Duncan Archibald Graham

Duncan Archibald Graham, (January 8, 1882 – February 18, 1974) was a Canadian physician and academic who held the first position in the British Empire of chair of clinical medicine, established by John Craig Eaton at the University of Toronto in 1919. He held this position and was chair of the department of medicine and physician-in-chief at the Toronto General Hospital, until 1947.
Born on a farm near Ivan, Ontario, he received a Bachelor of Medicine from the University of Toronto in 1905. He was an assistant bacteriologist with the Ontario Board of Health before starting his residency in pathology at the Toronto General Hospital. He was also a pathologist with the Tuberculosis League of Pittsburg. From 1909 to 1911, he did post-graduate studies in Europe. He was appointed a lecturer in bacteriology at the University of Toronto before serving in World War I with the No. 4 Canadian General Hospital.
In 1919, he was appointed to the Sir John and Lady Eaton chair in medicine at the University of Toronto. He was also the physician-in-chief of the Toronto General Hospital. From 1933 to 1935, he was the president of the Royal College of Physicians and Surgeons of Canada. From 1940 to 1941, he was the president of the Canadian Medical Association. From 1942 to 1946, he was a member of the National Research Council.
In 1968, he was made a Companion of the Order of Canada. He was a Commander of the Order of the British Empire. He received honorary degrees from the University of Western Ontario, University of Toronto, and Queen's University.
He died in Toronto in 1974.


Hofbauer cell

Hofbauer cells are oval eosinophilic histiocytes with granules and vacuoles found in the placenta, which are of mesenchymal origin, in mesoderm of the chorionic villus, particularly numerous in early pregnancy.
Etymology.
They are named after J. Isfred Isidore Hofbauer (1871-1961), a German-American gynecologist who described the cell type in his book ("Biology of the Human Placenta with a special emphasis on the question of fetal nourishment").
Function.
They are believed to be a type of macrophage and are most likely involved in preventing the transmission of pathogens from the mother to the fetus (so-called "vertical transmission"). Although there are many studies concerning placental vasculogenesis and angiogenesis, there has been a lack of evidence on the possible roles of Hofbauer cells in these processes. According to a systems level single-cell transcriptomics based study of human placental cell-cell communication, Hofbauer cells produce HBEGF, an EGFR ligand, which drives differentiation of villous cytotrophoblasts (VCT) towards syncytiotrophoblasts (SCT).
Histology.
Under histology sections, Hofbauer cells have appeared with discernible amount of cytoplasm.


GuideWell

GuideWell, formally GuideWell Mutual Holding Corporation (holding company for Florida Blue), is a mutual insurance holding company primarily focused on health insurance in Florida. It was created in 2013 by a reorganization initiated by Florida Blue, a member company of the Blue Cross Blue Shield Association. By health insurance premiums written, it is 10th largest in providing health insurance in the United States with about $15b in health insurance sales.
History.
It originally formed out of Florida Hospital Service Corporation founded in 1944, which became Blue Cross of Florida, and Florida Medical Services Corporation in 1946, which became Blue Shield of Florida. These merged in 1980 into Blue Cross and Blue Shield of Florida, which was renamed Florida Blue in 2012.
Subsidiaries.
The holding company controls corporations operating in insurance, health care providers, consumerism, and government.
Health Innovation Collaborative.
On 9 April 2020, Guidewell unveiled the COVID-19 Health Innovation Collaborative, an effort aimed at linking multiple creative health technology businesses around the U.S. to deliver strategies that tackle challenges in reaction to global pandemics in safety. The company is contributing $125,000 to delivering creative technological approaches that show the ability to reduce some of the health care problems affecting residents during crises of public safety.


UCD School of Medicine

The UCD School of Medicine ("Scoil an Leighis UCD") at University College Dublin, Ireland, was founded in 1855. At undergraduate level the school offers programmes in Medicine MB BCh BAO (undergraduate and graduate entry), BSc Biomedical Health and Life Sciences, and the BSc Radiography. At graduate level the school UCD offers over 40 programmes for health care professionals.
History.
Founded in 1855, the Catholic University Medical School was originally located on Cecilia Street. In 1908 it became the medical faculty of UCD. After its first 75 years of existence, the medical school relocated to Earlsfort Terrace in the 1930s. In 2007 UCD completed a long anticipated move to a state-of-the-art teaching and research health sciences complex at UCD's Belfield campus. The Health Science building sits adjacent to the Conway Institute (a biomedical and biomolecular research centre), Ireland's Centre for Research in Infectious Diseases, and the Centre for Synthesis and Chemical Biology. The UCD National Virus Reference Laboratory is also located on the Belfield campus.
The University College Dublin degree in Radiography is the oldest in Europe with the first graduates being conferred in 1994. It is the only Diagnostic Imaging Programme in the Republic of Ireland.
Medical School Curriculum.
A pre-medicine year is completed by approximately 85% of undergraduate entry students. Thereafter, undergraduate entry medical students embark upon a three-year pre-clinical programme, followed by their final two years of clinical training in one of the affiliated teaching hospitals, either St. Vincent’s University Hospital or the Mater Misericordiae University Hospital. Graduate entry medical students study a 2-year-pre-clinical programme and study the final two years in the affiliated hospitals. Both graduate and undergraduate students complete specialist training rotations at The National Maternity Hospital, the Coombe Women & Infants University Hospital, Children's Health Ireland at Crumlin, and Children's Health Ireland at Temple Street. Upon graduation students are awarded bachelor's degrees in medicine, surgery and obstetrics.
In September 2005 there was a restructuring of the medical programme in the systems-based model, as part of a university wide implementation.
UCD has established connections with several prestigious North American institutions, allowing medical students to participate in funded electives at Harvard Medical School, Washington University, University of Pennsylvania, University of Toronto and the University of British Columbia. The medical school also has a twinning medical programme with the RCSI & UCD Malaysia Campus.
Admissions and Rankings.
In 2020, of the five medical schools offering medical degrees to undergraduates in the Republic of Ireland, UCD had the highest required CAO points to gain entry, at 737.
In the subject listed as "Medicine", the 2021 QS World University Rankings gave University College Dublin a ranking of 151–200. The US News 2021 "Best Global Universities for Clinical Medicine" rankings gave UCD a position of 247 among 749 schools scored.
Notable Alumni.
Notable alumni and former students include:


The Neurosciences Institute

The Neurosciences Institute (NSI) was a small, nonprofit scientific research organization that investigated basic issues in neuroscience.
Active mainly between 1981 and 2012, NSI sponsored theoretical, computational, and experimental work on consciousness, brain-inspired robotics, learning and memory, sensory processing, and motor control.
NSI was founded by Nobel Laureate Gerald M. Edelman in 1981 in New York City. It remained an active research center until shortly before his death in 2014.
In 1993 NSI moved to San Diego, California—first into temporary quarters and then, in 1995, into a newly constructed complex on the campus of The Scripps Research Institute (TSRI). Designed by the firm Tod Williams Billie Tsien Architects, the three-building complex received much acclaim for its Modernist style and especially for an auditorium that became a favored venue for music and performing arts in the area. In October 2012, plagued by financial problems and as part of a sharp contraction in its research efforts, NSI moved into leased space in an office building in the village of La Jolla, several miles from its old location. Its former home, including the auditorium, formally became part of TSRI.
The Institute's size varied considerably over the years of its existence. At its peak, it included three dozen Ph.D.-level research scientists (called "Fellows") and a comparable research support staff. Following the 2012 contraction, fewer than half a dozen Ph.D.-level research scientists remained. This number dwindled in the year preceding Edelman's death.
History.
NSI was established in 1981 as an independent entity on the campus of The Rockefeller University in New York City. In founding the Institute, Edelman argued that the quest for fundamental understanding of brain functions was being impeded, at most existing institutions, by artificial barriers between scientific disciplines and by a reward structure that favored modest, incremental research rather than high-risk, high-payoff research. Edelman claimed that he would be able to break from this reward structure by securing private, unrestricted funding for research at NSI. However, he was mostly unsuccessful at this and NSI struggled financially throughout its existence.
In its very early years, NSI sponsored conferences, workshops, and other activities for visiting scientists; these programs were generally organized around a focused research problem. More than 1000 scientists from 300 institutes and 24 countries visited the Institute over its first two decades. NSI's financial problems in the decade before its 2012 contraction curtailed these activities, save for the Neurosciences Research Program meetings (see below).
In 1988, NSI began its own program of research in theoretical and computational neurobiology. Carried out by a small group of resident Fellows, the program was designed to develop biologically-based theories of higher brain functions. In 1993, following its relocation to San Diego, NSI added a program of experimental research, which would eventually include molecular, cellular, systems, and behavioral studies and would utilize flies, rodents, non-human primates, and humans.
In 2012, severe financial problems forced NSI to vacate its San Diego complex, reduce its computational programs, and shut down its experimental and theoretical programs entirely. The three buildings constituting its former home were ceded to TSRI. What remained of NSI was housed, in the year immediately preceding Edelman's death, several miles away in rented office space in the La Jolla business district.
Architecture.
Between 1995 and 2012, NSI occupied a three-building complex located on Torrey Pines Mesa in San Diego. It was bordered by TSRI to the west, the Sanford-Burnham Institute to the north, the University of California, San Diego to the south, and numerous biotechnology and pharmaceutical research companies to the east and in the immediate surrounding area. Following NSI's 2012 restructuring, the buildings were taken over by TSRI.
NSI commissioned the buildings in the early 1990s. Edelman has said that, in selecting an architect, his goal was to find one who could realize his vision of a "scientific monastery" where creative study of the brain could be conducted with few constraining rules and unlimited opportunities for communication. The resulting complex, designed by Tod Williams and Billie Tsien, has been awarded numerous honors, including the Honor Award for Architecture from the American Institute of Architects in 1997. The structural engineering firm chosen for this project was Severud Associates.
One of the complex's three buildings is an auditorium designed to accommodate both scientific lectures and musical concerts. Noted acoustician Cyril Harris worked with the architects to create the 352-seat auditorium. Considered to be among the most acoustically impressive small performance halls in the United States, the auditorium was built with an original system of faceted, sound-dispersing plaster panels that cover its walls and ceiling, so that the same sound can be heard in every seat.
Neurosciences Research Program (NRP).
Though it was founded in 1981, NSI traces its origin to 1962. It was in that year that a small group of scientists from diverse backgrounds began to meet regularly to discuss basic ideas about how the brain works. Their motivation was the idea that traditional barriers between different scientific disciplines had to be broken down if complex brain functions were ever to be understood.
Led by Francis O. Schmitt, this informal collection of research scientists was organized as the Neurosciences Research Program (NRP) at Massachusetts Institute of Technology. Over the next two decades, and through over 250 meetings and 125 scientific publications, the NRP developed innovative formats for intellectual exchange and disseminated knowledge to the worldwide scientific community.
The central group today exists as an honorary society, whose members number no more than 36 at any one time and serve seven-year terms. Over the past four decades, 17 Nobel laureates have been members of the NRP.
The Neurosciences Institute itself developed from the NRP as an independent institution on the campus of The Rockefeller University in New York in 1981. The NRP moved from Boston to New York in 1983, and became part of the Institute when it moved to San Diego in 1993.


