarda".
Since then, Type VI secretion systems have been found in a quarter of all proteobacterial genomes, including pathogens of animals, plants, and humans, as well as soil, environmental or marine bacteria. While most of the early studies of Type VI secretion focused on its role in the pathogenesis of higher organisms, it is now known to function primarily in interbacterial antagonism.
Structure and mechanism.
The T6SS is thought to resemble an inverted phage extending outward from the bacterial cell surface. It consists of 14 proteins that assemble into three sub-complexes: a phage tail-like tubule, a phage baseplate-like structure, and cell-envelope spanning membrane complex. These three subcomplexes work together to transport proteins across the bacterial cell envelope and into a target cell through a contractile mechanism
Phage tail-like.
The phage tail-like component of the T6SS is a dynamic tubular structure that undergoes cycles of assembly and disassembly. It can be up to 600 nm long, and has been visualized extending across the bacterial cytoplasm in electron micrographs. The tubules consist of repeating units of the proteins TssA and TssB (VipA/VipB) arranged as a sheath around a tube built from stacked hexameric rings of the haemolysin co-regulated protein (Hcp). At the tip of the Hcp tube sits a trimer of the phage tail spike-like protein VgrG, which is in turn capped by a pointed PAAR domain-containing protein. Contraction of the sheath is thought to propel the Hcp tube, VgrG and associated substrates outside of the bacterial cell, where the VgrG/PAAR spike facilitates penetration of the membrane of a neighboring cell. The tubule structure is dismantled through the action of the ATP-degrading protein ClpV, which sits at the tubule base.
Baseplate.
The phage tail-like tubule of the T6SS assembles on a structure analogous to bacteriophage baseplates. It consists of the proteins TssE, TssF, TssG, and TssK. The baseplate and phage tail-like complex interact in the bacterial cytoplasm, and then are recruited to the cell envelope by the membrane complex.
Membrane.
The T6SS membrane complex is responsible for anchoring the apparatus to the cellular membrane, and provides the channel through which substrates are propelled by the contraction of the phage tail-like tubule. This large (1.7 md) complex is formed from 10 interacting units of a heterotrimer containing TssJ, TssM and TssL. It is believed to span from the inner membrane to the outer membrane of the Gram negative bacterial cell envelope, forming a channel that opens and closes with a unique iris-like mechanism.
Substrate recognition.
Unlike substrates of other secretion systems (such as the general secretory pathway or secretion systems III and IV), those of the T6SS are not known to have any universally identifying features. Instead, they are recognized and selected for secretion through one of two structural components of the apparatus. One class of substrates binds within the pore of an Hcp hexamer. Since substrates are unstable in the absence of this interaction, it is thought that the substrate-Hcp complexes are secreted together, rather than Hcp serving as a passive tubule through which substrates pass. Members of the second class of substrates are targeted for secretion via interaction with the phage tail spike-like protein VgrG. These substrates are often modular proteins, such as the Rhs toxins, that possess PAAR domain for interaction with VgrG at one end. There are also instances where a VgrG and a substrate are both part of the same protein.
Anti-eukaryotic.
Although the ancestral function of the T6SS appears to be targeting of bacteria, a handful of systems have been identified that have evolved to target eukaryotic cells. In general, these eukaryote-targeting systems are involved in causing disease. For example, the intracellular pathogen "Francisella tularensis" requires the activity of a T6SS to escape from phagosomes and replicate in the cytoplasm of macrophages. The mechanism by which secreted proteins facilitate "F. tularensis" virulence is still unknown. The T6SS of "Vibrio cholerae" has a dual role, being able to target both bacterial and eukaryotic cells. At least one substrate it secretes is specialized for eukaryotic cell-targeting, functioning by cross-linking the cytoskeleton protein actin. "Burkholderia pseudomallei" and "Edwardsiella tarda" are two other organisms which possess a T6SS that appears dedicated for eukaryotic targeting. The T6SS of plant pathogen "Xanthomonas citri" protects it from predatory amoeba "Dictyostelium discoideum".
Antibacterial.
A wide range of Gram-negative bacteria have been shown to have antibacterial T6SSs, including opportunistic pathogens such as "Pseudomonas aeruginosa", obligate commensal species that inhabit the human gut ("Bacteroides" spp.), and plant-associated bacteria such as "Agrobacterium tumefaciens". These systems exert antibacterial activity via the function of their secreted substrates. All characterized bacterial-targeting T6SS proteins act as toxins, either by killing or preventing the growth of target cells. The mechanisms of toxicity toward target cells exhibited by T6SS substrates are diverse, but typically involve targeting of highly conserved bacterial structures, including degradation of the cell wall through amidase or glycohydrolase activity, disruption of cell membranes through lipase activity or pore formation, cleavage of DNA, and degradation of the essential metabolite NAD+. T6SS-positive bacterial species prevent T6SS-mediated intoxication towards self and kin cells by producing immunity proteins specific to each secreted toxin. The immunity proteins function by binding to the toxin proteins, often at their active site, thereby blocking their activity.
Regulation.
GacS/Rsm system.
Some research has gone into regulation of T6SS by two component systems. In "P. aeruginosa", it has been observed that the GacS/Rsm two-component system is involved in type VI secretion system regulation. This system regulates the expression of "Rsm" small regulatory RNA molecules, and has also been implicated in biofilm formation. Upon the GacS/Rsm pathway stimulation, an increase in "Rsm" molecules leads to inhibition of mRNA-binding protein RsmA. RsmA is a translational inhibitor that binds to sequences near the ribosome-binding site for T6SS gene expression. This level of regulation has also been observed in "P. fluorescens" and "P. syringae".
Quorum sensing.
There are various examples in which quorum sensing regulates T6SS. In "Vibrio cholerae" T6SS studies, it has been observed that serotype O37 has high "vas" gene expression. Serotypes O139 and O1 on the other hand exhibit the opposite, with markedly low "vas" gene expression. It has been suggested that the differences in expression are attributable to differences in quorum-sensing levels.
In "Vibrio cholerae", autoinducer-1 (AI-1) signals are detected by LuxQ, a sensor kinase. LuxQ activates LuxU, which then acts on LuxO, a DNA-binding protein which represses "HapR" gene expression. HapR is thought to LuxO deletions resulted in strong induction of "vas" gene expression, and hence T6SS expression, demonstrating that T6SS is regulated in some form by quorum sensing. However, O1 strains with LuxO deletions still had relatively quiescent T6SS compared to the O37 strain, suggesting that additional factors are also involved.


