The Grand Challenges in Global Health

The Grand Challenges in Global Health (GCGH) is a research initiative launched by the Bill & Melinda Gates Foundation that, if embraced by creative thinkers around the world, might bring about real progress in the health of the developing world. The word "thinkers" is an important distinction because the program encourages leaders of every discipline to contribute, whether it be engineers, biologists, pharmacists, scientists, etc. The program is founded on the assumption that with increased support and funding, contemporary science and technology can contribute to the fight against diseases affecting the developing world.
With the generous offering of grants for projects, proposals are welcomed as they fit one of a set of 14 challenges, categorized in groups among seven stated goals. With the targeting of specific challenges, the initiative focuses on a variety of health problems inherent in today's developing world. While the 14 challenges are direct, the scope of the project is comprehensive as it welcomes strategies of prevention, diagnosis, detection, examination, etc. The disciplines involved may include immunology, microbiology, genetics, molecular and cellular biology, entomology, agricultural sciences, clinical sciences, epidemiology, population and behavioral sciences, ecology and evolutionary biology, etc.
History.
In January 2003, Bill Gates first announced the Grand Challenges in Global Health at the World Economic Forum in Davos, Switzerland. In partnership with the National Institutes of Health (NIH), the Bill & Melinda Gates Foundation (BMFG) granted $200 million to the Foundation for the National Institutes of Health (FNIH). The goal behind the initiative was to fund research to advance the fight against disease that disproportionately affects people in the world's poorest countries. At this time the scientific board's responsibilities were outlined: to identify scientific or technological innovations that have a global impact or show potential for feasibility.
In May 2003, the scientific board requested ideas through widespread advertising and marketing strategies. These announcements welcomed innovative ideas, and more than 1,000 suggestions from scientists and institutions in 75 countries were submitted by July. The scientific board met to further discuss these proposals, which were presented orally with a statement of the problem, descriptions of obstacles to progress, the challenge itself, and a discussion of potential benefits and priority areas for study and application. The following questions raised during the meetings reflect the difficulty in defining these Grand Challenges: Does the proposal describe a difficult and discrete roadblock to progress? What is the likelihood that creative solutions are required and that grant proposals worthy of funding will be received to address it? Is there already substantial scientific activity aimed at solving the problem, which would make the intent of a grand challenge redundant? What are possible impacts on various diseases if the challenge is successfully met? Will envisioned advances be suitable for implementation in poorer parts of the world?
In October 2003, the scientific board announced the 14 Grand Challenges.
In August 2004, the evaluation of letters from around the world led to over 400 full proposals. Experts assessed proposals and the Executive Committee of the scientific board and staff members from FNIH and BMGF reviewed the projects to move into the negotiations for grants.
In May 2005, The Bill & Melinda Gates Foundation gave an additional $250 million to fund research for the initiative, bringing the foundation's commitment to $450 million.
In June 2005, the initiative announced grants for 43 new projects, attracting international partners.
Today, the work towards revolutionary advances in global health continues. 44 separate research projects are currently being managed, and solving even one of the 14 challenges could potentially improve the lives of millions.
The Grand Challenges.
Goal 1: Improve Vaccines
Goal 2: Create New Vaccines
Goal 3: Control Insect Vectors
Goal 4: Improve Nutrition
Goal 5: Limit Drug Resistance
Goal 6: Cure Infection
Goal 7: Measure Health Status
Today: The GCGH is launching a new Grand Challenge in Family Health. Currently, two new grant opportunities exist under this challenge:
Explorations.
Grand Challenges Explorations promotes invention in global health research. The Bill & Melinda Gates Foundation has committed $100 million to support scientists across the world in increasing the span of ideas to fight our most daunting health challenges.
Launched in 2008, Grand Challenge Explorations grants have already been awarded to 495 researchers from 42 countries.
Currently, nearly 500 researchers from over 40 countries are using Grand Challenges Explorations grants to experiment with groundbreaking ideas. While some are pursuing radioactivity to kill infected cells, others are trying to develop a waterless toilet that is cost efficient as well as environmentally productive.
The Explorations grant initiative requires two short page applications but no preliminary data. Applications are submitted online. Initial grants of $100,000 are awarded two times a year. Successful projects have the opportunity to receive a follow-on grant of up to $1 million and could eventually evolve into Grand Challenges project.
ESC Program.
The key challenge associated with such large-scale research projects called for by the initiative is the addressing of ethical, social, and cultural (ESC) issues related to the Grand Challenges. Dr. Peter Singer and Dr. James Lavery and a team of colleagues are employing projects to address these barriers, but for the GCGH initiative to be successful, compliance and collaboration with this concept is absolutely critical.
Project Goal.
The Ethical, Social, and Cultural Program of the Grand Challenges in Global Health, launched in 2005, is targeted to address the ethical, social, and cultural issues that may arise as a result of the initiative- either in the development of the research itself, or in the implementation of knowledge and technology by the communities in need. The GCGH ESC program is the first significant science project concentrated entirely on ESC issues linked to the developing world. ESC issues can have a series of consequences that involve new technologies and approaches: rejection of safety precautions or genetically modified foods, for example, because of culture sensitivity or perceived health, environmental, or economic risks. The ESC program assumes that science and technology are essential to global health development, but the appropriate development of this technology requires attention to the accompanying ethical, social and cultural issues. The program aims to link ESC activities with the research projects and to include voices from the developing world within these projects. Its two main goals are (1) to provide an advisory service for GCGH projects and (2) to create a research program to facilitate appropriate adoption of them in the long-term. The Bill & Melinda Gates Foundation is in compliance with this idea and granted money in November 2005 for the program to be carried out. The program is described and discussed at length in a series of four articles published in PLoS Medicine.
ESC Issues.
In defining ESC issues, the program's creators underwent a process of document analysis, group discussions with investigators and program staff, and interviews with experts from the developing world. The findings include thirteen issues that include: community engagement, public engagement, cultural acceptability, gender, post-trail obligations/benefit sharing, collaboration, the involvement of civil society organizations, affordability, accessibility, regulatory issues, collection, management, and storage of tissue samples, corruption and poor governance, and unintended consequences.
Program milestones.
Advisory service.
The ESC advisory service was created to address ESC issues identified at the start of GCGH research projects, as well as challenges encountered as projects progress. The aim is to work in a close, unified way with the investigators on ESC issues appearing in their projects and thus guide the achievement of their milestones. An advisory service co-leader and a lead bioethicist are assigned to each GCGH project. During the initial phase of communication, the co-leader and lead bioethicist define the issues and develop a strategy for addressing the challenge's issues based on their specific expertise. A process of consultation with the GCGH program officers has also been implemented to help identify issues within the challenges and its individual projects. The program officers often join the advisory service conference calls and offer expertise and insights that help anticipate ESC concerns.
Research program.
The goal of the research program is to provide knowledge in order to facilitate the successful adoption of technology by GCGH's targeted communities. With working papers, working groups, global case studies, and demonstration projects on public engagement, research enhances the ESC expertise with respect to specific goals of the Grand Challenges.
Criticism.
As is the case with most health initiatives, the GCGH have been subject to a fair degree of criticism.
A very widely circulated critique was published in 2005 in The Lancet. In the column, Anne-Emanuelle Birn, Sc.D., an associate professor of Public Health Sciences at the University of Toronto, described the initiate's role as "weak" for focusing too narrowly on the power of science and neglecting the importance of economic, social, and political factors. She cites the 20th century cultural obsession with technological advancement as one that cannot ignore the need to redistribute economic and social resources within impoverished communities. She suggests that rather than trying to finance, develop and distribute new and existing vaccines, a more sustainable effort might focus on public support for a universal, accessible public health system. She references Goal #4, which involves improved nutrition, as a specific challenge that is shortsighted and "overlooks key distributional questions." She explains that because malnutrition and famine are not the result of technical obstacles, but rather, political and economic ones, technology is not the answer. These issues are not about supply or the lack of nutritional value available in foods, but rather, poor income distribution and market shifts leading to populations unable to afford food.


Radial artery puncture

Radial artery puncture is a medical procedure performed to obtain a sample of arterial blood for gas analysis. A needle is inserted into the radial artery and spontaneously fills with blood. The syringe is either prepacked with a small amount of heparin to prevent coagulation, or must be "heparinised", by drawing up a small amount of heparin and squirting it out again.


Victor Henri Hutinel

Victor Henri Hutinel (15 April 1849 – 21 March 1933) was a French physician who was a native of Châtillon-sur-Seine, Côte-d'Or. He specialized in pediatric medicine and childhood diseases.
He studied medicine in Nancy, and later Paris, where he became an externe in 1871. He earned his medical doctorate in 1877, and in 1879 became "médecin des hôpitaux". In 1897 he was professor of internal pathology, and in 1907 became a professor of pediatrics, succeeding Jacques-Joseph Grancher (1843–1907) as director at the "Hôpital des Enfants-Malades" in Paris.
Among his written publications was a five-volume work on childhood diseases called "Les maladies des enfants". Another name for cirrhosis of the liver associated with childhood tuberculous pericarditis is sometimes referred to as "Hutinel's cirrhosis".


