get creating people!

from tomorrow, and for 30 days. Sounds like a rather good idea, avoiding the creative procrastination process. however, i shall unfortunately have to excuse myself from the daily fun due to upcoming exams. ah well, another time for me perhaps...

you thought it was all over...

... when you swallowed that bubble gum. well, it can be seen on a CT scan, sitting there, in the stomach.

you've got to hand it to the volunteer who agreed to swallow bubble gum and get a CT to confirm what was found in the kids.

Pediatr Radiol. 1992;22(4):298-9.

Bubble gum simulating abdominal calcifications.

Geller E, Smergel EM.
Department of Radiology, St. Christopher's Hospital for Children, Philadelphia, PA.

CT examination of the abdomens of two children demonstrated sites of high attenuation in the stomach, which were revealed to be bubble gum. Investigation of the CT appearance of samples of chewing gum showed that it consistently has high attenuation (178-345 HU). The attenuation of gum base, which contains calcium carbonate, was 476 HU. In addition, examination of a volunteer who had swallowed bubble gum confirmed the CT appearance.

"I had a little bird, Its name was Enza. I opened the window and in-flu-enza."

memories of a pandemic
some history
wikipedia
the science bit
in New Zealand
picture of a ward
street sweeper wearing mask

the art of self-diagnosis

medical students have been doing it for years, often inaccurately, thus providing many an anecdote to giggle about.
however, with the increasing availability of information (which in some ways is a good thing), the general public have also gotten on the self-diagnosis bandwagon.
there are good sites, there are bad sites, and there are unbelievebly awful-evil-money-grabbing sites. it can sometimes be difficult for the untrained eye to tell them apart. plus, there is always that personal bias which comes attached to self-diagnosis : 'knowing my luck, its got to be the worst possible thing that could possibly happen. oh dear...'.
take everything with a tonne of salt, have a dialogue with your doctor, and use information responsibly.

everest..

worrying. when getting to the top takes such a high priority, that those who are in need of help don't even figure.

'be nice to nettles week' amongst other things

as exams and deadlines approach, things get more hectic, and posts may begin to reduce in frequency... but in the mean time, a round up of randomness:

long term effects of childhood deprivation- a sobering read.

why medical dramas are not so accurate

'be nice to nettles week'

honey in wound management

proper posture

'How to Conduct a Physical Exam on an Assaultive Patient'

Kiwi gets prosthetic leg

Tahi, the flightless Kiwi bird, loses leg in a trap. flightless, and now a leg down, mobility is proving to be a bit of issue. humans take pity, so get in touch with the local artificial limb board and a special effects company who usually sort out false noses for humans in films such as 'lord of the rings', to sort Tahi out a false leg. leg gets fitted and made, he then hobbles off into the sunset...
BBC

How far cooking has come...

Some wartime recipes - note the lack of meat in 'mock goose' and 'mock sausages'. Oh, and grilled pigeon!!!

an elephant in London

very random, kind of wish i checked it out.

Poem: If

If you can keep your head when all about you
Are losing theirs and blaming it on you;
If you can trust yourself when all men doubt you,
But make allowance for their doubting too;
If you can wait and not be tired by waiting,
Or, being lied about, don't deal in lies,
Or, being hated, don't give way to hating,
And yet don't look too good, nor talk too wise;

If you can dream - and not make dreams your master;
If you can think - and not make thoughts your aim;
If you can meet with triumph and disaster
And treat those two imposters just the same;
If you can bear to hear the truth you've spoken
Twisted by knaves to make a trap for fools,
Or watch the things you gave your life to broken,
And stoop and build 'em up with wornout tools;

If you can make one heap of all your winnings
And risk it on one turn of pitch-and-toss,
And lose, and start again at your beginnings
And never breath a word about your loss;
If you can force your heart and nerve and sinew
To serve your turn long after they are gone,
And so hold on when there is nothing in you
Except the Will which says to them: "Hold on";

If you can talk with crowds and keep your virtue,
Or walk with kings - nor lose the common touch;
If neither foes nor loving friends can hurt you;
If all men count with you, but none too much;
If you can fill the unforgiving minute
With sixty seconds' worth of distance run -
Yours is the Earth and everything that's in it,
And - which is more - you'll be a Man my son!