Lionel Skeggins

Lionel Skeggins is a fictional character on the New Zealand soap opera "Shortland Street" who was portrayed by John Leigh. His casting on the show began in late 1993 as a guest role and ended in early 1999 as a fan favourite regular. Lionel returned for a cameo in the show's 25th Anniversary in 2017.
Creation and casting.
John Leigh auditioned for the role in 1993 but was considered risky due to his relatively "old" age and lack of TV experience. Leigh recalls the casting director pondering why he had no television experience at 27 years old and concluding, "'He musn't be very good!'". However, after landing a 2-week recurring role, the character proved popular and was eventually brought back the following year as a core cast member. He ended up staying for 5 years. Leigh's final scene in 1999 saw Lionel washed off a rock by a large wave. He described his characters fate, "Murray Keane was directing, he said, 'you're in this shot and you're not in the next one' and there was a big woosh." Lionel made his final appearance on 12 March 1999. In 2012 producers considered bringing the character back in a brief cameo for the shows 20th anniversary but ultimately decided against it. Leigh reprised his role as Lionel for a cameo in the shows 25th anniversary in 2017.
Storylines.
Lionel arrived briefly in 1993 to attend best friend - Leonard Dodds' (Marton Csokas) wedding. He returned in 1994 when Leonard and wife - Gina (Josephine Davison) gave him the hospital cafe's management contract. Lionel fell in love with Kirsty Knight (Angela Dotchin) but lost out on her affections to Greg (Tim Balme). However, by the end of the year, Kirsty and Lionel had gotten together and were engaged. Despite Stuart's (Martin Henderson) attempts to stop the marriage, the two married in early 1995. Lionel went into a coma following digesting bad drugs from Darryl's (Mark Ferguson) company and his marriage with Kirsty tightened. However, after the two moved into an old house, the marriage quickly deteriorated and they separated. By the end of the year the two were completely over when Kirsty suffered amnesia and returned to Greg.
Lionel moved onto Grace (Lynette Forday) but as 1996 ended he and Kirsty finally reconciled. However the relationship again fell apart and a reconciliation with Grace also fell through. Whilst talking through a divorce with Kirsty, the two narrowly escaped death in a plane crash and finally ended their marriage. In 1998 Lionel realized he really did love Kirsty but missed her by seconds as she left Ferndale. He was shocked to discover he had an illegitimate teenage son - Luke Billingham (Greg Freeman) and he started to date Mackenzie (Ingrid Park). The two married in 1999 but shortly after the wedding, Lionel discovered evidence to suggest his wife had tried to murder Oscar (Christopher Brown) and was washed off a rock whilst trying to escape her. His body was never recovered, however his wallet was found.
In 2017 Chris Warner (Michael Galvin) discovered Lionel in the hospital helping out following the volcanic eruption. Although confronted, Lionel appeared to be suffering from amnesia.
Character development.
Characterisation.
Whilst at first appearing as an immature prankster, Lionel's second stint saw the character develop into a more sensitive character with "little-boy-lost" vulnerability. John Leigh described Lionel as likeable, stating; "Lionel is this great trier. That's why people have latched on to him. He doesn't have all the swankiness of the doctors – their money and their looks. A lot of people always see themselves as falling a bit short of the mark and everyone does in some way. People identity with this struggle." Leigh found it difficult to understand how Lionel attracted women, saying, "Lionel is the sort of person you want to meet when you're ready to settle down. He's a nice guy. You can trust him. He can cook. He can fix things. None of these things is exciting to a young woman."
Kirsty and Lionel.