PGY

PGY, short for postgraduate year, refers to a North American numerical scheme denoting the progress of postgraduate dental, medicine, podiatry or pharmacy residents in their residency programs. It is used to stratify responsibility in most training programs and to determine salary. The grade of the resident is denoted with a numeral after the PGY designation, such as PGY-3 for a third-year resident.
The length of residency depends mostly on the field a graduate chooses to take. Medical specialties such as family medicine and internal medicine often requires three years, whereas surgery usually requires a minimum of five, and neurological surgery is the longest at seven years. Subspecialization (vascular or orthopedic spine surgery as a branch of surgery, for example) in any field will add time to postgraduate training.
For more information on specific medical residency programs, see the American Medical Association's Fellowship and Residency Electronic Interactive Database.
Dental residencies for general practice, known as GPRs, are generally one year, with a possibility of a second year at some facilities. Dental specialties, such as orthodontics, require 2–4 years, while oral and maxillofacial surgery requires 4–6 years. Some specialty programs require that applicants have completed at least a one-year GPR residency, while other programs require applicants to have some private practice experience as a general dentist. Regardless of requirements, completing a GPR residency will make an applicant more competitive for any specialty program.
Medical physics residencies range between two and four years, with at least two years fulfilling the necessary clinical experience. Completion of a CAMPEP-accredited residency allows one to sit for board examinations administered through the American Board of Radiology. PGY-3, and/or if also available -4, generally consist of scholarly research years, akin to a postdoctoral research position. Residencies options are either radiation oncology physics or medical imaging.
Pharmacy residencies are usually one year, but a PGY-2 can be completed, often as an option, for pharmacy specialties such as critical care, cardiology, oncology, etc.
In some teaching institutions, trainees are required to indicate level of training on all signatures (John Doe, M.D., PGY-1 or R-1; or John Doe, D.O., PGY-1 or R-1).
Residencies are also offered for those in the physician assistant profession in a variety of specialties such as surgery and emergency medicine.
Internships and residencies are also offered for those who have completed graduate education in psychology, known as interns and post-doc fellows.


John Taylor (athlete)

John Baxter Taylor Jr. (November 3, 1882, Washington, D.C. – December 2, 1908, Philadelphia, Pennsylvania) was an American track and field athlete, notable as the first African American to win an Olympic gold medal.
Biography.
He was born in Washington D.C. to former slaves. The family settled in Philadelphia, Pennsylvania, where he attended public schools and graduated from Central High School in 1902. He spent a year at Brown Preparatory School, also in Philadelphia, where he was the fastest high school quarter-miler in the country. As a freshman at the University of Pennsylvania, he was the ICAAAA (Intercollegiate Association of Amateur Athletes of America) champion in the quarter mile. He bested his personal time in 1907, and again was the ICAAAA quarter mile champion. He graduated from Penn's School of Veterinary Medicine in 1908, and was a member of Sigma Pi Phi, the first black fraternity. He was recruited by the Irish American Athletic Club in New York, and was its most prominent African American member.
1908 Olympics.
Taylor was a member of the gold medal-winning men's medley relay team at the 1908 Summer Olympics in London. He ran the third leg, performing the 400 meters. He followed William Hamilton and Nate Cartmell (fellow athletes from the University of Pennsylvania) and was followed by Mel Sheppard (a fellow athlete from Brown Preparatory School). In both the first round and the final, Taylor received a lead from Cartmell and passed one on to Sheppard. The team won both races, with times of 3:27.2 and 3:29.4. Taylor was the first African American to win an Olympic gold medal. His split for the final was 49.8 seconds.
He advanced to the finals in the men's 400 metres race at the 1908 Summer Olympics, winning his preliminary heat with a time of 50.8 seconds and his semifinal with 49.8 seconds. In the first running of the race, Taylor came in last place out of the four runners. However, teammate John Carpenter was disqualified after being accused of obstructing British runner Wyndham Halswelle and the race was ordered to be repeated without Carpenter. In protest at Carpenter's disqualification, Taylor and fellow American William Robbins refused to compete in the second final. Wyndham Halswelle ran the second final alone, with a time of 50 seconds, and was awarded the gold medal in the only walkover in Olympic history.
Less than five months after returning from the Olympic Games in London, Taylor died of typhoid fever on 2 December 1908 at the age of 26. He is interred at Eden Cemetery in Collingdale, Pennsylvania. In his obituary, "The New York Times" called him "the world's greatest negro runner."
In a letter to Taylor's parents, Harry Porter, fellow Irish American Athletic Club member and acting President of the 1908 U.S. Olympic Team wrote: "It is far more as the man (than the athlete) that John Taylor made his mark. Quite unostentatious, genial, (and) kindly, the fleet-footed, far-famed athlete was beloved wherever known...As a beacon of his race, his example of achievement in athletics, scholarship and manhood will never wane, if indeed it is not destined to form with that of Booker T. Washington."


Mears Group

Mears Group plc is a housing and social care provider. It repairs and maintains over 700,000 social homes across the UK.
History.
The company was founded in 1988 in Gloucestershire, where it is still based, and floated on the Alternative Investment Market of the London Stock Exchange, as Mears Group plc in 1996. In 1999 it acquired Haydon & Co and in 2007 Careforce. In 2008, the group had 8000 employees, and moved to the main market at the London Stock Exchange, with a £420m turnover.
In 2011 it took over more than 20 Home Improvement Services from Anchor, and in 2012 acquired Morrison Facilities Services from AWG plc. In 2012 it acquired Independent Living Services Scotland and launched Mears Nurseplus, enabling the company to offer health services as well as social care. Nurseplus (specialising in the care of adult and paediatric service users with complex health conditions, both acute and chronic that require clinical intervention and management) was awarded a place on the NHS framework contract to supply staff into NHS establishments across Scotland in November 2014.
In October 2014 it took over Omega Group Ltd., a private sector provider of residential lettings and management services to the social housing market. In December 2014 Torbay and Southern Devon Health and Care NHS Trust named the Group as the preferred bidder to run its Living Well@Home Services contract, integrating IT systems and deliver a range of community-based services for a minimum of five years.
In June 2015 it bought Care UK's home care division, with about 6,000 employees for £11.3 million. Subsequently renamed Mears Care, it looked after about 13,000 people.
In December 2016, executive director Alan Long announced that the company was pulling out of contracts with local authorities because it could not afford to operate on the money it was being paid.
In January 2019, it was announced that Mears Group would take over a Home Office contract to provide housing for asylum seekers in Glasgow from Serco.
In January 2020 it announced that it was to sell its domiciliary care division which employed 1,500 people across 18 branches in England and Wales and 1,000 people across 16 branches in Scotland. It planned to concentrate on providing housing with care. The division was sold to Cera Care in February 2020.
Cornwall Council confirmed the group as lead strategic partner for the delivery of extra care in Cornwall with a seven year agreement for 750 extra care housing units worth £150 million.
Performance.
Profits in the first six months of 2014/5 were £18.7m, an increase of 11%. Total group revenue was down 3% from £439.1m to £428.1m.
In a half-year trading update in July 2020, Mears said it expected to report a £6m loss after a 23% drop in revenue at its maintenance arm. Overall group revenue was down 8% to £405m. The company also announced it would be making an unspecified number of redundances, partly due to the impact of the COVID-19 pandemic in the United Kingdom.
Political involvement.
Mears was nominated as a Social Mobility Business Compact ‘Champion’ after signing the Social Mobility Business Compact, set up by the Deputy Prime Minister Nick Clegg in 2011, to encourage employers to offer young people fair and open access to employment opportunities.
The group, with the Local Government Information Unit, supported a report, in December 2014 by former care minister Paul Burstow calling for home care workers to be given key workers status and a living wage.


Horatio George Adamson

Horatio George Adamson (28 November 1865 – 6 July 1955) was a British dermatologist. He studied at St. Bartholomew's Hospital receiving his medical doctorate in 1888. He learned dermatology at the Middlesex Hospital in London from John James Pringle. Between 1909 and 1928, he lectured and practiced dermatology at St. Bartholomew's Hospital.
While working at the Downs Ringworm School of the Metropolitan Asylums Board in Sutton, Adamson developed an interest in mycology and modified Robert Kienböck's technique for X-ray epilation for scalp ringworm.
He was president of the British Association of Dermatologists for 1923–24 and a fellow of the Royal College of Physicians.


