Simple Steps to Increase Life Expectancy

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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...

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...

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 ,

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

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

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 .

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...

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.

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

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 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.

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...

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...

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...

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.

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.

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).

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...

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.

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...

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

Sensitivity analysis or fertilizing and grafting decision trees

Pauker and Kassirer 51 give an example of a young man for whom coronary arteriography might be considered given the patient's ventricular ectopic beats and an abnormal stress test. Figure 13.5 (redrawn from their paper) shows how the decision would change if the utility of coronary arteriography were to improve life expectancy after this invasive diagnostic method and subsequent surgery for left main coronary artery disease, compared to the expected 'baseline' utility, i.e. life expectancy without coronary angiogram. Available software for personal computers makes sensitivity analysis, based on numerous recalculations of decision analysis, fast and affordable in practice for an experienced decision analyst 51 , 62 . Based on sensitivity analysis represented in this figure, comparisons can be made between option A (perform the angiogram and surgery if necessary) and B (do not perform it). If life expectancy were less than 15 years after surgery, expected utilities for not performing...

Ceramic Inlay and Onlay Restorations

Kelly and Smales (2004) have shown that the traditional cast gold onlay is one of the least cost-effective, indirect posterior restorative options, and indirect porcelain onlays are likely to prove to be no more cost-effective. When dentists are undergoing treatment themselves, most still prefer traditional gold and amalgam restorations rather than the esthetic alternatives (Rosenstiel et al. 2004). In trying to assess the longevity of ceramic restorations, most studies have been short term and performed in a university setting where time pressures on the operator are less. Some concern has been expressed about the progressive wear of the composite luting agent giving rise to marginal discoloration and secondary caries. A highly filled, viscous luting cement is recommended because it is associated with lower polymerization stress and microleakage (Hahn et al. 2001). Bulk fracture of some of the ceramic materials due to the inherent brittleness of the material has also been observed,...

Relating the physical and chemical characteristics of nanomaterials to their toxicity

Nanomaterial shape has already been mentioned briefly, with nanomaterials found to have many different morphologies. Fibre shape, also known as high aspect ratio, appears to play an important role in determining the toxic potential of respirable particles. Asbestos fibres (which are not nanomaterials) are related to lung fibrosis (scar tissue formation) and cancer, in particular a rather aggressive form of cancer known as mesothelioma. Mesothelioma occurs in the pleural space between the outer lung surface and the inner wall of the rib cage. The tumour is slow growing, sometimes taking 40 years to generate discernable symptoms, by which time it is so far progressed that treatment is not possible and life expectancy is often under one year. Asbestos-related diseases currently kill more than 2000 people per year due to the widespread historical use of this material. The death rate is anticipated to increase further over the next decade, and there is currently no known cure for such...

Epilepsy and the Elderly

It is a truism of modern American medicine that care of the elderly will demand an increasing share of resources as our population ages. Largely because of advances in the prevention and treatment of vascular disease, the longevity of both men and women continues to increase, putting them at risk for a variety of diseases and disorders, especially typically nonfatal ones, such as seizure disorders. The number of elderly persons continues to grow at a much faster rate than the general population the number of people in the United States aged 75 and older, for example, comprised only 900,000 in 1900, reached 10 million by 1990, and is projected to exceed 13 million by 2000.' This demographic trend is magnified by the fact that the incidence of seizures and epilepsy increases above age 50. Furthermore, optimal care of older persons with epilepsy requires modifications in diagnostic, therapeutic, and psychosocial approaches.

Nonpharmacologic Therapy

This year, roughly 1.6 million people will be diagnosed with cancer in the United States and Canada. With improvements in detection and treatment, approximately two-thirds of those diagnosed with the disease can expect to be alive in 5 years. With improving longevity, the cumulative adverse effects of both the disease and treatment are becoming an increasingly important issue. Late-effects data show that both adult and pediatric cancer survivors are at greater risk for developing second malignancies, cardiovascular disease, diabetes, and osteoporosis than those in the general population. With respect to the growing population of pediatric cancer survivors, data confirm that they are eight times more likely than their siblings to have a severe or life-threatening chronic health condition. For example, the survivors of pediatric ALL have an increased onset of obesity, osteopenia, and associated comorbidities. Thus, it is important to provide supportive care and intervention and...