Upon returning in 1994, Lionel was paired with popular character Kirsty Knight (Angela Dotchin). Several people involved in production were skeptical that the "Beauty and the Beast" storyline could actually work, finding it unlikely the glamorous Kirsty would be attracted to the clumsy Lionel. However the unusual pairing was a hit with audiences, becoming part of the classic soap opera archetype of; the couple the audience know should be together even when the characters do not know it themselves. The couple were so successful a novel was released telling the two's story titled "Kirsty and Lionel - Shortland Street Books". The characters first began to share scenes when Kirsty was involved in a car crash that saw the deaths of TP Aleni (Elizabeth Skeen) and Steve Mills (Andrew Binns). Kirsty used Lionel as a shoulder to cry on and though Lionel was instantly smitten, Kirsty was not. Dotchin explained, "He's somebody who really looks after her, but it's not a blossoming romance. Lionel's not Kirsty's type, she doesn't see them together as a couple sexually. He's very much in love with her, but she's not in love with him." Nonetheless, several months later the two featured in one of the most iconic moments in the soap's history when the first ever cliffhanger featured on the soap centered around the wedding between the two being interrupted by Kirsty's past lover Stuart Neilson (Martin Henderson). The two got through the hiccup but after Kirsty was hit by a truck in another of the soap's iconic storylines, leaving her with amnesia, she forgot ever loving Lionel and returned to ex-boyfriend Greg (Tim Balme). However the two reconciled and the 1996 season ended on their kiss. The two's reconciliation did not last long and the two were amidst divorcing when the plane they were in crashed in the 1997 cliffhanger. However, in 1998 Lionel finally decided he wanted to be with Kirsty, only to miss her by seconds when she left to live in Wellington.
Luke Billingham.
In 1998 Lionel was shocked to discover he had fathered a son, 16-year-old Luke Billingham (Greg Freeman) when he himself was 16. Luke debuted as a "shy, inarticulate country boy with an adventurous spirit" who shockingly revealed to Lionel that he was his son. Though Lionel was in shock, he took Luke in, Leigh stated, "Lionel’s struggling to get through it as fatherhood is thrust upon him. He just inherited a 16-year-old son unlike most people who get to watch their kids from a baby and slowly get used to them." The storyline proved to be hugely topical, with the amount of single parent families in the nineties was at an all-time high. Luke instantly got into trouble in his new home, he was involved in a robbery at Lionel's bar, drove Lionel's car without a driver's license and stole a credit card to access online pornography. Despite this, Leigh insisted Lionel was the best possible father, "Lionel’s the best father. He talks through the troubles." After initially struggling to connect with Luke, when he was involved in a dramatic bus crash Lionel realised how much he loved his son and even went to the extent of cooking him gourmet school lunches. After only knowing each other a year, the father-son partnership was broken after Lionel died in scenes that Freeman described as, "draining". Luke soon became a father with his teenage bride, Josie Bergman (Karamia Muller) at age 16, similarly to his father Lionel.
Reception.
The character is remembered as hugely iconic and a fan favourite. He was named as one of the show's most successful comedic characters. Lionel was so well known, John Leigh was more recognized by some members of the public than Michael J. Fox. Leigh found the situation interesting, stating; "I've got people recognizing me as Lionel who wouldn't have even been born when I was on "Shortland Street"." The relationship between Lionel and Mackenzie Choat was noted as odd by one reviewer who believed Lionel was too good for her. Lionel was voted as the 4th best character on the show in a 2002 article. with the reason given; "he was such a cuddly old romantic. Because as a cupcake, he was as sexy as a bran muffin." In 2012, the character was named as one of the standout characters of the show's first 20 years. In 2017 "New Zealand Herald" columnist Ricardo Simich expressed his desire for Lionel to return for the soap opera's 25th anniversary. That same year "stuff.co.nz" journalist Fleur Mealing named Lionel as the 2nd character she most wanted to return for the show's 25th anniversary, citing her desire to determine whether he survived his apparent-death and for a chance to reunite with Kirsty.
The storyline that saw Lionel's marriage to Kirsty being uplifted by Stuart Neilson has been named as an iconic episode. Rachel Lang listed Lionel and Kirsty's romance as one of her favourite storylines. Lionel's final scene has been hailed as iconic with the question constantly lingering among the show's fans, actors and even John Leigh himself, what truly happened to Lionel and if he will return. A 1995 episode saw Lionel come close to death after contracting tetanus and as a result, New Zealanders receiving tetanus shots that month more than doubled. The period surrounding Lionel's exit from the show, remains the highest rating episodes in the show's first 25 years.
Lionel's return in 2017 was said to "surprise" fans.


