Simple Steps to Increase Life Expectancy

Better Mind Better Life

Better Mind Better Life

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Will Drinking Make One Live Longer

The drinking, those around him or her, and society. But are moderate and responsible drinkers likely to live longer than they would if they did not drink alcoholic beverages The bottom line for epidemiologists is total mortality. We know that, in most prospective studies, the consumption of one or two drinks a day lowers the death rate. We recently had a report from a very large survey (almost fifty thousand people) done by the American Cancer Society on the risk of dying according to alcohol consumption. Total mortality decreased by 21 percent for men and women who reported that they averaged one or two drinks per day compared with that of nondrinkers.

Estimating Life Expectancy

Even the most experienced oncologists have difficulty accurately predicting the exact life expectancy of patients with cancer. An experienced physician can usually predict whether a patient has six months or less to live, or when a patient may just have a few weeks or less to live, but more exact predictions are difficult. Often physicians will use one of two performance scales to assess cancer patients. The ECOG (an abbreviation for the Eastern Cooperative Oncology Group) and Karnofsky (named after the physician who developed it) scales provide standards to assess disability, progress, or decline and to help predict life expectancy. Family members can use these scales to assess a patient themselves and to allow them to communicate more effectively with health care professionals by phone.

Alternative Theories Of Life Vitalism Vs Mechanism

Here we face an important philosophical issue which is crucial for different concepts of life and also for the place that we assign to humankind, since we ourselves are living organisms. Such a controversy, which is often labeled as mechanism vs. vitalism, was already known in ancient Greek where atomists held a form of mechanism according to which life is a kind of self-moving matter, while Platonists defended a sort of vitalism posing a sharp distinction between matter and life. Aristotle tried, in a sense, to reconcile the opposition, observing that any object is constituted by matter and form, and living entities are alive because they have a special form. Therefore, life is not sharply distinguished from matter, since there is a continuous improvement before that matter is prepared to accept its proper form. This holds for the distinction between inorganic matter and life, as well as for various kinds of life. Vitalists retorted that apart from man (a unique and very special case...

Life Expectancy

Because estimates of healthy life expectancy reflect assumptions about measurement and modeling, they should be treated as indicators of population health rather than an accurate accounting of health experience. As noted earlier, a life table model generates health expectancies and thus the expectancies are subject to the model's constraints and assumptions. This makes it difficult to compare exact numerical estimates of healthy life expectancy across studies. Frequently, researchers focus on the relative proportion of life that is healthy (or unhealthy) or the consistency of group (e.g., sex, race, or period) differences in healthy life expectancy. Efforts to harmonize measures and methods have been promoted by the International Network on Healthy Life Expectancy (known by its French acronym of REVES Reseau Esperance de Vie en Sante). Recognized by the World Health Organization, REVES is a grassroots scientific organization dedicated to promoting international consistency in the...

Epidemiology And Etiology

Life Expectancy Though Americans are living longer than ever before, an estimated average of 78.14 years overall in 2008, U.S. life expectancy lags behind that of many other industrialized nations.5 There is nearly a 6-year gap between 2008 estimated life expectancy in males (75.29 years) and females (81.13 years).6 Disparities in mortality persist, with estimated 2008 life expectancy in the white population nearly 5 years higher than that of the black population.6 More than one-third of U.S. deaths in 2000 were attributed to three risk behaviors smoking, poor diet, and physical inactivity, accounting for nearly 35 of deaths in 2000 (Table 2-1). Currently, only 9 of Americans over 65 years

Toxic aye nts eg partcula Le air pollution23 environmental tobacco smoke radon

Older Americans use considerably more health care services than younger Americans, and their health care needs are often complex. Although in 2005, hospital stays for those 65 years or older were one-half of what they had been in 1970 (5.5 versus 12.6 days), they accounted for over 65 of hospitalizations overall, with longer lengths of stay corresponding to increasing age.11 Nine persons per 1,000 aged 65 to 74 years lived in nursing homes in 2004, compared with 36 of 1,000 aged 75 to 84 years, and 139 of 1,000 aged 85 years or older 11 as the aged live longer, more will require institutional care. After adjusting for inflation, health care costs increased significantly among older Americans from 8,644 in 1992 to 13,052 in 2004, three to five times greater than the cost for someone younger than 65 years. Medicare spending has grown nearly ninefold in the past 25 years, to over 507 billion in 2008, and Medicare roles are expected to increase to 78 million by 2030.4

New Conceptions of the Brain and of Creativity in the Latter Part of Life

Becoming very old is good - as long as I don't have to take the consequences Whether this is a real quote from Woody Allen or not, many of us probably agree with the sentiment. People seek longevity but want to keep their vital functions intact. For example After a certain age, in the late summers you start to listen eagerly for crickets and you get very relieved when you hear one. Let us then hope that you have not mistaken your tinnitus for the crickets

Balancing Treatment of Disease and Promotion of Health

Health is largely a result of positive lifestyle behaviors that are often challenging to change. Addressing issues such as smoking, obesity, substance abuse, and inactivity can reduce premature death by 40 (McGinnis et al., 2002 Schroeder, 2007). Positive lifestyle behaviors not only prevent premature death but also extend the average life expectancy by 14 years (Khaw et al., 2008). Currently, approximately 4 cents of every dollar spent for health care goes toward prevention and public health, with 96 spent on treating established disease (Lam-brew, 2007). Two thirds of chronic disease is behavior related and could be mitigated by working interprofessionally to help guide patients toward healthy choices (McGinnis et al., 2002).

Prognostic Significance Of Surgery

The prognostic effect of extensive surgery for low-grade gliomas is not well defined but there appears to be a positive effect on outcome.3,8 The association between extent of resection and longer survival for patients with high-grade malignant gliomas is similarly controversial,9 mainly because of a lack of randomized studies addressing the issue and the inconsistent and less-than-objective methodology used in determining extent of resection. The degree of cytoreduction achieved, as measured by extent of resection, appears to correlate with outcome. Patients with gross total resection live longer than those with partial resection, who in turn live longer than those who have biopsy only.18,65 A further consideration is that partial

Psychological Factors

The most prominent approach to personality at present is the five-factor model (Goldberg, 1993). The five broad personality domains in this model, for which OCEAN can be an acronym, are openness to experience, conscientiousness, extraversion, agreeableness, and neuroticism (Table 3-3). Research on the relationship of these factors to health variables has generated several findings. Conscientiousness has been associated with longevity among healthy individuals and better functional status in those with physical illnesses or impairments, whereas neuroticism is consistently found to be negatively correlated with health (Goodwin and Friedman, 2006 Smith and Mackenzie, 2006). Agreeableness, extroversion, and openness to experience generally tend to have weaker associations with health and therefore are considered less relevant to understanding links between personality and health. Likewise, a large body of research indicates that positive emotional states are associated with better health...

Ontogeny Phylogeny Language and Culture

Our understanding of thinking and reasoning would be gravely limited if we restricted investigation to young adult English speakers. The six chapters in Part VI deal with the multifaceted ways in which aspects of thinking vary across the human lifespan, across species, across speakers of different languages, and across cultures. In Chapter 22, Halford provides an overview of the development of thinking and reasoning over the course of childhood. In Chapter 23, Gallistel and Gelman discuss mathematical thinking, a special form of thinking found in rudimentary form in nonhuman animals that undergoes development in children. In Chapter 24, Salthouse describes the changes in thinking and reasoning brought on by the aging process. The phylogeny of thinking -thinking and reasoning as performed by apes and monkeys - is discussed in Chapter 25 by Call and Tomasello. One of the most controversial topics in the field is the relationship between thinking and the language spoken by the thinker in...