Rudyard Kipling

self harm

a perspective - article from the telegraph

that time of year again...

The times guide on how to deal with exams

tainted blood...

something everyone should know - article in the observer

Left to die: the hidden victims of an NHS blunder

Lorna Martin

Sun 16 Apr 2006 16.23 BSTFirst published on Sun 16 Apr 2006 16.23 BST

In 1991 The Observer revealed the scandal of patients infected by HIV as a result of the contamination of Health Service blood. Now, beset by illness and poverty, they are launching a final battle for justice. Lorna Martin reports

On a cold December morning in 1986, Gary Kelly woke with the worst hangover of his life. The previous afternoon he had practically skipped into Glasgow Royal Infirmary for a routine check-up, feeling healthier, more energetic and more indebted to the NHS than he could ever have imagined possible. He felt like the luckiest man in the world.

Back then the prognosis for people with leukaemia, which he had been diagnosed with the previous year, was not good. Bone marrow transplants were in their infancy. But chemotherapy and a transplant from his sister seemed to conquer this aggressive blood cancer.

'When I was told I had leukaemia I just assumed I was going to die,' he recalled. 'I knew of people who'd had it and they had all died. So when it looked as if the transplant had worked, I felt I'd been given a second chance. Because I'd come so close to death I realised how precious life is. I was cherishing every moment.'

Gary, then 23, had been cured of leukaemia against all the odds. But that December afternoon his consultant delivered devastating news. During his operation he had been given a contaminated blood transfusion. He had contracted HIV, a virus which destroys the body's immune system and for which there is no cure.

There was a long silence. 'If you want to cry, it's OK,' his father, sitting with him, said. Gary did, and so did his dad.

HIV and Aids were little understood in the mid-Eighties and they were surrounded by a huge stigma. Many people thought the viruses affected only gay men and drug addicts. Gary was neither.

'One minute I was feeling elated about being cured of leukaemia, thinking I had my whole life ahead of me again. The next I was told I was HIV-positive and my world came crashing down. I was too ashamed to tell anyone. I asked my dad, who'd come with me to the hospital, not to tell anyone and I went to the pub on my own and drank until I passed out,' he said.

Although he felt isolated that night, he soon discovered he was not the only victim of what has since been described as the worst treatment disaster in the history of the NHS. Thousands of people in the UK received blood contaminated with potentially deadly viruses during the late Seventies and Eighties. Much of it was imported from the United States.

Although doctors first became aware of a possible link between Aids and blood transfusions in December 1982, it took another four years before safer, heat-treated products reached Britain.

Most of those infected with HIV in that way in this country were men suffering from haemophilia, a genetically acquired disease in which the blood does not clot properly. To treat the condition they took products known as Factor VIII and Factor IX concentrates, which were made by distilling and concentrating the plasma of large groups of donors, sometimes as many as 25,000.

It was a cruel irony that for thousands of haemophiliacs across the world, the same 'miracle substance' they were being given to prolong their lives also handed them a sentence of prolonged illness and probable death. The vast majority have now succumbed to the disease.

Following a public outcry and on the recommendation of a High Court judge, the UK government announced plans in 1988 to compensate the 1,200 haemophiliacs who had been infected with the life-threatening viruses. It was a hollow victory and excluded people such as Gary.

He became one of the forgotten NHS Aids victims, one of an estimated 150 non-haemophiliacs in the UK who became HIV-positive as a result of receiving tainted blood but whom the Department of Health refused to help. Fifteen years ago The Observer launched a campaign to highlight their plight. Virginia Bottomley, then Health Secretary, initially rejected the demands for justice, despite protests from MPs of all parties.

There were 'special and tragic circumstances' surrounding the haemophiliacs' cases, she repeatedly stated, mentioning their 'double disadvantage' of hereditary illness and HIV. She said no comparison could be made between them and the scores of children, pregnant women, accident victims and cancer patients such as Gary who had been infected from blood transfusions during surgery.

'It was never explained to us why the hereditary nature of the illness made a difference,' Gary said. 'We all became HIV-positive or contracted Hepatitis C because we were given contaminated blood by the NHS. They spoke about it opening the floodgates. They hoped we would be silenced and go away. But the Observer campaign gathered so much momentum, public and political pressure intensified, and the government had to do something. The injustice was so glaring.'