Tropical spastic paraparesis

Tropical spastic paraparesis (TSP), is a medical condition that causes weakness, muscle spasms, and sensory disturbance by human T-lymphotropic virus resulting in paraparesis, weakness of the legs. As the name suggests, it is most common in tropical regions, including the Caribbean. Blood transfusion products are screened for HTLV-1 antibodies, as a preventive measure.
Signs and symptoms.
Some of the signs of Tropical spastic paraparesis are:
Individuals with TSP may also exhibit uveitis (inflammation of the uveal tract of the eye), arthritis (inflammation of one or more joints), pulmonary lymphocytic alveolitis (inflammation of the lung tissues), polymyositis (an inflammatory muscle disease), keratoconjunctivitis sicca (persistent dryness of the cornea and conjunctiva), and infectious dermatitis (inflammation of the skin).
HTLV-1 can be transmitted via breastfeeding (mother to child), sexual contact, via blood contact (transfusion or needle sharing).
Pathogenesis.
In Tropical spastic paraparesis, HTLV-1 shows elevated cellular acquired immune response as well as high production of proinflammatory cytokines. IFN overexpression has been demonstrated as well. Also the number of NK cells (CD56+ and CD16+) is diminished.
Diagnosis.
Among the methods of diagnosing tropical spastic paraparesis are MRI (magnetic resonance imaging) and lumbar puncture (which may show lymphocytosis).
Treatment.
Treatment of TSP involves corticosteroids to help with inflammation. Though any success with corticosteroids is short-lived, with symptoms worsened as the dosage is reduced. A synthetic derivative, 17-alpha-ethinyltestosterone, can be used to treat Tropical spastic paraparesis, improvement in motor and bladder function was reported but not sustainable.
Mogamulizumab, an anti-CCR4 IgG1 monoclonal antibody, is also being researched as a possible treatment for Tropical spastic paraparesis. The antibody reduces HTLV-1 proviral load and production of proinflammatory cytokines. Valproic acid has also succeeded in reducing the proviral load of HTLV-1 (though clinical benefits were minimal or none). A further combination of valproic acid and zidovudine has demonstrated a decrease in proviral loads (in animals).
Prognosis.
The prognosis for Tropical spastic paraparesis indicates some improvement in a percentage of cases due to immunosuppressive treatment. A higher percentage will eventually lose the ability to walk within a ten-year interval.
History.
For several decades, the term "tropical spastic paraparesis" was used to describe a chronic and progressive clinical syndrome that affected adults living in equatorial areas of the world. This condition was initially thought to be associated with infectious agents (such as "Treponema pertenue" and "Treponema pallidum", which cause inflammation of the central nervous system) and with chronic nutritional deficiencies (such as avitaminosis) or exposure to potentially toxic foods (such as bitter cassava).
Tropical myeloneuropathies are classified as two separate syndromes: tropical ataxic neuropathy (TAN) and tropical spastic paraparesis (TSP). They are placed together because they are found in tropical countries, although tropical spastic paraparesis
has occurred in temperate countries (e.g., Japan).


Justin A. Frank

Justin A. Frank (born February 25, 1943 in Los Angeles, CA) M.D. is an author who practices and teaches psychoanalysis in Washington, DC. Frank is a frequent contributor to The Huffington Post on topics as diverse as politics, film, and theater. He is a former Clinical Professor of Psychiatry at the George Washington University Medical Center.
Frank completed his psychiatric residency at the Harvard Medical School and became the Chief Resident at the Cambridge Hospital. Frank was awarded the DuPont-Warren Fellowship by Massachusetts General Hospital. Frank is also the co-director of the Metropolitan Center for Object Relations in New York.
Frank employs the principles of applied psychoanalysis to put together the kind of psychological profile used in his books about the Presidents: "Bush on the Couch: Inside the Mind of the President", which was extensively quoted from by Fidel Castro in his annual speech in 2004, and "Obama on the Couch: Inside the Mind of the President".
In 2018, he published "Trump on the Couch: Inside the Mind of the President."


Philip Hunt, Baron Hunt of Kings Heath

Philip Alexander Hunt, Baron Hunt of Kings Heath, (born 19 May 1949) is a former health administrator and a Labour Co-operative member of the House of Lords.
Early life and career.
Born in 1949, Philip Hunt was educated at the single-sex grammar school City of Oxford High School for Boys, later the Oxford School. He graduated from the University of Leeds in 1970 with a Bachelor of Arts degree in political studies.
Professional career.
Hunt became a works study officer in 1972 for the Oxford Regional Hospital Board, moving to Nuffield Orthopaedic Centre as hospital administrator in 1974. He was the first Secretary of Edgware and Hendon Community Health Council. He was the first Chief Executive of the NHS Confederation, and previously Director of the National Association of Health Authorities and Trusts (NAHAT) from its formation in 1990. Before that he was Director of its predecessor organisation, the National Association of Health Authorities (NAHA) from 1984 to 1990. In the 1993 Birthday Honours, he was appointed to the Order of the British Empire as an Officer (OBE) for "services to the NHS".
Hunt was President of the Royal Society for Public Health from 2010 to 2018.
Parliamentary career.
In 1997, Hunt was created a life peer in the House of Lords with the title Baron Hunt of Kings Heath, "of Birmingham in the County of West Midlands", taking the Labour whip. He served as a Parliamentary Under-Secretary of State (PUSS) at the Department of Health from 1999 until his resignation in 2003 over the Invasion of Iraq.
Hunt was re-appointed to government in May 2005 as a PUSS at the Department for Work and Pensions. He returned to the Department of Health as Minister of State in January 2007.
Following the appointment of Gordon Brown as Prime Minister, Hunt moved to the Ministry of Justice as a PUSS in July of that year. In the October 2008 government reshuffle, Hunt became Deputy Leader of the House of Lords and Minister of State for Sustainable Development, Climate Change Adaptation and Air Quality at both the Department for Environment, Food and Rural Affairs (DEFRA) and the newly created Department of Energy and Climate Change (DECC), later leaving DEFRA in 2009 to work solely at DECC. In June 2009, he was sworn in as a member of the Privy Council. He left his ministerial offices in May 2010 after Labour lost the general election.
Following the election of Ed Miliband as Labour Party leader, Hunt was appointed Labour's spokesperson on Home Affairs and the Cabinet Office in the House of Lords. He left these roles in September 2012. He served as Shadow Deputy Leader of the House of Lords from 2010 until 2017. He was a Lords spokesperson for Health, later Health and Social Care, from 6 September 2012 until leaving the role on 24 May 2018 to become a backbencher.
In September 2011, Hunt contributed to the book "What next for Labour? Ideas for a new generation"; his piece was entitled "Our NHS: The Labour Party Challenge".
From 2011 until 2014, he served as Chair of Heart of England NHS Foundation Trust.