Ethical Assumptions of the PP

We may ask about what environmental science is adding to these general ethical principles. I would say that environmental science has produced knowledge which is helping us to understand some of the ways in which the functioning biosphere is valuable as well as fostering an increased degree of respect for the complexity, longevity, and integrity of the biosphere. I do hold that coming to care for something or someone does involve taking the time to appreciate the relevant qualities. This is not to say that the arts do not also alert us to environmental qualities.

What do you do now

Brain parenchymatous hemorrhage is the most feared complication of cerebral CM. The reported incidence of hemorrhage varies from 8 to 37 in adults in different series. However, the risk of hemorrhage overall is believed to be relatively small, varying from 0.4 to 0.6 per year and is higher in patients that have previously bled. The risk of hemorrhage is cumulative over the life expectancy of the patient, and is therefore of more concern in younger patients. Despite the significant deficits that can develop after hemorrhage from a CM, patients often improve dramatically over time. Hemorrhages are most often contained within the capsule of the CM and rarely drain into surrounding brain parenchyma, or the ventricles or subarachnoid space. Repeated hemorrhages, however, can cause enlargement of a CM and a stepwise neurological deterioration.

Economics of Spine Care

At that time, it is estimated that health care spending will represent 19.5 of the gross domestic product. The paradox lies in what Americans are getting for their health care dollars. While the United States spends more on health care than any other country, in 2004, it ranked twenty-third in life expectancy for men and twenty-fifth for women.2 Approximately 20 of Americans between the ages of 18 and 64 years do not have health insurance.3 Among the working population in this age group, the average premium for workplace-based health insurance rose more than 115 from 1999 to 2008, burdening both employees and employers.4 One of the problems for this group is insurance being linked to employment. If someone loses his or her job, he also loses his access to affordable insurance coverage. Many in this group also feel that even if they have insurance, once a health problem arises, they are often denied coverage for treatment.

The Epidemiological Transition

One area of common interest to both demographers and epidemiologists is to describe and forecast global patterns of health. Originally, demographers found it useful to describe stages in the demographic transition'' to refer to the change from high fertility and high mortality rates in ''traditional'' societies to a pattern of low fertility and low mortality rates in ''modern'' societies (Thompson 1929 Notestein 1945). Subsequently, Omran (1971) extended this framework to describe three stages in the ''mortality transition'' consisting of (1) the age of pestilence and famine, associated with the predominance of mortality from epidemic infectious diseases, malnutrition, and complications of pregnancy and childbirth (2) the age of receding pandemics, during which mortality fell and life expectancy increased5 and (3) the age of noncommunicable diseases, during which mortality came to be dominated by chronic degenerative diseases such as heart disease, stroke, and cancer. A fourth stage...

Measurement of Mortality and Morbidity

Finally, the World Health Organization has taken the lead in refining summary measures of population health status that combine measures of survival and morbidity into a single metric (Murray et al. 2002a). Two classes of measures have received particular attention the disability-adjusted life-year (DALY), which is a ''health gap'' measure that combines time lost due to premature mortality with time lived with disability and healthy life expectancies (HALE), which measures the equivalent number of years of life lived in full health extrapolated from comparable cross-national data (World Health Organization 2000). Both sets of measures have been widely debated. In particular, critics have pointed out the data demands and complexity of making the calculations that involve numerous assumptions (Almeida et al. 2001). The weighting of disability states as well as the social values implicit in the weighting of life years at different ages has been similarly contested. Such debates...

Global Trends and Differentials in Mortality and Morbidity

Improvements in global health status, as measured by gains in life expectancy, have been accompanied by widening differentials both between and within countries. Life expectancy at birth currently ranges from 81.4 years for women in the established market economies of Western Europe, North America, Japan, Australia, and New Zealand, down to 48.1 years for men in sub-Saharan Africa (Bonita and Mathers 2003). While mortality rates have declined markedly for specific causes of death (such as coronary heart disease) in wealthy countries, other regions of the world have witnessed equally spectacular reversals in life expectancy. For example, between 1991 and 1994, life expectancy at birth in the former Soviet republics fell by 4 years for males and by 2.3 years for females (McKee 2001). Between 1994 and 1998, life expectancy for Russian men improved, but declined significantly again over the next three years (Bonita and Mathers 2003). Worldwide, about 37 million people are currently living...

