Viral pathogenesis

Viral pathogenesis is the study of the process and mechanisms by which viruses cause diseases in their target hosts, often at the cellular or molecular level. It is a specialized field of study in virology.
Pathogenesis is a qualitative description of the process by which an initial infection causes disease. Viral disease is the sum of the effects of viral replication on the host and the host's subsequent immune response against the virus. Viruses are able to initiate infection, disperse throughout the body, and replicate due to specific virulence factors.
There are several factors that affect pathogenesis. Some of these factors include virulence characteristics of the virus that is infecting. In order to cause disease, the virus must also overcome several inhibitory effects present in the host. Some of the inhibitory effects include distance, physical barriers and host defenses. These inhibitory effects may differ among individuals due to the inhibitory effects being genetically controlled.
Viral pathogenesis is affected by various factors: (1) transmission, entry and spread within the host, (2) tropism, (3) virus virulence and disease mechanisms, (4) host factors and host defense.
Mechanisms of infection.
Viruses need to establish infections in host cells in order to multiply. For infections to occur, the virus has to hijack host factors and evade the host immune response for efficient replication. Viral replication frequently requires complex interactions between the virus and host factors that may result in deleterious effects in the host, which confers the virus its pathogenicity.
Primary transmission.
Three requirements must be satisfied to ensure successful infection of a host. Firstly, there must be sufficient quantity of virus available to initiate infection. Cells at the site of infection must be accessible, in that their cell membranes display host-encoded receptors that the virus can exploit for entry into the cell, and the host anti-viral defense systems must be ineffective or absent.
Entry to host.
Viruses causing disease in humans often enter through the mouth, nose, genital tract, or through damaged areas of skin, so cells of the respiratory, gastrointestinal, skin and genital tissues are often the primary site of infection. Some viruses are capable of transmission to a mammalian fetus through infected germ cells at the time of fertilization, later in pregnancy via the placenta, and by infection at birth.
Local replication and spread.
Following initial entry to the host, the virus hijacks the host cell machinery to undergo viral amplification. Here, the virus must modulate the host innate immune response to prevent its elimination by the body while facilitating its replication. Replicated virus from the initially infected cell then disperse to infect neighbouring susceptible cells, possibly with spread to different cell types like leukocytes. This results in a localised infection, in which the virus mainly spreads and infects adjacent cells to the site of entry. Otherwise, the virus can be released into extracellular fluids.
Examples of localised infections include: common cold (rhinovirus), flu (parainfluenza), gastrointestinal infections (rotavirus) or skin infections (papillomavirus).
Dissemination and secondary replication.
In other cases, the virus can cause systemic disease through a disseminated infection spread throughout the body. The predominant mode of viral dissemination occurs through the blood or lymphatic system, some of which include viruses responsible for chickenpox (varicella zoster virus), smallpox (variola), HIV (human immunodeficiency virus). A minority of viruses can disseminate via the nervous system. Notably, the poliovirus can be transmitted via the fecal-oral route, where it initially replicates in its site of entry, the small intestine and spread to regional lymph nodes. Then, the virus disseminates via the bloodstream into different organs in the body (e.g. liver, spleen), followed by a secondary round of replication and dissemination into the central nervous system to damage motor neurons.
Shedding and secondary transmission.
Finally, the viruses spread to sites where shedding into the environment can occur. The respiratory, alimentary and urogenital tracts and the blood are the most frequent sites of shedding in the form of bodily fluids, aerosols, skin, excrement. The virus would then go on to be transmitted to another person, and establish the infection cycle all over again.
Factors affecting pathogenesis.
There are a few main overarching factors affecting viral diseases:
Molecular basis of virus tropism.
Virus tropism refers to the virus’ preferential site of replication in discrete cell types within an organ. In most cases, tropism is determined by the ability of the viral surface proteins to fuse or bind to surface receptors of specific target cells to establish infection. Thus, the binding specificity of viral surface proteins dictates tropism as well as the destruction of particular cell populations, and is therefore a major determinant of virus pathogenesis.
However, co-receptors are sometimes required in addition to the binding of cellular receptors on host cells to viral proteins in order to establish infection. For instance, HIV-1 requires target cells to express co-receptors CCR5 or CXCR4, on top of the CD4 receptor for productive viral attachment. Interestingly, HIV-1 can undergo a tropism switch, where the virus glycoprotein gp120 initially uses CCR5 (mainly on macrophages) as the primary co-receptor for entering the host cell. Subsequently, HIV-1 switches to bind to CXCR4 (mainly on T cells) as the infection progresses, in doing so transitions the viral pathogenicity to a different stage.
Apart from cellular receptors, viral tropism can also governed by other intracellular factors, such as tissue-specific transcription factors. An example would be the JC polyomavirus, in which its tropism is limited to glial cells since its enhancer is only active in glial cells, and JC viral gene expression requires host transcription factors expressed exclusively in glial cells.
The accessibility of host tissues and organs to the virus also regulates tropism. Accessibility is affected by physical barriers, such as in enteroviruses, which replicate in the intestine since they are able to withstand bile, digestive enzymes and acidic environments.
Virus factors.
Viral genetics encoding viral factors will determine the degree of viral pathogenesis. This can be measured as virulence, which can be used to compare the quantitative degree of pathology between related viruses. In other words, different virus strains possessing different virus factors can lead to different degrees of virulence, which in turn can be exploited to study the differences in pathogenesis of viral variants with different virulence.
Virus factors are largely influenced by viral genetics, which is the virulence determinant of structural or non-structural proteins and non-coding sequences. For a virus to successfully infect and cause disease in the host, it has to encode specific virus factors in its genome to overcome the preventive effects of physical barriers, and modulate host inhibition of virus replication. In the case of poliovirus, all vaccine strains found in the oral polio vaccine contain attenuating point mutations in the 5' untranslated region (5' UTR). Conversely, the virulent strain responsible for causing polio disease does not contain these 5’ UTR point mutations and thus display greater viral pathogenicity in hosts.
Virus factors encoded in the genome often control the tropism, routes of virus entry, shedding and transmission. In polioviruses, the attenuating point mutations are thought to induce a replication and translation defect to reduce the virus’ ability of cross-linking to host cells and replicate within the nervous system.
Viruses have also developed a variety of immunomodulation mechanisms to subvert the host immune response. This tend to feature virus-encoded decoy receptors that target cytokines and chemokines produced as part of the host immune response, or homologues of host cytokines. As such, viruses capable of manipulating the host cell response to infection as an immune evasion strategy exhibit greater pathogenicity.
Host factors.
Viral pathogenesis is also largely dependent on host factors. Several viral infections have displayed a variety of effects, ranging from asymptomatic to symptomatic or even critical infection, solely based of differing host factors alone. In particular, genetic factors, age and immunocompetence play an important role is dictating whether the viral infection can be modulated by the host. Mice that possess functional Mx genes encode an Mx1 protein which can selectively inhibit influenza replication. Therefore, mice carrying a non-functional Mx allele fail to synthesise the Mx protein and are more susceptible to influenza infection. Alternatively, immunocompromised individuals due to existing illnesses may have a defective immune system which makes them more vulnerable to damage by the virus. Furthermore, a number of viruses display variable pathogenicity depending on the age of the host. Mumps, polio, and Epstein-Barr virus cause more severe disease in adults, while others like rotavirus cause more severe infection in infants. It is therefore hypothesized that the host immune system and defense mechanisms might differ with age.
Disease mechanisms: How do viral infections cause disease?
A viral infection does not always cause disease. A viral infection simply involves viral replication in the host, but disease is the damage caused by viral multiplication. An individual who has a viral infection but does not display disease symptoms is known as a carrier.
Damage caused by the virus.
Once inside host cells, viruses can destroy cells through a variety of mechanisms. Viruses often induce direct cytopathic effects to disrupt cellular functions. This could be through releasing enzymes to degrade host metabolic precursors, or releasing proteins that inhibit the synthesis of important host factors, proteins, DNA and/or RNA. Namely, viral proteins of herpes simplex virus can degrade host DNA and inhibit host cell DNA replication and mRNA transcription. Poliovirus can inactivate proteins involved in host mRNA translation without affecting poliovirus mRNA translation. In some cases, expression of viral fusion proteins on the surface of the host cells can cause host cell fusion to form multinucleated cells. Notable examples include measles virus, HIV, respiratory syncytial virus.
Importantly, viral infections can differ by the “lifestyle strategy”. Persistent infections happen when cells continue to survive despite a viral infection and can be further classified into latent (only the viral genome is present, there is no replication occurring) and chronic (basal levels of viral replication without stimulating an immune response). In acute infections, lytic viruses are shed at high titres for rapid infection to a secondary tissue/host, whereas persistent viruses undergo shedding at lower titres for a longer duration of transmission (months to years).
Lytic viruses are capable of destroying host cells by incurring and/or interfering with the specialised functions of host cells. An example would be the triggering of necrosis in host cells infected with the virus. Otherwise, signatures of viral infection, like the binding of HIV to co-receptors CCR5 or CXCR4, can also trigger cell death via apoptosis through host signalling cascades by immune cells. However, many viruses encode proteins that can modulate apoptosis depending on whether the infection is acute or persistent. Induction of apoptosis, such as through interaction with caspases, will promote viral shedding for lytic viruses to facilitate transmission, while viral inhibition of apoptosis could prolong the production of virus in cells, or allow the virus to remain hidden from the immune system in chronic, persistent infections. Nevertheless, induction of apoptosis in major immune cells or antigen-presenting cells may also act as a mechanism of immunosuppression in persistent infections like HIV. The primary cause of immunosuppression in HIV patients is due to the depletion of CD4+ T helper cells.
Interestingly, adenovirus has an E1A protein to induce apoptosis by initiating the cell cycle, and an E1B protein to block the apoptotic pathway through inhibition of caspase interaction.
Persistent viruses can sometimes transform host cells into cancer cells. Viruses such as the human papillomavirus (HPV), human T-lymphotropic virus (HTLV) etc, can stimulate growth of tumours in infected hosts, either by disrupting tumour suppressor gene expression (HPV) or upregulating proto-oncogene expression (HTLV).
Damage caused by host immune system.
Sometimes, instead of cell death or cellular dysfunction caused by the virus, the host immune response can mediate disease and excessive inflammation. The stimulation of the innate and adaptive immune system in response to viral infections destroys infected cells, which may lead to severe pathological consequences to the host. This damage caused by the immune system is known as virus-induced immunopathology.
Specifically, immunopathology is caused by the excessive release of antibodies, interferons and pro-inflammatory cytokines, activation of the complement system, or hyperactivity of cytotoxic T cells. Secretion of interferons and other cytokines can trigger cell damage, fever and flu-like symptoms. In severe cases of certain viral infections, as in avian H5N1 influenza in 2005, aberrant induction of the host immune response can elicit a flaring release of cytokines known as a cytokine storm.
In some instances, viral infection can initiate an autoimmune response, which occurs via different proposed mechanisms: molecular mimicry and bystander mechanism. Molecular mimicry refers to an overlap in structural similarity between a viral antigen and a self-antigen. The bystander mechanism hypothesizes the initiation of a non-specific and overreactive antiviral response that tackles self-antigens in the process. Damage caused by the host itself due to autoimmunity was observed in the West Nile virus.
Incubation Period.
Viruses display variable incubation periods upon virus entry into the host. The incubation period refers to the time taken for the onset of disease after first contact with the virus. In Rabiesvirus, the incubation period varies with the distance traversed by the virus to the target organ; but in most viruses the length of incubation depends on many factors.
Surprisingly, generalised infections by togaviruses have a short incubation period due to the direct entry of the virus into target cells through insect bites.
There are several other factors that affect the incubation period. The mechanisms behind long incubation periods, months or years for example, are not completely understood yet.
Evolution of virulence.
Some relatively avirulent viruses in their natural host show increased virulence upon transfer to a new host species. When an emerging virus first invades a new host species, the hosts have little or no immunity against the virus and often suffer high mortality. Over time, a decrease in virulence in the predominant strain can sometimes be observed. A successful pathogen needs to spread to at least one other host, and lower virulence can result in higher transmission rates under some circumstances. Likewise, genetic resistance against the virus can develop in a host population over time.
An example of the evolution of virulence in emerging virus is the case of myxomatosis in rabbits. The release of wild European rabbits in 1859 into Victoria, Australia for sport resulted in a rabbit plague. In order to curb with rabbit overpopulation, myxoma virus, a lethal species-specific poxvirus responsible for myxomatosis in rabbits, was deliberately released in South Australia in 1950. This led to a 90% decrease in rabbit populations, and the disease became endemic in a span of five years. Significantly, severely attenuated strains of the myxoma virus were detected in merely 2 years of its release, and genetic resistance in rabbits emerged within seven years.