Otto Deiters

Otto Friedrich Karl Deiters (; 15 November 1834 – 5 December 1863) was a German neuroanatomist. He was born in Bonn, studied at the University of Bonn, and spent most of his professional career in Bonn. He is remembered for his microscopic research of the brain and spinal cord.
Around 1860, Deiters provided the most comprehensive description of a nerve cell that was known to exist at the time. He identified the cells' axon, which he called an "axis cylinder", and its dendrites, which he referred to as protoplasmic processes. He postulated that dendrites must fuse to form a continuous network.
His name is lent to the "nucleus of Deiters", also called the lateral vestibular nucleus, and to "Deiters' cells", structures that are associated with outer hair cells in the cochlea of the inner ear. Deiters died in 1863 from typhoid fever at the age of 29. After his death, his work pertaining to nerve cells of the spinal cord was edited and published by anatomist Max Schultze (1825-1874).


Oman Journal of Ophthalmology

The Oman Journal of Ophthalmology is a peer-reviewed open-access medical journal published on behalf of the Oman Ophthalmic Society and Chief Editor is Dr. Rashid Al-Saidi. It publishes articles on the subject of ophthalmology and vision science.
The journal is indexed with Caspur, DOAJ, EBSCO, EMR Index Medicus, Expanded Academic ASAP, JournalSeek, Global Health, Google Scholar, Health & Wellness Research Center, Health Reference Center Academic, Hinari, Index Copernicus, OpenJGate, ProQuest, PubMed, SCOLOAR, SIIC databases, and Ulrich's Periodicals Directory.


Foramina of Scarpa

In the maxilla, occasionally two additional canals are present in the middle line of the palatine process; they are termed the foramina of Scarpa, and when present transmit the nasopalatine nerves, the left passing through the anterior, and the right through the posterior canal.


Emerich Ullmann

Emerich Ullmann (23 February 1861 – 1937) was an Austrian surgeon who was a native of Pécs.
In 1884, he received his doctorate in Vienna, and afterwards worked in the surgical department of Theodor Billroth (1829–1894). Briefly, he worked as was an assistant to Louis Pasteur (1822–1895) in Paris, where he was involved with research of antisera against rabies. In 1885, he returned to the University of Vienna at the first department of surgery.
Ullmann was a pioneer of renal transplantation research. In 1902, he performed the first successful renal autotransplantation in a dog. Reportedly, the kidney remained functional for five days. Soon afterwards, he was unsuccessful in trying the first renal xenotransplantation (cross-species transplant) between a goat and a dog. Following an unsuccessful attempt to transplant a pig's kidney into a human patient, who was in the final stage of renal disease, he stopped research of kidney transplantation.
He also conducted investigations of tissue and other organ (non-kidney) transplants.


Michigan State University Twin Registry

The Michigan State University Twin Registry (or MSUTR) is a registry of twins produced by researchers at Michigan State University. The MSUTR has a lifespan perspective focused on understanding risk factors for internalizing and externalizing disorders.
Projects.
The principal investigators of the MSUTR are Kelly L. Klump, Ph.D. and S. Alexandra Burt, Ph.D. The MSUTR involves several independent but related projects, each of which is described below:
Adolescent Twin Study.
The MSUTR Adolescent Twin Study of Behavioral Adjustment and Development is a study of 206 same-sex male, 312 same-sex female, and 120 opposite-sex twins between the ages of 10 and 16 years old. The primary purpose of the study was to investigate genetic, environmental (e.g., teasing by peers, parent-adolescent relationships), and neurobiological (i.e., gonadal hormones) risk factors for disordered eating, antisocial behavior, mood, attention/hyperactivity problems, and temperament during early adolescence. In particular, this study aimed to understand whether these psychological characteristics are related to gonadal hormone levels during puberty, whether relationships amongst these factors are influenced by genes, and whether gene x environment interactions influence their development.
Adult Twin Study of Personality and Behavioral Adjustment.
The MSUTR Adult Twin Study of Personality and Behavioral Adjustment is a study of 168 same-sex male, 294 same-sex female, and 270 opposite-sex twins between the ages of 18 and 30 years old. The primary purpose of this study was to examine the extent to which genetic and environmental influences on eating pathology, ADHD, depressive symptoms, anxiety, personality characteristics, and substance use differ between men and women in young adulthood.
Michigan Twins Project.
The Michigan Twins Project (MTP) is an ongoing, population-based study of roughly 20,000 same-sex male, same-sex female, and opposite sex twins between the ages of 3 and 25 years old. The primary purpose of this study is to investigate genetic and environmental influences on a range of physical and mental health variables, as well as to compile a database of twin families in Michigan interested in participating in future twin research.
Hormones and Behavior Across the Menstrual Cycle.
The MSUTR study of Hormones and Behavior across the Menstrual Cycle is an ongoing study that will include a total of 590 same-sex female twins between the ages of 16 and 22 years old. This study aims to investigate associations between ovarian hormone levels and several psychological characteristics, including mood, personality, disordered eating, pubertal development, impulsivity and risk taking behaviors. The extent to which genes influence relationships amongst these variables will also be examined.
Twin Study of Emotional and Behavioral Development – Child (TBED-C).
The MSUTR Child Twin Study is an ongoing study that will ultimately result in a sample of approximately 500 same-sex female twins and 500 same-sex male twins between the ages of 6 and 10 years old. This study aims to examine the ways in which genes and risk experiences (e.g., peer pressure) interact in the development of acting-out behaviors, depressed mood, anxiety, and other problems in childhood.