Micro and Nanotechnology and the Aging Spine

The aging process presents a cascade of events that affect the health of the musculoskeletal system, in particular, the human spine. The maximum bone mineral density of an individual is reached between the ages of 18 to 20 years of age. As aging progresses, muscle size and strength begin to decrease, by as early as age 25. Accompanying these changes are reductions in hormone levels for both men and women, contributing to a decline in bone density and muscular strength. As we age, the musculoskeletal system experiences degenerative changes resulting in fibrosis, stiffening, and shrinkage of the soft tissue bone loss joint changes and tissue desiccation due to a reduction in proteoglycans and a change in collagen type (i.e., intervertebral disc).10 With respect to the aging spine, this fibrosis and stiffening reduces the osmotic properties of the disc and the ability of the disc to obtain and or maintain vital nutrients while eliminating noxious wastes. Disc desiccation initiates a...

Implications Of Mortality Declines For Population Health

Between 1950 and 1955 and 1990 to 1995, the world experienced dramatic improvements in mortality rates (Hayward and Zhang 2001). The infant mortality rate fell from 156.0 to 62.0. Life expectancy improved from 45.1 to 62.2 years for males and 47.8 to 66.5 years for females. Mortality declines were most dramatic in less developed regions of the world due to the high levels of mortality observed from 1950 to 1955. While methodological challenges make it difficult to ascertain trends in population health, this is only one source of confusion. Conceptually, the association between mortality changes and health changes in the surviving population is not as straightforward as one might think (Crimmins 1996 Crimmins, Hayward, and Saito 1994), and this partially accounts for the lack of clarity in the research literature. If mortality improvements occur primarily among persons already beset by health problems, a greater number of people will survive in poor health. This will lead to higher...

Locoregional Recurrence After Primary Radiation Therapy

Additional radiation therapy can sometimes be considered for this group of patients who are not surgical candidates. However, it is important that any potential patient be chosen carefully and judiciously. Carte blanche use of re-irradiation is associated with a high major complication risk (eg, necrosis) and poor therapeutic results. The recurrent malignant cells very likely would be in a rather hypoxic environment due to the effects of the initial radiation therapy (such as scarring) and this could decrease the efficacy of treatment. These patients would need to be evaluated with respect to the following criteria (1) general condition of the patient, (2) time interval since completion of initial radiation therapy, (3) radiation dosage initially administered to the tumor and adjacent vital organs, (4) tolerance of radiation therapy and development of any complications, (5) anatomic location, extent of recurrence and adjacent vital organs, (6) condition of previously irradiated...

Nanomedicine And The Aging Spine

Bionanotechnology is the merging of biology with nanotechnology (performs at the molecular level) by incorporating fabricated nanostructured materials and electronics into a living biological environment with functions that will diagnose and respond therapeutically. This term also applies to biomicrotechnology, which incorporates microstructured materials (performs at the cellular level) and electronics into a living environment. The application of these technologies in a clinical environment has been termed nanomedicine. Microelectromechanical systems (MEMS) and nanoelectro-mechanical systems (NEMS) are microsized systems capable of performing biological tasks at the cellular or molecular level and are deemed smart technologies. The specific application of micro or nanobiotechnology to develop micro nanosized medical devices will revolutionize medicine with the potential to regenerate tissue, restore mobility, and increase the longevity of spinal implantation, as well as improve the...

Implementation Results

Efforts to reduce mortality in the second half of the 20th century have brought about significant improvements in life expectancy at birth. In the developing countries in particular, this indicator has progressed considerably it was between 35 and 45 years in 1950 to 1955 (far behind industrialized countries), but reached the 60 to 70 years bracket in 1990 to 1995 (reducing the gap with more advanced countries) (Mesle and Vallin 2002). However, the progression of the HIV AIDS pandemic and the resurgence of old killers like tuberculosis (linked to HIV AIDS) and malaria appear to be reversing the gains achieved in mortality reduction, especially in sub-Saharan Africa. In many cases (e.g., in Southern Africa), the HIV AIDS epidemic will deplete the numbers of productive workers, create large numbers of widows and orphans, weaken the economies, and possibly cause HIV AIDS-related famines. In the most affected countries, the HIV AIDS crisis has shortened the life span and will modify...

