/health

  • Zeynep Tufekci - Why the World Health Organization Failed - The Atlantic
    https://www.theatlantic.com/health/archive/2020/04/why-world-health-organization-failed/610063

    Trump’s ploy to defund the WHO is a transparent effort to distract from his administration’s failure to prepare for the COVID-19 pandemic. It would be disastrous too. Many nations, especially poor ones, currently depend on the WHO for medical help and supplies. But it is also true that in the run-up to this pandemic, the WHO failed the world in many ways. However, President Trump’s move is precisely the kind of political bullying that contributed to the WHO’s missteps.

    The WHO failed because it is not designed to be independent. Instead, it’s subject to the whims of the nations that fund it and choose its leader. In July 2017, China moved aggressively to elect its current leadership. Instead of fixing any of the problems with the way the WHO operates, Trump seems to merely want the United States to be the bigger bully.

    This mission-driven WHO would not have brazenly tweeted, as late as January 14, that “preliminary investigations conducted by the Chinese authorities have found no clear evidence of human-to-human transmission of the novel #coronavirus (2019-nCoV) identified in #Wuhan, #China.” That claim was false, and known by the authorities in Wuhan to be false.. Taiwan had already told the WHO of the truth too. On top of that, the day before that tweet was sent, there had been a case in Thailand: a woman from Wuhan who had traveled to Thailand, but who had never been to the seafood market associated with the outbreak—which strongly suggested that the virus was already spreading within Wuhan.

    We can get a glimpse at that alternate timeline by looking at the two places where COVID-19 was successfully contained: Taiwan and Hong Kong. With dense populations and close links to and travel from China, Taiwan and Hong Kong are unlikely candidates for success. Yet Taiwan reported zero new confirmed cases on Tuesday, fewer than 400 confirmed cases since the beginning of the outbreak, and only six deaths. Taiwan’s schools have been open since the end of February and there is no drastic lockdown in the island of almost 30 million people.

    Taiwan and Hong Kong succeeded because they ignored, contradicted, and defied the official position and the advice of the WHO on many significant issues. This is not a coincidence, but a damning indictment of the WHO’s leadership.

    Taiwan’s and Hong Kong’s health authorities assessed the pandemic accurately, and not just with respect to the science. They understood the political complexities, including the roles of the WHO and China in shaping official statements about the virus. They did not take the WHO’s word when it was still parroting in late January China’s cover-up that there was no human-to-human transmission. They did not listen to the WHO on not wearing masks, which the WHO continues to insist are unnecessary to this late day, despite accumulating evidence that masks are essential to dampening this epidemic’s spread. Taiwan ignored the WHO’s position that travel bans were ineffective; instead, it closed its borders early and, like Hong Kong, screened travelers aggressively.

    Hong Kong and Taiwan remembered that China has a history of covering up epidemics.

    When independent access to Wuhan was denied, instead of simply relaying what China claimed as if it were factual, the WHO could have notified the world that an alarming situation was unfolding. It could have said that China was not allowing independent investigations, and that there were suggestions of human-to-human transmission that needed urgent investigation. That would have gotten the world’s attention. And it could have happened the first week of January, mere days after China reported 41 cases of a mysterious pneumonia, but before China’s first announced COVID death. This is when Taiwan banned travel from Wuhan and started aggressive screening of travelers who had been there in recent weeks. It’s also when Taiwan ramped up its domestic mask production, in order to distribute masks to its whole population, despite WHO (still!) claiming they aren’t necessary.

    Many countries may not have had their first imported case until late January or early February. Researchers estimate that acting even a week or two early might have reduced cases by 50 to 80 percent. With proper global leadership, we may have had a very different trajectory.

    A mission-driven WHO would not have repeatedly praised China for its “transparency,” (when it was anything but) nor would it have explicitly criticized travel bans when they were being imposed on China but remained silent when China imposed them on other nations. Strikingly, the only country the WHO’s leader, Tedros Adhanom Ghebreyesus, has directly criticized is Taiwan, whose diplomats he accused (without proof) of being involved in racist attacks on him. Unfortunately, the WHO seems to remember its principles only when they align with China’s interests.