Josiah Macy Jr. Foundation

The Josiah Macy Jr. Foundation, or Macy Foundation, is a philanthropic foundation founded in 1930 by Kate Macy Ladd (1863–1945) in honor of her father, Josiah W. Macy Jr. The current president is Holly Humphrey, MD, MACP.
History.
Since 1930, the Josiah Macy Jr. Foundation has worked to improve health care in the United States. Founded by Kate Macy Ladd in memory of her father, prominent philanthropist Josiah Macy Jr., the Foundation originally focused its initiatives on medical research. It was not until the 1950s that Macy began to focus on medical education as a means for improving health care.
Since the mid-1970s, the overwhelming majority of the Foundation’s grants have supported projects that broaden and improve health professional education. Today it is the only national foundation solely dedicated to improving the education of health professionals.
Overview.
The Foundation frequently hosts conferences and briefings that convene experts and leaders in the area of medical education. The Macy Foundation became internationally known for the support of the Macy conferences starting in the late 1940s : a series of interdisciplinary meetings of scientists, which played an important role in the foundation of cybernetics.


Masaki Watanabe

Masaki Watanabe (渡辺 正毅, 1911 – 15 October 1995) was a Japanese orthopedic surgeon, sometimes called the "founder of modern arthroscopy". Watanabe developed the first practical arthroscope.
Watanabe was born in Nagano and graduated from Tokyo Imperial University in 1937. He studied surgery under Professor Kenji Takagi, who, towards the end of World War I, had been one of the first surgeons to attempt to insert an endoscopic device into a patient. After World War II, Watanabe became director of the Department of Orthopedic Surgery at Tokyo Teishin Hospital, where he developed early arthroscopes during the 1950s, and, in 1958, he introduced the Watanabe no 21 arthroscope, which was equipped with a superior handmade lens.
When top Canadian orthopedic surgeon Robert W. Jackson visited Tokyo with the Canadian Olympic team in 1964, he came into contact with Watanabe, and this was the catalyst for the introduction of modern arthroscopic techniques into North America.
In 1972, along with a group of other surgeons, Watanabe was involved in founding the International Arthroscopy Association. In 1983, he was the recipient of the Asahi Prize.


Suvro Banerjee

Suvro Banerjee is a consultant interventional cardiologist, practicing in Kolkata. He has worked at various hospitals in the United Kingdom, and is a Fellow of the Royal College of Physicians of London as well as Edinburgh. His procedural skills, among others, include coronary and peripheral angioplasty, pacemaker, ICD and CRT implantation. He is the first doctor in Kolkata to successfully use the ICD which is the Implantable Carvioverter Defibrillatorto to treat a patient's abnormal heart rhythm.
Banerjee is a clinical examiner for the MRCP (UK) examinations in India. He is also a postgraduate teacher in Indira Gandhi Open University (IGNOU). He was the Steering Committee member for The Indian Consensus Guidance on Stroke Prevention in Atrial Fibrillation (2015) and Joint Convener for the Cardiological Society of India (CSI) Guideline Committee position statement on the management of heart failure (2017). He is a member of the Editorial Advisory Board for Indian Heart Journal Interventions. Currently, he is the Overseas Regional Adviser for East Region of India and West Bengal. He has also been involved as Principal Investigator in epidemiological studies with University of Calgary, Canada and Coventry & Warwickshire NHS Trust, UK. His work on the "Prevalence, awareness and control of hypertension in the slums of Kolkata" was carried out in collaboration with Kolkata Municipal Corporation. He has been conferred the fellowship of European Society of Cardiology and the American College of Cardiology.
He was the Honorary Treasurer of West Bengal Academy of Echocardiography, a post which he has held since 2013. Additionally, he was the Secretary of the Cardiological Society of India, West Bengal Branch (2017-2018).
For his philanthropic and social work, Dr. Banerjee was recognized by Rotary International as a Paul Harris Fellow in 2004. He regularly contributes to newspapers on matters of health and heart related diseases.