Georgia Hospital Association

The Georgia Hospital Association (GHA) is a non-profit trade association of 174 hospital and health system members. GHA was established in 1929 and provides education, research and risk management services to its members. It also represents and advocates health policy issues benefiting Georgia's citizens before the state legislature and U.S. Congress as well as before regulatory bodies. GHA is headquartered near Atlanta in Marietta, GA. GHA is an allied member of the American Hospital Association.
Affiliated societies.
The Georgia Hospital Association sponsors the following a professional membership societies:


American Association for Physician Leadership

The American Association for Physician Leadership is an educational organization focused on physicians who hold leadership and management positions. Its central offices are located in Tampa, Florida. Peter B. Angood is the chief executive officer of the 11,000-member organization.
History.
The organization was founded in 1975 as the American Academy of Medical Directors (AAMD) in Alexandria, Virginia. For most of this time, the primary focus of the association's activities has been encouraging physicians to assume more active roles in the leadership and management of organizations in the health care industry and helping physicians acquire leadership and management skills.
In 1982, AAMD moved its headquarters to Tampa. In 1980, the name was changed to the American College of Physician Executives (ACPE) to more accurately reflect the nature and direction of its growing membership. In 2014, after more than a year of preparation including member surveys and workshops, the organization rebranded and became the American Association for Physician Leadership. By broadening the scope of programs, products and services, the association strives to more fully support the physician workforce across the entire career span, from medical students to those in later career stages. This also includes physicians in clinical roles, nonclinical administrative roles and those on nontraditional physician career paths.


David Galton

David Abraham Goitein Galton (1922-2006) was a British physician, specialising in haematology.
Galton was born on 1 March 1922 in London, the son of a GP, Bernard, an Hungarian immigrant who had changed his surname from Goitein.
He studied Medicine at Hackney Downs School (formerly The Grocers' Company's School) followed by Trinity College, Cambridge, and at University College Hospital, graduating in 1946.
He was Professor of Haemato-Oncology in the University of London at the Royal Postgraduate Medical School and Honorary Consultant Physician at the Hammersmith Hospital.
He served as secretary to the Medical Research Council's working party on leukaemia, and later chaired its working party on leukaemia in adults, and its steering Committee on Leukaemia.
He also served as Honorary Director of the MRC's Leukaemia Unit and Leukaemia Research Fund.
He was a Fellow of the Royal College of Physicians (FRCP) and was made a Commander of the Order of the British Empire (CBE) in the 1986 Birthday Honours.
He died on 28 November 2006. A collection of his papers is held at the Wellcome Library in London.


Paraveterinary workers in Denmark

Veterinary nurses in Denmark, (known as "veterinærsygeplejerske"), undergo 38 months of training. The first 23 months qualify students as veterinary nursing assistants ("veterinærsygehjælper") while the following 15 months culminate in the title of veterinary nurse. Training is by way of apprenticeship with formal classes taking place at the Kolding Center for Vocational Education. At present there is one specialty certification available in Clinical Ethology in Dogs and Cats which requires an additional two years of study. Representation is by way of a workers' union known as "Veterinærsygeplejerskernes Landsklub". Licensure is required and administered by the "Fødevarestyrelsen" (Food Administration).


Seminars in Ophthalmology

Seminars in Ophthalmology is a peer-reviewed medical journal which publishes clinically oriented reviews on the diagnosis and treatment of ophthalmic disorders. Each issue focuses on a single topic, with a primary emphasis on appropriate surgical techniques.
Editor.
The editor in chief of "Seminars in Ophthalmology" is Prof.Mohammad Javed Ali, of the L.V. Prasad Eye Institute.


A. W. Dumas

A. W. Dumas was an American physician and co-founder of the Mississippi Medical and Surgical Association. He also served as president of the National Medical Association.
Biography.
Born Albert Woods Dumas in Terrebonne Parish, Louisiana on September 9, 1876, he was the son of John Sumpter Dumas, a carpenter and sugar boiler, and his wife, Susanna. In 1899, he graduated from the Illinois College of Medicine and settled in Natchez, Mississippi. At the start of the 20th century, Dumas was one of the few African American physicians in Mississippi and established a medical practice in Natchez in the late 1890s.
In 1900, he along with Dr. L. T. Miller and several other doctors co-founded the Mississippi Medical and Surgical Association, the state's largest and oldest organization representing African American health professionals.
He started the Dumas Infirmary in Natchez to service his patients. It was one of the few private facilities at the time that would accept blacks for treatment.
In 1941, he was elected President of the National Medical Association. He died on October 1, 1945.


Alfred Charles Garratt

 Alfred Charles Garratt (October 3, 1813 – June 30, 1891) was an American medical doctor who frequently used electricity as a medical tool. He was the first full-time medical doctor in electrotherapy in the United States and wrote the first book on the subject.
Biography.
Garratt was born in Brookhaven, New York, on October 3, 1813. His father was Richard Garratt. He was a graduate of Lenox Academy, and in 1836 a graduate of Medical School, College of Physicians and Surgeons in New York. He was also a graduate of the Berkshire Medical College.
Garratt was surgeon to the United States Dragoons at Fort Des Moines, Iowa, and United States Vice Consul at Port-Au-Prince for two years. After the government position as Vice Consul he practiced medicine and kept an apothecary's shop in Abington, Massachusetts. He was admitted to the Massachusetts Medical Society in 1849.
Garratt came to Hanover, Massachusetts, in 1851 and resided in the house left vacant by Dr. Fobes which was originally built by the Rev. Joab G. Cooper, rector of Saint Andrew's Parish. The house was built with wood from the old Episcopal Church building at Church Hill when it was torn down to make way for the present church in Hanover.
Medical electrical invention.
Garratt patented a physiological "button" battery on July 6, 1869. The invention (no. 92,301) consisted
of several button size discs made from copper or silver and an alloy of dissimilar metals. The assembly of "button" battery discs was constructed into a flexible insulation base. The small batteries were wired together and a set metallic connections were made at each end of the assembly for the plus and minus electrical connections. The idea behind the flexible insulation base was so that it could be worn upon uneven body parts like arms and legs.
Family.
Garratt's daughter Harriet was born in 1838. His son Charles was born in 1844. His second son, Joshua, was born in 1850 and his third son, Allen, was born in 1853. Garratt's first wife, Elizabeth, was born in 1817. His second wife, Martha, was born about 1815. By 1880 Garratt was widowed.
Later life.
Garratt moved to Boston after practicing in Hanover for about twenty years. In Boston he had a medical office for many years in the rear of the renown Tremont House. He became the first full-time medical doctor in electrotherapy in the United States.
Retirement and death.
Garratt retired from practice in 1888. In 1891 he died at the age of seventy-eight years.


Immune repertoire

The immune repertoire encompasses the different sub-types an organism's immune system makes of immunoglobulins or T-cell receptors. These help recognise pathogens in most vertebrates. The sub-types, all differing slightly from each other, can amount to tens of thousands, or millions in a given organism. Such a wide variety increases the odds of having a sub-type that recognises one of the many pathogens an organism may encounter. Too few sub-types and the pathogen can avoid the immune system, unchallenged, leading to disease.
Development.
Lymphocytes generate the immune repertoire by recombining the genes encoding immunoglobulins and T cell receptors through V(D)J recombination. Although there are only a few of these genes, all their possible combinations can result in a wide variety of immune repertoire proteins. Through selection, cells with autoreactive proteins (and thus may cause autoimmunity) are removed, while cells that may actually detect an invading organism are kept. The immune repertoire is affected by several factors:
Size.
Due to technical difficulties, measuring the immune repertoire was seldom attempted. Estimates depend on the precise type or 'compartment' of immune cells and the protein studied, but the expected billions of combinations may be an over-estimation. The genetic spatio-temporal rule governing the TCR locus rearrangements imply that V(D)J rearrangements are not random, hence resulting in a smaller V(D)J diversity.
Future developments.
Next generation sequencing may have a large impact. This can obtain thousands of DNA sequences, from different genes, quickly, at the same time, relatively cheaply. Thus it may be possible, to take a large sample of cells from someones immune system, and look quickly at the range of sub-types present in the sample. The ability to obtain data quickly from tens or hundreds of thousands of cells, one cell at a time, should provide a good idea, of the size of the person's immune repertoire. These large-scale adaptive immune receptor repertoire sequencing (AIRR-seq) data require specialized bioinformatics pipelines to be analyzed effectively. Many computational tools are being developed for this purpose. The Immcantation framework provide a start-to-finish analytical ecosystem for high-throughput AIRR-seq data analysis. The AIRR Community is community-driven organization that is organizing and coordinating stakeholders in the use of next-generation sequencing technologies to study immune repertoires. In 2017, the AIRR Community published recommendations for a minimal set of metadata that should be used to describe an AIRR-seq data set when published and deposited in a public repository.