Padding applications onto fabric surfaces finishing

The antimicrobial agent can be applied to the textile substrate by padding dry-cure, coating, spray and foam techniques, and also by exhuast application via a dyebath. The method usually applied on most textile substrates (but especially on woven and knitted systems) is where a solution containing the active agent is padded onto the surface of the fabric structure and then baked or cured onto the surface. This is generally the least expensive way of application (and some would dispute the longevity of efficacy or performance after laundering). Usually silver solutions, as well as chemically active agents such as triclosan, are applied in this manner. These surface treatments of textile fibres and fabrics significantly increase their performances for specific biomedical applications. Nowadays, silver is the most used antibacterial agent, with a number of advantages. Among them is a high degree of biocompatibility, an excellent resistance to sterilisation conditions (usually...

Research Priorities Of The Handbook Of Population

Drawing on a study conducted by the National Research Council (2001), Uhlenberg notes in his chapter that there are five primary areas in which future research on aging is likely to develop. First, Uhlenberg encourages multidisciplinary research on aging that explores connections among the social sciences in this manner, policy recommendations would incorporate a more complete picture of the aging process. Second, he emphasizes the importance of collecting longitudinal data. Only longitudinal data are adequate for drawing causal conclusions about aging. Uhlenberg's third proposed area of research involves conducting comparative analyses of aging across countries in order to expand the knowledge base about cross-country similarities and variance in the aging process. Just as in the area of infant mortality, research on adult mortality will benefit from multidisciplinary work that incorporates information from epidemiology, medicine, and biology, as well as from sociology, demography,...

Early Invasive Versus Early Conservative Strategies

Kuntz and colleagues used a decision model to compare routine coronary angiography in the convalescent phase of acute MI hospitalization with medical therapy and exercise testing.73 Because of the lack of clinical trial data in acute coronary disease, the estimates needed for this analysis were collected from trials in chronic coronary disease and from a variety of literature and expert opinion sources. Long-term survival was projected using the Coronary Heart Disease Policy Model of Weinstein and colleagues. Cost data (given in 1994 U.S. dollars) were obtained from Medicare data. In this model-based analysis, routine coronary angiography increased quality-adjusted life expectancy (through its effect on subsequent revascularization) in almost all MI subgroups examined. Only women aged 35 to 44 years with normal ejection fractions, no post-MI angina, and a negative treadmill test appeared not to benefit. When costs were factored into the model, however, the cost to produce an extra...

Antiplatelet Therapy

Analysis.80 In the 3522 U.S. patients enrolled in the trial there was no evidence that eptifibatide use altered resource use or costs through either a positive or a negative effect on clinical course. The absence of an effect on resource use despite reduced ischemic complications may be related to the very high (85 ) rate of routine diagnostic catheterization in the U.S. cohort. The cost of the eptifibatide regimen was 1014, and the 3.5 absolute reduction in death or MI at 30 days in the U.S. cohort translated into an incremental life expectancy of 0.11 life years per patient added by eptifibatide. The resulting cost-effectiveness ratio was 13,700 per added life year. In follow-up, the two stent groups had similar costs, whereas the balloon plus abciximab group exceeded these groups by more than 900. Therefore, at 1 year, the stent plus abciximab arm was 930 more expensive than balloon plus abciximab. At 1 year, 1.0 of the stent plus abciximab group had died, compared with 2.4 of the...

Cost Effectiveness And Health Policy

More serious challenges to the use of cost-effectiveness analysis as the primary tool for health care spending decisions come from methodologic considerations. Principal among these is the absence of any uniform method for measuring either health care benefits or costs for use in cost-effectiveness analysis. On the effectiveness side, several major problems face the analyst. Chief among these is the difficulty in accurately estimating the change in life expectancy attributable to a new therapeutic strategy. Unless the disease process under study is rapidly fatal, it is virtually impossible to obtain timely empirical life-expectancy data for use in cost-effectiveness calculations. Most commonly, analysts use survival or mortality rate measures at selected times, such as 30 days, 1 year, or 5 years, and attempt to project life expectancy from these figures with the aid of simple parametric survival modes. Examples include the Markov model and the declining exponential approximation of...