Hallux rigidus

Hallux rigidus or stiff big toe is degenerative arthritis and stiffness due to bone spurs that affects the MTP joint at the base of the hallux (big toe).
Hallux flexus was initially described by Davies-Colley in 1887 as a plantar flexed posture of phalanx relative to the metatarsal head. About the same time, Cotterill first used the term "hallux rigidus".
Signs and symptoms.
Although the condition is degenerative, it can occur in patients who are relatively young, particularly active sports people who have at some time suffered trauma to the joint (turf toe). A notable example is NBA star Shaquille O'Neal who returned to basketball after surgery.
Causes.
This condition, which occurs in adolescents and adults, can be associated with previous trauma.
The true cause is not known. Most commonly, hallux rigidus is thought to be caused by wear and tear of the first metatarsophalangeal joint.
Classification.
In 1988, Hattrup and Johnson described the following radiographic classification system:
Treatment.
Non-surgical.
Early treatment for mild cases of hallux rigidus may include prescription foot orthotics, shoe modifications (such as a pad under the joint, and/or a deeper toeboxto take the pressure off the toe and/or facilitate walking), specialized footwear ('rocker-sole' shoes), medications (anti-inflammatory drugs) or injection therapy (corticosteroids to reduce inflammation and pain). Physical therapy programs may be recommended, although there is very limited evidence that they provide benefit for reducing pain and improving function of the joint.
Surgical.
In some cases, surgery is the only way to eliminate or reduce pain. There are several types of surgery for treatment of hallux rigidus. The type of surgery is based on the stage of hallux rigidus. According to the Coughlin and Shurnas Clinical Radiographic Scale:
Stage 1 hallux rigidus involves some loss of range of motion of the big toe joint or first MTP joint and is often treated conservatively with prescription foot orthotics.
Stage 2 hallux rigidus involves greater loss of range of motion and cartilage and may be treated via cheilectomy in which the metatarsal head is reshaped and bone spurs reduced.
Stage 3 hallux rigidus often involves significant cartilage loss and may be treated by an osteotomy in which cartilage on the first metatarsal head is repositioned, possibly coupled with a hemi-implant in which the base of the proximal phalanx (base of the big toe) is resurfaced.
Stage 4 hallux rigidus, also known as end stage hallux rigidus, involves severe loss of range of motion of the big toe joint and cartilage loss. Stage 4 hallux rigidus may be treated via fusion of the joint (arthrodesis) or implant arthroplasty in which both sides of the joint are resurfaced or a hinged implant is used. Fusion of the joint is often viewed as more definitive but may lead to significant alteration of gait causing postural symptomatology. The implants termed "two part unconstrained" implants in which a "ball" type device is placed on the first metatarsal head and "socket" portion on the base of the big toe do not have a good long term track record. The hinged implants have been in existence since the 1970s, have been continually improved and have the best record of improving long term function.


Gastrosplenic ligament

The gastrosplenic ligament (also known as the "ligamentum gastrosplenicum" or gastrolienal ligament) is part of the greater omentum.
Structure.
The gastrosplenic ligament is made of visceral peritoneum. It connects the greater curvature of stomach with the hilum of the spleen.
It contains the short gastric arteries, short gastric veins, the left gastroepiploic artery, and the left gastroepiploic vein.
Development.
Embryonically, the gastrosplenic ligament is derived from the dorsal mesogastrium.
Clinical significance.
Gastrosplenic ligament entrapment.
Small intestine may loop through a perforation in the gastrosplenic ligament, ending lateral to the spleen and stomach. This is known as gastrosplenic ligament entrapment, and is usually caused by abdominal trauma. This is corrected with surgery.


Morten Rostrup

Morten Rostrup (born 7 March 1958) is a Norwegian physician.
He took the cand.med. degree in 1983 and the dr.med. degree in 1994, and acquired specializations in internal medicine and emergency medicine. He became a chief physician at Oslo University Hospital and professor of medical work at the University of Oslo.
In 1996 Rostrup was a co-founder of the Norwegian branch of Doctors Without Borders, serving as president from 1996 to 2002. In 1998 he became vice president of Doctors Without Borders' international council, serving as president from 2000 to 2004.
He is an uncle of Espen Rostrup Nakstad.