Epidemiology And Etiology Epidemiology

HF is a major public health concern affecting approximately 5 million people in the United States. An additional 550,000 new cases are diagnosed each year. HF manifests most commonly in adults over the age of 60. The growing prevalence of HF corresponds to (a) better treatment of patients with acute myocardial infarctions (MIs) who will survive to develop HF later in life, and (b) the increasing proportion of older adults due to the aging Baby Boomer population. The relative incidence of HF is lower in women compared to men, but there is a greater prevalence in women overall due to their longer life expectancy. AHF accounts for 12 to 15 million office visits per year and 6.5 million hospitalizations annually. According to national registries, patients presenting with AHF are older (mean age 75 years) and have numerous co-morbidities such as coronary artery disease (CAD), renal insufficiency, and diabetes.

What is apportionment

Apportionment can also refer to the division of payment responsibility. A man had a back injury while at work but also had a similar back injury at work two years ago with ongoing symptoms and treatment. The current treatment costs can be apportioned to both the old and the new injury, as can the impairment rating. Most jurisdictions have their own rules as to whether apportionment is used and in which circumstances. A great deal of skill and expertise are needed for an examiner to apportion an individual's current condition to all the causative factors, including the normal aging process.

Environmental and External Factors Related to Mitochondrial ROS

The consequences of paternal age on human fertility have come to the fore due to changes in human reproductive patterns, a combination of social changes, prolonged life expectancy, and a reliance on Assisted reproductive technology (ART) 113 . The association between increased paternal age and decreased sperm parameters has been well documented. Jung et al. 114 reported that older subjects (> 50 years) showed a 27 decrease in progressive motility compared to younger men (21-25 years). Another study also found that older subjects (> 55 years) exhibited approximately 25 lower total sperm count, semen volume, and sperm concentration compared to the younger age group (30-35 years) 115 . Furthermore, recent studies have also shown that ROS production and oxidative stress are increased in human spermatozoa during aging, suggesting a possible role for the decline in fertility 116 ,

The Rise of Cardiac Diseases

Another result of the decline of infectious diseases has been an increase in the average life expectancy. People now live long enough to succumb to diseases that take time to develop, which is the case with many cardiac diseases, particularly coronary heart disease. And again life-styles have changed. A lack of physical activity and a change in diet may contribute to the increased incidence of coronary heart disease.

Carol Jagger And Antony J Arthur

As few diseases or conditions present for the first time in later life, there are few treatments prescribed solely to older people. There is also little consensus on the definition of 'the elderly' since ageing can be considered a continuous process from birth to death. However the increasing likelihood of illness other than that under treatment and greater mental and physical frailty with ageing means that older people can be inherently different to younger adults and the numerous physiological changes that accompany the ageing process may alter the way in which older people respond to drugs.1

Hypertrophic Cardiomyopathy Pathology

The genetics of this disorder are well understood. Half of all cases result from inherited mutations, while the other half are the result of sporadic mutations. Fifty percent of these mutations occur in the beta cardiac myosin heavy chain on chromosome 14. Watkins et al9 screened beta cardiac myosin heavy chain genes for mutations in 25 unrelated families with HCM. Seven missense mutations were uncovered in 12 families. Six of these mutations resulted in a change in the electrical charge of the altered amino acid, and these were found to be associated with a shorter life expectancy. Patients with the mutation that did not produce a change in charge had almost normal survival.

Aging of ligaments and muscles

The ligaments surrounding the spine contribute to its intrinsic stability. They also restrain extremes of motion in all planes. All spinal ligaments have a high content of collagen. Ligamentum flavum, which connects the adjacent vertebrae, has a high percentage of elastin, allowing contraction during flexion and elongation during extension 7 . As part of the aging process, ligaments undergo chemical and macroscopic changes, including a rise in the concentration of elastin, which decreases tensile properties, resulting in ligamentous weakening affecting the stabilizing function of the longitudinal ligaments 13 . In addition, aging and degeneration of the ligamentum flavum leads to increased thickness and bulging, often disclosed during surgery for spinal stenosis.

Expressing the Burden of Disease Prevalence and Incidence

Tracking prevalence and incidence over time can help to determine health care strategies aimed at limiting the burden of a disease. For example, human immunodeficiency virus (HIV) prevalence has been rising over the past decade, partly because patients who previously would have died (from AIDS) within a few years of diagnosis now live longer. More effective treatment is prolonging life, and the rising prevalence is a sign of success of advances in therapy health care strategies should continue to provide highly active antiretro-viral therapy to treat HIV-infected patients. The incidence of HIV infection in particular communities is also increasing. This is a sign of increased transmission and means that more people are being infected health care strategies should therefore focus on primary prevention of HIV infection.

Introduction About Alzheimers Disease

In the early stages memory is slightly impaired. Items become lost names, events, and people forgotten. As some forgetfulness is typical of the aging process, these symptoms may be dismissed or disregarded. The first person to notice something wrong is often the afflicted person himself. He may admit it, hide it, or attempt to compensate.

Diagnostic Considerations for Esthetic Implant Therapy

Treatment planning may involve several specialties, including periodontics, prosthodontics, and orthodontics. Any treatment plan should include the least risky procedures in terms of success rate and longevity, because it is no longer appropriate to consider a high-risk procedure when a more predictable alternative such as dental implant is available. The value of higher risk endodontic or periodontal procedures to save teeth for prosthodontic abutments is sometimes questionable because dental implants are a more predictable alternative. For example, procedures such as root amputation or tooth hemisection, which have a five-year failure rate of 30 to 50 , are less appealing options than dental implants, which have a better success rate and are less risky (Langer et al. 1981, Buhler 1988, Green 1986).

Occupational Diseases

The Industrial Revolution fundamentally changed the methods of production and work relationships throughout the world. The factory system, which displaced workers from their land and homes, created new dangers. In addition to accidents caused by machinery, a faster pace of production, and long horn's, new diseases plagued the working classes. Because England was the first industrial nation, English reformers and physicians quantified, measured, and documented the effects of industrialism and urbanization on the lives of the English working classes. Edwin Chadwick, Thomas Percival, and William Farr were among a group of Benthamites, Tories, and social reformers who sought to use statistical and quantitative analyses to impose order and expose the horrible working and living conditions that were closely linked to the development of the factory system. Charles Turner Thackrah, a physician in Leeds, paid particular attention to the diseases of various trades and, in 1832, wrote The...

Patient Encounter Part 2

Patients with asymptomatic carotid artery stenosis of 60 or more may benefit from carotid endarterectomy if it is performed by a qualified surgeon with low complication rates (less than 3 ). There is considerable controversy over how this information can be applied to clinical practice. Currently, recommendations suggest considering carotid endarterectomy in patients with carotid artery stenosis of 60 to 99 who are between 40 and 75 years of age if there is a 5-year life expectancy and the operative risks are low.36

Twentieth Century Mortality Declines

Mortality rates have fallen dramatically in much of the world since the early days of the twentieth century, although life expectancy values are still lower than 50 years in a number of the lesser developed countries, particularly in Africa. Recent estimates for the more developed countries of North America and Europe place the average life expectancy between a low of 73 years for Ireland and a high of 77 to 78 years for Iceland, the Netherlands, Sweden, and Switzerland (Population Reference Bureau 1989). The primary causes of this enormous mortality de The high life expectancy values and corresponding low infant mortality rates of the more developed countries stand as an impressive testimony to the success of those countries in improving the quality of life of their populations. Conversely, the low life expectancies and corresponding high infant mortality rates in the less developed countries are, as was the case in Europe a century ago, a reflection of the poor quality of life...

Preventive Services for Older Adults

An emphasis on a shared decision-making approach is especially important when considering preventive services for older adults. Family physicians and their older patients should consider issues that contribute to the complexity of prevention in older adults, including unique goals of prevention, life expectancy, comorbidities, potential for harm, and patient values and preferences (Harris et al., 2001).