As a result of the campaign, the government eventually relented and extended its compensation scheme. The Eileen Trust, which provided one-off payments, plus small monthly sums, was established in 1992. The creation of these trusts was a first for the NHS, the only time in its history that it made an exception to the principle that it does not pay compensation without legal liability first being proved.

The rationale for this exception was linked to a presumption at the time that HIV would inevitably and swiftly progress to death. In addition, while no one was prepared to accept responsibility, it was nevertheless becoming increasingly difficult for ministers not to concede that a horrendous mistake had been made. In government-speak, 'an unavoidable inadvertent systematic failure' had occurred.

Victims were subjected to significant social problems. Many were treated as lepers. They had their doors daubed with graffiti, they lost their jobs and their children were not allowed to mix with other pupils at school. They were denied the opportunity to have normal relationships. To compensate, they were awarded an average one-off payment of £45,000, plus a monthly allowance of about £300.

Faced with an impossible situation, the victims were urged, some say coerced, into accepting the money from the government. They were advised against continuing to fight through the courts, as this would have taken years. Time had become their most precious commodity, and one they were told they suddenly had very little of.

So in June 1992, six years after he received the contaminated blood, Gary accepted a cheque for £43,500. In return, all the victims signed to waive their right to pursue any future legal action against the government. At the time, people with HIV were expected to live between three and five years. Suing anyone or worrying about their future security were the last things on their minds.

Not surprisingly, Gary spent his small windfall somewhat recklessly, booking a three-week holiday in America, even though his HIV status was supposed to prevent him from entering the country, and repaying some debts. 'Like many others I decided to go out with a bang. We were told we didn't have long. I spent two weeks at a blues festival in Chicago, something I'd wanted to do all my life, and another week in New York. I tried not to get down because I thought each day might be my last. I wanted to enjoy what little time I had left.'

For successive governments, drugs companies, some doctors and the blood transfusion services, this story would ideally end here and be remembered as a tragic medical mistake in which no one acted wrongly in the light of the only facts then known. Yet for some victims the problems had only just begun.

For most of those infected with tainted blood, the predictions of an early death proved correct. Of about 1,200 haemophiliacs infected, more than 800 have now died from Aids or hepatitis-related illnesses. Around 380 are still alive, along with around 20 non-haemophiliacs. With their one-off payments long gone, their health deteriorating, crippling side-effects from the powerful drugs that keep the virus at bay and their opportunities to work virtually non-existent, many rely on state benefits and exist in acute poverty.

Gary is one of them. Twenty years on from his transplant and the transfusion that saved him from one life-threatening illness and infected him with another, he sits in his basic, one-bedroom flat in Glasgow, surrounded by his Bob Dylan albums, his guitar and mandolin.

'Living longer than we ever expected has been both a blessing and a curse,' he said. 'Initially, you try to get your head around the fact that you're going to die. Then it doesn't happen, but because you think every day might be your last it's difficult to plan any kind of future. I got very depressed, and I know many people who either killed themselves or drank themselves to death as their quality of life was poor. I have been unable to form a relationship and most of the survivors are in pretty dire financial straits.'

The virus has taken its toll. His once fit body is withering away. He has had numerous bouts of pneumonia, his pancreas was badly damaged by the drugs he was taking, and he has to wear a permanent cast on his foot to limit bone deterioration.

He hands me a recent newspaper cutting reporting the case of Alan Best, 64, from Birmingham, who contracted HIV from a contaminated transfusion during surgery for pancreatitis at the private Nuffield Hospital in his home city in February 1995. Last year, after a seven-year legal battle, he was awarded £750,000.

Gary said: 'We were persuaded to accept one-off payments ranging from £21,000 to £80,000, depending on whether we had dependants, because there was an assumption that we were facing imminent death.' Because all the victims signed the waiver preventing further legal action, they have very limited options for the future, apart from asking the government for more money.

At the end of last year a detailed case was presented to the Department of Health, requesting a rise in the annual support available to the remaining victims from £3m to £7m per year and another one-off payment. A spokeswoman said the application had been received and was being considered.

Most survivors are not overly optimistic. Haydn Lewis is one of them. As a teenager in Wales he refused to be constrained by his haemophilia. At 18, he married his childhood sweetheart, Gaynor. In 1979, at 22, he began using 'the miracle' Factor VIII concentrate, expecting it to make his disease more manageable. The blood was contaminated.