Bishnupada Mukhopadhyaya

Bishnupada Mukhopadhyaya was an Indian orthopedic surgeon. The Government of India awarded him Padma Bhushan, the third highest Indian civilian award, in 1971.


Nonthrombocytopenic purpura

Nonthrombocytopenic purpura is a type of purpura (red or purple skin discoloration) not associated with thrombocytopenia.
Nonthrombocytopenic purpura has been reported after smoking mentholated cigarettes.
Examples/causes include:


John Gillies (doctor)

John Calum Macdonald Gillies FRSE is a medical doctor who worked as general practitioner (GP) and who is the Depute Director of the Scottish School of Primary Care. He was formerly the chair of the Scottish Council of the Royal College of General Practitioners (RCGP) from November 2010 to November 2014.
Early career.
Gillies was born in North Uist, Scotland. He studied at the University of Edinburgh, qualifying in medicine in 1975. Gilles travelled to Africa, working as a District Medical Officer in Ntcheu District Hospital, Malawi for 3 years. He gained his Membership of the Royal College of Physicians (MRCP) in 1978.
General principal.
Gillies returned to the United Kingdom and trained in general practice, gaining his Membership of the Royal College of General Practitioners (MRCGP) in 1985. From 1985 he worked as a GP principal in Glenluce, Wigtownshire. He then moved to Selkirk in the Scottish Borders in 1996 where he worked for the 16 years in until he retired from clinical practise in 2012. During the latter part of this time he was working as a GP trainer.
Academic GP.
Gillies was a Honorary Senior Lecturer at the University of Edinburgh. He was one of the authors of "Distilling the Essence of General Practice" which looked at the important and unique advantages of general practice and the development of primary care throughout the UK. Gillies was involved with education initiatives in Africa. He is an associate member of the University of Edinburgh's Global Health Academy. Gillies is on the members advisory board of the Wesleyan Assurance Society. He was chair of the Reference Group of the Scottish Government Health Department's Out of Hours Primary Care Review that reported in 2015. He chaired a group that looked into undergraduate medical education in Scotland that reported in 2019.
Gilles was involved with an initiative that presented a book of poems "Tools of the Trade" to every newly qualified doctor in Scotland.
RCGP Scotland chair.
Gilles was elected by the members of RCGP's Scottish Council to be chair, taking up the position in November 2010. His priorities as chair were to promote generalism and leadership in general practice. During his time as chair of RCGP's Scottish council he spoke out about health inequalities and about the support needed for GP practices to improve quality. In October 2013 he travelled to the Western Isles to unveil a memorial to a dedicated family of doctors. In November 2013 his chairmanship was extended for another year. He delivered a petition to the office of First Minister, signed by 21,000 Scots calling for further resources to be put towards general practice. He was succeeded by Miles Mack in November 2014.
Awards and honours.
Gillies was appointed Officer of the Order of the British Empire (OBE) in the 2016 New Year Honours for services to general practice. In 2018 he was elected a Fellow of the Royal Society of Edinburgh.
Personal life.
He is married to Mary, who is now retired from working as a GP, and they have two children together.


Foundation for Advancement in Cancer Therapy

Foundation for Advancement in Cancer Therapy (FACT) is a non-profit 501(c)(3) educational organization.
Established in 1971, FACT supports non-toxic, biologically sound alternative cancer therapies. FACT's goal is to educate physicians and patients about a different concept of cancer and chronic degenerative conditions in the hope that the public will gain an understanding of all viable medical options.
Brief history.
Foundation for Advancement in Cancer Therapy was established in 1971. They are a federally approved 501(c)(3) non-profit educational organization.
Ruth Sackman, featured in the film, was co-founder and president of FACT until her death in December 2008 at age 93. She organized the foundation after watching helplessly as her daughter, Arlene, diagnosed with acute leukemia in 1970, suffered through chemotherapy, becoming progressively weaker until succumbing to the disease. Sackman felt there had to be a better way and traveled the world to find it. For the next 37 years she helped hundreds of cancer patients in the U.S. and worldwide return to healthy lives, as well as educate many more about prevention and treatment of chronic disease. Sackman's yardstick for success was always long-term recovery, i.e., at least 10 years cancer-free.
FACT's goal is to educate physicians and patients about a different concept of cancer and chronic degenerative conditions: whether dealing with breast cancer, lymphoma, Lyme disease — it is a systemic disease. Tumors or abnormal cells are symptoms of a biochemical imbalance in the body, and that imbalance can be corrected with a well-designed, individualized metabolic program. A non-toxic, biologically sound program, focusing on the whole body and not just the tumor, can provide all the materials and conditions necessary to produce healthy cells and restore well being.
The primary tools for a comprehensive, metabolic approach are 1) a balanced diet of whole, unprocessed, preferably organic foods and 2) detoxification, to efficiently relieve the body of toxins released into the bloodstream as the immune system becomes energized to do its work. Attention must also be paid to optimum function of all the body organs and glands, as well as skeletal integrity, hormonal balance, stress management..
Book and documentary film.
The book, authored by founder Ruth Sackman, was published in 2003. The book shifts the focus of the cancer discussion from the treatment of the symptoms to correcting the cause of the health breakdown in the body as a whole. The goal is not neoplasm (tumor) reduction, as in conventional protocols such as chemotherapy and radiation. Rather, the success in the long-term recovery of the patient, i.e., returning the body to as normal a state of health as possible. "Rethinking Cancer" covers all the aspects of a comprehensive program that can provide the body with the factors required for restoration and maintenance of optimum health. However, this book is not intended as a self-treatment handbook. Guidance by experienced practitioners is vital, though understanding the logic of a non-toxic treatment approach is the first step.
The film of the same title is an educational documentary produced in 2009 that provides a rare look into the psychological and therapeutic journeys of five men and women who used biological therapies to overcome serious illness. In this documentary, four of the featured subjects had been diagnosed with cancer; two of these patients were considered terminal cases. The fifth patient had a severe case of Lyme disease. All five have outlived their diseases, between 15 and nearly 40 years, thus far.


Lindo Ferguson

Sir Henry Lindo Ferguson (7 April 1858 – 22 January 1948), known as Lindo Ferguson, was a New Zealand ophthalmologist, university professor and medical school dean. He was born in London, England, on 7 April 1858. Ferguson's parents were Louisa Ann Du Bois and William Ferguson. The family moved from Burton upon Trent, England, to Dublin, Ireland, in 1866.
Ferguson started college in 1873 at the Royal College of Science for Ireland. After earning a scholarship in industrial chemistry, he decided to instead study medicine at the Trinity College Dublin. He earned his medical degree in 1880 and continued his studies, specialising in ophthalmology. The Ferguson family moved to New Zealand in 1883, choosing Dunedin because of its medical school. Ferguson was the first ophthalmologist in Australasia.
Ferguson was appointed a Companion of the Order of St Michael and St George in the 1918 King's Birthday Honours. In the 1924 New Year Honours, he was appointed a Knight Bachelor. In 1935, he was awarded the King George V Silver Jubilee Medal. He was appointed a Commander of the Order of St John in 1937.


Vanguard Healthcare

Vanguard Healthcare - properly Vanguard Healthcare Solutions Ltd. is a provider of mobile clinical facilities based in Gloucester.
The company was established in 1999 as part of Cardinal Healthcare in 1999. Cardinal Healthcare was acquired by InHealth Group in 2002 and the mobile service’s management team left to create Vanguard Healthcare. In 2003 it had 6 mobile theatres and two wards in use, and in some cases provided staff as well as buildings. The company was bought by Nuffield Health in 2004. In April 2009 it again became an independent company following a management buyout backed by MML Capital Partners. In 2014 it has 40 mobile surgical units and claims to be the single largest fleet of mobile surgical facilities in the world. It operates across Europe and in Australia. Mike Farrar was employed as a Strategic Advisor in March 2014. The company made an “operating profit” of £1.6m in 2013/4 but the cost servicing loans from MML meant that it paid no corporation tax - and hasn't since 2009.
The company entered into a contract to perform cataract surgery for Taunton and Somerset NHS Foundation Trust in May 2014 using a mobile unit in a car park at Musgrove Park Hospital. The contract was quickly stopped when patients came back to the Trust's casualty department with a high rate of complication following surgery. A report on the incident was released on 16 October. Vanguard chief executive Ian Gillespie said: "No issues have been identified with the Vanguard mobile theatre facility itself." It was unclear who would be liable for any clinical negligence claims. Colin Close, the trust’s medical director, was quoted by the Somerset County Gazette saying: “Any financial responsibility would rest with us. If any patients wish to pursue compensation, we would work with them,” but the Trust said Dr Close had been misquoted. According to the Department of Health the NHS standard contract requires all contractors of NHS care “to hold and maintain adequate and appropriate indemnity insurance”. Mr. Gillespie said that it “has appropriate cover in place”.