Marketing and evaluation

Many claims are made by clothing manufacturers in promotional material concerning the performance and longevity of their products, especially in sports clothing which is not governed by CE marking regulations, and which are endorsed by well-known personalities. In the early development of sportswear and outdoor wear some of the prominent sportsmen and women within the activities themselves became consultants in the research and development process and helped to refine existing designs and develop new products for protective and performance clothing. These have developed into some of the most successful sportswear and outdoor brands such as Helly Hansen and O'Neill .

Diseases in the Pre Roman World

Third, the expression of disease can be influenced by many factors (e.g., age and environment). In general, the risk of disease increases with the age of the individual. With the exception of many Third World countries, people today live 30 to 40 years longer than they did in antiquity. This greatly increased longevity is a very recent development in human history and means that the prevalence of many diseases common among modern Western peoples, such as cancer and heart disease, is probably much greater than it was in antiquity. Environmental conditions, both geographic and cultural, can also influence the expression of disease. For example, exposure to smoke from wood-burning fires may be a factor in the prevalence of nasopharyngeal tumors in archeological skeletons (Wells 1977).

Clinical Studies of Preoperative PCI

In summary, pending the results of further prospective trials, there is not sufficient evidence to suggest that routine preoperative PCI is effective in reducing the risk of noncardiac surgery among patients with documented coronary artery disease who are at moderate clinical risk. In these individuals, preoperative PCI should be performed only for patients who have an indication for coronary revas-cularization unrelated to the noncardiac surgery. For a limited group of patients at higher risk, data are lacking, and the perceived risks and benefits of pre-operative revascularization need to be carefully weighed on an individual basis. Multidisciplinary communication, including the patient's medical specialist, cardiologist, cardiac surgeon, anesthesiologist, and surgeon intending to perform the noncardiac procedure, can be quite helpful in determining a rational preoperative strategy. Such a discussion can allow consideration of issues such as life expectancy anticipated risks and...

Nutrition and Disease

Women are believed to have suffered more than men from the deficient diet of antiquity and the early Middle Ages. Many sources from the ancient world indicate that men outlived women, and an examination of French and Italian records from the ninth century shows that, whereas more female childern than male reached the age of 15, males nonetheless enjoyed a greater life expectancy than females (Herlihy 1975). Numerous explanations of this paradox have been offered, including the underreporting of women because they were living in concubinage and death in childbirth (for a survey of theories, see Siegfried 1986).

Diseases of the Renaissance and Early Modern Europe

Outside the urban Mediterranean, the period of the Renaissance is better labeled the late Middle Ages. Most people lived in small villages and market towns, where goods, information, and epidemic disease passed through at a more leisurely rate. The British Isles, for example, had no town larger than 50,000 people until after 1600. But by the late sixteenth century, France, Germany, and England began to grow in population and in number of cities. The Thirty Years' War effectively eclipsed growth in Germanic Europe during the early seventeenth century. London and Paris, however, became the largest cities of Europe. By the eighteenth century, Scotland and Scandinavia began the processes of urbanization, commercialization, and protoindustrialization. A general improvement in health and longevity accompanied economic growth, even though the prevalence of infectious diseases remained high.

Diseases of Sub Saharan Africa since 1860

Disease has been an important factor in the history of sub-Saharan Africa since 1860. Across the continent people have been under constant attack by endemic diseases in their struggle for survival, and epidemic diseases have decimated millions. In 21 countries, life expectancy today ranges from only about 44 to 56 years according to I. Timaeus (personal communication). In some countries, mortality rates have grown recently, and in most regions they remain high. Increases have occurred in Angola, Ethiopia, Mozambique, Niger, Nigeria, and Rwanda. In the first three there were 250 to 299 deaths per 1,000 live births, and in Gambia, Sierra Leone, Mali, and Malawi child mortality rates were more than 300 per 1,000 (United Nations 1987). The direct causes of this mortality in most developing countries are the following diarrhea, malnutrition, malaria, measles, acute respiratory infections, tetanus, and other neonatal causes. Now AIDS reminds us of the potential havoc of an epidemic disease...

Agerelated bone loss and osteoporosis

Peak bone mass is achieved between the ages of 16 to 25 years in most people. After this age, bone mass slowly, but continuously, decreases. The greater the amount of bone achieved during the peak period, the lower the chance that a person will develop osteoporosis later in life. Normal rates of bone loss are different in men and women. In men, bone mass is lost at a rate of 0.3 per year, while for women this rate is 0.5 . In contrast, bone loss after menopause, in particular the first 5 years after its onset, can be as high as 5-6 per year 17 . Because women live longer than men, it is believed that increased longevity places women at higher risk of senile osteoporosis.

Clinical Course and Prognosis

Life expectancy has greatly increased from a predicted survival of 16 years in 1970 to more than 40 years for patients born in the 1990s.5 The average age of patients in the Cystic Fibrosis Foundation Registry is now more than 16 years, and almost 45 of CF patients in the 2006 Registry annual report are over 18 years old with the oldest

Additional Considerations and the Need for Combined Lymph Node Neck Dissection

Although the presence of regional node metastases has only a small effect on the life expectancy of patients with low-risk papillary thyroid carcinoma, especially in iodine-sufficient areas such as the United States and Japan,3,6,20,39,46 most endocrine surgeons recommend ipsilateral, or occasionally bilateral, modified radical neck dissection along with a central neck dissection in patients with clinically recognizable lymph node metastases.

Patients With Atypical GERD

Older individuals have decreased host defense mechanisms such as slowed gastric emptying and decreased saliva production. These patients often do not seek medical attention because they believe their symptoms are part of the normal aging process. PPIs are the most useful option in this population because they have superior efficacy and are dosed once daily. 5 In addition, there are fewer drug-drug and drug-disease state interactions compared with H2RAs and metoclopramide. Elderly patients may be sensitive to the CNS effects of metoclopramide and H2RAs.

Does General Anesthesia Have Any Lasting Effects on Mental Function

Although extremely rare in persons under the age of sixty-five, postoperative mental, behavioral, and neurological impairment in the elderly is quite real, has been well documented, and may be significantly underappreciated. With approximately 35 million Americans over the age of sixty-five and the current life expectancy of American women over eighty, and American men well over seventy, a huge number of patients are at risk for this complication. Fortunately, the vast majority of postoperative mental changes seen in the elderly patient will be temporary.

What options do I have for treatment of my prostate cancer

Various treatment options are available for prostate cancer, each with its own risks and benefits (Table 7). The options available may vary with the grade of tumor, the extent of tumor spread, your overall medical health and life expectancy and your personal preferences. The treatments for prostate cancer can be divided into those that are intended to cure your cancer (definitive therapies) and those that are palliative, intended to slow down the growth of the prostate cancer and treat its symptoms. Definitive therapies for localized prostate cancer include interstitial seed therapy (brachytherapy), external beam radiation (EBRT), and radical prostatectomy (open, laparoscopic, or robotic). Other therapies, such as cryotherapy, high intensity focused ultrasound (HIFU), and combination therapy (external beam radiation plus interstitial seed therapy) are not commonly used for men with localized prostate cancer.