Gregory F. Ball

Gregory Francis Ball is a Professor in the Department of Psychology and Dean of the College of Behavioral and Social Sciences at the University of Maryland, College Park. He is best known for his research into how seasonal hormonal shifts change the brain and reproductive behavior of different bird species.
Education.
Ball received his B.A. in psychology from Columbia University in 1977 and holds a Ph.D. in psychobiology from the Institute of Animal Behavior at Rutgers University (1983). He completed his postdoctoral research in comparative neuroendocrinology and ethology at Rockefeller University.
Research.
Ball's research focuses on the interrelation of hormones, brain, and animal behavior, specifically how hormones and the external environment result in the production of social behaviors and changes to neural biology. The Ball lab works with a variety of avian species that exhibit a high degree of neuroplasticity in response to hormone treatment, which allows for the study both of how hormones modulate learned behaviors and of how behaviors affect endocrine activity, thus leading to changes in social behavior. The author of over 200 scholarly publications, Ball's research continues to be supported by grants from the National Institutes of Health.
Administrative career.
Before becoming Dean of the College of Behavioral and Social Sciences at the University of Maryland in 2014, Ball was the Vice Dean for Science and Research Infrastructure in the Krieger School of Arts and Sciences at Johns Hopkins University, where he was also faculty in the Department of Psychological and Brain Sciences and the director of the undergraduate program in neuroscience, with joint appointments in the Department of Biochemistry and Molecular Biology, Division of Reproductive Biology at the Bloomberg School of Public Health, and in the Department of Neuroscience at the School of Medicine. From 2008 to 2010, Ball served as the Dean of Research and Graduate Education in the JHU School of Arts and Sciences. About the addition of higher education administration to his research portfolio, Ball notes, "Ever since middle school, I’ve wanted to make a living from the life of the mind. At this stage of my career, I’m most interested in shaping an institution of higher learning. I believe that strong universities are an important part of the health and the future of the United States."
Honors and Awards.
The JHU Student Council awarded Ball with the George E. Owen Teaching Award for outstanding teaching and devotion to undergraduates, and he received the Alumni Association Teaching Award in observance of his exemplary undergraduate instruction. In 2014, Ball was named a fellow of the American Association for the Advancement of Science.


Gerald Domingue

Gerald Domingue (born March 2, 1937) is an American medical researcher (bacteriology, immunology, experimental urology) and academic who served as Professor of Urology, Microbiology and Immunology in the Tulane University School of Medicine and Graduate School for thirty years and also as Director of Research in Urology. He is currently retired and resides in Zurich, Switzerland, where he is engaged in painting and creative writing. At retirement he was honored with the title of Professor Emeritus at Tulane (1967–1997). Prior to Tulane, he served on the faculty of St. Louis University (school of medicine); was a lecturer at Washington University (school of dentistry) and director of clinical microbiology in St. Louis City Hospital (Snodgrass Laboratory of Pathology and Bacteriology), St. Louis, Missouri.
Over the course of his thirty-nine-year career, Domingue received funding from the National Institutes of Health, Veterans Administration, and a variety of national and international research foundations; served on grant review committees of these agencies as well as consultant to various journal review boards. He also served as clinical microbiology and research consultant to hospital clinical laboratories and to industry. He enjoys international recognition as an authority on the basic biology and medical significance of atypical bacterial organisms and is considered a pioneer and an expert on the role of these unusual bacteria in the persistence and expression of kidney and urological infectious diseases.
Domingue was named a Fellow of the American Academy for Microbiology (1973) and a Fellow of the Infectious Diseases Society of America (1975). In 1995, he received the prestigious Palmes Academiques Medal (Chevalier) from the country of France.
Education and early work.
Domingue was born in 1937 in Lafayette, Louisiana. He was educated at Southwestern Louisiana Institute (presently University of Louisiana at Lafayette, LA), receiving the Bachelor of Science degree in three years (bacteriology with minors in chemistry and French); matriculating to graduate school at the University of Southwestern Louisiana (presently University of Louisiana at Lafayette)(graduate courses in bacteriology, atomic physics and advanced qualitative organic chemistry; served as instructor of laboratory courses in bacteriology and immunology in university); Louisiana State University(basic medical sciences) and Tulane University where he earned the doctorate (1964); holds the Ph.D. degree in medical microbiology and immunology; followed by a postdoctoral research fellowship in microbiology/infectious diseases and a residency in clinical microbiology under the mentorship of the late distinguished bacteriologist/immunologist, Erwin Neter at The Children's Hospital of the State University of New York, Buffalo, New York.
He first became interested in the role of atypical bacterial forms after noting that a large number of patients with urinary tract infections suffer from continual relapsing illness. Using a direct phase microscope, he examined the urine specimens of several patients with urinary tract infections and found atypical bacteria in his samples.
He began to investigate atypical bacteria (cell wall-defective, L-forms and difficult-to-culture bacteria) striving to better understand their biology and the role they play in causing disease. Over the course of the next 30 years, he was able to explain much of the mystery behind how the bacteria are able to persist in the body, and published a wide array of clinical and experimental studies on the subject.
L-form bacteria – electron dense bodies.
Domingue worked with a team that included pre and post-doctoral students and fellows along with faculty colleagues and laboratory assistants. Together they discovered that L-form bacteria are able to form tiny dense bodies within parent cells that already lack cell walls. They noted that the forms, which they called electron dense bodies were so small that they could pass through bacterial filters that normally withheld ordinary bacteria with cell walls.
The electron dense bodies could persist inside tissue culture cells in the laboratory. After applying these data to the human condition, Domingue reasoned that in some patients who suffer from chronic bacterial infections, the disease process could be related to the fact that bacteria are able to differentiate into the resistant electron dense bodies that he observed in tissue cultures.
Significant papers.
In 1974, he and his graduate student, Mary Green, along with Paul Heidger, a faculty collaborator, published two landmark companion papers in the journal "Infection and Immunity". The papers detail how L-form bacteria inside an experimental human embryonic kidney tissue culture system are able to persist in cells and explains how they are able to revert into the cell wall-containing parent bacterial form. They also proposed a detailed reproductive cycle for L-form bacteria, followed by electron microscopy of the microorganisms.
These papers set the stage for Domingue and his team to delve even further into the role that cryptic atypical bacteria play in causing persistent and recurrent infections. In 1997, he and a colleague, the late Hannah Woody published an invited extensive review article on chronic bacterial infection in "Clinical Microbiological Reviews". Among their conclusions was the claim that "difficult to culture and dormant bacteria are involved in the latency of infection and that these persistent bacteria may be pathogenic."
He implicated atypical bacteria in several kidney-related diseases including pyelonephritis, glomerulonephritis, idiopathic hematuria, and interstitial cystitis. He also speculated about their role in other diseases such as rheumatic fever, tuberculosis, syphilis, and rheumatoid arthritis.
In the review Domingue stated, "Clearly, any patient with a history of recurrent infection and persistent disability is sending the signal that the phenomenon (infection with atypical bacteria) could be occurring. The so-called autoimmune diseases in which no organism can be identified by routine testing techniques are particularly suspect." He went on to conclude, "Bacteriologic advances, which include special culture media and stains, electron microscopy and molecular techniques such as PCR (polymerase chain reaction), have revealed an increasing number of previously unidentifiable organisms in a variety of pathological conditions. It is unwise to dismiss the pathogenic capacities of any microbe in a patient with a mysterious disease." Over the course of his thirty-nine-year career Domingue published numerous papers, monographs, and book chapters devoted to atypical bacterial research. He delivered many invited international and national lectures about bacterial persistence and expression of disease and wrote a book on the subject, "Cell Wall-Deficient Bacteria: Basic Principles and Clinical Significance".
Other research.
Although Domingue's primary research focus was on bacterial L-forms, he also published extensively on the biological significance of the enterobacterial common antigen of gram negative bacteria– its antigenicity, immunogenicity, and vaccine potential against urinary tract infections.
He studied the immunological consequences of a vasectomy, as well as the role of various gram negative pathogens in the host-pathogen interaction in pyelonephritis, and the effects of antibiotics and chemotherapy on urinary tract infections.
He also published microbiological and immunological studies on bacteria that produce chorionic gonadotropin-like hormone and their role in an experimental tumor model.