Tony Dornhorst

Professor Antony Clifford Dornhorst CBE, FRCP (1915–2003), known as Tony, was a British physician and medical educator, described by The Guardian as "one of the outstanding academic clinician-scientists of his generation".
Dornhorst was born on 2 April 1915 in Woodford, Essex. His father was a company director of Dutch descent; his mother a musician.
He was educated at St Clement Danes School, but did not attend school between the ages of 12 and 14. He subsequently studied medicine at St Thomas's Hospital Medical School. At the age of 23, he became the youngest ever member of the Royal College of Physicians.
He served with the Royal Army Medical Corps in World War II, in Palestine, north Africa, Italy, and as the senior physician in Berlin, with the rank of lieutenant colonel. It was in Berlin that he met Helen, a Royal Army Medical Corps radiologist, who was to become his wife.
He was appointed a reader in medicine at St Thomas's in 1949 and became a consultant there in 1951.
He held the foundation chair of medicine at St George's Hospital Medical School from 1959 to 1980.
Serving on the Himsworth committee on matters relating to Northern Ireland, he once inhaled CS gas to better understand its effects.
He was a member of the Medical Research Council from 1973 to 1977.
He was made a Commander of the Order of British Empire (CBE) in 1977, as part of the Silver Jubilee and Birthday Honours.
He died on 9 March 2003.


Carlos Filizzola

Carlos Alberto Filizzola Pallarés (born 24 July 1959, in Asunción) is a Paraguayan politician. He has been a member of the Senate of Paraguay since 2003, and the President of the political party Party for a Country of Solidarity since its creation in 2000. He was Interior Minister in the government of Fernando Lugo, resigning on 15 June 2012 following violent clashes during an eviction of landless farmers occupying land.
Filizzola graduated from medicine from the Universidad Nacional de Asunción in 1985. From 1989 to 1991 he was Assistant Secretary General of the Central Unitaria de Trabajadores (the main trade union federation of Paraguay). In 1991 he was the first democratically elected "Intendente" (mayor) of Asunción, governing from June 1991 to December 1996.
Filizzola was President of the National Encounter Party from April 1996 to March 1999. In 1996 he founded the Movimiento Participación Amplia, Integración Solidaridad (PAIS) faction within the party; in 2000, he led the faction out of National Encounter and founded Party for a Country of Solidarity. In the 1998 presidential election he was the Vice Presidential candidate of Domingo Laíno of the Authentic Radical Liberal Party.
Filizzola was President of the Senate of Paraguay from 1 July 2005 to 30 June 2006.
Filizzola is the cousin of Rafael Filizzola, also a Paraguayan politician.


Frank Ayd

Frank Ayd (October 14, 1920 – March 21, 2008) was an American psychiatrist known for introducing the first antipsychotic medications into US clinical practice, being granted the first permit from the Food and Drug Administration to use Thorazine for schizophrenia. He took part in writing more than 50 books and authored over 400 articles. The “Ayd’s Lexicon of Psychiatry, Neurology and the Neurosciences” became a standard reference.
According to the New York Times, he was a chief pioneer in the field of psychopharmacology.
Born in Baltimore on October 14, 1920, in the family of a pediatrician, he graduated from Loyola College in Baltimore and the University of Maryland School of Medicine. His work began in pediatrics but soon he was called to active duty by the Navy and assigned to surgery at Bethesda Naval Hospital. Shortly afterwards he moved to the Veterans Hospital in Perry Point, Maryland and became a psychiatrist. Although initially having no interest in psychiatry, he changed his view and practiced it for the rest of his life, introducing many pharmaceutical agents. Frank Ayd studied, in his words, "practically speaking, every neuroleptic that ever got on the market in this country except for Clozaril and Risperdal".


Rosacea

Rosacea is a long-term skin condition that typically affects the face. It results in redness, pimples, swelling, and small and superficial dilated blood vessels. Often, the nose, cheeks, forehead, and chin are most involved. A red, enlarged nose may occur in severe disease, a condition known as rhinophyma.
The cause of rosacea is unknown. Risk factors are believed to include a family history of the condition. Factors that may potentially worsen the condition include heat, exercise, sunlight, cold, spicy food, alcohol, menopause, psychological stress, or steroid cream on the face. Diagnosis is based on symptoms.
While not curable, treatment usually improves symptoms. Treatment is typically with metronidazole, doxycycline, minocycline, or tetracycline. When the eyes are affected, azithromycin eye drops may help. Other treatments with tentative benefit include brimonidine cream, ivermectin cream, and isotretinoin. Dermabrasion or laser surgery may also be used. The use of sunscreen is typically recommended.
Rosacea affects between 1 and 10% of people. Those affected are most often 30 to 50 years old and female. Caucasians are more frequently affected. The condition was described in "The Canterbury Tales" in the 1300s, and possibly as early as the 200s BC by Theocritus.
Signs and symptoms.
Signs include facial redness, small and superficial dilated blood vessels on facial skin, papules, pustules, and swelling.
Erythematotelangiectatic rosacea.
Erythematotelangiectatic rosacea rosacea (also known as "vascular rosacea") is characterized by prominent history of prolonged (over 10 minutes) flushing reaction to various stimuli, such as emotional stress, hot drinks, alcohol, spicy foods, exercise, cold or hot weather, or hot baths and showers.
Glandular rosacea.
In glandular rosacea, men with thick sebaceous skin predominate, a disease in which the papules are edematous, and the pustules are often 0.5 to 1.0 cm in size, with nodulocystic lesions often present.
Cause.
The exact cause of rosacea is unknown. Triggers that cause episodes of flushing and blushing play a part in its development. Exposure to temperature extremes, strenuous exercise, heat from sunlight, severe sunburn, stress, anxiety, cold wind, and moving to a warm or hot environment from a cold one, such as heated shops and offices during the winter, can each cause the face to become flushed. Certain foods and drinks can also trigger flushing, such as alcohol, foods and beverages containing caffeine (especially hot tea and coffee), foods high in histamines, and spicy foods.
Medications and topical irritants have also been known to trigger rosacea flares. Some acne and wrinkle treatments reported to cause rosacea include microdermabrasion and chemical peels, as well as high dosages of isotretinoin, benzoyl peroxide, and tretinoin.
Steroid-induced rosacea is caused by the use of topical steroids. These steroids are often prescribed for seborrheic dermatitis. Dosage should be slowly decreased and not immediately stopped to avoid a flare-up.
Cathelicidins.
In 2007, Richard Gallo and colleagues noticed that patients with rosacea had high levels of the antimicrobial peptide cathelicidin and elevated levels of stratum corneum tryptic enzymes (SCTEs). Antibiotics have been used in the past to treat rosacea, but they may only work because they inhibit some SCTEs.
"Demodex" mites.
Studies of rosacea and "Demodex" mites have revealed that some people with rosacea have increased numbers of the mite, especially those with steroid-induced rosacea. On other occasions, demodicidosis (commonly known as "mange") is a separate condition that may have "rosacea-like" appearances.
A 2007, National Rosacea Society-funded study demonstrated that "Demodex folliculorum" mites may be a cause or exacerbating factor in rosacea. The researchers identified "Bacillus oleronius" as distinct bacteria associated with "Demodex" mites. When analyzing blood samples using a peripheral blood mononuclear cell proliferation assay, they discovered that "B. oleronius" stimulated an immune system response in 79 percent of 22 patients with subtype 2 (papulopustular) rosacea, compared with only 29% of 17 subjects without the disorder. They concluded, "The immune response results in inflammation, as evident in the papules (bumps) and pustules (pimples) of subtype 2 rosacea. This suggests that the "B. oleronius" bacteria found in the mites could be responsible for the inflammation associated with the condition."
Intestinal bacteria.
Small intestinal bacterial overgrowth (SIBO) was demonstrated to have greater prevalence in rosacea patients and treating it with locally acting antibiotics led to rosacea lesion improvement in two studies. Conversely in rosacea patients who were SIBO negative, antibiotic therapy had no effect. The effectiveness of treating SIBO in rosacea patients may suggest that gut bacteria play a role in the pathogenesis of rosacea lesions.
Diagnosis.
Most people with rosacea have only mild redness and are never formally diagnosed or treated. No test for rosacea is known. In many cases, simple visual inspection by a trained health-care professional is sufficient for diagnosis. In other cases, particularly when pimples or redness on less-common parts of the face is present, a trial of common treatments is useful for confirming a suspected diagnosis. The disorder can be confused or co-exist with acne vulgaris or seborrheic dermatitis. The presence of a rash on the scalp or ears suggests a different or co-existing diagnosis because rosacea is primarily a facial diagnosis, although it may occasionally appear in these other areas.
Classification.
Four rosacea subtypes exist, and a patient may have more than one subtype:
Variants.
Variants of rosacea include:
Treatments.
Treatment of depends on the types present. Mild cases are often not treated at all, or are simply covered up with normal cosmetics.
Therapy for the treatment of rosacea is not curative, and is best measured in terms of reduction in the amount of facial redness and inflammatory lesions, a decrease in the number, duration, and intensity of flares, and concomitant symptoms of itching, burning, and tenderness. The two primary modalities of rosacea treatment are topical and oral antibiotic agents. Laser therapy has also been classified as a form of treatment. While medications often produce a temporary remission of redness within a few weeks, the redness typically returns shortly after treatment is suspended. Long-term treatment, usually 1–2 years, may result in permanent control of the condition for some patients. Lifelong treatment is often necessary, although some cases resolve after a while and go into a permanent remission. Other cases, if left untreated, worsen over time.
Behavior.
Avoiding triggers that worsen the condition can help reduce the onset of rosacea, but alone will not normally lead to remission except in mild cases. Keeping a journal is sometimes recommended to help identify and reduce food and beverage triggers.
Because sunlight is a common trigger, avoiding excessive exposure to the sun is widely recommended. Some people with rosacea benefit from daily use of a sunscreen; others opt for wearing hats with broad brims. Like sunlight, emotional stress can also trigger rosacea. People who develop infections of the eyelids must practice frequent eyelid hygiene.
Managing pretrigger events such as prolonged exposure to cool environments can directly influence warm-room flushing.
Medications.
Medications with good evidence include topical ivermectin and azelaic acid creams and brimonidine, and doxycycline and isotretinoin by mouth. Lesser evidence supports topical metronidazole cream and tetracycline by mouth.
Metronidazole is thought to act through anti-inflammatory mechanisms, while azelaic acid is thought to decrease cathelicidin production. Oral antibiotics of the tetracycline class such as doxycycline, minocycline, and oxytetracycline are also commonly used and thought to reduce papulopustular lesions through anti-inflammatory actions rather than through their antibacterial capabilities.
Using alpha-hydroxy acid peels may help relieve redness caused by irritation, and reduce papules and pustules associated with rosacea. Oral antibiotics may help to relieve symptoms of ocular rosacea. If papules and pustules persist, then sometimes isotretinoin can be prescribed. The flushing and blushing that typically accompany rosacea are typically treated with the topical application of alpha agonists such as brimonidine and less commonly oxymetazoline or xylometazoline.
A review found that ivermectin was more effective than alternatives for treatment of papulopustular acne rosacea. An ivermectin cream has been approved by the FDA, as well as in Europe, for the treatment of inflammatory lesions of rosacea. The treatment is based upon the hypothesis that parasitic mites of the genus "Demodex" play a role in rosacea. In a clinical study, ivermectin reduced lesions by 83% over 4 months, as compared to 74% under a metronidazole standard therapy.
Laser.
Evidence for the use of laser and intense pulsed-light therapy in rosacea is poor.
Epidemiology.
Women, especially those who are menopausal, are more likely than men to develop rosacea. Those of Caucasian descent, especially those of Northern or Eastern European descent with highly pale skin, appear more affected.