Six years later, with two young sons, he was diagnosed as HIV-positive. He discovered a short time later that his wife Gaynor had contracted HIV from him. He had also been infected with hepatitis C which, in many ways, has even more serious consequences.

About 5,000 haemophiliacs contracted the potentially fatal liver disease from contaminated blood, as did an estimated 20,000 non-haemophiliacs.

Haydn and Gaynor had to give up careers with substantial incomes to live on disability allowances. Haydn, now 49, is incensed at the government's repeated refusal to hold an independent inquiry into the affair.

'It is beyond belief that the deaths of over 1,000 members of the British public can pass with no explanation given by the public bodies responsible for their care,' he said. 'We need this not to embarrass or point the finger of blame, but simply to find out what happened and to make sure a tragedy of this scale will never be allowed to happen again.'

It was insulting to those infected to have 'to beg' for elementary justice, Haydn said. 'We are living under a death sentence for the mistake of having trusted in the cleanliness of NHS blood and blood products. We have suffered in the worst way possible, not only financially but by losing our livelihood and our ability to lead a meaningful life. We have all lost friends who did not survive this terrible medical and scientific blunder.'

In desperation, Haydn and Gaynor are among a number of UK survivors hoping to sue four major US companies in the American courts, alleging negligence and fraud over the making and distribution of blood products used by haemophiliacs. If the UK government insists it is not responsible, he said, then it should do the decent thing and take the blood companies to court on the victims' behalf.

The US lawsuit alleges that the four companies sold blood products contaminated with HIV and/or hepatitis C, resulting in the deaths of thousands of people with haemophilia worldwide.

The action claims three of the firms recruited and paid donors from high-risk groups, including prisoners, intravenous drug users and blood centres with mainly homosexual donors, to obtain plasma used in Factors VIII and IX. It alleges that between July 1982, when evidence surfaced that people with haemophilia had died from Aids, and 1985 the firms acted in concert to avoid recalling the products or warning of the risks. Haydn said the American battle was a last resort, as the UK remained the only country which had consistently refused to hold an inquiry into the affair.

In the past 17 years, he has attended more than 150 funerals for fellow haemophiliacs who received the tainted blood. His brother, a haemophiliac too, also suffers from HIV contracted through bad blood products. Worst of all is the fact that Gaynor has been infected.

'I want an explanation. I want to be able to tell my sons and my wife how this happened and why it happened and who was responsible.'

Yet in some ways Haydn and Gaynor are among the luckier ones, because they still have each other. Most haemophiliacs given tainted blood have died, leaving angry and penniless widows. And among those infected as children, most remain isolated and alone.

Andrew Evans, a fellow haemophiliac, was five when he was infected with HIV and hepatitis C. His parents told him what had happened when he was 13. At 16 he was diagnosed with Aids and spent the next four years in and out of hospital. At one point he was told he had two weeks to live.

However, new treatments became available and helped him on the road to a partial physical recovery. He is now 29 and living alone in supported accommodation in Moseley, Birmingham.

'Emotionally the toll the virus takes can be enormous,' he said. 'The social aspect starts even before the symptoms show - the relationship difficulties around how to tell people and how they react when you do, and the stigma. These are all very difficult to cope with. And when the symptoms begin to take your life apart, it is difficult to recover. There is a feeling of isolation. Many people become virtual recluses, including me.'

Andrew spends much of his time working with the Haemophilia Society and the Macfarlane Trust, and has been helping with the court case.

'We are victims of NHS errors and in addition to living with life-threatening, debilitating illnesses, most of those who have not died are living in acute poverty. The capital payments [£21,000 in his case] have long since been spent, often on the advice of medical consultants on the basis of likely imminent death. We live on benefits and a trickle of money from the fund. It is demeaning that someone who, for instance, might need a new bed has to beg for money to buy it.'

Like many of those affected, Andrew has found it difficult to form a relationship. After he told his first love about his infection, she left him. That brought home the stigma, he said, and it took years for him to recover from this rejection. He met another woman but three months before they were to marry she died from Aids. He doesn't feel strong enough to seek another relationship.