National Down Syndrome Society

The National Down Syndrome Society (NDSS) is an American organization that offers support to people with Down syndrome, their families, friends, teachers, and coworkers, and educates the general public about Down syndrome. The mission of the NDSS is to be the leading human rights organization for all individuals with Down syndrome.
History.
The NDSS was founded by Betsy Goodwin and Arden Moulton. Goodwin's daughter Carson was born in 1978 with Down Syndrome. The parents soon discovered that the support and resources available to parents with Down syndrome children were very limited. Goodwin and Arden decided to create the NDSS, which gained official nonprofit status in 1979.
Areas of programming.
NDSS focuses on four items of programming to enhance the quality of life for those with Down syndrome.
Other initiatives.
In January 2019, it was reported in "Skeptical Inquirer" that the NDSS had just offered a free public webinar on facilitated communication. This is reportedly a thoroughly discredited communication method based on the theory that many people that are unable to speak are not cognitively impaired, but are simply suffering from an inability to produce the sounds for speech. A helper or "facilitator" assists by guiding the non-speaking person's hand over a keyboard. However, empirical tests have revealed that the facilitator is actually the one doing the typing, and not the person with the disability. Stuart Vyse, reporting for "Skeptical Inquirer", commented that "it is unfortunate that a leading Down syndrome advocacy group is promoting a belief system over evidence-based methods that work."


David Maclagan

David Maclagan FRSE (8 February 1785 – 6 June 1865) was a prominent Scottish doctor and military surgeon, serving in the Napoleonic Wars. He served as President of both the Royal College of Physicians of Edinburgh and the Royal College of Surgeons of Edinburgh. He served as Surgeon in Scotland to Queen Victoria.
Life.
Maclagan was born in Edinburgh on 8 February 1785, the son of Robert MacClaggan (d.1785), surgeon, and Margaret Smeiton, his second wife. His father changed his name to Maclagan some time before David was born, to disassociate himself from various Jacobite connections. Maclagan trained as a doctor and surgeon at the University of Edinburgh, graduating with an MD in 1805. Too young to join the army as a surgeon, he travelled to London and studied and practiced at St George’s Hospital. He was admitted into the Royal College of Surgeons in 1807.
From 1808 he served as a military surgeon with the 91st Regiment of Foot, serving during the Walcheren Campaign within the Napoleonic Wars. This action saw huge injuries, and Maclagan's experience would have increased exponentially from this experience. From 1810 to 1813 he served in various military campaigns, including the attack on Badajos during the Peninsular War, the Battle of Salamanca, the Battle of Vittoria, the Battle of the Pyrenees, the Battle of Nivelle and the Battle of Nive.
On return to Britain he became a practicing surgeon in Edinburgh in 1815, partly working for the New Town Dispensary on Thistle Street, which he co-founded in that year. In 1823 he lost out to George Ballingall in the choice for the University of Edinburgh's chair in Military Surgery. He was Consultant surgeon/physician at Edinburgh Royal Infirmary from 1848 until retiral.
He was elected a Fellow of the Royal Society of Edinburgh in 1828, his proposer was Sir John Robison.
He died at home, 129 George Street, in Edinburgh on 6 June 1865. He is buried in Dean Cemetery. The substantial grave lies against the north wall of the original cemetery (backing onto the northern extension). His wife and many of his children and grandchildren are buried with him.
Family.
With his wife, Jane Whiteside (1790-1878), he had an illustrious family including:
His grandchildren included:
His great grandchildren include:


Roy Mackenzie Stewart

Roy Mackenzie Stewart (1889–1964) was a Scottish neurologist.
After education at Lord Williams's Grammar School at Thame, Oxfordshire, Roy Mackenzie Stewart entered the University of Edinburgh Medical School and graduated there MB ChB (Edin.) in 1911. After serving on the staff of the Lancashire County Asylum at Prestwich, he joined in May 1915 the RAMC and was sent to France, where the explosion of a heavy gun caused him to have tinnitus for the remainder of his life. He was then stationed as a neurologist at Moss Side Military Hospital at Maghull (near Liverpool), from 1917 in 1918 in Salonica, and from May to November 1919 at the Royal Victoria Hospital, Netley. He received in 1920 the M.D. degree from the University of Edinburgh Medical School. In 1920 he became deputy medical superintendent of Whittingham Mental Hospital.
In 1922 Stewart became medical superintendent of Leavesden Mental Hospital. He introduced new standards of medical and nursing care and established regimens of training and treatment that were advanced for the era of the 1920s. The hospital housed about 2,600 patients (mostly severe subnormals with birth defects). He personally examined each patient and personally conducted post-mortem examinations with extensive histological studies. His clinical and necropsy reports were extremely thorough and detailed, so much so that his numerous published articles consisted largely of direct quotations from his routine hospital notes.
Stewart was elected FRCPE in 1929 and FRCP in 1942. He was in 1942 president of the neurology section of the Royal Society of Medicine. He was from 1943 to 1946 chair of the Mental Deficiency Committee and in 1946–1947 chair of the Mental Deficiency Section of the Royal Medico-Psychological Association. He gave in 1947 the Morison lecture on "Infantile Cerebral Hemiplegia" to the Royal College of Physicians, Edinburgh.
Family.
Roy M. Stewart's father was Surgeon Rear-Admiral William Henry Stewart, M.D., deputy inspector general of the Royal Naval Medical Service. In 1923 Roy M. Stewart married Agnes Maud Stirling (1900–1994), daughter of Royal Navy Commander Thomas Willing Stirling (1866–1930), O.B.E. Roy and Agnes Stewart had two daughters and two sons. Their elder son, Desmond Stirling Stewart (1924–1981), was a prolific writer on Middle Eastern history and culture – he wrote over a dozen books, including the Time-Life book "Early Islam" and a biography of T. E. Lawrence. Their younger son, Thomas H. M. Stewart (b. 1930), became a physician and professor of medicine at the School of Medicine of the University of Ottawa.


Graziella Pellegrini

Graziella Pellegrini (born July 12, 1961) is an Italian Professor of Cell Biology and the Cell Therapy Program Coordinator at the University of Modena and Reggio Emilia. She has developed and championed cell therapy protocols in hospitals across Italy.
Early life and education.
Pellegrini was born in Genoa. She studied molecular pharmacology at the University of Genoa, where she earned her PhD in 1988. She continued to study chemistry and pharmacology at the University of Genoa, and completed two subsequent degrees in 1989. Pellegrini completed extra training to become a pharmacist.
Research and career.
Pellegrini was appointed to the Italian National Institute for Cancer Research in 1988. She held positions at Celllife Biotechnology, the Advanced Biotechnology Center and the Veneto Eye Bank Association. She is best known for her work in translational medicine, and has developed epithelial stem cell mediated cell and gene therapies. She has worked with Michele de Luca for most of her academic career. In 1990 Pellegrini established the first urethral stem cell cultures for humans, which could be used to regenerate the urethra in patients with posterior hypospadias.
She showed that the p63 transcription factor, a homologue of P53 that is essential for regenerative proliferation in the development of epithelial cells, can distinguish human keratinocyte cells from their transient amplifying keratinocyte analogues. The identification of this marker is important in the clinical application of epithelial cultures for cell therapy.
In 2006 Pellegrini was appointed as an associate professor at the University of Modena and Reggio Emilia. She leads the Center for Regenerative Medicine “Stefano Ferrari”. Pellegrini has used the epithelial stem cells for the treatment of skin disease. She first outlined the feasibility of "ex vivo" gene therapy of laminin-332 junctional epidermolysis bullosa in 2006. This involved transplanting autologous epidermis flaps from epidermal stem cells that had been genetically corrected. She demonstrated the first successful clinical trial to treat junctional epidermolysis bullosa. For the following two years, Pellegrini and De Luca observed initial stem cell patients, when it became obvious that they could scale the technology. In 2017 the epithelial stem cells were used to treat a seven-year-old boy who had lost 80% of his skin to junctional epidermolysis bullosa.
In 2008 Pellegrini and De Luca co-founded the Holostem Terapie Avanzate, a biotechnology spin-out that develops advanced therapy producets that use epithelial stem cell cultures. They developed a culture system that creates limbal stem cell for the regeneration of corneas, which can restore vision to patients ocular burns who are deemed incurable. This system, Holoclar, was recognised by the European Medicines Agency in 2008, and received its approval for marketing from the European Commission in 2015. Holoclar is the first stem cell based medicinal product to be approved by the European Commission.
In 2020 Graziella Pellegrini and Michele De Luca, shared the Louis-Jeantet Prize for Medicine for the development of epithelial stem cell-based regenerative therapy in patients with severe eye and skin disease.
Pellegrini provides expert opinion for the World Economic Forum.


C.D. Muxes

Club Deportivo Muxes is a Mexican football club that plays in the Liga TDP, the Mexican third division. The club is based in Venustiano Carranza, Mexico City. It is the first professional Mexican football club declared as LGBT.
History.
The team was founded in 2018 with the aim of representing the LGBT community that until then had not had a representative club, in addition to generating spaces for the visibility of these groups. In its origins, the team competed in amateur leagues in Mexico City.
In 2020 the team joined the Mexican Football Federation, Subsequently, the club registered in the Liga TDP, being placed in Group IV with other teams from the Greater Mexico City.
On 25 September 2020, the team played its first official match. Muxes defeated FC Politécnico by a score of 0–4. Pablo de la Rosa scored the club's first goal in its history in professional competition.