Bader Philanthropies

Bader Philanthropies Inc. is a Milwaukee, Wisconsin based foundation that consists of funds from the Helen Daniels Bader Fund and the Isabel and Alfred Bader Fund. It pledges to give away $14 million annually. The organization will center on the health of older adults and improving lives of low-income Milwaukeeans and Jewish education in Milwaukee.
History.
The Helen Daniels Bader Fund has a history of focusing on Alzheimer's and the health of older adults, and the Isabel and Alfred Bader Fund which focuses on "improving the lives of low-income Milwaukeeans and Jewish education throughout the city."
Grantees.
These are among the grants awarded:


Queen Sirikit National Institute of Child Health

Queen Sirikit National Institute of Child Health () is large public hospital located in Ratchathewi District, Bangkok, Thailand. It serves as a teaching hospital for the College of Medicine, Rangsit University.
History.
With plans to expand the pediatrics department of the Women's Hospital (now Rajavithi Hospital), the cabinet of Plaek Phibunsongkhram approved the construction of a pediatrics building with a capacity of 137 beds on Ratchawithi Road, which was to be operated by the Women's Hospital. The opening ceremony took place on 24 June 1954. By a 1973 royal decree of civil service management, operations were transferred to the Department of Medical Services of the Ministry of Public Health on 3 December 1974 and the building became the Children's Hospital. In 1996, the name was changed to Queen Sirikit National Institute of Child Health in commemoration of the Queen.
The institute was the first medical institution to offer a pediatrics training program that was not led under the University of Medical Sciences (now Mahidol University), and it's setup was aided by the Faculty of Medicine Siriraj Hospital and Faculty of Medicine, Chulalongkorn University.
Rajavithi Hospital started providing medical education for students of the College of Medicine, Rangsit University since 1 June 1992. Students in this group also study at Rajavithi Hospital as a teaching hospital.


Pierre Debray-Ritzen

Pierre Debray-Ritzen (27 February 1922 – 7 July 1993) was a French psychiatrist.
He was a member of the Club de l'horloge.


Congenital preauricular fistula


Carlo de Leeuw

Carlo de Leeuw (12 December 1960 – 13 February 2020) was a Dutch footballer.
Club career.
A talented forward, De Leeuw came through the youth system of hometown club Feyenoord and made his professional debut for them against Excelsior on 23 September 1979. He won a penalty and scored one of their goals in the 1980 Cup final against eternal rivals Ajax. After four years he joined city rivals Excelsior for whom he had two different spells. He made his debut for them on 22 August 1982 against his former club Feyenoord. He scored 25 goals in 184 league and cup games for Cambuur between 1983 and 1989 and was voted best Cambuur midfielder of all-time in 2007. He played another 88 games for FC Eindhoven between 1989 and 1993 and had a season at FC Volendam for whom he played 22 matches in the 1991–92 season.
After being released by Eindhoven, he had a spell at amateur side Witgoor Dessel in Belgium.
International career.
He played 7 games for the Netherlands U-19 team, scoring 2 goals, between July 1978 and April 1979.
Later years.
After retiring as a player, he became kit man at Feyenoord and the national team in 2002.
Personal life.
In summer 2019, de Leeuw was diagnosed with tongue cancer and he died on 13 February 2020. He was survived by his wife Charlotte and their two daughters.


Remedy UK

Remedy UK was a pressure group representing junior doctors in the United Kingdom. The organisation was set up by four junior doctors in 2007 to campaign against UK government-led medical training reforms known as Modernising Medical Careers(MMC) and their implementation through the Medical Training Application Service (MTAS). Remedy UK was created in response to what was perceived to be an insufficiently robust response by the official doctors' trade union, the BMA, and professional associations (Royal Colleges of Medicine).
Remedy UK had over 13,000 members and campaigns as a grassroots doctors' organisation. It was supported by optional subscriptions from its members.
Remedy UK announced its closure on 15 May 2012, saying it had been "unable to sustain the management and leadership that an effective Remedy needs."
Campaigns.
Remedy UK have mounted a number of high-profile campaigns against Modernising Medical Careers.


Juan Almenar

Juan Almenar was a Spanish physician of the 15th century, and author of one of the first books on syphilis, "De lue venerea sive de morbo gallico" (Venice, 1502). He was born in Valencia.


NHS Employers

NHS Employers is an organisation which acts on behalf of NHS trusts in the National Health Service in England and Wales. It was formed in 2004, is part of the NHS Confederation, and negotiates contracts with healthcare staff on behalf of the government.
History.
In January 2004 the Department of Health announced the responsibility for negotiating staff terms and conditions was to be devolved by them to the NHS Confederation. In November 2004 NHS Employers was formed, and became the body that negotiates healthcare staff contracts on behalf of the government. They regularly collect and analyse the views of employers.
In September 2014, Danny Mortimer was named Chief Executive of NHS Employers, succeeding Dean Royles.
Initiatives.
In 2005, most NHS trusts estimated that around half of their staff were suffering from workplace stress, but less than a third of health service managers that responded were able to say that their trusts had a stress management policy at the time.
In 2012 they launched a "Speaking Up Charter", asking NHS trusts to commit to actions that would help staff to raise concerns.
In June 2014 they published statistics highlighting the proportion of women in various sections of the NHS workforce.


DHL Supply Chain

DHL Supply Chain is a division of Deutsche Post DHL and is affiliated with DHL. Headquartered in Bonn, Deutsche Post has 510,000 employees.
In 2016, DHL Supply Chain was primarily competing in strategic life sciences and healthcare, automotive and technology sectors of the market. The automotive sector, with its Lead Logistics Provider (LLP) service, has been shifting to China, India and Mexico as those countries become significant vehicle and parts manufacturers. In Canadian and USA markets DHL Supply Chain operated under the name Exel until January 2016.
In 2016, the DHL Supply Chain division's revenue decreased by 11.6% to €14.0 billion versus 2015, but operating profit improved by 27.4% to €572 million.
Headquarters.
DHL Supply Chain is incorporated in Bonn, Germany as a part of Deutsche Post DHL global headquarters. The main building is Post Tower. Located in the former government quarter and built using large quantities of glass, it is impressive because of its modern architecture. The tower is 162 meters (531.5 feet) high, 82 meters (269 feet) long and 41 meters (134.5 feet) wide.
Mergers and acquisitions.
The acquisition of the Swiss logistics provider Danzas and the largest American service provider in the field of international airfreight, Air Express International (AEI), by Deutsche Post, happened in 1999. Founded in 1815, the prestigious Danzas group was regarded as one of the world's leading logistics companies. With approximately 29,000 employees at the time of acquisition, Danzas had a strong logistics network on all continents.
The acquisition of AEI was similar. AEI had a network of branches in 135 countries. In addition to integrated logistics and multi-modal transport, it was offering warehousing, distribution, customs processing and IT-based logistics services. AEI was integrated into the Intercontinental division of Danzas. As a full-service provider, the merged companies provided Deutsche Post with a dense transport network as well as an impressive portfolio of value-added services.
The partnership with DHL International, which began with the acquisition of a minority interest in 1998, was expanded and intensified in 2000. Negotiations were then concluded, allowing Deutsche Post to establish a majority interest from 1 January 2002. In July 2002, Deutsche Post acquired a 25-percent share in DHL from Lufthansa Cargo and increased its majority stake to 75 percent.
At the time, DHL Worldwide Express had more than 71,000 employees worldwide. A pioneer in global express shipping, DHL's international network linked over 220 countries and territories. DHL became a wholly owned subsidiary of the Group in December 2002 after Deutsche Post acquired the remaining shares from two investment funds and Japan Airlines.
In December 2005, Deutsche Post acquired the British logistics company Exel for 5.5 billion euros. At that time, approximately 111,000 employees worked for Exel in 135 countries. The company concluded the first half of 2005 with a 55 percent leap in profits to 172 million pounds (251 million euros).
In 2006 Deutsche Post took a majority stake in Williams Lea, a business process outsourcing (BPO) provider specializing in document management and mail services.
In July 2011, DHL acquired Tag Worldwide, an international provider of marketing execution and production services.
In 2017, DHL sold the combined Williams Lea Tag business to Advent International.
In May 2018, DHL Supply Chain strengthened its presence in Latin America by acquiring Colombian logistics company Suppla Group. At the time of the acquisition, Suppla employed over 4,500 employees in 25 cities of Colombia.
Regions and sectors.
DHL Supply Chain is organized into six regions: North America, South America, APAC (Asia Pacific), Greater China, MLEMEA (Mainland Europe, Middle East, and Africa), and UK&I (United Kingdom and Ireland). The Exel brand was retained for North America (USA and Canada), with the headquarters for the region in Westerville, Ohio. In 2016, the Exel brand transitioned DHL Supply Chain for the North America region. DHL Supply Chain trades in six focus sectors: AEMCE (Automotive, Engineering, Manufacturing, Chemical and Energy) Consumer, Retail, Technology, Service Logistics, Life Sciences and Healthcare.
Consumer and retail.
Consumer and Retail are two of DHL Supply Chain's largest sectors. Both of these offer major growth potential for the division, since DHL manages the supply chains all the way from the source of supply to the end customer. Services in these sectors range from international inbound logistics and warehouse and transport services, to packaging and other value-added services.
Technology.
In the Technology sector, DHL Supply Chain's portfolio of offerings ranges from inbound-to-manufacturing services and warehouse and transport services to integrated packaging, returns management and technical services.
Life sciences and healthcare.
In 2011, DHL Supply Chain acquired Eurodifarm, a specialist in the controlled-temperature distribution of pharmaceutical and diagnostic products. The purchase was made to strengthen DHL Supply Chain's market leadership in Italy in this sector.
In England, DHL Supply Chain operated the NHS Supply Chain for the National Health Service until April 2019. It has a contract for patient transport services in North London and has been criticised for poor response times to patients wanting to book a service and for refusing disabled people permission to bring an escort. The Royal Free London NHS Foundation Trust oversees the call centre.
Automotive.
The Automotive industry is one of DHL Supply Chain's global sectors. The company has a strong presence in emerging markets such as China, India and Brazil.
Energy.
The fast-growing Energy sector is another market in which the DHL divisions provide logistics for both the build and run phases of major projects.
Products.
In the Supply Chain business, DHL Supply Chain provides customers in many industry sectors with logistics services along the entire supply chain – from planning, sourcing, production, storage and delivery to returns logistics and value-added services – in order to ensure logistics flow.
DHL Supply Chain offers warehousing, distribution, managed transport and value-added services as well as business process outsourcing, supply chain management and consulting. DHL Supply Chain's goal is to ensure that their customers’ products and information reach their markets quickly and efficiently, thus securing them competitive advantages.
Some of the key DHL Supply Chain products include: Lead Logistics Provider, Packaging Services, Integrated Logistics Procurement, Technical Services, Service Parts Logistics, e-Fulfillment, Airline Business.
Market position.
DHL Supply Chain was the global market leader in contract logistics with a market share of 8.3% (2010). In this highly fragmented market, the top ten players account for only about 23% of the overall market, the size of which is estimated to be €147 billion. DHL Supply Chain is the regional market leader in the regions of North America, Europe and Asia Pacific and also has a very strong position in rapidly growing markets such as Brazil, India, China and Mexico.
Financial results.
DHL Supply Chain, as the contract logistics business of Deutsche Post DHL, generated profitable growth in year 2011. Revenues and earnings were well above the previous year's level. The division reported a revenue increase of 1.2 percent to EUR 13.2 billion (2010: EUR 13.1 billion). As a result of portfolio adjustments made during 2011 – such as the divestment of a subsidiary in the United States that was not part of the division's core business – this result only partially reflects the division's operating performance. Adjusted for these consolidation and exchange-rate effects, SUPPLY CHAIN's revenues rose by nearly 6 percent, or more than EUR 700 million, in 2011.
This increase was fueled in particular by strong growth in the Asia-Pacific region as well as in the Life Sciences & Healthcare and Automotive sectors. Additional contracts worth EUR 1.3 billion were concluded in 2011, an increase of around EUR 200 million versus the previous year. Combined with additional operating improvements and strict cost management, increased business activity drove up the division's earnings in 2011. At EUR 362 million, the operating earnings were 56.7 percent above the previous year's level of EUR 231 million.