United Hospital Fund

The United Hospital Fund of New York (UHF) is a nonprofit organization that focuses on improving health care in New York. It conducts health policy research and supports numerous health care initiatives through fundraising, grantmaking, and collaboration with other health care organizations. Since August 2017, the organization is led by Anthony Shih.
Founding and early program history.
The United Hospital Fund was founded as a charitable organization in 1879, raising money for New York hospitals that provided health care for people who could not otherwise afford it. Originally called the Hospital Saturday and Sunday Association of New York City, it was formed "to obtain benevolent gifts for the hospitals of New York... and to provide for distributing these gifts... among such hospitals." Its first president was George Macculloch Miller. The organization changed its name to the United Hospital Fund of New York in 1916.
In 1935, the Fund established the Associated Hospital Service of New York (AHS), which later became Blue Cross and Blue Shield of Greater New York. It also helped found organizations that became the Greater New York Hospital Association (1904), United Way of New York City (1938), and the New York Blood Center (1956).
Recent research and notable activities.
In accordance with its mission, the Fund's research, policy analysis, and grantmaking focus on health care, primarily in New York. Its research addresses health insurance coverage, health care quality, and patient safety. It also has been committed to reorienting health care services toward the needs of particular populations: the aging, people with HIV/AIDS, the chronically ill, and family caregivers.
Since 2005, the Medicaid Institute at United Hospital Fund has published numerous reports and studies exploring ways to improve New York's Medicaid program. Separately, the Fund's health insurance project has published a series of reports on the logistical and policy implications of setting up a health insurance exchange in the state following the passage of the Affordable Care Act.
Working with the Greater New York Hospital Association, the Fund has led and participated in numerous efforts focused on quality improvement and patient safety at New York hospitals. These initiatives have led to lower incidence of central-line associated bloodstream infections and cardiac arrest, as well as lower mortality rates from severe sepsis.
The Fund's Aging in Place initiative, begun in 2000, explores ways to provide health care and social services to seniors in their homes and communities, particularly in naturally occurring retirement communities (NORCs). In 2008, the Fund set up the Next Step in Care campaign, which provides informational resources for family caregivers and works to build effective partnerships between caregivers and health care providers and professionals.
Following the events of September 11, the Fund allocated $1 million to an initiative focused on Disaster Relief Medicaid, which helped get temporary health insurance coverage to 340,000 New Yorkers.


Govan Mbeki

Govan Archibald Mvuyelwa Mbeki (9 July 1910 – 30 August 2001) was a South African politician, Communist and son of Chief Sikelewu Mbeki and Johanna Mahala and also the father of the former South African president Thabo Mbeki and political economist Moeletsi Mbeki. He was a leader of the South African Communist Party and the African National Congress. After the Rivonia Trial, he was imprisoned (1963–1987) on charges of terrorism and treason, together with Nelson Mandela, Walter Sisulu, Raymond Mhlaba, Ahmed Kathrada and other eminent ANC leaders, for their role in the ANC's armed wing, Umkhonto we Sizwe (MK). He was sometimes mentioned by his nickname "Oom Gov".
Early years.
Govan Mbeki was born in the Nqamakwe district of the Transkei region and was a part of the Xhosa ethnic group. As a teenager, Mbeki worked as a newsboy and messenger in the cities, and because of this, he saw the poverty urban black Africans lived in, and the constant police raids they endured. He attended Fort Hare University, completing in 1936 a Bachelor of Arts degree in politics and psychology and a teaching diploma. Mbeki met other African struggle leaders while attending the university.
Teacher, trader and communist.
For a time Mbeki worked as a teacher, but lost his job because of his political activities. He was a member of the South African Communist Party (SACP, then the Communist Party of South Africa, or CPSA) from the late 1930s, and joined the African National Congress in 1935. He then set up a co-operative store in Idutywa and began a writing career. From 1938 to 1944 he was the editor of "Territorial Magazine" / "Inkundla Ya Bantu".
Mbeki left journalism in 1944 and became a government-nominated member of the Transkei Territorial Authorities General Council until 1950. His role in the CPSA/ SACP was clandestine at the time, which helps explain why he received the nomination. Mbeki disparagingly referred to the council as a 'toy telephone': "You can say what you like, but your words have no effect because the wires are not connected to an exchange". In 1948 Mbeki stood as a candidate for the Natives Representative Council but lost the election.
When the CPSA/ SACP was banned in 1950 by the apartheid government, Mbeki remained in the African National Congress (ANC). In 1952 Mbeki was imprisoned together with Raymond Mhlaba and Vuyisile Mini for three months in "Rooi Hel" ('Red Hell' or North End Prison, Port Elizabeth) for disobeying apartheid laws by participating in the 'Campaign of Defiance against Injustice Laws' (Defiance Campaign). In 1954, a tornado destroyed his store, and Mbeki was dismissed from teaching again (he would lose his job three times, and be blacklisted from others, from the 1930s onwards). Mbeki moved to Port Elizabeth and joined the editorial board of "New Age", a prominent leftist newspaper linked to underground CPSA/ SACP networks. Mbeki played a crucial role in ensuring that the pages and columns reflected the conditions, demands, and aspirations of black working-class people, particularly in the countryside.
He also worked on the "Guardian", "New Age", "Fighting Talk" and "Liberation", and worked with 'Jock' Harold Strachan in the Port Elizabeth area, and helped him produce the newsletter "Izwe Lomzi" ("Voice of the People"). Mbeki was meanwhile actively involved in the major campaigns of the day, including the revival of the African National Congress in the 1940s, the Defiance Campaign and the Congress of the People.
Armed struggle and Robben Island.
In 1960, the ANC was banned, and along with the underground SACP, formed Umkhonto we Sizwe (MK), which became ANC's armed wing. Mbeki was involved, and, at his urging, Strachan assisted MK by turning his hand to improvised explosive devices based on substances like potassium permanganate, magnesium, glycerol and icing sugar.
Meanwhile, in November 1962, the then-Minister of Justice, John Vorster, banned "New Age". When the editorial board came out with its successor publication "Spark", Vorster went one step further by banning not the newspaper but its editors and writers. This effectively ended Mbeki's role as editor and journalist in the country. On 11 July 1963, he was arrested with other MK high commanders. In 1964, he was an accused in the Rivonia Trial and sentenced to Robben Island.
Books.
In 1939, Mbeki published his first book, "Transkei in the Making". A supporter of the 1950-1961 Pondoland peasant revolt, he wrote the pioneering study of the movement, "South Africa: The Peasants' Revolt" from 1958, which was published in 1964. Much of the book is an analysis of the political economy of the Transkei, rather than the revolt itself.
Following the Rivonia Trial, Mbeki served a long-term on Robben Island, during which he managed to run education classes with prisoners, many on Marxist theory, and wrote a number of significant analyses jail, which were kept on the island and used for discussions. The surviving copies have since been published.
In 1992, he published "The Struggle For Liberation in South Africa: A Short History" and in 1996, "Sunset at Midday: Latshonilangemini!"
Release and post-apartheid role.
Mbeki was released from custody after serving 24 years in the Robben Island prison on 5 November 1987. He served in South Africa's post-apartheid Senate from 1994 to 1997 as Deputy President of the Senate, and then the Senate's successor, the National Council of Provinces, from 1997 to 1999.
Mbeki died in Port Elizabeth on 30 August 2001. He was given state funeral during his son's presidency (Thabo) on 8 September 2001. His remains were the subject of controversy in 2006 when plans were made to exhume them, and place them in a museum. These plans were called off after Mbeki's family refused the request.
Awards and honours.
Mbeki received an honorary doctorate in the Social Sciences from the University of Amsterdam in 1978. His son Moeletsi attended the ceremony, as Mbeki was imprisoned at Robben Island.
On 26 June 1980, the Secretary General of the then-illegal African National Congress, Alfred Nzo, announced the conferring of the Isitwalandwe Medal, the ANC's highest honour, on Mbeki. Mbeki was, however, not present to receive the award, because he was serving a life imprisonment sentence on Robben Island.
Mbeki received international recognition for his political achievements including the renaming (at Mandela's suggestion) of the recently opened health building at Glasgow Caledonian University. The Govan Mbeki Health Building was inaugurated in 2001 at a ceremony featuring his son Thabo.
The Govan Mbeki Local Municipality in Mpumulanga is named in his honour.
In 2004 he was voted 97th in the SABC 3's Great South Africans.
In 2013 a large section of road between Swartklip and Baden Powell Road, running between the neighborhoods of Browns Farm, Gugulethu, Nyanga and Crossroads in Cape Town was renamed Govan Mbeki Road.
References.
Notes
Citations