Allen Lein

Allen Lein (April 15, 1913, New York City – March 26, 2003, Austin, Texas) was an endocrinologist and medical school professor. He was a Guggenheim Fellow for the academic year 1958–1959.
Lein was a student at the University of Chicago and then transferred to the University of California, Los Angeles (UCLA), where he graduated with bachelor's degree and Ph.D. in zoology, with a focus on endocrinology. During WW II, he served from 1943 to 1946 as an aviation physiologist in the U.S. Army and left with the rank of captain. After teaching at the Ohio State University and Vanderbilt medical schools, he became in 1947 an assistant professor in the physiology department of Northwestern University Medical School. There he eventually became a full professor, director of student affairs, and assistant dean of graduate studies. For the academic year 1954–1955 he was on sabbatical at Caltech, where he worked with Linus Pauling and together they wrote a paper entitled "The Combining Power of Myoglobin for Alkyl Isocyanides and the Structure of the Myoglobin Molecule". For the academic year 1958–1959 Lein was a Guggenheim Fellow at the "Laboratoire de Biochimie", "Collège de France".
In 1968 Lein became a professor of reproductive medicine at La Jolla's University of California San Diego School of Medicine, where he retired as professor emeritus in 1980.
His 135-page book "The Cycling Female: Her Menstrual Rhythm" was published in 1979 by W. H. Freeman and Company.
Lein stayed in La Jolla and remained active in teaching and research for many years after his formal retirement. Shortly before he died of a heart attack in 2003, he and his wife moved to Texas to be near their daughter.
His doctoral students include Neena Schwartz.
Upon his death he was survived by his widow, a daughter, a son, and three grandchildren.


Mortimer H. Appley

Mortimer Herbert Appley (November 21, 1921 – March 29, 2012) was an American psychologist and academic administrator. He became the chair of the psychology department at Connecticut College for Women in 1952. He went on to hold leadership roles at several other universities over the next two decades, including York University, where he founded and chaired the psychology department. In 1974, he became the sixth president of Clark University, a position he held for ten years; he has been credited with leading Clark out of significant fiscal difficulties during his tenure. He then left Clark to join Harvard University in 1984, first as a visiting scholar and later as a visiting professor.


Robert Cooke (physician)

Robert Anderson Cooke (1880–1960) was an American immunologist and allergist.
In 1916 Cooke and Albert Vandeveer demonstrated the role of heredity in the origins of allergy. According to Cooke, 48% of his allergic patients had allergies in their family history. While the trait of allergy is transmitted through heredity, parents and children may be allergic to different substances.
In 1918, Dr. Cooke suggested a mechanism of action for allergen injections as a "desensitization or hyposensitization," analogous to tolerance achieved in experimental anaphylaxis induced in animals. This concept suggested that the injections of an increasing amount of allergen or antigen slowly neutralized those antibodies responsible for the allergic reaction.


Tom Dening

Tom Dening (born August 1956) is professor of dementia research at the University of Nottingham. Dening qualified in Medicine at Newcastle University in 1980. He is the co-author of the "Oxford Textbook of Old Age Psychiatry", a standard textbook in that area.


Joseph W. Alexander

Dr. Joseph W. Alexander, DVM, (1947) is an American educator from the U.S. state of Oklahoma. He served as the Oklahoma Secretary of Science and Technology under Governor of Oklahoma Brad Henry, having been appointed by Henry in 2004 and leaving the post in 2011.
In addition to his service to Governor Henry, Alexander is also the President of the Oklahoma State University's Center for Innovation and Economic Development.
Early life.
Alexander earned by bachelor's degree in animal science from the University of Arizona, a doctors degree in veterinary science from Colorado State University, and a master's degree in educational administration and supervision from the University of Tennessee. After finishing his education, Alexander moved to Oklahoma where he became a professor of veterinary medicine at Oklahoma State University (OSU). In 1985, Alexander was promoted as the Dean of the College of Veterinary Medicine for OSU. He would remain in that position for the next sixteen years.
In 2001, Alexander was selected as the Interim Vice-president for Research and External Relations for OSU. He served in that capacity until 2003 when he was appointed to the dual position of Director of External and Legislative Affairs and President of the Center for Innovation and Economic Development.
Secretary of Science.
Following the election of Democrat Brad Henry in the 2002 Oklahoma gubernatorial election, Alexander served as a member of Henry's transition team.
In 2004, Governor Henry appointed Alexander as his Secretary of Science and Technology. As the Secretary, Alexander oversees all efforts by the State government to use science and technology to improve government and to better serve the citizens of Oklahoma. In particular, Alexander works with the Secretary of Commerce and Tourism to promote economic development throughout the State. As Secretary, Alexander has primary supervision over the Oklahoma Center for the Advancement of Science and Technology.


Richard Geller (meditation instructor)

Richard Geller (born 1952) is president of Boston-based MedWorks Corporate Meditation Programs that provides stress reduction courses based on meditation to corporations and their employees. His company serves corporations such as the Reebok division of Adidas, Medtronic, and Genzyme. Geller advises employers to use employee feedback in building their stress reduction and meditation program. Since 1996, he has also been a volunteer for the weekly meditation classes at Suffolk County House of Corrections, the Boston county jail as part of the Prison Mindfulness Institute.
Geller graduated from University of Massachusetts Medical School's "Practicum in Mindfulness-Based Stress Reduction" program, under the direction of Jon Kabat-Zinn.


Ian Battye

Ian David Battye (birth registered third ¼ 1952 – 28 February 2007), also known by the nickname of "Big Joe", was an English professional rugby league footballer who played in the 1970s. He played at club level for Kippax Welfare ARLFC and Castleford (Heritage №).
Background.
Ian Battye's birth was registered in Barkston Ash district, West Riding of Yorkshire, England, and he died aged 54 from throat cancer (Oropharyngeal cancer).
Genealogical information.
Ian Battye was married to Mavis, was the father of Michael Battye, and Richard Battye, and the younger brother of Brian H. Battye (birth registered during first ¼ in Barkston Ash district).


Hospital for Tropical Diseases

The Hospital for Tropical Diseases (HTD) is a specialist tropical disease hospital located in London, United Kingdom. It is part of the University College London Hospitals NHS Foundation Trust and is closely associated with University College London and the London School of Hygiene & Tropical Medicine. It is the only NHS hospital dedicated to the prevention, diagnosis and treatment of tropical diseases and travel-related infections. It employs specialists in major tropical diseases including malaria, leprosy and tuberculosis. It also provides an infectious disease treatment service for University College Hospital.
History.
The hospital's origins lie in a meeting of the Seaman's Hospital Society on 8 March 1821 at which it was decided to establish a floating hospital for injured seamen. The hospital moved onto dry land as the Dreadnought Seamen's Hospital in 1870 under the management of the Greenwich Hospital. Patrick Manson became physician to the Society in 1892 and promoted an interest in tropical diseases; he has been called the "father of tropical medicine".
In 1920, the Dreadnought Seaman's Society provided funds to allow the establishment of a Hospital for Tropical Diseases, initially based at 25 Gordon Street in London, but evacuated to Greenwich in 1939.
After the Second World War the hospital moved to temporary premises in Devonshire Street in 1947 and, after joining the National Health Service in 1948, it moved to more permanent premises at St Pancras Hospital which were opened by the Duchess of Kent in May 1951. The hospital moved to new facilities at Capper Street which were opened by Anne, Princess Royal in June 1999, and to the new University College Hospital Tower in Euston Road in July 2004.


Sousan S. Altaie

Sousan S. Altaie is Scientific Policy Advisor for the Office of In Vitro Diagnostic Devices in the United States. She joined the Food and Drug Administration in the Center for Drug Evaluation and Research in the Division of Anti-infective Drug Products as a primary reviewer in 1995. Six years later she joined the FDA's Center for Devices and Radiological Health as the Chief of Immunology and Molecular Diagnostics Branch. She is actively working as a member of the Global Harmonization Task Force (GHTF) and International Organisation for Standardisation (ISO) working groups. She was appointed the CDRH Critical Path Coordinator in 2004 and is actively involved in the Agency's Critical Path initiative. She has served as an observer, advisor and full member of various committees and subcommittees of the Clinical and Laboratory Standards Institute (CLSI).
Altaie has been an active member of the Washington DC Branch of the American Society of Microbiology, serving as the Counselor, President elect and the President. She completed a two-year Fellowship in Medical Microbiology at the Medical College of Virginia in Richmond, prior to joining the Department of Pediatrics, Division of Infectious Diseases at the State University of New York as an Assistant Professor, and also was appointed Director of Bacteriology and Serology Laboratories at the Children's Hospital of Buffalo. Her research interest is in the transplacental transmission of Lyme disease and she is the author of many peer-reviewed articles. Altaie received her PhD in Clinical Microbiology and Immunology from the University of North Texas in Denton.