ASC Healthcare

ASC Healthcare is a mental health service provider based in Bolton. It runs the Breightmet Centre an autism treatment centre in Bolton which opened in 2013, and a small hospital, Mayfield Court in Whalley Range which is used for short term placements of mental health patients. It also proposes to open a similar acute crisis unit for mental health patients in Blackburn.
The Breightmet Centre, which took patients from all over England, was forced to shut suddenly after "serious concerns" were raised by the Care Quality Commission in July 2019 and its registration was revoked. The inspectors identified serious concerns both with the centre’s physical environment and with the company’s understanding of patients' healthcare needs. The site was dirty, with food and human waste in some of the bedrooms and social areas. Services were taken over by Mersey Care NHS Foundation Trust. It was rated “Good” in 2018. The second inspection appears to have been undertaken as result of complaints by a parent of a 20-year old resident from Gloucestershire who said that both she and her son were absolutely traumatised.
Subsequently Mayfield Court, which was used by NHS trusts when there were no available beds, was also inspected by the Care Quality Commission. It was rated ‘inadequate’ overall and placed into special measures. There were complaints about the state of the premises. The service’s quality audits had failed to fully identify risks, including a ligature point and the external perimeter fence being easily climbable. There had been 10 incidents of people leaving the service without authorisation since May 2019.


HealthPlanOne

HealthPlanOne, LLC., now known as HPOne, is a sales and marketing organization that operates across multiple segments of the Medicare and health insurance marketplaces. Using specially developed technology solutions, the company provides outsourced sales, marketing and contact services for national and regional health plans, operates exchanges for individual consumers and employer-based group retirees, and manages lead generation in the Medicare industry. The company operates seven contact centers: two in Arizona (Phoenix and Gilbert), three in Florida (Tampa, St. Petersburg and Orlando) One in Westford, MA and Trumbull, CT.
History.
HPOne was founded in 2006 as HealthPlanOne in Southport, Connecticut by Bill Stapleton and entered the brokerage business in 2007. In 2008, the company raised $6.5 million of venture capital to expand its brokerage and enter the Medicare market. The company moved into the internet sales arena as it began marketing exclusive Medicare leads and launched its nationwide Medicare Exchange. In 2010, they added exclusive Individual/Family Plan and Group leads to their lines of business and by 2011, HealthPlanOne became the largest provider of exclusive Medicare leads in the country. In 2012, the company launched its integrated, cloud-based sales technology platform through its "Licensed Broker Solutions Center". In that same year, HealthPlanOne expanded its call center services to a facility in Tampa, Florida. It also launched its Mobile Application in 2012. In 2013, the company entered the Member Acquisition business acting as a full service contact and sales center for national and regional health plans. In 2013, the company also became an authorized Web Broker Entity through an agreement with The Centers for Medicare and Medicaid Services (CMS). They launched their "Employer Solutions" offering targeted at Employer Groups and Brokers and expanded their call center in St. Petersburg, Florida in 2013 as well. In July 2014, the company opened a third call center in Phoenix, Arizona and in December 2014 closed an investment round of growth capital from Peloton Equity, naming Carlos Ferrer and Theodore Lundberg to the Board of Directors. In May 2015, Leslie V. Norwalk, Esq., J.D., former head of The Centers for Medicare and Medicaid Services (CMS) and Richard Fernandes, Director and former president of Affinion Group, also joined its Board of Directors. In 2015, HealthPlanOne began doing business as HPOne, establishing a new corporate name as the company expanded its products and services. Its Connecticut headquarters moved from Shelton, Connecticut to Trumbull, Connecticut. Also in 2015, HPOne launched its "Stars Solutions" program for Medicare Managed Care Plans. This modular program enables Medicare insurers to tailor Stars initiatives to address unique member and physician opportunities. In that same year, 2015, HPOne launched a next-generation multi-carrier "Exchange Solutions" for retirees. The ClearChoice Exchange offers a national preferred provider organization group plan from United Healthcare alongside individual Medicare Advantage plans.


Thomas Boylston

Thomas Boylston (January 26, 1644-1695) was a prominent early-American doctor and patriarch of the influential Boylston family of Massachusetts.
Thomas Boylston was born in 1644 in Watertown, Massachusetts to Thomas Boylston Sr. He became a surgeon in 1665 and married Mary Gardner and they had twelve children. He was surveyor of Muddy River in 1674 and lived at the western end of the Brookline Reservoir which was then a marshy meadow. He lived in Brookline, Massachusetts (Muddy River) near what is now Boylston Street on land from his wife's family. He was the great-grandfather of U.S. President John Adams, through his granddaughter, Susanna.


John Brough

John Brough (rhymes with "huff") (September 17, 1811 – August 29, 1865) was a War Democrat politician from Ohio. He served as the 26th Governor of Ohio during the final years of the American Civil War, dying in office of gangrene shortly after the war concluded.
Early life and career.
Born in Marietta, Ohio, to an English immigrant and a Pennsylvania-born mother, Brough was orphaned at the age of 11. To support himself, he became a printer's apprentice, and later received three years of part-time education at Ohio University, where he worked part-time as a reporter for the "Athens Mirror". He rose to become a newspaper publisher in Marietta and then in Lancaster, where he and his brother Charles purchased the "Ohio Eagle", a paper that espoused the views of the Democratic Party.
Brough served two years as Clerk of the Ohio Senate (where he also served as the capital correspondent for his newspaper, as well as the "Ohio Statesman"). He was elected as a Democrat to the Ohio House of Representatives in 1837, representing the Fairfield-Hocking district, and served from 1838–39, chairing the Committee on Banks and Currency. He then took office as State Auditor, serving until 1845, when the Whigs swept most of the state's Democrats out of office in the Election of 1844.
He was a trustee of Ohio University from 1840 to 1843.
In 1841, he and his brother bought the "Cincinnati Advertiser" and renamed it the "Cincinnati Enquirer". Brough then moved to Indiana, where he entered the railroad business and became President of the Madison and Indianapolis Railway in 1848. He later presided over the Bellefontaine and Indiana Railway.
In Madison, Indiana, he was remembered for leading the railroad through a period in which it made Madison the leading pork packing city in the nation, but the line then fell prey to competition. His attempt to combat competing lines was the construction of two tunnels as part of an effort to avoid a steep incline at Madison. The company spent more than $300,000 on construction during two years, before the effort was stopped in 1855. The project was known locally as "Brough's Folly" and he left in 1853 when the Madison line underwent a short-lived merger with another railroad company.
Brough was a very large and corpulent man, as well as being a hard worker. The railroad company named one of its engines "John Brough" in his honor When it arrived in Madison on May 10, 1850, the Madison Courier of May 11 made the following comment that was printed in the Scientific American of June 1, 1850. "We are told this engine is called the John Brough on account of its great weight and for the great amount of business it is capable of doing."
Governor of Ohio.
Ohio Republicans and War Democrats dissatisfied with the leadership of Ohio Gov. David Tod turned to Brough after he made a strongly pro-Union speech in his hometown of Marietta on June 10, 1863. He was elected to the governorship that fall on a pro-Union ticket, partly due to his stronger support than Tod of the anti-slavery direction that the Northern war effort was taking. Having been elected as a representative of the Unionist Party, Brough is the last Ohio governor to date who was neither a Democrat nor a Republican. Brough also defeated Copperhead leader Clement Vallandigham. This prompted President Abraham Lincoln to wire Brough, "Glory to God in the Highest. Ohio has saved the Nation."
Brough took office in January 1864. Ohio historian Walter Havighurst described Brough as being "a big bull of a man with driving energy," and Richard H. Abbott wrote that he "had a reputation for rough and ready politics with a temperament to match... [he was] a blunt, outspoken, rude man who loved to chew tobacco [and thus] presented quite a contrast with his two handsome and dignified predecessors, William Dennison and David Tod."
As governor, Brough strongly supported the Lincoln Administration's war efforts and was key to persuading other Midwestern governors to raise 100-day regiments in early 1864 to release more seasoned troops for duty in Gen. Ulysses S. Grant's spring campaign. Ohio contributed more than 34,000 troops, and was the only one of the five participating states (the others were Indiana, Illinois, Iowa and Wisconsin) to exceed its quota. Brough supported Lincoln's reelection in 1864, despite the machinations of Ohio's favorite son Salmon P. Chase, and worked tirelessly to support the state's soldiers in the field. When Chase resigned as Secretary of the Treasury, Brough was offered the position but declined it to remain as governor.
With the conclusion of the war in 1865, the pro-Union alliance between Ohio's Republicans and War Democrats dissolved, and the now-dominant Republicans looked elsewhere for a candidate. On June 15, Brough announced that he would not seek the gubernatorial nomination again but would not decline it if offered; it was not. Later that summer, Brough stumbled in the State House yard, bruising his hand and badly spraining his ankle. Using a cane caused inflammation over time and gangrene eventually set in.
Abbott wrote that Brough "had given his full efforts to serving his state... [and did so] with energy and ability." Historian Richard C. Knopf wrote, "Whatever may be said of Brough's partisanship and his lack of personal dignity, one must assess in his favor the qualities of integrity, perseverance, and public spiritedness."
Personal life and death.
Brough was twice married and had seven children. In 1832, Brough married Achsah P. Pruden of Athens. She had two children. She died September 8, 1838 at Lancaster. Brough married Caroline A. Nelson, of Columbus, at Lewistown, Pennsylvania in 1843. She had five children.
John Brough died in office on August 29 at the age of 53. He was buried at Woodland Cemetery in Cleveland.
Brough is honored with a full-size bronze depiction inside the Cuyahoga County Soldiers' and Sailors' Monument in Cleveland, Ohio for his service as governor during the Civil War.
References.
General