    Be that as it may, President Trump’s own attempt to bully the WHO is worse than being merely a distraction from his own lack of preparation and the spectacular public-health failure that is now unfolding across the United States. The president wants to break the WHO even more dramatically, in precisely the way it is already broken. He wants it to bow to the outsize influence of big powerful nations at the expense of its mission.

    Defunding the WHO is not just foolish. It is dangerous: A pandemic needs to be contained globally, including in the poor countries that depend on the WHO. The WHO is the only global organization whose mission, reach, and infrastructure are suitable for this. The U.S. funds about 15 percent of the WHO’s current budget, and the already stretched-thin organization may not be able to quickly make that up.

    We must save the WHO, but not by reflexively pretending that nothing’s wrong with it, just because President Trump is going after the organization. We should be realistic and honest about the corruption and shortcomings that have engulfed the leadership of an organization that is deeply flawed, but that is still the jewel of the international health community.

    #OMS #Chine #Etats-Unis #Santé_publique

  • Closing the Parks Is Ineffective Pandemic Theater - The Atlantic
    https://www.theatlantic.com/health/archive/2020/04/closing-parks-ineffective-pandemic-theater/609580

    Par Zeynep Tufekci

    In the short run, closing parks may seem prudent, when our hospitals are overrun and we are trying so hard to curb the spread of COVID-19. But in the medium to long run, it will turn out to be a mistake that backfires at every level. While it’s imperative that people comply with social-distancing and other guidelines to fight this pandemic, shutting down all parks and trails is unsustainable, counterproductive, and even harmful.

    To start with, the park crackdown has an authoritarian vibe. In closing Brockwell Park, for example, pictures showed two police officers approaching a lone sunbather, who was nowhere near anyone else—well, except the police, who probably had something better to do. Such heavy-handedness might even make things worse, as it may well shift the voluntary compliance we see today into resistance.

    Finding sustainable policies is crucial, especially since this pandemic likely isn’t going away in a few weeks. It’s plausible that we will be social distancing, on and off, for another year. That means we need to consider how to maintain compliance with strict measures over that long of a time.

    he outdoors, exercise, sunshine, and fresh air are all good for people’s immune systems and health, and not so great for viruses. There is a compelling link between exercise and a strong immune system. A lack of vitamin D, which our bodies synthesize when our skin is exposed to the sun, has long been associated with increased susceptibility to respiratory diseases. The outdoors and sunshine are such strong factors in fighting viral infections that a 2009 study of the extraordinary success of outdoor hospitals during the 1918 influenza epidemic suggested that during the next pandemic (I guess this one!) we should encourage “the public to spend as much time outdoors as possible,” as a public-health measure.

    Read: How the 1918 pandemic frayed social bonds

    Mental health is also a crucial part of the resilience we need to fight this pandemic. Keeping people’s spirits up in the long haul will be important, and exercise and the outdoors are among the strongest antidepressants and mental-health boosters we know of, often equaling or surpassing drugs and/or therapy in clinical trials. Stress has long been known to be a significant suppressor of immunity, and not being able to get some fresh air and enjoy a small change of scenery will surely add to people’s stress. We may well be facing a spike in suicides and violence as individuals and families face significant stress and isolation: The Air Force Academy initially imposed drastic isolation on its cadets due to the coronavirus, but had to reverse course after two tragic suicides. Domestic violence is another real concern: Not having a place to go, even for an hour, may greatly worsen conditions in some households.

    The history of disaster response is full of examples of extraordinary goodwill and compliance among ordinary people that disintegrate after authorities come down with heavy-handed measures that treat the public as an enemy. Rebecca Solnit’s book A Paradise Built in Hell details many such cases, such as the lives lost when the military was ordered into post-earthquake San Francisco in 1906 to control the dangerous and unruly “unlicked mob” that was primarily a figment of the authorities’ imagination. Unfortunately, the official response worsened the subsequent fire (which was more damaging than the earthquake itself) by keeping away volunteers “who might have supplied the power to fight the fire by hand.” Some ordinary citizens were even shot by soldiers on the lookout for these alleged mobs of looters and dangerous behavior from citizens. Similarly, in the aftermath of Hurricane Katrina, as a review of Solnit’s book summarized, “there were myriad accounts of paramedics being kept from delivering necessary medical care in various parts of the city because of false reports of violence.”