Donald Balfour

Donald Church Balfour (August 22, 1882 – July 25, 1963) was a Canadian medical educator and surgeon who specialized in gastrointestinal surgery. He worked at the Mayo Clinic from 1907 until 1947, and was director of the Mayo Foundation for Medical Education and Research from 1937 to 1947.
Biography.
Balfour was born in Toronto, Ontario in 1882 and was educated at the Hamilton Collegiate Institute. He attended the University of Toronto, earning an M.B. degree in 1906 and M.D. in 1914. During his internship at Hamilton General Hospital in Hamilton, Ontario, he worked with the surgeon Ingersoll Olmsted, who recommended him to William James Mayo and Charles Horace Mayo. Balfour joined the Mayo brothers' practice in Rochester, Minnesota, in 1907, initially as a pathology assistant. In 1909 he became a junior surgeon and in 1912 he was promoted to head of a division of general surgery in what is now known as the Mayo Clinic. In 1910 he married William J. Mayo's daughter, Carrie Mayo.
Balfour worked primarily in gastrointestinal surgery, although he published papers in other surgical fields such as tonsillectomy and thyroidectomy. He designed various surgical instruments including abdominal retractors, operating tables and operating room mirrors; one of his landmark papers included a design for a stent to perform anastomosis between parts of the large intestine. He authored 225 publications and co-authored a textbook titled "The Stomach and Duodenum" (1935). Tuberculosis forced him to retire from surgery in 1933 and focus on medical education. He was appointed associate director of the Mayo Foundation for Medical Education and Research (now the Mayo Clinic College of Medicine and Science) in 1935 and served as director from 1937 to 1947. During the Second World War, Balfour served as an honorary consultant to the medical department of the U.S. Navy and to the Army Medical Library, and under his leadership the Mayo Foundation trained over 1500 medical officers of the armed forces. He retired from the Mayo Clinic and Mayo Foundation in 1947, and died in Rochester in 1963 from pulmonary edema caused by a myocardial infarction.
Honors and affiliations.
In 1948, Balfour was awarded the President's Certificate of Merit by President Harry S. Truman for contributions to the war effort. He received the American Medical Association's Distinguished Service Award in 1955 and the American Gastroenterological Association's Friedenwald Medal in 1956. He served as president of the American College of Surgeons, chaired the surgical division of the American Medical Association, and co-founded the American Board of Surgery. He was also a founding member of the World Medical Association.
Balfour held honorary fellowships of various international surgical colleges—the Royal College of Surgeons of England, Royal College of Surgeons of Edinburgh, Royal Australasian College of Surgeons, and Royal College of Physicians and Surgeons of Canada—as well as the Royal Society of Medicine and the Académie Nationale de Médecine. Throughout his career he was awarded honorary degrees from the University of Toronto, Northwestern University, McMaster University, Carleton College and St. Olaf College.


Icek Ajzen

Icek Ajzen (born 1942) is a social psychologist and professor emeritus at the University of Massachusetts Amherst. He received his doctorate from the University of Illinois at Urbana–Champaign, and is best known for his work, with Martin Fishbein, on the theory of planned behavior. Ajzen has been ranked the most influential individual scientist within social psychology in terms of cumulative research impact and, in 2013, received the Distinguished Scientist Award from the Society of Experimental Social Psychology. His research has been influential across diverse fields such as advertising, health psychology, and environmental psychology, and has been cited over 280,000 times.


Tracheoesophageal fistula

A tracheoesophageal fistula (TEF, or TOF; see spelling differences) is an abnormal connection (fistula) between the esophagus and the trachea. TEF is a common congenital abnormality, but when occurring late in life is usually the sequela of surgical procedures such as a laryngectomy.
Presentation.
Tracheoesophageal fistula is suggested in a newborn by copious salivation associated with choking, coughing, vomiting, and cyanosis coincident with the onset of feeding. Esophageal atresia and the subsequent inability to swallow typically cause polyhydramnios in utero. Rarely it may present in an adult.
Complications.
Surgical repair can sometimes result in complications, including:
Associations.
Neonates with TEF or esophageal atresia are unable to feed properly. Once diagnosed, prompt surgery is required to allow the food intake. Some children experience problems following TEF surgery; they can develop dysphagia and thoracic problems. Children with TEF can also be born with other abnormalities, most commonly those described in VACTERL association - a group of anomalies which often occur together, including heart, kidney and limb deformities. 6% of babies with TEF also have a laryngeal cleft.
Cause.
Congenital TEF can arise due to failed fusion of the tracheoesophageal ridges after the fourth week of embryological development.
A fistula, from the Latin meaning 'a pipe', is an abnormal connection running either between two tubes or between a tube and a surface. In tracheo-esophageal fistula it runs between the trachea and the esophagus. This connection may or may not have a central cavity; if it does, then food within the esophagus may pass into the trachea (and on to the lungs) or alternatively, air in the trachea may cross into the esophagus.
TEF can also occur due to pressure necrosis by a tracheostomy tube in apposition to a nasogastric tube (NGT).
Diagnosis.
TEF should be suspected once the baby fails to swallow after their first feeding during the first day of life. Esophageal atresia can be diagnosed by Ryle nasogastric tube; if the Ryle fails to pass into the stomach, then this indicates esophageal atresia and loss of communication between stomach and esophagus. TEF may be diagnosed by MRI which clarifies the atretic esophagus (if presents) and TEF, as well as its location and anatomy. Gastrograffin contrast swallow should not be used if TEF is suspected, due to its high risk of allergy and severe intractable chest infection.
Classification.
Fistulae between the trachea and esophagus in the newborn can be of diverse morphology and anatomical location. However, various pediatric surgical publications have attempted a classification system based on the below specified types.
Not all types include both esophageal agenesis and tracheoesophageal fistula, but the most common types do.
The letter codes are usually associated with the system used by Gross, while number codes are usually associated with Vogt.
An additional type, "blind upper segment only" has been described, but this type is not usually included in most classifications. (For the purposes of this discussion, "proximal esophagus" indicates normal esophageal tissue arising normally from the pharynx, and "distal esophagus" indicates normal esophageal tissue emptying into the proximal stomach.)
Treatment.
It is surgically corrected, with resection of any fistula and anastomosis of any discontinuous segments. Babies often need to spend time in a neonatal intensive care unit for feeding with a stomach feeding tube. Antibiotics, pain relief, a chest drain, oxygen, and ventilation may all be needed.