Naval Medical Research Unit Two

Naval Medical Research Unit Two (NAMRU-2) is a biomedical research laboratory of the US Navy established with the purpose to study infectious diseases of potential military significance in Asia. NAMRU-2 is officially registered as a subordinate command of Naval Medical Research Center located on Silver Spring, Maryland, U.S. and considered as the center network of laboratories around the world.
NAMRU-2 operates in several countries in Southeast Asia, including Vietnam, Laos, Singapore, Philippines, Thailand, and Indonesia. In Phnom Penh, Cambodia, NAMRU-2 opened, outfitted, and staffed a satellite laboratory to conduct regional infectious disease outbreak research, and diagnostic laboratory support within the Office of Defense Cooperation, U.S. Embassy Singapore.
Location.
NAMRU-2 was founded as Naval Medical Research Unit 2, at Rockefeller University in New York City in 1944 with Captain Thomas Rivers as commanding officer. It moved to Guam in 1945 to study medical problems of the Navy and Marine Corps during World War II pacific operations. In 1955 Commander Robert Allan Phillips convinced US naval leadership that a research presence was needed in the pacific region. NAMRU-2 was reestablished in Taipei, Taiwan in 1955 with now Captain Phillips as its commanding officer. Phillips would remain as commander for the next 10 years.
In 1966, NAMRU-2 opened a detachment at the Naval Support Activity Hospital in Da Nang, South Vietnam. It was here that Lieutenant Myron Tong performed some of his seminal research into pathogens infecting combat wounds resulting in the first descriptions of acinetobacter baumannii infection in combat casualties. The research detachment would remain until 1970 when it was disestablished.
In 1970, NAMRU-2 would establish a detachment in Jakarta, Indonesia upon the invitation of Indonesian Ministry of Health officials. In 1979, U.S. diplomatic recognition of the People's Republic of China resulted in the relocation of the NAMRU-2 Command from Taipei to Manila, Philippines and in 1990 due to political upheaval and possible threats to US personnel it was again relocated to Jakarta, Indonesia. The facility in Jakarta is located in 62,000 square feet of laboratory, office and storage spaces in three buildings within the Indonesian Ministry of Health, National Institutes of Health (Badan LITBANGKES) compound. In the 1990s NAMRU-2 performed cutting edge research on the use of primaquine as primary prophylaxis for plasmodium falciparum malaria in Javanese men living in Irian Jaya.
In 1998, NAMRU-2 became part of the newly reorganized Naval Medical Research Center.
In 2002, Phnom Penh activities were established by NAMRU-2 to conduct regional infectious disease research and diagnostic laboratory support, operating out of a laboratory located at the National Institutes of Public Health, Phnom Penh, Cambodia. In 2007, to reflect Navy Medicine’s priorities in response to global emerging infectious disease threats, NAMRU-2 recognized the activities in Phnom Penh as a detachment, while at the same time opening a detachment within the Office of Defense Cooperation, U.S. Embassy Singapore.
Achievement.
In 1946, NAMRU-2 was redesignated the U.S. Naval Institute of Tropical Medicine (NITM) reflecting its focus on tropical infections of interest to the military such as malaria and Dengue fever. In 1947 NAMRU-2 developed a therapeutic regimen for cholera utilizing whole blood and plasma-specific gravity as guides, this work was a breakthrough in determining life-saving extracellular fluid requirements. However NITM was disestablished shortly thereafter.
NAMRU-2 would respond to Cholera epidemics in Bangkok, Thailand in 1958, Sulawesi, Indonesia and the Philippines in 1961, where it became a world leader in cholera research and treatment. In 1961 it established a collaborative research site at San Lazaro Hospital in Manila to assist in the El tor cholera outbreak in the Philippines, here several key hypotheses of correct intravenous fluid rehydration for cholera treatment were proven.
In 1969 researchers at NAMRU-2 would be the first to demonstrate the role of attenuated Rubella vaccine in preventing naturally acquired disease in man.


Paul Leopold Friedrich

Paul Leopold Friedrich (January 26, 1864 – January 15, 1916) was a German surgeon and bacteriologist born in the town of Roda, Saxe-Altenburg.
In 1888 he received his doctorate at the University of Leipzig, and as a young assistant worked under Robert Koch (1843-1910) at the Reich Health Office in Berlin. From 1894 he worked as a privat-docent of surgery in Leipzig, where in 1896 he became an associate professor. Later he served as a professor at the Universities of Greifswald (from 1903), Marburg (from 1907) and Königsberg (from 1911). At Greifswald he succeeded August Bier (1861-1949) as director of the Surgical University Hospital. Two of Friedrich's well-known assistants were Ferdinand Sauerbruch (1875-1951) and Martin Kirschner (1879-1942).
Friedrich was skilled in many aspects of surgery, including pioneer work in the field of thoracic surgery (lungs). He is remembered for his studies of wound treatment and his efforts to reduce bacterial infections. Through experimentation, he demonstrated the importance of debridement (removal of infected tissue) within a six-hour time limit. He also did extensive work involving diseases that included peritonitis and tuberculosis. He is credited for introducing the practice of using seamless rubber gloves during surgery.


Andrew Thomson (author)

Andrew Thomson is a New Zealand born UN doctor and co-author of the international best seller "Emergency Sex and Other Desperate Measures"
Graduating top of his year from Auckland School of Medicine in 1983, Thomson has dedicated his life to humanitarian aid. He has worked as a medical officer in the UN in New York, Cambodia and Haiti. He has also worked with the international criminal tribunals for the former Yugoslavia and for Rwanda. His main work was in exhuming mass graves to gather forensic evidence to prosecute government officials.
Thomson's interest in humanitarian work came about when he was a medical student at the University of Auckland where he befriended Vary a Cambodian student who was one of the 60 doctors who survived the notorious killing fields.
"Emergency Sex" was published in October 2004 in a shroud of controversy as officials as high up as Kofi Annan tried to stop the book from being published. Thomson was sacked for his role in the book but with the help of the Government Accountability Project, a whistleblower's association, Thomson was reinstated and promoted.
The book has been optioned for television. Randall Wallace, script writer for Braveheart, is working on the screen play.
In 2006 Thomson received a Distinguished Alumni Award from the University of Auckland.
Thomson is currently a Senior Medical officer with the UN but is currently living in Cambodia with his wife and daughter.


Foramen cecum (frontal bone)

The frontal crest of the frontal bone ends below in a small notch which is converted into a foramen, the foramen cecum (or foramen caecum), by articulation with the ethmoid.
The foramen cecum varies in size in different subjects, and is frequently impervious; when open, it transmits the emissary vein from the nose to the superior sagittal sinus. This has clinical importance in that infections of the nose and nearby areas can be transmitted to the meninges and brain from what is known as the danger triangle of the face.


Friedrich Fehleisen

Friedrich Fehleisen () (1854–1924) was a German surgeon whose work focused on streptococcal bacteria. Dr. Fehleisen's work played a necessary role in the eventual uncovering of the etiology of many streptococcal illnesses. He made integral contributions to modern medicine's understanding of the "Streptococcus pyogenes" organism. He was born in Reutlingen, Württemberg, in 1854, and died in San Francisco, California, in 1924.
"S. pyogenes".
In 1883, he became the first person to culture and collect "Streptococcus pyogenes", which causes scarlet fever and other streptococcal illnesses. He cultured it from perierysipelas lesions on humans. One year later, the organism received its current name from Rosenbach. German physician Friedrich Loeffler subsequently demonstrated the presence of streptococci in the throats of patients with scarlet fever.
Erysipelas.
Additionally, Dr. Fehleisen uncovered the etiology of erysipelas, which is an acute streptococcal bacterial infection of the upper dermis and superficial lymphatics. His literature "Die Aetiologie Des Erysipels", which was originally published in 1883, outlines his findings. The book was republished in 2010, under the ISBN numbers 1149675756 and 9781149675755
References.
Fehleisen, F. Etiology of Erysipels Die, Berlin, 1883.


Xeromammography

Xeromammography is a photoelectric method of recording an x-ray image on a coated metal plate, using low-energy photon beams, long exposure time, and dry chemical developers.
It is a form of xeroradiography.
This process was developed in the late 1960s by Jerry Hedstrom, and used to image soft tissue, and later focused on using the process to detect breast cancer.


Nathaniel Heckford

Dr. Nathaniel Heckford (1842–1871) was a paediatrician in Victorian London, who founded the East London Hospital for Children. He met his future wife, Sarah Goff, during the 1866 cholera epidemic in Wapping, where he first determined a need for a children's hospital in the East End of London. Heckford died of tuberculosis (then known as consumption) at the age of 29.
The hospital started in 1868 in a warehouse in Ratcliffe, and moved after his death to Glamis Road, Shadwell. It was the first London hospital for children under two years of age. It was described in some detail by Charles Dickens in two pieces called 'A Small Star in the East' and 'On An Amateur Beat' published in "The Uncommercial Traveller".
In 1932 it was renamed as the Princess Elizabeth of York Hospital for Children. A decade later, it amalgamated with the Queen's Hospital for Children, which had been founded in 1867 as the Dispensary for Women and Children. The newly merged institution was called Queen Elizabeth Hospital for Children until its closure in 1963.
Heckford Street, off the east end of The Highway, commemorates Dr. Heckford. Created in the early 21st century, it is a small business park, mostly occupied by electrical and building trades.