    When the efforts to “flatten the curve” start working and the number of known infections starts going down, authorities will need to be taken seriously. Things will look better but be far, far from over. If completely kept indoors with no outlet for a long time, the public may be tempted to start fully ignoring the distancing rules at the first sign of lower infection rates, like an extreme dieter who binges at a lavish open buffet. Just like healthy diets, the best pandemic interventions are sustainable, logical, and scientifically justified. If pandemic theater gets mixed up with scientifically sound practices, we will not be able to persuade people to continue with the latter.

    This doesn’t mean we shouldn’t limit park attendance at all, but there are better answers than poorly planned full closures.

    Governments could make a special appeal to people who have yards to leave parks for those who do not. (Wealthier people tend to have their own yards or lots, which is another reason not to shut down parks and deny outdoor access to poorer people.)

    #Zeynep_Tufekci #Espaces_verts #Coronavirus #Exercice #Autoritarisme

  • How Will the Coronavirus End? - Ed Yong (The Atlantic)
    https://www.theatlantic.com/health/archive/2020/03/how-will-coronavirus-end/608719

    The U.S. may end up with the worst COVID-19 outbreak in the industrialized world. This is how it’s going to play out.

    #prospective (trop déprimé pour lire en détail ; l’article conclut en croyant toujours à l’exception américaine)

    The Crisis Could Last 18 Months. Be Prepared., by Juliette Kayyem, Former Department of Homeland Security official - The Atlantic
    https://www.theatlantic.com/ideas/archive/2020/03/there-isnt-going-be-all-clear-signal/608512

    The shutdowns happened remarkably quickly, but the process of resuming our lives will be far more muddled.

  • Forum ouvert par le Network for Computational Modeling in Social and Ecological Sciences (#CoMSES) pour que la communauté ABM puisse échanger sur le sujet :

    https://forum.comses.net/c/covid-19/24

    –-> Vous pourrez notamment y trouver une revue/veille des démarches de modélisation de l’épidémie.

    #modélisation #covid-19 #coronavirus #épidémie

    –—

    PS. Je mets ci-dessous dans ce fil de discussion des liens vers des sites qui proposent des modélisations que je reçois notamment via la mailing-list geotamtam... mais... je n’y connais rien... donc aucune idée de ce que partage (ceci dit, ça vient d’un réseau de chercheurs...), je me dis que ça peut peut-être servir à quelques seenthisien·nes...

  • Why Do People Still Love Consumer Tech ? - The Atlantic
    https://www.theatlantic.com/health/archive/2020/01/why-do-people-still-love-consumer-tech/604909

    Everywhere I turned, there were signs that I didn’t totally understand. “Can textiles empower mothers to share their personal experience of pregnancy ?” one big, blue banner asked, fighting for attention among hundreds of others in a cavernous exhibition hall. “Shop with your DNA,” implored another. Just around the corner, in lofted lights, a company promised that its products are “where sleep tech meets holistic wellness.” Across the room, a plumbing-fixture company got right down to business (...)

    #domotique #technologisme #domination #InternetOfThings #marketing

  • The Rise of Identity Fusion and Allegiance to Trump - The Atlantic
    https://www.theatlantic.com/health/archive/2019/09/identity-fusion-trump-allegiance/598699

    The idea was never fully formed, and Lecky died at just 48, his work unpublished. But today, the basic concept is seeing a renewed interest from scholars who think Lecky was truly onto something. When the psychologist’s students compiled his writing posthumously, in 1945, the postwar world was grappling with how humans were capable of such catastrophic cruelty. Surely entire armies had not been motivated by their relationships with their mothers. The early science of the mind was beginning to delve into the timeless questions of philosophy and religion: Why do we do destructive things—to others, and to ourselves? Why do we so often act against our own interests? Why would a young boy risk his acceptance to Harvard to pile manure into a school gym?