Wilhelm Busch (surgeon)

Karl David Wilhelm Busch (5 January 1826 in Marburg – 24 November 1881 in Bonn) was a German surgeon.
Biography.
He was born in Marburg, and studied at the University of Berlin, where he was a student of Johannes Peter Müller and Bernhard von Langenbeck. He received his doctorate in 1848. In 1855, he was appointed professor of surgery at Bonn, and afterwards acted as consulting surgeon general in the army in 1866 and during the Franco-Prussian War. In 1867 he became director of the Surgical Clinic of the University of Bonn (), the world's first in cancer immunotherapy. Among his students at Bonn was dermatologist Joseph Doutrelepont.


C. Randy Gallistel

Charles Ransom Gallistel (born May 18, 1941) is an Emeritus Professor of Psychology at Rutgers University. He is an expert in the cognitive processes of learning and memory, using animal models to carry out research on these topics. Gallistel is married to fellow psychologist Rochel Gelman. Prior to joining the Rutgers faculty he held positions at the University of Pennsylvania, where he was chair of the psychology department and Bernard L. & Ida E. Grossman Term Professor, and at the University of California, Los Angeles.
Academic career.
Gallistel obtained his BA in psychology from Stanford University in 1963 and his PhD in physiological psychology from Yale University in 1966. He joined the faculty of Psychology at the University of Pennsylvania in 1966, where he became full professor in 1976. He moved to UCLA with his wife, Rochel Gelman, in 1989. They moved to Rutgers University, the State University of New Jersey in New Brunswick, NJ in 2000, where they became Co-Directors of the Rutgers Center for Cognitive Science. Gallistel was elected to the American Academy of Arts and Sciences in 2001 and to the National Academy of Sciences (USA) in 2002.
Research.
Gallistel has made experimental and theoretical contributions to several areas of behavioral and cognitive neuroscience: 1) The nature and development of the representation of numerosity in young children, in collaboration with his wife, Rochel Gelman. 2) The psychophysical analysis of the neural substrate for electrical self-stimulation of the brain. 3) The theory of action and its close relation to the theory of motivation. 4) The theory of learning. 5) What it means to say that brains represent the experienced world. 6) The brain's representation of the abstract variables central to conceptions of space (distance & direction), time (duration and phase), numerosity, rate (number/duration) and probability (subset numerosity/set numerosity). 7) The nature of the engram, the physical realization of memory in brains.
Gallistel is an advocate of the computational theory of mind, and as such he criticized the view of memory as an alteration of synaptic connections (a view that is related to Associationism). His critique, in particular, focuses on how the Associationst theory of mind allegedly cannot explain how the brain encodes quantitative data such as distances, directions, and temporal durations. Gallistel rather argues that such memories could be collected inside the neurons, at the molecular level, and to support his claim he remarks the considerable capacity of polynucleotides for storing information.


Original antigenic sin

Original antigenic sin, also known as antigenic imprinting or the Hoskins effect, refers to the propensity of the body's immune system to preferentially utilize immunological memory based on a previous infection when a second slightly different version of that foreign pathogen (e.g. a virus or bacterium) is encountered. This leaves the immune system "trapped" by the first response it has made to each antigen, and unable to mount potentially more effective responses during subsequent infections. Antibodies or T-cells induced during infections with the first variant of the pathogen are subject to a form of original antigenic sin, termed repertoire freeze.
The phenomenon of original antigenic sin has been described in relation to influenza virus, dengue fever, human immunodeficiency virus (HIV) and to several other viruses.
This phenomenon was first described in 1960 by Thomas Francis Jr. in the article "On the Doctrine of Original Antigenic Sin". It is named by analogy to the theological concept of original sin. According to Thomas Francis, who originally described the idea, and cited by Richard Krause:
"The antibody of childhood is largely a response to dominant antigen of the virus causing the first type A influenza infection of the lifetime. [...] The imprint established by the original virus infection governs the antibody response thereafter. This we have called the Doctrine of the Original Antigenic Sin."
In B cells.
During a primary infection, long-lived memory B cells are generated, which remain in the body, and provide protection from subsequent infections. These memory B cells respond to specific epitopes on the surface of viral proteins in order to produce antigen-specific antibodies, and are able to respond to infection much faster than B cells are able to respond to novel antigens. This effect shortens the amount of time required to clear subsequent infections.
Between primary and secondary infections, or following vaccination, a virus may undergo antigenic drift, in which the viral surface proteins (the epitopes) are altered through natural mutation, allowing the virus to escape the immune system. When this happens, the altered virus preferentially reactivates previously activated high-affinity memory B cells and spur antibody production. However, the antibodies produced by these B cells generally ineffectively bind to the altered epitopes. In addition, these antibodies inhibit the activation of higher-affinity naive B cells that "would" be able to make more effective antibodies to the second virus. This leads to a less effective immune response and recurrent infections may take longer to clear.
Original antigenic sin is of particular importance in the application of vaccines. In dengue fever, the effect of original antigenic sin has important implications for vaccine development. Once a response against a dengue virus serotype has been established, it is unlikely that vaccination against a second will be effective, implying that balanced responses against all four virus serotypes have to be established with the first vaccine dose. However, in 2015, a new class of highly potent, neutralizing antibodies that is effective against all four virus serotypes has been isolated, bringing hope for the development of a universal dengue vaccine.
The specificity and the quality of the immune response against novel strains of influenza is often diminished in individuals who are repeatedly immunized (by vaccination or recurrent infections). However, the impact of antigenic sin on protection has not been well established, and appears to differ with each infectious agent vaccine, geographic location, and age. Researchers found reduced antibody responses to the 2009 pandemic H1N1 influenza vaccine in individuals who had been vaccinated against the seasonal A/Brisbane/59/2007 (H1N1) within the previous three months.
In cytotoxic T cells.
A similar phenomenon has been described in cytotoxic T cells (CTL). It has been demonstrated that during a second infection by a different strain of dengue virus, the CTLs prefer to release cytokines instead of causing cell lysis. As a result, the production of these cytokines is thought to increase vascular permeability and exacerbate damage to endothelial cells.
Several groups have attempted to design vaccines for HIV and hepatitis C based on induction of CTL response. The finding that the CTL response may be biased by original antigenic sin may help to explain the limited effectiveness of these vaccines. Viruses like HIV are highly variable and undergo mutation frequently; due to original antigenic sin, HIV infection induced by viruses that express slightly different epitopes (than those in a viral vaccine) would fail to be controlled by the vaccine. In fact, the vaccine might make the infection even worse, by "trapping" the immune response into the first, ineffective, response it made against the virus.


Diana Perkins

Diana Perkins is an American professor at the University of North Carolina's (UNC) School of Medicine where she teaches psychiatry. She is a fellow of Consultation/Liaison Psychiatry and the Medical Director of Outreach and Support Intervention Services at UNC Hospitals and the UNC–Chapel Hill School of Medicine. Perkins’ primary research interests include early identification and treatment of schizophrenia, emphasizing treatment of the prodromal period and early intervention of the first episode of schizophrenia. She is noted for publishing a study that demonstrated that using a polygenic risk score (PRS) based on data from genome-wide association studies improved the psychosis risk prediction in persons meeting clinical high-risk criteria.
Education.
Perkins' undergraduate work was completed at the University of Maryland in Psychology and Biochemistry; she also received her Doctor of Medicine there. She completed a graduate degree in Epidemiology from UNC.