Mutalyzer

Mutalyzer is a web-based software tool which was primarily developed to check the description of sequence variants identified in a gene during genetic testing. Mutalyzer applies the rules of the standard human sequence variant nomenclature and can correct descriptions accordingly. Apart from the sequence variant description, Mutalyzer requires a DNA sequence record containing the transcript and protein feature annotation as a reference. Mutalyzer 2 accepts GenBank and Locus Reference Genomic (LRG) records. The annotation is also used to apply the correct codon translation tables and generate DNA and protein variant descriptions for any organism. The Mutalyzer server supports programmatic access via a SOAP Web service described in the Web Services Description Language (WSDL) and an HTTP/RPC+JSON web service.
Background.
Genetic testing is generally performed in families with hereditary disease. Any sequence variant identified in a gene can be described in test reports using the position of the change and the nucleotide or amino acid involved. With this simple rule, a deletion of the nucleotide guanine (G) in a stretch of 4 G nucleotides might be described in 4 different ways, when each of the G positions is used. Although different descriptions do not affect the functional consequences of the change, they may obfuscate the fact that two persons share the same variant or the real frequency of a variant in the population. The standard human sequence variant nomenclature proposed by the Human Genome Variation Society was developed to solve this problem. Proper variant descriptions are expected to facilitate searches for more information about the functional consequences in the literature and in gene variant or locus-specific databases (LSDBs).
Mutalyzer is used by the Leiden Open Variation Database (LOVD), which stores sequence variant information for many human genes, to check variant descriptions before submission of new data. This helps data sharing, display and integration with other genetic resources (e.g., Ensembl, UCSC Genome Browser, NCBI sequence viewer)


Felice Bedford

Felice Bedford is an American research psychologist born in Brooklyn, NY whose work includes theories of mindfulness meditation and imagery in illness, how the wrong conclusions have been drawn from neuropsych data, mathematical models of growth of the head and body on perception, and a comprehensive theory of perceptual learning and adaptation. Genetic contributions have advanced knowledge of mitochondrial DNA haplogroup T2e Haplogroup T especially in Sephardim worldwide and "conversos" from Mexico. A civic contribution has been services as an expert witness in Arizona to prevent wrongful convictions based on perceptual misidentifications, especially cross-racial ones. She has taught over 10,000 Introductory Psychology students.


John M. Kane

John M. Kane is an American psychiatrist who directs the NIMH-funded Advanced Center for Interventions and Services Research in Schizophrenia at The Zucker Hillside Hospital. Dr. Kane is the recipient of many awards including the Arthur P. Noyes Award in Schizophrenia, the Kempf Fund Award for Research Development in Psychobiological Psychiatry, the Lieber Prize for Outstanding Research in Schizophrenia and the Dean Award from the American College of Psychiatrists. He has published over 300 papers in scientific journals and is one of the most cited doctors in research papers in psychiatry. In the past, he served on the council of the American College of Neuropsychopharmacology and has chaired the NIMH Psychopathology and Psychobiology Review Committee.
Kane is Vice President for Behavioral Health Services of Northwell Health and Chairman of Psychiatry at The Zucker Hillside Hospital. He is Chairman of Psychiatry and Professor of Psychiatry and Molecular Medicine at the Hofstra North Shore-LIJ School of Medicine.


Canadian Neonatal Network

The Canadian Neonatal Network (CNN) is an organization composed of neonatologists and neonatal health professionals from across Canada. The network was created in 1995 by Dr. Shoo Kim Lee, and currently its steering committee is composed of Drs. Keith Barrington, Aaron Chiu, Kim Dow, Jonathan Hellmann, Bruno Piedboeuf, Molly Seshia, Prakesh Shah (who also serves as the Associate Director of the Network) and Wendy Yee. Sandy Maksimowska currently holds the position of CNN Project Coordinator.
Recognition.
The CNN was recognized in 2004 by the Canadian Institutes of Health Research (CIHR) with their "CIHR Knowledge Translation Award". In the award citation, the CIHR described the CNN as "the archetype of the knowledge translation network in Canada."
Membership.
Canadian hospitals with tertiary NICUs can become institutional members, and individuals with research background in neonatology are welcomed to apply. All applications are screened through a steering committee.


Incisive canals

In the opening of the incisive foramen, the orifices of two lateral canals are visible; they are named the incisive canals or foramina of Stensen.
Through each of them ascends the terminal branch of the greater palatine artery while the nasopalatine nerve descends, to anastomose with the posterior septal branch of sphenopalatine artery and the greater palatine nerve respectively.


Oxford Health Plans

Oxford Health Plans is an American health care company that sells various benefit plans, primarily in New York, New Jersey and Connecticut.
As of 2004, it is a subsidiary of UnitedHealth Group, the largest healthcare company in the world, claiming to be "among the first" to allow patients to see specialists without a referral and to offer alternative medicine treatments.
Overview.
The dark blue membership cards carried by members belonging to its family of "Oxford Health Plans" included various subtitles, such as "Freedom Plan" and "Liberty Plan"; the card's color changed to white. "The Wall Street Journal" described their HMO as "trend-setting" and noted that Oxford "even let patients visit specialists outside its own network."
History.
The company was founded in 1984 by Stephen Wiggins targeting "upscale" doctors and consumers. It claimed major growth in the 1990s increasing from 217,000 members to nearly two million. However, by mid 1998, the company had replaced its founder/CEO, and his successor, William Sullivan.
The "Wall Street Journal" described the company's services as "Ill-Managed Care", and "Newsweek"'s "Deliver, Then Depart" had criticized is practice of limiting payments for new mothers to "drive-by deliveries." The firm was fined $3 million for a variety of legal violations amidst false claims of alleged profits that included double counting of premiums. In 2004 it merged with the 1985-founded UnitedHealth Group.


Enitan Carrol

Enitan Carrol is a British physician and Professor of Clinical Infection, Microbiology and Immunology. Carrol studies the mechanisms that underpin bacterial infection. In 2020 she was featured in Nicola Rollock's exhibition "Phenomenal Women: Portraits of UK Black Female Professors."
Early life and education.
Carrol studied medicine at the University of Aberdeen.
Research and career.
In 2013 Carrol was made a Professor at the University of Liverpool. Her research considers the biological mechanisms that underpin bacterial infections. Carrol has investigated clinic deterioration of children, and looked to understand whether the use of a paediatric early warning score (PEWS) could be used to prevent admission to critical care. In particular, she proposed the use of VitalPAC, an electronic handheld device that healthcare professionals can use to document vital signs and automatically calculate PEWS. Patients with a higher PEWS score require more urgent medical attention, and alert messages are sent to senior nurses and doctors.
She is a member of the National Institute for Health and Care Excellence (NICE) sepsis development group. As part of this work, Carrol has studied the use of antibiotics in treating sepsis. She is interested in whether Procalcitonin (PCT) could be used to improve the assessment and treatment of sepsis. In 2020 Carrol started to work with Imperial College London on the development of rapid diagnostic tests for severe illnesses through the use of gene signatures. Such tests will study the genetic make-up of patient blood samples, and compare them to a comprehensive library of the gene signatures of particular diseases.
Academic service.
Carrol is the Knowledge Exchange Lead at the University of Liverpool Institute of Infection and Global Health. As of February 2019, there were only 25 Black women professors in the United Kingdom. She is a member of Iyiola Solanke's Black Female Professor Forum. In 2020 her portrait was included in Nicola Rollock's exhibition, "Phenomenal Women: Portraits of UK Black Female Professors".


Red Cross Sint Maarten

Red Cross Sint Maarten is the Red Cross national society of Sint Maarten. While technically it is an overseas branch of the Netherlands Red Cross it is registered as an independent entity under Sint Maarten law, auxiliary to the Government of Sint Maarten. Its mission is to prevent and alleviate human suffering wherever it occurs, increasing the self-sufficiency of the communities of Sint Maarten, and ensuring that there is respect and willingness to help in the society. In the aftermath of Hurricane Irma it played an important role in helping the affected people in the country.
Activities.
Response to Hurricane Irma.
Following the devastating impacts of category 5 Hurricane Irma on the 6th of September 2017, the Netherlands Red Cross has raised 19 million euros in the Netherlands for response and recovery. They began organising relief efforts via Red Cross St Maarten, focusing on food and water distribution as well as the distribution of non-food items. A team of approximately 70 people (volunteers and staff) has coordinated Red Cross efforts in the areas of WASH, Restoring Family Links, health, shelter, food, mapping of the most vulnerable areas and conducting assessments. Early recovery focused on cash-based assistance, roof repair and school meal projects. Long term recovery projects currently focus on safe and healthy living, economic security, disaster risk reduction and response preparedness.
Regular activities.
Apart from disaster recovery, the organisation works with training people in first aid, providing first aid at events, collecting and re-distributing second-hand clothes through clothes drives, and fundraising for local and regional emergencies. There is also a building in Belvedere district called the Red Cross Senior Citizens Home, however it is not managed by Red Cross Sint Maarten.
Locations.
The main office of Red Cross St Maarten is located on Airport Road along the runway of Princess Juliana International Airport. In June 2019 the organisation opened a service point in Philipsburg to provide information on ongoing and upcoming Red Cross projects.
Criticism.
In the first weeks after Hurricane Irma some were accusing Red Cross St Maarten for an inadequate and slow response. A Dutch marine was quoted complaining that the military had to distribute their own rations and water because the Red Cross was not providing supplies. According to his account, the marines' primary objective of keeping order on the island was hindered by having to do aid work at the same time.
After Red Cross St Maarten had distributed food vouchers to people, some residents questioned their impartiality by implying that only "a certain few" had received vouchers, whereas people in need were excluded. They claimed that this was a result of a lack of coordination and poor organisation on the Red Cross's part.