Hepatoduodenal ligament

The hepatoduodenal ligament is the portion of the lesser omentum extending between the porta hepatis of the liver and the superior part of the duodenum.
Running inside it are the following structures collectively known as the portal triad:
Manual compression of the hepatoduodenal ligament during surgery is known as the Pringle Maneuver. The hepatoduodenal ligament should not be confused with the cystoduodenal ligament. The cystoduodenal ligament is also found in the lesser omentum and is distinct from the hepatoduodenal and hepatogastric ligaments. It represents a variation in the anatomy of the omental bursa and its foramen


Notifiable diseases in the United States

In the United States, the National Notifiable Disease Surveillance System (NNDSS) is responsible for sharing information regarding notifiable diseases. As of 2020, the following are the notifiable diseases in the US as mandated by the Centers for Disease Control and Prevention:


Thelma Brumfield Dunn

Thelma Flournoy Brumfield Dunn (February 6, 1900 – December 31, 1992) was a medical researcher whose work on mice led to significant advances in human cancer research.
Early life.
Thelma Flournoy Brumfield was born in Renan, Virginia, the daughter of William Andrew Brumfield and Effie Flournoy Thornton Brumfield. Her father was a physician and a college health officer.
Education.
Brumfield attended public schools in both Richmond and Lynchburg. She attended Cornell University, transferred to Westhampton College for one year, then returned to Cornell University where she won the Guilford Prize for excelling in an English prose composition, for an essay entitled "Virginia Tobacco." That same year, she received an A.B with honors in entomology. She earned a medical degree in 1926 at the University of Virginia School of Medicine, and then began an internship at Bellevue Hospital.
Medical Research.
In 1942, Dunn became a fellow at the National Cancer Institute. She stayed at the institute as a staff pathologist beginning in 1947, until her retirement in 1970. She was head of the Cancer Induction and Pathogenesis Section of the pathology department.
Dunn's work involved the origins and development of cancer in laboratory mice. She developed methods of inducing malignant tumors in the stomachs and intestines of experimental animals and studied the behavior of the cancer cells that resulted. Dunn is known as the "First Lady of Cancer Research". According to Harold L. Stewart of the National Cancer Institute, Dunn's important contributions to the field of cancer research include her studies of mammary tumors, reticulum-cell sarcomas, leukemia, plasma-cell tumors, mast-cell tumors, the granular-cell tumors, cervical cancer and the common liver tumor of the mouse. Stewart also mentions Dunn's discoveries the protein-secreting, plasma-cell tumors that originate in the ileocecal region of mice, a finding that initiated a program of animal research that's led to a better understanding of the fatality of human cancer. She developed lines of a transplantable mast-cell tumor of a mouse, now known as "Dunn cells", used widely in laboratory studies.
Publications.
Dunn's research publications published definitive articles on the normal and pathologic anatomy of the kidney, the adrenal gland amyloidosis, congenital and induced ocular lesions, and the spontaneous lesions that accompany the aging process and which constitute the pathologic basis for the so called "geriatric diseases". Article titles included "Attempt to Detect a Mammary Tumor-Agent in Strain C Mice by X-Radiation" (1950), "Transplantation of Hepatomas in Mice" (1955), "Morphology of Mammary Tumors in Mice" (1958), "Studies of the Mammary-Tumor Agent of Strain RIII Mice" (1961), "Further Studies of the Mammary Tumor Agent of Strain RIII Mice" (1962), "Occurrence of Tumors in Wild House Mice" (1962), "Histology of Some Neoplasms and Non-Neo-plastic Lesions Found in Wild Mice Maintained Under Laboratory Conditions" (1963), "Attempts to Detect Nodule-Inducing Virus in Strain RIII Mice" (1970). In retirement she wrote a book, "The Unseen Fight Against Cancer" (1975), explaining cancer research for a general readership.
Awards and recognitions.
While attending Cornell University and the Medical School of the University of Virginia, Thelma Brumfield's peers elected her to membership in the honorary societies of Phi Beta Kappa and Alpha Omega Alpha. In 1958, the National Institutes of Health chose Dunn as one of six members of the delegation of distinguished American women physicians sent to the Soviet Union for the exchange of information and views on science and cancer. Also in 1958, the American Medical Women's Association elected Dunn "Woman of the Year" for the District of Columbia. In 1959, the Washington Society of Pathologists elected her its president. In 1961, the American Association for Cancer Research also elected her its president. Dunn was the first woman to be elected to both organizations. In 1962, Dunn met with John F. Kennedy as a recipient of the Federal Woman's Award for outstanding contributions to the government.
Personal life.
Thelma Brumfield married William Leroy Dunn, a fellow medical doctor, in 1929. They had three children. Their son John Thornton Dunn (1932-2004) became a medical researcher prominent in the study of thyroid disorders and public health. Thelma B. Dunn was widowed when W. Leroy Dunn died in 1982; she died in 1992, aged 92, at a retirement home in Lynchburg, Virginia. Her papers are archived at the University of Virginia.


Edwin Claybrook

Edwin Claybrook (1872 – February 28, 1931) was an American surgeon remembered for describing Claybrook sign. He died on February 28, 1931 at Alleghany Hospital.


American Association of Tissue Banks

The American Association of Tissue Banks (AATB); a transplant trade organization that is dedicated to ensuring that human tissues intended for transplantation are safe and free of infectious disease, of uniform high quality, and available in quantities sufficient to meet national needs.
The AATB provides accreditation for over 100 tissue banks. According to their website, AATB is a voluntary association of organizations committed to obtaining tissues for allografts (transplant) and providing the general public and the medical community with the safest products possible. The program is not regulatory in nature, but educational.
The AATB also accommodates accreditation to non-transplant tissue banks and whole body donation programs.
To avoid violating the Health Insurance Portability and Accountability Act, AATB must through their legal anatomical authorizations obtain consent which allows AATB representatives access to donor information for accreditation reviews.


P. Blaud

Jean-Pierre or Pierre Blaud (1773/1774, Nîmes – 8 May 1859, Beaucaire),
often seen as "P. Blaud of/de Beaucaire"
was a French doctor of medicine who in 1832
introduced and started the use of Blaud's pills or iron pills as a medication for patients suffering from anemia.
Blaud of Beaucaire was one of the leading physicians at the Hospital of Beaucaire ("l'Hospital de Beaucaire") in France.


Karl Ewald Hasse

Karl Ewald Hasse (23 June 1810 – 26 September 1902) was a German physician and professor of special pathology, born in Dresden. He was the son of historian Friedrich Christian August Hasse (1773–1848).
Biography.
Hasse studied medicine at the medical-surgical academy in Dresden and at University of Leipzig, earning his doctorate in 1833. Later, he continued his education in Paris and Vienna, and subsequently returned to Leipzig, where in 1836 he received his habilitation. In 1839 he became an associate professor of pathological anatomy in Leipzig, and in 1844 relocated to Zürich, where he was appointed medical director of the cantonal hospital and a professor of pathology.
In 1852 he was appointed professor of special pathology at the medical clinic of the University of Heidelberg, and in 1856 garnered the same position in Göttingen, where he served as medical director until 1878. Among his written works was "Anatomische Beschreibung der Krankheiten der Circulations- und Respirations-Organe", a book that was translated into English by William Edward Swaine and published in 1846 as "An anatomical description of the diseases of the organs of circulation and respiration".
Hasse died in Hanover.
He was instrumental in the decision by the Swiss psychiatrist and pioneer of psychosurgery, Gottlieb Burckhardt, to enter the medical field of nervous diseases.
Selected publications.
From 1874, Hasse directed Gustav Born, the father of Max Born. Hasse's anti-semitism led him to treat Born with disdain -(Greenspan 2005:10). Nancy Thorndike Greenspan (2005) "The end of the certain world: the life and science of Max Born".


Paul Louis Duroziez

Paul Louis Duroziez (8 January 1826, Paris – 16 January 1897, Paris) was a French physician remembered for describing Duroziez's sign and Duroziez's disease. He studied medicine in Paris, graduating in 1853. He worked with Jean-Martin Charcot and later as a surgeon in the Franco-Prussian war in 1870. He worked as a general practitioner rather than in hospital, but was highly regarded by physicians for his publications on heart disease. He was elected president of the Société de Médecine in 1882 and became a Chevalier of the Légion d'honneur in 1895.


Rudolf Chrobak

Rudolf Chrobak (8 July 1843 – 1 October 1910) was an Austrian gynecologist who was a native of Troppau, Austrian Silesia.
In 1866 he received his medical doctorate from the University of Vienna, and worked as an intern at Vienna General Hospital and as an assistant in the clinic of Johann von Oppolzer (1808–1871). In 1880 he became an associate professor, and in 1889 succeeded August Breisky (1832-1889) as professor and director of the second "Frauenklinik" in Vienna. Chrobak maintained this position until his retirement in 1908. With Friedrich Schauta (1849–1919), he was responsible for the planning and design of the new hospital department for gynecology in Vienna.


International American University College of Medicine

International American University is an offshore private medical school located in Vieux Fort, Saint Lucia in the Caribbean. The school's offshore office is located in Dallas, Texas.
The university is listed with the World Directory of Medical Schools (https://search.wdoms.org/) and with Europa World of Learning(http://www.worldoflearning.com/).
IAU is recognized by ECFMG, the Medical Council of Canada, Medical Council of India and the St. Lucian Medical and Dental Council. The University is registered with the Ministry of Education in St. Lucia.
The University is also a member of the Association of Commonwealth Universities (ACU).


Leopold Z. Goldstein

Leopold Z. Goldstein (1899-1963), an American physician and endocrinologist, was born in Camden, New Jersey, graduated from Camden High School and the University of Pennsylvania Medical School in 1922. He continued a path in medicine initiated by his older brother, Hyman I Goldstein. His younger brother, Henry Z. Goldstein specializing in otolaryngology, also a graduate of the University of Pennsylvania completed the brothers' careers in medicine. Goldstein died in Paris in 1963.
He was chief of gynecology and obstetrics at Einstein Medical Center, Associate Professor at Thomas Jefferson University Medical Center, and an associate of the Gynecology Department of the University of Pennsylvania, all of Philadelphia, PA. During the late 1920s, Goldstein undertook postgraduate studies in Vienna, Austria, and the Rotunda Hospital in Dublin.
He co-authored, "Clinical Endocrinology of the Female" with Charles Mazer, published in Philadelphia and London by W.B. Saunders Company, 1932. He also was the author of over forty articles in his specialty published in respective medical journals during his career, and was a proponent of the use of the Colposcopy in physical examinations of female patients.


Gary R. Epler

Gary R. Epler is an Associate Professor of Medicine at the Harvard Medical School and has written scientific books regarding Occupational lung diseases and the Diseases of the Bronchioles.
Education.
Epler earned his medical degree at the Tulane University School of Medicine, He completed his residency in internal medicine and obtained his Fellowship in pulmonary medicine at the Boston University Medical Center.
Research and career.
Dr. Gary Epler did research on the Bronchiolitis Obliterans Organizing Pneumonia which is inflammatory bronchiolitis obliterans with patchy organizing pneumonia and may be referred to as Epler’s pneumonia. He is currently serving at the Brigham and Women’s Hospital as a Physician in the Department of Pulmonary and Critical Care Medicine and also associate professor of medicine at the Harvard Medical School.