British victims point to the way other countries have helped their sufferers. Canada held a £1.24m investigation lasting five years into its tainted blood scandal. It concluded this 'national public health disaster' was caused by systematic failure, a blood service that recoiled from its responsibility and governments that showed no leadership. The victims were given an apology and 'set up for life' with average awards of £750,000.

Last February a trial alleging criminal negligence causing bodily harm and endangering the public began in Toronto against a pharmaceutical company and the Canadian Red Cross.

Margaret Unwin, head of the UK Haemophilia Society, said this was being closely watched. 'The UK is the only country that has not been open and honest about this,' she said. 'There has never been an apology. Many people say that's all they want. The government has continued to refuse any legal responsibility or grant an independent public inquiry. The financial hardship is difficult, and these people desperately need more support. But more than that, they need truth and justice and for someone to say sorry.'

No one expected, two decades on, that there would be any survivors of one of the greatest medical disasters in NHS history. Nor did its victims expect still to be waiting for the government to explain the 'inadvertent systematic failure' that caused this tragedy.

How could deadly tainted blood get into a system that was supposed to save lives? Gary Kelly, Haydn and Gaynor Lewis and Andrew Evans are not the only ones who think the wider public deserves an answer to that question.

Contamination timeline

1966 First blood clotting products for haemophiliacs are produced.

1970 Four US-based pharmaceutical companies to distribute Factor VIII and Factor IX around the world.

1975 World Health Organisation resolution states each country should be able to supply blood and blood products.

1978 A test to determine a history of viral hepatitis in blood donors is developed.

1981 The US Centre for Disease Control and Prevention organises a task force in response to a disease later called acquired immunodeficiency syndrome, shortened to Aids.

1982 Several haemophiliacs contract Aids in America. In the UK worries grow over the safety of imported commercial blood products from the US.

1983 First haemophiliac in the UK dies from Aids.

1988 UK reveals it is relying on American imports of blood products.

1988 The government agrees funding for the Macfarlane Trust charity to assist haemophiliacs who contracted HIV from contaminated blood products.

1991 The Observer campaigns to extend compensation scheme to non-haemophiliacs affected similarly.

1992 A multi-million pound compensation package for infected nonhaemophiliacs is announced.

2004 Patients infected with hepatitis C from contaminated blood to receive at least £20,000.

2006 Trustees of the Macfarlane and Eileen Trusts urge the government to increase financial support to those patients still alive.

healthcare outcomes: US Vs UK

Disease and Disadvantage in the United States and in England

James Banks, PhD; Michael Marmot, MD; Zoe Oldfield, MSc; James P. Smith, PhD

JAMA. 2006;295:2037-2045.

Context The United States spends considerably more money on health care than the United Kingdom, but whether that translates to better health outcomes is unknown.

Objective To assess the relative heath status of older individuals in England and the United States, especially how their health status varies by important indicators of socioeconomic position.

Design, Setting, and Participants We analyzed representative samples of residents aged 55 to 64 years from both countries using 2002 data from the US Health and Retirement Survey (n = 4386) and the English Longitudinal Study of Aging (n = 3681), which were designed to have directly comparable measures of health, income, and education. This analysis is supplemented by samples of those aged 40 to 70 years from the 1999-2002 waves of National Health and Nutrition Examination Survey (n = 2097) and the 2003 wave of the Health Survey for England (n = 5526). These surveys contain extensive and comparable biological disease markers on respondents, which are used to determine whether differential propensities to report illness can explain these health differences. To ensure that health differences are not solely due to health issues in the black or Latino populations in the United States, the analysis is limited to non-Hispanic whites in both countries.

Main Outcome Measure Self-reported prevalence rates of several chronic diseases related to diabetes and heart disease, adjusted for age and health behavior risk factors, were compared between the 2 countries and across education and income classes within each country.

Results The US population in late middle age is less healthy than the equivalent British population for diabetes, hypertension, heart disease, myocardial infarction, stroke, lung disease, and cancer. Within each country, there exists a pronounced negative socioeconomic status (SES) gradient with self-reported disease so that health disparities are largest at the bottom of the education or income variants of the SES hierarchy. This conclusion is generally robust to control for a standard set of behavioral risk factors, including smoking, overweight, obesity, and alcohol drinking, which explain very little of these health differences. These differences between countries or across SES groups within each country are not due to biases in self-reported disease because biological markers of disease exhibit exactly the same patterns. To illustrate, among those aged 55 to 64 years, diabetes prevalence is twice as high in the United States and only one fifth of this difference can be explained by a common set of risk factors. Similarly, among middle-aged adults, mean levels of C-reactive protein are 20% higher in the United States compared with England and mean high-density lipoprotein cholesterol levels are 14% lower. These differences are not solely driven by the bottom of the SES distribution. In many diseases, the top of the SES distribution is less healthy in the United States as well.