Nordic Studies on Alcohol and Drugs

Nordic Studies on Alcohol and Drugs (Norwegian: Nordisk alkohol- & narkotikatidskrift) is a bimonthly peer-reviewed open access medical journal covering research on the health effects of alcohol and other drugs. It was established in 1984 as Alkoholpolitik – Tidskrift för nordisk alkoholforskning (Swedish for "Alcohol Policy – Journal for Nordic Alcohol Research"). It was originally published as part of a partnership between the Nordic Council for Alcohol and Drug Research and the Finnish alcohol company Alko. It was previously published by Walter de Gruyter until being acquired by its current publisher, SAGE Publications, in 2017. The editor-in-chief is Matilda Hellman (University of Helsinki). According to the "Journal Citation Reports", the journal has a 2017 impact factor of 0.683, ranking it 33rd out of 35 journals in the category "Substance Abuse".


Edward Spencer Cowles

Edward Spencer Cowles (September 22, 1879 - November 16, 1954) was an American physician.
Life.
He married Florence Wolcott Jacquith and was the father of Virginia Cowles.
Awards.
The Persian translation of his book "Conquest of fatigue and fear" won the Iranian Royal Book of the Year Award in 1957.


John Dalrymple Edgar Holmes

Lt. Col. John Dalrymple Edgar Holmes (1867 - 2 March 1915) was a British veterinary scientist and bacteriologist who worked in India as Imperial Bacteriologist. He worked on the production of veterinary vaccines especially for rinderpest.
Holmes was born in 1867 to Reverend John Holmes at Tipperary, where he went to the local grammar school before going to Trinity College, Dublin. Graduating with a BA in 1890 he joined the Royal Veterinary College and qualified MRCVS in 1895 and joined the Army Veterinary Department. He was deputed to the Indian Civil Veterinary Department in 1900 and worked as an Assistant Bacteriologist at the Muktesar Laboratory. He went to Cambridge for studies and received a DSc in 1905 followed by work at the Pasteur Institute in Paris. He returned to India and served as a Professor of Sanitary Science at the Punjab Veterinary College in Lahore. He was appointed Imperial Bacteriologist in 1907 to succeed Alfred Lingard. In 1912 he was awarded the Steele Memorial Medal for his work in veterinary medicine. In 1913 he was made Companion of the Order of the Indian Empire. His work in India included major studies on rinderpest.
Holmes' writings included "Veterinary Pharmacopoeia of Bazaar Drugs" and "". He died of a cerebral haemorrhage at Bareilly. He is commemorated at the Royal College of Veterinary Surgeons Memorial in Belgravia House, London.


Kappo

 are healing techniques that often involve stimulation of specific acupuncture points. Kappo is commonly used in martial arts such as Danzan Ryu and Judo. "Kappo" contains two kanji: "katsu" (活 “resuscitation, life”) and "ho" (法 “method”).
More specifically, kappo refers to resuscitation techniques used to revive someone who has been choked to the point of unconsciousness, to lessen the pain of a strike to the groin, to help unlock a seized thoracic diaphragm, to stop a bleeding nose, and other common training injuries. These techniques, as practiced by the martial arts of Judo and Danzan Ryu, can involve striking specific points on the body, manual manipulation of the carotid triangle to open closed arteries, or manually opening and closing the lungs to allow air to flow in and out. The manual manipulation of breathing, which has some similarities with rescue breathing and CPR, is called "katsu".
A tradition in some Judo schools involves teaching kappo to all new shodan (black belts). This instruction is followed by a session where each of the shodan choke someone, are choked themselves, and resuscitate someone using kappo.
Homophone.
Japanese language contains many homophones; "Kappō" written as 割烹 means “cooking” especially relating to Japanese cuisine.


Noreen Fraser Foundation

The Noreen Fraser Foundation (NFF) is a national, non-profit, philanthropic organization based in Los Angeles. Its mission is to raise funds for breakthrough research that advances precision medicine for the prevention and treatment of women's cancers. Their hope is that the cancer will
become a manageable disease that patients will live with and not die from, until it ceases to exist.
The Noreen Fraser Foundation was founded in 2006 by producer Noreen Fraser. Since then, NFF has been actively involved in numerous successful fundraising campaigns, including Stand Up To Cancer and MenForWomenNow.com.
Noreen’s Story.
Noreen Fraser was diagnosed with Stage IV breast cancer in 2001. By 2003, her cancer had metastasized to her bones. After years of fighting, Noreen pledged to devote herself to raising money for focused research to find new techniques to prevent and fight cancer.
She started the Noreen Fraser Foundation in 2006 and recruited other survivors and prominent figures in the medical, entertainment, and business industries to join the organization. In 2008, Noreen Fraser co-created and co-produced the network television special "Stand Up To Cancer" (which raised over $100 million for cancer research).
Prior to starting the Noreen Fraser Foundation, Noreen produced other award winning television shows including, "Entertainment Tonight", ABC’s "Home Show" and "The Richard Simmons Show". Prior to her death in 2017, Noreen was working on producing a documentary about cancer’s effects and developing a television project that would serve to raise awareness for women’s cancers.
Fundraising Programs.
Men for Women Now.
The Men for Women Now campaign targets men and urges them to encourage the women in their lives to schedule appointments for a mammogram and a Pap smear. Last May, the campaign worked with notable celebrities to create e-cards for Mother’s Day.
In Fall 2009, NFF and Men For Women Now teamed up with SocialVibe to create a Save The Boobs Facebook application to raise awareness about Breast Cancer Awareness Month, which takes place in October.
Stand Up To Cancer.
Stand Up To Cancer (SU2C) is a charitable program of the Entertainment Industry Foundation (EIF) established by media, entertainment and philanthropic leaders who have been affected by cancer. The program was televised in over 170 countries on ABC, NBC, and CBS, three major broadcast networks, on September 5, 2008. The campaign raised over $100 million. Noreen Fraser Foundation (NFF) co-created Stand up to Cancer and is a member of their Executive Leadership Committee (ELC).


James N. Butcher

James N. Butcher is an American psychologist. He was a member of the Department of Psychology at the University of Minnesota. He received the Bruno Klopfer Award in 2004.
He was involved in the creation of the 2nd revision of the Minnesota Multiphasic Personality Inventory.
He graduated from Guilford College (B.A. psychology, 1960) then the University of North Carolina at Chapel Hill (M.A. experimental psychology, 1962; Ph.D. clinical psychology, 1964).


Notching of the ribs

Notching of the ribs (or rib notching) is a radiologic sign where the surface of the rib is deformed. It can be characterized as unilateral or bilateral, and should be differentiated between affecting the upper (superior) or lower (inferior) surface of the rib.
Causes.
Inferior rib notching can be associated with aortic coarctation (as a result of dilatation of intercostal arteries), superior vena caval obstruction, arteriovenous fistula, or following a Blalock Taussig shunt.
Causes of inferior rib notching by etiology:
"Arterial": aortic coarctation, aortic thrombosis, pulmonary-oligemia/arteriovenous malformation, Blalock Taussig shunt, Tetralogy of fallot (TOF), absent pulmonary artery and pulmonary stenosis.
"Venous": arteriovenous malformations of chest wall, superior vena cava or other central venous obstruction.
"Neurogenic": intercostal neuroma, Neurofibromatosis type 1, poliomyelitis.
"Osseous": hyperparathyroidism, thalassemia, Melnick–Needles syndrome.
Other causes of superior rib notching include: poliomyelitis, osteogenesis imperfecta, neurofibromatosis, Marfan's syndrome, collagen vascular disease, and hyperparathyroidism.


Costochondral joint

The costochondral joints are the joints between the ribs and costal cartilage in the front of the rib cage. They are hyaline cartilaginous joints (i.e. synchondrosis or primary cartilagenous joint). Each rib has a depression shaped like a cup that the costal cartilage articulates with. There is normally no movement at these joints. Joints between costal cartilages of the sixth and ninth rib are plane synovial joints. Articulation between costal cartilage of the ninth rib and tenth rib is fibrous.
The lateral end of each costal cartilage is received into a depression in the sternal end of the rib, and the two are held together by the periosteum.


Cladosporium

Cladosporium is a genus of fungi including some of the most common indoor and outdoor molds. Species produce olive-green to brown or black colonies, and have dark-pigmented conidia that are formed in simple or branching chains. Many species of "Cladosporium" are commonly found on living and dead plant material. Some species are plant pathogens, others parasitize other fungi. "Cladosporium" spores are wind-dispersed and they are often extremely abundant in outdoor air. Indoors "Cladosporium" species may grow on surfaces when moisture is present. "Cladosporium fulvum", cause of tomato leaf mould, has been an important genetic model, in that the genetics of host resistance are understood. In the 1960s, it was estimated that the genus "Cladosporium" contained around 500 plant-pathogenic and saprotrophic species, but this number has since been increased to over 772 species. The genus "Cladosporium" is very closely related to black yeasts in the order Dothideales. "Cladosporium" species are often highly osmotolerant, growing easily on media containing 10% glucose or 12–17% NaCl. They are rarely grown on media containing 24% NaCl or 50% glucose and never isolated from medium with 32% NaCl or greater. Most species have very fragile spore chains, making it extremely difficult to prepare a mount for microscopic observation in which the conidial chains are preserved intact.
Health effects.
"Cladosporium" species are present in the human mycobiome but are rarely pathogenic to humans, but have been reported to cause infections of the skin and toenails as well as sinuses and lungs.The airborne spores of "Cladosporium" species are significant allergens, and in large amounts they can severely affect asthmatics and people with respiratory diseases. "Cladosporium" species produce no major mycotoxins of concern, but do produce volatile organic compounds (VOCs) associated with odours.
Hyperparasitism on rusts.
Several "Cladosporium" species are known to be hyperparasitic to rust fungi.