The Clinical Challenges

The socioeconomic and human burden of cardiovascular disease is staggering. One in 5 Americans, or 61,800,000 individuals, live with high blood pressure, coronary heart disease, stroke, congenital cardiovascular disease, or congestive heart failure. Cardiovascular disease is the leading cause of death in the U.S., accounting for 1 of every 2.5 deaths, and is the primary or contributing cause in 65 of all deaths. Each day 2,600 Americans die of cardiovascular disease, and in a third of these, death is premature, occurring below the current average U.S. life expectancy of 75 years.

Option of irradiation

- Mild compression of neurostructures without relevant clinical neurological signs where it can be anticipated that the irradiation will stop the further progression of the tumor, or the patient's life expectancy is less than 3-6 months. - Disseminated disease with life expectancy less than 3-6 months.

From the Sushruta Samhita ca 3000 bce

Penis Sup Dorsal Vein Cut Problems

The highest incidence rate for prostate cancer is in African Americans (54.8 per 100,000) for white persons, it is 23.7 per 100,000. The lowest incidence rate is in Asians and Pacific Islanders (10.7 per 100,000). The lifetime probability for development of prostate cancer is 16.7 (one per six). For a 50-year-old man with a 75-year life expectancy, the lifetime risk for development of microscopic prostate cancer is 42 the risk for development of clinically evident prostate cancer is 10 and the risk for development of fatal prostate cancer is 3 . Approximately 95 of all prostate cancers arise from an area of the gland where it can be readily detected by rectal examination.

Biomedical Demography

The HRS, Manton has long directed the NLTCS, and Crimmins, Haywood, and Singer have worked with the MacArthur data. The very large Chinese Longitudinal Survey of Healthy Longevity was devised by Zeng and Vaupel. Vaupel (and colleagues) participated in the design, funding, and analysis of large longitudinal studies of aging among older Danish twins, very old Sardinians, and elderly Russians living in Moscow and St. Petersburg. Weinstein and Goldman are the leaders of the Taiwan Study of the Elderly (Weinstein and Willis 2000). In particular, there has been a rapid growth of interest in using genetic information in medical-demographic research (Ewbank 2000). Of particular interest is the information from DNA about specific genes, as in research by Ewbank (2001), and Yashin (Yashin et al. 2000). Information from DNA about genetic polymorphisms (i.e., mutations) can be used to determine the genetic structure of a population and to make inferences about the influence of migration and...

Effects of laundering on UV protection

The preceding discussion outlines the need for UV protective textiles and the complexities associated with making a textile impervious to ultraviolet radiation. What is not certain, however, is the magnitude of the market for UV textiles. According to most industry experts, people have been led to believe over many decades that sunscreen lotions are an equivalent alternative to covering up with clothing. Thus currently the market is limited to audiences that are very aware of the risks of skin cancer due to UV exposure. It is apparent that campaigns to increase public awareness of the harmful risks of UV exposure and education regarding the beneficial effects of UV textiles have to be mounted to develop the UV textiles market. Nevertheless, there is guarded optimism among manufacturers that the need for UV protective fabrics will grow as people live longer lives and are more active outdoors. However, in the immediate future the most promising market for UV protective textiles appears...

A working model of resistant ambivalence

The case of Roger illustrates both the information value of resistant ambivalence and the value of understanding it from the client's perspective. Roger, a 50-year-old married man with two children, was referred for therapy by his physician because he was not complying with the recommended dietary and life-style changes, nor was he taking the prescribed medication to control his life-threatening hypertension. Sessions with him were oriented toward understanding his perspective on why he was acting this way. He stated that My life is ok, my marriage is ok, my kids are ok, my job is ok but when I sit down to a plate of ribs, I'm in heaven The only passion he seemed to experience in life was when he was eating foods that he enjoyed, but which also contributed to his problems with hypertension. He also described how his parents lived. They were in their eighties and according to Roger, examined every morsel of food before eating it to determine whether it was healthy or not. Further, he...