Congenital Aortic Stenosis

Trileaflet aortic valves are congenitally abnormal when three cusps and three commissures are miniaturized within a small aortic ring190 (see Fig. 7-1A, middle right) or when an aortic valve has three dysplastic leaflets.44 In a hydrauli-cally ideal aortic valve with three equal cusps, total dias-tolic force is equally distributed among the three cusps and their sinus attachments. Cuspal inequality results in unequal distribution of diastolic force, and cuspal inequality is a common variation of normal (see Fig. 7-1B).196'225 The fibrocalcific process of aging proceeds more rapidly in the cusp or cusps that bear the greatest hemodynamic stress.13'225 Accordingly, congenital cuspal inequality enhances the aging process, converting a functionally normal trileaflet aortic valve into fibrocalcific aortic stenosis

Oxidative Stress Theory of Aging

The oxidative stress theory has been further substantiated in a number of model organisms where the supplementation or depletion of ROS-scavengers has either increased or decreased life span, respectively 28 . A simple test of the involvement of ROS in aging organisms involves administration of antioxidants. A large number of studies have examined the efficacy of administration of antioxidants to aging organisms and how this affects longevity. Supplementation with vitamin E significantly increases the life span in nematodes 32 , Paramecia 33 , and diphtheria Zapronius paravittiger 34 , It has also been shown in Podospora anserine that glutathione (GSH) addition increases lifespan by 13 and also strongly reduces the formation of end products of ROS-induced lipid damage 35 . 36 and approximately a 34 increase in life expectancy 37 . The overexpression of Cu, Zn SOD in motorneurons of Drosophila also resulted in a 40 increase in life span 38 . Caloric restriction can substantially...

What is brachytherapyinterstitialseed therapy Who is a candidate What are the risks

Who is a candidate for interstitial seed therapy Similar to radical prostatectomy, the goal of interstitial therapy is to cure the patient of prostate cancer. With this in mind, the candidate should have a life expectancy of more than 7 to 10 years and no underlying illness that would contraindicate the procedure such that he will not benefit from a cure. Men with significant obstructive voiding symptoms and or prostate volumes greater than 60 mL are at increased risk for voiding troubles and urinary retention after the procedure. Men who

Trajectories of Population Aging

The first comparison in Table 5.4 is between the more developed regions (Europe, Northern America, Japan, and Australia and New Zealand) and the less developed regions (Africa, Latin America, and Asia excluding Japan). In general, countries included in the more developed regions have had higher levels of income, higher life expectancy, and lower birth rates since 1950 than countries in the less developed category. Although this is a crude division of world societies, it is clear that it captures large differences in population aging. Between 1950 and 2000, population aging progressed much more rapidly in more developed areas, and the difference between more and less developed was marked in 2000 (14.3 over age 65 years in more developed, compared to 5.1 in less developed). Between 2000 and 2050 it is anticipated that the proportion of old will nearly double in developed regions (to 26.8 ) and triple in less developed regions (to 14.0 ). In 2050 the less developed regions will have...

Public Pension Programs

Two basically different approaches to reforming public pensions are being debated (Disney 2000). The less radical approach, referred to as ''parametric'' reform (Chand and Jaeger 1996), argues that unfunded PAYG schemes can be brought into equilibrium by making changes in a few parameters. More money available for paying pension benefits could come from either increasing taxes on the workers or by increasing the proportion of the working age population that participates in the labor force. Pension expenditures could be reduced by decreasing benefits, either by directly cutting benefits or by increasing age for pension eligibility. The approach of increasing normal retirement age has received support from some demographers who point out that that increasing life expectancy and improving health of cohorts entering old age make a fixed retirement age (such as 60 or 65) increasingly obsolete (Chen 1994 Uhlenberg 1988). The general view of those favoring parametric reform is that by making...

Cervical and thoracic zygapophyseal joint pain

Zygapophyseal or facet joint pain somatic dysfunction is a common diagnostic label used by manual therapists (Maitland 1986 Trott 2002 Gatterman 1998 McClune et al. 1998). This section explores what is documented, rather than speculated, about this syndrome in terms of diagnosis and treatment. Zygapophyseal joints are involved in the normal ageing process of cervical spondylosis, but changes such as anterior and posterior osteophytes, bony hypertrophy and foraminal stenosis are commonly found in the asymptomatic population and thus are not intrinsically a source of symptoms (Gore et al. 1986 Friedenberg and Miller 1963 Teresi et al. 1987 Matsumoto et al. 1998).

Cervical spondylosisstenosis

The ageing process is associated with certain anatomical changes in the cervical spine. The nature of these changes is dealt with in more detail in Chapter 3 here we wish to consider the symptomatic presentation of these degenerative changes, often referred to as cervical spondylosis. In brief, these changes involve the early desiccation and transverse fissuring of the intervertebral disc. The associated thinning of the disc leads to greater load bearing at the zygapophyseal and uncovertebral joints, which may produce osteophytes and posterior bulging of the disc as a bony ridge (Taylor and Twomey 2002). These degenerative changes may produce lateral foraminal stenosis affecting the nerve root or spinal canal stenosis affecting the spinal cord.

General Health Conditions in South Asia

South Asia is home to most diseases of humankind surprisingly, yellow fever and some others are absent. The major causes of death include infectious and parasitic diseases such as tuberculosis, diarrhea, malaria, typhoid, gastrointestinal disorders, and a variety of childhood diseases such as tetanus, pneumonia, whooping cough, diphtheria, measles, and other preventable diseases (Nyrop 1984). A health survey in Pakistan during the mid-1970s revealed that nearly 30 percent of the people had malaria, and almost 100 percent had worm or parasitic afflictions (Nyrop 1984). Although published data on many health indicators are lacking or woefully deficient, some indication of health conditions may be obtained from life expectancy, crude death rates, and infant mortality rates. Death rates in South Asia, as in most developing regions of the world, have declined markedly since the 1970s, although they are still above the world average. Within South Asia, Sri Lanka has the lowest death rate...

Classical Antiquity The Golden

Some generalizations seem reasonable, nonetheless. There was probably a surplus of men among the adult population because more women died in the 25- to 45-year age group. Much of this is probably attributable to death associated with childbirth. If this period had the attributes common to most prein-dustrial societies, about 30 to 40 percent of the total population was composed of children. What is singularly lacking is a sense of what the probability of a child at birth growing to adulthood was. This is both the most important factor in determining life expectancy at birth (much of the spectacular change in this parameter in modern times is the result of decreasing childhood mortality).

The Later Middle Ages

In 1347, the plague began its journey through Europe. When the pandemic ended in 1350, a third of the population of Europe was dead. The population of Europe on the eve of the epidemic has been estimated at 75 million. Although life expectancy at birth was only around 30 years, the very high infant mortality rate artificially lowered this relative to the life expectancy of a person who reached adulthood. Women tended to fare worse, probably as a result of childbirth, although some authors also cite tuberculosis and malaria (Russell 1977). Before the year 1000, no city in medieval Europe had a population exceeding 20,000. In 1340, the largest European cities were Venice, Paris, Florence, and Genoa, each with populations around 100,000. Closely behind were cities such as London, Barcelona, Bologna, Brescia, Ghent, and Cordoba, each of which had populations over 50,000 (Beloch 1937, 1940, 1961

The ultrafine hypothesis

This conclusion has led to the calculation of the effects (benefits) of reducing concentrations of ambient particles. Such calculations may be based on either time-series studies or on cohort studies. Using the latter, it has been calculated that exposure to 2008 levels of PM2 5, in the UK, causes an effect equivalent to 29,000 deaths at typical ages in 2008 (Committee on the Medical Effects of Air Pollution 2010). The phrase equivalent to is important it is likely that exposure to particles contributes to many more deaths than 29,000 (this is explained in detail in the recent report by the Committee on the Medical Effects of Air Pollutants (2010)). Reducing concentrations of particles extends life expectancy but cannot, of course, actually prevent deaths all people die. Such calculations have formed the basis for the cost-benefit analysis that underpins the UK Air Quality Strategy (Department for the Environment, Food and Rural Affairs 2007).