Hospital for Hire

"Hospital for Hire" is an episode of the British comedy television series "The Goodies".
This episode is also known as "The National Health Service" and "Doctors".
Written by The Goodies, with songs and music by Bill Oddie.
Plot.
The National Health Service is having problems, and the Goodies are disgusted with the poor services. In a frustrated response to their criticisms, the National Health Service suggests to them that they study medicine and become doctors themselves in order to improve things. As a result, the Goodies become doctors. They pass all the tests — including beer drinking and nurse chasing.
Later, Graeme develops a special tonic and the Goodies sell it at a medicine show. They also set up their own eccentric outdoor hospital, performing X-rays (one scene shows Graeme being frightened and running away at the sight of a skeleton emerging from behind the X-ray machine) and operations, as well as setting bones and delivering babies.
The Goodies become obsessed with curing people, and collect patients from all over, including a patient from the back of an ambulance. Soon, all of Britain is cured by Graeme's tonic. Even a mummy, in a museum, is brought back to life by Graeme's tonic.
When the Goodies later become ill, they discover that curing the nation from sickness has unexpected disadvantages.


Rural health clinic

A rural health clinic (RHC) is a clinic located in a rural, medically under-served area in the United States that has a separate reimbursement structure from the standard medical office under the Medicare and Medicaid programs. RHCs were established by the Rural Health Clinic Services Act of 1977 (P.L. 95-210), (Section 1905 of the Social Security Act). The RHC program increases access to health care in rural areas by
As of 2018, there were approximately 4,300 RHCs across 44 states in the U.S. RHCs facilitate 35.7 million visits per year and provide services for millions of people, including 8 million Medicare beneficiaries.
As primary care facilities, RHCs are essential to the health care safety net in rural America. Unlike FQHCs, RHCs are not legally mandated to provide care to patients who cannot pay but many of their patients are uninsured. Recent evidence shows that the presence of RHCs enables greater appointment availability for Medicaid patients.
Requirements for certification.
Location.
At the time of creation of an RHC, the clinic must be located in an area that has the following characteristics:[6]
Staffing.
In addition, a RHC must employ a nurse practitioner (NP) or a physician assistant (PA) and have a NP, PA, or certified-nurse midwife (CNM) available at least 50 percent of the time the RHC operates.
Services.
At least 50% of services furnished in an RHC must be services typically performed in an outpatient setting and RHCs are prohibited from primary providing behavioral health services.
Survey and recertification.
RHCs must be certified through a survey process by a State Survey Agency and meet Medicare’s Conditions for Certification. RHCs must undergo an annual program evaluation to ensure quality of care.
Payment design.
Rural Americans face a number of challenges in accessing healthcare, namely a lack of healthcare professionals and access to providers. Only 10 percent of physicians and 23 percent of specialists reside in rural areas. Compared to their urban counterparts, rural residents have to travel much farther to receive treatment. 23 percent of the rural population are Medicare beneficiaries while 45 percent of rural poor are covered by Medicaid.
To encourage the development of RHCs serving rural, under-served communities, Medicare reimburses RHCs using cost-based reimbursement. RHCs receive an all-inclusive rate (AIR) per visit for all Medicare services rendered. This is different from most medical providers in the United States, which are paid based on the cost of the services provided using the Physician Fee Schedule (PFS).
If an RHC is owned by a hospital with fewer than fifty beds, there is no cap for the cost-based reimbursement. If, however, the RHC is owned by a hospital with more than fifty beds the cost-based reimbursement is capped at $83.45 per visit. Reimbursement for independent RHCs is capped at the same rate as provider-based RHCs with more than fifty beds. This cap is adjusted annually based on the percent change in the Medicare Economic Index (MEI).
Prior to 2001, State Medicaid Programs were required to pay RHCs via a cost-based reimbursement model similar to that of Medicare. This methodology required that RHCs submit cost reports in order for states to determine reasonable costs for personnel, services, supplies and other administrative fees. However, the passage of the Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA 2000) replaced cost-based reimbursement with a state-specific prospective payment system (PPS). The BIPA PPS model requires states to reimburse RHCs at least 100 percent of the average of the costs of the clinic in fiscal years (FY) 1999 and 2000 trended forward for inflation, creating a "floor" for Medicaid reimbursement. States are allowed to reimburse RHCs for Medicaid via any methodology they chose but the total Medicaid reimbursement must at least exceed this "floor".
Criticism and proposed regulatory changes.
The RHC program was criticized in the 1990s for allowing enhanced reimbursement to remain for RHCs, even if that clinic is no longer in a rural or under-served community. The Government Accountability Office and the HHS Office of the Inspector General both released studies that showed that RHC status was not revoked for those RHCs located in rural areas that grew into urbanized areas. To address this issue, Congress passed the Balanced Budget Act of 1997 (BBA) eliminating the grandfather clause for RHCs that had allowed them to retain their status despite the fact that the RHC’s location requirements no longer qualified the RHC for the program.[8]
However, the Centers for Medicare and Medicaid Services (CMS) released the final regulations implementing the BBA more than three years after they proposed those regulations which voided the final regulations due to the Medicare Modernization Act of 2003 (MMA). The MMA requires that CMS finalize any rule within three years of proposing that rule. If the rule is not finalized within three years, it must be proposed again before it can be finalized. Before the rule could take effect, lobbying groups, such as the American Medical Association (AMA), National Rural Health Association (NRHA), American Academy of Family Physicians (AAFP), and the National Association of Rural Health Clinics (NARHC), put pressure on Congress to change the law.
On June 26, 2008, CMS released a second proposed rule to implement the BBA-required elimination of the grandfather clause and to make changes to the RHC and Federally Qualified Health Center (FQHC) conditions of participation.[9] However, President Obama put a hold on all pending rules from the George W. Bush Administration, and once again, CMS failed to finalize the rules within the three year time period.


Council for Responsible Nutrition

The Council for Responsible Nutrition (CRN) is a Washington D.C.-based trade association and lobbying group representing
ingredient suppliers and manufacturers in the dietary supplement industry. CRN's current president and CEO is Steve M. Mister.
History.
The Council for Responsible Nutrition was established in 1973 in Washington, D.C.
Membership.
CRN represents more than 100 companies that manufacture dietary ingredients and/or dietary supplements, or supply services to those suppliers and manufacturers. CRN’s member companies produce a large portion of the dietary supplements marketed in the United States and globally. Its member companies manufacture popular national brands as well as the store brands marketed by major supermarkets, drug stores and discount chains. These products also include those marketed through natural food stores and mainstream direct selling companies.
CRN member companies are expected to comply with a host of federal and state regulations governing dietary supplements in the areas of manufacturing, marketing, quality control and safety. Its supplier and manufacturer member companies also agree to adhere to additional voluntary guidelines as well as to CRN’s Code of Ethics.
Activities.
CRN sponsors two annual events. The Conference: CRN’s Annual Symposium for the Dietary Supplement Industry, is an event for the dietary supplement industry, and The Workshop: CRN’s Day of Science is an event for scientists interested in nutrition and dietary supplement scientific research.
In February 2019 Scott Gottlieb said that the U.S. Food and Drug Administration needed stronger powers over health claims for food supplements and the FDA warned a dozen companies to stop claiming their products can cure diseases. The Council opposed any suggestion that the sector needed stronger regulation.
Affiliate organizations.
CRN has two affiliate organizations. The CRN Foundation is a 501(c)(3) organization, representing the dietary supplement industry, whose mandate is to provide consumers with information about responsible use of dietary supplements, and to provide researchers and healthcare practitioners with education on the proper role of supplements in a healthy lifestyle. CRN-I is an international arm of the CRN whose mission is to provide science-based information to regulators, health care professionals, and the media, particularly those outside the United States, supporting the safety and benefit of dietary ingredients and dietary/food supplements, and to promote sound nutrition and food safety policies well-grounded in science.


Lyall Stuart Scott

Lyall Stuart Scott FRCSED, FRCSGLAS (22 September 1920 – 8 October 1977) was a Scottish consultant surgeon who specialised in urology.
Career.
Lyall Stuart Scott was educated at the High School of Glasgow and Strathallan School, Perthshire; graduating from the University of Glasgow in 1943. Thereafter, he joined the Royal Army Medical Corps, serving in Italy and Austria, where he was appointed Deputy Assistant Director of Medical Services for the Eighth Army.
Following demobolisation he returned to Glasgow and worked in several hospitals in the area. In 1948 he became a Fellow of the Royal College of Surgeons of Edinburgh (FRCSED) and in 1949 a Fellow of the Royal College of Physicians and Surgeons of Glasgow (FRCSGLAS). In his speciality, he qualified Master of Surgery (ChM) in 1955 and Doctor of Medicine (MD) in 1960, both with commendation. In 1961 he was awarded honorary membership of the New York Academy of Sciences.
In 1962 he was appointed consultant urologist at the Western Infirmary, Glasgow and the Royal Beatson Memorial Hospital. In 1967 he was appointed senior consultant urologist, head of department, at the Western Infirmary, Glasgow. Scott published numerous research papers.
Scott served on the editorial committee of the British Journal of Urology, on the council of the British Association of Urological Surgeons and on the urology committee of the Royal Society of Medicine.
He was also a former president of the Scottish Urological Society and member of the International Society of Urology.