Robert Sobukwe

Robert Mangaliso Sobukwe (5 December 1924 – 27 February 1978) was a prominent South African political dissident and teacher, who founded the Pan Africanist Congress in opposition to the South African apartheid system.
During his lifetime, Sobukwe was considered to be so dangerous by the National Party government that its parliament enacted the "Sobukwe clause", a statute which on its face seemed to grant broadly applicable powers, but was specifically intended to authorise the arbitrary extension of Sobukwe's imprisonment.
Early years.
Sobukwe was born in Graaff-Reinet in the Cape Province on 5 December 1924. The youngest of six children, he came from a poor household and was educated locally. He attended a Methodist college at Healdtown and later Fort Hare University where he joined the African National Congress Youth League (ANCYL) in 1948 and was elected president of the Student Representative Council (SRC).
Mainstream politics.
In 1952, Sobukwe achieved notoriety backing the Defiance Campaign. He identified with the Africanists within the African National Congress (ANC) and in 1957 left the ANC to become editor of "The Africanist" newspaper in Johannesburg.
He was a strong believer in an Africanist future for South Africa and rejected any model suggesting working with anyone other than Africans, defining African as anyone who lives in and pays his allegiance to Africa and who is prepared to subject himself to African majority rule. He later left the ANC to form the Pan Africanist Congress (PAC), and was elected its first President in 1959.
Sobukwe became known as the Professor or simply "Prof" to his close comrades and followers, a testament to his educational achievements and powers of speech and persuasion. He spoke of the need for black South Africans to "liberate themselves" without the help of non-Africans. He defined non-Africans as anyone who lives in Africa or abroad Africa and who does not pay his allegiance to Africa and who is not prepared to subject himself to African majority rule. His strong convictions and active resistance inspired many other individuals and organisations involved in the anti-apartheid movement, notably the Black Consciousness Movement.
At Fort Hare, where generations of young Black South Africans were exposed to politics, he joined the African National Congress Youth League (ANCYL) in 1948. The organisation had been established on the university campus by Godfrey Pitje, who later became its president. In 1949, Sobukwe was elected as the first president of the Fort Hare Students' Representative Council, where he proved himself to be a good orator.
In 1950, Sobukwe was appointed as a teacher at a high school in Standerton, a position he lost when he spoke out in favour of the Defiance Campaign in 1952. He was, however, reinstated. During this period he was not directly involved with mainstream ANC activities, but still held the position of secretary of the organisation's branch in Standerton.
In 1954, after moving to Johannesburg Sobukwe became a lecturer of African Studies at the University of the Witwatersrand. During his time in Johannesburg he edited "The Africanist" newspaper and soon began to criticise the ANC for allowing itself to be dominated by what he termed "liberal-left-multi-racialists". He strongly believed in non-racialism. He was an ardent supporter of Africanist views about liberation in South Africa and rejected the idea of working with Whites.
Sobukwe also argued that whites should be excluded from the ANC as it was impossible to have a relationship between blacks and whites until further progress had been made. He argued that a reliance on whites would disempower the realization that many of these Africans had, that they had the power to overtake a society that had been taken from them. The fight in the ANC was brutal, causing a fair amount of violence which lead to the creation of the Pan-Africanist Congress. PAC excluded white men. A goal of PAC was to get rid of the servant mentality through the identification of other African Nationalist movements and through, what they called it, "self-identification". To know that there were others out, trying to achieve the same things, gave the Africanists a real sense of power and unification. This sense of unification and power would end in 1960 in the town of Sharpville. A protest by PAC would become a police massacre. In the massacre sixty-nine people were killed and Sobukwe was taken without a fair trial in addition to both the ANC and PAC being banned. Other organizations were inspired by the actions of Sobukwe.
Internment.
On 21 March 1960, the PAC led a nationwide protest against the hated Pass Law which required black people to carry a pass book at all times. Sobukwe led a march to the local police station at Orlando, Soweto, in order to openly defy the laws. He was joined en route by a few followers and, after presenting his pass to a police officer, he purposely made himself guilty under the terms of the Pass Law of being present in a region/area other than that allowed as per his papers. In a similar protest on the same day in Sharpeville, police opened fire on a crowd of PAC supporters, killing 69 in the Sharpeville Massacre.
Following his arrest, Sobukwe was charged with and convicted of incitement, and sentenced to three years in prison. After serving his sentence, he was interned on Robben Island. The new General Law Amendment Act was passed, allowing his imprisonment to be renewed annually at the discretion of the Minister of Justice. This procedure became known as the "Sobukwe clause" and kept Sobukwe in prison for a further six years. Sobukwe was the only person imprisoned under this clause.
Robben Island imprisonment.
Sobukwe was kept in solitary confinement but permitted certain privileges including books, newspapers, civilian clothes, bread, etc. He lived in a separate area on the island where he was strictly prohibited from contact with other prisoners. His only contacts with them were through his secret hand signals while outside for exercise. Despite this, he succeeded in giving his approval to the external PAC to adopt a Maoist political program. He studied during this time and received (among others) a degree in economics from the University of London.
It is speculated that Sobukwe was subjected to this special treatment because the South African government had profiled him as a greater troublemaker than the regular ANC prisoners. Sobukwe's son disputes this.
Throughout his imprisonment, Sobukwe maintained communication with his friend Benjamin Pogrund who later became his biographer ("Sobukwe and Apartheid", Johannesburg: J. Ball, 1990).
Kimberley: internal exile.
Sobukwe was released in 1969. He was allowed to live in Kimberley with his family, but remained under house arrest. Kimberley was suggested as an area where he could not easily foster subversive activities and also a place where he could live and work, while being easily monitored by the state. He was also restricted through a banning order, which disallowed political activities.
Various restrictions barred Sobukwe from travelling overseas, thus curtailing his attempts to further his education. For this same reason, he had to turn down several positions as a teacher at various locations in the United States.
Sobukwe completed his law degree with the help of a local lawyer, in Galeshewe, and he then started his own practice in 1975 in Kimberley.
Illness and death.
Due to lung cancer, Sobukwe was hospitalised in 1977. His doctors requested that the authorities allow him freedom of movement on humanitarian grounds. This request was refused indefinitely. He died on 27 February 1978, and was buried in Graaf-Reinet on 11 March 1978.
Legacy.
Robert Sobukwe Street in Pretoria (formerly known as Esselen Street) is named after him. Robert Sobukwe Road in Cape Town (formerly known as Modderdam Road) is named after him in June 2013.
Central Block at the University of the Witwatersrand was renamed to Robert Sobukwe Block in 2016 following major support among students and alumni.


Adenoviral keratoconjunctivitis

Adenoviral keratoconjunctivitis, also known as Keratoconjunctivitis epidemica is a common and highly contagious viral infection of the eye.
The clinical course of (AKC) should be divided into an acute phase with conjunctival inflammation of varying intensity with or without corneal involvement and a chronic phase with corneal opacities. AKC is caused by many different serotypes and is highly contagious during the acute phase.
Epidemiology.
The economic and social price of AKC as a community epidemic is high.
Clinical signs.
Corneal opacities, the hallmark of the chronic phase, are usually self-limited. They may occur as numular keratitis.
Treatment.
Topical steroids should be avoided because they prolong viral replication, frequently lead to long-lasting dry eye symptoms, and corneal opacities almost always recur after discontinuation of topical steroids. There is currently no effective and clinically applicable topical antiviral agent for the treatment of the acute phase of AKC. Topical cidofovir is the first antiviral agent which has effectively reduced the incidence of corneal opacities, but local toxicity rules out its clinical application. Recently, NMSO3, a sulfated sialyl lipid, has demonstrated a greater antiviral potency against adenovirus in vitro than cidofovir exhibiting minimal cytotoxicity. Topical cyclosporin A (CsA) appears to be effective in the treatment of persistent corneal opacities. Topical interferon might be effective as a prophylaxis of infection. Topical interferon is currently not commercially available due to unsettled patent issues.
Prevention.
Adequate infection control measures should be followed as prevention and to reduce epidemic AKC outbreaks.


Postcrania

Postcrania (postcranium, adjective: postcranial) in zoology and vertebrate paleontology refers to all or part of the skeleton apart from the skull. Frequently, fossil remains, e.g. of dinosaurs or other extinct tetrapods, consist of partial or isolated skeletal elements; these are referred to as "postcrania".
Sometimes, there is disagreement over whether the skull and skeleton belong to the same or different animals. One example is the case of a Cretaceous sauropod skull of "Nemegtosaurus" found in association with the postcranial skeleton "Opisthocoelicaudia".
In paleoanthropological studies, reconstruction of relationship between various species/remains is considered to be better supported by cranial characters rather than postcranial characters. However, this assumption is largely untested.


John M. Coates

John Coates is a neuroscientist and applied physiologist working on the biology of risk taking. He was until 2016 research fellow in neuroscience and finance at the University of Cambridge. Before that he was a trader on Wall Street, working for Goldman Sachs, Merrill Lynch and running a desk at Deutsche Bank.He developed novel techniques for analyzing and trading tail events such financial crises.
Coates then retrained in physiology and neuroscience and began researching the biology of risk taking and stress. Monitoring in real time the cardiovascular and endocrine systems of traders, he found that the state of their physiology (rather than their psychology) is the single largest predictor of their risk taking and performance.
In 2012, Coates published the best-selling book "The Hour Between Dog and Wolf: how risk-taking transforms us, body and mind".