    These questions meant studying the roots of identity, and how a person could be at peace with being hateful and even dangerous. Now, decades later, an emerging explanation points to something more insidious than the possibility that someone simply identifies with a malicious group or blindly follows a toxic person. Instead, out of a basic need for consistency, we might take on other identities as our own.

    The process of de-fusing, then, might involve offering alternative systems of creating consistency and order. If people who are inclined to fusion have the option to fuse with entities that do not wish to exploit them, and that are generally good or neutral for the world, they might be less likely to fuse with, say, a demagogue. “But, of course,” Dovidio says, “that’s hard.”

    #fusion #psychologie_sociale

  • What Happens If You Don’t Pay a Hospital Bill? - The Atlantic
    https://www.theatlantic.com/health/archive/2019/08/medical-bill-debt-collection/596914

    Eventually, collectors might opt to sue you, in which case they might be able to garnish your wages or put a lien on your property. Antico estimates, based on an ADP report, that about 1.5 percent of American employees have a garnishment on their wages for a medical reason.

    [...]

    After trying to collect on their own behalf for a while, some hospitals and doctors’ offices sell their debt to debt buyers, who pay pennies for each dollar owed, then try their hardest to simply collect more than they paid. Why hospitals sell their debt is a matter of debate, but several consumer lawyers speculated that it’s because hospitals don’t want their good names associated with aggressive debt-collection tactics. They’d rather leave the intimidating calls to a more anonymous-sounding organization like Pendrick Capital Partners, one prominent medical-debt buyer. That way the hospital at least gets paid a small amount right away, instead of holding out for the full sum.

    #systéme_de_santé #états-unis

  • Narcan Makes Fentanyl Overdoses Feel Safer to Some - The Atlantic
    https://www.theatlantic.com/health/archive/2019/06/narcan-makes-fentanyl-overdoses-feel-safer-users/591217

    The drug, which can shut down breathing in less than a minute, became the leading cause of opioid deaths in the United States in 2016. More and more drug users are seeking it out, craving its powerful high.

    Some of those users say they feel a measure of security because many of their peers carry naloxone, which can quickly restore their breathing if they overdose.

    Data suggest that in San Francisco, drug users may be reversing as many overdoses as paramedics—or more. In both cases, the numbers have risen sharply in recent years.

    Read: America’s health-care system is making the opioid crisis worse

    In 2018, San Francisco paramedics administered naloxone to 1,647 people, up from 980 two years earlier, according to numbers from the city’s emergency-response system.

    That compares with 1,658 naloxone-induced overdose reversals last year by laypeople, most of them drug users, according to self-reported data from the DOPE Project, a Bay Area overdose-prevention program run by the publicly funded Harm Reduction Coalition. That’s nearly double the 2016 figure.

    “People who use drugs are the primary witnesses to overdose,” says Eliza Wheeler, the national overdose-response strategist for the coalition. “So it would make sense that when they are equipped with naloxone, they are much more likely to reverse an overdose.”

    The widespread availability of naloxone has radically changed the culture of opioid use on the streets, Hogan said. “In the past, if you OD’d, man, it was like you were really rolling the dice.” Now, he said, people take naloxone for granted.

    “I feel like as long as there is Narcan around, the opiates can’t kill you,” says Nick Orlick, 26, referring to one of the brand names for the overdose-reversal drug.

    #Opioides #Overdoses #Naxolone

  • The Arthur Sackler Family’s Ties to OxyContin Money - The Atlantic
    https://www.theatlantic.com/health/archive/2018/04/sacklers-oxycontin-opioids/557525

    Much as the role of the addictive multibillion-dollar painkiller OxyContin in the opioid crisis has stirred controversy and rancor nationwide, so it has divided members of the wealthy and philanthropic Sackler family, some of whom own the company that makes the drug.