Ear pain

Ear pain, also known as earache, is pain in the ear. Primary ear pain is pain that originates from the ear. Secondary ear pain is a type of referred pain, meaning that the source of the pain differs from the location where the pain is felt.
Most causes of ear pain are non-life-threatening. Primary ear pain is more common than secondary ear pain, and it is often due to infection or injury. The conditions that cause secondary (referred) ear pain are broad and range from temporomandibular joint syndrome to inflammation of the throat.
In general, the reason for ear pain can be discovered by taking a thorough history of all symptoms and performing a physical examination, without need for imaging tools like a CT scan. However, further testing may be needed if red flags are present like hearing loss, dizziness, ringing in the ear or unexpected weight loss.
Management of ear pain depends on the cause. If there is a bacterial infection, antibiotics are sometimes recommended and over the counter pain medications can help control discomfort. Some causes of ear pain require a procedure or surgery.
83 percent of children have at least one episode of a middle ear infection by three years of age.
Signs and symptoms.
Ear pain can present in one or both ears. It may or may not be accompanied by other symptoms such as fever, sensation of the world spinning, ear itchiness, or a sense of fullness in the ear. The pain may or may not worsen with chewing. The pain may also be continuous or intermittent.
Ear pain due to an infection is the most common in children and can occur in babies. Adults may need further evaluation if they have hearing loss, dizziness or ringing in the ear. Additional red flags include diabetes, a weakened immune system, swelling seen on the outer ear, or swelling along the jaw.
Causes.
Ear pain has a variety of causes, the majority of which are not life-threatening. Ear pain can originate from a part of the ear itself, known as primary ear pain, or from an anatomic structure outside the ear that is perceived as pain within the ear, known as secondary ear pain. Secondary ear pain is a type of referred pain, meaning that the source of the pain differs from the location where the pain is felt. Primary ear pain is more common in children, whereas secondary (referred) pain is more common in adults.
Primary ear pain is most commonly caused by infection or injury to one of the parts of the ear.
External ear.
Many conditions involving the external ear will be visible to the naked eye.  Because the external ear is the most exposed portion of the ear, it is vulnerable to trauma or environmental exposures.  Blunt trauma, such as a blow to the ear, can result in a hematoma, or collection of blood between the cartilage and perichondrium of the ear. This type of injury is particularly common in contact sports such as wrestling and boxing. Environmental injuries include sunburn, frostbite, or contact dermatitis.
Less common causes of external ear pain include:
Otitis externa.
Otitis externa, also known as "swimmer's ear", is a cellulitis of the external ear canal. In North America, 98% of cases are caused by bacteria, and the most common causative organisms are "Pseudomonas" and "Staph aureus". Risk factors include exposure to excessive moisture (e.g. from swimming or a warm climate) and disruption of the protective cerumen barrier, which can result from aggressive ear cleaning or placing objects in the ear.
Malignant otitis externa is a rare and potentially life-threatening complication of otitis externa in which the infection spreads from the ear canal into the surrounding skull base, hence becoming an osteomyelitis. It occurs largely in diabetic patients. It is very rare in children, though can be seen in immunocompromised children and adults. "Pseudomonas" is the most common causative organism. The pain tends to be more severe than in uncomplicated otitis externa, and laboratory studies often reveal elevated inflammatory markers (ESR and/or CRP). The infection may extend to cranial nerves, or rarely to the meninges or brain. Examination of the ear canal may reveal granulation tissue in the inferior canal. It is treated with several weeks of IV and oral antibiotics, usually fluoroquinolones.
Middle and inner ear.
Acute otitis media.
 Acute otitis media is an infection of the middle ear. More than 80% of children experience at least one episode of otitis media by age 3 years. Acute otitis media is also most common in these first 3 years of life, though older children may also experience it. The most common causative bacteria are "Streptococcus pneumoniae", "Haemophilus influenzae", and "Moraxella catarrhalis". Otitis media often occurs with or following cold symptoms. The diagnosis is made by the combination of symptoms and examination of the tympanic membrane for redness, bulging, and/or a middle ear effusion (collection of fluid within the middle ear).
Complications of otitis media include hearing loss, facial nerve paralysis, or extension of infection to surrounding anatomic structures, including:
Referred ear pain.
A variety of conditions can cause irritation of one of the nerves that provides sensation to the ear.
Conditions causing irritation the trigeminal nerve (cranial nerve V):
Conditions causing irritation of the facial nerve (cranial nerve VII) or glossopharyngeal nerve (cranial nerve IX):
Conditions causing irritation of the vagus nerve (cranial nerve X):
Conditions causing irritation of cervical nerves C2-C3:
Pathophysiology.
Primary ear pain.
The ear can be anatomically divided into the external ear, the external auditory canal, the middle ear, and the inner ear. These three are indistinguishable in terms of the pain experienced.
Secondary ear pain.
Many different nerves provide sensation to the various parts of the ear, including cranial nerves V (trigeminal), VII (facial), IX (glossopharyngeal), and X (vagus), and the great auricular nerve (cervical nerves C2-C3). These nerves also supply other parts of the body, from the mouth to the chest and abdomen. Irritation of these nerves in another part of the body has the potential to produce pain in the ear. This is called referred pain. Irritation of the trigeminal nerve (cranial nerve V) is the most common cause of referred ear pain.
Diagnostic.
While some disorders may require specific imaging or testing, most etiologies of ear pain are diagnosed clinically. Because the differential for ear pain is so broad, there is no consensus on the best diagnostic framework to use. One approach is to differentiate by time course, as primary causes of ear pain are typically more acute in nature, while secondary causes of ear pain are more chronic.
Acute causes may be further distinguished by the presence of fever (indicating an underlying infection) or the absence of fever (suggesting a structural problem, such as such as trauma or other injury to the ear). Etiologies leading to chronic pain may be broken down by the presence or absence of worrisome clinical features, also known as red flags.
One red flag is the presence of one or multiple risk factors including smoking, heavy alcohol use (greater than 3.5 drinks per day), diabetes, coronary artery disease, and older age (greater than 50). These factors increase the risk of having a serious cause of ear pain, like cancer or a serious infection. In particular, second hand smoke may increase risk of acute otitis media in children. In addition, swimming is the most significant risk factor for otitis externae, though other risk factors include high humidity in the ear canal, eczema and/or ear trauma.
If red flags are present it may be necessary to do additional workup such as a CT scan or biopsy to rule out a more dangerous diagnosis. Such diagnoses include malignant (or necrotizing) otitis externa, mastoiditis, temporal arteritis, and cancer. It is important to note that while the presence of a red flag does raise suspicion for one of these four disease, it does not guarantee a diagnosis as any one symptom can be seen in a variety of situations. For example, jaw claudication can be seen in temporal arteritis, but also in TMJ dysfunction.
If there are no red flags, other sources of referred ear pain become more likely and are reasonable to pursue.
Management.
Management of ear pain depends on the underlying cause.
Antibiotics.
While not all causes of ear pain are treated with antibiotics, those caused by bacterial infections of the ear are usually treated with antibiotics known to cover the common bacterial organisms for that type of infection. Many bacterial ear infections are treated with cleaning of the area, topical or systemic antibiotics, and oral analgesics for comfort. Some types of bacterial ear infections can benefit from warm compresses included in the treatment. Some of the causes of ear pain that are typically treated with either a topical or systemic antibiotic include:
Some bacterial infections may require a more advanced treatment with evaluation by otorhinolaryngology, IV antibiotics, and hospital admission.
Procedures.
Some causes of ear pain require procedural management alone, by a health professional, or in addition to antibiotic therapy.
Other.
Given the variety of causes of ear pain, some causes require treatment other than antibiotics and procedures.
Epidemiology.
2/3 of people presenting with ear pain were diagnosed with some sort of primary otalgia and 1/3 were diagnosed with some sort secondary otalgia.
A common cause of primary otalgia is ear infection called otitis media, meaning an infection behind the eardrum. The peak age for children to get acute otitis media is ages 6–24 months. One review paper wrote that 83% of children had at least one episode of acute otitis media by 3 years of age. Worldwide, there are 709 millions cases of acute otitis media every year. Hearing loss globally due to ear infection is estimated to be 30 people in every 10,000. Around the world there is around 21,000 to 28,000 deaths due to complications from ear infections. These complications include brain abscesses and meningitis.
Otitis externae peaks at age 7–12 years of age and around 10% of people has had it at least once in their lives.
Cerumen impaction occurs in 1 out of every 10 children, 1 in every 20 adults and 1 in every 3 elderly citizens.
Barotrauma occurs around 1 in every 1000 people.
Of people presenting with ear pain, only 3% was diagnosed with eustachian tube dysfunction.
History.
Not much was known about ear pain and acute otitis media before the 17th century. It was a common phenomenon with no treatment. That changed when the otoscope was invented in the 1840s by Anton von Troeltsh in Germany.  Another shift came with the invention of antibiotics. Before antibiotics was introduced there use to be a high rate of ear infections spreading to the bone around the ear, but that is now considered a rare complication.
Society and culture.
There was previously a strong tradition of treating acute otitis media with amoxicillin. One quote from the 1980s shows this sentiment by saying "any child with an earache has an acute amoxicillin deficiency". However, people started realizing that using antibiotics too much can cause bacteria to gain resistance. Increasing resistance makes antibiotics less effective. The term antibiotic stewardship is then used to describe the systematic effort to educate antibiotic prescribers to only give these medications when they are warranted. In particular to children, most ear pain resolves by itself with no complications. There are guidelines in place to help determine when antibiotics for ear pain are needed in children.
The ear itself played a role in treatment via acupuncture, also known as auriculotherapy. It was believed that acupuncture of the ear could be used to correct other pain or disorders in the body. Such practices may have started as far back as the Stone Age. The first documentation of auriculotherapy in Europe was in the 1600s. One physician described stimulating the ear by burning or scarring to treat sciatic pain, while another physician applied this treatment for toothache. Paul Nogier is known as the father of ear acupuncture for his theory that parts of the ear corresponds to other areas of the body in a reliable fashion.
Research.
There are currently studies going on delivering antibiotics directly into the middle ear.


Vladimir Roslik

Vladimir Roslik (c. 1941 – c. 1984) was a doctor arrested and killed during the Uruguayan military dictatorship of 1973–1985.
He was the last victim to die under torture during this dictatorship prior to the return of democracy in 1985.
Roslik was born and died in San Javier, Río Negro. He studied medicine in the USSR, at the Patrice Lumumba University. Several monuments to him stand in his hometown.


Viktor von Hacker

Viktor von Hacker (October 21, 1852 – May 20, 1933) was an Austrian surgeon born in Vienna.
In 1878 he received his medical doctorate at the University of Vienna, and after graduation remained in Vienna as an assistant to Theodor Billroth (1829–1894). Later he was a professor of surgery at the Universities of Innsbruck (1894–1903) and Graz (1904–1924).
Hacker is remembered for his work involving esophagoscopy, esophageal surgery and gastrointestinal surgery. With German-American surgeon Carl Beck (1856–1911), he is credited with developing a surgical technique for balanic hypospadias.
In 1885, Hacker assisted Billroth when the latter performed the first resection of the pylorus followed by posterior gastrojejunostomy. Afterwards, Hacker documented a detailed account of the operation. With surgeon Georg Lotheissen (1868–1941), he published two treatises concerning the esophagus, "Angeborene Missbildungen, Verletzungen und Erkrankungen der Speiseröhre" (Congenital abnormalities, injuries and diseases of the esophagus) and "Chirurgie der Speiseröhre" (Surgery of the esophagus).