Research Directions

Some studies have shown that formerly married women plan much later retirements than formerly married men because they have had lower earnings and expect only small retirement payments (Hatch 1992). More generally, working and nonworking life expectancy vary according to occupation, class of worker, education, race, and marital status (Hayward and Grady 1990 Burr et al. 1996). Moreover, these economic and social characteristics, because they are related to income during working life, are also related to postretirement income (Pampel and Hardy 1994).

Substantive Concerns

Human fertility has attracted great attention over the past half-century.1 In fact, the largest, coordinated social science research efforts in history (the World Fertility Surveys and Demographic Health Surveys) have had fertility as their focus. Motivation for this attention emanates from the important and wide-ranging consequences of fertility and fertility change. Fertility levels are key components of population change and have been, historically, the component most difficult to predict (Bongaarts and Bulatao 2000). Also, fertility levels alter cohort sizes that, in turn, impact a full set of age-graded institutions such as schools, the labor force, marriage, and social security. Finally, human fertility is strongly linked to parenting or social replacement, the process of socializing group members. Except perhaps for increasing longevity, no 20th-century change has impacted individual lives more than have fertility changes. Consider, for instance, the cascading consequences of...

Specific Patient Populations and Situations

Patients who have multiple comorbidities, such as cardiac disease, vascular disease, or diabetes have an increased risk for postoperative complications.6,7 The preoperative evaluation and optimization of patients with these conditions is critical. The addition of an arthrodesis increases the length of anesthesia as well as the amount of blood loss. Both of these factors can delay recovery time, and patients with multiple comorbidities are therefore more likely to require an extended rehabilitation period. These factors should all be considered when deciding upon the advisability of supplemental fusion with decompression. Finally, for patients with a limited life expectancy, treatment should be focused on obtaining an immediate improvement in quality of life without subjecting the patient to a prolonged and painful recovery period.

Structure of the Model TRULS1

Note that the submodel (iii) used to purge the fuel sales statistics of the nuisance factors affecting the number of vehicle kilometres driven per unit of fuel sold, is not shown in the diagram, as it is only an auxiliary relation (a measurement model) which does not form part of the model's recursive causal structure. Nor does the diagram show the dynamic, partial adjustment structure of the car ownership model. A vehicle pool is an inert matter, comparable to a human population, although with generally higher rates of turnover and shorter life expectancy. The stock of cars registered within a given geographic unit changes from one year to the next, in response to the flows of (i) new car acquisition (births), (ii) used car sales (migration), and (iii) scrapping (deaths). Given the very high level of purchase tax imposed on automobiles in Norway, used cars can be sold abroad only at very substantial losses. Thus, the only important downward adjustment mechanism operating at the macro...

General Guidelines for the Use of Opioids

Others may take morphine for weeks, months, even years. Many cancer patients need treatment with morphine even though their cancer is under good control for a long time. Taking morphine does not have any kind of negative effect on the course of the disease. In fact, many doctors believe that patients on morphine live longer because they are better able to rest, eat, and sleep, are more interested and active in the life around them, and therefore are able to use their natural ability to fight the disease more rigorously.

Theoretical Issues General Conceptual Approaches

As evidenced in Wise's work, there is a growing interest in cross-disciplinary collaboration with social scientists on the part of public health and medical researchers. Further, I believe a consensus is emerging in support of the view expressed by Frank, who points out (citing Carey 1997) that, in demography, there is a growing recognition that studies of biology of death, mortality, longevity, and life are all informed by biological processes that demographers cannot afford to ignore'' (2001 563).

Historical Trends The Infant Mortality Transition

Vital statistics registration remains inadequate in most areas of the world today, and even modern-day international comparisons are difficult due to variability in definitions, completeness of registration, and data quality (United Nations 2001 12-16). Nevertheless, it is possible to say with some confidence that ''for most of human history, life expectancy probably fluctuated between 20 and 30 years'' (Weeks 1999 131). Life expectancies in this range imply that only 63 to 74 of infants survive the first year of life (Weeks 1999 Table 4.2). During the premodern period, IMRs were probably on the order of 260 to 370 per 1,000 live births. Some time during the latter part of the 19th century, there was a major reduction in infant mortality in Western Europe. Scholars seem to agree that the transition to lower infant mortality, as well as to lower child and adult mortality and longer life expectancy during this early period, was largely due to a major reduction in deaths from infectious...

Physiology of Hemostasis

Classic hemophilia varies in severity from family to family. In the most severe cases, in which plasma is essentially devoid of factor VIII, the patients may bruise readily and bleed apparently spontaneously into soft tissues and joints, with the latter resulting in crippling joint disease. Trauma, surgical procedures, and dental extractions may lead to lethal bleeding. The life expectancy of those with severe classic hemophilia is foreshortened, death coming from exsanguination, bleeding into a vital area, or infection. The prognosis of classic hemophilia has

Data And Methods Conventional Methods and Techniques

Life expectancy and life span are also critical measures used in mortality analyses. Life span refers to the maximum number of years a person can live (Nam 1994). Life span for humans is currently 122 years, based on the life of Jeanne Louise Calment, of Arles, France, who died in 1997 (National Research Council 1997). This life span could increase if a single individual outlived Madame Calment. Life expectancy is a summary measure of the average number of additional years a group of individuals can expect to live at a given exact age (Rogers, Hummer, and Krueger 2003b). U.S. life expectancy has increased remarkably over the last century, from just 47 years in 1900 to the present 77 years (Anderson and DeTurk 2002 Minifio et al. 2002). Although the U.S. is now enjoying the highest life expectancy at birth ever achieved by individuals in this country, at least 20 other countries have higher overall life expectancies at birth. For instance, compared to a current U.S. life expectancy at...

Endogenous androgen deprivation

Nieschlag and colleagues compared the life span of castrated and intact singers and did not reveal any differences in total or cardiovascular mortality (Nieschlag et al. 1993). In agreement with a neutral or beneficial effect of endogenous androgens in men, bassos tended to live longer than tenors. By contrast and in agreement with an adverse effect of androgens in women altos had a reduced life expectancy as compared to sopranos (Nieschlag etal. 2003).

Sports performance with increasing age

Elite veteran athletes are, by definition, not representative of the aged population, but nevertheless provide a valuable insight into the potential of the human body to cope with the aging process and give an indication of the limits to which an aging population might aspire. These performers have often maintained high levels of physical training throughout their lives, but importantly still show marked declines in performance over time with increasing age. This simple observation tells us that the decline in physical performance is not simply due to a disuse phenomenon. Figure 3.3.3 shows the world records for three track athletic events the 100-m sprint, the 800 m and the 10000 m. In all three events in both men and women, the decline in performance occurs in an almost linear manner until around 70-75 years, whereupon the decline in performance begins to accelerate. The extent to which this reflects a population effect is unclear, as participation in masters or veterans sports is...

Conclusions And Research Directions

A complex web of elements shapes adult mortality patterns, risks, and causes. As such, demography has arisen as an interdisciplinary field that derives insights from sociology, geography, economics, history, biology, epidemiology, and medicine to better understand the multidimensional forces that shape mortality in the contemporary world. Future work that seeks to better understand the causes and consequences of adult mortality in the U.S. and throughout the globe must capitalize on the interdisciplinary nature of demography if future gains in life expectancy are to be understood and maintained (Weinstein, Hermalin, and Soto 2001). Although the U.S. population is generally healthy with good longevity prospects, several factors may hamper future gains. For instance, the increasing prevalence of obesity is an alarming trend and presages increasing mortality from diabetes, heart disease, and some forms of cancer. Further, in the four decades since the U.S. Surgeon General brought to...