Uganda Cancer Institute

Uganda Cancer Institute (UCI) is a public, specialized, tertiary care medical facility owned by the Uganda Ministry of Health. The facility is located along Upper Mulago Hill Road, on Mulago Hill, in the Kawempe Division of Kampala, about north of the central business district of the city. The geographical coordinates of the institute are: 00°20'29.0"N, 32°34'40.0"E (Latitude:0.341389; Longitude:32.577778).
Overview.
UCI is a cancer treatment, research, and teaching center, affiliated with the Makerere University School of Medicine and with the Mulago National Referral Hospital, the teaching hospital for the medical school. UCI maintains an inpatient facility with a capacity of 80 beds. It attends to an average of about 200 patients daily.
In October 2011, ground was broken for a three-story, integrated cancer training and treatment facility, measuring nearly . The new building, called the "Uganda Cancer Institute/Fred Hutchinson Cancer Research Center Clinic and Training Institute", is a project of the UCI/Hutchinson Center Cancer Alliance, a collaboration of UCI and the Fred Hutchinson Cancer Research Center in Seattle, Washington, USA. In May 2015, the completed facility opened and began attending to patients.
History.
UCI was founded in 1967 with twenty beds, as the Lymphoma Treatment Center, to treat childhood lymphomas, predominantly Burkitt's lymphoma, the most common childhood lymphoma in Uganda and endemic to tropical Africa. In 1969, UCI expanded to a total of 40 beds, when the Solid Tumor Center was added to focus research on Kaposi's sarcoma and liver cancer. "During the 1960s and early 1970s, UCI was a leading international medical research center, in its areas of specialization. UCI established collaboration with the National Cancer Institute (NCI) in Bethesda, Maryland."
In 1972, following the expulsion of Ugandan Asians by dictator Idi Amin, nearly all of NCI's scientists left. "Professor Charles Olweny, a Uganda researcher, interrupted his studies at NCI in the USA and returned to become the first Ugandan director of UCI. In 1982, following the overthrow of Idi Amin, Olweny was forced to leave Uganda for security reasons, leaving leadership of UCI in the hands of Professor Edward Katongole-Mbidde. When Katongole-Mbidde left UCI to become the director at the Uganda Virus Research Institute in 1995, Dr. Jackson Orem took over the helm at UCI. Between 2011 and 2015, the bed capacity at the institute was increased to 80.
International collaboration.
The international research centers with collaborative projects with Uganda Cancer Institute include, but are not limited to the following:
Brachytherapy.
In 2016, the institute installed a "Flexitron Cobalt-60 High Dose Rate" brachytherapy system from Elekta. The system is part of a two-year renovation plan that UCI is implementing at a cost of US$49 million.
Teletherapy.
In March 2016, the "Cobalt-60 Teletherapy" unit at UCI, which had been in use for the previous 20 years, broke down. Efforts to acquire a replacement unit are underway, with installation expected in 2018. In the interim, the Uganda Ministry of Health has arranged with the Aga Khan University Hospital in Nairobi, Kenya, to offer teletherapy to some Ugandan patients.
A brand new teletherapy machine, manufactured in the Czech Republic, arrived in Uganda in August 2017. The machine was purchased at a cost of €642,000 (more than UShs2.7 billion), contributed by the government of Uganda and the International Atomic Energy Agency (IAEA). It is expected that installation of the new machine will take at least one month. Following installation and testing of the new machine, the institution started treating patients using the new telepathy machine on 4 December 2017 and officially commissioned it on 19 January 2018.
In February 2020, UCI commissioned a new Bhabhatron II Cancer Therapy Machine, donated to Uganda by the government of India. This machine, which also uses Cobalt 60 as the source of radiation will supplement the one acquired 2 years earlier from the Czech Republic. The new unit was installed by Indian technicians. A group of Ugandan oncologists and technicians were earlier sent to India to train on how to operate the new machine.
Also in 2018, Samta Memorial Foundation, an Indian-based non-government organization donated a mobile mammography unit that is now in use at UCI.
Medical directors of UCI.
The following medical researchers have served as director of UCI since its founding in 1967:


Truman Abbe

Truman Abbe (November 1, 1873 – May 2, 1955) was an American surgeon, son of Cleveland Abbe and brother of Cleveland Abbe, Jr.
Biography.
He was born in Washington, D. C. on November 1, 1873. He graduated from Harvard University in 1895. He received his degree in medicine at Columbia University in 1899, then pursued post-graduate studies at the University of Berlin.
Abbe began work in 1902 at Georgetown University. Afterwards, he was appointed instructor at George Washington University (1905). In 1907, he was awarded a silver medal at the Jamestown Exposition for his researches into the uses of radium in medicine.
His papers were donated to the National Library of Medicine in 1983.


Vizient, Inc.

Vizient Inc., based in Irving, Texas, is a corporation that serves over 5,000 not-for-profit health system members and their affiliates, including 1,360 acute care hospitals. Founded in 2016, it is a successor company to VHA, Inc., founded in 1977 as a network of not-for-profit health care organizations working in clinical, financial, and operational management. VHA and UHC (University HealthSystem Consortium) owned a supply chain company called Novation and aptitude(R), the industry's first online direct market for local contracting. VHA also owned Provista, the enterprise's supply chain company serving the non-acute market as well as government, education, and business sectors. There are 1,600 employees across the enterprise.
VHA changed its name in 1994, adopting the initials of its former name (Voluntary Hospitals of America). The name change was to move beyond the outdated and often-misunderstood concepts of "voluntary" and "hospitals", while retaining its name recognition.
On April 1, 2015, VHA and UHC (University HealthSystem Consortium) merged to make one company, Vizient, making them the largest member-owned health care company in the nation. The combined organization officially aligned under the Vizient brand in 2016.


Jacques Daviel

Jacques Daviel (11 August 1696 – 30 September 1762) was a French ophthalmologist credited with originating the first significant advance in cataract surgery since couching was invented in ancient India. Daviel performed the first extracapsular cataract extraction on 8 April 1747.
Daviel earned his medical degree from the Medical School of Rouen, practiced in Marseille where he was affiliated with the medical school there, then restricted his practice to ophthalmology in 1728. He was on the staff of Hospital d'Invalides and became oculist to Louis XV.
In March 1756 he was elected a Fellow of the Royal Society. In 1759, he was elected a foreign member of the Royal Swedish Academy of Sciences.
Daviel died of apoplexy in 1762 while on a trip to Geneva, Switzerland.