    In recent months, as protesters have begun pressuring the Metropolitan Museum of Art in New York and other cultural institutions to spurn donations from the Sacklers, one branch of the family has moved aggressively to distance itself from OxyContin and its manufacturer, Purdue Pharma. The widow and one daughter of Arthur Sackler, who owned a related Purdue company with his two brothers, maintain that none of his heirs have profited from sales of the drug. The daughter, Elizabeth Sackler, told The New York Times in January that Purdue Pharma’s involvement in the opioid epidemic was “morally abhorrent to me.”

    But an obscure court document sheds a different light on family history—and on the campaign by Arthur’s relatives to preserve their image and legacy. It shows that the Purdue family of companies made a nearly $20 million payment to the estate of Arthur Sackler in 1997—two year after OxyContin was approved, and just as the pill was becoming a big seller. As a result, though they do not profit from present-day sales, Arthur’s heirs appear to have benefited at least indirectly from OxyContin.

    The 1997 payment to the estate of Arthur Sackler is disclosed in the combined, audited financial statements of Purdue and its associated companies and subsidiaries. Those documents were filed among hundreds of pages of exhibits in the U.S. District Court in Abingdon, Virginia, as part of a 2007 settlement in which a company associated with Purdue and three company executives pleaded guilty to charges that OxyContin was illegally marketed. The company paid $600 million in penalties while admitting it falsely promoted OxyContin as less addictive and less likely to be abused than other pain medications.

    Arthur’s heirs include his widow and grandchildren. His children, including Elizabeth, do not inherit because they are not beneficiaries of a trust that was set up as part of a settlement of his estate, according to court records. Jillian receives an income from the trust. Elizabeth’s two children are heirs and would receive bequests upon Jillian’s death. A spokesman for Elizabeth Sackler declined to comment on the Purdue payment.

    Long before OxyContin was introduced, the Sackler brothers already were notable philanthropists. Arthur was one of the world’s biggest art collectors and a generous benefactor to cultural and educational institutions across the world. There is the Arthur M. Sackler Gallery at the Smithsonian Institution, the Arthur M. Sackler Museum at Harvard, and the Jillian and Arthur M. Sackler Wing of Galleries at the Royal Academy of Arts in London.

    His brothers were similarly generous. They joined with their older brother to fund the Sackler Wing at the Met, which features the Temple of Dendur exhibit. The Mortimer and Theresa Sackler Foundation was the principal donor of the Serpentine Sackler Gallery in London; the Sackler name is affiliated with prestigious colleges from Yale to the University of Oxford, as well as world-famous cultural organizations, including the Victoria and Albert Museum in London. There is even a Sackler Rose—so christened after Mortimer Sackler’s wife purchased the naming rights in her husband’s honor.

    Now the goodwill gained from this philanthropy may be waning as the Sackler family has found itself in an uncomfortable spotlight over the past six months. Two national magazines recently examined the intersection of the family’s wealth from OxyContin and its philanthropy, as have other media outlets across the world. The family has also been targeted in a campaign by the photographer Nan Goldin to “hold the Sacklers accountable” for OxyContin’s role in the opioid crisis. Goldin, who says she became addicted to OxyContin after it was prescribed for surgical pain, led a protest last month at the Metropolitan Museum of Art, in which demonstrators tossed pill bottles labeled as OxyContin into the reflecting pool of its Sackler Wing.

    While it doesn’t appear that any recipients of Sackler charitable contributions have returned gifts or pledged to reject future ones, pressure and scrutiny on many of those institutions is intensifying. In London, the National Portrait Gallery said it is reviewing a current pledge from the Sackler Trust.

    #Opioides #Sackler

  • Most Maps of the New Ebola Outbreak Are Wrong - The Atlantic
    https://www.theatlantic.com/health/archive/2018/05/most-maps-of-the-new-ebola-outbreak-are-wrong/560777

    Almost all the maps of the outbreak zone that have thus far been released contain mistakes of this kind. Different health organizations all seem to use their own maps, most of which contain significant discrepancies. Things are roughly in the right place, but their exact positions can be off by miles, as can the boundaries between different regions.