Clinical use in osteoporosis

Bones, which leads to an enhanced fragility of the skeleton and therefore to a greater risk of fracture. It is defined as present in women when the bone mass is more than 2.5 SD below that of the young woman (t score). It is a very common disorder which will become even more common with the increase in life expectancy. It is also frequent in men, although less so than in women. Its main cause is the continuous loss during life of both cancellous and cortical bone, which is exacerbated in women after the menopause. The second contributory factor is failure to achieve adequate peak bone mass during adolescence. The causes of these changes are not yet clear, although genetic factors are involved, at least for the latter.

Conservative Followup in Clinically Detected Primary Hyperparathyroidism

Corlew and associates36 reported a more carefully explored series of 47 patients with primary HPT who either refused surgery or were not offered this option, some of whom were considered poor surgical risks. The diagnosis was accurately established in these patients by measurement of albumin-corrected serum calcium and intact PTH. The patients were classified into three groups on the basis of their levels of serum calcium one fourth had serum calcium levels higher than 2.78 mmol L. Sixteen of the 47 patients (34 ) either died or suffered from complications that the authors considered to be possibly related to primary HPT, such as peptic ulcer disease (8 patients), with bleeding in some cases renal failure (5 patients) renal calculus (1 patient) hypercalcemic crisis (1 patient) and ventricular conduction defect (1 patient). With the exception of the patient with hypercalcemic crisis, who initially belonged to the group with the lowest serum calcium levels, the serum calcium levels did...

History and Geography

With the rapid advances in gene.transfer therapy, it may soon become possible to correct the defect from which the multiple pathological processes of this disease result. Then, instead of merely prolonging life by treating the symptoms, physicians may give CF infants a normal future.

Classification by service life

The classification of chemical protective clothing by expected service life is based on the useful life of the CPC item. Thus, service life reflects the longevity of the product and how it relates to the user's expectations. The service life of chemical protective clothing generally fits into three classes

Beam Radiation Therapy

Candidates Any man of any age, even if he is not in good health, has a life expectancy of less than ten years, or has cancer that has spread beyond the prostate. Not appropriate for very large prostates unless initially shrunk by hormone therapy, nor for men with chronic bowel disease.

Heart Related Diseases

There has also been an increase in average life expectancy. People now live long enough to succumb to diseases that develop slowly, such as many cardiac diseases, particularly coronary heart disease. Lifestyles, too, have changed. Lack of physical activity and changes in diet may contribute to increased coronary heart disease.

Steroids or Corticosteroids

Thus steroids can improve the quality of life in some cancer patients. At least one study, conducted in Britain, has shown that selected patients on corticosteroids live longer as well. However, caution must be exercised with these medications. In particular, patients with peptic ulcers or poorly controlled high blood pressure are not good candidates for treatment with steroids.

Microsurgical Resection

In the report from Memorial Sloan-Kettering, median life expectancy in patients with metastatic brain tumors from breast cancer treated with surgical excision plus WBRT was 16.2 months from the diagnosis of the brain tumor and 14 months from the time of craniotomy (some patients had WBRT first rather than postoperatively).139 The 1-, 2-, 3-, and 4-year post-craniotomy survival rates were 55.3 , 25.7 , 18.6 , and 7 , respectively. However, this series is confounded by the inclusion of patients who also had carcinomatous meningitis at the time of surgery. If these patients are excluded, the median life expectancy after craniotomy increases even further to 17.4 months. In the report from The University of Texas M.D. Anderson Cancer Center (M.D. Anderson), patients with metastatic brain tumors from breast cancer treated with surgical excision plus WBRT had a median life expectancy from the time of craniotomy of 16 months, and the 3- and 5-year survival rates were 22 and 17 ,...

How I Made My Decisions

In assessing treatment options, I quickly ruled out watchful waiting and seed radiation therapy as not appropriate for my Gleason 7 cancer. Hormone therapy by itself also seemed inappropriate, since it would not cure the cancer and brought with it serious side effects. That left beam radiation therapy and surgery as the logical options. I calculated my life expectancy to be more than fifteen years. A major factor in my ultimate decision was a distinct unwillingness to live with uncertainty. Surgery for me offered the advantages of finding out the precise severity of the cancer and also being able to use the PSA postoperatively to ascertain possible recurrence.

Treatment Approach for Patients with Solid Brain Tumors

Is controlled, now determines longevity. For patients with cancers that are sensitive to chemotherapy or hormonal therapy (such as breast cancer) or patients with little disease other than their brain tumor, extended survival measured in years, and even cure, now becomes possible.

Population And The Social Sciences

Review progress of the relatively new specialty of biodemography which draws on epidemiology, biology, and demography to examine a variety of interesting and important issues, e.g., human senescence, longevity, frailty, and genetic variation. Finally, chapter 22 by Land, Yang and Zeng is devoted to mathematical demography and covers efforts to increase the precision and power of demographic analysis through the incorporation of mathematical models and mathematical statistics.

Treatment Options Operative Care

There are numerous factors to consider. One must always keep in mind the full longevity of the patient. Young players can lay out a year after a significant spinal surgery and still return to play. Older players are less likely to return to play after a major spinal reconstructive operation.

Treatment of osteoarthritis

For the joint-injured athlete the situation is often different, with onset of radiographic changes and symptoms of increasing severity at a considerably younger age 5,18,44,45,53,69,72,73 . These individuals at the time of onset of symptoms have a longer life expectancy and expectations of a higher level of physical activity, even after joint surgery. The remarkable success of arthroplasty as a treatment for older individuals with severe OA is replaced by a high rate of implant failure and revision surgery among those operated on at a younger age 74-76 . Osteoarthritis in the young, often resulting from joint injury during athletic activities, thus represents a continued and unresolved challenge for the sports medicine community.

Surgical treatment of OA

For the patient in whom the treatment modalities discussed above do not provide sufficient pain relief, surgical treatment has to be considered. While the treatment methods used are the same as for any patient with OA, the often younger age of the patient with postinjury OA provides an important confounding factor in the decision. As mentioned, these patients often have expectations of a continued high level of physical activity and usually have a longer life expectancy than the average patient with OA. Joint replacement in these young patients is associated with a much higher risk of implant wear, loosening and revision than the average OA patient around the age of 70 74-76 . The risk for loosening and revision of a knee implant is more than three times higher in the patient operated on while younger than 65, than if older than 75 at surgery 74 . For this reason, surgical interventions other than joint replacement should be considered first if at all possible.

Medical Overview and Epidemiology

Although SCD continues to be associated with a reduced life expectancy (Charache 1994 O.S. Platt et al. 1994), treatment for the disease has improved significantly (Cohen 1998 Ris and Grueneich 2000). Treatment advances reflect findings from clinical, molecular, and genetic studies (Hagar and Vinchinsky 2000) and the use of new tools, including transcranial Doppler ultrasonography, to evaluate patients for stroke risk (Abboud et al. 2004 Adams 2000).

Overall effect of testosterone

Testosterone has many biological functions and, as demonstrated in this chapter, testosterone is a safe medication. There are only very few reasons why testosterone should be withheld from a hypogonadal patient (see 13.6). Nevertheless, to date many hypogonadal men do still not receive the benefit of testosterone therapy because they are not properly diagnosed and the therapeutic consequences are not drawn (e.g. Bojesen et al. 2003). Some physicians even believe that the shorter life expectancy of men compared to women could be attributed to effects

Geographical contrasts and demographic variation

The comprehensive evidence of the English parish studies discussed in Chapter 5. 4 above confirms the evidence derived from scattered local studies in Italy, such as the comparison between Grosseto and Treppio first mentioned in Chapter 1 above. Malaria, even the relatively mild P. vivax, enormously increased mortality levels, sharply reduced life expectancy at all ages, and significantly altered the age-structures of human populations in Europe in the past, wherever it became endemic. However, occurrences of malaria tended to be highly localized because of the very complicated ecological requirements of the disease, as, for example, at Old Salpi, where just by moving a few kilometres away the environment became much healthier. Consequently malaria generated enormous regional variations in demographic patterns in early modern Europe. In view of the compelling evidence from ancient sources for the endemicity in large areas of central and southern Italy of all three species of human...