Isaac Swainson

Isaac Swainson (1746–1812) was famous for his botanical garden, which was largely funded from the profits of a herbal remedy for venereal disease. For his commercial activities in the latter field, he has been called a "radical quack". He was a relative of William John Swainson, the zoologist, and of Charles Swainson (naturalist). A plant genus is named after him. A biography has been recently produced
Velno's Vegetable Syrup.
Swainson moved to London where he served as assistant to a Dr. Mercier in Frith Street, Soho, where he settled. Later, he purchased from Dr Mercier the recipe of a patent medicine called "Velnos’ Vegetable Syrup", named after Vergery de Velnos. This was one of many cures for venereal diseases based on vegetables rather than mercury, which is extremely toxic. This brand became well-known and Swainson reputedly made as much as £5,000 a year from its sales. In addition to curing various venereal diseases, including “the pox” and the “French disease”, it was claimed to cure leprosy, gout, scrophula, dropsy, small pox, consumption, tape worms, cancer, scurvy, and diarrhea
Whether he believed in the efficacy of his remedy or not, he did study the conventional medicine of the era and gained an MD in 1785, although there is no record of his subsequent election to the Royal College of Physicians.
Sturt's Desert Pea.
Swainson, who was less noted for botany, is honoured by the genus name Swainsona, which is now known as the emblem of South Australia. Its common name is Sturt's desert pea.


Haemal arch

A haemal arch (also spelled hemal arch), also known as a chevron, is a bony arch on the ventral side of a tail vertebra of a vertebrate. The canal formed by the space between the arch and the vertebral body is the haemal canal. A spinous ventral process emerging from the haemal arch is referred to as the haemal spine.
Blood vessels to and from the tail run through the arch. In reptiles, the caudofemoralis longus muscle, one of the main muscles involved in locomotion, attaches to the lateral sides of the haemal arches.
In 1956, Alfred Sherwood Romer hypothesized that the position of the first haemal arch was sexually dimorphic in crocodilians and dinosaurs. However, subsequent research established that the size and position of the first haemal arch was not sexually dimorphic in crocodilians and found no evidence of significant variation in tyrannosaurid dinosaurs, indicating that haemal arches could not be used to distinguish between sexes after all.
Haemal arches play an important role in the taxonomy of sauropod dinosaurs, as sauropods exhibit a wide range of morphologies of the haemal arches. In 1878, Othniel Marsh named the sauropod "Diplodocus" after the distinctive shape of its haemal arches, which were forked to have both an anterior and posterior process. Though once thought to be a specialized characteristic of "Diplodocus" and its close relatives, forked chevrons are now known to have been widespread among sauropod dinosaurs, although titanosauriform sauropods returned to the unforked condition.


Southampton Leisure Holdings

Southampton Leisure Holdings PLC was the parent company of Southampton Football Club Ltd and was listed on the Alternative Investment Market of the London Stock Exchange. The company was placed into administration on 2 April 2009.
Subsidiaries.
The wholly owned subsidiary companies of Southampton Leisure Holdings PLC were:
History.
On 30 June 2006, Rupert Lowe resigned as Chairman of Southampton Leisure Holdings, along with other directors Andrew Cowen, Guy Askham, Mike Richards and David Windsor-Clive.
On 26 February 2007, Michael Wilde offered his resignation as a Director effective from 28 February 2007 as a result of his failure to bring in new investment. The resignation was accepted by the board as being in the best interests of the company.
On 27 April 2007, it was rumoured that Paul Allen, the American entrepreneur who formed Microsoft with Bill Gates, may launch a takeover bid for the club. An apparent close source said "he believes there is long term investment value in UK Soccer. Southampton is a sleeping giant, a family-supported club with traditional values, and we see the value in taking the brand global."
Administration.
Shares in the Company were suspended from trading on 1 April 2009, when the Company announced that it was in negotiations to secure additional financing to ensure that it was able to continue trading.
On 2 April 2009, Southampton Leisure Holdings declared administration after it failed to gain investment to last for the next financial year. Administrators Mark Fry and David Hudson, partners of Begbies Traynor, took over control of the parent company and all assets until a new owner could be found.
On 27 July 2009, DMWSL 613 Limited, a company controlled by Markus Liebherr bought Southampton Football Club and all its assets form the administrator. On 2 October, the listing of the shares for Southampton Leisure Holdings was cancelled.
The company was placed in Creditors' Voluntary Liquidation on 22 February 2010.


KTU Faculty of Medicine

KTU Faculty of Medicine is the first and only medical school in Trabzon, Turkey. The school is officially founded in 1973 and it is the oldest and largest medical faculty of the Eastern Black Sea region.
Foundation.
Dated 4 January 1973, Karadeniz University Faculty of Medicine, 6th faculty of Karadeniz University was founded under the name of Faculty of Medicine and Health Sciences according to the Chapter 1650. In addition to its own divisions, Trabzon Faculty of Medicine, established as a unit of Hacettepe University, was also staffed by the Faculty of Medicine and Health Sciences. Trabzon Faculty of Medicine, once affiliated to Hacettepe University, admitted students in 1976-1977 instructional year and those students continued their education in Hacettepe University. In accordance with the legal decision, issued 41 and dated 20.7.1982, KTU Faculty of Medicine and Health Medicine joined together as Karadeniz University Medicine Faculty.
Divisions.
The faculty is composed of three divisions, namely Basic Medical Sciences, Internal Medical Sciences and Surgical Medical Sciences.


Kawai Tsugunosuke

 was a Japanese samurai of the late Edo period, who served the Makino clan of Nagaoka. Kawai was a senior military commander of Nagaoka forces during the Boshin War of 1868–1869. He escaped to nearby Aizu after his domain's fall; however, he contracted gangrene from an untreated leg wound, and died in Aizu.


List of medical specialty colleges in the United States

This list of medical specialty colleges in the United States includes medical societies that represent board certified specialist physicians. The American Medical Association maintains a list of societies represented in its House of Delegates, while the American Association of Colleges of Osteopathic Medicine maintains a list of osteopathic specialty colleges. The American Association of Physician Specialists maintains a list of specialties colleges open to physicians with either M.D. or D.O. degrees. Some societies are not affiliated with these associations.


Brad Buckley (politician)

Bradley Leo Buckley is a Texas veterinarian and Republican member of the Texas House of Representatives for House District 54, which includes part of Bell County and all of Lampasas County in Central Texas.
Education.
Buckley earned his Bachelor of Arts degree in 1989 and his Doctor of Veterinary Medicine in 1993 from Texas A&M University.
Career.
Since 1994, he has been a veterinarian having his own practice in Killeen, Texas.
Texas House of Representatives.
On May 22, 2018, Buckey defeated incumbent Scott Cosper in the Republican primary runoff election for the Texas House District 54. On November 6, 2018, Buckley won the general election with 53.8% of the vote; Kathy Richerson, his Democratic opponent, received 46.2%.
In 2021, Buckley introduced legislation that would prohibit companies that produce meat-like substances made from plants from using the terms "meat" in their labelling. Livestick companies and their lobbying organizations supported the bill, while plant-based food companies like Beyond Meat and Impossible Burgers described the bill as a violation of free speech.


Consejo Superior de Deportes

The High Council for Sports (CSD) () is a Spanish government agency responsible for the promotion, planning and development of physical culture and sports activities of any kind, the coordination and support to social entities dedicated to sports as well as the relations between the Government and the Spanish Olympic Committee.
It's also responsible for the management and promotion of centers and services intended for sports practice, the sports education in schools and the inspection of the sports activities.
The agency is led by a senior official with the rank of Secretary of State that holds the title of President of the National Sports Council. Since 31 March 2021 the President of the agency is José Manuel Franco.


Congenital non-progressive hemangioma


National Council on Severe Autism

The National Council on Severe Autism (NCSA) is a non-profit organization that pursues recognition, policy and solutions for individuals, families and caregivers affected by severe forms of autism and related disorders. The organization was founded in May 2018 by Jill Escher, Feda Almaliti, Amy Lutz, and Alison Singer, president of the Autism Science Foundation. The NCSA is the first group to advocate exclusively for the needs of autistic individuals needing high levels of support. The organization is already controversial concerning its views on low-functioning autism, with some supporting its goals of medical treatment and additional support, and others believing that the organization detracts from autistic people.
Formation.
In an article on Psychology Today, Lutz wrote that the Council was set up to advocate for suitable housing arrangements, adequate developmental services, and scientific research. The National Council on Severe Autism has issued position statements on issues such as guardianship, crisis care, employment and what qualifies as a community-based setting. The NCSA supports the option of appointing a guardian to make decisions for severely autistic individuals when necessary. Additionally, they note that the number of studies that focus on severe autism have declined dramatically.
Kimberlee McCafferty, an autism parent and writer, wrote that as a parent of a severely autistic child, she supports the organization because it gives her the opportunity to discuss the challenges of severe autism. She claimed that those challenges are not adequately portrayed in the media, as the media tends to mainly focus on successful autistic individuals. Many parents have expressed support for the organization's existence, noting that severe autism can often be dangerous.
Advocacy.
, NCSA has almost 7,000 Facebook followers.
The NCSA has created a series of webinars in response to the COVID-19 pandemic to provide advice and answer questions about the effects of the pandemic on autistic children.
Responses.
Support.
Many parents have expressed support for the organization's existence, noting that severe autism can often be dangerous.
Opposition.
Shannon Des Roches Rosa, the senior editor for the news site Thinking Person's Guide to Autism, claims that the organization will take away autonomy from autistic people. She claims that the organization wants parents or guardians to make decisions for autistic individuals, and that there are no autistic people on the board of directors. Amy Lutz, the organization's secretary, stated in response that most autistic individuals served by the organization cannot advocate for themselves, saying “We fully support self-advocates pursuing the support that they need, but this is completely separate.” The Maine Autism Collective wrote an open letter to the NCSA saying that they disagree with their view that autism is a medical condition.