Pharmacologic Therapy Chemotherapy

Preventing and managing chemotherapy toxicity are crucial to optimizing patient outcomes (e.g., curing, prolonging life, or palliating symptoms). The decision to start chemotherapy depends greatly on the overall patient picture, with emphasis on PS and comorbid conditions. Knowledge of the major adverse effects of individual regimens is important for anticipation and prophylaxis of such toxicities. Many regimens require appropriate premedication and hydration. Furthermore, decisions to start chemotherapy must include the full consent and understanding of risks by the patient. Counseling on the chemotherapy and risk of toxicity is imperative before dosing. Lung cancer regimens and their associated toxicities are shown in Table 90-4. (See Chap. 88 Cancer Chemotherapy and Treatment for dosing recommendations in renal and hepatic failure.)

Global burden of coronary heart disease

Coronary heart disease is decreasing in many developed countries, but is increasing in developing and transitional countries, partly as a result of increasing longevity, urbanization, and lifestyle changes. Civilization kills. Since 1990, more people have died from coronary heart disease than from any other cause. Unlike stroke, coronary heart disease is a comparative newcomer on the world stage. Variations in death rates are marked they are lower in populations with short life expectancy.

History of Public Health and Sanitation in the West before 1700

Cleansing agents for the skin, and oils, soaps, unguents, and other cosmetics used to maintain a good personal appearance and skin tone. Moreover, concern for personal hygiene went far beyond the realm of attracting sexual partners or performing religious cleansing rituals. Greeks and Romans worshiped health and consequently elevated in importance to their life-style the technical knowledge they believed would promote individual health and longevity.

Arkansas Cancer Research Center Neuro Oncology Program Strategy

Metastatic Brain Tumours

What follows is a description of our current treatment philosophy and priority ranking in the Neuro-Oncology Program at the Arkansas Cancer Research Center. A breakdown of our case distribution for each treatment modality over the past 3.5 years according to tumor number and the tumor location relative to eloquent brain is given in Figure 55-6. All patients with breast cancer and solid brain tumor metastases receive WBRT at our institution. A single brain metastasis as the only evidence of residual disease (isolated metastasis) is extremely rare with breast cancer, as compared with the situation with non-small cell lung cancer, melanoma, or renal cell carcinoma. We reserve additional measures to maximize local control, such as surgical resection or SRS, in an effort to increase life expectancy for patients with a KPS score of 70 or greater who have controlled or controllable disease (defined as a reasonable chance of at least a 6-month life expectancy if the CNS disease were not...

Appraising directness

Deaths in the setting of an acute MI (the clinical outcome)'4'. If we are to avoid harming patients the way this drug did, we must think twice before assuming that a surrogate outcome, such as reducing cardiac rhythm problems, provides a direct answer to a clinically important question, such as prolonging life.

The epidemiology of leg ulcers

Age of 40, ulcers are fairly equally distributed between the sexes. At the age range of 65-74 years, the female male ratio is 2.6 1. This increases to a ratio of 10.3 1 over the age of 85 (Dale & Gibson, 1986). This difference is probably, in part, because women live longer than men, but may also be because of the increased risk of deep vein thrombosis during pregnancy.

Biomarkers for Inflammation in BPH

Prostate has a fully active immunologic response and involves a broad spectrum of immune responses against foreign antigens. Moreover, prostate contains scattered stromal and intraepithelial endogenous inflammatory cells such as T and B lymphocytes, macrophages, and mast cells 104, 125 , T cells increase with age, which correlates with the incidence of prostate inflammation during the aging process 126 . T cells are known to release factors that stimulate matrix formation and secrete potent epithelial and stromal mitogens, which could promote prostate stromal and epithelial proliferation hyperplasia 127 ,

The PKB Signaling Pathway

Through direct phosphorylation and inactivation of components of the apoptotic machinery, including BAD and caspase-9. BAD, a member of the Bcl-2 family of regulators of apoptosis, promotes dimerization and activation of the initiator caspases (those that initiate the process of apoptosis). Caspases are proteases that contain a cysteine in their catalytic site and cleave protein at an asparate residue, hence their name (cysteine-asparate proteases). Caspase-9 is one such initiator caspase, and its role is to cleave and activate other so-called effector caspases, those that destroy vital components of the cell (inhibitors of DNA nucleases, DNA repair enzymes, and components of the cytoskeleton). PKB can also directly phosphorylate caspase-9, rendering the enzyme less sensitive to activation. The other type of protection is offered by phosphorylation of FKHR-L1, a transcription factor (member of the Drosophila forkhead winged-helix family AFX, FKHR, and FKHR-L1, which are orthologs of...