    Sinai, a cartographer at UCLA, has been working with the Ministry of Health to improve the accuracy of the Congo’s maps, and flew over on Saturday at their request. For each health zone within the outbreak region, Sinai compiled a list of the constituent villages, plotted them using the most up-to-date sources of geographical data, and drew boundaries that include these places and no others. The maps at the top of this piece show the before (left) and after (right) images.

    #cartographie #santé #RDC #erreur #ebola

  • The Arthur Sackler Family’s Ties to OxyContin Money - The Atlantic
    https://www.theatlantic.com/health/archive/2018/04/sacklers-oxycontin-opioids/557525

    In recent months, as protesters have begun pressuring the Metropolitan Museum of Art in New York and other cultural institutions to spurn donations from the Sacklers, one branch of the family has moved aggressively to distance itself from OxyContin and its manufacturer, Purdue Pharma. The widow and one daughter of Arthur Sackler, who owned a related Purdue company with his two brothers, maintain that none of his heirs have profited from sales of the drug. The daughter, Elizabeth Sackler, told The New York Times in January that Purdue Pharma’s involvement in the opioid epidemic was “morally abhorrent to me.”

    Arthur died eight years before OxyContin hit the marketplace. His widow, Jillian Sackler, and Elizabeth, who is Jillian’s stepdaughter, are represented by separate public-relations firms and have successfully won clarifications and corrections from media outlets for suggesting that sales of the potent opioid enriched Arthur Sackler or his family.

    But an obscure court document sheds a different light on family history—and on the campaign by Arthur’s relatives to preserve their image and legacy. It shows that the Purdue family of companies made a nearly $20 million payment to the estate of Arthur Sackler in 1997—two year after OxyContin was approved, and just as the pill was becoming a big seller. As a result, though they do not profit from present-day sales, Arthur’s heirs appear to have benefited at least indirectly from OxyContin.

    The 1997 payment to the estate of Arthur Sackler is disclosed in the combined, audited financial statements of Purdue and its associated companies and subsidiaries. Those documents were filed among hundreds of pages of exhibits in the U.S. District Court in Abingdon, Virginia, as part of a 2007 settlement in which a company associated with Purdue and three company executives pleaded guilty to charges that OxyContin was illegally marketed. The company paid $600 million in penalties while admitting it falsely promoted OxyContin as less addictive and less likely to be abused than other pain medications.

    Long before OxyContin was introduced, the Sackler brothers already were notable philanthropists. Arthur was one of the world’s biggest art collectors and a generous benefactor to cultural and educational institutions across the world. There is the Arthur M. Sackler Gallery at the Smithsonian Institution, the Arthur M. Sackler Museum at Harvard, and the Jillian and Arthur M. Sackler Wing of Galleries at the Royal Academy of Arts in London.

    His brothers were similarly generous. They joined with their older brother to fund the Sackler Wing at the Met, which features the Temple of Dendur exhibit. The Mortimer and Theresa Sackler Foundation was the principal donor of the Serpentine Sackler Gallery in London; the Sackler name is affiliated with prestigious colleges from Yale to the University of Oxford, as well as world-famous cultural organizations, including the Victoria and Albert Museum in London. There is even a Sackler Rose—so christened after Mortimer Sackler’s wife purchased the naming rights in her husband’s honor.

    Now the goodwill gained from this philanthropy may be waning as the Sackler family has found itself in an uncomfortable spotlight over the past six months. Two national magazines recently examined the intersection of the family’s wealth from OxyContin and its philanthropy, as have other media outlets across the world. The family has also been targeted in a campaign by the photographer Nan Goldin to “hold the Sacklers accountable” for OxyContin’s role in the opioid crisis. Goldin, who says she became addicted to OxyContin after it was prescribed for surgical pain, led a protest last month at the Metropolitan Museum of Art, in which demonstrators tossed pill bottles labeled as OxyContin into the reflecting pool of its Sackler Wing.

    While it doesn’t appear that any recipients of Sackler charitable contributions have returned gifts or pledged to reject future ones, pressure and scrutiny on many of those institutions is intensifying. In London, the National Portrait Gallery said it is reviewing a current pledge from the Sackler Trust.