Impact Of Trials On Dental Practice

A key focus of research has been the performance of direct posterior restorations (fillings), the longevity and reasons for failure of direct resin-based composite (RBC), amalgam and glass ionomer cement (GIC) restorations in stress-bearing posterior cavities. Predominantly studies have been either of the longitudinal or retrospective cross-sectional type, with few controlled clinical studies. GIC perform significantly worse compared with amalgam and RBC.82 However, reasons for placement and replacement of direct restorations in dental practice relates to many factors, and aesthetic and safety concerns have resulted in an increased use of RBC or GIC restorations in posterior teeth.83 The handling and fluoride leaching properties of GIC have made them popular in general practice.84 partial edentulism.85 A key concern has been the longevity of RBBs, however studies suggest that with appropriate case selection, preparation design and cementation they are a viable treatment option...

Etiology of Achilles Tendinopathy

The aging process results in a decline in the physiologic proportion of type I collagen as it is gradually replaced by a relatively higher concentration of type III collagen. Type I collagen provides mechanical strength to tension, whereas type III collagen is associated with decreased elasticity and increased weakness to tensile loads. This natural change with age results in histologic tendinopathy predisposing patients to partial tears and subsequent pain.

Discrepancies in Genetic Models of Adrenergic Receptor Function

It is possible technically to make an a1-AR KO that is both inducible in time and tissue specific to avoid developmental and systemic effects (58), but the time and effort required would be enormous, and incomplete KO would almost certainly be a factor. Thus, it is useful to note a key advantage of typical germline mouse KOs They are predictive of drug effects in humans (66,67). It is also pertinent that drug effects take time, particularly in heart disease. For example, the fraction of life with a1-antagonist exposure in ALLHAT was about 5 (4 yr of an average 75-yr life expectancy) (25). The fraction of life over which pathology developed in the AB KO was similar, about 8 (8 wk of 104-wk life expectancy). In conclusion, it seems reasonable to expect that the KOs will guide development of new drugs to target a1-ARs.

Intraspinal Drug Therapy

The decision to start intraspinal drug therapy is based on pain location, pain mechanism, and life expectancy. In contrast to neurolysis, intraspinal drug therapy may be effective in controlling more generalized pain. This is because the drug diffuses throughout the intrathecal space to reach receptors located at multiple levels of the spinal cord. As discussed earlier, neurolysis is less effective for neuropathic pain. Therefore, intraspinal drug therapy may be more effective in these cases. The location of the pain influences the technique of delivery. Pain that is localized and unilateral is often better managed with the epidural delivery of opioid and local anesthetic combinations. However, if the life expectancy is longer than 3 months, epidural delivery may be more costly and less effective over time because of development of epidural fibrosis. Pain that is more diffuse is better managed with intrathecal drug delivery. Because neuropathic pain is often less responsive to the...

Etiology and Epidemiology

Although A. duodenale can be ingested in contaminated food, water, or possibly breast milk, the more common route of infection, and the only one for N. americanus, is through penetration of the skin. Larvae in the soil typically enter through the skin of the feet, frequently causing dermatitis, once called ground itch or dew poison in the southern United States, and water itch or coolie itch in India. Then the parasites travel through the bloodstream to the alveoli of the lungs, climb the respiratory tree, and make their way into the esophagus. During their migration through the airways into the esophagus, the host sometimes develops a cough, wheeziness, or temporary hoarseness. The hookworms are then swallowed and pass into the gut, where some will successfully attach themselves to the small intestinal mucosa and begin nourishing themselves on their host's blood. In the small intestine, hookworms will grow to a length of about 1 centimeter and mature in 6 to 8 weeks after initial...

Group Artistic Creativity and Lifespan Productivity

An additional aspect of Kurosawa's career that bears special mention is his lifespan production and creativity. Lifespan creativity in terms of critical praise for film directors generally follows an inverted U, where success increases after their first film, followed by a decline in ratings in later films. Yet Kurosawa's career followed a multiple wave pattern, with international success in the 1950s - generally considered Japan's golden age of film - followed by disappointing results until the mid-1970s, and a surge of creative accomplishment in the 1980s, followed by smaller, less praised productions toward the end of his life. It is noteworthy that throughout his life, Kurosawa's films were realized with relatively modest budgets by Hollywood standards. This lends weight to the observation that creativity, critical and commercial, and success are not directly correlated with large budgets. Creativity in popular film is especially problematic, since it is a creative field that is...

Carotid Bifurcation Intervention

Compared with medical therapy, CEA has also been demonstrated to significantly reduce the incidence of stroke or operative death at 5-year follow-up in asymptomatic patients with carotid stenosis of 60 or more as assessed by carotid ultrasound (11.8 vs. 6.4 ARR 5.4 95 CI 3 to 7.8).6 It is important to emphasize that, in this asymptomatic population, the early hazard associated with revascularization persists up to 2 years from the time of CEA. If the life expectancy of a patient is less than 5 years, then significant benefit should not be anticipated. In addition, participation in these asymptomatic carotid trials required documentation of a perioperative stroke and death rate of less than 3 at the investigation site, and generalization of these findings is predicated on reproducing similar procedural outcomes.

What is cervical myelopathy and how does it develop

Cervical myelopathy is the most common cause of spinal cord dysfunction in patients older than age 55. Spinal cord dysfunction arises secondary to spinal cord compression, a diminished vascular supply, or both. In some patients, spinal cord compression occurs due to a congenitally narrowed spinal canal. In the majority of patients, spinal cord dysfunction occurs secondary to compression by degenerative changes associated with the normal aging process. Progressive cervical spondylosis may lead to spinal cord compression, which may be exacerbated by spinal instability (e.g. spondylolisthesis), especially at C3-C4 or C4-C5, kyphotic deformity, ossification of the posterior longitudinal ligament (OPLL), and large central disc herniations. Rheumatoid arthritis with associated instability involving the craniocervical, atlantoaxial, or subaxial spinal regions is an additional cause of cervical myelopathy.

Spinocerebellar Ataxia Type

Management, Prognosis, and Future Perspectives. At present, there is no specific treatment for patients with SCA5. Symptomatic and palliative therapy is similar to that described for SCA1. Although SCA5 is disabling, the disease progresses slowly, and life expectancy is not shortened. Quantitative data about the rate of progression in SCA5 are not available. At present, the chromosomal localization of the SCA5 gene is known. To further understand the pathogenesis of SCA5 and to develop diagnostic tests, the SCA5 gene must be cloned and the mutation identified.

The Permanent Maxillary Incisors

Root length may vary considerably, but deflections of the root are relatively rare. When the root is exceptionally short, in conjunction with an abnormal contour of the crown, this anomalous condition is referred to as dwarfed root, and the lack of root support may endanger the tooth's longevity in the mouth.

Polybraided Rope and Tape

Polybraided wire fence is more visible than wire strand and can be electrified. Braided fence material may look like 3 s-inch diameter rope or a flat ribbon fabric V2 to 2 inches in width (Fig. 15.16). The fence material is braided polyester, polyethylene, or similar flexible fabric-like material with metal (copper, stainless steel, etc.) strands incorporated into the weave. This allows electrification, while preventing crimping and breakage of the wires. The braided material is forgiving to a horse that runs into it and will not break. The flexible fabric material creates a slippery surface that will allow a hoof or head, which may have gotten through the fence, to be removed easily without cutting the skin. Select UV-resistant materials. Currently, the polybraided fence materials have a 10- to 15-year life expectancy, with some companies offering a 25-year warranty. Manufacturers offer detailed information about installation of these types of fences.