Martin Cline

Martin J. Cline (born 1934) is an American geneticist who is the Professor Emeritus of Medicine at the University of California, Los Angeles (UCLA). He did postdoctoral training in hematology-oncology at the University of Utah and was at the University of California, San Francisco before going to UCLA. His research has been in cell biology, molecular biology, and genetics.
Accomplishments.
Cline was the first to successfully transfer a functioning gene into a living mouse, creating the first transgenic organism. His research has also pertained to the molecular genetic alterations in cancer, especially in leukemia.
In 1980, Cline conducted a rDNA transfer into the bone marrow cells of two patients with hereditary blood disorders. He did so in direct opposition to National Institute of Health gene therapy guidelines and without the approval of the Institutional Review Board at the University of California Los Angeles (UCLA), where his research was conducted. The ethical concerns that were generated prompted a call for review by a number of organizations—including the National Council of Churches, Synagogue Council of America, and the United States Catholic Conference. Consequently, Cline was forced to resign his department chairmanship at UCLA and lost several research grants.


Pulmonary consolidation

A pulmonary consolidation is a region of normally compressible lung tissue that has filled with liquid instead of air. The condition is marked by induration (swelling or hardening of normally soft tissue) of a normally aerated lung. It is considered a radiologic sign. Consolidation occurs through accumulation of inflammatory cellular exudate in the alveoli and adjoining ducts. The liquid can be pulmonary edema, inflammatory exudate, pus, inhaled water, or blood (from bronchial tree or hemorrhage from a pulmonary artery). Consolidation must be present to diagnose pneumonia: the signs of lobar pneumonia are characteristic and clinically referred to as consolidation.
Signs.
Signs that consolidation may have occurred include:


Partho P. Sengupta

Partho P. Sengupta is an Indian-American cardiologist. He is the Abnash C. Jain Chair & Professor of Cardiology at West Virginia University School of Medicine and the Chief of Division of Cardiology, Chair of Cardiovascular Innovation and Director of Cardiac Imaging at West Virginia University Heart and Vascular Institute.
Education and work.
Dr. Sengupta received his medical degree from Government Medical College in India. Later, He finished the cardiology fellowship from All India Institute of Medical Sciences and from both Mayo Clinic in Arizona and Minnesota. From 2004 to 2010, Sengupta was the Assistant Professor of Mayo Clinic College of Medicine and Science and in 2011 he became the Director of Noninvasive Cardiology and Cardiac Imaging at University of California. Between 2011 and 2017, he was the Director of Interventional Echocardiography, Director of Cardiac Ultrasound Research and Core Lab at Mount Sinai School of Medicine. From 2017 to the present, he was the Chief of Division of Cardiology, Professor of Medicine and The Abnash C. Jain Chair of Cardiology at West Virginia University Heart and Vascular Institute.
Awards and honors.
Sengupta has won excellence awards including American Society of Echocardiography Young Investigator Award in 2004, Mayo Clinic Research Award in 2007, Mayo Brother's Distinguished Fellowship Award in 2009 and AACIO Young Investigator Award in 2010. He was awarded American Society of Echocardiography 14th Feigenbaum Lecturership for recognizing his contributions to research in the field of echocardiography. In 2020, Sengupta was named a Richard Popp Excellence in Teaching Award recipient by the American Society of Echocardiography. He has been recognized by international societies including the American Society of Echocardiography, American Medical Association, European Society of Cardiology and British Society of Echocardiography for his roles in education and innovation. A group of researchers led by Sengupta won the National Heart, Lung, and Blood Institute big data analysis challenge for creating innovative paradigms in heart failure research.


Spondylolisthesis

Spondylolisthesis is the displacement of one spinal vertebra compared to another. While some medical dictionaries define spondylolisthesis specifically as the forward or anterior displacement of a vertebra over the vertebra inferior to it (or the sacrum), it is often defined in medical textbooks as displacement in any direction. Spondylolisthesis is graded based upon the degree of slippage of one vertebral body relative to the subsequent adjacent vertebral body. Spondylolisthesis is classified as one of the six major etiologies: degenerative, traumatic, dysplastic, , pathologic, or post-surgical. Spondylolisthesis most commonly occurs in the lumbar spine, primarily at the L5-S1 level with the L5 vertebral body anteriorly translating over the S1 vertebral body.
Types.
Olisthesis (synonym olisthy) is a term that more explicitly denotes displacement in any direction. Forward or anterior displacement can specifically be called anterolisthesis. Anterolisthesis commonly involves the fifth lumbar vertebra. Backward displacement is called retrolisthesis. Lateral displacement is called lateral listhesis or laterolisthesis.
A "hangman's fracture" is a specific type of spondylolisthesis where the second cervical vertebra (C2) is displaced anteriorly relative to the C3 vertebra due to fractures of the C2 vertebra's pedicles.
Anterolisthesis.
Classification.
Anterolisthesis can be categorized by cause, location and severity.
By location.
Anterolisthesis location includes which vertebrae are involved, and may also specify which parts of the vertebrae are affected.
"Isthmic" anterolisthesis is where there is a defect in the pars interarticularis. It is the most common form of spondylolisthesis; also called spondylolytic spondylolisthesis, it occurs with a reported prevalence of 5–7 percent in the US population. A slip or fracture of the intravertebral joint is usually acquired between the ages of 6 and 16 years, but remains unnoticed until adulthood. Roughly 90 percent of these isthmic slips are low-grade (less than 50 percent slip) and 10 percent are high-grade (greater than 50 percent slip). It is divided into three subtypes:
Severity.
Classification by degree of the slippage, as measured as percentage of the width of the vertebral body: Grade I spondylolisthesis accounts for approximately 75% of all cases.
Signs and symptoms.
Symptoms of lumbar anterolisthesis include:
Other symptoms may include tingling and numbness. Coughing and sneezing can intensify the pain. An individual may also note a "slipping sensation" when moving into an upright position. Sitting and trying to stand up may be painful and difficult.
Physical Exam.
The major components of the physical exam for spondylolisthesis consists of observation, palpation, and maneuvers. The most common finding is pain with lumbar extension. The following physical involves specific assessment for spondylolisthesis. However, a general examination, most importantly neurological examination, must be done to rule out alternative causes for signs and symptoms. Neurological examination is often normal in patients with spondylolisthesis, but lumbosacral radiculopathy is commonly seen in patients with degenerate spondylolisthesis.
Observation.
The patient should be observed walking and standing. Most patients present with a normal gait. An abnormal gait is often the sign of a high grade case. A patient with high grade spondylolisthesis may present with a posterior pelvic tilt causing a loss in the normal contour of the buttocks. An antalgic gait, rounded back and decreased hip extension, can result from severe pain. While standing, the patient should be observed from the front, back, and signs. Increased and decreased lumbar lordosis, inward curvature of the lower spine, has been seen.
Palpation.
Detection of spondylolisthesis by palpation is most often done by palpating for the spinous process. Each level of the lumbar spine should be palpated. Spinous process palpation by itself is not a definitive method for the detection of spondylolisthesis.
Diagnostic Imaging.
In adults with non-specific low back pain, strong evidence suggests medical imaging should not be done within the first six weeks. It is also suggested to avoid advanced imaging, such as CT or MRI, for adults without neurological symptoms or "red flags" in the patient's history. General recommendations for initial low back pain treatment is remaining active, avoiding twisting and bending, avoiding activities that worsen pain, avoiding bed rest, and possibly initiating a trial of non-steroidal anti-inflammatory drugs after consulting a physician. Children and adolescents with persistent low back pain may require earlier imaging and should be seen by physician. Once imaging is deemed necessary, a combination of plain radiography, computed tomography, and magnetic resonance imaging may be used. Images are most often taken of the lumbar spine due to spondylolisthesis most commonly involving the lumbar region. Images of the thoracic spine can be taken if a patient's history and physical suggest thoracic involvement.
Plain Radiography (X-Ray).
Plain radiography is often the first step in medical imaging. Anteroposterior (front-back) and lateral (side) images are used to allow the physician to view the spine at multiple angles. Oblique view are no longer recommended. In evaluating for spondylolithesis, plain radiographs provide information on the positioning and structural integrity of the spine. Therefore, if further detail is needed a physician may request advanced imaging.
Magnetic Resonance Imaging (MRI).
Magnetic resonance imaging is the preferred advanced imaging technique for evaluation of spondylolisthesis. Preference is due to effectiveness, lack of radiation exposure, and ability to evaluate for soft tissue abnormalities and spinal canal involvement. MRI is limited in its ability to evaluate fractures in great detail, compared to other advanced imaging modalities.
Computed Tomography (CT).
Computed tomography can be helpful in evaluating bony vertebral abnormalities, such as fractures. This can be helpful in determining if the fracture is a new, old, and/or progressing fracture. CT use in spondylolisthesis evaluation is controversial due to high radiation exposure.
Treatment.
Spondylolisthesis patients without symptoms do not need to be treated.
Conservative.
Non-operative management, also referred to as conservative treatment, is the recommended treatment for spondylolisthesis in most cases with or without neurological symptoms. Most patients with spondylolisthesis respond to conservative treatment. Conservative treatment consists primarily of physical therapy, intermittent bracing, aerobic exercise, pharmacological intervention, and epidural steroid injections. The majority of patients with degenerative spondylolisthesis do not require surgical intervention.
Surgical.
There are no clear radiological or medical guidelines or indications for surgical interventions in degenerative spondylolisthesis. A minimum of three months of conservative management should be completed prior to considering surgical intervention. Three indications for potential surgical treatment are as follows: persistent or recurrent back pain or neurologic pain with a persistent reduction of quality of life despite a reasonable trial of conservative (non-operative) management, new or worsening bladder or bowel symptoms, or a new or worsening neurological deficit.
Both minimally invasive and open surgical techniques are used to treat anterolisthesis.
Retrolisthesis.
A retrolisthesis is a posterior displacement of one vertebral body with respect to the subjacent vertebra to a degree less than a luxation (dislocation). Retrolistheses are most easily diagnosed on lateral x-ray views of the spine. Views, where care has been taken to expose for a true lateral view without any rotation, offer the best diagnostic quality.
Retrolistheses are found most prominently in the cervical and lumbar region, but can also be seen in the thoracic area.
History.
Spondylolisthesis was first described in 1782 by Belgian obstetrician Herbinaux. He reported a bony prominence anterior to the sacrum that obstructed the vagina of a small number of patients. The term “spondylolisthesis” was coined in 1854 from the Greek σπονδυλος, "spondylos" = "vertebra" and ὀλισθός "olisthos" = "slipperiness," "a slip."