    #Opioids #Sackler

  • Si tu as des calculs rénaux, va plutôt te faire centrifuger chez Disney !

    Roller Coasters Could Help People Pass Kidney Stones - The Atlantic
    https://www.theatlantic.com/health/archive/2016/09/for-kidney-health-roller-coaster-therapy/501278

    “What was amazing was within just a few rides it became obvious that there was a huge difference in passage rates whether you sat in the front or the rear of the coaster,” Wartinger tells me. “There was a lot more whipping around in that rear car.”

    The stones passed 63.89 percent of the time while the kidneys were in the back of the car. When they were in the front, the passage rate was only 16.67 percent. That’s based on only 60 rides on a single coaster, and Wartinger guards his excitement in the journal article: “Preliminary study findings support the anecdotal evidence that a ride on a moderate-intensity roller coaster could benefit some patients with small kidney stones.”

    • L’article original

      Validation of a Functional Pyelocalyceal Renal Model for the Evaluation of Renal Calculi Passage While Riding a Roller Coaster | The Journal of the American Osteopathic Association
      http://jaoa.org/article.aspx?articleid=2557373

      Abstract
      Context: The identification and evaluation of activities capable of dislodging calyceal renal calculi require a patient surrogate or validated functional pyelocalyceal renal model.

      Objective: To evaluate #roller_coaster facilitation of calyceal renal calculi passage using a functional pyelocalyceal renal model.

      Methods: A previously described adult ureteroscopy and renoscopy simulator (Ideal Anatomic) was modified and remolded to function as a patient surrogate. Three renal calculi of different sizes from the patient who provided the original computed tomographic urograph on which the simulator was based were used. The renal calculi were suspended in urine in the model and taken for 20 rides on the Big Thunder Mountain Railroad roller coaster at Walt Disney World in Orlando, Florida. The roller coaster rides were analyzed using variables of renal calculi volume, calyceal location, model position on the roller coaster, and renal calculi passage.

      Results: Sixty renal calculi rides were analyzed. Independent of renal calculi volume and calyceal location, front seating on the roller coaster resulted in a passage rate of 4 of 24. Independent of renal calculi volume and calyceal location, rear seating on the roller coaster resulted in a passage rate of 23 of 36. Independent of renal calculi volume in rear seating, calyceal location differed in passage rates, with an upper calyceal calculi passage rate of 100%; a middle calyceal passage rate of 55.6%; and a lower calyceal passage rate of 40.0%.

      Conclusion: The functional pyelocalyceal renal model serves as a functional patient surrogate to evaluate activities that facilitate calyceal renal calculi passage. The rear seating position on the roller coaster led to the most renal calculi passages.

  • Fentanyl Is So Deadly That It’s Changing How First Responders Do Their Jobs - The Atlantic
    https://www.theatlantic.com/health/archive/2017/05/fentanyl-first-responders/526389


    @fil

    As the number of fentanyl overdoses in America climbed last fall, the New Hampshire State Police Forensic Laboratory released a photo to highlight the drug’s particular dangers. The photo showed two vials. One showed how big a lethal dose of heroin might be: 30 milligrams, a small scoop. The second showed the equivalent for fentanyl: 3 milligrams, a bare sprinkle.

    It was a warning to potential users, but also a visual reminder that fentanyl is so potent that it is dangerous even for people might accidentally touch or breath a tiny amount of it. People like police, EMTs, forensic labs technicians, and even funeral directors. A puff of fentanyl from closing a plastic bag is enough to send a full-grown man to the emergency room, as a police officer from New Jersey described in a Drug Enforcement Agency video last fall. The DEA made the video as part of an official warning to law enforcement about the dangers of handling fentanyl.

    The unprecedented rise of fentanyl has forced police and crime labs to change how they work. Police departments are using protective gear like Tyvek suits and respirators. Crime labs are looking for new ways to detect fentanyl without opening the bag. And both have stocked up on naloxone, the drug that reverses overdoses, for their employees.