Conclusion: Based on self-reported illnesses and biological markers of disease, US residents are much less healthy than their English counterparts and these differences exist at all points of the SES distribution.


Author Affiliations: University College London and Institute for Fiscal Studies (Dr Banks), Department of Epidemiology, University College London (Dr Marmot) and Institute for Fiscal Studies (Ms Oldfield), London, England; and RAND Corp, Santa Monica, Calif (Dr Smith).




Middle aged white people are healthier in England than US
Janice Hopkins Tanne
New York
news, BMJ 2006;332:1047 (6 May),


People aged 55 to 64 in England are healthier than their counter-parts in the United States, a new study shows. This is despite the fact that the US spends $5274 (£2900; 4193) per person on medical care each year and the United Kingdom as a whole spends only $2164.

The disparity between the health of middle aged white English and American people found is so great, the study found, that the prevalence of diabetes and heart disease among Americans of the highest socioeconomic status is similar to that among the lowest status English people.

The study's authors, Michael Marmot and colleagues at University College London, found that middle aged white English people had lower rates of diabetes, hypertension, heart disease, heart attacks, strokes, lung disease, and cancer than middle aged white Americans (JAMA 2006;295: 2037-45[Abstract/Free Full Text]). The reason remains a puzzle, although the study suggests some possible reasons.

For the US data the study used information from the US health and retirement survey (4386 people), which included self reported information, and the national health and nutrition examination survey (2097 people), which included results of physical and laboratory examinations. For England the study used the English longitudinal study of ageing (3681 people), which included data from three separate years of the health survey for England (5526 people), and biological results from the 2003 health survey for England.

All four surveys included data on age, sex, household income, and education.

In both countries, people of higher socioeconomic status were healthier than those lower down the social scale, the study says.

"Americans report higher levels of disease than the English, and in most cases much higher levels," the study reports. Differences in prevalence rates between the two countries for all diseases were all significant.

Higher rates of cancer in the US may be explained by higher rates of screening, but this does not completely explain the higher prevalence in the US. Cancer mortality was higher in the UK.

In both countries about 20% of people in the study smoked.

Heavy drinking was more common in England. Obesity was much more common in the United States.

The authors considered whether lifetime access to health care could account for the differences, given that members of all socioeconomic groups in England had free access to health care. In the US people aged over 65 have health insurance in the form of the Medicare programme, but they may not have had insurance earlier in their lives. But the authors did not think this gave a full explanation, because although Americans in the highest socioeconomic status group almost always had health care their health outcomes were often worse than those of their English counterparts.

seagull randomness

don't ask why, just felt like it...

comtemplating the weather

wondering why he bothered coming on to this beach

no, i don't think i'll swim in that

this is a little more like it

oh i do like to be beside the seaside...

chilling, just chilling...

shoo-bee-doo

yes?

you looking at me?

hello?

who me? oh, i had nothing to do with it

seagull apartments

group hug!

ATTEN-TION!

oooohhhh... so that's what i look like!

you're right Jo, this is a cool way to while away the time

OK people, ready, steady...

now, best side for the camera...

pinocchio

the sun is coming through! the sun is coming through!

quiet time

reflection

by the river bank

yup, this is what it's all about...

flying into the sunset

flying out to sea

a lovely little walk...

A- that wave looks cool - let's go surf. B - forget it, it's freezing, i'm flying off home, now!

don't get in the way of this gull - he's upholding the law

don't even think about it, this space is mine

caught on cctv

random flower pic

another random flower

stunning

for those of us born in spring...

this is depressing.

the rest of them are just jealous we're born in the better season.

nature's big brother

wildcam Africa! it's even got sound!
and how they did it.

(NB - i think it's no longer live, but it's all still pretty riveting viewing. it can get particularly addictive (esp when it was live!) - you have been warned.)