Third Theory Of Life Organicism

This view is usually supported by holders of the or-ganismic conception who want to suggest a third way between the Scylla of vitalism (which is against any scientific inquiry of life which is per se resistent to science) and the Cariddis of mechanism (which has a unique and too narrow view of science, assuming that physics is the model of scientific thinking). According to organicism we must abandom the analytical and sum-mative conception typical of physics, according to which any phenomenon can be explained by splitting it into its elementary units and then recombining these units into the original unit. This method cannot work in biology because organisms are whole in themselves and cannot be split into parts (because they die). As Bertalanffy says, Having stressed the relevance of organization for life, the organicismic view changes quite significantly our common sense concept of life itself because we now have to realize that ''life'' is a general term indicating a great variety...

Basic Theoretical Properties Of Life

While both mechanism and vitalism are monochromatic, or ''flat,'' in the sense that both see life as a single phenomenon with only one dimension, even if in opposite directions (respectively reduced to matter and to spirit), organicism is polychromatic and more varied, allowing a more subtle analysis of concepts of life. Particularly interesting for our purposes is the doctrine of various levels of life, comprising three basic levels (1) the level of the cell, which is the simple system capable

Children and Adolescents

Additional burdens may include restrictions on diet and multiple medications. For transplant patients, this can mean the need to take large quantities of medications, often as many as 20 or more pills per day, which may have unpleasant side effects. Patients may experience significant emotional stress related to acceptance of their illness, the need for multiple inpatient admissions, and or life-threatening medical events (Reynolds et al. 1986). Adolescents with ESRD, who are often acutely aware of their life challenges, can express disabling concerns about their long-term health and life expectancy, as well as their future prospects for a career, spouse, and family.

Practical Implications

Others strongly criticize the distinction between biological and biographical life, holding that human life must be always protected in itself, because it is always a great gift. However, this view either introduces a version of vitalism, by saying that ''human life'' has a special value only because of its intrinsic constitution (independent of its actual organization), or such a view uses the expression ''human life'' in a wider sense which includes in its meaning also the transmission of life. These two different aspects are of course strongly connected, since if human life had an intrinsic value, then it is plausible to think that also its transmission should deserve a very special care. Since for centuries reproduction and sexuality were considered a sort of sacred field, this distinction did not emerge but after the ''sexual revolution'' of the 1960s, diffusion of contraception, and a sort of ''secularization'' of sexuality (seen as a normal function of the person), no special...

The Meaning Of Medical Futility

If we ask if something is futile, we need to inquire, ''Futile for what '' Things can be useful or futile as means to different ends. To be in one's home during the last days of life may be futile from the perspective of prolonging life, yet useful for giving comfort. Thus, depending upon one's goal, something's utility or futility may change. Medicine has various important goals, such as preserving life and relieving suffering. Our disputes may arise from how we rank these values when they conflict. Some hold that prolonging biological life, even permanently unconscious life, is intrinsically valuable and always the most important goal in medicine. Most physicians disagree, maintaining that this stance tends to give too little attention to people's autonomy, suffering, or quality of a life (K. Payne et al., 1996. Ann. Internal Med. 125,104-110 L. M. Kopelman, A. Kopel-man, and T. Irons, 1992. In Compelled Compassion (A. L. Caplan, R. H. Blank, and J. C. Merrick, Eds.), pp. 237-266....

Grounded in Medical Science

The first feature these and other contested cases have in common is that they are grounded in medical science. These court cases about medically futile treatments arise in the context of standard medical care, so stable scientific information must justify claims about patients' diagnoses, treatments, or prognoses. Reliable information, for example, must support assertions that procedures will fulfill established medical goals such as prolonging life, restoring sentience, or relieving pain. Research and evidence helps distinguish which treatments are useful and which are futile in treating certain conditions. Clinicians should use the best available information to determine when treatments are ideal, standard, innovative, experimental, unverified, or utterly futile. As more information becomes available, our views sometimes change. Earlier disputes about the use of frontal lobotomies to treat severe psychiatric disorders, for example, were resolved with greater information that this...

Laboratory Evaluation

A further correction of the reticulocyte count is necessary if there is evidence from the peripheral blood smear that reticulocytes are being released prematurely from the bone marrow (shift cells or shift reticulocytes). Under these circumstances, reticulocytes live longer than the usual 24 hours in circulation, and thus the uncorrected reticulocyte count will overestimate the rate of new cell production. The second correction is shown by the equation for determining the marrow production index MPI RI 2. The normal MPI value is 1.0. The RI is divided by a factor of 2 to account for the prolonged reticulocyte life span in the circulation.

Donald L Price1234 Tong Li14 Huaibin Cai5 and Philip C Wong134

Alzheimer's Disease (AD)' the most common disease manifesting as memory loss and dementia in the elderly' affects more than 4 million elderly individuals in the United States (Brookmeyer et alv 1998 MayeuX' 2003 Cummings' 2004). Due to increased life expectancy and the baby boom' the elderly are the most rapidly growing segment of our society. Thus' over the next several decades' the number of persons with AD in the United States will triple. Because of its prevalence' costs' lack of mechanism-based treatments' and impact on individuals and caregivers' AD is one of the most challenging diseases in medicine (Price et alv 1998 Wong et alv 2002 Citron' 2004 Walsh and Selkoe' 2004). The development of effective new therapies will have a significant impact on the health and care of the elderly. This review focuses on important research relevant to AD' including the diagnosis of clinical syndrome value of laboratory studies' particularly new imaging efforts advances in genetics and...

Challenges in Understanding the Meaning and Impact of Programs and Courses

A second challenge in identifying creativity programs or courses lies in the difficulty in establishing longevity and in embedding them in the context of either teaching or training. This is necessary so that they can survive on their own merits. Otherwise, they may just have a champion who may sponsor them initially. Then this champion may lose interest or not be able to sustain the onslaught of possible criticism in order to gain acceptance for something new. By the time research is completed and an article written and published, the data are out of date, both in the creation of new programs and courses, and in the demise of them. The shelf life of a creativity course or program is short in comparison to more traditional content. English 101, Introduction to English, or Basics of English are going to be around, recognized, and accepted in programs of study in many colleges and universities consistently over time. No one will ask What is this Creativity 101, however, will get no such...

Palliative care programs

Hospice and palliative care programs are conceptually similar, yet different in the consideration of the life expectancy for the patient and the possible services needed for care and support. Hospice criteria require that patients and those close to them acknowledge that they have six months or less to live. Palliative care

Underlying Moral Debates About Peoples Quality Of Life Suffering And The Bestinterests Standard

Typically, competent adults can decide what treatments are in their best interest, and what quality of life they wish to support. This is called the self-determination standard. When people are faced with a choice between prolonging life and preventing great suffering, they sometimes believe there are worse things than dying. Most of us would not want to endure a mindless existence of intense and chronic pain with no prospect of improvement. Some people leave advance directives about their desires in such circumstances or designate surrogates to make decisions for them if they become incompetent. Friends and family can help inform these decisions even when no advance directive has been left and no surrogate appointed. They can have a role in determining what they believe the person would have wanted given his or her values, thereby using the substituted judgment standard.

Prosthetic Technologies and Techniques Beyond the Mere Fixture

The increasing predictability and longevity of porcelain laminate veneers offer a beneficial asset to the esthetic modification of implant-adjacent teeth (Garber and Adar 1997, Fradeani et al. 2005). They allow for alteration of shade and tooth shape and convey the illusion of changes in tooth position. Smile design, restoration durability, and color conformity of natural and replaced teeth are prerequisites for a highly esthetic